Bionic Mamas

you're not losing a vagina, you're gaining a son


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Items Gestational, For The Nonce

Dateline: 38 weeks, 4 days.

Item: I am still pregnant.

Item: I wonder if that will be true for much longer.

PicsArt.com
The view from now

Item: Had a nice visit at the OB’s yesterday. Sweetly enthusiastic u/s tech kept enthusing during my BPP, making me feel a bit jaded in comparison. (Partly, I’ve been spoiled by the image quality at the high-risk place I go for growth scans.). She really was adorable, taking care to point out specific bones, to enthuse over how Jackalope was practicing breathing, “which they don’t do all the time so we don’t always get to see it!” Apparently both placenta and fluid levels are fantastic, or words to that effect.

After a rather too-lengthy wait for the OB portion of the visit (not because anyone was late but because there are few slots for BPPs, and this was the best we could do), a punchy and overtired Bean accompanied me back to the exam rooms, where he roll on the floor. Blood pressure up a bit, which I suspected as I’ve been having these darling little panic attacks, but not enough to worry anyone; weight down a bit. “Undress from the waist down,” said the nurse, and I said no, I’d wait to talk to the doctor before setting myself up for cervix rummaging, thank you. I do not remember that fondly at all, and have decided I am not submitting myself to painful procedures without good reason.

This, it transpired, was perfectly fine with Dr. White*, who came in wearing yet another pair of hip glasses. (Between my previous visit with her, this one, and my doula’s report of meeting her at a delivery, no repeat frames yet.) She agreed that there wasn’t much to do with the information except satisfy general curiosity and encourage me to go to the hospital quickly when labor starts if it happens that I am secretly already fairly dilated. “But,” she said, “that is already what you are planning to do, so it doesn’t matter.”

* Who is, point of order, not white. But I am into using fairly obvious nicknames this time around (why have I been protecting Dr. Russian and pals?) and the other obvious ways to alter her name are not nice.

I really like her. She was so encouraging about everything, saying she really thought everything was going to go well and I would do great and my birth plan looks good, too. She talked to me for a long time, wanting to hear again a bunch of details from my labor with the Bean, and here, gentle reader, is where she really won me over. I was describing the Horrible Cab Ride, and how even though it was Horrible, I was apparently at 4 cm both before and afterwards (leading to my point about how much better and faster everything went after the epidural, not matter what the books say). “It sounds like you were in transition,” she said.

Internets, I was floored. YES, that is exactly what I thought at the time. Everything about how I was feeling and acting was exactly how transition is described, except supposedly I wasn’t because transition is said to happen from 8-10cm. (This led to some real shock at the hospital when the resident said, brightly, “you’re at 4 cm!” not realizing I had been told the same four hours of agony previously. “WHAT??” I said, or perhaps roared. “Um, maybe four and a half,” she said, in a frankly adorable attempt to mollify me.)

When I told my mother about the transition confusion, she said the same thing (minus the cab) had happened to her when I was born, and that moreover, when she was in med school, they were taught that transition was a kind of labor, not a particular point in dilation. (In other words, maybe many people experience transitional labor in the 8-10 cm range, but that doesn’t mean the two are synonymous). Until Dr. White’s comment, I have never heard anyone with more recent training agree with that concept, and I can’t tell you how relieving it was to hear that maybe I am not crazy, and that did happen. Redeeming, that’s the word.

Anyway, yay, Dr. White. On the basis of nothing except our chat (which included how I’d thought I was going into labor last Thursday and then not and then that being able to walk to a restaurant two blocks away for my date (!) with Sugar on Monday made me think I was having a pre-labor burst of energy and then how I could barely sleep that night from pain because in fact I was not up to that walk and how I’ve been having these panic attacks, sometimes without even consciously thinking about anything that worries me), anyway, on the basis of that long parenthetical, she mentioned cheerfully several times how if I happened to go into labor in the next couple days, she would be on call. “Go ahead and make an appointment for next week, just in case,” she said. She almost rolled her eyes when I asked about their induction date policy. (It’s 41 weeks. I never bothered to ask before because I never expected this pregnancy to last longer than the Bean’s. But here I am, still knocked up.)

And then I went home. And then I lay on the bed in various kinds of back pain and contraction exhaustion for several hours, while the Bean covered me with stuffed animals and trucks. And then I lost a great deal of sleep last night in the same way, unisom notwithstanding, and had a pretty rough morning, to boot. And I am starting to wonder if she might be onto something.

At least we have made it to the lunar new year. The Bean and Sugar are both rabbits, you see, and I have been secretly hoping for a little horse, like me.

