Always hungry

So, now that the big decision has been made, there’s only a few more decisions to follow: what is maternity leave going to look like? How should I approach my boss with my plan for taking leave? And the all-important, should I finish my degree or not?

Thank you to everyone who sent good wishes to Kelly and I this weekend. I loved reading your emails and comments. I am very excited about moving to Rochester, and have created a google map here to chart out important sites to know and visit when we move there. We will probably look for places in the South Wedge because it is so close to Strong Memorial Hospital, where Kelly will be doing his residency.

Kelly and I spent a very productive weekend together, doing laundry, going grocery shopping, washing all the remaining Passover seder dishes (our kitchen is ours again!), completely cleaning out the pantry and mopping the floor, and stuffing more holes in our kitchen with steel wool to keep out the mice. We also managed to finally clean out the box where we dump the mail every day and to throw out a pile of old receipts. I even managed to fill another bag with books to sell, bringing me up to 5 large paper bags so far. I’ll probably double that number.

Even more exciting, we had great romance this weekend! We had recently had some pretty crummy attempted sex that left us both feeling frustrated, but this weekend we had hot sex multiple times. It’s nice to know that despite having so many changes in my body, which can leave me feeling uncomfortable swollen in the vulva (greater blood volume + worse circulation due to the weight of the placenta on my veins) and awkward and ungraceful as I roll around my belly weight, as well as having a constricted range of movement, I can still find a way to get it on. The trick, apparently, is having lots of space so that I don’t have to scrunch up (pregnant belly crunches are not sexy) or stretch out my stomach (it’s already a bit maxed). The other trick is not to wear lingerie that is now ridiculously, uncomfortably tight, and to find positions that are comfortable to maintain, like lying on my side. I haven’t really experienced either a reduction or an increase in sexual desire with pregnancy, although I have heard and read about that being common.

I am always hungry lately, and there is plenty of action going on in my tummy. I still can’t feel or see particular body parts (hand? elbow? foot? butt?), but I feel lots and lots of bumping, jumping, and swishing around. I wish I were getting a bit bigger in the belly, but hopefully I am just a late bloomer. My midwife says that my weight gain curve is fine. And little things have me noticing that I am still growing – I just bought a new bra a few weeks ago, and already I can’t wear it because between when I bought it and now, the band around my chest has become too constricting. I knew my cup size was bigger, but I hadn’t thought that my rib size was going to change. I guess it’s because all my organs are now sitting higher than normal.

For the last two nights, I have had horrible nightmares. Saturday night I dreamed about teaching the final day of my Ex College course, but everything went wrong. We couldn’t get to the project presentations – we couldn’t even get past the opening activity. The classroom was full of visitors who were alternately rude and distracting or there to observe me. I ended up threatening to drop my students’ grades by a letter unless we could conduct class and cover the content I had prepared. I felt ineffective, humiliated, and like I was violating my own values. Sunday night I dreamed I was trapped in a Nazi death camp where many of my friends had already been killed. The camp was located in a high-altitude mountain range with lots of snow (and also some magical, glowing, orange glass objects that were valuable and I might be able to trade for my freedom). I managed to temporarily escape, but the weather forced me back. After the war, my lover (not Kelly) had joined the resistance and was not interested in helping me find and extradite our baby from the Nazi-controlled territory, who had been adopted in the meantime by strangers. I felt afraid, alone, and betrayed. On the other hand, I have slept really well, going right to sleep and falling right back asleep after getting up in the middle of the night to pee, and waking feeling refreshed. I think it has helped that I have been stuffing one of my softer stuffed animals under my stomach to stabilize myself on my side.  I got the idea from my dad, who mentioned that there are tummy wedges to make pregnant women more comfortable during massage.

