Archive for pregnancy

Birth and Breastfeeding in Season 1 of Lost

There will, of course, be spoilers for Season 1, which is all I’ve watched so far. This is a warning re: such, and I’d really really appreciate it if you didn’t comment with spoilers for seasons *past* Season 1. Any such spoilers will a) make me all angry and annoyed, and b) not be approved. Thanks.

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Links links and more links from your lackadaisical and unloquacious blogger

Cult of Mommon over at Letters from Gehenna. In general, read the whole post, but in particular, this bit:

The “gift” of motherhood is a trap, simultaneously erasing investment and effort and commitment and choice and dedication and making it unconscionable to express displeasure, talk about issues, have postpartum depression, express a realistic picture of what it is to have a baby. It erases the experience in order to replace it with something clean and pristine that can be adored without contemplation of consequences or actual respect for the real efforts of mothers.

An Interesting Parallel and
Parallels Part 2 over at Keyboard Revolutionary. My teaser for you:

So what does it mean when another wielder of authority says, “Do what I say or your baby will die”? Are they looking out for your best interest….or are they a bully, a rapist, an abuser, deliberately playing on your unignorable instinct to protect the ones you love in order to get what they want from you?

My opinion: doctors and obstetricians who manipulate and coerce women into unneeded surgery are committing assault. They need to know that this is what they’re doing, and the ones who don’t care and won’t change need to be prosecuted.

Single Serving Pie in a Jar. I need canning jars and pastry. Stat.

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The system is broken if it doesn’t leave people whole – Part 5

Previous: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change

But then, I’m kind of an optimist. Or perhaps the better word would be idealist, although I think we are wrong as a society to say “idealist” with the kind of sneer. If we do not ask for and strive for the ideal then we’ll never come close. Asking for a compromised position right off the bat means that the eventual product will inevitably be even more compromised (just look at the current American health care debate for a prime example of that).

As I said before, I don’t believe that all or even most doctors and registered midwives are evil people looking for the quickest and most painful way to hurt people. That’s ridiculous. Of course most of them are caring and well-meaning people. I say that even though I’ve witnessed quite a few fairly ignorant or arrogant people in the field, one or two exceptionally abusive and manipulative individuals, and rather a lot of folks who exhibit that passive “just following orders/my protocols/our customs” well-intentioned uselessnes.

But the problem is this. The system is broken. It did not and does not have women’s best interests or the best interests of their babies at heart. It is a fraud.

A 30% c-section rate (and a 19% primary c-section rate) is not a bug, it is a feature of the broken system.

That some women would choose to give birth unassisted because they fear what they will experience otherwise at the hands of the medical system, this is also a feature. Unassisted birthers can be used by the mainstream model to make homebirth seem extreme and outlandish, something that only those crazy hippies or religious fundamentalists would do.

I say that as someone who chose to give birth unassisted, and who feels that this can be an awesome valid choice for some folks, but that it should never feel like the only choice available.

When I say that I believe people are well-intentioned, I should also say that it’s time for folks to face the fact that intentions really don’t matter. Or at best they matter only a little bit. What matters is not what you intend, it is what you do. It is the real results of your actions in real people’s lives. If you as a provider through your action or inaction facilitate 20% of of your clients right into unnecessary surgery with very real and significant impacts on their life, health, future fertility and reproduction and on their future children’s life, health and births, but you meant well, it doesn’t reverse the effects. It doesn’t change the real effects that a cesearean scar on her uterus and belly produce.

It seems to me that with a system as broken as this there are only two ethical choices. The first is the actively try to fix the system from the inside. The second is to work outside the system to provide another option for women. I suppose, now I think of it, that there’s a third ethical choice, which is get out of this business entirely. Passively continuing within the system, acting in such a way that you perpetuate the harm that it does, this is not an ethical choice.

I’ll be honest, I’m not sure if it is possible to fix the broken system from the inside, but if you are a care provider within the medical model, there’s a lot you can do to try. Here’s a few suggestions:

  • Practice research-based care.
  • Accept that women are individuals, their bodies are individual, and there is a wide range of normal.
  • If a rule is a bad rule, don’t follow it.
  • Don’t induce women at 38 weeks, at 39 weeks, at 40 weeks, at 41 weeks, at 42 weeks because you’re pretty sure she should deliver by now.
  • Actually, don’t induce them at all if you can help it. Women will, for the most part, go into labour spontaneously when they and their baby/ies are ready.
  • Don’t hold the threat of induction over their head, ever. “If you don’t go into labour by 42 weeks, we’re not allowed to do a homebirth.”
  • Don’t encourage women to induce “naturally”. We do not know exactly causes labour to start spontaneously, but we know that it seems to be a combination of factors regarding readiness for both mother and child. Knowing that, it seems foolish to think that a “natural” induction would be any less dangerous than an “unnatural” one. I would suggest that there is no such thing as a “natural” induction.
  • Actively encourage home birth for all women, low and high risk, since this is actually supported by research. Don’t force it, of course, but assume as a matter of course that this is where birth occurs. Research has shown repeatedly that hospital birth is not as safe as home birth.
  • If a woman prefers a hospital birth, do not admit her to the hospital before she is in active labour (4 cms).
  • Do very few cervical checks. Do none if you can manage it. Learn to gauge the progress of her labour using other less interventive signs.
  • Intermittently monitor the fetal heartrate with a stethoscope instead of using continuous electronic fetal monitoring.
  • Accept that it is not uncommon and not pathological for labour to proceed in a less than straight ahead fashion. Pauses and breaks in labour are actually quite common and don’t mean the process is broken and needs fixing.
  • Learn about non-narcotic comfort measures for women in labour.
  • Accept that there is a difference between pain and suffering, so that just because a woman is experiencing pain, that doesn’t mean she is suffering.
  • Accept that you don’t need to rescue women from their birthing process.
  • Learn to sit on your hands. A lot. Birth needs very little “doing”. If sitting on your hands isn’t a good option for you, learn to knit. Embroidery is probably another good option. Machine quilting might be a bit much.
  • Buy a good quality labour and birthing pool and make it available for your client’s births.
  • Don’t transfer women to the hospital or start otherwise intervening because of arbitrary timelines that have nothing to do with what is actually happening for her in her body. This includes long early labour, long active labour, long pushing stages, long periods with membranes released before the birth of the baby.
  • Use antibiotics responsively, not automatically.
  • Practice informed consent. Be able to articulate the benefits and problems inherent in the interventions you do offer or that clients request, so that nobody ever says, “if only someone had told me what this could do”.
  • If a woman has PROM (premature rupture of membranes), do no cervical checks at all. Be watchful for signs of infection and encourage good hydration and nutrition, but otherwise just be patient.
  • Talk a lot more about nutrition with your clients, since this is one of the only things actually shown by research to make a difference in the health of women and their babies.
  • Study methods to safely facilitate vaginal breech birth.
  • Keep mother and baby together in the period immediately following birth (out to a half an hour or more). They need each other.
  • Practice expectant management of the third stage of labour (delivery of the placenta).
  • Leave the cord intact until the placenta is delivered.
  • Foster friendships with likeminded individuals in your field. Have someone you can call when you think things aren’t going as they should.
  • If a cesarean is necessary, be as humane as possible. Don’t let a hospital’s rules get in the way.
  • Don’t be a martyr. Take good vacations. Get sleep at night. Spend time with your family. Birth work is unpredictable, but try to just live your life.
  • Take good naps at homebirths and eat good food. Nobody needs your attention 100% of the time, and it can be reassuring for women if her care providers remain relaxed and low key.
  • Get help to deal with stress. Foster positive relationships in your personal life.

Perhaps you already do some of these things. Perhaps these do not seem like workable suggestions to you. But if not, ask yourself why and own your answers. And feel free to add your own in the comments section.

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The system is broken if it doesn’t leave people whole – Part 4

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
Part 3: Illustrative Non-Fiction

I didn’t stop being interested. I hung around with a lot of unassisted birthers online. I didn’t stop reading or following research. The evidence for less interventions or for only appropriate usage of interventions keeps piling up, they reversed the prohibition on “allowing” women to go past 41 weeks without inducing them, a vancouver doctor did a massive study on episiotomy and proved once and for all how useless and dangerous it was and the rate actually dropped, there are positive changes.

At the same time, the rate of positive change is very very slow, and it often seems like for every one step forward there’s half a step back and one step off in a complete other non-helpful direction. I’ve been witness to two births in the last couple of months, one a homebirth and one a very interventive hospital birth. It was night and day between the two.

The homebirth was a VBAC and resulted in a home waterbirth to a beautiful baby. This was after the mother was told she couldn’t possibly have a homebirth after a previous cesarean. She then asked her care providers whether she could at least labour in a tub of water in the hospital and was told that of course she couldn’t. Irrirtated at being undermined at every turn in her very reasonable and safe wishes for her birth, she sought out a traditional birth attendant who had no problem facilitating her (safe) homebirth.

The hospital birth was of a young woman having her first baby with registered midwives as her caregivers. It was truly shocking to me. It was as though someone had brought to life my old story of the cascade of interventions. The fact that the birth ended in a c-section was all so unnecessary, every step along the way so unsupported by the available research.