Oh, and post-scriptural Item: Thank you for your many kind and encouraging comments on the birth plan. I do want to clarify that many of the things you thought it was horrible to have to request are, in fact, standard at this hospital. I know from being there all but plan-less with the Bean that they always hurl the newborn onto your chest and assume you will all room together. (In fact, the dumb tour guide we had last time said that was mandatory, which sounded intimidating. That was only one of many things she was wrong about. The LCs at that place…I don’t have much good to say about the two I encountered last time. I plan to skip the whole business this time and just see the good one I eventually found in Brooklyn if needed. And my insurance will pay! Thanks, Obama!) As far as I know, non-gestational parents can hang with the baby post-caesarean. Nor do I think anyone’s penis gets automatically docked in the absence of a specified desired to leave the thing alone.

The yelling and so on — well, I certainly hope none of my providers would do such a thing. It’s just that I’ve been so wrong on that count before, and felt so helpless to do anything about it (or even, for a long time, to admit it had happened). Really, putting all that in was mostly an exercise in showing myself I could be an advocate for myself, taking control and all that.

I really do like and trust the OBs in this practice, as much as my twice-shy self can trust anyone. Even Dr. Smarm I think is probably okay, despite not being my favorite: she gets very good reviews online, and Dr. Ready seemed genuine when she assured me that, weird appointment or no, she would not do the things I fear. I feel a bit defensive on this point, partly because of my own history, but also because I often feel sort of demographically pressured to believe I should see midwives instead of OBs. I like midwives, in the abstract, but sometimes the praise of them necessitates a villain in a way I find problematic. Point of order, I have good reason to have chosen OB care, both times. I really like this hospital, and no midwives deliver there. The local midwifery practice everyone loves delivers at a hospital I do not love. The hospital with the fancy birth center and therefore more midwives is farther from our house, and the present cab ride is sufficiently long. In particular during my last pregnancy, I was thought to be at increased risk of needing a c-section, and I thought on the whole I preferred to know the person performing it.

This is part of a longer rant on the problems of birth activism’s concerning itself with abandoning medical systems in favor of options (midwives, home births) that may be great for many people but require, among other things, “good” health. Midwifery has a problem, in my ever humble etc., if hospital-based practices risk out patients for things like gestational diabetes. More to my point, it is not ultimately appropriate to advocate that “healthy” people abandon hospital care en mass as a primary response to problems in that care, inasmuch as removing the most privileged (in health but also, statistically, in race, class, and education) from the system, leaving those less well positioned to advocate for themselves stuck in a system activists would do better to improve. (Mind you, I am talking about activist rhetoric here; a given individual’s decision to have a home birth I have no ideological argument against.)

But meanwhile, my back hurts. I am going to take a bath.


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Bloody Business

Before I begin, I want to just say, in a small voice, how crushed I feel by May’s latest news, by the utter un-rightness of it, by how badly the universe is flubbing its lines. This is not how the story is supposed to go, dammit. I know we talk a lot about how unfair all of this business is, but sometimes the unfairness is just so fucking unfair. It is not the only thing that has been Not Right lately; that doesn’t make it any less wrong.

I am wondering if any of you happens to know what counts as a normal postpartum drop in hemoglobin and what doesn’t. Imagine you have this patient who, after two days of fairly heavy vaginal bleeding, arrives at a hospital in labor. Her hemoglobin at that point is 13; her hematocrit is 37.8. Following a vaginal delivery, her numbers are 7.3 and 21.7, a drop in the neighborhood of 44%.

Question one: Is that normal? If not, how abnormal?

Question two: Are there causes of postpartum decreases in hemoglobin other than blood loss? Does the placenta itself (or the baby) in some way count towards the starting number?

Question three: Do you do anything about those numbers, beyond suggesting an iron supplement? Do you do anything if the patient calls three weeks later complaining of continued extreme fatigue, dizziness, breathlessness, etc.?

Question four: Supposing a patient with this history is pregnant again. One likely source of postpartum bleeding (vaginal septum) is gone, though possibly the vaginal wall where it attached has scar tissue. Is postpartum hemorrhage in such a case likely to recur? Do you do anything in particular to lessen the chances of her feeling terrible for months again? Is there anything you can say to her to help her feel less frightened?

Question five: Is this patient a good home birth candidate? Just kidding.

My hospital records — the short version only — from the Bean’s birth arrived this week. I’d put off ordering them for a couple of years, which I guess is good, considering that I find myself a little taken aback anyway. This is just the abstract — test results and some nonsense from the lactation consultant, an extremely silly person. There are errors: I am listed as having a didelphic uterus (nope, not that normal), and hemoglobin and hematocrit are reversed in one place. (I flatter myself that a hematocrit of seven might have been more worthy of note.)

