Becoming Mother

A book and a blog for first-time mothers

Tag: truth

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.

screenshot_20170207-165547

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

I Heart Daycare (and some ramblings about feminism)

Some women tear up as they leave their children at daycare for the first time.

I practically skip inside.

Grin from ear to ear.

I. LOVE. DAYCARE.

Last Monday was Henry’s first day of daycare. Another daycare mom saw me taking him inside and asked if it was his first day. After I nodded, she jumped out of her van and gave me the biggest hug and said, “Isn’t it great!”

“YESSS!!!” I yelled.

“With the first one, you’re bawling about it and then the second, you’re just like ‘have fun!'”

She gets it.

It’s true. The first time we started daycare was much more involved and made me a little nervous. We spent about 20 minutes going through the list of critical bits of information that the infant teacher needed to know to feed, change, and soothe our baby to sleep.

She likes to be rocked to sleep while being held sideways. Like this. And try to put her down 90 minutes after she wakes up. We haven’t started solids yet. How do you heat the bottle for her? She likes it just lukewarm. Not too warm. If she starts crying and she’s not tired, she might be wet. Sometimes. Just check. You’re going to check every hour or so, right? Okay. She’s really pretty easy to take care of. 

But after two days, I’m pretty sure we thought daycare was a Gift from God. (Thank you, Ms. Cathy!)

It was like, Wait… We just drop the baby off at 7:00 a.m. and we don’t have to be back until 6:00 p.m. at the latest????

Game on.

Here’s some money.

Here’s lots of money.

I love you. Here’s some cookies.

Do you like Panera? I got you a gift card. Happy Valentine’s Day.

Thank you so much. You’re wonderful.

daycare

Daycare pretty much taught our daughter about hand-washing, drinking from a cup, and sitting in a chair for meals. They helped us potty train her. They taught her how to sit in a circle for storytime, how to cut with scissors, how to hold a crayon, and how to fingerpaint. They provided an atmosphere full of dress-up clothes, kid’s kitchens, and books, books, books. (We didn’t have to buy any of it! And I’m not responsible for cleaning up the toys!) They taught her how to walk in a line and take turns. They showed her that a room can be stunningly decorated with the artwork of little hands.

And oh so important… They introduced her to the concept of sharing.

They used the classroom to teach rules. They modeled politeness and respect for others. They reinforced the lesson that actions have consequences.

This does not make me sad.

It doesn’t make me feel like I’m not doing my job as a mother.

I don’t regret sending my kids to daycare.

I wholeheartedly embrace it. I even embrace it to the tune of half of my salary.

***

On the surface, it’s easy to see why some moms love daycare as much as I do. It gives women a break from the role of being a mother.

This is huge.

Mothers in particular are constantly carrying around a mental list of things to do that just grows longer and heavier with each child.

Daycare allows them to put some of that down.

And pick something else up.

But my love of daycare goes beyond that.

Daycare, I believe, is an expression of feminism.

For those of you who are completely turned off by the term “feminism”, stay with me for a minute. Because that word gets a bad wrap in some circles. Feminism doesn’t mean “man-hating” or “female victimization.” (I do not blame men individually for the culture and structure of our society. I blame patriarchy.)

Feminism is about sharing power. It’s about making sure that everyone has a voice. It’s about making sure that when important decisions are made about policy (both in government and business), the people who are making those decisions don’t all come from the same background (White. Male. Native-born. Able-bodied. English-speaking.).

Millienials are the first generation to kind of get feminism. Not all of them do, but from my anecdotal observations, it seems like some of the assumptions that we had about gender and power are finally not assumptions anymore.

One of our former teenage babysitters told us that when she was catcalled in the school hallway, she turned around, went up to the guy, and told him in very clear terms,

“You don’t treat me that way!”

Baller.

***

When I was growing up in the late 80s and early 90s, we were taught in school to imagine our futures. What would we like to be when we grew up? Doctors, astronauts, teachers? Athletes? Superheroes? Dinosaurs? Robots? We were encouraged to let our imaginations run wild.

Like many women in their 30s, I truly do not ever remember an adult — teacher, parent, or family friend — telling me that I couldn’t do whatever I wanted to do. No one told me that I was expected to get married and have kids right away. (Although my grandmother did ask me when I turned 18 if I was interested in any good boys…)

I was like many of my female friends. In high school, we all worked hard and earned good grades.

