Becoming Mother

A book and a blog for first-time mothers

Tag: childbirth

Why are American Women Dying in Childbirth?

 

American women are more likely to die from complications in pregnancy and childbirth compared to women in any other developed country.

It’s true.

But why?

***

At 1:27 p.m. on February 2, 2017, I gave birth to an 8 lb. 10 oz. boy.

Because there was meconium in my amniotic fluid, a NICU team was paged to be present at the birth to make sure that the baby’s lungs were clear.

Those first minutes after birth were very blurry. There was just too much going on to fully appreciate everything that was happening. From my perspective as the birthing mother, I remember my son turning his head upward and looking me in the eyes (that really happened). I remember seeing that he was a boy. (A boy!?! Really!?! What?!?!)

I remember dropping my head back against the bed and crying in relief that it was over. I remember thinking, “Well, that’s the last time I’m doing that.”

I was euphoric and so, so grateful. We had made it. We had survived that. Both of us. That was what I was thinking.

I did not know that I was hemorrhaging. 

This is the thing about hemorrhaging: It happens so fast.

It happens while mothers are crying from happiness that their baby is alive and breathing. It happens while they’re trying to get a good look at their baby’s face. It happens silently as the room’s atmosphere turns from the intensity and suspense of the pushing phase into joy and excitement of the delivery phase.

No woman wants to believe that it’s going to happen to her. I had none of the risk factors associated with postpartum hemorrhage.

But it still happened to me.

While we were celebrating and crying and basking in the joy of the birth, my midwife was tracking my blood loss. I remember looking down and seeing her furrowed brow every time more blood poured out of me. But I didn’t think anything terrible was happening. I was flooded with joy and gratitude that labor was over.

But in the first ten minutes after birth, more and more nurses entered the room and the treatments started. My midwife told me each treatment that she was doing to stop the bleeding. By this time, I had lost about 1200 mL of blood, about 2.5 pints of blood. In other words, I had lost about 25% of the blood in my entire pregnant body.

Surviving postpartum hemorrhage requires a medical professional who quickly realizes what is happening and starts treatment immediately.

In my case, the midwife tried a shot of Pitocin. When that didn’t work, she gave me Cytotec. When that didn’t work, she gave me IV Pitocin. She kept massaging my uterus. She was on her last treatment before starting a blood transfusion: a shot of methergine.

That’s how close we were to a true emergency.

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My heart rate during labor. You can see exactly when the hemorrhage begins and how my body responded.

 

Hemorrhage is one of the leading causes of death in childbirth.

Causes of Death in Childbirth

Still.

Let me be clear: postpartum hemorrhage isn’t caused by a lack of care. This would probably have happened to me if I had given birth anywhere else.

But women die from hemorrhage when doctors and nurses don’t quickly recognize the amount of blood loss and begin treatment. Some states, like California, have codified and implemented standardized procedures and training for nurses and doctors so that teams can quickly and efficiently follow protocol to prevent postpartum hemorrhages from killing mothers. Instead of “eye-balling” how much blood a mother loses during delivery, nurses were taught how to collect and measure postpartum blood loss to help them quickly identify hemorrhage.

“Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn’t use the protocol had a 1.2 percent reduction.”

But not all states have such standardized protocol.

***

A joint investigation by NPR and ProPublica found that more women are dying of complications related to pregnancy and childbirth compared to any other developed country.

In every 100,000 births in the United States, 26 women die. In other developed countries, the numbers range between 5 and 9 births. And those numbers have climbed from 17 to 26 deaths from 2000-2015.

Seriously.

Seriously.

It seems unimaginable. Really? In the United States? But we have so much technology. We have some of the best hospitals in the world.

Maternal Mortality

What the hell is going on?!?

There were several major findings from this investigation.

  1. The U.S. is spending more money on research, equipment, and training for improving infant outcomes. Think of how much progress we have made in helping premature babies and treating newborns born with previously fatal deformities and diseases.
  2. Decreased education and training about caring for birthing mothers, for both doctors and nurses. This leads to a lack of knowledge that is passed on to the mother when she is discharged from the hospital.
  3. Lack of standardized best practices for caring for birthing mothers among the states. Unlike other developed countries, there is no nationwide effort for reducing the maternal death rate in the United States. Responsibility has been left to individual states to decide if and how they investigate maternal deaths.

America has not conquered maternal mortality. We like to think that because we have advanced technology and highly trained medical professionals that tragedies like a woman dying in childbirth just simply don’t happen anymore.

At least not nearly as much as it used to.

It’s a kind of hubris, really. To think that we have mastered childbirth. We have tamed it and told it who’s boss. In fact, we’re so good at childbirth that we should just focus most of our attention on the infants. They’re the ones that are the most vulnerable, right?

But the truth is…

“In recent decades, under the assumption that it had conquered maternal mortality, the American medical system has focused more on fetal and infant safety and survival than on the mother’s health and well-being.”

~Nina Martin & Renee Montagne, “The Last Person You’d Expect to Die in Childbirth”

***

If there was one major takeaway from this report that I want to share with everyone it’s this:

Women still die in childbirth. 

Giving birth in the United States does not guarantee that both mother and baby make it out alive.

