pregnancy/parenting


Contact me if you want tickets for this worthy cause! BCPO Raffle 2012 Flyer

The TWiT Netcast Network with Leo Laporte

Megan Morrone kindly invited Brad and I to talk about parenting in the digital age on Jumping Monkeys, a show she does with Leo Laporte.  We had a great time doing it, though I’m not sure we were a paragon of parental unity.  Apparently, Brad and I will have to work out whether we’re going to read Izz’ and Cal’s emails and when to have their GPS chip installed.

Of course, there’s nothing freakish or remarkable about how so many twins came to crowd the preschools of New York City. Older mothers are more prone to throwing off two eggs at once, but they’re also more likely to have trouble conceiving, and opting for in vitro fertilization. The number of twins nationwide has increased by 65 percent in the past two decades.

Like every age of plenitude, for better or for worse, this era of multiples will probably come to an end.

Read more:  For an Era of Twins, the End May Be Near – New York Times

Isabella Granick Stone and Calista Granick Stone were born healthy and squealing on December 8th, 2007. Here’s how it went down:

On December 7th, my doctor called to inform me that my test for preeclampsia came back positive. Preeclampsia is a pre-seizure condition marked by high blood pressure and protein in the urine. The cure is delivery of the baby. So now I had a medical reason for induction, and I went in to the hospital later that afternoon.
Given my condition, we all expected the induction to take quite some time. Instead, they gave me a hormone to “ripen” the cervix and that sent me into full fledged labor less than an hour later. I think they gave me a quick release rather than slow release dose by accident. I also think I was ready to have the babies, as I was at 40 weeks and 5 days.

After a difficult hour or two, I settled in and spent the next 10 hours in unmedicated labor. I remember it as the same 5 minutes over and over again. Sleeping, noticing pain, breathing and moaning 5 times, pain receding, breathing and moaning 5 times, falling asleep again. Early in the morning on December 8th the anesthesiologist came to put in the epidural needle “just in case” it was needed. There were several scenarios where I definitely wanted the epidural, including a breach delivery of Baby B. However, getting the epidural in wreaked my concentration and resulted in a pretty painful 45 minutes as I tried to find a position that exposed my back for the doctor, but was also comfortable enough for managing the pain. Once that was done I tried to settle back into my pattern, but I’d lost my concentration and was getting close to 8 cm dilation. I got the epidural at about 7AM.

It was odd after the night of contractions not to know if I was having one, and to be sitting there chatting with Brad but knowing I was in labor. It was nice not to be in pain, but it was a strange disconnected feeling. At around 11A, the doctors came in to tell me that it was time to push the babies out, a process for which Kaiser requires mothers of twins to be in the operating room.

The operating room has a lovely view of the city, and when I got there there was a blimp lazily floating above the houses. I was to look at that view for the next 5 hours as I attempted to push out Baby A. The problem was that my contractions were six minutes apart. So even though I was pushing very effectively, the baby was sliding back in the interstitial period. I needed more contractions. First I agreed to pitocin, but that didn’t work. Next I wanted to stand up to allow gravity to help me, but I wasn’t permitted/able because I’d had the epidural. The nurses suggested other potentially helpful supported positions, but those did not work.

I believe the problem was that I was on magnesium sulfate for the preeclampsia, and that is a muscle relaxant. Taking a muscle relaxant when trying to have a muscle, the uterus, do the difficult work of pushing out a baby, is not helpful. After about 4 hours of pushing, they asked me how long I was going to keep at it. I told them I planned to push until the baby came out, and that I felt fine and would keep going. Having had the epidural had given me the break I needed (and a few hours sleep) to feel strong and rested. Still, the doctors began to talk about delivering the babies by Cesarean, which I did not want. I refused steadfastly, at which point they offered me “one last option”. They would use the vacuum on Twin A’s head to hold her in place, and I was to push her out. Brad asked everyone to leave the room, and we discussed it. I agreed to the vacuum, but would not agree that it was our last option. Nonetheless, the previously empty operating room flooded with people, clearly preparing for the surgical birth of the babies. One of the doctors was trying to tell me why the procedure was necessary. I remember saying “Let’s not talk about that. Let’s just win this thing right now.”

They put the vacuum on Isabella’s head, a contraction came, and I pushed her out in a single effort. Calista came headfirst 24 minutes later. It was the most exhilarating thing that ever happened to me.
Regarding my last post about induction, risk, health and welfare, here’s what my experience has lead me to conclude.

One medical intervention leads to another. Because I was induced, I needed morphine for the first two hours. Because I was on magnesium sulfate, I needed pitocin and eventually the vacuum.

You need a lot of medical knowledge if you want special treatment. I credit Charity Pitcher-Cooper, my Bradley Method teacher, with helping me have the experience I wanted. Charity said or showed us films that said a number of things I didn’t agree with in our 12 week class. In the final analysis, however, it was because of her that I knew to ask for the labor stimulating hormone that was less powerful and had less side effects (I can’t imagine what would have happened to me with the stronger agent). I was able to agree with the doctor about what signs indicated the babies were having trouble and what the absence of trouble looked like. This emboldened me to resist the surgery just because it was taking longer than they liked.