It’s sometimes mind-boggling that as a birthing community, in which I include doctors, midwives, doulas, OBs, pregnant women and partners and all the rest, we can know the right things to do or not do. We can have the research in front of us, from well-executed and documented studies and trials and we can have it for years with every new study backing it up, and yet the reality of the abuses that occur in mainstream birthing all in opposition to what we know continue. Does spontaneous uninterfered with birth just not have a great marketing department? I don’ t know, and I sometimes feel very discouraged.

Next: Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 3

Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics

The last birth I went to as a doula was for an aboriginal woman and her husband who had been referred by a friend of a friend. I met them, literally, outside the hospital’s door when they were going in for an induction. She was only 38 weeks pregnant, but was diabetic and her doctor was quite concerned that her baby would be enormous. “Huge, 10 pounds at least!” was the way it was quoted to me.

She was pretty chilled out about being induced early, because with her previous child, now an active three-year-old, she had been induced at 38 weeks as well. 10 hours later she was holding her vaginally birthed baby in her arms. Hard to argue with that record of success, and although I suggested that perhaps waiting at least another week would be a good idea, big baby or no, I could see that this idea was falling on deaf ears. I didn’t say much.

She went in for her induction in the evening and they gave her prostaglandin gel applied to her cervix. Her cervix was “unfavourable”, which is to say, nowhere near ready for giving birth, but the induction happened anyway. By 1 a.m. she was having frequent sensations and was throwing up – often a good sign of progress in birthing. This continued through the night. Her husband wouldn’t lie down and sleep for an hour to remain rested, so when morning came they was pretty exhausted, but they were both convinced that things must be going swimmingly and the birth would be soon.

The OB-of-the-day arrived and checked her and her cervix was as it was before, not dilated at all, not effaced, still posterior. Still, in other words, unfavourable. But still, her sensations were still frequent, and so the doctor started her on pitocin. The sensations became more uncomfortable and during one when she was moaning through the sensation a nurse poked her head in the door and said, “You look like you’re in pain. I’ll get you some demerol.” She came back and put it in the IV, I think. This, by the way, is an excellent example of the kind of “informed consent” that is often demonstrated in hospital births. She wasn’t asked whether she wanted it. She wasn’t even asked if she was in pain or suffering. She wasn’t presented it as an option with these pros and these cons. It was just given to her.

Once the pitocin was started, of course, external fetal monitoring was put on next. The contraction monitor worked consistently, but the baby, as babies pretty consistently do, kept moving around and the monitor would no longer be correctly placed so that the nurse would come in and fuss with the monitor, get the baby heart swooshing away on the speaker again and then bustle off, only to repeat the scene five or ten minutes later. She dozed with the demerol for quite a while, not even feeling her contractions any more and her husband and I dozed too in uncomfortable upright chairs against the wall.

The OB-of-the-day kept coming in and telling the nurse, who had already been upping the pitocin on schedule, to up it some more. At one point the nurse said, “We’re already at the limit that we’re supposed to use for an induction.”

The OB replied, “This is an augmentation, not an induction. Up it some more.” The nurse bit her tongue and did as she was told.

Every time she was checked her cervix was unchanged. Or no, a little changed. Effaced (thinned) to two fingers instead of three, still not dilated at all, but perhaps less posterior. This was considered to be progress.

Finally, after 24 hours from the first prostaglandin gel and about 2 hours before the OB-of-the-day was supposed to end her shift, the OB came and inspected the situation.

The baby was healthy as a horse, moving around, repeatedly bashing and kicking at the monitor, strong heart rate throughout, so they couldn’t use fetal distress as their reason for a c-section.

For some reason (because her cervix never dilated much most likely) they had never gotten around to rupturing her membranes, so they didn’t have that artificial timeline on their side, something to point to with assurance for why they needed to do a c-section.

Since she’d had a previous large baby vaginally it would be very difficult to argue cephalopelvic disproportion (where the pelvis is too small or narrow to allow the passage of the baby’s head).

And of course, they couldn’t just let her go home, say, “Oops, our mistake, your body wasn’t ready.” Not with that enormous ten pound baby inside.

Nope, they needed an ironclad irrefutable reason to cut this woman’s belly open. So they told her her baby was breech.

How big was that baby, do you think? 7 pounds, 3 ounces. And showing signs of prematurity. And sleepy, oh so sleepy, wouldn’t get on the boob and nurse, not for days and days and days. I lost track of them when she went home to her active three-year-old with her belly cut open.

It’s not like I did them any good. And while, as I say, I kind of suspect I just really wasn’t very good at this doula thing, I’m not sure that another doula could have improved things, prevented the outcome. I realized that as a doula I didn’t have any power to change the system. I might be able to occasionally help a woman emotionally or practically, but I would be witness to so much abuse. I stopped going to births as a doula.

