Wednesday, October 27, 2010

An American Werewolf in Labor

There are few absolutes when it comes to labor. There's no way to know just when it will start, how long it will last, or how it will feel. But one thing that I think applies universally is a quote from midwife Suzanne Stalls: labor is hard work, it hurts a lot, and you can do it.

Even with labor being so unpredictable and with no two labors being exactly alike, while pregnant I loved hearing other people's birth stories. For me, labor has always been clouded in fear and mystery, and even though learning how it went for someone else told me nothing about how my labor would go, it was still reassuring to know it could be endured.

Of course it's always nicer to hear the stories of relatively easy labors, but even the tougher experiences are promising, because they echo the most important part of what Suzanne Stalls says: labor is doable.

For me, labor was intermittent and gradual, and therefore quite manageable. Twenty-four hours passed between the contraction that was convincing enough to take seriously and the final push that brought it all to a close. That may sound long, but although labor was exhausting and all consuming in the last hours, for the most part it was what happened in the background, an interruption that came and went throughout an otherwise busy day.

On the day I went into labor, the Irish fella and I were frantically calling around looking to replace house cleaners who had failed to show. Weeks of construction in our new home had been completed the day before, and movers were scheduled for the next day. Months of living out of suitcases were coming to an end, but before we could move into our new house, we had to rid it of the dust, muddy boot prints, and general filmy filth that you’d expect at a construction site.

I had been having strong cramps throughout the morning and, at a scheduled midwife appointment, had been told that if I wanted to have my baby in the new house, I really ought to move that day. I met up with the Irish fella for lunch and I mentioned this as casually as I could, reminding him that it is common for women, particularly with their first pregnancy, to think they are in labor when they are not. This is false labor, I assured him, both because I believed it and because actually going into labor that day didn’t really suit our plans.

After a morning-long search, the Irish fella had found two cleaners to work on our house that evening. We made a list of supplies we needed and planned to spend the afternoon doing a preliminary scrub before the professionals arrived. Before setting off to buy mops and brooms and bleaches and detergents, the Irish fella suggested we time my cramps, which were twenty minutes apart.

We walked around a hardware store and a supermarket. We went to the house we'd been staying in and packed up some things we'd need for our first night in our new home. By the time we got to the new house, I was having cramps every ten minutes.

In my antenatal class, it was drilled into us that the best thing you can do in labor is stay upright, forward, and mobile. The Irish fella, for whom standing still is anathema, was all for my being active in labor. He handed me the vacuum.

We cleaned for a while, and my cramps, which we were now calling contractions, had intensified and were occurring every five minutes. The idea of being upward, forward, and mobile is to help things progress, but what I wanted then was to slow it down. I decided to rest.

The house was mostly empty, but we had one room that was furnished and decorated, with paintings hanging and new sheets on the bed, with books on the shelves and towels neatly folded on the side table. The Irish fella had put this room together before the construction work began, as a sort of shrine to normalcy. I was grateful for a bed to climb into.

The cleaners arrived and scrubbed the house around me. The Irish fella came to check on me from time to time, and we wondered whether we should cancel the movers we’d booked for the morning. The contractions intensified, and by 8 pm we called the midwife. At this stage, we really just wanted someone to tell us if I was actually in labor. We were still living in the reality in which moving house was the priority, and wanted to know if we should transition fully into the reality of my being in labor.

The midwife kept me on the phone long enough to hear me through a contraction. She said I sounded fine (“You are not screaming”) and to call her back in the night. We called the instructor from our antenatal class, asking her if she thought it'd be better for me to get up and move around or stay in bed. She said I could have hours or days to go. She told me to have a glass of wine and go to bed.

Labor is often compared to marathon running. Having now experienced both, I agree that there are similarities: both require endurance, mental and physical strength, controlled breathing, and regular hydration and energy repletion. Both also require proper pacing, which is where the analogy falls apart.

When you are running a marathon, you know exactly where you are in the race—you know how far you’ve gone and how far you have to go. In labor, you don't, and having contractions for ten hours only to learn you are 1.5 centimeters dilated is akin to thinking you are nearly at the finish line when you are still doing warm-up laps. And not knowing how much more intense contractions are going to get can frighten women who are managing quite fine into receiving pain medication that they may, if they choose, do perfectly well without.

The Irish fella and I settled into bed. The contractions continued to come every five minutes, lasting for one minute, and getting stronger as the night went on. I got through each by exhaling deeply for a count of ten, inhaling deeply for a count of ten, and then repeating three times until the minute had passed. I reminded myself that each contraction was getting me closer to meeting my baby. On occasion I heard myself asking God or my mom for help.

The Irish fella and I had a hot water bottle between us, and throughout the night we’d press together to push it as hard as we could against my lower back during contractions. I didn’t sleep, but I managed to doze during those five-minute spells when there was no discomfort at all. I considered calling the midwife again around 3 am, but when I envisioned her arriving and the lights going on and the atmosphere changing, I decided to wait.

At 8 am we sat in bed and discussed what to do. Should we call the midwife? Should we cancel the movers? If I was only in the very early stages, we reasoned, I could have a good twelve hours to go, in which case we may as well have our furniture moved. We called the midwife, hoping she’d come examine me, and expecting she’d say I was maybe at two centimeters, in which case we’d stick to our moving plan.

When the midwife arrived, we waited for a contraction so she could feel my cervix. I breathed deeply—ten seconds out, ten seconds in, repeat—and when I opened my eyes she was removing her rubber glove and smiling. “Nearly seven centimeters,” she said. “I can get you through this.” She told the Irish fella he should go out for a walk, get a coffee, and come home in about an hour. She suggested I get in the bath. We rescheduled the movers.