We went to college.

We got good grades there, too.

Maybe we went to graduate school.

And we got good grades there, too.

We followed the rules. We were doing fine.

We got jobs. We didn’t negotiate salary (because that’s not what good girls do, even though they should, we just couldn’t imagine drawing a line in the sand. That’s not who we are.)

And then we had children.

And everyone looked at us and said, “Are you going to stay home or return to work?”

No one asked our partners if they were going to stay home.

And there you have it.

The message is clear. It’s your baby.

It doesn’t provide any economic benefit to this company. It’s even costing us productivity. Make up your mind. Do you want to work here or not? Six weeks is a lot of time for you to be gone. You don’t want to make that kid dependent on you anyway, do you?

What happened?

What about all the things that I could be now that I’m an adult?

Was it all just empty promises, fueled by good intentions and a dream of equality?

Because, I’m here to tell you, access to affordable (!!!) quality daycare is critical for keeping women’s voices at the table. (Side note: The United States was a hair’s breadth away from free universal preschool for all in the 1970s. Here’s what happened to that awesome, bipartisan bill.)

The tide is turning, though.

Almost all of the dads that I know assume as much responsibility for their kids’ lives as their mothers do. When they take care of their kids, they’re not “babysitting.”

I mean… duh.

They’re being dads.

When they take their kids to the grocery store, it’s not some miraculous event that comes around only once every few years.

My husband knows how to swaddle a baby better than I do. He was the one who made the baby food and showed me how to make smooth formula without all the clumps. He can change a diaper in the dark and he’s even yelled at me for making too much noise while he’s trying to put the baby to sleep.

Ah…

Hope springs eternal.

Week 12: Destiny or Chaos?, a.k.a. The Deep Questions

Regardless of how you define “life,” at 3 months old, a baby has officially been a growing organism for a whole year.

From this:

fertilization

To this:

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In 365 days.

A. Ma. Zing.

This child was conceived four months after a miscarriage. We could have tried sooner, but, you know. Closure. Time. Space. All of these things are good and healing.

Because I was charting my basal temperatures every day for months before all of my pregnancies, I had a pretty good idea of when I would ovulate.

I thought.

Day 14 is ovulation day for a “typical” 28-day cycle. Mine was usually Day 16, but sometimes, it was as late as Day 22. This meant that I had short luteal phases, which can make it difficult to get pregnant or to keep a pregnancy. (I often had a nine-day luteal phase, and sometimes as low as six days. Not good.)

When we conceived our first child, it was Day 18. So, based on past experience, we decided to aim for Days 14-18. You know. Cover all our bases.

Right?

But Days 14-18 of that particular cycle landed right smack in the middle of our “vacation” to the D.C. area. 

I put vacation in quotation marks because we were traveling with a 2 1/2 year old.

So, yeah, it wasn’t really a vacation that was very conducive for baby-making. But that was the timeline.

So be it.

Three days before we left for that trip, our daughter went to bed early and this beautiful window of an hour with nothing to do opened up.

It was Day 11. In the 22 months of data that I had collected, I had never ovulated before Day 14. But whatever. Let’s just have a good time, we thought.

As it turned out, that was my ovulation day.

We officially started “trying” on Day 14, but of course, nothing we did at that point would have gotten us pregnant.

The best laid plans sometimes, right?

***

It would be easy to write this story as destiny. That because our baby is so beautiful and perfect, we were just meant to have sex days before we had planned. God just knew that we needed to get together then in order to make this beautiful baby. Or something like that.

Believing in destiny is all well and good when it’s going your way.

But for all the healing that believing in destiny can do, it can just as easily bleed you dry.

When we miscarried, were we just meant to have sex at the wrong time?

Was that destiny?

Or is destiny just a comforting idea that we hold on to when it helps us?

If there is no destiny, is it all just chaos and luck?

Or do we call it chaos so we don’t need to acknowledge the real consequences of our actions?

Although I’ve been thankful for this child that made his way from cell to zygote to blastocyst to embryo to fetus to baby…

I sometimes wonder about the two pregnancies that didn’t get this far. What would they have been like? Were they boys? Girls? One of each? Did they have chromosomal problems? Would they have been perfect if my body could have held onto them? Would they look like my two living children, who both look more like their cousins than they do their parents?