I completely agree with the report’s observations that labor and birth put women in the most vulnerable position in their entire lives. They don’t know what’s going on. They’re immersed in the pain and process of labor. Birthing women depend on everyone around them, doctors and nurses alike, to notice the signs that an emergency is unfolding.

If you or someone you know will be giving birth in the United States in the near future, I strongly encourage you to read ProPublica’s full investigative report on this topic.

This is not a political issue. ProPublica is an independent organization that is not funded by political donations.

This is a human issue.

American women are not immune to maternal mortality.

For the women who die every year from pregnancy and childbirth from preventable or treatable conditions, let’s raise our awareness of this problem and insist that we study this at the national level, not just the state level.

We can do better than this.

The death of a new mother is not like any other sudden death. It blasts a hole in the universe.

~Nina Martin and Renee Montagne, “The Last Person You’d Expect to Die in Childbirth

A Birth Story in Songs

When the right music finds the right moments, what we see and feel is carved even more deeply into our memory.

Cognitive psychologists have studied this. In long-term memory, what we tend to remember with the most clarity in the long run are the most unusual and emotional moments of our lives. Because of its ability to mirror or even amplify those emotions, music can be an anchor that fastens those memories in place for the duration of our lives.

As I labored this past February during the birth of our second child, the right music found the right moments over and over again.

I don’t think it was coincidence.

To be honest, I made music playlists for each of my births and loaded them with songs that I would like to hear.

But as anyone who has experienced labor will tell you, ain’t no one DJing your birth when the shit hits the fan. In my first birth, we barely touched the playlist once I was in active labor. It just played on. And whatever order I had chosen when I was willy-nilly loading the songs was the order that they played.

I honestly only remember one song from one moment of my first labor. It was the song playing when our daughter was born, “I Will Be Here,” by Steven Curtis Chapman. It was a sentimental Christian ballad that I added to the playlist on a whim, and one that I didn’t even particularly like anymore. Sure, it was a sweet song. It reminded me of those first vows that we said at our wedding eight years earlier.

But it wasn’t really a birth song. And it certainly wasn’t the one that I would have chosen.

So it was surprising to me just how many times the right music found the right moments in this birth. For me, the music felt like another birth attendant.

The songs held my hand.

The songs urged me one.

And sometimes, the songs were the screams from my own heart.

Someday, I’ll share with you a written version of this birth story. I’m thinking about releasing it as a free Kindle Single, if I can make the time this summer to do that.

But for now, let’s go on a ride.

Let’s give birth.

With songs.

February 2, 2017

 

Early Labor: 3-4 centimeters

3:00 a.m.

Contractions every 3-4 minutes. Standing, hips swaying. Eyes closed.

I Can’t Make You Love Me If You Don’t” Bonnie Raitt

Here in the dark, in these final hours
I will lay down my heart and I’ll feel the power

5:00 a.m.

Contractions every 2-3 minutes. Lying on my side on the bed. Leg, dangling off the side to help the baby turn into position.

Landslide” Fleetwood Mac

Can the child within my heart rise above?
Can I sail through the changing ocean tides?
Can I handle the seasons of my life?

7:00 a.m.

Contractions every 2-3 minutes and requiring controlled breathing to cope. Lying on my left side, gripping the headboard of the bed. Eyes sometimes open, sometimes closed.

Society” Eddie Vedder

Society, have mercy on me
I hope you’re not angry if I disagree
Society, crazy and deep
I hope you’re not lonely without me

Active Labor: 5-7 centimeters

9:00 a.m.

Contractions every 1-2 minutes. In the birthing tub. Blue light in the water. Legs floating. Head leaning back on the edge of the tub. Holding Doug’s hands as he sits behind me next to the tub.

Hypnotic, oscillating moments of weightlessness and heaviness. Baby pushing between pelvic bones, twisting in each contraction.

A lot of groaning.

“Teardrop” Massive Attack

Love, love is a verb
Love is a doing word
Fearless on my breath
Gentle impulsion
Shakes me, makes me lighter
Fearless on my breath
Teardrop on the fire
Fearless on my breath

Transition

A.K.A Climbing the Ladder and Wrestling with God:

7-10 centimeters

10:25 – 10:55 a.m.

Forty-five second, double-peaked contractions every other minute.

This part… Oh, this part. I will write about this in detail later. It was thirty minutes of my life that I will never forget because it is the second time in my life that I encountered God.

“God Moving Over the Face of the Waters” Moby

Stalled: 10 centimeters

11:30 a.m.

Contractions every 1-2 minutes, but no urge to push. Although completely dilated, my water still hadn’t broken. Back in the tub for pain relief. I pressed my face into the edge of the tub and cried.

Doubt. Such deep, deep doubt.

“Last Man” Clint Mansell

12:00 p.m.

Contractions every 2-3 minutes. When my midwife checked me, she told me that the baby still needed to come down farther. I tried a number of different positions but nothing helped. I asked her (okay, screamed for her) to break my water.

That worked.

“Redeemer” Paul Cardall

Pushing

12:55 p.m.

This is another part that I will write about in much greater detail. For right now, just know there was a lot of screaming.

I mean… Yeah. A lot of screaming.