It was a huge relief to know that I was not only definitely labor, but that I was actually quite far along. We were all delighted. The midwife brought in her birthing stool and prepared the bed with rubber sheets. The kraamzorg arrived—the nurse who would attend the birth and care for me after—and set out clothes for the baby. I apologized over and over for not having any furniture for them to sit on, and for the general state of the house.

I also apologized each time I felt a contraction coming, because it was impossible to concentrate on anything else in the midst of one. But between contractions, I was myself, and with a heightened politeness. The mood was so pleasant and the two women who buzzed around me while I floated shamelessly in my bathtub were so friendly that we were, dare I say, having a nice time.

There was laughter and small talk and banter, and then every five minutes, I would morph into some primal version of myself—not a werewolf perhaps, but some form of lowing, moaning creature. Once a contraction was over, I’d return to the conversation until the next one started.

The Irish fella returned. At 11 am, I got back on the bed, and the midwife suggested she break my water to speed things up. I couldn’t see anything over my enormous bump, but I heard her ask the Irish fella if he saw what color the warm liquid was. “Green,” he said. “Erwtesoep,” she said. Pea soup. “And what does this mean?” she asked him, instructor to student, and he answered, “We have to go to hospital.”

The green color of the water is a sign that there is meconium, the baby’s first feces, in the amniotic fluid. Breathing this can be harmful to the baby, and its presence is a sign that the baby is stressed. Although the midwife was monitoring the baby’s heart and it sounded fine, a more accurate method of heart monitoring—whereby a monitor is physically clipped to the skin on the baby’s head—can only be done in the hospital. By law, we had to move.

At 8 centimeters with the end just in reach, getting up, putting jeans on, walking to the car, and driving to the hospital was the last thing I wanted. And I'd like to extend sincere apologies to the poor man with whom I held mid-contraction eye contact while stopped at a red light. But within 15 minutes, I was in a hospital bed ready to resume.

But everything was different, and I think it shut my labor down. The midwife had to leave so the doctor could take over. The heart monitor meant I couldn’t move around anymore, no more shower or bath. I still had my hot water bottle, which the nurse wanted to take from me because it was giving me burn blisters, but I wouldn’t give it up.

Two hours passed and I was still at 8 centimeters. The doctor explained that they would like to give me a drug that helps speed up contractions. So ingrained is the belief in natural childbirth in the Netherlands that even this relatively minor intervention was explained to me with reassurance that it was nothing I was doing wrong, that I was still doing all the work, but that they had to do this to help move things along, to help me.

Things were harder now. The drug sped contractions up so I was now having four every ten minutes, and they were far stronger. We were left alone, and the Irish fella sat next to me and rubbed my shoulders while pressing the hot water bottle into my back. When a particularly hard contraction had me hyperventilating, he would breathe deeply until I was back on course by following his pattern. But in between contractions, there were kisses, there were jokes about the faces I was making, there was a phone call about the delivery of our new dining room table. In between, I was tired and thirsty, but I was fine.

When I was at ten centimeters, the doctor said I was ready to push. In spite of it being 24 hours since I put down the vacuum and climbed into bed, when the doctor said it was time I heard myself say, “already?” And so there I was, in the hospital, knees to ears, Irish fella to my left, doctor, nurse, and intern at my legs, waiting for a contraction so I could push. In three pushes, my baby was resting on my chest.

It’s a bit of a blur, those first minutes. The Irish fella cut the cord. The doctor and intern and nurse took the baby to a table to examine him, and the Irish fella followed them. I stayed on the bed, streaked with sweat and blood. My belly was a soft, empty pouch. I was dying of thirst but my Powerade was just out of reach, and not a person in the room was paying any amount of attention to me. From a tray across the room, the placenta seemed to say, “Tell me about it, sister.”

It was all over and I felt fantastic. One benefit to drug-free labor that I appreciated right away was that I could walk around, and felt no grogginess. My baby was placed on my chest and began to feed. The physical pain of contractions was gone, and the elation of knowing my baby and I made it through labor happy and healthy made it all worth while. They say women forget the pain, but I don't think that's it. I remember it. And as soon as it was over, I remember thinking it was not at all worth fearing. It wasn't that bad, and it was definitely worth it.

For the last week I’ve been hearing the birth stories of the women from my antenatal class, and some of them had labors that were far longer and harder than mine. Still, we have all said it is something we know we want to do again. We know it will be hard work and it will hurt, but we also know it will be manageable, completely worth it, and most important, we know we can do it.

Wednesday, October 13, 2010

Toni Braxton Hicks: Get It?

Spoiler alert: I was working on this post last Tuesday, and had intended editing it later. But my bump had other plans, and within three hours labor had begun. I’m posting this now anyway because the blog has been idle too long.

I love a good band name pun: Daisy Chainsaw, Kathleen Turner Overdrive, JFKFC. At one point in my life I thought Olivia Newton John Denver would be a fantastic name for a particular duo, because I was five years old and believed "Rocky Mountain High" and the soundtrack to Grease were the only music I’d ever need.

Last night, after I had been awakened by a strong tightening of my uterus and was getting up for my third pee, I thought of another one: Toni Braxton Hicks. This morning I not only understand how lame this is, but also the extent of its exclusivity. I was playing to a very select audience: heavily pregnant women roaming the house in the middle of the night, exhausted but too uncomfortable to sleep, loopy with expectation.

It sounds ridiculous to say this so late in the game, but in some ways I am just starting to accept myself as a pregnant woman. Or perhaps it’s more accurate to say that I can feel the part of me that is the pregnant woman expanding, literally and figuratively, and taking over the parts that I was before I was tucked away in the background of my own body. And I feel completely okay with this.

I’ve gotten used to people reacting to me solely as someone who is pregnant. I was telling a colleague that I notice people smiling at me more, granting me the right of way in supermarket aisles, and approaching me frequently for directions on the street as though they feel safer around me for being pregnant. My colleague said that’s because they don't know my belly is actually filled with the wallets of unsuspecting strangers.