Kelly and I thought a lot about baby names this weekend, and we are singing a song to the baby every day, the baby’s song.  I got this idea from one of the videos we are watching in birth prep class.  If you read the same story or sing the same song to the baby before it is born every day, it will recognize it after it has been born and find it calming.  Our baby’s song is a slightly altered version of Lechi Lach (Go Forth), a song by Debbie Freidman (listen here). Our lyrics go:

Lechi lach in a land that I will show you
Lech l’cha in a place you do not know
Lechi lach on your journey I will bless you
And you shall be a blessing, you shall be a blessing
You shall be a blessing lechi lach

Lechi lach and I will never leave you
Lech l’cha wherever you may go
Lechi lach on your journey I will bless you
And you shall be a blessing, you shall be a blessing
You shall be a blessing lechi lach

The original lyrics are based on genesis 12:1-2, and our altered version is based on that plus Kelly’s remembered version of the second version, which to me more truly represents God’s love for humanity and parents’ love for children than the actual second verse, which is about making Abraham’s name great.

This is the last week of Hypnobirthing, and I have to say that we have been terrible at doing our homework.  We’re going to have to really gear up in the last trimester.

Decision: Rochester

Well, after lots of conversation and some tears – oh, and about 5 hours of total sleep last night – we have made our decision. We are moving to Rochester (in late August).

Thank you to everyone who helped us with advice and information yesterday (and in the case of Laura, food). This has been a tough week, but we both feel like we are making the right decision for ourselves and our baby.

We have talked about leaving the door open to move to Seattle after Kelly’s internship ends, but of course we’ll have to make that decision then.

E-hugs are appreciated.

Rochester said yes

Both Seattle and Rochester have offered Kelly positions, so Kelly and I have to decide where to move by tomorrow, when Seattle wants an answer. Aside from all this, I am so tired today! I have been getting that sparkly-lightheadedness again today, and a headache. I wish I could just lie down and nap all afternoon. I am not sure I am up for a huge, life-impacting discussion tonight. Plus, we have Hypnobirthing tonight from 6:30 until 9:00, which cuts into my prime awake time. To top it all off, the car has another problem – a metallic “thunk” noise when I take my foot off the accelerator or switch gears. And it’s hot, and my allergies are acting up, and we still have mice in our apartment, and worst of all, I dreamed about eating a fluffy, delicious bagel last night. (In my dream, Kelly and I went to a Passover seder at Stacey’s, where Stacey’s mom told us that egg bagels were a traditional Pesach food. I was like “allllRIGHT!”)

How will we make this decision? It’s not like the Berkeley or Chicago decision (Berkeley, duh), or the Boston or nothing decision (Boston seemed like the better option). It’s true that wherever we move, it is for a minimum of one year (for Kelly’s internship) and a maximum of two to three years (the point at which we will hopefully move to Kelly’s first settled position as a minister). We thought the same thing of Boston (that we would be here for a minimum of one year for Kelly’s internship and then move a year or two later after a search for a position) but the MFC turned him down for the credential last fall and so plans changed – it will have been 2 years after all.

But we are in a different situation now. By the time we move, we will have a newborn, and from everything I have read, the upcoming year promises to be full of lifestyle and relationship upheaval. How can we make the first year after having a baby go smoother? All indications point to having a large support network that is willing to help us out with everything from child care to hand-me-downs to bringing over a meal or helping clean the house after the baby is born. I think staying in Boston would give us less of a network than moving to live in the same city as one of our families, despite the large number of friends we have here. I mean, with family you can integrate into their routine and do one dinner a week together or something. But on the other hand, this is individualist America and our families expect us to be independent. We also expect it of ourselves! Which is extremely difficult because financially, being a single income family is less viable than it was for my parents’ generation, and the economy seems like it is about to tank.

A couple nights ago, Kelly and I had a really good, deep conversation about what it is that we each really want. Our deepest longing, the thing that is motivating us in this decision. When you get right down to it, what we want is very simple. What Kelly really wants is the security of knowing the rent is paid for and that our family has enough to eat. What I really want is to spend as much time as possible with him and our baby. Lately, it has seemed like we spend a lot of time doing chores when we’re together because we both work full-time, so the evenings and weekends are when grocery shopping, laundry, dishes, housecleaning, and budgeting have to get done.

