Friday, August 31, 2007

Confessions of a beached whale

You know how once you get a new life experience, you sometimes realize what an asshole you've been all of your life? What, that doesn't happen to you? Well, erm, that's embarrassing then.

When it comes to most things relating to fertility and reproduction, I think I've always been on solid ground. I am positive that I never in my pre-infertility life told anyone infertile to "just adopt", and I know for sure that I have ALWAYS given my subway seat to pregnant women, and insisted that they go ahead of me in the bathroom line. However, I actually only recently realized that saying "you're huge!" to a pregnant woman isn't the heart and soul of courtesy. I am fairly certain that I have enthusiastically gushed about the tremendous size of the bellies of several of my pregnant friends in the past, and now consider myself fortunate that nobody ever actually slapped me upside the head. I meant it in the nicest possible way, I swear. I LOVE big pregnant bellies, and think they're gorgeous, so it never really occurred to me that people might not like having theirs pointed out. It wasn't until a pregnant friend complained to me about people saying that she was huge that I realized that this comment could possibly be interpreted in a different way. Sometimes I'm a little slow.

The other day, Nina's post in which she discussed her feelings about being called "fatty" because of her pregnant belly, made me think about how my feelings about this issue have and have not changed with my own pregnancy. Here's what I came up with:

Being a bit hormonal, I am even more mortified than ever that my comments might have made my gorgeous friends feel anything less than wonderful about themselves and their bodies at a time when they may have been feeling fragile. On the other hand, I don't mind a bit if people point out that I am huge. You know why? Because I AM huge. Enormous. Gargantuan. I can't believe that I'm already this big at not-quite 30 weeks. Having an enormous belly does create many logistical and emotional issues. I can't sleep, it's hard to negotiate small spaces, and hauling this thing around is no picnic either. I'm also worried about stretch marks, sagging muscles, etc. However, when people comment on my size, I nonetheless take it as a compliment. Because I'm not fat, I'm pregnant, dammit, and I refuse to conflate the two in my mind. Mystery has no such compunction, and has taken to calling me a name that translates roughly to "fatty" as a pet name. I suppose that I should be offended, but really I'm not. It actually annoys me more when people say "you're not that big", because given how supersized I actually am, it's obvious that they're lying, which makes it clear that THEY think that being huge is a bad thing. I'd rather that people just said "you're huge, and so cute!" That way I can at least pretend that they're being honest in both parts of the sentence.

Maybe one of the reason that being pregnant doesn't make me feel fat relates to my prepregnancy body shape. I've always been a curvy girl. I have big round boobs, have until recently had a small waist, and then a big old butt. I've described it as a J Lo ass in previous posts, but to be honest, my ass looks like it ate J Lo for lunch. It's not a fat thing, it's just the way I am. Losing weight doesn't help. Surprisingly enough, men seem to love it, but the fashion industry does not. I've always had trouble finding trousers that have enough space for my arse, but have a small enough waist that you can't look straight down the back. For the last few years, with the "low rise" trend, it's been even worse. Pants that look great from the front don't have enough fabric to make it all the way around the curve in the back, leaving several inches of crack flapping in the breeze. So, while I have plenty of body issues, my body issues don't relate to my belly.

Being pregnant has made only three discernible changes to my body shape. First, my boobs got bigger. Then my belly got huge. Now I am sporting a rather impressive set of cankles. Well, I could do without the cankles, but two out of three ain't bad. My butt actually looks small now, in comparison with Mt. Eggbert in the front, and maternity pants fit great! So, while I realize that I'm likely to start puffing up in strange places in the next 10 weeks, I'm actually pretty happy with the way that I look right now, at least above the knee (and below the neck--am I the only one with pregnancy-related frizz issues?)

Still, I'll never call another pregnant woman huge again. Even though I embrace the term, I do feel like an idiot for missing the boat on this issue for so many years.

In other news, I'm still having heartburn, and I never sleep anymore, but otherwise, I'm doing well. I am beginning to realize that the last trimester is going to be a bit of an uphill slog as my weight increases and basic functions become more difficult, but still think that so far I've been pretty lucky. Last week I asked my doctor how long she'd let me go if Eggbert is overdue, and she said only 1 week, so at the MOST I have only 11 weeks and four days to go. Hopefully my luck can hold out for that long.

