Getting started

"Hey," I grabbed Caleb's hand across the center console, interrupting his story. "I need you to know that I am feeling really scared."

"Scared about what?" Caleb asked, naming a few specific possibilities.

My eyes filled with tears, "I don't know. All of it. I am just scared."

We were driving to our first prenatal appointment for our new baby. Not only was it this baby's first appointment, it was our first prenatal appointment ever in a medical office, seeing an OB.

[Start here if you don't know the story of our first baby's birth.]

Something like 8 weeks pregnant and already none of my pants fit

I had started thinking through this decision of who to see for prenatal care, just months after Sammy was born. I knew I did not want to have a home birth. It seemed early, so early, to be thinking about this, but I knew that I had to start thinking about it now or I would not be ready. With the guidance of my favorite article about birth of all time, I made what I loosely call my birth plan. Instead of a specific play-by-play, this is a list of what is important to me in birth:

• I want to feel safe. 
• I want to do skin to skin immediately. 
• I want to remember. 
• I want all the options. 
• [Added later] I want straight answers only: yes, no, I don't know. "We'll see" or "Maybe" are not options.

I didn't pull the article up on my phone during the drive, but I thought about it and remembered it and that gave me strength. The OB we were going to see had been described by others as "a midwife in an OB's body." If the midwife who was there for Samuel's birth could have offered us the option of a hospital birth, I would have taken it. But she only does home births. 

So many things drew me to the midwifery model, like the time spent with each client ("clients" in a midwifery world because pregnancy is not an illness). The focus on wellness and holistic nutrition. The through review of each test or procedure with pros and cons and the genuine lack of pressure as you decided what you wanted to do. 

But I also wanted all the options, with no judgement of my choices. And I didn't think I could handle having a midwife like the one I left halfway through my first pregnancy. 

I haven't talked much about that experience on here or at all, probably because the birth itself ended up overshadowing it. But as we drove to our appointment, I remembered driving to that first appointment for Sammy. The office where this midwife took appointments was located nearly an hour from our house. We'd interviewed her early on and been impressed with her for a variety of reasons, all of which fell apart as we began to see her regularly. I was nervous, but often did not feel much better after our visits. The drive was stressful to me, and the best way I can describe her was somewhat cold. Despite what she said, I did not feel like my questions were welcomed, and I had a lot of questions, having never been pregnant before. She constantly compared herself to being better than a traditional OB in terms of flexibility, time, etc. Sometimes she did not listen to what I said, but assumed she understood. Finally it all became too much and I told her I was going to switch. She instantly became difficult to get ahold of, and when I finally did get in touch with her, she spoke harshly and critically about my new midwife, recommending that due to my nervousness and anxiety, I just go ahead and find an OB who would deliver in a hospital. Looking back on it, I don't think I had any more anxiety than the average first-time mother. 

So. Here we were driving to my first prenatal appointment with a new doctor. I held Caleb's hand tightly. I bit my lip to keep from crying as the nurse made small talk as she took my blood pressure and placed an unwelcome hand on my belly for a fleeting second to comment about how I was showing already. Finally, it was all too much, and I burst into tears as I described our first birth.

The nurse seemed shocked, and didn't really know what to say. "Eleven pounds? You should probably just have a c-section this time," she suggested unhelpfully.

Instantly, I was aware that I no longer wanted to share my story with this person. "We'll see," I said, intentionally folding my arms across myself as a way to close myself off.

She turned to Caleb and acted as if she was telling him a secret, cupping both hands around her mouth and saying "C-section".

I was ready to get off the table and leave. I did not feel like a human or at all respected. She wouldn't let me sit next to my husband, whose hand I needed. After she left, I quickly moved back into the second chair. It was a small move, but it reminded me of my dignity as a human. I was not there to just be examined on a table. I was there to receive care - and also I was there to interview them. They were professional adults - but so was I. Maintaining my own sense of agency by posturing my body in the chair instead of on the table became my act of rebellion for the next few visits to that office. It reminded me that I have choices and that I have a voice. Even when I was weeping.

In the end, I loved the OB, but made the decision to transfer based on her staff. Until one September day when she told me she was leaving to start her own practice. And that is where I landed, thankfully. 

36 weeks

Dear Baby,

Our life has been a whirlwind of doctor appointments, finger pricks, careful food tracking, medications, ultrasounds, and insulin injections. We have a gestational diabetes that just won't be controlled. But we don't have much longer before we meet YOU. The thought of it simultaneously gives me relief and scares me. How will we do it? Some days, most days, it feels like we are just barely feeding ourselves, going to work, and keeping everyone clean. But somehow, you will fit right in.

