“Pregnancy seemed to be a world of arbitrary rules”

This was my experience to a T. That’s why it was so refreshing to read this article posted by a friend on Facebook last week. Economist Emily Oster approached her pregnancy like, well, a scientist. She wanted to know the why behind the long list of seemingly arbitrary rules that a pregnant woman is given by her doctor and she had the tools of her trade at her disposal. She did a lot of research about the research- the actual peer-reviewed studies these rules are (supposedly) based on and, thankfully, wrote a book about what she found (which is now at the top of my reading list).

One of the most controversial issues surrounding pregnancy is alcohol consumption of any kind and Oster tackles this issue specifically here. Remember when the universe exploded because pregnant Gwenyth Paltrow drank a Guinness? And check out this comment on Oster’s Huffington Post article from NOFAS, the National Organization of Fetal Alcohol Syndrome:

comment

As Oster points out in this article, most women don’t need to be convinced that they shouldn’t go on a 24 hour booze bender or do cocaine off a toilet seat while pregnant. Most women are wondering about the safety of an occasional glass of wine or beer- a part of their lives they enjoyed before pregnancy, like a weekend road trip (which Oster points out is also “risky” behavior but somehow not controversial). NOFAS comment suggests that even questioning the “zero drinks is the only safe amount” policy during pregnancy is selfish and reckless.

Such criticism frames this issue as black and white, like the only options are selfishly drinking and likely harming your child or selflessly never touching a drop. They also reinforce this impossible ideal our society has placed on motherhood: 100% unquestioning sacrifice for our children to the point that we stress over Goldfish vs organic Bunny crackers.  Oster is simply challenging us to seek more information- where do these hard and fast rules come from and what does the science really say? And if provided with more information, don’t we have the capacity to weigh the pros and cons for ourselves to decide what’s best?

Oster’s work, in my opinion, goes beyond the debate over whether or not you can have sushi or a glass of champagne while you’re pregnant.  It is a good reminder for me of how important it is for women to take charge of their health- pregnant or not, it’s still YOUR body. She says: “pregnancy and childbirth (and child rearing) are among the most important and meaningful experiences most of us will ever have; probably the most important. Yet we are often not given the opportunity to think critically about the decisions we make. Instead, we are expected to follow a largely arbitrary script without question. It’s time to take control.”

I believe most doctors are well-trained experts who have their patient’s best interest in mind and I usually feel comfortable following their recommendations. But empowering yourself with knowledge about your health (whether pregnant or not, really) and your child’s health and feeling comfortable speaking your mind are important for multiple reasons, one of which being that sometimes health professionals have different recommendations. After little V was born, we had a bit of a rough road with nursing and he barely nursed at all for the first 36 hours of life. Our nurse thought this was a huge issue and wanted little V taking formula out of a bottle right away, but the hospital’s lactation consultant was less concerned and suggested we wait it out until we were at home and more relaxed. A few hours before we were set to go home, the nurse came over and started shoving a formula bottle nipple into little V’s mouth after I’d already expressed my apprehension about this (I was worried this might interfere with breast feeding down the road). In that moment, the mama bear came out and I tearfully demanded that she stop. I shakily reminded her that we’d decided to wait based on the recommendation of the lactation consultant. Fortunately, Little V started nursing shortly after we got home.

I don’t think she was a bad nurse; if anything, she was probably just having a bad day. What I find most disturbing is that I almost didn’t say anything because I was feeling emotionally fragile and intimidated (of course, I’d just given birth!!). But we’d talked about this very situation in my childbirthing class and had learned these tools: it’s ALWAYS ok to ask “why”. And if you know why, but still don’t feel comfortable, it’s always ok to ask “can we wait X amount of time and talk about it again then?” I think having this prompt in my head empowered me to speak up.

As Oster argues, we are continually weighing the pros and cons in our lives when deciding what house to buy or job offer to take. If only provided with more information, we might be better able to do the same in other important areas, like how we’d like to navigate our pregnancies and the birth of our child. Oster’s book looks like a great place to start.

 

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Nesting.

A new kind of nesting.

A new kind of nesting.

At 37 weeks pregnant, I can see the finish line! Last night I dreamed that I gave birth on the tiled floor in our entryway. I just pulled that baby right out myself and laid him on my chest while J rushed around getting ready to go to the hospital. I say, the positive thinking that hypnobirthing has given me! I usually have worst-case scenario dreams about everything, but I’ve yet to have one about labor or birthing. 