Also this week, I finally tracked down a picture I didn’t know existed until recently, of Sugar cutting the Bean’s umbilical cord. That is to say, it’s a picture of my crotch, post delivery but prior to the arrival of the placenta. I thought it might feel sort of empowering to see that, since I was scared to look at that part of my body for weeks after birth, not wanting to see all the stitches. Maybe it would have been, but I found it hard to pay much attention to my flesh, finding the pool of blood I was apparently lying in rather visually distracting. When I say pool, understand, I mean pool. I don’t mean the bed was a mess. I mean liquid. I mean depth. I mean volume.

I thought I was done finding new things to feel angry and scared about, regarding the Bean’s birth, but I guess I was wrong.

I haven’t written in much detail about how sick I was after the Bean was born, partly because at the time, I was filled with confusing hormones, alternately elated and distraught, and, well, sick. I’d been pretty thoroughly conditioned to believe that only people with (unplanned) c-sections were allowed to feel sick or sad after birth, anyway; the websites said I should be exulting in my all-powerful womynhood and resuming my exercise routine while teaching the baby French. All that matters, as you know, is that the baby is healthy. The vessel has done its job.

So, here: I was pretty sick after the Bean was born. For the first week or so, I had an annoying tendency to black out every time I tried to nurse him. The nurse I asked about it told me that was “oxytocin, filling your body with feelings of well being.” Later I realized that was the only time I wasn’t lying flat. I couldn’t hold him during the lactation class and was grateful that lesbian privilege meant I alone among the women there had someone to help. (Men weren’t allowed.) We left early because I couldn’t sit up anymore.

For the endless rounds of pediatrician visits for weight checks in the first few weeks, I took cabs. One day Sugar had a work meeting, and I couldn’t carry the Bean in his carseat. I could barely carry the car seat. We tried to take the subway once. Sugar carried the baby while I shuffled behind her, hips still entirely disconnected, like a troll aunt of some kind. (Sugar got lots of congratulations for her new baby in those days. She deserved them, but my own invisibility beside this gorgeous, healthy, thin woman and her perfect baby was sometimes hard to take. “Don’t worry, honey,” one woman said, “you’re next!”) Sugar went to the store for a different kind of iron supplement for me while I took the dwindling Bean to a lactation group. I remember feeling such utter hatred for the other woman there, so pink and healthy with her fat, pink baby, who was younger than the Bean. While Sugar was gone, I started shaking convulsively. I was losing my vision, trying to figure out how I was going to get myself onto the floor without dropping the baby, who was so, so heavy. Sugar arrived just in time, and held him while I lay my head on the desk and shook. No one asked if I was okay. I took a cab home.

It’s hard to write this without feeling I am exaggerating things, but this happened. Other things happened, too, many of them good. I stayed conscious for the ride home from the hospital, even if I did have to go immediately to bed and so missed the cats greeting the Bean. Friends came over, and I sat and talked with them. But it was months before I could walk around the neighborhood normally. Going up the gentle incline of the train station left me breathless, my vision blotchy. I feel existentially queasy looking at pictures of me with the Bean in the early weeks, because I am so very grey.

I got better. The human body really does have amazing powers of restoration. But does the patient’s recovery mean the treatment regime was wisely chosen? The heroic medicine doctors, the bleeders and purgers and givers of mercury, thought their treatments worked because their patients often survived, when the truth is those patients recovered in spite of the medicine. Regardless of whether I should have had different treatment in objective terms — and I gather from google that sources differ on the guidelines for iron infusions and blood transfusions and so on — I feel sure the other aspects of treatment could have been better. Only one nurse, when I was already in the process of being discharged, mentioned my hematocrit drop and asked if I really felt okay. (Desperate to leave, I said yes.) The nurse practitioner at my OB office told me I should expect to feel tired when I described my trouble breathing while walking. At the infamous postpartum appointment, Dr. Russian didn’t know my hematocrit levels and dismissed my questions on the topic. None of that was helpful, even if it was the case that the best course of action was waiting for my body to rebuild itself. It’s a kind of gaslighting, I think, not to tell a patient that how she feels is not in her head or her weak moral constitution.

