Now I'm the know-it-all

The other day, I took a prenatal yoga class for the third or fourth time. Amid all the cute bellies on first-time moms, I felt compelled to offer a dash of perspective from the side of motherhood -- the one that's been there already.

Read more in "Reality Check for New Moms" at DC Metro Moms.

I dreamed a dream Part II: Background

I wanted to stay in the moment in my post the other day about my dream that my baby might have Down Syndrome. But there are a couple of other background factors I'd like to acknowledge.

First of all, we didn't do any early fetal testing, so who knows. I didn't even look into all the options that are out there. My feeling about prenatal testing is similar to my feeling about intervention with in labor: they both often serves mostly to lead to more interventions and more worries.

But I also know at least two folks who learned at their 20-week sonograms that their babies were not going to make it to delivery or more than a few hours after. That's pretty important information to have, I think. I wasn't up for skipping this one diagnostic.

The report -- now two months ago -- said that everything with our baby was, "unremarkable" except for bilateral choroid plexus cysts, which, in the presence of other indications, might point toward Trisomy 18. A few articles suggested a link between the cysts and Down Syndrome (Trisomy 21), but it sounds from this one like the likelihood of a problem with no other issues is slim.

We went with the cheapest ultrasound place we could find since everything is out of pocket. I felt like the tech was plenty competent, but you just never know, and it does feel a little weird that the cyst remark was on the written report but that the tech said to our faces that everything was fine.

We could get another sonogram to see if the cysts disappeared in the third trimester as they usually do or if there is anything else that looks possibly suspicious, like closed, clenched hands. I just checked, and two of the sono images from 20 weeks show hands that look pretty open to me. I've read that some folks just have these cysts their whole lives and there's no problem. They don't always disappear. I didn't learn until a few years ago from an MRI that I have a Rathke cleft cyst.

So if I get another sono and the baby's cysts are still there, do I worry more? What is the point of another $170 or the $500 most other places charge? Besides, when the baby is bigger, it's harder to see things. I remember being disappointed in a sonogram around 35 weeks to confirm that my son was breech; it was much less fun and dramatic than at 20 weeks when you could see the whole baby. My husband and I both felt like he was just a mess of parts and walked away not only disappointed about the breech position but significantly less giddy for having "seen" our kid than we'd been months earlier. So I don't think I really want to go there.

And even if I do and the cysts are still there, what is the point? I guess I could start doing some reading. My sister lent me Expecting Adam a while back, and maybe Waiting for Birdy would be a good read as well. But I don't want to scare myself into expecting something that probably won't happen. I've already decided not to finish reading Knocked Up, Knocked Down, because I know from her blog (and writings elsewhere) how that story turns out, and I am just not up for reading about the journey from the happy expectant phase through to the stillbirth right now. My mother-in-law had a stillbirth, and it's been my main worry throughout this pregnancy. (Many Trisomy babies are stillborn, and most don't live past age one).

I think my body, mind, and spirit will be better served by active preparation for birth that looks at the event/experience as something powerful and sacred and that holds the space open for whatever comes after to be whatever it is and not be already layered on with a ton of meaning I've spun for weeks in the prenatal period.

The second piece of background is that I realized much later the day after the dream that it might have been spurred by reading this Carolyn Hax "Tell Me About It" column in the Washington Post that day. A reader whose family was not supportive of her plans to become a single mom via artificial insemination was asking for feedback, and another mom of a special needs child wrote in that despite having a supportive co-parent, she'd had to give up everything to care for her child. If you don't have a ton of money, she suggested, or a "village," -- and if you're writing to an advice columnist! -- maybe it's time to re-think. Kids are not made to order, she reminded.

I really liked Carolyn's response: "...you're posing a question every prospective parent should answer: Am I ready to get what I want, or am I ready to get what I get? The former is dreaming, the latter is parenthood."

We will get what we get, and I will do my best to enjoy this pregnancy for the experience that it is, right now, in this moment. And while I'm at it, to just enjoy life with my family as it is now.

I dreamed a dream (Part I)

As I slept the other night, a vision came into my head of a child with a crowded mouth of ill-fitting teeth. Then I heard the words, "She has Down's."

My eyes popped open. It was the middle of the night, and my 4-year-old son lay sleeping next to me, with my husband on the other side, oblivious to the pronouncement I'd just heard in my head.

Oh my God. I asked my baby -- using the name we have recently warmed to but reserve the right to change our minds about -- "Does that mean you? Do you have special needs?"

Previously asleep, she started moving right away. And she replied: "We will be fine, Mommy. I am the perfect child for you to have. We will be fine."

At first I remained concerned and wide-eyed, my heart racing. But I kept listening. What should I do? "Trust. Love. Breathe."