What alternate course of events may have played out if those pregnancies lasted?

Destiny?

Or Chaos?

When it comes to conceiving a child, it feels like a bit of both.
57e3d4dbd417f

 

Week 10: The Baby Weight

You know how you feel when you wake up one morning and you see an enormous zit right in the center of your chin?

You think, Ick. This isn’t how I look.

Maybe you meet someone for the first time on this day that you have this huge zit on your face, you end up thinking, Oh, please don’t think this is the way that I always look. I usually look a lot better than this.

When you’re in the bathroom washing your hands and you look up in the mirror, you think, No… That’s not really me.

That’s how I feel about the baby weight.

fit-belly-and-tape-measures-1483641452sx4

***

At two months postpartum, the uterus is done shrinking. You’ve lost the baby, the placenta, and all the excess fluids. And what remains is officially “the baby weight.”

In this pregnancy, I gained 45 pounds.

Pregnancy books will reassure you not to worry. A lot of women lose up to 25 pounds in the first few weeks!

Ha. Ha.

I’m only down 23 pounds.

Wait… Wait…

Damn it.

Trust me, it doesn’t feel so stupendous when you’re still carrying around another 22 extra pounds.

***

The first pounds are always the easiest.

After the birth, I was already down 12 pounds.

At two weeks postpartum, my body went into flush-the-system-out mode and I started shedding pound after pound. Sure, it was mostly water weight, but God, it felt good every other day to look down and see my weight another pound closer to my pre-pregnancy weight.

This is awesome, I thought. Keep on going!

Then at four weeks postpartum, my weight stabilized. I started walking 30 to 40 minutes every day and I enjoyed that. It improved my mood, for sure, but it didn’t do much for dropping more weight.

Then, at five weeks postpartum, I noticed that most of my maternity pants weren’t fitting very well anymore.  (Okay, one pair of leggings got a huge snag in them and I had to throw those ones away, but nevertheless.)

A good sign, I thought.

So I went to Macy’s and grabbed a few pairs of black stretchy athletic pants. Sweatpants? Perhaps. Yoga pants? Sure. Running pants? I was open to it. Whatever made me feel like I somewhat possessed an inkling of the figure that I had before this pregnancy.

Now, you have to remember, I had no idea what size I was anymore. I hadn’t worn anything but maternity leggings, yoga pants, pajama pants, and dresses for the past six months.

Staring at the sizes, I thought, Okay, be liberal here. Get a size above what you think you are. 

So I did. And I got the size above that one.

I pulled on the smaller size first. When the waistband hit my thighs, I thought, Oh, sweet Jesus…

I should have stopped there, but I thought, Go ahead and see if the second larger size fits.

Another bad idea. I got them up over my hips, but really, who was I kidding? My entire midsection was shaped like a shitake mushroom.

Defeated, I went back out and picked up the next larger size.

At least they’re on clearance. And I’ll be able to use my 20% off coupon that I got in the mail.

“Sorry,” the cashier said, “You can only use that offer on sale and clearance items.”

“Isn’t this a clearance item?” I asked

“Oh, actually this is a Last Chance item.”

“Oh good God,” I said.

“I know, it takes a while to know the different kinds of sales.”

“Yeah, I don’t speak Macy’s.”

“Will you be using your Macy’s card today?”

“Sure.”

After I swipe my card, I see a screen of available offers come up. Oh! There’s the 20% off one!

“Look at that!” I point it out to her.

“Oh, yeah, that won’t work,” she says as she folds my pants and puts them in a bag.

“Why is it being offered to me if it doesn’t work?”

“I mean, you can try, but it won’t work on this item.”

I try. It doesn’t work.

“Well, that’s just cruel,” I say.

“Yeah…” she agrees. “I keep telling them they need to fix that glitch.”

***

I’ve lost the baby weight before.

Okay, all but the last five pounds. But still.

I remember that it took until ten months postpartum for my thyroid to stop going completely bonkers and for all the cardio kickboxing and portion controlling to finally eat away at that stubborn extra layer week after week after week.

I remember telling my husband that I wish I had been kinder to myself at two months postpartum, when it felt like I should just stop caring. The rationale went something like this: You’re not getting much sleep, but at least you can look forward to eating all day.

Another part of me cared tremendously about seizing opportunities to return to my pre-pregnancy physical condition. And when I fell short of my own expectations, I would get upset at myself.