But pregnancy didn’t swallow me whole. It gradually pecked away at me. At the start, it was complicated secret. Then it was a celebrated announcement. And then for a long stretch, it was just a fact, one that I tried to keep from interfering with my life as much possible.

I didn’t want my pregnancy to dominate all the conversations I had, or to limit what I still had the energy to do. I didn’t want to bore everyone around me or be perceived differently. I avoided maternity clothes for as long as I could. I took pride in still having the energy to stay out late, even when I might have preferred a night in bed with a book. One friend refers to this time not as my pregnancy, but my sobriety.

In trying to maintain my pre-pregnant self, I was not making any room for my pregnant self. This is very easy to do when you do not have friends who are going through a pregnancy at the same time as you. Not that my friends don’t care – they just can’t relate. And my friends with children have already moved from being pregnant women to being parents, more consumed by juggling soccer practices and Justin Bieber crushes than worrying about whether their water will break in public.

It was the Irish fella who had the idea to go to an antenatal class, so we would be forced to focus one night a week on the fact that we were going to be parents and had no idea what to expect from any of it. It was a new club we were joining, and we had to embrace the change, ready or not.

Driving to the first meeting, we were both feeling a little insecure. What if the other couples were just better and smarter at this than we were? When we pulled up to home of the instructor, I was bottoms-upping a take-away latte, sucking back the remaining foam, as the other couples made their way to the door.

“For feck’s sake,” the Irish fella said, “put that down before we’re thrown out.” During the class introductions, he continued to present us as best he could, volunteering the fabrication that he and I had been together for two years, and casting a dim view on my sharing that we’d met in a bar.

That first day, the instructor divided us into groups, with the men on one side of the room and the women on the other. The women’s task was to take a whiteboard on which was drawn a cartoonish outline of a naked pregnant woman and label it with various symptoms we were experiencing.

Now, anywhere else, when people ask how I’m feeling, I always say I feel great, because nobody really wants to hear over brunch that your gums bleed constantly because you are carrying 50 percent more blood than normal or that your expanding uterus has caused a substantial reorganization of some major organs, forcing you to breathe like a suffocating goldfish, among other discomforts. What I mean when I say "great" is that I feel great, considering.

But the women in my class didn’t hold back. One grabbed the marker and labeled the diagram’s feet “SWOLLEN!” Another drew little bubbles in the belly and wrote “GASSY!” Sore nipples, migraines, patchy skin, constipation, heart burn and, on a positive note, “great hair” were added. I had found my people!

Why it had taken me so long to see the value in getting to know other pregnant women, I don’t know. I have a particular aversion to anything with "mommy" as a qualifier, including (hypocritically) mommy blogs and mommy friends. And yet I have running friends, work friends, writing friends, pub friends. Every role you have in your life comes with new knowledge, new vocabulary, new experiences, all of which are best shared with others who have similar interests or ambitions. You have to find them.

The women in my class are all figuring out how to balance their pregnant selves with their working selves, their adventurous selves, their partner selves, their selfish selves. We are all taking on something new and unknown that feels too huge to not mean everything and yet too foreign to be part of our identities at present. We are preparing to make room to be moms while maintaining everything else that have worked hard to be.

It would be unfair to expect people to see me as anything but pregnant now, including myself. What was as small as a pine seed in the first ultrasound has grown into a watermelon-sized bump that is part hindrance, part armrest, part my little boy.

But now that I live in a body that I maneuver with the nimbleness and grace of the Kool Aid man, now that my mind is full of labor and motherhood, and now that I have embraced this so fully, it’s all about to change again.

Our class has already planned a December reunion, at which we’ll meet the literal fruits of each other’s labors. The first of us is being induced today, and we are all thinking of her and cheering her on, wondering who will be next, whether we are strong enough, how it will be. I hope we can continue to be a source of support for each other as we tackle the next phase, beyond the bump. If for no other reason, I'll need these women to test my new material on, the jokes that only a new mom can understand.

Wednesday, September 22, 2010

Define "prepared" ...

The Irish fella tells me to not always believe what I think. What he means is, when we are seeking the expert opinion of, say, a realtor, we should not spend half the meeting hearing what I believe is going to happen with the housing market. Ditto for consultations with plumbers, tax advisors, lawyers, and city hall clerks.

Both pregnancy and labor are things I previously knew little about beyond the broadest of strokes. Before becoming pregnant, I mostly associated the condition with sacrifice—one that took away wine and sushi and left your breasts like two windsocks on a still day. As for labor, I associated it with terrible pain, and assumed my pregnant friends spent nine months fearing the inevitable.

But it’s remarkable how little I really understood about the process. For example, I can’t remember when I didn’t know that a woman in labor had to be fully dilated before she was ready to push, but I didn’t know exactly what had to be dilated. Yes, it’s embarrassing. I just hadn’t given it any thought.

When you aren’t preparing for labor, you don’t bother to break down the details. You keep it abstract. You hear the term “birth canal” and picture Moses himself slowly bobbing his way down the Nile, even though with a spot of consideration you understand the journey to be more a matter of width than length.

I looked to experts. Early on in my pregnancy, the Irish fella and I sat side-by-side reading books I’d bought. His was explaining the importance of knowing the various stages of labor and what happens at each, and mine was telling me there are no stages of labor, that it is best understood as one fluid process.

Another book suggested we would be better prepared for labor if I put the Irish fella on the floor and covered him with a blanket, and then slowly removed it to reveal him again. In this scenario, he is the fetus and the blanket is the cervix. I’m fairly open-minded, but it’s hard not to be cynical about advice like that.

Time went on, and as one pile of books warned me against the advice given in the other, I stopped reading. It wasn’t hubris; I just didn’t want to learn anything and then be told to unlearn it. But when people asked what I was doing to get ready for labor, particularly for the drug-free home birth we’re hoping for, I felt like a slacker.