Sunday, August 26, 2007

10 weeks later

Tuesday will be the 10-week anniversary of my amniocentesis, which was done reluctantly, after a "positive" quad screen for Down Syndrome. One would think that after 10 weeks, I would have formulated some coherent emotional/intellectual response to the events surrounding the amnio, and some conclusions about screening in general, but honestly, I'm just as confused about it as I was during that scary time. I've sat down to try to process and summarize my thoughts and feelings several times, but every time I ended up walking away. Well, with the 10-week mark approaching, it seems like it really is time to clear my head, so hear goes.

I'm normally an information girl. Inquiring minds want to know, and all that. So, upon becoming pregnant at age 38, you would think that I would naturally have signed up for every kind of screening possible. However, after almost three years of infertility, I was not only reluctant to take any chances whatsoever with this precious pregnancy, but also, to be honest, I was reluctant to even think about the possibility that something could be wrong with little Eggbert. So, while my doctor, citing my 1 in 200 risk of chromosomal abnormalities, recommended amniocentesis at 16 weeks, I declined. I did, however, let her do the quad screen, which involved a nuchal fold translucency screening at 12 weeks coupled with a set of three blood tests at 15-16 weeks. Denial being my friend, I never seriously considered the possibility that the result might be "positive". But then it was, predicting an estimated risk of 1 in 35 of Down Syndrome.

That positive screening result turned my world upside down. While before I actually did the test, odds like 1 in 35 didn't sound too alarming to me. I had been very comfortable with my age-based risk of 1 in 200 (a result already scoring as "positive" on most screening tests), and even at 1 in 35, that means 34 times out of 35, all will be well, right? Well, while that is technically true, there is another factor involved in estimating the psychological impact of a risk estimate. When reacting emotionally to risk, I find that there are two factors that matter to me: the probability that something will happen, and then the suck factor--how much it will suck if it does happen. So, a risk of 1 in 35 of rain tomorrow doesn't cause me to bat an eye, whereas a risk of 1 in 35 that I will drop dead tomorrow would cause me become hysterical. It drives Mystery crazy that I freak out if he e.g. goes clambering around on coastal rocks like a mountain goat, displaying his natural athleticism and incredible sense of balance to all within visual range, because even though I realize that the odds that he will fall are low, the suck factor involved in watching my love plunge to his death would be enormous. The thing that I hadn't really thought through about screening was that a chromosomal abnormality diagnosis comes with a huge suck factor. Yes, children with chromosomal abnormalities can go on to have wonderful lives in some cases, but nonetheless, hearing that there might be something wrong with your beloved child is not something that's easy to take in stride.

It was hard. I freaked out. I cried. I despaired. I whined and pouted. I decided to have the amnio after all, not so much because it would affect the outcome of the pregnancy, but because I couldn't go on another 21 weeks in that mental state. I needed to know, and I needed to know RIGHT THEN. So, I had the amnio, and after several stressful days, I found out that Eggbert has the right number of chromosomes. We were in the 34 out of 35 category. That was a tremendous relief. Words can't even really describe the feeling. Honestly, it was kind of like getting the positive beta result--one of those days that changes your life. Still, it didn't change my life back to quite what it was before. One of the things that I realized during my fit of self-pity was that there's nothing special about me or Mystery that should make us exempt from the normal and abnormal stresses of parenthood. Infertility not only doesn't buy you a free pass from miscarriage (as we all know, many from bitter experience) or stress during pregnancy, but it also doesn't exempt your kids from the risk of disease, injury, death, or bad hair days. There is actually no reason to think that I "deserve" a kid with DS any less than anyone else. It was a sobering thought.

But back to my real focus here--having been one of the many "false positives" resulting from a quad screen or triple screen test, and as a result having suffered profound stress and worry unnecessarily, how do I now feel about screening in general?

I really don't know. I don't even know what I'd do if I were lucky to become pregnant again in the future.