Today, the rational side of my brain tells me, Your body is amazing. You just sustained another life for three-quarters of a year. You gave birth to a healthy baby (without tearing!) and lost 23 pounds in eight weeks. Give yourself a break. 

***

It is hard to keep this all in perspective, but I try.

I tell myself that people don’t usually stare at the big ol’ zit. While we think they’re looking at all our flaws, they’re usually looking at the whole package of who we are. Smile. Confidence. Congeniality.

In the meantime, I’m doing the daily work of exercise and portion control. It’s hard. Especially when I need to get up at 4:00 a.m. to exercise. And all my exercise clothes are tight. And I’ve gone two weeks without any change in weight or inches.

The truth is, exercise improves my mood. So even if I don’t lose weight, I know I’ll keep doing this.

But I’ll still have to acquire a transitional work wardrobe while I’m dropping the weight.

And that means a lot of time in fitting rooms, learning to love myself through this.

Week 6: A Great Time to Return to Work

Not.

It’s no secret that parental leave in the United States blows big time. Until now, the most our government has been able to approve is the Family Medical Leave Act (1993), which guarantees that employees won’t lose their jobs while they take up to 12 weeks of unpaid medical leave related to family responsibilities, which can include giving birth.

Go us.

Hard-line Republicans would say that government has no business in providing paid leave to its citizens, regardless of the reason. That’s simply not the role of government. We don’t want to become a “nanny-state,” do we?

And why should workers be paid when they’re not working? Says the hard-nosed capitalist who views human beings solely as workers, completely divorced of any human attachment that might decrease their productivity.

In her book, “O

(Sorry, just needed to spend 40 minutes feeding and soothing a baby. Ahem.)

In her book, Overwhelmed: Work, Love, and Play When No One Has the Time, Brigid Schulte describes capitalism’s “ideal worker” as

“…freed from all home duties, [he] devotes himself completely to the workplace. He is a face-time warrior, the first one in in the morning and the last to leave at night. He is rarely sick. Never takes a vacation, or brings work along if he does. The ideal worker can jump on a plane whenever the boss asks because someone else is responsible for getting the kids off to school or attending the preschool play… So tied to the job is the ideal worker that he works endless hours, even if it costs him his health and his family” (p. 77).

Obviously, there is no room in this ideal worker for care-taking. Also, this ideal worker is decidedly male.

Maybe we should neither be surprised or dismayed by this. After all, we have a capitalist economy. But pure capitalism won’t survive, my friend. Pure capitalism is calculating, cold, and ultimately cruel. If we all adhere purely to capitalism, there would be no more room for care-taking of any kind.

As long as we don’t see our country longitudinally, we’re fine. As long as only the present matters, we’re fine.

After all, pure capitalism can make a generation great.

But the generation that came before and the generation that comes after will suffer for it.

As long as our country doesn’t need to a future, capitalism is splendid.

But back to parental

(Sorry, had to rock a screaming baby to sleep once again. Also, I had a bowl of Grapenuts with one hand while holding the pacifier in the baby’s mouth with the other hand. Also, Terminator Genisys is playing in the background. I’m missing a lot of the plot points, but it doesn’t seem to matter. And for as much as I like Emilia Clarke as Daenerys, I’m not crazy about her in this movie.)

Let me summarize my rambling, because this was supposed to be a post about the lack of parental leave in this country.

What I’m saying is that our country’s capitalistic view of screw-your-need-for-parental-leave-there’s-nothing-in-it-for-the-company is dangerously short-sighted.

But, in fact, there is something in it for the company.

A future, healthy, educated workforce to do their future, highly-skilled jobs.

People like this don’t just grow out of the ground.

They start as babies. Cared for by tired, invisible, and underappreciated hands. Mostly by mothers who have either dropped out of the workplace or are pausing their careers as they take time off to give birth and provide care.

They start as children. Educated by underpaid, overworked teachers.

They end as old people. Cared for, once again, by tired, invisible, and underappreciated hands. Sometimes by their children. Sometimes, by nursing homes, where the care-takers make a few dollars more than minimum wage.

This care-taking is work, even if it is done with love.

It’s work that is done behind the scenes.

It’s work that creates the pedestal on which the Ideal Worker stands.

Now, excuse me, the baby is crying again.