I do not think of labor as something that will happen. It's something that I will do. So it’s not that I didn’t want to prepare, I just wasn’t sure what preparing meant.

Studying too much about how labor will work and what must be done at (or by) what point makes birthing seem like a one-size-fits-all process. My midwife told me some women hold their breath and push until the small capillaries in their faces burst because they are told it is time and they must. But this is ineffective if your body isn't ready, regardless of how dilated you are. Not to mention it wastes valuable strength and disrupts the flow of oxygen to the baby.

In labor, women can feel vulnerable, and we can unknowingly resign ourselves to behaviors and procedures that are dictated by doctors or by our own ingrained expectations rather than an attentiveness to what is actually going on with our bodies. We forget to believe what we think. To trust what we feel.

A friend of mine began to scream during labor, startling her midwife, who asked her why she was making so much noise. My friend realized she didn’t actually feel the need to scream; she was doing it because it’s what she thought she was supposed to do. Television is a terrible labor coach.

Another friend, when her midwife asked her to push, realized she had never been told what to push, or from where exactly, or how. She panicked and labor abruptly stopped. When she relaxed and gave over to her own body’s instincts, she had no trouble at all.

Trusting your own instincts also means believing that you know how to breathe. There are breathing methods you can learn, such as Lamaze and its infamous “hee-hee-hooos” that are said to help ease the pain of contractions, and there is the Bradley technique, which consists of long, deep breaths to relax a woman between contractions.

I don’t dispute that these can be effective—but they have to be learned and remembered and executed properly. A doula—a trained labor companion—told me she does not recommend these methods to women because they are too easily forgotten in the throes of labor, leaving women without the trusty pain management system on which they’d planned to rely.

The same doula has coached woman in prison through labor, women who had no birth preparation, some of whom were in handcuffs while delivering their babies, and she said they breathed beautifully, all on their own.

Relying on—and asserting—your instincts seems to me paramount in labor and beyond. You can’t parent if you don’t trust yourself. Looking to experts to inform yourself is good, but in the end you have to be able to filter what you read and hear and decide for yourself. Otherwise you just react, and toss your logic out the window.

For example, months ago, the Irish fella and I read in several publications that it’s no longer safe to put blankets in cribs. We stocked up on sleeping “bags” that are recommended for the baby to wear to bed instead. When the kraamzorg—the nurse who will visit our house after our baby’s birth—asked us if we had a blanket for the baby, we very confidently said no.

She looked at us blankly, and we explained that babies were suffocating. She searched for the words. Finally she just said: “But it will be cold.” Then she used layering hand gestures to illustrate: mattress, baby, blanket. I’ve never felt myself plunge from informed to inept in such a short time.

So to prepare for labor, I’m thinking of it as a joint effort of baby and me. I know what it will require for him to move from the uterus to the midwife's arms, and being able to visualize this helps me understand what positions and motions make the best use of gravity and of the shape and workings of my own body to make this passage easier for him and for me. I trust that my body is made to do this. I trust I have the physical and mental capacity to endure it. That's just what I think. But I believe it.

Tuesday, September 7, 2010

Two Boobs and a Blanket

For the last two months, I’ve been working for a news and information website that serves the international community in various European countries. The company organizes a massive expat fair in Amsterdam every year—a major event that involves lots of exhibitors and the blood, sweat, and tears of my colleagues.

To remind our readership of the fair’s date, and us of approaching deadlines, there is a ticker at the top of the site that tells exactly how far away the expat fair is: it’s 4 weeks, 4 days, 22 hours, 7 minutes, and 34 seconds from right now. This is of particular interest to me, because the fair date is also my due date.

I’m not banking on the baby arriving on that day, even though 10/10/10 seems like a pretty lucky birthday. But in Holland they don’t allow the baby to stay put more than two weeks past the due date, which means the end of this pregnancy is undeniably nigh. According to my midwife, the little guy is positioning himself well for his big debut, dropping into place and slowly altering my walk into one that will eventually scream “there is a skull in my pelvis.”

As for me, it’s time to nest. Friends have described this phase to me: how they got up in the night to scrub the kitchen floor or how each time they tried to relax on the couch in the evening they had to get up again to investigate something that “smelled musty.”

Parenting Weekly
describes nesting as “the uncontrollable urge to clean one’s house brought on by a desire to prepare a nest for the new baby, to tie up loose ends of old projects and to organize your world.” It’s a natural part of preparing for labor. But what I’m experiencing may be a titch more than that, because my nest looks like this:

This is the second-floor landing of my new house. The bathtub that someone recently asked if I’d be using during labor? That’s going to go right there against the back wall, as soon as the pipes are laid and the floor is put down. And there will be walls, of course. I’ve got plumbers, painters, carpenters, plasterers, and electricians crawling all over the joint, all of whom assure me I’ll have a proper house by month’s end.

October 10 is just one of many delivery dates noted in my trusty blue diary: the tiles arrive Monday, the washer and dryer on September 20 , the refrigerator September 27, the dining room table on October 1—and the list goes on. The only post-baby delivery is the couch, which is unfortunate, but who knew it took 12 weeks—a trimester!—to deliver a couch in the Netherlands?

I’ll tell you who knew: a friend of mine who is an organizational wonder. To give you a taste, last year she hosted a Halloween “pre-party” at which she served dinner to six of us, hemmed one woman’s costume, gave me a haircut, and got herself ready, all in less than an hour. She’s a machine.

Last February I invited her over for tea. We got to talking about her list of things to do before even thinking about trying to have a baby. At the time I knew I was expecting, but I hadn’t made this public, and as she went down her list—get a new mattress, because pregnancy can be hard on the back; buy new furniture for the guest room, because family will want to visit; purchase new furniture for living room, because that's where you spend the midnight hours feeding your baby—I began to feel ill prepared.

