Friday, October 8th 2010
This is the third post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here and the second here.
“Why are you just standing there?”
Last time, I ended with my water breaking all over my bedroom floor. Thankfully, it was a hardwood floor and was easy to mop up. But I’m getting ahead of myself.
I slept terribly for my entire third trimester. My doula serenely said it was my body’s way of preparing me for sleepless nights with a newborn. You will be happy to know I didn’t strangle her. I ended up having to take a nap every afternoon to even approach five hours of sleep for every twenty four, because I was uncomfortable and restless at night. Unfortunately, I often even struggled to read or work at night, because the discomfort that kept me from sleeping also kept me from concentrating.
So when I got a decent night’s rest on the evening after my due date, and found myself roused once groggily in the night, felt a little wetness that made me worry I had peed myself, and decided to drift back to sleep, I hope you won’t think too ill of me.
Chances are good my amniotic sac started to tear sometime in the night, and the movement of standing up blew open that tiny rip.
I looked down at the floor. Brendan looked down at the floor. We looked at each other. I started to laugh. “Why are you just standing there?” he asked incredulously.
“What should I be doing?” The more I laugh, the more I leak.
“I don’t know, get in the tub or something!”
So I do. Brendan hands me the phone while I’m standing in our bathtub, and I call the birth center. The midwife is pleased to hear my water has broken, is unconcerned, and says to keep her updated in terms of if and when labor starts. She wants me to come in in twelve hours to do a non-stress test, but otherwise recommends I go about my day.
This one of many major differences I experienced with a midwife versus a doctor. Hospital protocol is to bring a pregnant woman in if her water breaks, even if labor hasn’t started, and they are a lot more aggressive about inducing labor if it doesn’t start on its own.
I convince Brendan to go into work for a few hours so he can do some things that really needed to happen that day, and I lounge around a bit. By mid-morning I am having very mild contractions that are seven minutes apart or so.
Brendan and I spend the day grocery shopping, baking cookies, and going for walks along the Charles River. I was feeling triumphant and strong. I was kicking ass at this whole labor thing. It must be my athletic background, I told Brendan, and my high pain threshold, that is making me have such an easy time of things. I was buoyant, even as I started to need to pause and concentrate on the contractions when they happened.
Around six in the evening we went to the Birth Center, where I completely believed they would check my dilation and say I was at four centimeters. I had been laboring all day, after all. My midwife checks me. “Maybe one centimeter,” she says.
Are you kidding me? I begin to feel nervous, like maybe my vision of hanging out in the birthing tub while playing cards with my sister and husband was not going to happen. Maybe I had underestimated labor a little bit.
My non-stress test comes out fine. I’m starting to really feel contractions, and my body keeps trying to move away from them. I have back labor, which isn’t so great.
At this point, time starts to feel different. I know we went home for a while, where my sister joined us and she and my husband got some good. I know I lay down on the floor, then the bed, that I tried to take a hot shower, and that nothing really worked. I was starting to feel miserable, and a little panicked. I am a perfectionist, and I had had this idea that somehow labor would be different for me, than, you know, the millions upon millions of women who have come before me.
Time to go
I asked to go back to the birth center, probably around eleven at night. We get there and I’m maybe three centimeters dilated, and I can’t be admitted until I’m in active labor, which is at least four centimeters. We hang out in the lobby with my two midwives (one is in training). They inject little subcutaneous sacs of water into my lower back that burn horribly, but reduce my back labor pain by half. I am starting to moan with each contraction, and while I want to be holding someone’s hand, I don’t really want to talk. I really start to wonder what I was thinking with this whole natural labor thing.
By one thirty or so in the morning, I am considered in active labor so we can go upstairs to one of the birthing suites. No one else is there that night so I get the best one (though all three are great). I get into the tub as soon as the water is ready. Nothing feels right, the water temperature feels wrong, it doesn’t seem deep enough, I can’t position myself to get comfortable, I hate everything. Over the next few hours the pain gets worse. Yes, contractions are like menstrual cramps. They are like menstrual cramps that cover several orders of magnitude more surface area, are several orders of magnitude more painful, and they come in waves of pain that crest, only for you to know that in another minute and a half you’ll have another one. I am a natural birth advocate, but I am not going to tell you labor is fun.
There were some highlights, of course, like the times Brendan carefully smoothed the hair from my face and got me to sip some water, like the way he and my sister watched out for each other over that long night. The moment I opened my eyes between contractions to see every midwife and doula sitting on the floor of the bathroom, reading their own copy of my birth plan while they waited for my next contraction.