What we would both like is a situation where Kelly can be the main wage-earner and I can work part-time or stay at home. So the question is, how close to this situation can we get with this move? The other factor here is that Kelly’s internship is going to be very, very intense, both in terms of time (he will be on 24-hour call for portions of each week), and in terms of emotional stress (he is leaning towards the hospital with the major trauma center, but in either case he will be dealing with people who need spiritual guidance as they deal with severe health problems). If I am working full-time, we are both going to come home needing to unload, and I worry that that will put a large amount of strain on our relationship. So, here are factors that affect how able we will be to afford me working only part-time:

• The cost of rent
• The willingness of family members to do regular free child care (or child care exchange)
• The cost of the move (though, since we will be moving cross-country again in a few years, to me this seems like it’s either a large cost now or a delayed large cost then)
• The support network we could depend on (a synagogue we fit in with, local friends, extended family, family friends)
• Kelly’s stipend (about $65 more a month in Rochester than Seattle) and the flexibility of his regular working hours
• The length of Kelly’s internship (9 months in Seattle, 12 in Rochester)
• Opportunities for Kelly’s professional ministerial development, so when he goes in front of the MFC again next spring he has a track record of continued involvement in a UU church

There is also the unrelated matter of which city we would more like to live in – which city is more vegan-friendly, has better public transportation, has a culture we fit in with (apparently neither of us fit in as New Englanders), has the better independent video stores and cheap movie theaters, the better library system, the better public parks, the better weather, the larger community of people living a similar lifestyle. I’d add in the better schools, but we will be moving before that becomes an issue.

The choice is not clear, especially since we don’t really know the answers to some of the factors above. Like, how much child care/child care exchange would Ellen be willing to do? or Alex and Steve? How flexible would Kelly’s regular working hours be at each location? What kind of professional UU opportunities might exist for Kelly in Seattle? Is there a decent Temple in Rochester? What is the culture of Rochester like? (Of course, I have much more experience with Seattle, and Kelly didn’t really explore the city with this life stage in mind when he was living there.)

Overall, overwhelming. I’ll keep y’all updated as I know more.

As it happens…

Well, as most of you know, Kelly has applied to year-long chaplaincy residency programs in Boston, Rochester NY, and Seattle. Boston turned him down, as did one location in Seattle. Swedish Medical Center in Seattle offered Kelly a position on Friday and gave him one week to respond. First thing on Monday, we contacted Strong Memorial Hospital in Rochester. Kelly had a particularly good interview there, and at the end of the interview Strong’s chaplains requested that if another program made Kelly an offer before he had heard their decision he let them know before he accepted so they could have the chance to make an offer as well. We just heard from them at 3PM today that “they haven’t heard from Kelly’s references yet”…and until they do, presumably no offer is forthcoming. This delays not just our decision about where to move, but our ability to even know if we have a decision to make! Augh! At this point, we have definitely decided we are moving, but by Friday we will know where. Very stressful times.

We’re just hanging in here, putting our faith in the universe and our trust in each other.

Allergies to food?

So, I’m vegan, and I am trying to eat as healthily as possible. Kelly and I have actually changed our diet substantially since I became pregnant. For instance, we buy all this whole-grain stuff now instead of more processed grains (whole wheat flour, whole wheat pasta, soba noodles, brown rice). We are also experimenting with more high-protein foods. Last night we cooked with seitan for the first time, and it was a success.

But, I have also been having more heartburn. Pregnancy leads to more heartburn, but if you have a wheat allergy or something, so does eating more whole-wheat foods (I think). Does anyone know how I can go get tested for food allergies? Or should I wait until I am not pregnant any more?

EDIT:

I called the allergist’s office in my medical practice, and they said that they don’t test for food allergies during pregnancy.  This makes sense, because if you end up having a major reaction it might affect the baby or something, or even just lower your general health for a while.  But this also sucks, because what if I am having smallish reactions all the time?  The eight most common food allergies are milk, eggs, fish, shellfish, peanuts, tree nuts, soy, and wheat.  I already don’t eat milk, eggs, fish, or shellfish, and have stopped eating peanut butter since I got pregnant.  I seem to eat tree nuts with impunity, but I have noticed mild reactions to both soy and wheat lately.  But I need those things to be vegan!