I started my own list: Get divorced. Decide whether to refinance or sell the house. Find out if the Dutch government provides maternity leave assistance to the self-employed. See if it’s really true what they say about 18-month waiting lists for day care (it is).

I’ve historically been a more seat-of-my-pants person than some, but in spite of appearances the Irish fella and I actually wasted no time trying to get ready for this baby. We began our house search in March, made an offer in June, and closed the deal in July. Then came August.

Holland shuts down in August. Stores close. Towns are deserted. Everybody—everybody—goes on holiday in August, generally for three weeks. So when you consider how little time we’ve had—less than ten days—to prioritize projects, find builders, and order materials, the house is coming together rather impressively. Sure, there’s a dismantled toilet on what will be my bedroom floor, but I’m trying to see this as a sign of progress.

And behind one of the doors in the photo is a peaceful, freshly-painted room with the most beautiful nursery furniture I’ve ever seen. It’s my sanctuary in what will eventually be a really nice house. I don’t know if it’s the calm-inducing pregnancy hormones, but I’m feeling relaxed.

A few months ago I reassured myself by joking that all a baby really needs is two boobs and a blanket—I can give him that and some. If the little guy shows up early, even if there’s no hallway floor per se, he’s got two parents who can’t wait to receive him and a nice place to sleep. Not a bad start.

Monday, August 30, 2010

Circumcision: Willy or Won’t He?

The night I learned I was pregnant, my unsuspecting Irish fella was out with a friend of his whose wife had just learned she was expecting. They toasted this news into the wee hours, and my Irish fella spent that night dreaming about babies, specifically that he had twin daughters.

Upon learning the next morning that I, too, was pregnant, he continued dreaming about having twin girls, one dressed in blue and one in yellow. The dreams were detailed and recurring, and we began to believe in the girls, and had picked out perfect names for them. An eight-week ultrasound eliminated the possibility of twins, but we still leaned very heavily toward ‘girl’. It wasn’t a preference—just a feeling.

When we went for the 20-week ultrasound, the first image we got was that of our baby yawning. It was incredible to see. The technician took us on a 30-minute gray/blue grainy tour, pointing to and measuring the skull, the lips, the hands, the feet. “Here are the lungs,” she beamed, “and the heart, and the stomach, and here is the liver, and here—” she drew an arrow onscreen—“are the balls!”

And indeed, there were the balls. This meant we had to rethink our names, but it also meant, for me anyway, that we had to talk about something else.

In the States, although the practice is increasingly questioned, circumcision is still the norm. It’s not something I had made up my mind about, but it’s something I thought we should discuss. But because the Irish fella is ‘unsnipped,’ I assumed his answer to the circumcision question would be absolutely not.

“Absolutely not,” he said, “and don’t be Googling it.”

But I’m a Googler, so of course I Googled. The United States, I learned, is the only country in the world that circumcises the majority of its male infants for non-religious reasons, and I was curious to know why so many parents opted for this.

Many members of the parenting discussion groups I visited online seemed to believe it was better for the baby. But as far as medical benefits, there are none, and the American Academy of Pediatrics has been saying as much since 1971. In fact, no national medical organization in the United States recommends circumcision. Claims that circumcision helps reduce the instance of infection and the spread of STDs are unfounded.

One woman in a pregnancy forum said she was going to circumcise her son because she didn’t want to have to handle his bits in order to wash them. The improbability of avoiding touching your son’s privates while caring for him in the early years aside, this is misinformed. The penis in its natural form is a self-cleaning mechanism, much like a vagina, and it is not true that an uncircumcised penis is more difficult to clean—not in adulthood and not in infancy. In fact, the baby books are very clear on how to care for a newborn’s foreskin: leave it alone.

What I’ve found, both online and in speaking to mothers of sons, is the overwhelming majority of parents lean in favor of circumcision so the baby will “look like daddy.” This seems widely accepted, but it doesn’t hold for me.

These are well-meaning parents, as I believe most are. But the “look like daddy” argument is a self-perpetuating one that ensures the continuation of circumcision while negating medical research that not only dismisses any benefits of the practice, but that actually points to the potential damage—physical and psychological—that can result from it.

I understand that children are wonderfully inquisitive and observant and will notice and ask about the differences between their bodies and their daddy’s (and mommy’s). But on hearing something like, “people used to cut the skin off because they thought it was safer, but now we know that is not true so we didn’t do that to you,” I think most little boys will accept this simple truth rather than have confusion instilled about their masculine identity.

Adults over-complicate, but kids don’t. Explaining my divorce to a small child sounded something like this: “We decided we are better friends when we aren’t married to each other.” It took a little more explaining to grown-ups, but the additional details didn’t really change the core truth of what I’d said to my friend’s six year old. We shouldn’t impose our instinct to over-analyze on children. We should allow them to enjoy a period of life where simpler explanations are acceptable, particularly when they tell us all we need to know.

I can only conclude that we, meaning Americans, circumcise because it’s what we’re used to doing, and because the majority of boys in the States get the snip, a circumcised penis is what we are more accustomed to seeing.

One woman wrote in an online forum that she once saw an uncircumcised penis and it looked like Darth Vader in a turtleneck. She said it was ugly, and worried that girls wouldn’t be attracted to her son. I can’t imagine society accepting elective surgery on the genitals of female babies because we prefer how it looks.

And of course circumcision is not the norm worldwide. According to some statistics, about 60 percent of infant boys are circumcised in the U.S., and Australia is not far behind. Only about 30 percent are snipped in Canada, and figures drop to less than 20 percent in countries elsewhere in the world. I mentioned these numbers to an Australian friend of mine, a circumcised male, who immediately fell into a fit of insecurity about whether Dutch girls think he looks like a freak.