Besides angry, I feel a bit scared by these new documents, in particular the picture. My septum is gone and presumably won’t break and bleed again. I expect it caused some of the trouble, in addition to other tears. The midwife at my new clinic says that didelphic cervices can bleed a lot, and suggested they might try rectal cytotec in addition to pitocin if it seems necessary. (I haven’t talked numbers with her, just my experience of being anemic.) If the pre-labor bleeding was a placental abruption — and we’ll never know, since the head of the OB practice didn’t see fit to take it seriously — there’s a chance that won’t happen again, and a 100% chance I won’t let it be ignored this time. I have the reassurance that I did survive, however sick I got. But there is still that nauseating feeling of almost having been run down by a bus, not realizing it was even there until it passed.


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Happy Hour Items

Greetings, internets, from a local trendy bar that turns out to be more than capable of turning out something “fun and non-alcoholic,” if requested. I thought this order might reassure the woman giving me side-eye as I, well, bellied up to the bar, but it turns out that is just how she holds her face.

Nevertheless, I am looking rather fecund at present, even in the tent-dresses that are all I can tolerate wearing at present. I haven’t had much of the stretching and cramping and so on I had in early Bean-pregnancy since the first couple of weeks, but lately anything putting even nominal pressure on my uterus makes me sore and dizzy and nauseated. An ultrasound probe, for instance. I tried a belt for twenty seconds this week and was off all afternoon, and even my maternity jeans, which felt fine at first, caused trouble after an hour. Sure hope this sorts itself out before the weather turns.

The nuchal scan went well, I’m into the lowest risk zone for miscarriage, and my body is rapidly outing itself, but Sugar is interviewing for a new position at work, so we are in the odd position of telling people in real life but not on Facebook, where Sugar’s colleagues will see it, lest the idea of her taking time off in, say, February, make another candidate look more appealing. (Her job does not give “paternity” leave — or indeed maternity leave beyond six weeks of disability (stay classy, academia) — but she took unpaid FMLA leave when the Bean was born. Besides giving them invaluable bonding time, the leave was frankly necessary for my health, as I was in no condition to be left alone with an infant, being among other things rather deficient in the hemoglobin department.)

The not-telling has me a little blue, it turns out. I don’t mind waiting a little longer, but I sure hope they hire somebody before February. That concern would not seem silly if you knew how long it’s taken them to schedule interviews. Meanwhile, why does a group email seem so much more intrusive than a social media announcement? Thank heavens for you all.

(Speaking of, have I mentioned how over the moon I am to be pregnant at the same time as our beloved May? I am in danger of leaving orbit.)

Meanwhile, the nuchal. It went well! Despite my anxiety-fueled delusions of intuition, risks of trisomy 13, 18, and 21 are as low as the statisticians are willing to concede. (I gather that in some circles it is poor form to admit happiness at this news, but I am not in those circles. I would not bear a grudge against anyone happy to find she didn’t have the diseases I have, for one thing. For another, my father’s line of work leaves me without certain protective illusions.) Because I was too deep in denial to schedule childcare and because the timing of the appointment interfered with prime toddler napping hours, the Bean joined us. He was not exactly an advertisement for bringing a toddler to such an event, but with Sugar there to wrangle his truck beads, he did okay. We have not, to answer gwinne’s long-ago question, told him the score, but he clearly suspects something, though I don’t know what. There have been several pointed questions lately along the lines of, “What’s in YOUR belly?” (I equivocate. “Lots of amazing things, just like in your belly.” “My belly!!!” Fin.)

We had the same super-nice doctor go over the results as last time. His southernness relaxes me. I find myself stifling the thought that if only I did have a high-risk pregnancy, I could see him. We talked for a while about my peculiar mix of normal and anomalous reproductive anatomy, and get this, he actually apologized at one point for asking too many personal questions! I told him that particular bar had been set rather low by the doctor who invited his receptionist in to see my vaginal septum, and he appreciated my stories about the look on the same doctor’s face when, after he told a fully-clothed me he was sure I didn’t have a septum, I replied, “I can put two fingers inside and they don’t touch.” (This diagnosis is not rocket science. Necessary equipment is two fingers and a functioning brain.)

ANYWAY, this doctor, who is not a condescending nitwit, delivered the happy news that not only were the ultrasound findings good, but this time, in contrast to last time, my blood count numbers were also all good. I find it cheering that my body or the placenta or whatever is in charge of whatever PAPP-A even is, is doing so much better this time (to the tune of about 85 percentiles higher than last time). Low PAPP-A is associated with a host of unpleasantries I was watched closely for last time, including pre-eclampsia and also IUGR, pre-term labor, and placental insufficiency, all of which also go along with mullerian anomalies.