After a while, the midwives smartly decided I needed to move from the tub, since a change of pace might help move my labor along. I labor on all fours on the giant king-size bed for a while, but am starting to panic about the pain and how long everything seems to be taking (again, it’s actually all taking a normal amount of time). The midwives suggest a gentle intervention – how about an injection of Benadryl? It won’t harm the fetus and will make me a little sleepy, which will help me rest between contractions. Amazingly, it works: I am alternately screaming and sleeping for a few more hours, giving me the strength I need to ride out my dry back labor.
Transition
Those of you who know anything about birth know how women act during transition. This is the point at which a lot of women tell everyone, in no uncertain terms, that they have decided not to have the baby and are going home. They start packing their things or otherwise give up on the process. For me, I started apologizing. I thought, though no one had indicated it in any way, that I was about to be transferred to the hospital for an epidural, that that was my fate. “I’m so sorry, Brendan. I can’t do it. I’m sorry.”
“You are doing it, though,” he said. “You are doing it.”
I thought I saw a hint of a smirk in the face of my doula and midwives, who have seen hundreds more births than we have. They got me to move to another position, and told me maybe I might feel like pushing soon, and if so that I could. They also said, gently, maybe we should go over to the bathroom again. You can pee, and maybe we can set up the tub for you again.
So I pee, and then when I get up I get the URGE TO PUSH. The URGE TO PUSH, to me, was the most delightful, empowering, wonderful part of childbirth. Labor is all about getting out of the way of your body so it can do its job of dilating your cervix. Pushing is something you get to do. Of course it hurt. But it was also one of the most awesome (not as in awesome, dude, but awesome, full of awe) things I have ever done.
It turns out I am good at pushing. So when I felt the URGE TO PUSH I started to push my baby out. I felt the well-named ring of fire as the baby’s head crowned. “Wait, wait!” my midwives yelled. “We aren’t ready!” They sprinted to get everything together so they could catch the baby.
And that is how I ended up giving birth to my amazing daughter standing up, at 9:45am on a drizzly day in March 2008, holding on to my husband’s shoulders, standing by a toilet.
Bonding to our baby
This gorgeous baby troll (let’s just be honest, all newborns are a little troll-like) was passed to me from between my legs where my midwife had caught her. I looked at the baby. I looked at the baby again. “It’s Joan!” I shouted. “It’s Joan!” It was a baby girl, a rather purply-blue baby girl, but a girl nonetheless.
We had wanted to let the cord pulse a bit more and not cut it while I held her, but the midwives were understandably concerned about the color of our daughter, so they encouraged us to cut the cord now so they could warm her up and make sure she was breathing well. Brendan cut the cord, then followed the midwife to the bedroom where they put Joan on a little warming table and ran some oxygen near her face. I am guessing that the reason Joan came out looking a little blue was due to my rather overzealous pushing, rather than there being anything inherently wrong with her. They slowly walked me away from the bloody massacre of the bathroom over to the bed, where I could push out the afterbirth and hold my baby.
Because I had lost so much blood (they estimated I lost 500cc, which is the technical definition of postpartum hemorrhage), the midwives decided to give me an injection of pitocin to speed up the afterbirth so they could be sure I wasn’t hemorrhaging. I pushed out the placenta and thankfully I was fine, but it was a smart intervention anyway.
There are so many other pieces of this story I could tell, from the sound of my sister crying with joy as she videotaped the birth, to the doula who held my hand as I was sewn up (I had a second degree tear). All the grandparents got their moment to hold Joan. Brendan went to Christina’s to buy us milkshakes (this was a very important part of our birth plan). And I sat in a darkened room, staring and staring with a mix of fear, delight, and unadulterated love at the bright pink, eight pound three ounce baby in my arms. We were home by five o clock that same night, where the grandparents greeted us again and we celebrated our wondrous, gorgeous, perfect child.
* * *
In the final installment next week, I’ll reflect on the experience and broader issues around sexism and overpathologization regarding both IVF and reproductive choice.
Thursday, October 7th 2010
The “Around the Web” series highlights informative websites, and also targeted blog posts and news articles, relevant to the courses I teach. This semester I teach Anth 143: Biology of Human Behavior, an introductory-level course that covers the basics of evolution, behavioral biology, and the interaction of biology and culture. My hope is that these posts are useful not only for my current students, but other people hoping to gain background or insight into these topics.
This week I covered infanticide and sexual coercion, and showed Steven Pinker’s TED talk on the history of human violence as a provocative way to help us think about violence, culture and variation. Because this is a 100-level course, I make more of a point to demonstrate themes or introduce ideas, rather than provide a ton of content that they can look up on their own. But that always means that a lot of interesting stuff ends up omitted from my lectures. I didn’t talk about step-parenting, though I hope to touch on it in a later lecture. I only touched on the Thornhill and Thornhill rape-as-adaptation material (though they did need to watch and be quizzed on a mini-lecture I prepared on it before coming to class).