It reminds me of the Dr Seuss story about an island inhabited by two breeds of Sneetch: some have stars on their bellies and are considered vastly superior to those without. The star-less Sneetches obtain a large and fabulously Seussian machine that puts stars on their bellies, prompting the original star-bellied Sneetches to acquire a machine that removes their stars. Chaos ensues: nobody knows anymore whether it’s preferable to have a star or not to have a star.

Of course a star is not a foreskin and a baby is not a Sneetch. The bottom line is that every parent should choose what they think is best for their child. Inform yourself and weigh the pros and cons.

For me, my baby will not be circumcised, not because he’ll be growing up in Europe and not because he’ll look like his daddy if we leave him intact, but simply because it is not necessary.

Monday, August 23, 2010

Do or Do Not. There Is No Try.

Child bearing, like politics and religion, is not considered a safe or polite topic of casual conversation in the States. You do not break the ice at a cocktail party by asking when a couple plans to have children. Even if the response is a well-practiced quip, the woman who has undergone three unsuccessful IVFs will think you’re a dolt.

Reasons for not having children can range from the medical to the monetary, but they are all personal. And of course there are couples that simply do not want to have children, and this choice is not one they will want to defend over the cashew dish. Even if a couple already has a child, you don’t ask when they will have more.

This does not appear to be the rule in the Netherlands. Here, people ask. At work, in the pub, of strangers, of friends. In the past, I’ve been asked not only why I don’t have children, but whether I can or if I just don’t want to, and I’ve been told whether I should. Perhaps it was my ambivalence about the subject that kept me from being offended.

I never counted on having children. I could see living very happily without them—the freedom to travel, to focus on career, to live spontaneously. And I did these things while married. My former husband and I lived in three different countries and three states in the years we were together. We both got to go back to graduate school. He started his novel and I advanced in my career. We partied. We traveled. And we talked about children, in a “someday” sense.

I also never assumed having a baby was a choice I could just make—I’ve watched too many friends go through the frustration and heartbreak of infertility. I began to think of getting pregnant as something that takes more deliberate intervention to achieve than it does great measures to prevent.

Of course nobody was asking when my Irish fella and I would have children, because we weren’t dating that long, but it was more than that. When the man in question is in his 50s with no history of long-term, serious relationships and no children, people assume it’s something he doesn’t want, or that he is by now too set in his ways to entertain. And at 37, I’m definitely considered of advanced age in the Netherlands, especially for my first child.

But since learning that I am pregnant, people here have not been shy about asking whether the baby was planned. Nobody State-side has asked, but I suspect it’s just out of politeness, or that people have drawn their own conclusions. Mostly I think people assume that not preventing enough is the same as trying, which certainly seems logical.

But I think there may be a gray area between preventing and trying. We were sometimes very diligent about protection and other times less so. But I wouldn’t say I was hoping to be pregnant. The timing was all wrong for some very obvious reasons, like I was still married, and I hadn't yet told all of my extended family that I was separated, never mind dating. When I took the first pregnancy test, it was to eliminate pregnancy as a possibility and to put my mind at ease.

When it was positive, I took another, then another. If I had been trying, then wouldn’t I have taken a positive result as a success? And yet I wasn’t aghast either. With each positive result, I sat and waited for the panic attack that never came.

It was manageable news, but without being sure it was good news, I wasn’t sure how to share it. I Googled: “how to tell your boyfriend you are pregnant.” From the resulting advice, you could easily distinguish those who were definitely not trying—“know what you will say if he starts verbally attacking you!”—from those safely in the “trying” camp—“buy him a ‘World’s Best Dad’ shirt and let him guess!” Nothing fit my situation.

I refined my search: “how to tell your boyfriend you are pregnant when you haven't been dating very long, but you are pretty sure he will be happy once he gets used to the idea.” No hits.

I went to his house the next morning. I brought croissants. I had planned a small speech. But when he asked how I was, I just said, “I’m pregnant.” After a few seconds of silence that felt like millennia, he said, “Well, we have to buy a house, and we have to learn Dutch.” And he put the kettle on.

If you measure “trying” by how we reacted to the news, then maybe we were. Or maybe we just didn’t think it would actually happen, and got lazy. It doesn’t really matter at this stage—we’ve skipped over “trying” and are getting ready for “doing.”

Thursday, August 19, 2010

Box of Tricks

I recently spent the afternoon with a friend I’ve known since high school, a whopping 19 years. She has a five-year-old son whom she delivered at her home in a nearby town, and while she drank a goblet of wine that I eyed longingly from the rim of my water glass, she told me her birth story.

She said she first felt contractions around 1 am, and managed to sleep through them until about six the next morning, when she sank into the couch and watched television until they became stronger and closer together, at which time she called the midwife.

The midwife arrived on her bicycle, birthing stool in hand, and within two hours my friend’s son had arrived, the house had been cleaned, and the midwife had left. My friend’s recollections were all positive. The labor was quick, she said, and didn’t hurt so much as it “was uncomfortable.”

Stories like hers are always reassuring. It helps to think that someday I’ll (knock wood) be on the other side with my own happy, healthy home birth story. But then one thing she had said echoed back: the midwife had left. She left? She just left? You have a baby and then midwife just hops on her bike and leaves you there, in your house, alone with a new baby?

Of course this should have dawned on me before. The fact that I am not going to be staying in the hospital means I will not have a staff of nurses looking after me and my new bundle throughout the first night. But I had somehow not envisioned giving birth and then being left to my own devices with a baby in my house. I know nothing about babies.

My friend reassured me: the midwife will leave, yes, but the next day, the kraamzorg will arrive.

Kraamzorg sounds like an evil spirit you will want to ward off, but it’s a good thing. Zorg in Dutch means care. Kraam on its own actually translates to market booth, but when coupled with –zorg, it refers to care given to a woman who has just had a child.

