I've Moved!

My new blog is called Reflections from a Global Nomad, in order to acknowledge that we no longer live in Maadi and that we are, in fact, global nomads, not staying in one place longer than two or three years. Please join me at http://DeborahReflections.blogspot.com

Wednesday, January 27, 2010

A Momentous Day

It was Sunday. It started off pretty normal, I think. I was exhausted--partly because I hadn't slept so well the night before, due (once again) to too many trips to the bathroom. I also was anxious. I knew that the day had the potential to be pretty momentous, and not necessarily in a good way. We had an ultrasound scheduled for that afternoon.

It was a routine ultrasound, for routine screening of genetic defects, of which we are not particularly at risk. But two things were stuck in my mind: When researching nucal translucency online, I had run across a sentence saying, in effect, "some people who go in for this ultrasound discover that the fetus has no heartbeat." And a few nights earlier, I had woken up with particularly painful cramps in my abdomen. The cramps were not accompanied by any blood at all. They actually were similar to cramps that I've had in the past when dealing with constipation (not a pleasant topic, but face it, it's common for many people and not just during pregnancy), and I had pretty well convinced myself that that's what they were. I didn't call the health unit, didn't consult with any medical professionals, didn't even tell my husband. But there was still that niggling worry in the back of my mind ... what if it was more? What if the ultrasound showed that the fragile little heartflutter that we saw before had disappeared altogether, rather than turning into the fragile little heartbeat that it should now be? You can see how quickly I go back and forth between trusting God with my worries and taking them right back upon myself. I have a feeling that the struggle to leave this little one in God's eminently capable hands is going to be a long one ...

Anyway, in addition to dealing with the anxiety, I was dealing with exhaustion. As I mentioned, part of it was due to too many nighttime excursions to the loo, as my British friends would say. But there's more to it than that. No matter how long I sleep at night, how well I sleep, or how few times I have to get up, I'm still exhausted during the day. I accepted that up until recently, but I'm coming out of the first trimester now. I'm supposed to be getting my energy back, and I'm not. I can easily sleep 12 hours at night, then take an hour-long nap within three hours of getting up in the morning, and still be ready for bed by 8pm. Friends have told me how tired and pale I look; one former labor and delivery nurse called me up just to ask if I'd been taking my iron tablets--she tried to be nonchalant, but it was clear she was concerned. I told her that I didn't have iron tablets, but I'd been taking my prenatal vitamins daily. She agreed that they should have an adequate amount of iron, so I should be okay. But this conversation made me curious, so I did what I always do when I have an unanswered question--I turned to the internet.

On Sunday afternoon, before the ultrasound, I started researching pregnancy and anemia. At first, everything seemed like old hat--there was nothing that What to Expect When You're Expecting hadn't already told me (great book, by the way; I highly recommend it, although I think I ended up with a British version--but I picked it up locally, so it's not too surprising). Then something clicked. It was something I'd read a million times but hadn't really applied to my prenatal vitamin. All the websites that talk about dealing with anemia and getting enough iron while pregnant caution readers that the body's absorption of iron is inhibited by calcium and is promoted by Vitamin C. I had skimmed over that important information so many times--and then it hit me. In order to disguise the nasty taste of my vitamin, I had been taking it with milk. As in high calcium, low Vitamin C, exactly the opposite of what I needed. I've probably prevented my body from actually using all that iron that the prenatal vitamin is providing. So I decided that I needed to start taking the vitamin with grape juice (low calcium, 100% RDA Vitamin C). That alone would have made the day momentous--I still don't have much energy, but it takes a while to replenish iron in the body, so I expect to feel better before too much longer. I also fully expect to be told by my doctor tomorrow that I'm anemic, based on last month's blood work, and I intend to explain what I'd been doing and see what other changes I need to make to replenish the iron as quickly as possible. So hopefully, one problem turned the corner and began being solved on Sunday, before it could do serious harm to me or the baby.

With one concern relieved (although I was beating myself up over my apparent inability to connect the dots earlier), I headed off to the hospital for the ultrasound. Jeff was able to meet me there, and we followed the instructions we'd been given as to where to go and whom to talk to. In no time, I was lying on the table with the cold goop on my abdomen, Jeff standing beside me. The doctor, whose English was perfect--he'd spent a few years in New York--was surprised that we wanted a nucal translucency ultrasound. He wanted to know why we were worried. He accepted that it's routine screening now in the United States, and seemed to have the typical Egyptian attitude of "well, if you want it, you can have it, although it does blow my mind that such an expensive procedure is routine, even for low-risk pregnancies, in America." (The ultrasound cost LE150, roughly $30, which is a big deal in a country where the average citizen survives on around LE10 or $2 a day.)