IMG_3958

Sometimes, this is how you have to nap. (Moving your hand is *not* optional.)

Week 5: The Hospital Bill Arrives (A.K.A. Why You Can’t Shop for Health Care)

One of the major talking points of Republicans about their plans for replacing the Affordable Care Act is that…

“It will encourage Americans to shop around for their health care.”

To which I say…

Bullshit.

“Shopping around” for health care isn’t a thing in the United States.

You cannot shop around when you don’t know the prices ahead of time.

I mean… Duh.

(You also cannot shop around if there is only one hospital in your area, as is true for all Americans who live far from larger cities.)

If we’re “consumers” of health care, shouldn’t we have the same amount of information that we have when we are consumers of cars or computers, or even breakfast cereal?

But we don’t.

We often don’t know how much our health care costs until we tear open the bill that finally comes to our mailbox weeks later.

Surprise!

***

Before we had this baby, I tried to figure out about how much it was going to cost us out-of-pocket.

You know. For budgeting.

For planning our Flexible Spending Accounts.

You know. Because we want to be responsible. Because we want to make sure we’ve saved enough money to cover our health care costs.

We’re not in poor health. We don’t have pre-existing conditions. We’re fairly young. We’re gainfully employed.

Republicans should love us. Any plan put forth by them should definitely benefit us right? We’re kind of what they had in mind for good American health care “consumers.”

But the truth is you can’t blame “consumers” for the complicated mess that is the health insurance industry, nor can you blame them for the high costs of health care. You can’t tell Americans to just save their money and choose wisely.

I tried that approach and it didn’t work. Not because I didn’t try hard enough, but because the system is not designed to be transparent to patients.

The patients are an afterthought.

***

Our health insurance provider had some estimates for the costs of giving birth in the two main hospitals where I live. These costs were based on their negotiated rates for medical procedures with those hospitals.

But they were just estimates.

So I called the hospital’s pricing line, staffed by the billing department, for a more precise answer.

Ha. Ha.

First, no one picked up the line. It went straight to voicemail. Over and over again.

So I left a message.

Someone called me back the next day.

When I asked the billing department’s representative about specific prices for having a baby at their hospital, he said that he couldn’t give me any prices.

The pricing line. Couldn’t give me any prices.

So I got specific. I told him that I would be giving birth in the birthing center that is attached to the hospital, where I would be rooming in with my baby 24/7. So we wouldn’t be using the nursery. Would we be charged a fee for the nursery? I asked.

“Yes,” he said.

“Why?” I asked.

“Because it’s available to you.”

“So how much will the nursery cost us?”

“I can’t quote you a price on that. It all depends on your insurance and how long you stay.”

“But don’t you have average prices for average stays? Anything?”

“We have a price sheet you can look at, but it’s not going to be inclusive of all of your expenses.”

“I’ll take whatever you have,” I said.

So he referred me to this pricing list, published on the hospital’s website. Why he didn’t give this to me at the beginning of the phone call, I’ll never know.

hospital-claim-2

Indeed, these charges showed up on my insurance claim for the birth.

hospital-claim_ink_ink_li

But so did this mysterious $3500 charge. And a boatload of other charges that are all labeled “Ancillaries” and have no identifying characteristics other than a medical code that only medical transcribers can interpret.

hospital-claim-3_ink_li

I mean, really. Don’t I deserve a little more information than this? If we’re going to pay $1800, I’d kind of like to know what it pays for.

So I wait for the hospital bill to show up. Maybe they have more information than my health insurance company.

Not really.

IMG_20170306_134632

From this bill, I can see that the ambiguous $1850 charge on my insurance claim is actually for the “Recovery Room.” But the other charges?

Who can tell?

The underlying message here is,

Please just accept this price. Your insurance company and the hospital have already decided on a negotiated rate and it’s really just best that you accept this price, pay it, and move on. See how expensive this birth was? You’re lucky that your insurance company is paying so much. So just suck it up and pay. There’s no free lunch, Friend.

***

I’m not the only one who has a problem with this.

“Childbirth is the number one reason why people go to the hospital,” reports Vox’s Johnny Harris in this well-researched video on this very topic. He finds that prices for uncomplicated deliveries in the United States vary from $1189 to $11,986.

I have to admit, I am slightly jealous that their out-of-pocket expenses were only $841.