A kraamzorg is a person who comes to your house to look after you for one to three weeks after you give birth, depending on your situation and what your insurance covers. She coaches you with breastfeeding and shows you how to change and generally care for your baby. She gives you time to rest and recover, and even does your shopping, cleans your house, and cooks your dinner.

My midwife gave me the number of a kraamzorg service. Like all things that are completely foreign to me and perfectly commonplace in the country I live in, I expected a catch, or at least a lot of questions. But the kraamzorg wanted only two pieces of information from me: Do I expect only one baby, and do I have a dog? Then she took down my address and said I would be receiving a kraampakket in the mail soon.

A few days on, a medium-sized box with an image of a koala bear and her baby arrived at my door. This box, my kraampakket, contains everything I need to deliver at home, from bandages to an umbilical cord clip to baby shampoo to a pack of diapers that I realized as I unfolded and unfolded one are actually for me.

With every encounter I’ve had with my midwife and now the kraamzorg service, I am left with a feeling that there is really nothing to fuss about. Rather than leave me feeling ignored or ill-informed, the simplicity of the system puts me at ease.

I am not by nature complacent, and I am definitely capable of digging in my heels and getting my way when I feel I’m absolutely right. But I’m also more than happy to surrender control when I trust that someone else has my interest at heart and better knowledge than I in a given situation. This is definitely true of my midwife, and I’m expecting it to be true of my kraamzorg.

If something feels off, I certainly will say so, and if I have concerns, I will absolutely voice them. But my midwife strikes me as so competent and capable that I haven’t felt any need to question her or fret about anything. The entire basis of the Dutch approach to pregnancy and labor is that my body is designed to do this. My midwife has seen this whole thing time and time again, and if she is satisfied that everything is going as it should, I’m quite happy with that.

Every three weeks I see my midwife, we listen to the baby’s heart, she checks my blood pressure, measures my uterus with her hands (I’ve yet to and most likely will not have any internal exams or even be weighed), and asks me how I’m feeling.

During my last visit, I mentioned that I’d been trying to count the baby’s movements, something I’d read to do in a book, but because I have an anterior placenta—it is on the front wall of my uterus—I can’t really feel kicks or movements as strongly or frequently as I would otherwise. Her answer: “Don’t count the movements. And don’t read books.”

Of course it helps that my life is full of things that simply do not allow me to obsess over my pregnancy, what with buying and selling a house, working full-time, negotiating a thankfully graceful divorce, embracing a relatively new relationship, and doing all this on two feet that have swelled to the size of bread loaves and with a belly that juts out so unnaturally that I frequently misjudge the amount of clearance I need to pass through a space. If my midwife tells me the baby is growing and developing well, then that’s one less thing to think about, and if my kraampakket holds all I need to have my baby at home, then cool.

I’m not sure this would work for all personalities. I definitely know people who need to arm themselves with as much knowledge as possible, thinking that is the best way to safeguard against anything going wrong. But I think more often than not, that method just introduces new things to needlessly worry about. And the fact is, there’s not much you can do to prevent many of the things that can go wrong. But I trust that my midwife will be able to detect anything that warrants concern, and will deal with it appropriately.

In the meantime, outside of taking care of myself and eating well and taking my vitamins and being sensible about things, there’s not much for me to do but let the baby grow.

There's No Place Like Home

The learning curves of a first pregnancy are not unlike those of settling into a new country of residence (and I should know, because I’m going through both things right now). Both require the quick absorption of important knowledge, the challenging of previously held opinions and perspectives, and the letting go of the little things you take for granted in life -- the ways you think you know how things work.

Sometimes what’s at stake is relatively small and yet disproportionately inconveniencing, like the day I popped out to the grocery store for some baking soda, only to be sent off on a frustrating trek that ended in a pharmacy, where such chemicals are sold in the Netherlands. These incidents catch you off guard, whereas you anticipate the larger differences, like banking systems and mortgages.

There are clear differences between the Netherlands and the US when it comes to health care. In the Netherlands, medical coverage is paid for by the state until the age of 18, at which point every resident must purchase private insurance. But the packages are generous and affordable, and insurance companies are not allowed to deny coverage to anyone, nor charge higher premiums based on age or existing conditions. Health care Shangri-la!

And using your health insurance is as easy as obtaining it. Everyone must have a huisarts, or a family doctor, who is essentially the system gatekeeper. If you want to, say, see a physical therapist, you go to your huisarts and say, “I would like to see a physical therapist,” and he writes you a note saying indeed, you may.

That’s all. He doesn’t point you to a particular therapist—you can go anywhere in the country with that note, to any doctor or specialist you want. There’s no examination. No waiting period. No paperwork. No resistance.

For about 150 euro a month ($190), I have one of the most extensive (and expensive) policies available. Prescription drugs and alternative therapies are covered and medical procedures from intensive surgeries to drop-in ear cleanings cost me nothing.

So imagine my surprise when, upon learning I was pregnant, I asked my Dutch insurance provider what maternity care coverage I had, and the answer came: “When the baby is being born, someone is coming to your house.”

This seemed incredibly vague. I went to my huisarts and reported that I was pregnant. He asked if I was happy about it, and I said I was. “Then congratulations!” he said, and he shook my hand, grinning.

He’s a happy holistic doctor who twinkles like the crystals that crowd his office. He curled his long Dutch form back into his chair and folded his hands in his lap, nodding pleasantly. He had the manner of an uncle you may find yourself sitting next to at a wedding, whom you’ve not seen in many years, and who approves of you but isn’t sure what to say to you. It was as though he had no idea why I was coming to him with this news.

I said I would like to see an OB/GYN, and he pulled out his notepad and scribbled his permission. “Have a good pregnancy!” he called to me, waving, as I left.