This month’s appointment

I just had my April meeting with my midwife, in which I asked a TON of questions and took up a lot more of her time than I think she had planned to give me.

Here are some answers:

• Kicking more on one side than another is normal.
• Having loose stools is normal.
• Feeling a fluttering inside your vagina like the baby is kicking there means that it is.
• I am gaining enough weight.
• The Cambridge Birth Center has a standard birth plan that the midwife fills out with the mother, but I am welcome to write my own birth plan to talk over with Tiffany.  She said that that might be useful so that she can tell me what will fly and what will not.  In her experience, medical providers do not sign birth plans saying that they have read and understand them (books I have read recommend that you have your doctor/midwife do this, although not have them say that they agree).
• If everything is going well at the birth center, they perform the following standard procedures:
  • vaginal exams with fingers to check dilation
  • intermittent heartbeat monitoring with a doppler monitor
  • if it hasn’t broken by 8 cm dilation, the midwives break the water to see if there is any meconium in it.
• If there is meconium in the amniotic fluid, you get immediately transferred to the hospital.  (In the industrialized world, meconium in the amniotic fluid can be detected in 8-25% of all births after 34 weeks’ gestation. Of those newborns with meconium-stained amniotic fluid, approximately 10% develop Meconium Aspiration Syndrome.)
• If you get transferred to the hospital, you get a routine IV and continuous electronic fetal monitoring.
• In terms of informed consent in hospitals, while medical providers should be able to give their rationale for a certain intervention or procedure, I am not likely to receive either a summary of evidence or a list of risks and benefits that includes specific numbers or percentages.  If I refuse a procedure a medical provider has recommended, I will probably have to sign a refusal of care form.
• Tiffany mentioned that the two cases where she believes I would have the most reason to inquire about the benefits and risks of an intervention are vacuum or forceps extraction and non-emergent C-section.  Other than this, I should trust the judgment of my medical providers.
• Breech vaginal births are not offered anywhere in the Boston area, to her knowledge.  Breech babies are always birthed by C-section.
• I asked Tiffany why she thought there was such a discrepancy in the percentage of cesareans for first-time mothers and for mothers who had had previous vaginal births.  She answered that moms who have had a previous vaginal birth have the confidence to know that they can give birth vaginally, know their pelvis will be big enough, and have looser muscles and tendons than the first time around, so overall everything about birth goes easier and faster.

I guess what I got out of all of that is that it is up to the pregnant lay woman to do her own research and become informed about the various interventions, routines, and procedures that medical centers provide and what the appropriate indications are for them.  I am also getting the sense that I am a homebirthing type of person, which may be the case for baby number two.

Any advice on how to help the first birth go smoothly?

I can finish my degree!

Great news today.  I met with my graduate advisor, and if I take two classes in the summer, I can definitely finish my degree whether or not Kelly and I move out of the area.  I will have just three courses left, and two of those will be my thesis.  The third course I will be able to take at another university and transfer to Tufts, and it will be an elective course, so I should be able to find a course that my advisor and department are willing to approve, wherever we move.

Any courses I take while not working full-time at Tufts will not have tuition remission, of course, but for three courses, that seems okay.  $12,000 is not a very expensive investment for a degree.

In my anarchism class this week, I taught on the topic of education and it got me all excited about it again.  I mean, when I think to myself, “what will I do with this degree?” I don’t come up with much of an answer, but I think it should a) get me a higher level of administrative job, b) open the possibility of a PhD program to me if I am interested in going into academia, and c) perhaps open more possibilities to me in K-12 education as a consultant or program administrator, or in a K-12 nonprofit.

I got to talk to the ‘rents, but I think I am going to go for it.  Time to actually finish something I start!