That said, Tuesday was one of my favorite classes so far, because students really seemed to come prepared to talk, and think, and listen… and remember, this is a class of 700 where, if the iClicker results are an indication, 550 show up regularly. Rather than give them much new content from what they’d already heard in the mini-lecture online, I had them unpack and analyze what they had learned. I was really impressed with their sophistication, and their confidence in questioning some of the basic assumptions of the material.
So bravo to you, Anth 143, for your brave thinking, your willingness to contribute, and your intelligence!
The dark side of behavioral biology
We do nasty stuff to each other. We fight, cheat, lie, threaten, beat up, maim, kill, rape. We raid, colonize, war, oppress. It’s not pretty. Are these essential parts of human nature? Are they challenges we must overcome to be moral? Are they dictated to us by culture?
Of course, you all know by now that most of our behavior is a hot mess of genes times environment interactions. And that many behavioral biologists think that it is problematic to assert that “psychological adaptation underlies all behavior,” as do Thornhill and Thornhill (1992). Adaptation does not necessarily explain ALL behavior, though it helps with a lot. And yet I was very impressed with the parallels some students made in class this week between some elements of the risk factors associated with infanticide in humans and non-human primates.
Here are a few links regarding evolutionary psychology, a field that, to my mind, embodies this notion of psychological adaptations for all behavior, and universals in human behavior that seem divorced from context. First is a jpg of a game for EvoPsych Bingo, second a smart post from Boing Boing on what is wrong with evolutionary psychology. You are welcome to ponder the issue yourself, and you are certainly not required to agree with my criticisms.
Next, an interesting article in Scientific American by John Horgan on problems with seeing our ancestry as fundamentally violent: Quitting the hominid fight club.
For those of you not in my class, check out the readings I had this week: Carl Zimmer’s amazing and probably now classic piece First, Kill the Babies chronicling Sarah Blaffer Hrdy’s work on infanticide, and then this biography of Hrdy by Claudia Glenn Dowling that offers even more insight into her work.
Other random but useful tidbits
These aren’t really related to this week’s topic, and instead are just links I want to share.
If you ask for it, then I have to let you have it. A slideshow/poetry reading on the meaning of teaching. I wish every student would watch it. via Greg Laden’s Blog
A few cool posts that came out AFTER our week on mating and marriage: Sex, Evolution and the Case of the Missing Polygamists by Eric Michael Johnson, and Choosing Mates: Do we really want who we say we want? over at the Lay Scientist.
Advice from graduate students to college students — you know, the people that you interact with the most, do most of the hidden labor like grade your papers, and probably know you best.
And finally, my favoritest article this week, a speech entitled What are you going to do with that? over at the Chronicle for Higher Education. Please read it, read the whole thing, then bookmark it, then spend some time figuring out what excites you about life and how you will avoid becoming a boring forty year old (if you’re over forty, how you’ll avoid becoming a boring whatever-age-you’ll-be-in-five-years).
Reference
Thornhill, R, & Thornhill, NW (1992). The evolutionary psychology of men’s coercive sexuality Behavioral and Brain Sciences, 15, 363-421
Wednesday, October 6th 2010
This is the second post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here.
Preggers
A few weeks after the positive blood test, I had my ultrasound where we saw a tiny little bean and a beating heart. During this time I was having what felt like bad menstrual cramps. The nurse told me this was quite normal, but I still spent a lot of mental energy fretting over it. The rest of the first trimester was pretty uncomfortable. In addition to being exhausted, I was nauseous. I didn’t want to eat vegetables. In fact, all I really wanted was toast (gluten free, of course). I concocted a pretty awesome smoothie that I would drink once or twice a day, made of chocolate almond milk, peanut butter and ice cubes. It settled my stomach, and it’s probably because of those smoothies that I only lost four pounds.
At this point we also transitioned from medical doctor care to a midwife. At first we were just given to the next available midwife in our practice. But when it became clear that in order to stay in that practice we’d have to have a hospital birth, we transferred to the Cambridge Birth Center in Cambridge, MA and the midwives there.
Where to give birth and why
The Cambridge Birth Center is a stand-alone birth center associated with (and across the street from) the Cambridge Hospital. There are no doctors, but you can get into the OR in four minutes for an emergency C-section if you need to (yes, they practice and time these things). So I was completely confident that, if I had a straightforward, low-risk pregnancy and labor, I would be best suited to the birth center, and if anything went wrong I was minutes from a doctor.
We were a bit nervous about this decision, because of the stigma attached to IVF children. Do IVF pregnancies lead to more difficult pregnancies or labors? Are we going to have a child with greater or fewer limbs than the average? The reality is that, while the egg was fertilized in a rather special manner, a fertilized egg, then blastocyst, trophoblast, and so on that makes it to become a fetus, and then makes it trouble-free through the first trimester? That fetus is very, very likely to be healthy and normal.