I asked whether I should still be considered at increased risk for the MA complications, or whether my delivery of a normal-weight, full-term baby (albeit one at the low end of normal on both counts) meant my future risk was lower than MA baseline. I was pleased by the caution of his answer, which amounts to that it would mean that, if I had a more typical MA combination, but that my rara avis status means that there are no relevant statistics. (I found one case report of someone like me in the journals I searched, and the dominant theory of fetal development says I am impossible.). He is therefore recommending to my OB practice that I still have cervix-length checks and regular growth scans. I know some people find that sort of thing intrusive, but I find it very reassuring. Meanwhile, in a surprisingly decent move on my psyche’s part, I simultaneously feel much more confident than last time that things will work out, because they did once.

Yeah, I don’t know who I am anymore, either.

I am supposed to be using my time away from the house to work on another writing project, so I will have to tell you about the midwife at the OB office another time. Meanwhile, a picture, because pictures!

12 weeks 1 day

ETA: I just realized these aren’t even items. You must feel so cheated!


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The Bendectin Story

Hello, Gentle Readers. Greetings from thank-God-we-are-finally-pulling-out-of-St.-Louis, aboard Amtrak’s Texas Eagle. We are running late, which I would be more annoyed about except that Sugar flew home yesterday and was so much later in so much less pleasant a way. She spent most of the day in the Detroit airport, spent $100 on a cab home from Newark, ate a soggy tuna melt from an all-night diner at midnight in our kitchen, while discovering that the freezer door had been just slightly open for the last two weeks. In contrast, I was fed a steak dinner and gelato and lay on a reasonably comfortable bed and read A Bargain For Frances to The Bean during our delay. Advantage: Amtrak.

The other reason trains rule with toddlers: no seatbelts. “The cars and trucks are going to meet their friends,” he says. (This wholesome, wooden-toy moment brought to you by several hours of puzzles on the iPad.)

The cars and trucks are going to meet their friends

Thank you for your spotting reassurances. It hasn’t come back, and there was so very little that my working theory is self-inflicted crinone-applicator wound. Mad skills. I has them.

I should have written sooner to tell you, except that I’ve had my hands full managing my father at my in-laws and wrangling the Bean. I’ve also been quite drowsy, thanks to my new best pharmaceutical buddy, doxylamine succinate, AKA, Unisom.

I’m not taking it for insomnia, though I have been having trouble sleeping for several weeks. I’m taking it because remember how I was puking in trash cans? Well, it turns out this stuff is a whiz at sorting out nausea, and, get this, it is category A for pregnancy. Category fuckin’ A, y’all. Do you know how many things are A? Not bloody many, thanks to the difficulty of ethically arranging the kind of studies the FDA requires for that designation; it’s pretty much folic acid and this stuff.

So why didn’t anyone mention this to me (or maybe to you) before now? Doxylamine in combination with B6 used to be used by 40% of pregnant Americans, as a drug called Bendectin. There were at least 25 studies and two meta-analyses, which basically say: this does not cause birth defects. But if Bendectin wasn’t a teratogen, it was, says a friend of my father’s, a lit-ogen: that is, it caused law suits.

According to dad (whose business this is), about 3% of babies have a serious birth defect of some kind. No one likes that. A certain number of parents sued the makers of Bendectin. And even though the science is absolutely, uncommonly clear on this subject, law suits wear a company out. Eventually, the drug was taken off the market simply because its maker tired of defending it in court.

Meanwhile, some corners of the popular press believe that smoke always means fire, and jumped happily on the Blame-Bendectin Bandwagon (also the name of my new ska band). Bendectin is used in a third of pregnancies of children with birth defects! Well, if it was used in 40% of pregnancies, excuse me if I think that’s good news — if 40% of all pregnant women took it and it’s only present in 33% of cases of birth defects, that almost sounds protective, the was I figure it. Anyway, the magazines said, you can make something just as good at home: just combine half a tab of doxylamine with some B6…. *headdesk*

Folks, I gotta tell you, this stuff is great. I haven’t tried combining it with B6 yet, because I haven’t been able to find the B6 in small enough doses. But half a unisom a night, and I have almost no nausea, let alone reasons to defile public transit property. Twice now, most recently two days ago, I’ve decided to stop taking it, and both times my body has made me aware in no uncertain terms what a stupid decisions that was. Morning sickness definitely still in effect, when not masked.

I keep re-googling this, convinced that anything I’m getting this much benefit from must be terrible for babies, even if I did learn about it from my OB’s website. Eventually, I asked myself why I was so anxious about it, given that I take my nightly singulair without concern, and there’s hardly any data at all on that one. I think the answer comes down to thalidomide and the curse of Eve.