All my maternity photos are work bathroom selfies. #NotSorry

You're following your growth curve from the past 16 weeks, clocking in now at approximately 7.5 lbs, which would actually make you smaller than your brother if you were born on your due date, but you won't be born on your due date. We'll decide at some point in the coming days if we want to induce or have a c-section. Someday, the way you were born will be one of the least interesting things about you, but for now, it feels like a big decision.

We have wonderful doctors working with us to inform us on all levels about this decision, and they are kind with me and spend hours willingly answering every detailed question I ask: "Can you show me on my body where the incision would be? What would that morning look like for me? What kind of pants do women usually wear afterwards? How many people would be in the room?"

Meanwhile, at home, we had a plan to finish renovations on an upstairs room for your brother. It went awry when your dad broke his elbow early on in our third trimester. It might get done, it might not. Moving Sammy there might be too many transitions all at once. We'll have to see. In any case, whether we squeeze you into our room or set up the bassinet in the living room, you'll have a cozy spot to sleep near people who adore you.

We have tired eyes as we finish our nesting, but our hearts are happy. See you soon little one. In the meantime, as we make our last decisions, I keep coming back to this quote:

“Birth is working with mystery and the unknown. So our power actually comes from letting go of the ‘how am I going to make this happen? How am I going to achieve this goal?’ And going to a place of wonder and curiosity. I actually don’t know what the outcome is going to be. I’m going to discover it as I go. And my power comes from a place of receptivity and a willingness to allow the process to unfold without needing to know how it’s going to go, or to have it go a particular way.”

Close call

There are some moments in life when the line between heaven and earth seems to fade away for a while and leave everything clearer.

Last weekend, I went to be Saturday, noting that I was feeling really great. I woke up in the night and was no longer feeling great. For the sake of the delicate reader, we'll call it indigestion. As the day progressed, I didn't have any more indigestion, but I did feel worse and worse. I laid in bed. My back hurt, my belly ached. Everything felt off. Everything felt wrong.

Late in the day on instinct, I googled "signs of preterm labor". Check, check, check, check, maybe? Two that were no, two that were maybe, the rest were yes. I took a deep breath. Caleb had been primary parent all day, and I could hear his voice was tired as he managed bath time. I didn't want to just walk in and announce it. I needed to think. I looked through all my informational hospital literature. I looked at more websites.

Finally, bath time was over. I reviewed my symptoms with Caleb and the weariness was instantly gone from his voice. "You need to call." My eyes filled with tears. "I'm scared. I'm not ready for this."  I sat on my bed for a few minutes before I could make the call, crying, realizing that this could be the start of a whole new journey to either stay pregnant or visit a little tiny NICU baby. I wondered why I'd spent so much time recently being stressed about our house being messy and other trivial things. What a waste. I called, the friendly triage nurse calmly told me I needed to come in to see what was happening on a monitor.

Sammy was now running cheerily around the house in his diaper. After I got off the phone, I caught him and held him for a minute, explaining that I needed to go to see the doctor to make sure the baby was okay, and that I hoped I'd be home when he woke up, but I didn't know, and that I might be gone for a little while.

We decided what would be the least stressful for me was for Caleb and Sammy to drop me off, since the hospital is near our house, and then have them come home and have a normal night of bedtime routines. It gave me a lot of comfort to know that Sammy would be enjoying his usual snuggles with Dad before bed, even if that meant that I would be alone. I knew several people who would be willing to come and sit with me, but I felt strongly that I wanted to be alone or only with Caleb. This ended up being a perfect intuition.

We pulled up to the ER, and I kissed them both goodbye. I walked through security and had my backpack, which consisted of all the things I thought I might need for a night or two away, searched. I walked up to the triage desk. "Baby time?" they asked. "I hope not!" I replied. I carry babies 100% out, so it's not uncommon for people to think I am full-term, though I still have three more months.

I walked through my symptoms, and then an aide came up to me with a wheelchair. "L&D run?" he asked the triage nurse. I climbed in the wheelchair, he placed my backpack on my lap, and we turned to go through the double doors. That's when it hit me. "This is the part I missed last time."

Time and space seemed to open up as I rode, imagining this same trip 19 months (minus two days) earlier. I don't remember riding to the hospital or going to the L&D unit from the ER. And now I was getting to do it all. I fell silent, observing. It was longer than I'd imagined, though I am guessing we took it at a faster pace last time. The poor aide tried to ask me some friendly questions, but I was a poor conversation partner, hushed by the opportunity to consciously see what my body had experienced before. It smelled like the NICU, a combination of new plastics, cleaning agents, and some other unidentifiable smells.