The other reason we were firm in our decision is that a number of interventions that are automatic upon entering a hospital are not physiologically necessary, and even increase the risk of later interventions. Pubic hair shaving is still a common practice in some hospitals, which is just plain dehumanizing. More common are continuous fetal monitoring and putting in an IV immediately. Continuous fetal monitoring is more likely to find false positives, which means it’s more likely to find pathology in a fetal heartbeat that goes up or down but resolves on its own naturally. IVs restrict movement and lower the barrier for a doctor to suggest, and a woman to agree to, pharmaceutical interventions. This is in addition to the many other criticisms I could launch but won’t because I find it all so exhausting.
The biggest issue, for me, is that if you walk into a hospital you have at least a 33% chance of having a Cesarean section, and the reasons behind that are largely related to the ratcheting up of interventions as one intervention necessitates the next one. A C-section is major abdominal surgery. It takes a long time to recover. It is hard to breastfeed, it is hard to pick up your child, and you spend more days in the hospital. These are days when your sleep is more disrupted than when you’re home, and you increase your and your child’s chances of infection by being in a hospital, and extra days when you as a family could be figuring out a routine at home to make sure the mother isn’t the only one bonding to the new baby.
Then there are indications that C-sections create health concerns for the baby as she gets older. Babies of C-sections have higher rates of allergy (i.e., Roduit et al 2009), asthma (i.e., Davidson et al 2010) and Celiac (gluten intolerance) (Decker et al 2010). I am a C-section baby myself and I have severe allergies, allergy-induced asthma, and gluten intolerance (a trifecta of awesomeness!). Given that I’ll be passing on some of the genetic proclivities for these things, I wasn’t too keen on giving my child the environmental components that would also increase her risk if I could avoid it.
So we started seeing a midwife, and I got to know a different part of Cambridge better than I’d known before. I really fell in love with Inman Square.
Going meta
Throughout my pregnancy, I devoured popular books on pregnancy (good: anything by Sheila Kitzinger, bad: What to Expect When You’re Expecting) but also searched for a lot of information on PubMed and kept an Endnote library devoted to my results. I read about the craptastic relationship between symphysis-fundal height measurements (this is when they use measuring tape to measure the size of your belly) and birth weight (i.e., Johnstone et al 1996) – even in those studies that found a statistical correlation, SFH often explained very little of the variance in birth weight. I read about exercise during pregnancy (de Groot et al 1994) – and I played soccer through my first trimester, jogged through my second, and worked out five days a week through the whole pregnancy, up to the day before my due date. I read about meconium, I read about fetal monitoring, I read about maternal stress. When I wasn’t working I was reading, and when I wasn’t reading I was exercising. All the other time I was in prenatal appointments or sleeping.
Of course, as excruciatingly long as the pregnancy felt, as boring and normal and yet delightful as it was, it did eventually come to a close. Family flew in from out of town to be around for my due date, and there was a lot of pressure – joking, but pressure nonetheless – to produce offspring before everyone left. When my due date brought with it the occasional half-hearted contraction, nothing I hadn’t felt before, I went to bed disappointed.
The next morning I woke up, got out of bed, and my water broke all over the bedroom floor.
* * *
Next time, I’ll talk about the joys of drug-free labor.
References
Davidson, R., Roberts, S., Wotton, C., & Goldacre, M. (2010). Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study BMC Pulmonary Medicine, 10 (1) DOI: 10.1186/1471-2466-10-14
Decker, E., Engelmann, G., Findeisen, A., Gerner, P., Laass, M., Ney, D., Posovszky, C., Hoy, L., & Hornef, M. (2010). Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children PEDIATRICS, 125 (6) DOI: 10.1542/peds.2009-2260
de Groot LC, Boekholt HA, Spaaij CK, van Raaij JM, Drijvers JJ, van der Heijden LJ, van der Heide D, & Hautvast JG (1994). Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy. The American journal of clinical nutrition, 59 (4), 827-32 PMID: 8147326
Johnstone, F., Prescott, R., Steel, J., Mao, J., Chambers, S., & Muir, N. (1996). Clinical and ultrasound prediction of macrosomia in diabetic pregnancy BJOG: An International Journal of Obstetrics and Gynaecology, 103 (8), 747-754 DOI: 10.1111/j.1471-0528.1996.tb09868.x
Roduit, C., Scholtens, S., de Jongste, J., Wijga, A., Gerritsen, J., Postma, D., Brunekreef, B., Hoekstra, M., Aalberse, R., & Smit, H. (2009). Asthma at 8 years of age in children born by caesarean section Thorax, 64 (2), 107-113 DOI: 10.1136/thx.2008.100875