“Press On” Robinella

Life is filled with bitter music
Breeze that whistles like a song
Death gets swept down like an eagle
Snatches with our shoes still on

Press on

“Welcome Home” Radical Face

All my nightmares escaped my head
Bar the door, please don’t let them in
You were never supposed to leave
Now my head’s splitting at the seams
And I don’t know if I can

“Holocene” Bon Iver

And at once I knew I was not magnificent
Huddled far from the highway aisle
Jagged vacance, thick with ice
And I could see for miles, miles, miles

“The Wound” Gospel Whiskey Runners

The road is long and dusty and alone
I’ve got not place to rest, no place to call my own
My eyes have seen the glory of your love
And I won’t turn back this time
No, I won’t turn back this time

“Work Song” Hozier

When my times comes around
Lay me gently in the cold, dark earth
No grave can hold my body down
I’ll crawl home to her

Birth

1:27 p.m.

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“You’re All I Need to Get By” Marvin Gaye and Tammi Terrell

Like the sweet morning dew, I took one look at you,
And it was plain to see, you were my destiny.
With my arms open wide,
I threw away my pride
I’ll sacrifice for you
Dedicate my life for you

“I’ll Have to Say I Love You in a Song” Jim Croce

Every time I tried to tell you
The words just came out wrong
So I’ll have to say I love you in a song

Postpartum Hemmorhage

1:35 p.m.

“Do You Realize” Flaming Lips

Do you realize that you have the most beautiful face
Do you realize we’re floating in space,
Do you realize that happiness makes you cry
Do you realize that everyone you know someday will die

And instead of saying all of your goodbyes, let them know
You realize that life goes fast
It’s hard to make the good things last
You realize the sun doesn’t go down
It’s just an illusion caused by the world spinning round

2:10 p.m.

I asked Doug to take a picture of Henry’s face so I could see him up close.

When I saw the picture, what I thought was,

Yes.

That’s exactly right.

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Postpartum Levels of Sleep Deprivation

*In the fashion of the “DEFense readiness CONdition

DEFCON 5

When: Immediately post-birth – Day 5 or Day 6

Description: You’ve just labored for God knows how long, so you’re already physically exhausted. But you are riding on a hormonal high because your baby is out and in your arms. At first, you believe that you will be able to rest as soon as everyone leaves your hospital room.

Only, they don’t ever really leave. For very long, at least. So what you end up with are minuscule catnaps that amount to no real rest. You close your eyes and try to drift off, but your brain doesn’t really power down.

You pray that once you return home, you’ll be able to sleep. But then, new stressors await you at home, no matter how many people are there to help out. Your life is in flux. The baby warps the fabric of time and space and requires your concerted attention for figuring out how to move through the day in order to keep everyone alive.

And then you’re processing the birth experience, remembering everything that happened. The horrible. The beautiful. The painful. The moments you never, ever want to forget but are already slowly falling through the cracks in your memory.

Then, there are your plummeting postpartum hormones. Your constant need to mop out all the fluids pouring out of you. The postpartum hunger as your body prepares to breastfeed. The afterbirth cramps that continue to pulse in waves.

All of this adds to your mounting anxiety and despair that you will literally never power down again. Although you desperately close your eyes and tell yourself, This is it. Everyone is taking care of everything. I can sleep—You still don’t sleep.

Your mind wants to fall asleep, but your body won’t follow suit.

DEFCON 4

When: Days 7-14

Description: You sleep in one-hour increments around the clock, totaling about 5 hours. You do not reach restorative, REM sleep, but the sleep is deep enough for your brain to put a period to the last segment of time that you were awake. It’s not that you never find the opportunity to sleep. Your body just physically won’t completely let go of consciousness for whatever reason.

Your need for round-the-clock self-care continues, along with your round-the-clock eating which coincides with your baby’s feedings. Your postpartum hormones are still swinging up and down, making you unpredictably emotional.

Sometimes, you just need to cry at 2:00 a.m.

Every time you wake up from a one-hour nap, you feel that you’ve taken a few steps away from full-on psychosis. But after a few hours, when you hear yourself talking, you think, Is that me? Did I say that? Do I sound weird to other people?

You cannot make decisions and you hope no one asks you to do so. Your cognitive processing is at an all-time low. Your head feels warm and fuzzy.

Stupid things make you laugh.

You utter the words, “Oh, sweet, sweet exhaustion.”

DEFCON 3

When: Day 15 – Whenever the baby has only one night feeding.

Description: Small 1-2 hour chunks of sleep at night + 2 naps, totaling 5-6 hours.

You are doing two or three night feedings each night, but it feels like six. Up and down. Up and down. Up, up, up. And down.

But there’s a good side. This is the first time you really achieve restorative, REM-sleep. You begin to dream regularly again, although sometimes you wish you didn’t. Nightmares of losing your baby or discovering your child dead in his crib haunt you.

This is also where chronic sleep deprivation sets in. When you wake up from a good chunk of sleep, you feel restored. It’s deceptive. You feel like you can do anything. Grocery shopping! Daycare drop off! Make my own breakfast! Yes, I can do it all!

But by the sixth hour that you are awake, you are completely spent. This time, your body wants to sleep, but your mind doesn’t. That familiar warm, fuzzy feeling in your head returns and you feel your eyes start to involuntarily close. It happens at predictable intervals, too, because all the sleeping in one-hour increments has trained your body to power down with or without your permission.