But who am I kidding? Many, many Americans now have deductibles as high as $6000 now, making my $1000 deductible seem enviable.

The truth is that knowing the costs of this birth would have been helpful for me and my husband, but it didn’t break our bank. We earn enough money jointly that we can absorb a financial blow like this.

But what about the millions of Americans who can’t save $5000 to have a baby in a hospital?

What about those Americans who are “too rich” to qualify for Medicaid, but not rich enough to afford any kind of useful health insurance plan? One that doesn’t deter people from seeing the doctor simply because of the cost?

So politicians, quit telling people that they should learn how to make wise choices so they can save for their health care costs.

And quit telling people that they should “shop around” for their health care costs. 

Not only is it demeaning, but often it is completely impossible.

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 2: Crying

Before I had our first child, this was one of my greatest fears: that my baby’s cries would make me hate my child.

No joke, that was a real fear. I never, ever found the sound of babies crying to be worthy of an Awww, poor thing. I mostly thought, God, someone shut that kid up!

So imagine my surprise when we took our daughter home from the hospital and I wasn’t pissed off at her every time she cried.

Imagine my surprise when my first thought wasWhat’s wrong? What can I do to help you? How about this? How about this?

Now, here we are again. Dealing with a new child’s cries.

***

Not by any stretch of the imagination is Henry a colicky baby. I’ve heard those stories and that is not what we’re dealing with. (And parents of colicky babies, allow me to bow down and kiss your feet, you Parent of Steel.)

No, the cries that we dealt with in the past week have come in defined bursts that (at first) seemed to correspond with post-feeding digestion and then (later) seemed to correspond with how tightly we held him or covered him so that he wasn’t cold.

We’re talking about the kind of crying that is all-out, red-faced, exasperated wailing. The kind that is silent at first because the baby is winding up for a good scream. The kind that reverberates not only in your ears, but in your heart.

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In this crying fit, his whole body tenses, from his face to his toes.

And here’s what that sounds like:

 

But then, it passes. And for a moment, I wonder if our child has just been possessed by a demon for a period of time. Because here’s what he looks like when it’s over.

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And then I think, How can I be mad at that face? I love that face.

Sometimes, nature is a sick, sick bastard.

***

When was he crying? Maybe it’s gas. He looks like he’s in pain. When was the last time we fed him? What was his last poop like? Was it watery or runny? What color was it? Was it a lot or just a little?

Maybe it’s the formula. Maybe we should try one that has the lactose broken down already? 

Doug googles and I do the feedings. We make adjustments and mental notes. I keep track.

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Then, the next day…

Did he look like he was in pain today? How long did he cry? After he ate? Did he poop? If he’s not better by tomorrow, maybe we should try soy formula. I hope he’s not constipated on soy, like Felicity was. Then, we’ll have to go to the super expensive formula.

Feedings and poop: this is what you talk about when you’re learning about your newborn. These are the only windows into why your baby is crying. If you can’t engineer a solution from those clues, it’s time to call the pediatrician.

***

We had a lot of help in the afternoons and evenings over the past week. But the nights and the mornings were entirely in my hands. Once my husband and daughter disappeared behind the door and the car rolled out of the garage, I was on my own.

I was okay until Thursday morning.

It was the second day that Henry was crying in pain.

He wailed. And wailed. And wailed.

I tried to feed him. His forehead wrinkled and he screamed.

I changed him. He calmed for a moment. Then cried more.

I bounced him. Rocked him. Tried to burp him. I laid him on the ground and rubbed his tense body. I bicycled his legs. I rubbed his back. I put him on my shoulder. I turned him over and patted his back. I patted his butt. I shushed him. I put him in the bouncer. I played music. I cradled him. I balanced him on one arm.

Then, I did all of these things again.

Through his screams, I syringe-fed him this stuff, which some people swear by:

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Wailing. Wailing. Screaming. Screaming.

I put him down on the ground, feeling the warm weariness of three hours of sleep blur my vision.

But no, it wasn’t the sleep deprivation. It was tears.

Turns out, burp cloths aren’t just for spit up. They’re also great for tears.

He cried and I cried. Looking at him, writhing in pain, I cried more.

How am I going to get through this morning? This week? This month? I didn’t hug Felicity before she went to daycare. Fail. How can I care for two people? My face is still bloated. I wish I could wear normal pants again. How long did it take to lose my belly last time? How many more hours until Cate is here to help? How many more days until Friday night when Doug does the night feedings?

