Week 41!

Fetus is still in there, having a grand old time! She is 4 days past due now, and I’ve been having contractions for 3+ days. They are mild to moderate in nature, and not very painful, but enough to be uncomfortable and tiring. They started out spaced quite a bit apart, and progressed to every 30 minutes, then 20, then 10, and even 5, but varies and returns to a rate of every 30 minutes and/or 20 minutes with complete lack of predictability. I can sleep through most of them, but wake up to it 3-4 times a night.

I’ve been lounging a lot, but also doing some walking and yoga stretching. I did do 35 squats with a 20 pound weight after walking a short hill yesterday, but that turned out to be a big mistake because I felt grouchy and tired the rest of the day. Husband has been very patient and nice with massages when I wake up in the morning with a kinked spine and foot massages when we watch TV.

Also had my fair share of pineapple cakes. Bribing Fetus to come on out and join the human world of delicious treats. In fact, she’s been bribed this whole week, with Chinese home cooking, including tomato beef noodle soup, mapo tofu, zha jiang noodles, etc.

I had a doctor’s appointment today, and I’m currently 2 centimeters dilated and 80 percent thinned out, so I guess the last 3 days have not been in vain. The non-stress test results were fine, and the amniotic fluid still looks good, so my doctor did not think it’d be a problem to wait a little longer, though she wanted to have a game plan for potential induction if I went past 41 weeks. Potential induction would involve use of Cytotec, a synthetic prostaglandin. In the meantime, she offered to strip/sweep the membranes, which basically involves insertion of a finger into the opening of the cervix, and moving it around to separate the amniotic sac membranes from the cervix. This causes release of prostaglandins which may speed up labor. However, I did not recall what any of my classes and/or reading material had to say about this procedure, and I was undecided on it, so we held off.

After Husband went to work, I went home to consult some books along with Google. It seemed to me that membrane stripping was relatively benign, with minimal risks, compared with some of the horror stories one of my books seemed to suggest about Cytotec. I really hope to avoid being induced to begin with, and although I think some of the hippie set tend to overstate the risks of Cytotec, both Google and Expecting Better seemed to indicate there’s evidence membrane stripping is relatively safe and and up to 25 percent effective, so I called the doc’s office back to see when I could come in to get it done.

I went in basically as soon as I hung up the phone, and was seen within 5 minutes. The sweep itself lasted probably less than 20 seconds. She literally just poked her finger up in there and swished it around a little. The internet said it could be crampy and uncomfortable, but it was even less so than I imagined. It sort of felt like my bladder was being poked a little, but otherwise was entirely bearable. I felt like contractions began to speed up within the hour (after a pretty slow morning and early afternoon), but who knows if this is coincidence. Stay tuned.

Unmedicated Birth?

Although my mother and mother-in-law both gave birth without the assistance of epidural analgesia, this does not appear to be the norm for most women, at least in the current times. I do not go around broadcasting that I plan to have an unmedicated birth, because I really have no clue how it will ultimately all play out, and it could very well be the case that medical interventions become necessary… but hopefully not.

Some of the sentiments I’ve heard about an unmedicated birth are quite snide, and I get these from all kinds of people, including those who are professional healthcare providers (not my own, fortunately). No, I don’t want a gold star or a pat on the back for needlessly suffering through pain, nor do I believe that “natural suffering” should be part of the grand experience of labor and birth. Believe me, if I could literally snap my fingers and have a pain-free birth, I’d do it. However, the fact remains that no medication or medical procedure is without attendant risks and potential complications.

Some studies suggest epidural use causes increased labor time and increases the need for instrumentation use in the form of forceps and/or vacuum, which in turn leads to increased risk of severe tearing (here). I have no strong opinions on what other people should or should not do, except that I believe every woman should have enough information on data and risks to come to whatever conclusions based on her personal preferences. But just as to myself – as a person who has never undergone any sort of surgery, medical procedures frighten me. I have not so much as had tonsils removed, had a mole biopsied, or ever needed stitches. No joke, the most invasive medical procedure I have undergone is probably a pap smear. So the mere idea of having a needle in my spine that pumps drugs continuously in my body, along with a catheter up my urethra, or potentially having someone stitch my vagina or slice my belly open, causes just as much if not more anxiety than the fear of labor pain.

Further, having worked in the medical field, I have a selective awareness of all the things that can and do go wrong with medical interventions. I’ve had a case where a patient experienced a severe spinal infection from spinal analgesia and have also had a case in which a woman permanently and completely lost bladder control after a catheter mishap during birth. Granted, these complications are extremely rare, but at least with an unmedicated birth, I know what the worst complication is – pain. Pain sucks, but if you can tolerate it, it’s a lot less scary than complete loss of bladder control, paralysis, or a c-section.

All this being said, I dread pain and am not about to go into this without the right resources and tools, which is why we decided to take a Hynobirthing class. My clients are almost exclusively composed of healthcare providers, and being a person who very much appreciates medical technology, embracing alternative measures was not easy for me. This is particularly the case because the alternative measures inevitably involve a certain degree of what I describe as Hippie crap, for lack of a better term.

I own more than a handful of boho skirts and love Bob Dylan. I don’t wear deodorant because I don’t need it but that does not mean I want to give birth while dancing in a naked circle in the ocean or that I will ever be sold on the spiritual/emotional benefit of candles, incense, or aromatherapy [NOOOOO]. I am not one of those “spiritual not religious people.” I am not searching for cosmic truth or seeking to be one with nature.

I previously had no interest in meditation, spirituality, and certainly no interest in hypnosis, because I liked my life at a certain pace, and I liked to be in control. On my high school graduation night, a hypnotist performed a demonstration, and of about 40 people, I and one of my friends were the only two skeptical individuals who were not able to succumb to the hypnotist’s antics, despite following directions.