Did you see a lot of thalidomide documentaries as a kid? I did, or at any rate, the ones I saw made a big impression. And I think my psyche stored away somewhere the idea that what happened to those children was not just a horrible accident but a judgement of sorts on their mothers, for trying to escape a natural but unpleasant part of pregnancy. Chalk that up to one more subtle way ideas of the natural as applied to women’s experience are always ready to become a cudgel.

The unisom is kicking in now, and Little Rock comes early in the morning; I must to bed. But y’all: what we need more of is science.


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Well, That Went Well

I was going to write you a whole story, including the inauspicious movie ad by the clinic (“This Is The End”) and the auspicious way the hotdog stands smelled AMAZING, how I bought hpt’s so that I could pee on a stick after the blood draw but before the phone call (and in so doing learned that the 42nd street CVS sells honest to god vibrators), only then I sat there, next to the open box, crippled with indecision about whether or not to test, given that Sugar was off working a shift in my stead at the food coop and so on, and then the phone rang…but like me when the nurse on the phone asked how I was feeling, you would probably prefer that I dispense with the pleasantries.

Yes. Yes, I am.

221, for those of you who like numbers.

Prime factors of 13 and 17, which I like.

Starrhillgirl points out that, rendered as all caps, 221 is a very enthusiastic pair of breasts:
@@!

That seem auspicious, even I must admit.


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Post-Ovulatory Items

Sshhh, internets, the Bean is sleeping. Finally. I should be in the other room, using this time to finish my semester grading, but the Bean is also sick, and if I move, nap over. So how’s about some items, since I’m here for the foreseeable?

Item: for those following along at home, I was finally deemed worthy of triggering on Saturday. Transfer day is Friday. Cross your fingers, if you don’t mind, for an easy transfer and a conclusive beta to follow. Of course, I’d prefer a conclusively high beta, but what I’m most focused on at the moment is numbers that mean I get to go on our planned summer trip of friends and family and beautiful, quiet places in the north woods of Michigan. When I ran this idea past Dr. BF, he said it was all fine as long as they were satisfied nothing ectopic was happening. No one wants to risk a rupture that far from a hospital, not even me.

Item: There will be Valium at the transfer, and don’t think I haven’t made mention of that to every warm body I can find at the Baby Factory. (I know some clinics always use Valium — and I find their logic of reducing uterine contractions convincing — but mine doesn’t.) Look, I know things have changed in the down-there department, post-Bean, and it’s wholly reasonable to suspect at least one of those pesky cervices is a little easier to navigate now that six pounds of baby has gone through it, but I don’t care to test that theory for no good reason. A tiny part of me is holding out hope that Valium plus baby plus lack of septum (and therefore more space for the hand that rocks the speculum) might mean no tenaculum, even. A girl can dream.

Item: I mentioned this to the nurse who took my blood on Tuesday (progesterone check), and she asked if my inseminations had always been difficult. They were, I said, but less bad with the Valium. I think the first one, with no Valium, was traumatic for everyone, not just me, and for me it was downright ghastly. (To say nothing of the pressure I felt to think warm, welcoming thoughts for a baby, while I was getting stabbed and prodded to the point of tears.) Yes, she said, I think I was there.

And you know what, I feel downright comforted to know that she remembers. The Baby Factory is a big place, with a lot of patients, and this was some time ago. I just looked back at the post I wrote at the time, which in no way captures the horror — no doubt I was imagining some future baby reading about his beginnings and didn’t want to scare the mite (guess who hasn’t filled in the birth story page of her son’s baby book?). We don’t need to go back over such old wounds as that, but suffice it to say that directed coughing in no way distracts from the pain of having yet another cervix stabbed with pointed tongs yet another time, and that seeing the doctor break a sweat isn’t very calming. No one said anything much about it at the time — and what could they have said that would have done anything but worry me? — but I am relieved to know that my impression of the day wasn’t crazy.

Item: That the transfer is on Friday means a doctor I haven’t met before (I think. Unless she was at the aforementioned IUI of nightmares.) will be on duty. And thank heavens for that. Had it been Thursday, we could have had the same guy who did the Bean’s ET, which has a cute aspect to it and all, but also has the less winning quality of requiring me to spend more time pants-less with a paternalistic asshole.

Seriously, I don’t know what this guy’s deal is, but it certainly could use a slightly more robust idea of his patients’ bodily autonomy. I found myself in stirrups with him again last week. He looked at my chart and said, in a disbelieving tone, “natural FET cycle? Why would you do that?”