Next: Part 4: The more things don’t change
Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 2

Previously: Part 1: I maunder on about my experiences as a doula

I’m making this all sound a little grim, that’s because it is a grim business and the statistics bear that out. In British Columbia, where I live, the current c-section rate is over 30%. It’s not a stretch to suggest that for every three women who give birth in this province, one will end up with major abdominal surgery. This is not a supportable rate. The World Health Organization recommends that a reasonable c-section rate should be no more than 5-10%, and this rate has been shown repeatedly to produce the best outcomes for mothers and babies.

Now if a reasonable rate with the best outcomes is 5-10% and our current rate is over 30% then 20-25% of birthing women are having unnecessary surgery.

Let me repeat that.

The medical model of birth as practiced in British Columbia (and the rest of Canada and much of the United States) results in 20-25% of all birthing women, perhaps as many as 1 in 4, having unnecessary surgery. 2/3rds or more of the c-sections performed do not improve outcomes for mothers and babies.

And of course, it’s not as though the women who are giving birth vaginally are getting off scott free in this system. They’re birthing under the ever present threat of major abdominal surgery, for one thing. Forceps and Vacuum extractor are used 3.4% and 6.3% of the time, so that means another 10% of women at the very least are having episiotomies and having their babies pulled out with varying degrees of skill. 45% of women have epidural anesthesia, which is certainly successful, most of the time, at blocking sensation, but also makes far more likely the perceived need for “augmentation” of labour, including artificial rupture of membranes and pitocin augmentation – I couldn’t find a rate for pitocin usage, but it tends to be fairly high, often as much as twice as high as the c-section rate. 21% of women in BC also have their labour artificially “induced”.

Women are having pretty awful birth experiences. Not universally, of course. But a lot of them.

I used to explain to people how the cascade of interventions worked, how one intervention would lead to another and then another, and how one simple bad decision on the decision tree could lead to a seemingly necessary (but really unnecessary) c-section. And in my explanation, I’d pile them on a little. My hypothetical birthing women experienced as much intervention as I could believably throw at them in order to demonstrate the point.

And people were a little disbelieving. Who could blame them? It does seem a little outrageous that doctors, who are in the main probably well-meaning people, could end up performing unnecessary major abdominal surgery on one fifth to a quarter of their healthy birthing patients.

But the problem with my hypothetical is I saw it played out or heard about it played out in almost exactly the ways I’d described far too many times. It wasn’t just an illustrative fiction, it was a common reality.

Next: Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change
Part 5: The system is broken. What next?

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The system is broken if it doesn’t leave people whole – Part 1

The medical model of childbirth. Don’t doubt that it is broken, perhaps from the very beginning, right to the core.

When I was just getting started with this birthing thing I was pretty enthusiastic. I did a lot of reading. I wrote optimistic essays about birthing choices for my shockingly bad website. I tried to be a doula, though I’m not sure I was ever a particularly good one. I went to conferences and training days by the dozen. I believed that I could make a difference. I believed that positive change was inevitable, that the facts were lining up and soon everyone would have to agree on the appropriate approach. All we had to do was be firm, keep tabulating research, and make it available. Wait the change out and it would happen.

But as I say, I was a perhaps not very good doula, and in the main the births I ended up attending were those of strangers, often strangers that I hadn’t met before I found them in the labour and delivery room at a local hospital (ah, the free referral service of the local doula organization), and by the time I got there things were already on their downward spiral. The induction was on and it was only a matter of time before someone became exhausted and bored and suggested a c-section. Hapless women of colour with poor english and their equally hapless husbands and partners were funnelled through to the operating room and for all my enthusiastic soothing and panting and rocking and walking and changing positions there was nothing I could do to change it.

In all the births I attended at that time, there were only two decent ones, one a homebirth, the other a hospital birth, older white mothers full of determination. They knew what they wanted. They fought for it, and they were very clear about what they wanted from me. So, it worked, you see. They had the education, experience, determination and white privilege to get what they wanted, a birth that wasn’t abusive or horrible. It certainly helped that they were women having second babies, as second babies are always more responsive to the arbitrary timelines of the medical model. It was a gift to be their doula, it really was.

In between births I did postpartum doula work, some volunteer, some for a pretty good wage. Here too I could see how damaging the medical model was. One young woman I was helping for free was in Canada alone, her husband in Malaysia waiting on his visa application. She’d given birth alone, a young non-white woman with no apparent partner and poor english. She’d had a good nurse, she felt, but the doctor, a woman, was rough and impatient with her, and had performed an episiotomy that resulted in a fourth degree tear, very painful and with a difficult and perhaps surgical recovery.