So how did I get over this?

First, I told myself I had to. I did some light research and found that plenty of women can and do experience bearable births without epidural use, and told myself that if I wanted to take this path, I would have to consider, accept, and follow the advice of the practitioners who specialized in this area. I’m not one to follow anything blindly, but I did make a commitment to this particular path. I bought Ina May’s Guide to Childbirth, my friend gave me Mindful Birthing, and I signed up for prenatal yoga.

During my first couple of yoga classes, I internally cringed at instructions to “send loving thoughts” to my baby and affirmation cards about beautiful birth goddesses. When told to “let go,” my instant thought was Let go of what? No, I don’t want to. But then the Asian mom in me said Listen to the teacher! What do you know? Plus, you paid for this, so pay attention and just do it! While yoga was not life-altering, it did bring a sort of calm and balance into my life.

In turn, the breathing techniques and general culture involved in prenatal yoga primed me for the Hypnobirthing class, which was taught by an experienced and knowledgeable midwife. The course featured much informative material about the stages of labor and delivery, the relevant anatomy, and exercises for managing pain. Don’t get me wrong; I still engaged in internal eyerolling at some of the videos, particularly the one where the narrator spoke like she was trying to get me to join a cult, and proclaimed nonsense about the spirals of the nautilus shell having some relation to the order of the universe and pain relief [please, just don’t]. However, I do strongly believe the meditation, breathing, and relaxation practices and visualization techniques were on point, useful, and will be immensely helpful during labor and birth.

In the end, as with all things in my life, I settled on a mishmash of what worked for me. I fully embraced Ina May’s perspective on dispelling the fear associated with birth, but ignored her implicit calls for further socializing medicine; I incorporated the benefits of prenatal yoga without resorting to paganism; and I fully engaged in meditation/relaxation exercises without committing to birthing in a tub at home and eating my placenta.

Thoughts on Ignorance as a Cause of Post-Partum Depression

I am not a psychiatrist, a medical specialist, or even a scientist, but I have a sneaking suspicion that post-partum depression, while obviously a complex condition, is rooted at least in part in one phenomenon: distorted expectations from lack of sufficient and accurate information.

Likely owing to society’s desire to increase the population of humans, and general squeamishness and avoidance of gross subjects, most women are exposed to only a very topical and rosy view of pregnancy, birth, and motherhood throughout their lives leading up to the decision to reproduce. Everyone’s heard of “pregnancy glow.” On the other hand, things like pregnancy constipation, pregnancy constant flatulence, pregnancy insomnia, pregnancy leaking of urine, and pregnancy leaking of amniotic fluid are less frequently mentioned, if at all. After labor, everyone knows about the “bundle of joy,” but probably not the bundle of shit on the delivery table.

Unless a woman happens to keep company with a horde of brutally honest women who don’t mind sharing things like a desire to literally die during childbirth because of the horrible pain (thanks mom!); how badly their vaginas tore, got infected, then tore again; among other horrifying stories not fit for dinner conversation, a woman may find herself pregnant and learning these very real possibilities for the first time. Society wants you to think of the glow, not the farting, leaking, pain, tearing, and shitting, because if women carefully considered all these downsides, some undoubtedly would have second thoughts. It is true the more women know and contemplate the implications of these realities, the more careful they are going to be about their decision to reproduce, but this should not be a bad thing.

Again, I’m not a medical professional, but I speculate jumping into pregnancy imagining the glow and the rewards of motherhood, then being subsequently ambushed by a slew of physical ailments, followed by serious physical compromise or injury during labor, topped off with the reality of becoming responsible for a squirming, screaming, crying, shitting bundle of mess all while suffering sleep deprivation and possible problems with breastfeeding, is an easy recipe for depression.

This is exactly why all women should seek out all the relevant information, both positive and negative before deciding to have children. Having worked in the field of healthcare law for many years, I know the detailed and precise description of risks and complications, both common and rare, discussed with women before they have so much as an appendix removal, brow lift, or boob job. For almost all surgeries, no matter how minor, physicians will review risks, benefits, and alternatives, providing an overview of common complications, expected outcomes, and even some remote risks, such as death. They are required to do this for every procedure, even life-saving surgeries most people in their right mind would never refuse. The basic rationale behind this practice is that people should know what they are getting into, and that includes not only common and expected risks and outcomes, but at least an idea of remote and unlikely complications as well.

Yet, as it relates to reproduction, a completely elective choice in this day and age, women hear merely about “pregnancy glow,” “bundle of joy,” and perhaps vague references to fatigue and morning sickness before committing to something of significant medical, physical, and emotional impact not only for the next 9 months, but indeed, possibly for the next 18 years. With this in mind, it’s actually amazing more women do not suffer post-partum depression.

Of course, while society has a tendency to give women inaccurate impressions, women need to take responsibility for their own decisions. I doubt many women look into the full panoply of risks, complications, and outcomes associated with pregnancy, labor, and the post-partum period in great detail before deciding to become pregnant; I know I didn’t, and I am actually someone who really took my sweet time deciding to have children at all. I had cataloged in the back of my mind a collection of horror stories from honest women over the years, and went into this with an understanding of a lot of worst case scenarios, because that’s my personality. I figured if I could accept the possibility of these worst case scenarios, then I would not have any regrets, but as far as being actually informed, this is totally not sufficient, and I met with plenty of surprises upon finding myself pregnant.

As with most things in life, preparation is key, and I surmise the more women know, the more they can do to prepare emotionally and physically, and the less shock and disappointment they will experience, which in turn would reduce the likelihood of post-partum depression.