And the nesting. It is happening. I’ve heard stories of full-term ladies getting on hands and knees to clean their kitchen floor with a toothbrush or organizing baby socks by color. I’m doing the equivalent of this for sure- but only at work. I’ve cleaned/organized my desk, am currently cleaning and organizing the lab’s -20 freezer, and happily creating the most elaborate spreadsheets for my bacterial strains, plasmids, and what-have-you. I’ve had (almost) limitless energy the last couple days at work. It’s just so funny that our house, where the baby and I will actually spend the next 3 months, is pretty much a disaster and I have no motivation to change that. Does this mean labor is near? I’ve read the nesting urge increases towards the end. Either way, I am being super productive at work, so bring it on!

 

 

Hypnobirthing – what does science say?

http://www.hypnotism.co.uk/Cartoons/Self-hypnosis.jpg

In the previous post, I talked about how the year of 2012 has been the year of doing shit I never thought I would do. And signing up for a class called “hypnobirthing” would have been right at the top of the list had I even known such a thing existed pre-pregnancy. I mean,  I once had an anxiety attack DURING a yoga class. And Therapist M has tried to talk me through some meditation exercises a couple of times, but they’ve only made me more anxious. I don’t seem like I’d be the type of person who could achieve deep relaxation during childbirth.

So why bother? As many of my friends say, there’s no prize for having a drug-free labor. But one of my own recent medical experiences revealed to me that unnecessary medical interventions can cause more problems than they solve. In my case, one unnecessary drug created a cascade of issues that resulted in an emotionally and physically traumatic ER trip and what would have been about $10,000 in medical bills, if not for our glorious health insurance. And although I’m all for doing whatever it takes if my baby’s life is at risk, giving birth doesn’t usually involve a medical emergency. I mean, people give birth to perfectly healthy babies in caves, taxis, on airplanes, in fields… yet all kinds of seemingly unnecessary medical “things” come standard during in a hospital birth.

Anyhow, hypnobirthing came highly recommended by our midwives. The idea is that there is a culture of fear surrounding birth and that this contributes to a stressful environment during labor. Movies, TV shows, and even birth horror stories from strangers on the street all make childbirth seem scary and painful. Then all the standard poking and prodding laboring women experience further diminishes any hope for relaxation. And all this stressful input causes our fight or flight response to kick in during labor, which causes the cervix to clamp down (making the pain of contractions a hell of a lot worse) and the whole birth process to stretch out into eternity. So hypnobirthing uses principles of hypnosis (essentially, meditation) to promote relaxation and a calm environment to prevent stress, thus encouraging the body to open up and give birth on its own.

All this intuitively makes sense to me. From an evolutionary perspective,  it seems beneficial that our bodies would have a mechanism to stall labor in the event of a real or perceived life-threatening situation (like being chased by a rabid animal). And as J and I continue to practice hypnobirthing techniques, I do find myself able to be more and more relaxed each time. So whether or not hypnobirthing works for birthing, it has definitely helped minimize the take over of My Anxious Self in everyday life. But I’m still feeling skeptical. Will hypnobirthing actually help when shit hits the fan during labor? And here I’m looking for cold hard facts- do women who use hypnobirthing during labor have shorter, less painful, and simply easier labors then women who don’t use it? 

So lately I’ve been delving into the research- is there actually compelling scientific evidence that hypnobirthing works? Perhaps not surprisingly, I haven’t found loads of peer-reviewed studies about hypnobirthing. Here I’ll present the first study that popped up in google scholar and review some others next time. If you have a compelling study to recommend, let me know!

This first study is out of Australia (1) and sounds extremely promising from the abstract… they claim to have found shorter labor times, less drug-taking, and fewer c-sections in  hypnobirthing moms (based on surveys) compared to the general population. However, there are serious limitations to the study (most of which the author discloses herself). The sample size is small- around 80 for most of the stats. And instead of a proper control group (ideally, a similar subset of women who were not in the hypnobirthing program but took the same survey), they compare their results to stats from the general population. And one can think of all kinds of problems with this comparison. For example, the study suggests that hypnobirthing can play a role in minimizing c-sections: 22% of individuals in the study had c-sections compared to a general public rate of 38.4%. But what role does the actual hypnobirthing play here? Hypnobirthers are probably less likely to have a c-section even if the techniques themselves are useless. For example, a woman who already knows she’ll get a c-section (for whatever reason) probably wouldn’t bother signing up for a hypnobirthing class in the first place.

In general, this study contains a LOT of qualitative statements about the benefits of hypnobirthing but not a lot of numbers to back up the claims. And because there’s no control group, much of the information collected in the survey seems compelling but it’s hard to know what to make of it. For example, women were asked to address their discomfort level during labor and the author finds an average of 5.8 out of 10. This seems pretty good… except without a comparison to a non-hypnobirthing group, how can we know? And participants who opted for an epidural are excluded from this average.  I imagine their pre-epidural discomfort would increase this average substantially.