Um, okay. Pretty wise for a 28-week-old fetus. But then again, who knows how long that soul has been around. It would appear that it has an edge on mine!

Lately when I've woken up at this time of night -- without any alarming warning, just with alertness -- I have to get up. There's just no use staying in bed. I make a snack or do a little yoga, or read, or all three. But this night I could tell my baby just wanted me to rest.

So I did. And I thought about her words. I fell back asleep.

The next day, I wasn't shaken or upset. I felt peaceful. Accepting. It's not up to me what child is going to come into our lives. There is no script of how things should be unless I make it up in my head and cling to it, which does no one any good.

So, for the moment, I am less anxious or worried (or avoidingly distant) than I've been much of this pregnancy and more of the mind that whatever is the right experience for me to have will be the one I will have.

Whatever life looks like, however hard the challenges we face, we can always choose to believe that things are, in fact, fine.

Poetry and motherhood

Last month I attended an amazing session on the politics of writing motherhood at the Split this Rock Poetry Festival.

Read more about it here in a piece I wrote for Mothering.com

Reflecting on NIH VBAC conference

As I wrote shortly after attending the first day of the NIH conference on Vaginal Birth After Cesarean (VBAC) a few weeks ago, the experience was tiring. The panelists might have been trying to convey the message the uterine rupture is really rare -- less than 1% -- and that it does not deserve to be weighted more than a whole lot of other issues, including complications and risks of cesarean delivery. But honestly, it did not help this hopeful VBAC mom to see a bunch of photographs of uterine rupture!

I admired the birth activists who spoke out, women who have been working hard on this issue while I've been comparatively on the sidelines, not regularly attending ICAN meetings (in part because I didn't believe I would ever regain my fertility or get pregnant). But here I am, four and a half months along, and ignoring this issue is not an option. I've chosen to work with a midwife at home, and I hope that my baby's cord is long enough this time and that other factors go in my favor for a successful HBAC (homebirth after Cesarean).

No matter what kind of care I'd chosen, it's important that I understand the climate surrounding this issue as well as the facts. Indeed, the whole point is that the climate has dictated which facts get to "count," which in turn reinforces the tenor of the climate. Everything goes in a circle! But the way it spins has been heavily influenced by medical articles and the publicity surrounding them, and, most significnatly, by pronouncements by the American College of OB/Gyns (ACOG). Although the NIH statement is not perfect, it does call on ACOG to rethink its position about surgical facilities and anesthesia needing to be "immediately available" anywhere a VBAC is attempted.

It was powerful to follow the rest of the conference and the coverage by birth activists and then to write this news bulletin at Mothering.Com: "National Institutes of Health Conference Calls Vaginal Birth After Cesarean a "Reasonable Option."

Check it out for more background on the issue and responses to the conference.

NIH conference addresses vaginal birth after cesarean (VBAC)

More personal reflections will follow, but below is my official report from attending day one of the NIH conference on VBAC, a post I've also published in my column at the Washington Times Communities.

This week, the National Institutes of Health is holding a Consensus Development Conference entitled “Vaginal Birth After Cesarean: New Insights,” a three-day public meeting that, though focused on an obstetrical, biomedical model of hospital births, has drawn birth activists representing midwifery and homebirth interests.

The first day of the conference presented several short reviews of research on the topics of patterns regarding Vaginal Birth After Cesarean (VBAC), risks of VBAC versus cesarean section, and maternal and neonatal outcomes from VBACs, from “Trial of Labor” (TOL) and “Elective Repeat Cesarean Delivery” (ERCD).

In the United States today, some 31% of births are c-sections. Of the 1.3 million c-sections performed each year in the U.S., 40% are repeat c-sections. According to research presented by Dr. Kimberly D. Gregory, the rate of VBACs in the U.S. rose from 3% in 1981 -- when the NIH recommended a decrease in the overall national c-section rate, including a recommendation to increase the use of VBAC -- to a high of 23% in 1996. In that year, the rate began to decline after the publication of a a medical journal article about the risks of TOL.

In 1999, the American College of Obstetricians and Gynecologists (ACOG) required the “immediate” availability of emergency c-section facilities in any hospital that offered TOL and VBAC. Currently, the VBAC rate in the U.S. is around 7%*, even though VBACs, when attempted, are 60-80% successful.

The speakers at the NIH conference discussed the fact that risks associated with c-section need to be weighed against the potential risks of VBAC, which include a 1% or lower chance of uterine rupture. It was noted that much attention gets paid to this dramatic and catastrophic event, while less information is shared with mothers about the many risks associated with surgical delivery, including a higher likelihood of placental accreta in future pregnancies (a condition in which the placenta grows into the uterus).