And then came the second momentous event on Sunday--by far the more momentous of the two. We saw our baby. And he* looked like a baby. A real baby, not the bean-shaped blob of former ultrasounds. The head was clearly a head, although disproportionately large, as expected at this stage of development. The body was clearly a body. I never did see the legs, although the doctor insisted that all the major body parts were present. But the baby was waving at us. You could clearly see his little hand sticking up above his head. And then he decided to greet us--or maybe to protest the ultrasound--in a more visible way. With the doctor holding the ultrasound wand perfectly still, we saw the baby's entire body shake, then lift. After that, baby did not take a break; he was jumping around for the rest of the ultrasound.

The doctor pinpointed the heart and showed us the little heartbeat, although by that point, I didn't need to see it. The baby's movements were enough to convince me that our little guy is still alive and kicking. But the doctor had another surprise in store for us. He turned on the speakers. And I heard the most beautiful sound--the rapidly beating heart of our preborn child. We even heard the extra effort that it took to make a particularly high leap in the womb. It was a strong, steady heartbeat that would have reassured even the most anxious mother that her baby was doing just fine.

It was such a special time. I don't know if it was seeing the baby, or hearing the heartbeat for the first time, but something inside me that hadn't fully believed that we really are pregnant finally started to believe. It still doesn't feel completely real yet, but ... I'm not quite sure how to explain it. Even though it doesn't always feel completely real, I completely believe now that there really is a little life growing inside of me. Before, I knew it was true, but I didn't fully believe it somehow. I'm sorry; that's the best I can do. Maybe others who have experienced pregnancy can explain it better than I can.

So there you go. That was my momentous day. I'm sure there will be others during--and after--this pregnancy, and I'll be sure to share them with you as well.

*A note on pronouns: It's still too early to tell the baby's sex from the ultrasound, although we will find out just as soon as we can. I generally use whatever pronoun pops out, although it seems to be feminine most of the time for me, whereas Jeff tends to use masculine pronouns. Some days I say "she" all day; others I say "he" all day; and others, I alternate. But Jeff and the doctor both were saying "he," and that is technically the correct pronoun to use when the sex is unknown and you don't want to use the cumbersome, politically correct "he or she." So for the purposes of this post, I'll stick with masculine pronouns ... although I make no promises about future posts.

Sunday, January 17, 2010

The Birth That's Right for Me

Last night I finished reading a book called The Birth That's Right For You: A Doctor and a Doula Help You Choose and Customize the Best Birth Option to Fit Your Needs by Amen Ness, Lisa Gould Rubin, and Jackie Frederick-Berner. I have to say--I loved this book!

Everyone has an opinion about childbirth. People who have given birth before are adamant that others should (or should not) have experiences like theirs. It seems that the web is full of natural-birth advocates, whereas real life is full of medicated-birth advocates. Doulas and midwives say that the best place to give birth is at home or in a stand-alone birthing center. Doctors and disbelieving lay people insist that the only safe place to give birth is at a hospital. Many people assume that birth will happen in a hospital, with a doctor in attendance, and anything else occurs only if you wait too long to head for the hospital. Others assume that if you go to the hospital, you'll end up with a Cesarian or a cookie-cutter vaginal birth that you weren't really present for anyway, because of the drugs. Even if you go natural, people will push Lamaze, or Bradley, or waterbirth, or hypnobirth ... No matter what the opinion is, it seems like everyone has one, or at least an assumption about what childbirth will look like.

That's what I loved about this book--they didn't.

This quote from the introduction pretty well sums up the philosophy of this book: "The best and most satisfying birth experiences happen when you're able to make choices in labor and delivery that are based on who you are, not someone some childbirth expert tells you that you should be." So if you feel most comfortable giving birth at home, go for it! If a homey birth center is more up your alley, feel free. And if you feel most protected and comfortable in a hospital setting, that's exactly where you should be. Narcotics, epidural, natural pain management strategies--you'll know what methods will work best for you based on how you handle stress and pain in your normal, not-giving-birth-at-the-moment life.