Another woman I served for a few weeks, helping out through the nights, had been pregnant with twins. Her babies were delivered via c-section, for no other reason than that they were twins. She was struggling with the continuing pain of her incision, not being able to breastfeed her son, who wouldn’t latch and would only take a bottle, and pumping around the clock to supply them both with breastmilk. She was exhausted.

Another woman was in Canada from England, but was not yet covered by MSP. The doctor she saw would not permit her to attempt a trial of labour after her previous c-section, so she was forced to undergo another surgery and pay for the entire thing out of pocket as well.

I was called to help with breastfeeding with another older couple, who gave birth at home with registered midwives. She had a tear which required stitching and while the midwives were stitching it up they kept the baby in another room away from her. For an hour and a half. The first time she tried to breastfeed after her birth her baby was already through its wide awake period and slept instead. Two days later, still not nursing.

All of this is a very long-winded way of saying that after a few months of thinking about birth! and babies! with stars in my eyes! and then attending a weekend workshop in which women imagined awesome births and inspirational stories were told by the doula instructors of how they had saved women’s births and so on, I somehow plunged headfirst into the deep end of how awful and how broken the medical model of birth really is.

Next: Part 2: Statistics
Part 3: Illustrative Non-Fiction
Part 4: The more things don’t change
Part 5: The system is broken. What next?

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Let’s not forget who actually delivered the baby

Saw coverage on the news of a super fast unintended homebirth (17 minutes post-911 call), attended at the last moment by a police officer who lived in the neighborhood. The coverage took the tack that this sort of coverage always seems to take: Police Officer Delivers Baby! It is her first delivery! The police officer was even heard to utter that she’d helped the father out, that it was a “Two-Man Job”.

Notice whose work and contribution is completely erased here? The mother.

The woman who pushed a baby out of her body with a muscle that, at full-term pregnancy, is the largest and strongest muscle in the human body. The woman whose body incredibly stretched enough to carry a baby inside, and to allow passage of a baby out, and which will now heal and return to its orignal shape. The woman who experienced whatever pain or intensity there was to experience in the delivery. The woman who had already been carrying and nourishing this baby for nine months and experiencing whatever physical discomfort (and/or pleasure) might have been involved in that for her. That woman.

Let’s be absolutely clear here: this mother DELIVERED her baby. If both the police officer and the father had not been present, the baby would still have been born. That’s the truth.

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A post that never got posted, June 13, 2006: Fat

(I’ve been writing this entry, off and on, for most of a month now.)I have tried to rejoice in the body I had. I’ve tried very hard. But in the end I fell into the same trap, that of excusing my fatness by comparing it to the fatness of others. You know that one, the “I’m chubby, but I’m not as fat as/fat in the same way as so-and-so. And, you know, I exercise, and eat healthy… so…”All of which really means, “I’m fat, but I have a good attitude, and it’s not like I’m *trying* to be fat, so you should all forgive me and treat me in the privileged way you treat skinny people.”I’ve never dieted, officially. There are a lot of reasons why that’s pointless and punishing. I can honestly say that I have no real idea what I weigh right now. Something over 200 lbs, I think, but beyond that I don’t know.Of course, having said that, I’ve had days where I secretly rejoiced in the fact that I had eaten less, or nothing, or forgotten to eat until evening, as though that made me virtuous. Conversely, on days when I’ve been very snacky, I try to hide this fact from myself (and certainly from others), and felt ashamed, because if I say that I’m eating healthy I can’t possibly slip like that. Whenever I go to someone’s house with a scale, I do weigh myself, but then discount it as unimportant and pat myself on the back for not caring. The process leaves me feeling shaky and uncomfortable, but I do it anyway.

I equated “not dieting” with having a healthy attitude about my weight. I equated not obsessively weighing myself and worrying over any ounce gained or lost with having a healthy attitude about my weight. I equated being comfortable telling people my weight with having a healthy attitude about my weight.

But in revelling in the idea that I was being “good” (not dieting, not being obsessive), and of course revelling in the praise I did receive when I told people my weight (usually along the lines of “Wow! You’d never know you weight that much! You carry it so well!”) I forgot that I really was focusing a lot of energy and concern on exactly the issue I prided myself in not caring about.

And also, in so doing, I still managed to put myself in a place of judgment around other people and their fat. I was “good” because: I wasn’t as fat as they were (some kind of invisible line I always stayed just this side of); I didn’t care about being fat the way they did (not caring is “enlightened”); I wasn’t succumbing to some kind of brainwashing about needing to diet the way they were (I was smarter); etc.