1:00 p.m. and 7:00 p.m. is when you feel it. Like clockwork.

1:00 p.m. is not so bad because the baby usually wants to sleep.

But 7:00 p.m. opens a previously hidden door to hell.

Everyone is home now. It’s dinner time. Maybe you have to cook. (Or maybe you just assemble salads and sandwiches, like I usually do.) The daily dishes mount in the sink. The mail comes in. The baby is in the prime “witching hours” of fussiness. He cries, but won’t really eat. He’s asleep, then awake 10 minutes later. Then, asleep. Awake. Crying. Refuses the pacifier. All you want to do is slink away from everyone, miraculously unnoticed and unneeded and bed down in your dark room with the cool sheets to soothe the building heat in your head.

God forbid, one of you gets sick.

That’s when the shit really hits the fan.

DEFCON 2

When: Transitional period of one nightly feeding/waking – no nightly feedings/wakings

Description: This is arguably the most frustrating period of sleep deprivation, simply because you’ve had a taste of the good nights. At this level, you have a bit of an expectation that you will fall asleep and stay asleep for a good six or seven hours. Sure, you’re not technically as sleep deprived as you were during DEFCON 3. But after several days of solid sleep, you begin to believe that your baby has finally dropped the night wakings.

And then it happens. The old familiar 2:00 a.m. wail.

Devastation.

DEFCON 1

When: Whenever your baby has no more nightly feedings or wakings

Description: Besides occasional nights when your child is teething or sick, your child is sleeping through the night and so are you. You begin to forget the horrible sensations of being sleep deprived. Sure, you remember that you hated it, but you truly start to forget the actual sensations of constant sleep deprivation. Sometimes, you tiptoe into your child’s room to watch him sleep so peacefully.

You actually miss waking up in the middle of the night to comfort him.

And then you start thinking…

Hey, maybe we’ll have another?

Nature has a sick, sick sense of humor.

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Week 3: Growing and Shrinking

Well, we have another large child.

In one day, Henry logged fourteen feedings. Every hour, on the hour, throughout the morning and in the early evening. Instead of doing a normal full feeding, he would snack. An ounce here. An ounce there. Drift off to sleep just long enough for me to go through the routine of putting him down…

And then he’s awake again. And ravenously hungry. Screaming for food, as if saying, What the hell, Mom!?!?! Where’s the food!?!?!

Repeat. Over and over again. With the occasional crying fits.

Then it dawned on me.

He was going through a growth spurt.

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3:30 a.m., listening to Stephen Colbert

I had forgotten how exhausting growth spurts can be.

For three days, he did this. Thank God he slept most of the nights, but during the mornings, I felt like I was clinging to the edge of sanity.

When it was all over, his newborn clothes no longer fit.

Just like that.

Good-bye newborn clothes.

And hello very developed baby. We have a three-week-old child that lifts his head, coos, and is starting to bat at things accidentally. Our daughter didn’t start doing these things until she was about two months old.

At his two-week check up, the results were in.

Two weeks ago, at birth, he was 8 pounds, 10 ounces and 21 inches long.

Now, he’s 10 pounds, 3 ounces and 22.5 inches long.

Big boy.

If there’s one thing Doug and I know how to do, it’s make a big child.

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10:00 a.m. Newborn, passed out. Coffee, balanced between knees.

***

Quick notes on Postpartum Recovery

I’m completely off the 800 mg of Motrin.

I am walking about two miles a day now in about 45 minutes. It doesn’t feel like too much and it’s a great postpartum workout to start getting my cardio endurance back. My FitBit is registering it as a 450 calorie workout, which in my peak condition is equivalent to a strenuous cardio kickboxing workout.

I am sleeping about five to six hours per day on the weekdays. About seven and a half hours on the weekend when Doug does the night feedings.

I’m down 17 pounds now. 28 pounds to go.

When I look at my body in the mirror, I feel like I’m one of those hybrid animals in Greek mythology. The top half of me resembles my pre-pregnancy self. The bottom half… not so much.

I am pear-shaped. And I’m never pear-shaped. (I tend to put on weight in my waist.) I have a distinct desire to find the invisible zipper where I can unzip and step out of this bottom-heavy suit.

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Week 3 postpartum

 

My appetite is much lower this week. I’m no longer eating two breakfasts and having huge snacks between meals. My only concern is that I hope that my thyroid isn’t swinging underactive.

My new mom hormones are calming down. I’m now able to fall back asleep pretty quickly after the night feedings. Yesterday, I was even able to be okay with Henry sleeping in his crib in his room while I slept in my own room. (Sorry American Academy of Pediatrics. We’ll do the back sleeping on a firm surface and we won’t do bed-sharing. But there’s no way we’ll make it six months or a year with a baby sleeping in our room.)

I would love to be wearing normal pants, but I think I have at least two more weeks of maternity pants.

Nearly all of my swelling from the pushing phase is gone.

I got my hair cut and dyed. Win.

***

Pictures from the Week 3

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Early morning coffee mishap

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Birth announcements

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Morning awake period: 8:00 a.m. to noon (short dozing sessions in between)

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Batting lessons

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Five hours of sleep = 50% energy

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The hands we hold on to

I Wore a FitBit During Pregnancy and Childbirth: Here’s What I Learned

Disclosure: I’m a bit of a data nerd.