I started this book feeling pretty confident that I wanted a natural birth in a stand-alone birthing center, with a midwife to catch the baby and my husband and a doula to help coach me through it. I wanted a natural birth because I truly do believe that a medication-free birth is best for the baby--narcotics can cause a baby to born sleepy, so sleepy in some cases that the child can't even breathe without help; an epidural is difficult to dose right, and if you're given too high a dose, you may not feel your body's cues to push or be able to push effectively when you try, resulting in the need for an emergency Cesarian, which is major abdominal surgery. I figured that the best way to have a natural birth was to birth in a location where that was the only option--there would be no pressure, no repeated offers, and a major relocation to the hospital if I changed my mind. But I also have to admit--I was pretty scared of the whole notion of natural childbirth. By the time I get back to the States, I may or may not have time for a natural childbirth course. Even if I take one, they often seem to rely on one's ability to relax using visualization, which is not my strong point. And the more I read about birth, the more I am told that fear, anxiety, and an inability to manage the pain of contractions combine to stall labor, resulting in a Cesarian ... which I absolutely do not want unless it's necessary to save the life of my baby.

As I read this book, I started thinking about my natural coping strategies. What do I do when I'm afraid, stressed out, and in pain? My first response, at least to pain: Go to the medicine cabinet. Uh-oh, Houston, we have a problem. Because I really do want to avoid medication during childbirth, yet I also really do have a notoriously low tolerance for pain. And the natural coping strategies that I've read about so far really don't fit my personality all that well, either. I can't visualize to save my life. I do eventually relax in a hot tub or pool, but never until I can be confident that everyone else is engaged somewhere else, and no one is paying attention to me--unlikely if I'm using a birth pool to take the edge off of contractions during labor, with my attentive husband and doula hovering over me. When I'm in pain, I don't "walk it off." I tend to freeze, sink into the couch or bed, and maybe rock back and forth just a little. My main coping strategy is prayer, combined when possible with a generous dose of medication. I haven't seen either of those strategies listed in any natural childbirth books!

So where does that leave me? Someone who wants a natural birth but who seriously doubts her ability to have one? This book helped me realize that it really doesn't have to be an all-or-nothing proposition. I can give birth in a hospital, with a doctor or nurse midwife who is supportive of my preference for natural birth. But if my labor stalls and it starts looking like a Cesarian is in my future, or I just can't handle it, I'm exhausted, and I need to sleep--to remove myself from my body so that I stop fighting the work my contractions are trying to do--I can request an epidural. And the knowledge that I can request an epidural, that I don't have to handle the pain indefinitely if I feel like I can't do it, will allow me to focus on one contraction at a time, which I think I can handle. And if I can't, there's the epidural. After all, if I can't relax enough for my contractions to fulfill their function, I'm headed for a Cesarian. As much as I shudder to think of a needle going that close to my spine, a catheter staying there, an IV pumping me full of fluids to avoid a sudden drop in blood pressure--all of those things will happen by necessity if I have to have a Cesarian. Why not try everything possible to avoid one?

So here's what I'm currently thinking I want in childbirth. Keep in mind, though, that as I do more research on natural childbirth methods, gather information about classes that may be available once I'm back home, and come into more information in general, I may change my mind. And that's okay. But here's what I'm currently thinking:

  1. I intend to deliver in a hospital, with my husband and a doula by my side, using natural coping strategies. However, it will give me peace of mind to know that medication is available if I need it. (I'm still going to have to get myself okay with the idea that I'll probably have to have an IV, or at least a hep-lock, soon after I arrive at the hospital, but that's a compromise I think I can make.)
  2. There is a women's center 30-45 minutes from my hometown that is staffed by two female obstetricians and one female midwife. Seeing as how I've never had a pelvic exam from a male doctor, and the very thought makes me tense up like crazy, I think I need to give them a call on Tuesday (after the holiday), ask a few questions, and see if they could be a good match for me. I don't want a male doctor doing a routine exam to cause me to tense up and stall my labor on the big day--and I know myself well enough to know that I will never be comfortable with a man who is not my husband doing anything "down there." This women's center was recommended by a doula who is a firm advocate of natural childbirth, so I'm pretty sure that they will be supportive of my desires for a natural childbirth. But they also deliver in a hospital, and the doula who recommended them knows that I want the option of pain medication, so I'm thinking that will be an option too. I'll confirm all of this when I talk to them. And I already know that these practitioners are preferred providers for my insurance, which is a big financial plus!
  3. I want to hire a doula who is very experienced in natural childbirth, but who also can function well within a medicated childbirth situation. I have referrals for two women--one a newly certified midwife who still does doula work while building her midwife practice, and one who is in training to be a midwife. I'm thinking they will be comfortable functioning as doulas in any birth situation, but their midwife training will be particularly useful when it comes to helping me keep the birth natural. I've already sent emails to these women, so I'm waiting to see if they're available and how much they charge before I start trying to figure out which of them is the better match for us.
  4. I'm still hoping to find a natural childbirth class that will work for me, and maybe even a last-minute "crash course" for my husband.
  5. My ultimate goal at the end of the day--or the beginning of the day, depending on when the baby decides to arrive--is a healthy baby and a healthy mama. My secondary goal is vaginal birth, as opposed to a Cesarian. (Cesarians are fine for those who need or want them--please don't think I'm saying anything other than that--but I'd really rather avoid surgery if at all possible.) My tertiary goal is a natural vaginal birth, as opposed to a medicated vaginal birth.
So there you have it. The birth that's right for me. At least, the birth that I think is right for me at the moment. Any comments or suggestions? I'm still exploring natural birth options in particular, so if there's something that worked really well (or really not-so-well) for you, I'd love to hear about it.