From a logical perspective, the argument for doing the quad screen is unassailable. Crunching the numbers makes that clear. The risk of miscarriage from amniocentesis, if it is done between 16 and 20 weeks by an experienced practitioner at a high-quality facility is estimated at around 1 in 1600. The risk of a chromosomal abnormality is about 1 in 200 for a woman my age. The risk of doing no screening is that you will be blindsided on your child's birthday by a diagnosis that not only changes your life forever, but also may require immediate and effective intervention you your part to advocate for the best interests of your child. The risk of a "false positive" is about 5%. So, if you take a group of 1600 women like me, and

They all do amniocentesis right away, then on average:

1591 will receive a clean bill of health
8 will receive an early diagnosis of a chromosomal problem, and
1 healthy fetus will die.

If, on the other hand, they all do the quad screen first, then on average:

1520 will receive a clean bill of health
80 will get a positive screening result

If the women with "negative" results then refuse amnio, and the women with "positive" results all have amnio, then on average:

1592 will receive a clean bill of health
1-2 will receive a clean bill of health, but will then be blindsided with a chromosomally abnormal child on the birth day
6-7 will receive an early diagnosis of a chromosomal problem
0 healthy fetuses will die

So, if the choices are screening and going directly to amnio, from the perspective of the baby's health, the choice is clear to me. Both procedures will diagnose almost all cases of chromosomal abnormalities, but by choosing to do the quad screen first, the overall risk to the group of 1600 women of an amniocentesis-induced miscarriage is reduced to a negligible level. If I was a doctor, I'd recommend that my patients have the quad screen, based on these numbers. However, these calculations overlook two things:

First, once you actually GET that positive quad screen, your risk of miscarriage from amnio is still 1 in 1600, so given the outcome, you are still facing a difficult choice

Second, getting the positive screen is tremendously stressful.

How do you quantify the cost of that stress? I don't have any idea. Is it actually worth it? I don't know. What would I do if the situation came up again? I have no idea.

I did leave out one of the options. It's only fair to consider them all.

If nobody does any testing:

1582 will have chromosomally normal kids
8 will be blindsided with a chromosomally abnormal child on the birth day

Is that better? Is that worse? After 10 weeks, I still have no idea.

I do think that if the amnio result HAD shown a chromosomal abnormality, I'd be glad that I did the tests. But of course there's really no way of knowing.

I do know that I am beyond grateful for the fact that my little Eggbert has the right number of chromosomes. I realize that doesn't guarantee health or happiness, but I'll take it.

Tuesday, August 21, 2007

Mind your manners

Many years ago, I took an intensive language course in preparation for a study abroad program. The course was great, in that it tried to prepare us not only for the linguistic challenges that we would face, but also for the cultural issues that would almost certainly arise. Going into the course, I had fancied myself a sophisticated world traveler, and therefore not in need of a lesson on cultural differences, so I wasn't entirely receptive to this message at first. However, I was struck by a metaphor that the instructor used. She described a situation in which you visit a culture in which the standard polite greeting is to spit in your face upon meeting. Since you KNOW this about the culture before you go there, the first time it happens, you're started, and perhaps a little disgusted, but not annoyed. The second time, you're less startled, still disgusted, and moderately amused. After the 10th time, though, it's just about impossible not to become annoyed. The intellect can only overcome one's own cultural baggage to some extent, and beyond that, it's just about impossible not to have an emotional reaction to behavior that is considered unacceptable in your own culture, even when you KNOW that no offense is intended.

I've found that indeed, in every country where I've spent a sufficient period of time, there is some habit or custom that I find difficult to accept. Well, after 11 months in Korea, I am now fairly certain that I have identified my Korea-specific Achilles heel. You see, I don't like to be pushed.

I don't mean metaphorically pushed. I mean physically pushed, either by a hard jostle with the shoulder, or by actually having someone reach out their hand to push me. Koreans are lovely people when you know them, but apparently it is 100% acceptable to push a stranger who is in your way, even if you can see with your own eyes that that person doesn't actually have a choice about being there. Impatient to get off of a crowded train? No worries, just push the person in front of you until they slam into the person in front of them. It won't get you out any faster, but it'll make you feel better. Are you having trouble negotiating your shopping cart through a crowd? Just slam it up against the legs of the person in front of you. Sure, they're stuck too, so the only result is to make them yelp with pain, but hey, wasn't that more amusing than just standing there waiting? What if the person in your way is elderly, disabled, a small child, or a pregnant woman? No worries. This is a democracy. What if they're not in your way at all? Oh heck, push them anyway.