We arrived to L&D and they gave me a gown and hooked me up to monitors. I know they tried to hook me up to monitors last time, and I also know that I was combative. I looked at them in wonder, realizing that though I had a baby in a hospital, I'd never really seen the monitors or the machine that tracks contractions. I felt such a sense of relief- both to be there and to know I was in the right place if anything was going wrong, and to have had the opportunity to go on that journey consciously.

After being connected to the monitors, I text-updated our families and a few friends. Then I put my phone away and reflected. When you're only 26 weeks pregnant, it's quite a jolt to see a baby cradle and warmer lined with a hospital blanket. I was glad for the solitude, glad to be left alone with my thoughts. I knew based on the time that Caleb was probably feeding Sammy dinner and I thought about how much love I felt for the two of them. The line between heaven and earth is very thin, indeed.

I sat with all of this for quite a while. A really long while. That's when I knew I was not having an emergency situation. I couldn't see the fetal monitor behind me, but I imagined that it must not be picking up on anything exciting. Caleb, meanwhile, put Sammy to bed. My mother-in-law arrived to my house so that Caleb could come and join me. My brother and I texted each other hospital toilet jokes. (I am sure the nurses wondered what was making me laugh so loudly.)

Caleb arrived shortly before the doctor. I was not dilated at all. (My first time being checked for that while not in active labor and it was just as terrible then as it was during labor. Yuck.) There had been no contractions, baby was doing well, but they emphasized that they were glad I came in. I was glad too. We left holding hands, grateful to be going home for what would be a normal night, grateful for the blessing of routine. 

PPD II

I'm going to start this post with something I wrote a year ago, in October 2017, then bring it back to the present.

(My first post about postpartum depression)

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10/13/17
It's hard to describe how difficult this week has been.

Historically, when I have thought about depression, I have imagined it Eyore-style, a little raincloud over someone's head that follows them around. But what I experienced this week was the opposite. It was like being in the sharp, blinding sunlight all the time. Hot, irritating, feeling like "c'mon, you better be working, you're burning daylight and moving too slow."

More metaphors: it felt like there was a hive of wasps stirring angrily inside.

And when it finally abated, it felt distinctly like cloud cover, descending with the peace that passes all understanding, weighing down, sending cooling rain, and finally I could rest.

I didn't sleep the first four nights of this week except for an hour here, 20 minutes there. I woke for the day at 1:15, 4:30, or 3:30, unable to relax enough to go back to sleep.

"Take deep breaths," they said. But I couldn't. I was physically unable because I had no more emotional resiliency left. It felt like labor, but I don't know what, if anything, was birthed.

I could feel myself descending lower and lower, but I didn't realize it was the postpartum depression. I participated in a survey during pregnancy through a university that was researching a large group of pregnant women. I got a follow-up questionnaire this week. I answered a few questions about the birth and about the baby's health. Then I got to the PPD questions:

"In the past week have you been A) as happy as you've ever been B) slightly less happy than usual  C) significantly less happy than usual D) completely unhappy." (I can't remember the exact options, but you get the idea.)

Similar questions followed about suicide, level of interest in activities, ability to sleep, ability to work, appetite and others. This is a pretty standard questionnaire to screen for PPD. I took it at every doctor appointment for myself and baby during my maternity leave. It was given to me along with the standard paperwork for every doctor's appointment. But after those first twelve weeks, it seemed to disappear. Interesting, given that PPD can arise any time within the first year after the baby was born.

This time as I answered the questions, my answers were different. Significantly unhappy, little to no interest in daily activities. Not sleeping. Very anxious.

The thing that is a bear about something like depression is how long it lasts. When I first started feeling depressed, I reached out through almost all of my channels to say I needed help. And I got help. But that was months and months ago. How do you go back to those same channels and say the same things again?

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Now, in October 2018, I've been seeing a new counselor for several months. I had seen one last fall, but it wasn't a great fit. At my last appointment, my new counselor gently suggested I needed to make time to connect to and move my body. She asked if I was doing anything now to feel at home in my body, like yoga, going for walks. I thought about my life and wondered if doing dishes or scrubbing the floor under the high chair counted. I wanted to laugh and tell her that I didn't know how anyone had time to do that, but I knew she was right.

Part of me felt like I shouldn't have needed to see a counselor to tell me that I need to exercise to help myself feel better. But a bigger part of me thinks that every new parent should see a counselor, someone who is a good fit, to help transition into this stage of life. It's such a big change - and there's minimal guidance on how to do it. It is hard, when you're already overwhelmed, to imagine finding the time to interview or try out different therapists. But when you find one... magic. (Well, actually, it's a lot of work, but then you feel a little lighter and less alone and it's good.)