Not in the sense that I like to design studies and collect data. Just in the sense that I like to look at charts and graphs and timelines and other visuals.

Call it “data-nerd-light.”

I began wearing a FitBit Charge HR last February, shortly after I started running as a regular form of exercise.

At first, it was useful for keeping track of my exercise. Having information about my sleep patterns and steps was just fun information to use to challenge myself.

Then, in early May 2016, I got pregnant.

Over the course of my pregnancy, I regularly wore my FitBit and amassed loads of interesting data about how my body changed and responded differently to exercise over the course of my pregnancy.

The FitBit Charge HR will monitor your heart rate and calories burned, as well as your number of steps, floors climbed, and miles traveled. Then, it spits out all of this data into usable and easy-to-read charts.

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I started this pregnancy at 147 pounds (at 5′ 7.5″) and my ending weight was 192 pounds, which is a 45-pound weight gain. My pre-pregnancy condition was quite good. I was running about two miles in the morning every day and lifting weights once or twice per week. I was maintaining my weight. I had good energy. I could climb several flights of stairs without getting winded.

So what does pregnancy do to a healthy body? Let’s take a look.

Resting Heart Rate

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My pre-pregnancy resting heart rate was about 56 beats per minute, a sign of a fairly athletic lifestyle. You can see my heart rate climb steeply in the second trimester when I have my first major growth spurt, and then again in the last trimester during the last month of growth. Both time periods correspond to an increase in blood volume in my body.

Fun fact: at the end of pregnancy, a woman’s blood volume increases 40-50% throughout pregnancy.

Weight Gained

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I put on most of my weight during the second and third trimester growth spurts, and just a few pounds gained in the first trimester. This is a healthy weight gain curve, although, I assure you, it didn’t feel healthy at the time. I remember that I kept thinking, No! Four pounds in a week! This baby is going to be twelve pounds by the end of this!

Daily Calories Burned: Pre-Pregnancy

On the left is a typical day of exercise on a pre-pregnancy day, which includes a two-mile run in the morning and regular movement at work.

On the right is a day that I’m proud of: the day that I ran six miles around the National Mall in Washington D.C. Included in this number are the other calories that I burned throughout the day, just by existing. See the number of calories burned? Keep that in mind as I show you how many calories during the late third trimester.

Daily Calories Burned: First Trimester

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In my first trimester, I continued to run whenever I felt well enough. (Weeks 7-11 were Nausea City, so I limited my exercise to walks during this time.) But I took it easy. I didn’t exercise in the peak heart rate zone if I could help it. I monitored my run pretty closely so I stayed in the lower heart rate zones.

Daily Calories Burned: Second Trimester

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I continued to run in the second trimester. In the early second trimester, I incorporated more indoor aerobic exercise because it was so damn hot outside in late July to August. In this screenshot, you see the end of October, when I was 24 weeks pregnant, right at the end of my second trimester growth spurt.

The important difference is my resting heart rate, which has jumped to 70 beats per minute. Because of that elevated resting heart rate at this point, I was more likely to reach a fat-burning heart rate for daily activities, beyond the time when I was intentionally exercising.

Daily Calories Burned: Early Third Trimester

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I continued to incorporate running in my exercise all the way to 32 weeks of pregnancy, but over time, I slowly decreased my running in favor of walking. By 33 weeks of pregnancy, I was done running. This screenshot is from Week 30. It’s not terribly different from my second trimester stats. Notice that my resting heart rate continues to rise.

Daily Calories Burned: Mid-Third Trimester

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This is when pregnancy becomes an outright test of endurance. This screenshot is from Week 36 (which, for my 41.5-week pregnancy, was mid-third trimester). On this day, I walked for 30 minutes. And I existed. End of story.

I mean, it’s the day after Christmas, for goodness sake. What could I possibly have done? I’m sure I was doing things like eating my fifth sugar cookie and picking up bits of wrapping paper and rogue pine needles. Along with a rousing game of “Ketchup or Mustard?” with our three-year-old. (What? You’ve never heard of that game? You just ask the person if they want ketchup or mustard over and over and over again. That’s it. Fun, huh?)

So that’s why pregnant women say, “God, I’m so tired” at the end of the day. Not only are they carrying around a lot of extra weight, but their resting heart rates are elevated, causing them to be burning loads of calories for hours.

But wait. It gets harder.

Daily Calories Burned: Late-Third Trimester

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Okay. So here I was at five days past my due date. At this point, I was desperate to get this kid out of me. So I decided to go for two thirty-minute walks, which you can clearly see on the graph. My pace was much, much slower than normal because my hips were so gelatinous and my gait was off. But pace isn’t important. It’s getting the heart rate up there that counts.

With just two thirty-minute walks and existing for 24 hours, I burned as many calories as I did when I ran six miles and existed for 24 hours. Courtesy of an elevated resting heart rate and additional body weight.

In addition, my body’s center of gravity was off, it was difficult to move, and I had an assortment of new aches and pains to deal with just to get through the day (and night).

What were your calories burned on the day you gave birth?

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So glad you asked.