Wednesday, January 13, 2010


Okay, so this isn't a real blog post. But I went to Baby Wash on Monday, and on the way back, I saw something that you'd never see in America, so I took a couple of pictures, and I want to share. Here you go:

Tuesday, January 5, 2010

Not Much

Going on, that is.

I realized that I haven't posted anything in over a week, and I'm trying to do better about not disappearing for long periods of time, so I thought I'd pop in with an update.

I haven't posted anything lately because there hasn't been that much going on. I'm about 10 weeks along now, with no major problems. I haven't even had any morning sickness, although I do feel a queasiness that comes and goes throughout the day, sometimes slight and sometimes not-so-slight.

My daily routine has pretty well established itself: I get up shortly after 7a.m. to feed the cats, then go back to bed, getting up again around 9. I laze around the house, waiting for my daily dose of energy to arise, eating breakfast and reading online until 11 or so. I get a shower. Then I have a brief productive period--at least as productive as it gets nowadays--when I do laundry, the dishes, and sometimes sweep the floors. Then the exhaustion kicks in again, and I sit. I may read, watch TV, or get on the computer, but it's nothing productive. I try to cook dinner when Jeff comes home ... but as often as not, he walks in the door, takes one look at me, and asks what I want to order for dinner. We eat dinner, watch a little TV, and I'm in bed again sometime between 9 and 10. I wake up four or five times a night to go to the bathroom. Then I get up around 7 to feed the cats, go back to bed until around 9, etc etc.

I feel very lazy. But I'm just so tired--I don't have the energy to actually *do* anything. I don't know how women do it who work outside the home during their first trimesters, or who already have children who need to be cared for, or who can't afford to hire help around the house. People keep telling me that I'll get my energy back in a few weeks. I can't wait.

Of course, there are days when I do have to do something. I have to get up early to go in to the health unit for an appointment, or I have to go to the commissary. Over the weekend, we actually had friends over for a game afternoon--we played Settlers of Catan, which is a really fun game that never gets old. On days when I have to get up early, I take a nap around lunchtime, when the workers renovating the apartment downstairs take their lunch/prayer breaks. On days when I have things going on in the afternoon, I just don't do laundry or anything else. But overall, I'm spending my days in the apartment, doing what I feel like I can do, and waiting to get my energy back.

I also realized that by the time I need maternity clothes, I won't have time to wait for them to arrive from the States, and I really have no idea where to buy special size maternity clothing here (I'm on the large side even without the soon-to-come pregnancy belly). So Jeff and I agreed that I should go ahead and order some stretchy pants, in a size larger than I actually wear, so that my in-between regular and maternity pants are here whenever I need them. The plan is that we'll order maternity pants the day I first need my stretchy pants. They arrived yesterday--now I'm wondering if I'll even need maternity pants, with as big as they are already, and stretchy too. We also ordered a few maternity shirts to have on hand for when the time comes. They shipped a couple of days ago, so they should be here within a few weeks. It would be nice to know that I could just go out to the mall and find things as I need them, but living overseas makes it more difficult to do that. Jeff suggested that I could just go traditional Egyptian in my dress during the pregnancy--I probably could find appropriately sized gallabeyyas and/or abayas. But I'd rather wear clothing that I'd feel comfortable in even once I go back to the States for the birth.

So that's what's going on with me. I'm spending lots of time lying around, trying to plan ahead for things that could sneak up on us. We're also planning to go on a Nile cruise in February--one we'd already booked before we got pregnant--so I'm really hoping that the exhaustion lifts before then. (And for the worry-warts, my embassy doctor has already approved the trip; we'll talk at my next visit about the things I should avoid or be careful of, but she has no problem with me going.)

And now it's 11:30, so I need to go get my shower. Computer time ran long this morning ... but since I'm still yawning, I'm not sure how much productive time I'm going to get today anyway.