Issues of weight and fat make me feel angry. There are days when I just wish that absolutely would just SHUT UP ABOUT IT ALL ALREADY. I don’t want to hear about your Atkins diet progress or the list of things you’re permitted to eat today. I don’t want to hear anyone say they just want to lose 10 pounds when they’re already beanpole skinny.

I especially don’t want you to tell me that you think I’ve lost weight, and so I look good (this happened just yesterday, actually). On the other hand, sometimes I do. And then I feel guilty for feeling good.

I moved past some of this, but some of it is still current. I’m more confident about my weight (right now probably a bit above 270, including those pounds put on for baby) , and my right to weigh what I weigh and be in the world and take up space. And I’m more and more convinced that our obsession with weight loss as a society has a lot to do with shutting women up (and down) and making sure their focus isn’t on anything important or radical. I still don’t always know how to talk to other people about weight, about their weight, about issues to do with weight, and I managed to get into a huge fight with my sister on the topic of weight over the summer – she was trying to play devil’s advocate to my HAES, who are we to judge, etc., screed. I really wanted to say, “Look, you *can’t* play devil’s advocate by parroting back everything that the mainstream says. I’m the bleedin’ devil’s advocate here!” but instead we just yelled at each other and cried a lot and I wish it hadn’t gone that way.

And I’m trying to find that balance between empathizing with folks re: their unhappiness about weight – “You’re right, it sucks when you don’t have clothes that fit. That feels very frustrating.” – so that they feel heard, and yet not compromising on the basics – “If your clothes don’t fit, it’s time to get clothes that do fit.” rather than “If your clothes don’t fit, it’s totally reasonable to try dieting until they do.” This stuff feels especially hard with family, because these are the folks who I love, and who I know love me and have actually never criticized me for being fat or encouraged me to diet except in the backhanded “You look great, have you lost weight?” way. So I can’t be quite as flippant as I am with some other folks: “I just want to lose 10 pounds.” “Really? *looks them up and down* Your leg below the knee should do it.”

And pregnancy, by heck, is a full-on adventure in body acceptance every day. As a pregnant fat person I’ve been struggling with finding comfortable clothes that fit, struggling with finding representations of my body in pregnancy illustrations (all pregnant women apparently start out slightly underweight and have no discernible fat layer, aside from breasts), and struggling with my own body image not quite being what my current reality is.

And every pregnancy site on the web is full of exhortations not to gain too much weight or it’ll be hard to drop those pounds later. I find myself completely unworried on the topic of the weight I’m gaining (it’s clearly going to a good purpose), almost completely unworried on the topic of my exciting new collection of stretch marks (a good purpose, again, has clearly been served, despite the actual physical discomfort of popping new stretch marks), and yet strangely weirded out and uncomfortable with my entirely benign and non-painful little wobbly belly underneath my firm pregnancy belly. It’s the same old wobbly belly pooch I had when I was just a non-pregnant fatty, and I was fine with it then, but somehow it’s different in its current position, and I’m not sure I could explain why. Ah well.

This post = much rambling, and I’m not sure if there’s a point. But does there really need to be?

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A post that never got posted, August 16, 2006: “Yes”

Yes. I want to have a baby, to have a child. I want to be pregnant, put all my attention and care into my health and diet and connecting with a new life. I want to invite a soul in and watch it grow. I want to feel and watch my body change. I want to give birth exultantly, however that happens, whether painfully or pain-free, whether a short labour or long. I want to catch a baby with my own hands and look into its eyes soon after it is borne, to nurse it when it is ready and to birth a placenta still attached.I want to nurse and carry and snuggle that baby, to sleep beside it at night and hold it in my arms during the day, to keep it clean and dry and warm and comfortable and respect its needs and timetable.I want to do all of these things. And I will.

And now, I am.

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Yet another post about keywords, sort of

In which I answer the many questions posed on search engines that lead folks here. ‘Cause hey, it’s better than no post at all. Perhaps we’ll make this a regular feature? Because after all, I need to be even further up in the search engine results for “ejaculation” than I already am.

“can you get pregnant from post-ejaculation”

Yes, technically you can. Post-ejaculate can contain sperm, and as everyone keeps on saying, it only takes one. This is technically true, but realistically the reason there are so many sperm involved in an ejaculation is that it takes a lot more than one in most situations. Sperm are fragile little critters, and ova don’t succumb to the first sperm to show up in their neighbourhood in most situations – it takes the combined efforts of many sperm to produce enzymes to break down the proteins around the ovum so that conception can take place. And of course, no amount of ejaculate, including pre- or post- will get a woman pregnant if she isn’t in or near the fertile time in her cycle, which doesn’t help if she doesn’t know when that is, or if her cycle is irregular or unpredictable.