I have other thoughts about the experience, but an election is coming up, and I’ve got other posts I need to make very soon. Remember, if you want to receive the Granick Slate Card, which should be out in the next day or so, you need to check back here, or subscribe by visiting here.

Tomorrow is my due date. Its common for first time mothers to give birth anytime around the “due date”, plus or minus about two weeks. However, it is much less common for multiple gestation pregnancies, like my twins, to go all the way to term. Like many women, I’m now confronted with the question of whether or not to induce labor. Below I review some of the freely accessible medical literature on this question and conclude that there is no “Answer” to how an educated consumer of medical care would answer this question.

First, though, the added factor that I’m carrying twins complicates an already complicated issue in a couple of ways. There’s an increased chance of stillbirth with at-term twins, so getting them born is a higher priority. Twins are hard to carry, so hanging on to them longer has an deleterious impact on my fitness and health. And, I’m already at risk for an increased c-section rate, so I’m not sure whether to give additional risk greater or lesser rate (if its going to happen anyway, who cares vs. its already bad why make it worse).

Second, I should say that I would just schedule the c-section or induction if the babies would be healthier with it, even if the choice would compromise my ability to care for them right after their birth. The end result you are looking for is healthy babies, healthy mom. But these babies are perfectly fine, and the non-stress test they are submitted to every week shows health and liveliness. So we’re talking about health risks in the absence of evidence of any problems.

My natural childbirth teacher and the midwife community rejects induction. I respect this view, but I do think it tends to be based on a quasi-religious belief that “natural” is better than “medical”. Without getting too deeply into this opinion, I’ll just say that the metaphor they always use for birth is what a cat does when it goes into labor. But we are not cats. Human babies have disproportionately gigantic heads. This causes a different set of problems than a mama cat faces.

My doctor, like many doctors, recommends induction at 41 weeks. This is because a 1999 study shows that induction at 41 weeks (versus waiting for spontaneous labor at 42 weeks) has no effect on c-section rates and decreases the stillbirth rate. I respect my doctor, trust her, and think she’s very competent. But, I think she’s trained to believe that the application of her skills increases the chances that everything works out ok, as opposed to doing nothing. I don’t believe that this medical view takes into account all the relevant health and emotional factors for either mother or babies, it is intended to maximize survival regardless of other costs. Which is great if survival is at stake. But what if its not?

For example, induction and an unnecessary c-section has far less of an impact on her than on me. Induction means being connected to an IV and to fetal heartbeat monitoring devices. That means being pretty restricted in terms of movement, which means that a lot of the labor management techniques I learned in childbirth class will not be available to me. As a result of the more powerful contractions brought on by induction drugs and the limitations on my movements, I’d be more likely to need the epidural, which has its own risks and rewards.

More troublesome for my decision making, there are studies that reject my doctor’s conclusion:

Here’s a 2005 study saying that induction at 41 weeks means longer labor, more epidurals and no outcome benefits for babies or mother.

Plus, there are several other studies that show that elective induction increases the risk of C-section in first time mothers:

October 2000

February 2002

In short, you can basically find a study to support either view about the risks and benefits of induction. To determine which is right, or perhaps “righter”, you need to look at the methodology of each in a much more in-depth way that is appropriately the domain of professional scientists and medical professionals, and not the casual medical consumer like myself. I can look up critiques of each of the studies, but even there I’m just going by what someone else says, since there are criticisms on both sides. Do doctors and scientists have a consensus, because if so, its not clear to me, and consensus is often wrong.

In the end, I feel left with not much more than gut instinct. What do I follow, my doctor, or my anecdotally-based prejudice against induction? Whatever I decide, anything could happen. Take a simple game, like Blackjack. You play according to the odds, but sometimes you lose and sometimes you win. The same is true with medical decisions, and could be true for me. But I won’t have the mantra I recite to comfort myself when I lose at Blackjack, which is “at least I have the satisfaction of knowing that I played correctly”.

For the pregnant woman, there’s no odds cheat sheet to pull out of your wallet when you’re sitting at the green felt table.

If you’ve read “The Paradox of Choice”, then you are familiar with author Barry Schwartz’s argument that trying to maximize outcomes is a recipe for unhappiness, because in today’s option-rich world, there’s always going to be a different option that might be better than the choice you are about to make. Better, Schwartz says, to be a “satisficer” and just find something really good, rather than worry about whether its the best. Unfortunately, Schwartz fuzzes over the neurotic existential core question that drives one to be a maximizer rather than a satisficer. Probably we’d all be satisficers if only for the relief of stopping shopping around, if only I could tell the difference between getting something really good that’s maybe not the best, and worst of all, Settling.