At first, I interpreted the pushing as subtle expressions of anti-foreign sentiment. I do stick out like a sore thumb here, so I assumed that the pushing was related to my appearance. However, the more I looked around, I realized that everybody pushes everyone else, and nobody seems to get mad, or even to notice.

This is hard for me. Americans are particularly orotective of their personal space (ask any European, Asian, or African), and in that way, I'm typically American. I don't even like being crowded, and having a stranger make avoidable physical contact for no reason feels like an act of aggression. I have been particularly sensitive to this since I've been visibly pregnant. It is just very hard for me to understand how someone could really think it's OK to push a pregnant woman when she's not in the line of gunfire or something. I'm trying to learn to cope with it, but it's hard.

Being hugely pregnant actually raises lots of issues about manners and etiquette, no matter where you are in the world. Should people let you ahead in bathroom lines? Should you be annoyed if they don't? Should people give you a seat on the bus/train? Do they? Does it bother you?

Since I've been showing, I've spent time in three countries: Indonesia, Singapore, and Korea. Here is the score:

Long bathroom lines encountered:

Indonesia: ~100
Singapore: ~10
Korea: ~100

Times someone has offered to let me go ahead:

Indonesia: 0
Singapore: 0
Korea: 0

Rides on trains/subways when empty seats were not available:

Indonesia: ~10
Singapore: ~10
Korea: ~10

Times someone offered me their seat:

Indonesia: 1 (an old man who was then immediately given a seat by a young healthy man, who had been ignoring me)
Singapore: 0
Korea: 4 (but that number includes 2 Americans)

Unimpressive, all around.

In Korea there are specially designated seats on the subway for people who are "elderly, disabled, or pregnant" (that's what the sign says), and generally, people that don't "qualify" don't sit there, even if there are many empty "special" seats, no needy people, and the rest of the train is full. However, people from the "normal" seats pretty much never give up their seats. So, it's all about rules, not about the "honor system". I suppose that's fair enough. However, the "honor system" IS used by people deciding whether they qualify for the "special" seats. When do you become elderly? Well, according to my own observations, some people seem to become elderly at age 50. Then, once sitting, people in the "special" seats don't seem to give them up, even to someone who fairly clearly needs them more. I have actually only seen a sitting passenger get up from a "special" seat once, and that was when I got up from a "special" seat, because there was a very old woman with a cane standing. Apparently this shamed the healthy 50-year-old man next to me to the point at which he then offered me his seat. Does that count? I don't know.

What's it like where you live? Do people give up their seats for pregnant women? Do you?

Friday, August 17, 2007

The third trimester

I really don't know how this happened, but somehow I've found myself in the third trimester. It's become clear to me that pregnancy has its own time frame, which is completely different from every other kind of time that I've ever experienced. TTC time feels like dog years. Each month seems to take almost a year off of your life. Before TTC, a month took about a month, more or less. But in pregna-world, a month seems to take about five minutes.

Don't misunderstand me, they are an action-packed five minutes. I laughed, I cried. In the last month, I've experienced constipation, anemia, hypoglycemia, diarrhea, bizarre navel pains, a level of sweating that MUST put Seoul in danger of flooding, and many other strange symptoms. Still, pregnancy III, The Belly Strikes Back, has somehow snuck up on me. So far it's kind of like pregnancy II, but with hem*orrhhoids.

On the one hand, I'm thrilled. Somewhere along the way, I've started to believe that there might actually be a baby at the end of all of this. On the other hand, the fact that my due date is now less than three months away forces me to start actually preparing for the arrival of this so-far fictitious baby, which freaks me out. We now have baby clothes in the house. And bottles. Ack! We almost bought diapers the other day, but at the last minute we choked. As for the big-ticket items, well, it turns out that Korea had another trick up its sleeve for us. We have now spent three straight weekends shopping, and STILL haven't found a single crib for sale. Or a decent stroller for under $1000. Or for that matter, a Baby Bj*orn or a onesie. If I don't find where these items are kept, I may be forced to draw the conclusions that Korean parents keep their babies at home and naked until they can walk. Surely there must be another explanation, something that involves mandatory cosleeping, a preference for separate pants and little tops, and a belief that strollers are foreign luxury items, rather than basic necessities. Still, it's pretty alarming. We can always buy the Bj*orn on line, and we plan to visit the US while I'm on maternity leave, so we can wait and buy the stroller then. The crib issue is a more vexing problem, though. While I love the idea of cosleeping, the reality is that both Mystery and I are terrible flailers. We regularly whack each other upside the head in our sleep. Somehow I just don't think this is the ideal sleeping environment for a newborn.