On traveling internationally in the first trimester

From July, 2016
[I'm giving this one a TMI warning, in case you don't want to hear TMI about some pregnancy details.]

I had never been to Uganda before.

I had been looking forward to this trip for months. I had been to Kenya, Tanzania, and Madagascar, and I was now especially eager to see what Uganda was like and to meet my coworkers there.

But now I had a secret little traveler who would be joining me, I would be about six weeks pregnant when I arrived.

The week before, I had an extra-early appointment with my midwife, just to check in before I would be gone for two weeks. She and Caleb heard the baby's heartbeat, just for an instant. I missed it, but it was real to me in other ways. My midwife once mentioned that sometimes you can hear the baby's little soul calling out to you before they are created. I thought this was beautiful and true. Even before this baby was born, I knew he or she was going to be persistent.

So off we went, my persistent baby and me, traveling halfway around the world and landing in Kampala late at night. For the sake of length, I'll not go into detail about the wonderful work details of the trip. Really everything went swimmingly for day one and the first part of day two. And then it was lunchtime. I had enjoyed the food at all the previous meals. And suddenly mid-lunch, my stomach turned. And kept turning. For the next two weeks.

All I wanted was macaroni and cheese, but cheese is not an easy find in rural Uganda. Or macaroni.

That night, we got back to our hotel. I was extremely excited, because my room had a squatting toilet, and I had wanted to stay in a room with a squatting toilet for a long time. However, when I squatted down, I realized that I was spotting. I tried not to panic, spotting can be normal. Our hotel had no internet and no phone. At the time, I didn't have a smartphone, but my phone did offer the ability to text and call internationally at exorbitant rates. I texted a photo to Caleb and asked him to send it to our midwife. He texted back saying he had talked to her and that she wanted to know if I could call her.

"Many women experience spotting. It could be nothing. But I need you to make a plan for accessing emergency medical care in case you miscarry and start to hemorrhage. Are you near a hospital?"

I very much doubted this, but I knew that I was in good hands. "I will ask the staff tomorrow." I explained. She also suggested that I talk to the baby and ask him or her to stick around. And so I had the scariest conversation with my baby who was the size of a blueberry. (I will stick to "him" as a pronoun since that is what he was, even though I was convinced he was a she at the time.) I told him that based on what I had felt so far, it didn't seem like he was the type to just give up, and that we really, really wanted him to stick around because we already loved him so much. But I also recognized that he was on his own path and that he had to follow that. I tried to hold space for both possibilities. I wished Caleb was with me.

The next morning, I explained what was happening to both my colleagues who were with me on the trip. When we went to the office, I explained the situation to the staff member in charge. She sprung into action. I stayed close to the office instead of venturing out and visiting families for the next few days. I got a snack tray one day that was full of easy things to eat and I was well cared for.

The spotting continued lightly, but thankfully did not get worse. We completed our work in Uganda and flew to Nairobi for the next portion of the trip, a staff conference. My stomach continued to turn. In Uganda, I had eaten all of the one snack I'd brought that sounded good: almond butter packets. Caleb sent some with a coworker who was meeting us in Kenya, but by that point, I couldn't eat any more of it.

During the conference, we had candy baskets on the tables that contained small hard candies. Some were caramel flavored and I liked these very much. So much, in fact, that I would eat all of them from all the baskets. I'd read that if you just keep eating small amounts of whatever you can get, the nausea isn't as bad. The buffets of food at the conference center were incredible, but with so many smells swirling around, I was eating meals that consisted of 3 pieces of broccoli and a pickle. "Surely my coworkers are going to figure this out," I thought to myself. Thankfully they did not.

During the day, I would occasionally send Caleb emails of all the foods that sounded good to me that I could not get, I titled the emails "weird food cravings just for fun":

grilled hotdog with ketchup on bun

oatmeal

ice cream

pickles

cucumbers

extra crispy fried chicken (this was only briefly)

buttermilk biscuits

donuts

My pregnancy symptoms continued, and I was relieved as things felt less and less scary and more and more... nauseating? 

Upon finally arriving back to the US, Caleb took me straight to Arby's to get curly fries, and then to the grocery store. In a jet-lagged stupor, I told him to stop me if I started spending too much money. He didn't stop me. Bless him. 

From June 10, but really from a month earlier...

Two lines pop up immediately, I don't even have to wait three minutes. My eyes open wide and I gasp. It is 5:40 am. Caleb is holding Sammy so he will sleep for another hour. I go back to lay in bed, jittery with emotions.