So what does this have to do with Voila, Baby!? My cousin Kimberly Brown has started a business helping expecting and new parents prepare for and supply their offspring. This is a godsend for we maximizers, who want to get the right thing/a good deal/something special but don’t have the time or information to decide between 10 different kinds of strollers or diapers or cribs or all the stuff you need to have, never mind the bells and whistles. Kimberly’s put the family genetic shopping gene plus years of on-the-ground New Jersey training and her investigative journalism instincts to the task of figuring out what all the products do and helping people find the one that works best for their budget, lifestyle, aesthetics, etc. Avoid the dangers of settling and the depressive spiral of maximizing by letting Voila, Baby! figure this stuff out for you. Plus, your boss won’t catch you surfing baby sites while you’re at work.

On Saturday in Brad’s and my natural childbirth class, we watched a video which (in a short segment at the end) claimed that male circumcision was sexual assault and that abolishing it was one of five or six things that would help improve infant mortality rates. (I have the video at home and I will post the exact claims when I have a chance to review.) I proclaimed this claim “not charitable to the Jews” which instigated a discussion about the health risks of the practice.
I am not a fan of circumcision, but the claim that male circumcision has any adverse health effects on little babies struck me as wrong. Our instructor (who is to be commended for following up) provided us after class with the following statistics:

No one keeps records of circ deaths in the US. Doctors agree the
number of botched circ’s are under reported. Deaths are even harder
to count- due to the fact that the death maybe attributed to another
cause- infection, menigitis, urethral blockage etc. There have only
been 2-3 circ deaths in the medical literature, as case studies, since
the 1950’s.

Guestimated death rate for Circ in the US is reported to be- 2-3 per
year, or as many as 229 per year, depending on the source.

Here is my response:

I’ll have time to look at these numbers later in the week, but these statistics prove my point, which is that the movie is deeply misleading, if not outright false, when it says that abolishing circumcision is one of 5 or 6 important things to do to improve the infant mortality rate. Even if I take Charity’s highest guestimate, 229 US deaths per year, as true, the death rate among boys from circumcision (with about 2M boys born alive every year) is .01%. (or .016 if we just count the approx 70% that are circumcised). This is hardly a killer worth noting compared with prematurity, birth defects, drug abuse, SIDS, or the other double-digit infant killers. If we wanted to stop infant mortality, there are far more productive places to put our efforts, ones which perhaps don’t have the ideological heft of “sexual assault”, don’t point the finger at the practices of religious minorities, but are more uncomfortable for the powers-that-be. For example, the number one cause of infant mortality last year was prematurity, and one of the three major causes of prematurity is carrying multiples (cigarettes and drugs are the other two), and so many more (rich, white) people are having multiples now because of fertility assistance like IVF. That would be a more productive thing to attack, but of course, its far more politically unpalatable.

Of course, the 229 number is flagrantly, recklessly false. About 28000 babies die every year. Of those, I assume half were boys, 14000. If 229 of them died from circumcision, that would be an incredible 1.6% of the deaths that occur attributable to circumcision. That would mean that circumcision, while still at the bottom, is a more likely cause of death than menengitis, heart attack, bronchitus or a host of other baby diseases. http://www.cdc.gov/nchs/fastats/infant_health.htm (Cover up, anyone?) Later if I have time I’ll try to track down where that number came from.

I’d be interested in what information and thoughts readers have, both about circumcision and about the broader question of how the medical establishment and the media dispense information about health risks. Maybe I’ll hear from my colleague Prof. Dan Harrison, who I know is an expert on the sociology of circumcision!

For those of you with whom I have not had the pleasure of speaking in the past five months, who do not read Valleywag, or my husband’s blog, Brad’s Sketchpad, I’m hereby formally announcing that Brad and I are expecting twins in early December.

For those of you who have known me for a long, long time, you are probably pissing yourselves with schadenfreudistic glee that not only did I get married and procreate like I said I never would but you always knew was bullshit, not only that, but also fate duped me into having two at one time.

Others may be thinking, and indeed, have said in not so many words to my very face, “fucking over-achiever, it figures.” Both responses are welcome insights into the vulnerabilities of my personality, more of which are sure to be revealed by the awesome task ahead.
My own feelings could first be described as “shock” and now as “awe”. The science of how your body changes to accomplish this feat of procreation is nothing short of miraculous. On the other hand, its also pretty uncomfortable, and doctors disagree on some of the most basic questions, the answers to which you would think we would know, given how long women have been doing this thing.

Now that I’ve come out as a pregnant lady, I’ll be blogging more about the stuff that occupies my mind these days. Its not much different from the stuff I usually think about, but just writ in a different context. For example, my interest in security means I think a lot about risk mitigation and the strengths and limitations of cost-benefit analysis. Now I’m translating that framework for policy making to the question of whether to eat sushi, what baby car seat to buy or whether to use plastic or glass bottles.