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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