In the end, I didn’t find any rigorous scientific evidence in this study that women who use hypnobirthing during labor have shorter, less painful, and simply easier labors than women who don’t use it.

But… that doesn’t mean it’s not out there. And I’m willing to give it a go, sample size = 1.  

(1) Phillips-Moore, J. (2012). Birthing outcomes from an Australian Hypnobirthing Prgramme. British Journal of Midwifery, Vol. 20, Iss. 8, pp 558 – 564.

Some of the best of 2012

Indeed. Especially when half caffeinated.    (Image: zazzle.com)

It’s nearly the end of 2012, and it’s definitely been a year of ups and downs. This morning, I have been reflecting on some of the positives of 2012:

I officially became a PhD candidate

I had a blast vacationing/conferencing in the UK over the summer

I turned the big 30

I have experienced all the fun of Little V so far, and have been pregnant for nearly 2/3 of 2012

It’s been an eventful year! And it’s been a year dominated by, of course, science and babies. Pregnancy has resulted in some serious lifestyle changes. Some are predictable, like no booze. And yes, when you are a grad student (or a someone surrounded by other someones who just love the stuff), not drinking is an adjustment. But others were a complete surprise to me. And I have definitely changed in ways I never would have predicted.

So, with these big changes in mind, here are a few things that babies and science could NOT have lived without this year:

1. THE HALF CAFF/HALF DECAF COFFEE

I know, I know. Many pregnant women swear off coffee their entire pregnancy. But here I made a compromise- after reading some of the studies tentatively linking caffeine to miscarriage, I did drastically cut down to about 1.5-2 caffeinated cups a day. One thing that did help tremendously was that I realized that the routine of consumption was just as important as the little boost of caffeine itself. I simply love getting up in the morning and enjoying a couple of cups of coffee or meeting a friend for a latte in the afternoon. So rather than ration out the volume, I made an executive decision to trick my mind (and J’s). I switched to making half caff/half decaf in the morning. And honestly, I can hardly tell the difference. And because I only have about a cup of caffeine in the morning, I had no guilt about enjoying the occasional single shot latte in the afternoon.

2. THE BODY PILLOW

This one is a little more recent but was definitely a game changer. As an avid stomach sleeper, pregnancy made sleep difficult for me. You basically have to sleep on your side, and preferably your left side. For a month or so I used an assortment of pillows for between my knees, below my hips and my head. This definitely helped but I struggled to sleep for more than a couple of hours at a time and I could rarely get in more than 6 hours a night.  Because I was getting up at strange hours to study for my general exam, these bad nights of sleep were crushing. And my usual solution to tiredness was now severely limited (refer to #1). After a particularly rough night, I was having a nice little Saturday at BB&B and I remembered my sister’s praises of the body pillow for pregnancy. It was the best $20 I’ve ever spent. Other than getting up to pee several times in the night, I am in a dead sleep while bear-hugging that thing. I call it my boyfriend and J knows better than to get between us.

3. THE ELECTRONIC LAB NOTEBOOK

I honestly don’t know- does anyone still use a paper lab notebook? A couple years ago I made the switch from paper to having a new word document for every month. Having all my lab notebooks accessible at any time from home has really freed me up to do some work from home. And this kind of flexibility has been awesome as I get fatter and lazier by the day.

4. THE GOOD BLENDER

Until Taco Time and cupcakes start counting as health food, I have never been very good at eating healthy and this makes you feel really guilty when you are pregnant. When my midwife told me to steer clear of the salad bar at work, my fresh fruit/veggie consumption pretty much tapered off to the occasional apple and a few cherry tomatoes. Then I learned that I could combine all these gross healthy veggies (like kale and spinach) into a blender with delicious fruit (strawberries, raspberries, peaches) along with other healthy stuff (like flax seed, nuts, plain yogurt) into a blender and I would get a drink that tastes pretty much like strawberries. I now make a couple of these a day. The trick is a good blender- I splurged on a NutriBullet but any blender that can actually crush up frozen fruit will do. I feel awesome after drinking one of these things. I also get the satisfaction of being, for the first time in my life, one of those people who actually consumes the proper amount of fresh fruits and vegetables (humble brag!).

That’s all for now. Happy New Year!

35 weeks… but who’s counting?

Happy holidays!

It was absolute bliss to take 5 straight days off of work! J and I also had a pre-Christmas “treat yo-self” weekend at a lodge not far from the city. I enjoyed a pregnancy massage (wowza!) and ate several bags of peanut brittle. The beauty of being not far from home was that we felt zero pressure to go explore the outside world. We were like 2 little bears, holed up for winter in our room.