Dr. Mona Lyndon-Rochelle explained that the risk of maternal death is highest with an elective repeat c-section without a trial of labor. Thus, then, how can we grapple ethically with the fact that more and more hospitals are banning VBAC procedures and forcing women who deliver there into mandatory repeat c-sections?

This question was raised in a Q&A session and was noted by the panel to be the very point of the conference. The NIH cannot force hospitals to change their policies, but the hope among birth activists is that the institute will make recommendations that will halt the trend toward denying women the birth they desire, forcing them into major abdominal surgery if they are unable or unwilling to find another institution at which to birth or a midwife with whom to work at home. According to the International Cesarean Awareness Network (ICAN), over 800 hospitals in the U.S. have banned VBACs.

When attendees asked questions about the safety of VBAC at home, or HBAC, they were met with the explanation that no research of acceptable quality was available on the subject, and even that it was not possible to obtain statistics on homebirth. Upon being questioned by attendees about non-medical effects of surgical delivery (including a question from Gina, an ICAN chapter leader for and the author of The Feminist Breeder blog), the panelists admitted to a dearth of information on issues like postpartum depression (PPD), post-traumatic stress disorder (PTSD), difficulty establishing or maintaining breastfeeding, and difficulty bonding with an infant.

In light of the fact that some hospitals not only ban VBACs but also require all c-section babies to spend time (one participant said four hours at the hospital where he practices) in the Neonatal Intensive Care Unit (NICU), it would seem that questions of mother-child bonding need to be investigated. A panelist noted that these were excellent questions that were discussed to some degree in the planning committee before it was determined that there was inadequate research to discuss them in this forum.

The conference will end Wednesday, March 10 with a presentation of the NIH’s draft statement at 9:00 a.m. followed by public discussion, after which the panel will meet in executive session before providing a summary of its findings to the press in a 2:00 telebriefing. The draft statement will be available after the proceedings at consensus.nih.gov with the final statement to follow four to six weeks later.

Further coverage of the conference from a VBACivist perspective can be found at the ICAN blog at http://blog.ican-online.org/, The Feminist Breeder Blog, which includes live radio coverage and interviews via podcast at http://thefeministbreeder.com/nihvbac/, and Momotics Blog at http://momotics.com/category/nih-vbac/.

*The most recent statistics used by the papers at the conference cite a VBAC rate of 8.5% in 2006.

Tired and missing my kid

It feels good to look forward to seeing your son. Lately I've felt so swamped -- and especially after all that snow with no break -- I haven't exactly loved all my many minutes with my boy.

Today I went to the National Institutes of Health for a conference on Vaginal Birth After Cesarean (VBAC), which I hope to write about in more depth later. But the experience of the day was something in and of itself. Getting dressed in real-people clothes, taking my boy to a friend's so she could drive him to school and pick him up, getting on a crowded Metro during rush hour, and then listening to a lot of doctors talk about best outcomes for moms and babies... Well, it was intense. Especially considering that I'm 4 months pregnant and hoping for a home VBAC (HBAC) with baby #2.

I knew E would probably be okay, but I also knew it was a long day for both of us. We were both exhausted when I picked him up from the park. I could not wait to trade my button-down and blazer for a sweatshirt and just sit on the couch hugging and talking to him. If we weren't both hungry with dinner nowhere in sight, I would have happily sat there for an hour. It felt good for that to feel so good.

For someone always looking at her watch and struggling to just be in the moment when I really want to be writing or researching or exercising, that uncomplicated couch time was a true delight.

Fabulous birth symposium!

I was blown away at this week's symposium at George Mason University: "Perinatal: A Symposium on Birth Practices and Reproductive Rights" organized by MFA candidate and mother of two, Jessica Clements. There were so many great panels and talks, I hardly know where to begin. In fact, I may leave summary to a print writing venue but for now feel compelled to share a link to the story of Joy Szabo from The Unnecesarean. Szabo is a woman who has already had a VBAC and has been told by her Page Hospital in Arizona that if she refuses a c-section for her current pregnancy, the hospital will pursue a court order to force her to have a surgical delivery.

Henci Goer reported on this issue in her fabulous talk, "Cruelty in the Maternity Wards: Fifty Years Later." She had just added the info about Szabo to her talk, which detailed other incidents of abuse and an overall culture of abuse in mainstream maternity care. The news about Szabo broke October 1, and the The Unnecesarean has updates about conversations with the hospital, but I don't see that Szabo has had the baby yet. I've followed the discussion onto Facebook and am going to see if I can learn more that way. (Too many different logins so I can't do it now. Must streamline!)