A newborn. Holy cow. If everything goes well (please let it go well!) Eggbert will be a newborn in only three months.

Saturday, August 11, 2007

News from the world

M-B was induced yesterday, three weeks early, after a very difficult pregnancy. Please go visit and wish her luck with the delivery and with her new baby SON.

Friday, August 10, 2007

Things that end in -emia

Hi all,

I would have posted more in the last week, but honestly, I've been too damn tired. Ever since I got back to Korea, my energy has been ebbing dramatically from day to day until as of Monday, I could barely crawl out of bed. I was just starting to think "this is not normal" when an email from my doctor arrived, informing me that I got an F- on my last hemoglobin test, and tanked the glucose tolerance test too. No, I don't have gestational diabetes, it seem to be rather the opposite. My blood sugar wasn't too high, but rather too low. After extensive consultation with Dr. Google, I came to the conclusion that this probably just means that I need to eat more often, and avoid sugary foods. My doctor, though, had different ideas, and made me repeat the glucose tolerance test. Have I mentioned that the syrup that they made me drink is unspeakably vile? Well, if not, it is, and it didn't get any better the second time. Luckily, I managed to register as alive the second time through, so I managed to skate with a heavy-duty iron supplement (for the anemia), and advice to eat more often (for the hypoglycemia). After only two days of iron, I'm already feeling better, so hopefully I'll be back to something approximating normal soon (well, whatever version of normal has a belly the size of Texas, anyway).

In other news, my belly button is KILLING me. Seriously. I had never imagined that a belly button could be so painful before, but mine is incredibly sore. Is this a normal part of the process whereby an "innie" becomes an "outie"?

Friday, August 3, 2007


I can't believe that I'm almost at the six-month point. I never thought I'd get here. I've had six months to get used to the idea, but I'm still sometimes astonished when I look down and see my belly. Then I think "where are my feet? I thought I had feet?"

The lovely M-B asked if I knew the sex. The answer is no. My doctor(s) know the sex, but I have asked them not to tell me. Why? I can think of a few different answers, but I really don't know which one is the true motivation. It seems to change from day to day. Really the bottom line is that waiting to find out feels right for me and Mystery. If it stops feeling right, then we'll call the doctor and find out.

Reasons, in no particular order:

-To keep from getting flooded with pink or blue gifts (yes, I do realize that this means that we'll get green and yellow instead...)

-To keep from projecting a personality onto Eggbert before we even meet. Let's face it, some girls hate pink, and some boys love dolls, but it can be very difficult not to project one's own expectations about sex/gender-appropriate behavior onto a child. De-emphasizing the sex in our own minds at this point is one way for us to practice being open-minded about the little person that we hope to welcome in November.

-To avoid disappointment, part I. I don't think that either of us has a strong preference, but that may just be denial speaking. I can't imagine feeling anything but joy on the actual birth day, whereas finding out now, before we have an actual baby to hold, opens us up to the possibility of disappointment.

-To avoid disappointment, part II. Right now, I am very much enjoying both boy fantasies and girl fantasies. Since I don't know Eggbert's sex, the world is my oyster. I can dream about whatever I want. I think that finding out now would expose me to a sense of loss, since it would render half of my fantasies infeasible. At least on the birthday, I'll have a baby to console me.

-To do at least one thing the "old-fashioned" way. Given the years of infertility, the multiple interventions, the high-tech conception, and the intensive monitoring associated with this pregnancy, I'm enjoying the fact that there is still a little mystery left in the process.

I totally get why other people want to find out. I always thought I'd want to find out too. I can see a huge number of arguments for finding out. In the end, though, it doesn't make any difference to the baby, so there's not any "right" or "wrong" thing to do. For us, this decision feels good, and in the end, this decision IS all about what we want. So why did you decide to find out or not?