But the question that overrides everything: What is wrong? What can I do? I will do anything. Just tell me what I need to do.

I wiped my tears on the burp cloth one last time and picked him up. I cradled him in my arms and told him that I was sorry. Sorry for not knowing how to help him. Sorry that he had to share me with another child. Sorry that I wasn’t at my best.

I clutched him to my chest, covered him with a flannel receiving blanket, and then held a pacifier in his mouth. His lips closed on it.

Then, he was silent.

He had fallen asleep.

I dropped my head back in relief.

Oh, thank you God. 

***

Over the past three days, we’ve arrived at some temporary hypotheses for the cause of the crying.

1.) Milk allergy.

Solution: We switched to soy formula. (Courtesy of Doug’s genes.)

Results: So far, so good. No diarrhea. No constipation. Regular diapers. No more crying fits where it seems like he is in pain.

2.) Extreme need for warmth and swaddling. (Courtesy of my genes.)

Solution: Double swaddle. One layer is a muslin blanket. One layer is a flannel receiving blanket. Put on mitts and a hat. Hold tightly against your chest. (Although, he is picky on this point. My chest seems to be the gold standard right now.)

We are trying these things right now. Every day is an experiment. Every time he finally goes down for a nap, we breathe a collective sigh of relief.

Maybe it’s over, we think.

But who are we kidding? We know better. Tomorrow, it might be something else. Next week, something else. And definitely next month, something else.

Sometimes, it’s this:

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Sometimes, it’s this:

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Flexibility.

Flexibility.

Flexibility.

That is life for now.

These Holy Hours

1:00 a.m., 3:00 a.m., 5:00 a.m.

These are holy hours

when the soft rooting of newborn hunger stirs the silence

And weary, warm exhaustion is brushed aside once more

In these holy hours

new life feeds and grows, minute by minute

Neurons connect and thicken

their paths beginning to deepen

Eyes open and drink

swallowing light and one familiar face

Eyes, free of shame and guilt and secrecy

Eyes that stare and stare

Eyes that wonder

These are holy hours

but hours for which no one wants to awaken

save the mother, whose body craves the contact

In these hours

ordinary actions become superhuman feats

witnessed by no one

In these hours, maternal instinct strengthens and sharpens

and all other desires recede

and it is mothers who detect and interpret

even the smallest of signals

In these hours, love is quietly knitted together

one diaper, one feeding, one burping at a time

In these holy hours

two human hearts rest closely together

synchronize and slow

synchronize and slow

the inside, now the outside

These are holy hours

when questions of creation come forth

and the shells of sacred mysteries begin to crack

under the magnitude of these most ordinary of moments

Their rays of light shining through

Revealing new truths in the Whole Story

Beginning of beginnings

These are quiet, still hours

when the rhythm of the present slows

suspended between the past and the future

when memories and hopes and prayers

swirl and mix

creating new galaxies of possibilities.

These are holy hours

When the Divine bends down to offer mother and child

a blessing that washes over them

and pulls them underneath into an ocean of warm sleep

once more.

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The First Week: In Pictures (Pt. 2, How We Eat and Sleep)

Day 5

My postpartum belly continues to slowly shrink. And if you’re wondering what it looks like to wear cabbage leaves inside of your bra, look no further. A little lumpy, but not too bad. I wore the leaves for two days to relieve the pressure and pain.

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Everyone has different sleeping arrangements that work for them. I’m in favor of whatever works for the parents.

Because if the parents have lost their minds, it doesn’t matter whatever positive benefits studies show.

We are following pretty closely to what we did last time. One parent sleeps apart from the baby and gets a full night’s sleep and the other parent sleeps next to the baby in the baby’s room. During the week, Doug gets to sleep in our bedroom without the baby (since he is working full-time.) Then, I take the night watch. During the weekend, I get to sleep in our bedroom and Doug takes the night watch.

I haven’t dreaded being the night watch parent so far. In fact, I think my hormones are demanding it. On Day 4, I thought I could just knock myself out with some Zzquil and sleep for eight hours and be totally caught up on sleep.

Ha. Ha.