You know that thing when some guy asks you some supposedly neutral question, like what your name is or why you look a certain way (usually: not thrilled just to be near him), and you just know that no matter what you say, you’re about to get hit on/told you are misbehaving/both? (And okay, I’m sure there are instances of women doing this, but stick with me here.) And you seem, in that moment, to have a choice about how to respond — to take the question at face value or to address its obvious subtext by ignoring him/ rolling your eyes/ telling him off — but really, there is no choice, because either you are going to walk right into the condescension (by being nice), in which case you aren’t allowed to complain about it, or you are going to socially overreact, which means you get called a bitch? Anyway, Dr. Paternalistic (who shares a name with a city in California, if you are local and curious) is like that. There’s no right answer. Except instead of his being a stranger on the street, he is the only one in the room wearing pants, and he’s holding an ultrasonic baton.

Gamely, I said, “why not?” And really, why not? My actual doctor thinks my odds of success are the same this way as in a more medicated cycle. But he didn’t like that answer, because this kind of cycle means I have to come into the office a lot, which, by the way, I haven’t indicated any impatience with, because I don’t actually mind. So I said that I liked that this cycle meant I could avoid the progesterone shots (since my body will make its own, meaning the suppositories are sufficient insurance). This isn’t an insignificant reason, to my mind — a few extra office visits versus stabbing myself in the increasingly lumpy ass for three months? No contest — but he looked unconvinced. “Also,” I said, bracing myself, “I liked the idea of letting my body do its own thing, since there’s no indication of any problem with my hormones.”

“I GUESS,” he replied, with all the self-effacing deference I’d expect from a fourteen year old. And then he stuck a dildocam in my vagina. Because that’s how this game goes. At least there’s no septum for him to make me feel bad about anymore.

Item: I cried on the bus ride to school after that. I’m sure it’s frustrating, as a doctor, when patients don’t make the same decisions you would — hell, I’m frustrated by other people’s decisions all the time — but maybe make a distinction between decisions that actually have anything to do with health outcomes and those that don’t. And then maybe try not to be a jackass, also.

Item: On the other hand, the nurse who gave me my trigger shots (two, because they are subcutaneous now and therefore weaker) on Saturday is in my good books. She, too, noticed and commented on the NATURAL scrawled on my chart. They don’t do many cycles this way, and that note has a lot of highlighter on it. “Good for you! Making your own follicle!” And then she stabbed me in the stomach (because that’s how this game works) and we talked about people eating their placentas. Not our thing, we agreed, but no reason others can’t do it. Imagine that.

Item: For the medical record, the progesterone is different this time. Last time, it was little waxy bullets from a compounding pharmacy, but this time I was given a choice between Crinone twice a day or prometrium thrice. My decisions was entirely based on math: 2<3. So far, the crinone is fine, except for making me crampy and leaving an absolutely revolting substance behind for removal during shower-time spelunking. Still, I will take gross over painful any day of the week.

Item: For the further medical record, following an awful morning of intense nausea, I decided to be pushy and ask if I really needed the doxycycline I'm on, given that I've had no invasive egg retrieval this time, no one thought I needed prophylactic antibiotics for an IUI (which is not essentially different from an embryo transfer), and my stomach is still all ducks and drakes from this sinus adventure. Message relayed via nurse is that I can indeed stop it, and I think I shall. I shall carry on with the methylprednisolone (how much extra do you think my insurance paid for the pre-metabolized version of a cheap, old drug?), as I can see the medical point of that one.

Message goes on to say that I must also stop taking Prilosec and Pepcid post-transfer, which is less good news. (Sinus doctor wants me to stay on both for another month while things heal; they a not presently back to normal.). I remember from last go-round that Dr. BF didn't even want me taking lysine for cold sores while under his wing, so this is hardly surprising. Lysine is an amino acid, for crying out loud; it's in FOOD. Similarly, I was directed to take both Pepcid and Prilosec while pregnant with the Bean, though admittedly later in the process. I guess every drug is suspect except the fertility drugs, which we all know wouldn't hurt a fly. I am at heart a Good Girl, though, so I will try for a bit and cry to my new OB if things get hairy.

Item: I can't believe the Bean is still asleep, but I woke him up prematurely yesterday (following his passing out on the floor in the late afternoon, following heroic meltdown, following utter refusal to nap earlier) and he still didn't go to sleep in a timely manner last night.

Item: Acid reflux and moral purity be damned, Sugar and I are going out for what I hope is a last-gasp cocktail tonight. Which means the Bean will have a babysitter, and sleep, well, that's her problem.


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Falling Lessons

I took the Bean to the playground for half an hour yesterday.  He came home with two bumps on his forehead, one of them scraped, a fair amount of grit on his face (I had already helped him clean out the stuff in his mouth), assorted tear-tracks on his cheeks, and a big smile.