Now, I know what you’re thinking. That peak heart rate must have happened during my pushing phase.

Nope.

That was when I started hemorrhaging after the birth. Obviously, this wasn’t part of the plan and it isn’t a typical part of the birthing process for most women (thank God). Only about 4% of women will experience a postpartum hemorrhage. (The most likely cause of my PPH was an “overdistended uterus” due to my baby being over 8.8 pounds.)

As a result, my heart rate soared in the peak heart rate zone for close to an hour. As blood poured out of me, my heart pumped loads of fresh blood to the affected tissues and organs. All of this put my body into metabolic overload and it was the main reason I ate like a crazy person for the first five days post-birth.

Most of my labor raised my heart rate into a low fat-burning zone rate, so it was still important that I ate and drank during labor. This is what I will never understand about typical hospital policies regarding labor. Is it really worth it to deny women the right to eat during labor simply because of the minuscule possibility that 1) she’ll have a C-section and 2) during that C-section she aspirates?

Labor burns a lot of calories. And if you’re restricted to clear fluids, you’re pretty much relying on the sugar in Sierra Mist to pull you through. I think that if you have the urge to eat, you should be allowed to eat. The risk of eating harming a woman in labor is just far too small.

I mean, really… When you are awake for days and laboring for hours and hours, you burn a lot of calories.

screenshot_20170213-073429

 

So there you have it. An inside look at one slice of what a woman goes through when she carries a child and gives birth. It is a test of strength and endurance simply to carry a child to term and give birth.

The fact that women give birth so often might make the process seem ordinary, but it is truly an extraordinary feat for both mother and child to come out on the other side, whole and alive.

Finally, We’ve Had the Baby

I was supposed to have a January baby. Thought there was no way I would end up giving birth in February.

Ha.

Ha.

Just like last time, my expectations for what would happen during this birth didn’t quite pan out.

Like just about everything else in parenthood.

I’ll write about the details later. Not today.

Today, I simply say that life is unpredictable and messy. No matter how much we like to pretend that we have things under control, we very much do not. We don’t like the storms that plow through our neatly plotted lives. They uproot what we’ve planned. They can undo our hard work and make it irrelevant and meaningless.

But a lot of beautiful things can emerge from the storms of our lives.

Like rainbows.

Years ago, my husband worked in a lasers lab. One day, he told me something interesting about rainbows. The shape of a rainbow is actually a circle, not a semi-circle. If you were to be flying above a rainbow and looking down at it, you would see a circle.

It’s your perspective on land that limits your ability to see the full circle.

When you’re too close to the storm, it’s hard to see the full beauty of the rainbow. It’s hard to see that is has no end. That, like many truths in nature, it goes around and around. Forever.

But the more distance that you gain from a turbulent time, the more you realize that even hope and goodness still abound.

In fact, maybe they exist because of the storm.

For these reasons, I especially like the term “rainbow baby.” A “rainbow baby” is a baby who is born after a miscarriage, stillbirth, or infant loss.

Today, we had our own rainbow baby.

Henry Glass

February 2, 2017

1:27 PM

8 pounds 10 ounces

It’s a funny thing though.

Even though this is the deepest part of winter

Even though the storm of labor has just now passed

And I’m sitting here, holding this flawless face in my arms,

I feel like I’m seeing the whole rainbow.

Not just half of it.

“Do You Realize” by the Flaming Lips

Do you realize that you have the most beautiful face
Do you realize we’re floating in space,
Do you realize that happiness makes you cry
Do you realize that everyone you know someday will die

And instead of saying all of your goodbyes, let them know
You realize that life goes fast
It’s hard to make the good things last
You realize the sun doesn’t go down
It’s just an illusion caused by the world spinning round

41 Weeks: The Answer is No. And Yes.

No, I haven’t had the baby.

No, I’m not going to ask to be induced.

No, the baby doesn’t seem to be huge. Just average-sized.

Yes, the baby is healthy. So am I.

Yes, I’m positive they calculated my due date correctly.

Yes, I’ve tried that. And that. And that.

Yes, I’m losing my mind.

Yes, this is eating into my maternity leave now.

Yes, I’ve had some signs that I’m getting ready.

But no.

No real, regular contractions.

keep-calm-i-m-still-pregnant-2

***

This last week has been an interesting combination of nice and awful.

Nice, because my mom is here, helping with our daughter, running errands, and just helping the hours pass. With Scrabble and Penny Press word puzzles.

Nice, because I haven’t had to work. My daily responsibility is to get my daughter to daycare. And take walks.

But it has also been awful.

Starting with the fact that this last week was the first week of Trump’s presidency. What a week… Can anyone process all the garbage that’s coming out of the White House right now? I feel like every day this week, there has been something else that threatens fundamental American principles, values, and norms. (Please tell me I’m not the only one.)

And then there’s the thought that my mind returns to about every other minute of the day: I’m still pregnant.

My mind spins on and on.

Why in the hell is this baby still in there? Am I not walking enough? Am I not eating enough? Is it because I’m drinking decaf coffee? Is it because I have some undiagnosed hormonal imbalance? Is it because I’m 35?

Oh, you’ll go into labor earlier with your second one, they all assured me. The second time is much easier. Your body still has the muscle memory from the last birth. It will happen a lot sooner and faster this time.