Still, I can only assume from the question that pregnancy is an unwanted consequence, in which case, it’s better to be ridiculously careful than cavalier.

“i’m 8 week pregnent can i have sex with my patner”

If you do not have a history of early miscarriage (more than a couple) then there’s no reason why you can’t have sex with your partner.  Enjoy!

But for any partner-folk who show up here to get ammunition in their strange “battle” to have sex with partners who don’t want to have sex and are claiming pregnancy as an excuse, just because you can have sex doesn’t mean that you have to. Let’s be absolutely clear that absolutely everybody can refuse to have sex at absolutely any time for absolutely any reason, and nobody has any obligation to have sex or continue sex, ever. If either partner is feeling squoogy on the topic of sex during pregnancy for any reason, that’s okay. We’re all complicated folks with complicated internal worlds, and pregnancy is an odd time – full of upheaval and change. Sex can become less of a priority or more of a priority for both or either or any partner during that time and kindness and communication should always be a primary response. Coercion is a poor sexual response.

“can a woman get pregnant after her cycle”

What does “after her cycle” mean?  Women can get pregnant if they have intercourse during or slightly before the fertile time in their cycle. This fertile time varies from woman to woman, and even from cycle to cycle for, so more information is needed to evaluate this question.

“can you get pregnant if his ejaculation is inserted in you with your fingers”

Yes. In fact, I’d say that this is a better chance than the scenario above with post-ejaculate. Look folks, if you don’t want a pregnancy to happen, the best bet is to keep male ejaculate away from female genitalia. It’s just that simple. There’s lots of ways to do that, including condoms both male and female, celibacy, and lots and lots of kinds of non-penis-in-vagina (PIV) sexual acts.

“i had sex on the 8th day of my cycle and the condom burst but there was no ejaculation is there a high chance i could be pregnant?”

This timing depends on you and your cycle, so there’s no hard and fast answer here. Every woman’s cycle is different, and if you don’t believe me join Fertility Friend (it’s free for the basic services) and check out their excellent Chart Gallery. If you’re like me with a longer cycle and later ovulation (day 19 or thereabouts) then there isn’t a high chance of pregnancy from even ejaculatory sex on day 8. If you’re the stereotypical average woman who ovulates on day 14, there’s still little risk, even from ejaculatory sex, since most sperm live no longer than 5 days (and 5 days is only likely if there is fertile cervical mucous). If you ovulate on day 10, however, ejaculatory sex would not be your pregnancy-avoiding friend.

Of course, if there was no ejaculation, then it depends on how likely it is that there was sperm in your partner’s pre-ejaculate. If he hasn’t ejaculated in at least three days, then the chance of there being live and viable sperm in his pre-ejaculate is very slim (not none, but pretty darn low). If he has ejaculated within three days, then there is a greater likelihood of their being viable sperm.

Combine these two factors – your own cycle and your partner’s ejaculatory history – and you get your answer.

None of which answers the question of STDs, just pregnancy. It’s a lot easier to pick up an STD from unintentionally unprotected sex, so if your partner isn’t someone you regularly have sex with, and/or if you are not currently monogamous, testing is a good idea, as well as letting any other current sexual partners know about the situation, before you have unprotected sex with them.

“will my breasts go droopy after an abortion?”

An abortion will not cause your breasts to change.

However, a pregnancy will. Breast changes are one of the earliest signs of pregnancy for many women, including breast growth and increased breast fullness. Pregnancy also causes relaxation of the ligaments that support your breasts – though this is more pronounced later in pregnancy.

When your pregnancy ends those changes will reverse, which can mean feelings of less fullness, smaller breasts and a bit of, yes, breast droopage or sag. Some women will notice changes like these and some women won’t. It’s a very individual thing.

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Choice and Gender

This is an older post that I’m reposting from my personal blog.

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I spent some of my break-time reading this post over on Alas, a Blog, ostensibly on the concept of “Choice for Men” (i.e., the choice of men to decide post-conception not to support children they participate in creating). I’d be more in favour of something like this if they were asking for the ability to officially declare this preference prior to having sex, and back it up with sterilization, and then not pay child support, but hey, that’s me. Regardless, the vitriole and fuzzy logic can be interesting and instructive.

Here’s how choice regarding conception and birth go for men and for women, ‘kay? And I dig that I’m talking about ideal human relationships where neither party is being coherced into sexual activity, people actually think about this stuff instead of just rut like bunnies, and both parties are respectful of each other.