Our little vacation was perfectly timed since last week My Anxious Self was on high alert. The past few months, Therapist M has been pointing out that I may have some trouble setting attainable goals for myself and being realistic, which provides some pretty fertile soil for anxiety. Perfect example- time. If I have a 9am meeting, for example, I completely underestimate the time that it takes to wake, shower, get ready, get the bus, and arrive at on time. My first instinct is to give myself an hour because an hour feels like a long time. What actually happens is I am barely out the door at 8:50 am. I’m drenched in stress sweats and hoping that this one time the 15 minute bus ride will only take 5 minutes.

I have set some similarly ambitious goals for myself about wrapping up lab work before little V comes. And reality has started to sink in- within the next 5 weeks, I’ll  (probably) be having this baby. I’d been hoping to find a really clean stopping place for my 2 projects before leaving. Actually, let’s be honest, I’ve been hoping to make incredible progress- to nearly finish one project (maybe I can write a manuscript on maternity leave!) and make a few months worth of headway on the other project in the next few weeks. And what’s that phrase again- crazy people do the same thing over and over and expect different results?

Setting lofty goals comes from a good place, I think. I want to push myself (and impress my advisor, sure). But the result is that most days I feel like a failure. And with each failure, it’s almost as if I can see the time it will take to get my PhD extending before my eyes- I will still be here in 8 years if this PCR fails again! Not logical, but all the same, it feels so real.

So my goal for today is to set some REALISTIC goals for myself for the next few weeks. First trick is coming to understand what “realistic” means- can I accurately estimate how long things might take? And the second trick is to make these goals very flexible. If the baby comes early or my ankles swell to the size of tree trunks and I can’t walk, I do not want to be obsessing over plasmid transformations. I want to put dissertation baby in the corner- just for a little while- and enjoy this crazy adventure of having a baby.

 

Pregnancy dreams- and my possible sexism.

Oh, the 80’s.

Before I was even pregnant, I would have a recurring dream that went something like this- I would suddenly realize I had a baby (or several). I would be excited yet terrified. I would then find myself somewhere away from said baby(ies) and panic would set in as I realized that I had forgotten about baby(ies) and that they were alone and probably hungry, scared, etc. Panic stricken, I would spend the rest of the dream trying to get home and/or properly dial a phone to reach someone that could help me. (Why is it so hard to operate a phone in a dream?!?!). Of course, I would wake up having never reached home after many frustrating attempts to get there.

My dreams have gotten incredibly vivid as I get closer and closer to meeting little V and just last night I had a replay of “The baby dream”. Except, for the first time ever, I actually got myself to the hospital, gave birth (hypnobirthing worked great I’m happy to report!), and even successfully breast fed the little bugger. Then I left the hospital ALONE and suddenly, I was at a conference in Minnesota with my advisor, frantically trying to call J to get an update on our hours-old infant. Then a long procession of frustrating things happened, as usual- I get ahold of the neighbor who tells me our baby cries all the time. This makes me feel so sad. I get ahold of J who is out and about without the baby, seemingly unaware that babies cannot be left alone in the house. I am screaming into the phone at him about this, and adding other advice like “make sure he sleeps on his back!” and “he has to eat every 3 hours!”. And the whole time I am also trying to operate a computer to buy a plane ticket home because, what the hell am I doing at a conference when I just had a baby? And, I wake.

I feel like “The baby dreams: versions 1 and 2” must be about my anxiety over balancing baby life with the other life compartments (Venn Diagrams!). And it’s hard to disregard this fear- it’s pretty legit. It will be hard. I worry that I’ll feel guilty that one baby or the other (little V or dissertation) are suffering from a lack of attention. Both babies and grad school are more than full-time gigs. I’ll have to make sacrifices.

But “The baby dream: Version 2” also reveals something a little more disturbing- that I seem to regard myself as the only capable parent. In reality, I have an incredible husband and we plan on splitting up parental duties 50/50. In my dream, I have to reprimand J about leaving the baby home alone. Wow. Really psyche? In my dream, I seem to be the only one with any parenting common sense and J is useless.

I’m now trying to figure out if there are parts of me that really, genuinely, feel like I know best when it comes to looking after little V.  I’m used to being around families where the duties are largely defined by gender: mom stays home and takes care of babies/house, dad works. Both J and I grew up in families where things operated this way. So probably some gender biases have seeped into my subconscious. I’m also a child of the 80’s where there were no shortage of TV shows/films about the hilarious consequences of men *trying* to take care of babies. Does a part of me doubt that a man can be just as wonderful a nurturer as a lady?