My mind had other ideas. It kept playing and replaying images from the birth. Over and over again. And when I wasn’t remembering the visuals, my mind would nurse on the songs on the playlist that accompanied all of the visuals from the birth that will remain with me forever.

Honestly, how could my mind do anything else after experiencing birth?

Birth is such a tremendously life-changing event. In my experience, it far surpasses other milestones like graduations or even my wedding. The only times in my life that approach this level of preoccupation were the times I fell in love. That’s it.

So what does all of this mean?

I basically didn’t fully descend into a deep sleep from birth to Day 5 (February 1st, the last day that I got a full night’s sleep, until February 6th). I “rested.” But during that rest, my senses were amplified. Everything was on high alert. I noticed everything, as if my mind were logging all of the possible noises that could come from my baby and what they meant.

Oh, that snort is okay. He’s fine. 

Now, he’s smacking his lips and eating his fingers. He’s hungry.

He’s whimpering. He needs to be held close.

Oh, he startled himself awake when his arms flinched. He needs to be swaddled more tightly.

It’s a little easier this time to understand what the sounds mean because I know a range of possibilities of why babies wake up. But obviously, this is a new baby and this is an entirely new inventory of sounds. It’s taking my mind time to acquire this new language.

From Day 5-7, I was able to establish a passable sleeping pattern for myself. At least, one that steers me off the road to psychosis. I was able to sleep in one-hour increments and still reach a deep enough level of sleep for my body to partially restore itself. During the night, I was even able to dream in one-hour increments between feedings.

Nevertheless, I’m still not close to being able to drive safely. Would you want someone like this on the road?

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So, you’re welcome.

This is markedly different from my first child, when I went on a 12-day bender with nearly no sleep at all. Not only did my hormones keep me awake, but so did all of the breastfeeding challenges that grew worse over time and never improved.

So this is what is working for us right now. Me, sleeping on the inflatable mattress in the baby’s room, close enough to calm my mind, but far enough away to still sleep somewhat soundly. Maybe it’s just me, but I actually sleep with earplugs in my ears. That’s how heightened my senses are. I can still hear him through the earplugs when something’s wrong.

Nature. Just wow.

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Best friend, “Bear,” holds the first boy among our Monday Night Dinner friends. After six girls. (Just means we’re raising a legion of strong women.)

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We bought these tiny 2-ounce bottles, thinking we would use them for a few weeks. Of course, he outgrows them in two days. Now, we’re on to 4-ounce bottles. I guess it *does* make a difference that he stayed in the womb for an extra week.

Day 6
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Nasty? Yep. After this birth, I’ve forever crossed into the realm of “badass-dom.”

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Collecting things for the baby book

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You know you have amazing friends when this is the card they get you.

I saw this card one night as I was preparing for the night watch and I had to smile. My friend, Suzy, gave me this card for my birthday last Thanksgiving (yep, same day), and it was such an encouragement. I was 32 weeks pregnant and already feeling massive. Wondering how much larger I was going to be at the end. (Thank God, I don’t have the gift of foresight.)

I think she knew I needed to hear that.

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The night watch supplies. Not pictured: Stephen Colbert videos via smartphone.

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When I see his legs crossed like this, I think, “Oh. That makes sense. Now I understand what I was feeling for the last month.”

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3:30 a.m.

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Wide awake, studying my face.

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The “old man” face

Day 7

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Just before I lie down for another 1-hour nap, I see that it’s Henry’s 1-week birthday, right down to the minute.

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For how much walking I did to get labor going, you would think that I would not miss it. Especially some of these mornings have been so cold. But, of course, I do. I haven’t really been outside since the birth (except to take H to the pediatrician).

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Can I just say, this page of the baby book is uniquely challenging. Although, when I posed this challenge to the Facebook hive mind, I got some great ideas for how to inject humor into the bleak and unforgiving reality of the time in which we are living.

My favorite? Use “Donald Trump language” to fill out the whole page.

So that is where we are so far.

And now I’m going to do something daring.

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Here I am, in full postpartum glory.

Exhausted. Imperfect, but authentic. Continuously putting faith in the idea that I have all I need, even though I feel short on everything.

There’s a cliche saying that I grew up hearing in the Southern Baptist church. God, I really hated it when people said it. But I cannot deny the truth of it in this moment.

They would say, His grace is sufficient for me.

In other words, Trust that God will give you what you need to pull through.

I’m doing just that.

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