In short, it was a successful trip.

I could have prevented all three big falls, and if I correctly understood the conversation the nannies on the bench were having about me, I should have.  (If they weren’t talking about me — and I am 90% sure they were — they were talking about someone doing the same things I had just done.)  They were particularly unimpressed with the idea of letting a young toddler climb the tallest piece of equipment alone only to watch him tumble from the highest platform to the middle one while I was on the ground, too far away to catch him.

If my goal at the playground were to eliminate falls and bumps (as it might well be if I had a parent employer to answer to), I’d agree, but in fact, I do not regret letting him climb up there, and I will do it again.  He is a toddler, and falling down is his job.

My job is to keep him safe.  When he was an infant, that meant making sure he was never going to fall and being there to catch him if he started to.  (Not that I always succeeded: his very first successful proto-crawling was straight off the bed.)  These days, as I see it, it means giving him the chance to make mistakes in a setting where mistakes aren’t fatal.

So I let him climb the tall equipment by himself.  I guard the high drop-offs and stand ready to catch him if he goes flying off the end of a big slide, but otherwise, I am working on keeping my distance in the playground, letting him decide what he wants to climb up or dangle from.  Most of the time, he moves in safe ways, and if I am surprised to find he is suddenly tall enough to lower himself down in a new place or strong enough to pull himself up when he changes his mind, that he can balance well enough to scale the steeper steps, he seems to know just what he can do.  From time to time, he gets a little hurt, and if he doesn’t get up and carry on by himself, I pick him up and talk to him until he is ready again.

I read about a study some time ago on this topic, which I had hoped to link to here but can’t find.  (And holy mother of pearl, did my attempts at finding it ever turn up nests of fear-mongering nonsense and ambulance-chasing slimeballs.)  The gist was that going too far in keeping young children from ever being able to hurt themselves actually increased the likelihood of serious injury later in life, perhaps because children who don’t get hurt are less likely to develop an appropriate sense of personal vulnerability.  A toddler with no such sense (or, as I like to put it, “a toddler”) may bump his head or even break a bone, but a teenager who hasn’t internalized the possibility of hurting himself has access to much more dangerous environments and might die.

Lest this post turn into “Tender Timebombs: How Taking Care Could…KILL YOUR CHILD,” let me say that I don’t advocate the kind of blindness to history that romanticizes the lives of two-year-olds who cook over open fires and so on (see: letters to the New Yorker editor in response to that spoiled children article making the rounds).  I am glad that the playgrounds here have rubber under the equipment, and I did notice the maximum height the Bean could fall from and the material he would hit (3 feet-ish; wood) before choosing not to climb with him yesterday.  At home, we are currently embroiled in another round of power struggles over his desire to climb into our windowsills: our windows are (per NYC law) barred, but not all windows are, and falling from that kind of height is not the kind of lesson you recover from.

Even outside, we aren’t always in playgrounds, of course, where physical risk tends to be mitigated (lest it be litigated, ya get me?); we also spend a fair amount of time in our community garden, which is beautiful and fun and not at all childproofed.  There is a special box of dirt for toddlers to dig in (God bless the woman who pushed that addition through; I didn’t object at the time, but I didn’t Get It, either), but there are also rusty tools, unstable piles of brick and rubble, and more than a few shards of broken glass.  Now that late summer is here and the plants are tall, I often can’t see exactly where the Bean is while simultaneously getting my own work done.  So I don’t.  He does his work of exploring and digging and climbing the uneven slate steps, and I do mine of watering and weeding and letting him go.  I keep him away from the gate (cars being one of those one-time lessons), shut the shed door (lawnmowers, ditto), and remind him to be safe when he is near the bricks.  I try not to worry, and sometimes I even succeed.

Can you find the toddler hidden in this picture?  Me neither.
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Trick Question!  He was already back at the stairs.

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The last time we were in the garden together, the woman with the bed next to mine was pruning her blackberry bush and consequently building a huge pile of prickly brush, which the Bean naturally found most alluring.  She was worried about the Bean and clearly biting her tongue a bit at my not moving him away from it, so I did make him watch me put my finger near it and mime getting hurt.  I expected that play to mollify her a little and have no effect on him whatsoever, but in fact he left the pile alone.  I almost wish he hadn’t, since I still don’t know whether he understood me or not, and if he had pricked his finger, he’d have seen cause and effect.  It’s not that I want my child to get hurt, you understand; it’s just that a pricked finger (or a bumped head or a scrape or two) is a very cheap way to learn a very valuable lesson.