Massachusetts birth data

The Mass. Dept. of Public Health keeps statistics on birth and publishes an annual report, found here. Unfortunately, unlike in New York, hospitals do not track labor interventions.

The data is pretty interesting. Some bullet points from the most recent report (2006):

• Massachusetts has only 2 freestanding birth centers, the Cambridge Birth Center and the North Shore Birth Center. I am planning to give birth at the slightly larger one, Cambridge, which had 114 births to North Shore’s 83.
• The C-section rate for Cambridge Hospital, the hospital that the Cambridge Birth Center is affiliated with, is 29.2%, lower than the state rate of 32.5%.  The primary C-section rate (as opposed to repeat C-section rate) for Cambridge Hospital is 19.8%.
• Infant mortality rates have been steadily dropping since about 1870, and continue to do so. The current rate for Whites in Massachusetts is around 5 deaths per 1,000 live births.
• Massachusetts has around 25 pregnancy-associated deaths per year.

The most intriguing data is on Table 32, “Cesarean Section Deliveries for Singleton Births by Licensed Maternity Facility and Number of Previous Births, Massachusetts: 2006,” which suggests that whether your first birth is vaginal or cesearean has an extreme, almost determinative, influence on your subsequent births. Here is the data for Cambridge Hospital:

First Birth

Births: 675

C-sections (number, percent): 171, 25.3%

Second or Later Birth without prior C-section

Births: 430

C-sections (number, percent): 41, 9.5%

Second or Later Birth with prior C-section

Births: 181

C-sections (number, percent): 158, 87.3%

The Mother-Friendly Childbirth Initiative says that a “mother-friendly” hospital, birth center, or home birth service has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals.  It’s clear from the evidence that that target is only met in cases where there is a second or later birth without a prior c-section.  For first-time mothers, not having had the prior experience of a natural birth increases the risk of cesearean.  Why?  I would guess it’s because women who have not previously given birth do not know what is normal for them and what is not.  If you can make it through the first birth vaginally, then you are much more likely to have subsequent vaginal births, whereas if you have a c-section, you are very unlikely to have subsequent vaginal births.  In addition, the more cesarean sections you have, the greater the risk of complications with each additional surgery, while the risk with multiple vaginal births remains the same.

I wonder why more doctors don’t talk about the two paths for birthing, the importance of the first birth for putting you on a path, and the long-term consequences and risks of each path if you plan on having multiple children.  I mean, obviously there will be 10-15% of women in any case who need cesarean sections, and obviously they should get them, but the numbers indicate that more than just medical need is driving the rates.

Hypnosis

Kelly and I went to the first class in the hypnobirthing series last night. Our instructor seems pretty flaky, and also pretty on-board with what appears to be a for-profit venture to market hypnotherapy techniques. You know, “HypnoBirthing(R) – The Mongan Method.” But despite the HypnoBirthing(R) Institute’s moneymaking aspect – certifying legions of official HypnoBirthing(R) labor companions, doulas, childbirth education trainers, and fertility therapists to spread the gospel of the HypnoBirthing(R) system – it does seem to be grounded in actual science.

I didn’t know much about hypnosis before reading Hypnosis for a Joyful Pregnancy and Pain-Free Labor and Delivery, but it seemed pretty bunk-like to me.  My previous exposure comes from the middle school party games I used to play at sleepovers, like “light as a feather stiff as a board” and “bloody Mary.”  A memorable experience was at Rachel’s birthday party one year.  We took turns relaxing on a couch and being led into a trance state by a friend slowly counting backwards from 100, pausing every few numbers to suggest deeper relaxation.  I was self-conscious so it didn’t work on me, but Rachel was very able to get into a trance, and we ended up asking her where she was and what she saw (a castle with a red flag).  Then, when she woke up, she didn’t remember what she had seen – she was embarrassed that it had worked.  But the game I played most often was one you could do on a playground.  You stood behind someone and chanted while they closed their eyes and relaxed.