The day before nothing had sounded good to eat. Except for kettle corn. Which I don't even like. I ate an enormous bag of it and a chocolate milkshake. That night, I said to Caleb, "Just bring me something to eat and I will eat it without looking at it while watching Netflix." That was when the lightbulb went off. Oh. I know this feeling. I remember this. 

By the time Caleb and Sammy wake up, the initial shock has worn off and excitement has set in. 

Dear littlest one, we are so so excited to meet you. I am hoping that you look like me and are smaller than your brother, but however you are will be perfect. 

I am also really really afraid of losing you. 

It's different being pregnant the second time. I know how sweet this first trimester time is, before everyone starts trying to touch my belly (which I hate so readers, please don't do it).  Even though my body has already shifted in some pretty big ways, many people don't know I am pregnant. Depending on how bloated I am, I don't look pregnant. (Let's talk about bellies and bloating another time.) You, my sweet one, are the size of a strawberry. But for some reason, I just have this gnawing, nagging worry in the back of my mind and in my heart that for some reason, your genetic code will be lacking something important and you will cease to be with us here. I am terrified of that. It's a cycle too, because why am I so afraid of it? Is it because it will happen? 

So I pray what I prayed for Sammy, which is that I desperately want you, but I also release you to follow your path, whatever it may be. I will control what I can, which is admittedly less than it was the first time - sleep is a bit less and so are meal prep times. But in the end, you are and will always will be your own being. 

I love you and even though I sometimes get overwhelmed, I can't wait to meet you and get to know you. 

Office housework subverted

A few months ago, we were talking about gender at work. More specifically, we were talking, as a department, about gender norms in our culture and around the world - how do these play into global poverty and our work? It was a rich discussion that took place in small groups - each with a volunteer note-taker. At the end of the session, all the note-takers were asked to send their notes to someone to compile them for posterity.

Then one of my colleagues said, "Can all the note-takers raise their hands?" I assumed that she was doing this as an accountability measure so that we would know who to follow up with if notes didn't come in. But she had something else in mind.

"I just wanted to see how many note-takers were women. I recently attended a conference where the man in our group took notes, 'because women are always the ones to do it'."

Minds exploded and the room burst into chatter.

"Women are also the ones who usually bring treats for celebrations, organize potlucks, and contribute the majority of the potluck food," I heard her continue to one of my (male) coworkers who had never noticed this before.

This isn't isolated to my work place alone. But it's possible the way the men have responded is unique.

Last week we had the first ever day of men only bringing treats to work. We arrived on Friday and there was a small spread of pastries, homemade chocolate cake, and orange juice with a sign that said, "Happy Mothers Day!"

This week, my birthday celebration was arranged by male coworkers. There were lunch plans for Friday, treats the day of, treats on Friday again, and a card.

I feel touched in a way that is sort of surprising to me. I was always touched when my female colleagues ran the celebrations in years past, but this felt different somehow. As I sat with it, I started to piece together the puzzle. By now, nearly everyone has seen the famous "mental load" comic. Previous birthday celebrations, though very appreciated and very welcomed, had this sort of very subtle undercurrent. I am almost uncomfortable naming it, because it is so subtle that I didn't notice it until I experienced something different. By naming it, it makes it feel bigger than it is/was. But if I don't name it, you won't know what I am talking about so here we go:

Say one of my female coworkers plans my (or anyone's) work birthday celebration. There is usually some combination of a card, an invite to a restaurant co-selected by all the month's birthday celebrants, possible treats, and this weird quirky thing we do where we put the celebrants' faces in a random photo that is somehow related to the time of year, chosen restaurant, person's favorite animal, or none of the above. Example from this year - me as an empanada:

This is all a lot of work that needs to be done but is also worth it because you get to also eat the treats and go to the restaurant. But when I show up on my birthday and find gluten free treats, and later go out to a restaurant and get a card, even though I love it, I also know the work it took to do it and that it usually fell on females. So it was almost like... "Thank you and also I'm sorry and I feel your pain." Pain is too strong of a word, but you know what I mean. I know that you had to think about this when you were not at work. I know that you had to exert some extra planning during your home time. I know you had to fit in making a funny image with my face on it during your real work. And I know you did it because you value me and because you know if you don't do it, it's possible that no one else will either. And overall, it's a small thing. But it's happening over and over, for all the birthdays, and all the holiday potlucks. Here is a poem of sorts that speaks to this.

To have the whole thing be planned and carried out by men felt subversive and different and refreshing. And more men are volunteering to take notes in our meetings too. So thank you men. Thank you for hearing and acknowledging and showing up and saying "I've got this one." Because showing up and practicing in the little things sets us up for success at the big things.