Ha.

Ha.

Maybe I should have had my membranes swept at 39 weeks to speed the process along. Maybe that’s the reason I went into labor earlier with my first child. My doctor swept my membranes–without my consent, might I add–at 38 weeks. It still took me until 40 weeks and 4 days to go into labor though, and another day to actually give birth.

So I ask myself, What is so different about this time?

I keep comparing this whole experience to what happened to me with my first baby. I can’t help it. I’m looking for patterns and signs, aligning them with last time, and then making estimates.

I’ve lost six pounds of water weight. Should be another two days.

Or

The baby has moved down further. Probably just another week.

Then I blow past my estimates. Over and over again, I’m disappointed.

Every morning I wake up, and I tell myself to start fresh. I go for a walk in the darkness of the morning. Enya sings to me and I feel understood.

Winter has come too late
Too close beside me.
How can I chase away
All these fears deep inside?

I’ll wait the signs to come.
I’ll find a way
I will wait the time to come.
I’ll find a way home.

I tell myself that today is a new day. Today might be the day. I tell myself that tomorrow, maybe, we’ll be through this birth.

I tell myself to imagine my future self, reaching back through time, shaking me by the shoulders, telling me to not wish away these last moments of pregnancy.

I tell myself that once this birth is over, I will likely mourn its passing.

I tell myself to enjoy this time with my mom.

I tell myself that all I have right now is this moment.

This day.

I tell myself that even though my mind craves the certainty of falling back onto my previous experiences, in my heart I know this birth will be nothing like last time.

I tell myself, Just one more afternoon.

Then, Just one more night.

Then, Just one more morning.

Today could be the day.

40 Weeks, 4 days: Mountain Climbing

Baby,

I think we’re close.

It feels like we’ve been climbing together for so long.

At first, it was a gradual slope, one that I could walk without much of a problem (although–who am I kidding–the nausea was tough). I brought provisions along for the both of us. Assurances that we would make it through this journey together, whole.

But that slope became a hill. My heart picked up speed, so did yours. The further we climbed, the more of my supplies I left behind. I held on to things that I thought you might need. Because I knew you were fragile, so tiny and dependent. I knew I was tough and I could go without.

But now that hill is a mountain, so steep and imperceptibly tall in front of us. When does it end? I’ve let go of even more, hoping it will make us just a little lighter. My hands can’t find any holds in the rock. I feel like I’m climbing blind, hoping that my fingers will feel what my eyes cannot.

mountain

But now, our companions will stay behind as we go forward. They will cheer for us from a safe distance, while we trudge on.

Alone. Together.

What comes next is the hardest part.

Now that the oxygen is thin,

Now that we’re at our heaviest,

our achiest,

our tiredest,

Now that we’ve given up all that we can,

I will have to reach down and pull out that last bit of strength and will

For the both of us

Because you are depending on me

I will lower my head, reach my hands up into the darkness, and feel for the ledge

For you

I will pull, pull, pull

Even though my body tells me that it will break

And my mind tells me that I will fall

My spirit will say, Yes.

Yes.

Now.

You’re ready.

Open your eyes.

Week 39: What We Learn From Pain

I’ve been thinking a lot about pain this week.

Probably because I know that, very soon, I’ll be in the presence of the Mother of all Pains.

Labor.

I bow in its presence.

What’s that saying? Better the devil you know than the devil you don’t know?

In that sense, labor is a devil that I know. But let’s be honest. It’s been three years since we’ve spent any time together. And having known labor, I’m left speechless.

I know its power.

I know that it will require every last piece of my strength and my will.

And I know that won’t be enough. I’ll have to go deeper into myself, into my reserves that I haven’t had to use for years, just to hold on to the belief that I’ll make it through.

Because that’s the only way that I can transform from a doubtful, anxious human being to a powerful vehicle that brings new life into this world.

That’s what labor does. It transforms you.

***

This weekend, I was reminded of just how transformative pain can be.

In Glennon Doyle Melton’s memoir, Love Warrior, she says this about pain:

What if in skipping the pain, I was missing my lessons?

Instead of running away from my pain, was I supposed to run toward it? …

Maybe instead of slamming the door on pain, I need to throw open the door wide and say, “Come in. Sit down. And don’t leave until you’ve taught me what I need to know.”

love-warrior

Glennon spends most of her life running from and numbing pain through bulimia and binge-drinking. When her husband confesses that he has been cheating on her for years, she is thrown into a crisis that she feels she cannot solve on her own. She finally enters therapy so she can figure out how to pull herself and her family through their quagmire.

In the most poignant moment of her memoir, she finds herself in a hot yoga class. While other women express that their intentions for their yoga practice are to “embrace loving-kindness” or to “radiate sunlight to all creation,” Glennon says that her intention is to “stay on this mat and make it through whatever is about to happen without running out of here.”

As she lies on her mat, she allows the pain of her life to overwhelm her. She sees memories of all the things that have hurt her and she imagines all the terrible things that might still happen. While everyone else participates in the yoga session, she lies on her mat, weeping. She allows herself to feel all the pain that she has been running from and numbing herself from feeling.

At the end of the session, her yoga teacher tells her,

That–what you just did? That is the Journey of the Warrior.