Part of the chant went like this:

Concentrate, concentrate on what I’m saying.  People are dying, babies are crying.  Concentrate, concentrate on what I’m saying.  Crack an egg on your head, let the yolk run down, the yolk run down, the yolk run down.  Crack an egg on your head, let the yolk run down, the yolk run down, the yolk run down.  Stab a knife in your back and let the blood drip down, the blood drip down, the blood drip down.  Stab a knife in your back and let the blood drip down, the blood drip down, the blood drip down.  Spiders crawling up your back, spiders crawling down your back.  Spiders crawling up your back, spiders crawling down your back.  A pinch, a squeeze, cool breeze.

The point of that one was to give someone the chills and creep them out.  For each part of the chant, there is a corresponding action with light touch, and with the final words you blow on the back of their neck.

There was another one where you would stand behind someone and lead them through a guided meditation up the stairs of a skyscraper until they stood completely relaxed on the roof.  Then you would have them look over the edge and you would give them a sharp shove in the back to throw them off their balance and jerk them out of their trance.  When they turned to look at you, you would ask them what color they saw as they fell.   I usually saw red or green.

The point of all this is, I spent a considerable amount of time as a tween conditioning myself not to relax during hypnosis!  As we all know from watching movies, as soon as you are completely relaxed, something horrible and ominous happens.  For instance, if you take a relaxing, long, hot shower, you might end up either stabbed (Psycho) or with your girlfriend torn apart by semi-trucks (The Hitcher).  If you enter a trance and symbolically re-live a calming memory, you might find yourself cutting into a birthday cake filled with blood (Alias).

In the hypnobirthing class yesterday, the teacher led the class through a script that involved standing in a familiar kitchen, visualizing a lemon, picking up a big kitchen knife, cutting the lemon in half, and taking a bite.  The point of the script was to illustrate the mind-body connection, because if you really spend time imagining eating a lemon, you begin to salivate and possibly even feel that sharp twang in each side of your jaw you get from eating very acidic foods.  But to begin in a comforting, familiar place and then pick up a giant kitchen knife!  I just felt like that was tapping right into the horror movie archetype.

Anyway, more than the class itself, it was the book I linked to above that introduced me to the idea that hypnosis is a legitimate method used to relieve pain in many different medical and clinical settings.  It involves a trance-like state (called both focused concentration and deep relaxation) characterized by a high degree of suggestibility.  Hypnosis can be used to introduce suggestions to a willing participant, and is effective enough that it can reduce or eliminate the need for anesthesia in surgery.  In childbirth, the purpose of hypnosis is twofold.  First, a first-time mother is often tense and afraid, and her tension and fear can prevent the labor from progressing until she is physically exhausted and needs intervention.  Hypnotic suggestions to induce feelings of relaxation and well-being can speed the progress of labor while making it a more pleasurable experience.  Second, a state of hypnosis can allow you to reduce your brain’s reaction to pain stimulus using a technique called glove anesthesia, which allows you to temporarily transfer a feeling of numbness to any part of your body.  Using hypnosis takes practice, and it has some pitfalls.  If you work with a professional hypnotherapist, you can often re-create the trace state later, once you know what it’s like.  As an individual working with books, tapes, and a HypnoBirthing(R) trainer, it will probably be more difficult.  Also, you can screw yourself up if you, for instance, forget to turn off the numbness to a part of your body, or if you are in a suggestible state and people tell you to do things without realizing your greater vulnerability.

Overall, I think that with relaxation, meditation, and hypnosis, as well as facing my fears about giving birth and being a parent, and with the bellydancing movements, and doing art and reading a lot, and having a tub to relax in during labor, if everything goes well I will end up with a drug-free, intervention-free childbirth.  Yay.

Finally, pictures!

Click on the pictures to see bigger versions.  You can now see my belly (22 weeks in the photos above), even though there’s not much to see.  Several people have mentioned that if you didn’t know I was pregnant, you would just think I had put on a few pounds.  Haha!

Kelly and I go the first class in the Hypnobirthing series tonight.  Exciting!