First off there’s the near infinite time period prior to engaging in sexual activity for both parties to decide a) whether or not they want to have sex with someone of the opposite sex, b) what sorts of sex (vaginal vs. non-vaginal to have) and c) what sorts of contraception to utilize. They can also meet each other and talk about these issues together.

Men and Women have equal potential ability (in a relatively perfect world without abusive relationships/etc.) to choose not to be responsible to a child during this time period. Men and Women do have different options for contraception which is caused caused by both biology and politics. However, they do have three options to choose from in common which virtually guarantee a lack of responsibility to possible future children in this time period: not having sex, not having vaginal sex, and being permanently surgically sterilized (tubal ligation and vasectomy).

Then there’s the time period of the sex act itself. Men and Women have different choices that they can make during this time. Women get to choose whether to have vaginal sex, whether to have vaginal sex during what may be a more fertile time for them, whether to have vaginal sex with a fertile man (vs. a provably sterile one), whether to use condoms or a diaphragm or another barrier method, whether to use spermicides, whether to have the male ejaculate in her vagina or not, and so on. Men get to choose whether to have vaginal sex, whether to have vaginal sex with a fertile woman (vs. a probably sterile one), whether to use condoms or another barrier method, whether to use spermicides, whether to ejaculate inside the woman’s vagina, and so on.

Of course, all of these choices have varying degrees of risk for pregnancy, and the people involved in the act choose their own level of risk. Obviously, a man and a woman relying on the withdrawal method alone for contraception have a higher acceptable level of risk than does a couple relying on oral contraception, condoms and withdrawal together. Ostensibly, this means that one couple is demonstrating greater reluctance to support a child.

Post-ejaculation/sex, the man no longer has any options for whether or not he’s willing to create a new life. Sorry, it sucks, but hey, that’s how biology works. Pregnancy is a thing that occurs in a woman’s body. Men don’t get to say what happens in/to women’s bodies.

Post-sex, women have the choice (at least in Canada) to use at least two varieties of morning-after pill, if they feel their precautions weren’t sufficient or broke down at some point in the process.

They can also, should they end up pregnant, choose one of several methods of abortion (if it’s accessible/affordable/safe in their area) should they not wish to carry the pregnancy through to term for any reason. I’m not sure when their legal right to do this ends in all areas, but in North America it’s usually somewhere between three months and just pre-birth.

Yup, this is a choice that women have that men don’t, but then, men don’t get pregnant. This doesn’t mean that in this ideal and respectful situation men can’t talk to women about what choices are and so on. But as one man said, men can only really be pro-support, not pro-choice. This means they can only choose to either support a woman’s decisions either way, or not, because the choice isn’t theirs to make.

This means that women have a longer period of time to make a choice about whether or not to support a possible child. Please note that this longer period of time is really only three to nine months longer. Considering that both parties have the near-infinite period of time prior to having sex in common to make that choice, and that this longer period of time is based in the reality of biology – women get pregnant and men don’t – this isn’t really unfair.

And yes, women can choose to give babies up for adoption post-birth (which requires the father to also give consent for this, if he can be found, usually). Realistically, this doesn’t often happen, just as abortion doesn’t often happen. Most unexpected pregnancies become births and babies, not abortions.

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SMCR – The Society for Menstrual Cycle Research

I’m attending a three-day scientific conference on Menstrual Cycle Research out at the University of British Columbia. I’m volunteering, of course, because then I can get in for free. The big topic, of course, is menstrual suppression, but there’s papers and studies being presented on all sorts of related topics, including fertility awareness, menopause, and so on. Lots of interesting stuff. It’s probably the first time I’ve ever been surrounded by a bunch of PhDs who are all experts on a topic I actually know a heck of a lot about, and it’s quite exciting to get to hear a lot of high-level discussion of the issues.

I’ll be writing a couple of posts on my palm as I go along and posting them here when I’m done. Today was the opening day of the conference, and I recognize the structure, so familiar to me now from Kim Stanley Robinson’s descriptions in the Red Mars series (he has a love affair with scientific conferences and writes about them in most of his books). There was an opening plenary and a welcome from a local Musqueam elder, and then some breakout sessions. I chose the menstrual cycle topics one, and of the papers presented today, a couple had some interesting insights. One rather large and over-reported study (two groups gave talks on the same set of research data), was, unfortunately, very poorly designed, so they didn’t really get any useful data. What a waste!

They questioned women on their contraceptive usage and their menstrual product usage, and interestingly they included as the only fertility awareness-type option, the rhythm method! Unbelievable, and many in the audience were quick to point out that “the rhythm method” is an outdated term for a very poor form of natural birth control based on the calendar, quite unrelated to the modern practice of sympto-thermal charting which has an incredible success rate.
Anyway, I’ll post more about the conference soon.

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