***

I cried when I read that. Because it is exactly how I felt after I gave birth the first time.

I felt that I had just confronted all of my weaknesses and flaws, all of my fears and failures, all of my doubts.

And I had come out on the other side.

Alive. Whole. Transformed.

Before giving birth, I feared that I wasn’t strong. That I was too weak. Too inexperienced. That I wouldn’t know my own body more than my doctors. That when push came to shove, I would get out of the way and let someone better handle the hard stuff.

I feared that that’s how it would probably be when I became a mother. That I would smile in deference and listen to everyone else who knew better than me about what was best for my child.

That I wouldn’t cause problems by raising my concerns.

That I would continue to be “the good little girl.”

That when my time would come, I would numb the pain so I could listen to the doctors respectfully, follow directions like a rational person, and push on command.

Even though I so desperately wanted to be that woman who wouldn’t be squashed and silenced by norms…

I suspected in my heart that that’s exactly who I was.

Another woman who would believe the limitations that everyone else had decided for her.

***

In her memoir, Glennon echoes similar thoughts.

I realize that I have allowed myself to see it all and feel it all and I have survived…

I’d been fully human for an hour and a half and it had hurt like hell. It had almost killed me, but not quite. That “not quite” part seems incredibly important.

Accepting pain rather than running from pain is not a mainstream sentiment in our culture. We’ve built an entire culture around numbing pain. Not just through medication, but through addiction. To drugs. To alcohol. To possessions.

And addiction to distractions.

Smartphones and constant Internet access have helped to create these personal mini-universes, free from empty moments in which we might otherwise feel boredom or pain or discomfort.

But what is the human experience when we don’t allow ourselves to feel pain, whether it’s physical or emotional?

When we don’t allow ourselves to feel the pain, we rob ourselves of a rich understanding of who we are and what we can overcome.

As Glennon Doyle Melton puts it,

Don’t avoid the pain. You need it. It’s meant for you.

Be still with it, let it come, let it go, let it leave you with the fuel you’ll burn to get your work done on this earth.

Bring it on.

I’m ready.

Global Billing: Wait, You Want Me to Pay Before the Baby is Born?

Let’s imagine that I need knee surgery.

Let’s say the total estimated expenses for my knee surgery are $20,000.

I have “fairly good” health insurance (at least these days…) so I will pay my $1000 deductible and then 20% of the total costs as co-insurance, which is $4000. And of course, we’ll be paying with our credit card which has a 10% APR (because who has $5200 in their savings account anymore?)

When will I pay for these costs? After I have the knee surgery, right?

Ah, but then the surgeon says, “Yeah, we’re going to need you to pay for the procedure in full, at least a month before your scheduled surgery.”

Wait, what?

Seriously?

And this is becoming a standard practice for obstetricians now. Take a look at these discussion forums, in which mothers talk about the different variations of this wonderful billing protocol called “global billing.”

In some cases, you may have the added bonus of paying two deductibles if your baby was conceived in one calendar year, but born in the next. (Which, by the way, is anyone who conceives a baby from April-December.)

(And in case you’re wondering, it’s also terribly expensive to not have a baby. When I miscarried last year, our out-of-pocket expenses were $1500 for a D&C.)

Global billing can be useful. It simplifies all the billing involved in prenatal care by bundling all the prenatal visits and the obstetrician’s fees for delivery into one big package.

When I had my first child, that obstetrician also practiced global billing, but she didn’t send me a bill until all the services were performed. Then, we got a big, fat $3000 bill about a month after our daughter was born.

That was exciting.

money

***

With this pregnancy, our estimated out-of-pocket expenses begin at about $1400, just for prenatal visits and delivery.

And then there’s that lovely line in the letter explaining that they would like to start immediately collecting payment for all of these services… at my next appointment.

At 23 weeks.

Oh, and…

“These fees are to be paid in full by the 35th week of your pregnancy.”

Their administrative assistant delicately told me that these expenses would not include the hospital costs or ultrasounds.

So let’s add those expenses here:

  • One ultrasound at 20 weeks. (about $300)
  • Any non-stress tests.
  • My hospital bed for 2 days: $1720 (20% of $8600)
  • My baby’s bed in the nursery for 2 days: $1120 (20% of $5600)

Even if I don’t use it. That’s right. Even if I room-in the whole time, I will be paying for the availability of the nursery bed. Ha!

  • Anesthesiology fees, if I have that.
  • That newborn hearing test machine that will roll into my room and seem like a good idea. ($400. Not covered by insurance).

I mean, really. What other medical procedures do physicians require to be paid for in full before you have them done?

And by the way, I really hate referring to birth as a medical procedure. I did all the work until the baby came out. I humbly acknowledge how many people were required to pick up the aftermath of the birth and take care of me during recovery, but I was the one doing the “medical procedure” for the first 34 hours.

Maybe I should be paid. Ha!

When I told my husband about all of this, his response was, “They aren’t getting a dime until after January 1st!”

You know, when next year’s FSA accounts go into effect.

You know, after the baby is born.

The good news is the hospital’s billing department is agreeing to let us start paying after January 1st. Nice of them, huh?

But really, isn’t it a bit strange that we have to request this?

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