I called the office of an OB/GYN -- whose name, seriously, is Dr. Lipps -- and explained to the receptionist why I was calling.

“I took a pregnancy test…,” I began, in my bad Dutch.

“And you are not pregnant?” She interrupted.

“No, no, I am pregnant, so I’d like to see the doctor,” I said.

“So you do not have problems getting a baby,” she confirmed, switching to English.

“Seemingly not.”

“You are pregnant.”


“Then you do not need a doctor.”


A second trip to the huisarts cleared things up for me. In the Netherlands, a doctor is not involved in pregnancy or labor unless there is a medical problem. And because hospitals are only for sick people, no hospital stay is factored in either.

What my health insurance covers is a midwife, and the assumption is that I will have my baby at home.

My huisarts explained that you can only deliver in the hospital if you have a medical reason for doing so, or if you pay for it yourself. And even in the hospital, it’s just you and your midwife, and a midwife cannot administer pain relief. And unless you deliver at night, you are sent home a few hours after delivery.

I’ve since learned that, due mostly to outcries of the Netherlands’ many expat residents – the city of Amsterdam alone is the adopted home of people from over 175 countries – it was recently made possible to elect to deliver in the hospital at no personal cost (although there is still no overnight stay) and to insist on an epidural in specific hospitals. But the request can only be honored if the anesthesiologist is on call and available when the time comes, and most go home at 5pm.

Now, I have had many friends over the years share their birth stories with me, and they range from the planned C-section that ensured labor didn’t mess with a busy New Yorker’s schedule to a friend who delivered, as her husband was frantically driving her to the hospital, in the front seat of her pickup truck.

Most of my friends who have become mothers had given a lot of thought to their birth plans and knew exactly what they wanted, and why. Those who wanted drugs and a hospital stay had very convincing reasons for doing so, as did those who wanted to have their babies with little or no medical intervention.

Where and how you give birth is an extremely personal decision, and I’m probably in the minority when I say it’s not one I’d ever given any real thought to making. A friend of mine from the UK recently had her first baby in the Netherlands, and she was able to insist on a hospital birth with drugs. But I’m actually embracing the home birth idea, and the more I think about it the more it appeals to me.

I am not a woman who has always visualized child birth as an empowering experience. I do not think of a labor as a “hero’s journey.” Other than a brief dabbling in my youth, mainly for the drugs, there’s nothing hippie or bohemian about me. You’d have to dig pretty deep to find my inner earth mother. The only clear idea I’ve ever formulated about child birth is that it will hurt. A lot.

But given that, why not be in the comfort of your own home, where you can be in your own bed, use your own bathroom, have all your own clothes and things around you, and feel relaxed and comfortable in a familiar environment?

And so barring any medical problems, the plan is indeed that, when the baby is being born, someone is coming to my house.

Wednesday, August 18, 2010

Eat, Pray, Love -- Or Get Your Act Together.

Things always seem harder to have done than they are to actually do.

On reflection, the amount of change in my life over the last year is staggering. I separated from my husband after twelve years together (a third of my life, I often tell myself, for dramatic effect); I lost my job and found another; and along the way I started dating a 51-year-old Dubliner whose life before me was calm, quiet and, above all, independent. That changed in January when I learned I was pregnant – the first child for both of us.

The day my husband left, we woke up very early. We had tea. He took our two dogs on a walk while I got their crates ready. We all piled into the taxi and headed to the airport. They were returning to the States, and I would be staying on in our home in the Netherlands.

At Schiphol we walked the dogs up and down the parking lot and gave them tablets so they wouldn’t be anxious. We stood in the check-in line for Indianapolis. Then the dogs were taken away on a large trolley, and my husband gave me a kiss and disappeared behind a sliding door. I went to work.

When I got home that first evening the house was empty and still, but not in a way that felt permanent. That comes with time. The first night I somehow put off thinking about it. I sat on my balcony and drank a bottle of wine. I smoked cigarettes.

In fact I spent several nights sitting on my balcony, drinking wine and smoking cigarettes, emotionally stuck. An old friend with whom I’d only recently reconnected offered me the keys to his Shanghai apartment, which was vacant for the summer while he traveled. And so, on a lark, I went.

I landed in China with my friend’s address written in English. I had it translated into Chinese characters so I could communicate to a taxi driver where I wanted to go. That was as far as my planning had gone.

At the start I embraced Shanghai. I went to museums. I drank cocktails with other travelers who invited me to join them for fried crickets. I wandered gardens. I went to a tea ceremony with three Chinese students who wanted to practice English.

But I got up later each day and stayed closer and closer to the apartment. Toward the end of my trip, I mostly sat on my friend’s balcony, drinking wine and smoking cigarettes.

In stories, when your life changes dramatically, the thing to do is to go far away and find an answer of some sort, discover something about yourself, run with the change as far as you can and see where it leads.

My experience: when your life changes dramatically, the thing to do is to face the change, and reinforce normalcy around that change as much as and as soon as you can. Let yourself feel the strangeness and the sadness, but force yourself to function in the “new way.”

By all means, drink wine on balconies, when you are doing so for the right reasons. But don’t smoke cigarettes. There’s just no benefit to doing that, ever.

A year on, I’m amazed and humbled by just how lucky I am. My ex-husband and I remain truly good friends – which we agree is perhaps what we are supposed to be. I’ve embarked on a new relationship and I’m navigating my first pregnancy in a foreign country, preparing for the future while making sense of the past, and proudly carrying my baby bump through my daily grind.

There’s a lot of change still to come, and there’s a lot that’s happened that I’m still processing. There’s also been a lot of frustration dealing with Dutch law, a few surprises relating to the Dutch health care system and the Dutch approach to pregnancy and labor, and of course the awkwardness, hilarity, and learning curves of a new relationship and a first-time pregnancy. This blog is my way of documenting all of this.

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