34 = A Spring Chicken, But 35 = An Old Bird?! I Cry Fowl!

Chickens

I was busy all weekend doing what I love: teaching expectant families all about how to get a baby out (Saturday – Express Class) and where to go when the baby is actually coming out (Sunday – Maternity Tour). It was a gorgeous, sunny, not-too-hot weekend and I was stuck inside both days catching glimpses of the sun when and where I could. AND I WASN’T EVEN MAD.

I mean, I saw how nice the weather was the night before, and I may have even mumbled, “Ohhhhhh, I don’t want to go to work tomorrow!” before going to bed, but some sort of alchemic transformation happens when a class or tour begins. And then I know I’m exactly where I need to be, doing exactly what I’m supposed to be doing. I’m not sure if anyone else can truly understand this, unless they too, are lucky enough to have a job that they love.

At the end of class on Saturday, a healthy and fit-looking young couple came up to me to ask a question about their particular situation. “I’m 35 years old,” she began and I already knew where this was going… “And yours is considered a “Geriatric Pregnancy,” am I right?” She kind of laughed and then said, “Yep – ‘Advanced Maternal Age!’ And my provider wants to induce me at 39 weeks. I just wanted to know what my chances are of having an induction that goes okay. One that won’t end with a Cesarean.”

Now, I don’t know the particulars of this woman’s health history, and I’m not a medical provider, so I’m not going to debate this plan of action. But I could tell that she wanted to know if this induction at 39 weeks would be considered “medically necessary.” Again, without knowing her personal health history, I’m not going there with her.

Here’s what I told her instead: “If your provider had a Momma over the age of 35 who had a “negative outcome” during their birth, it might change how they practice from that point forward. But many providers are only looking at the relative risk of increased complications that can happen to women over the age of 35. Is your provider looking at your absolute risk?”

This is not something that many providers consider. They read a study that says a woman’s risk of stillbirth increases after the age of 35, but their focus remains solely on the age of the woman in their care, and this can translate into only discussing her relative risk. If they were looking at the woman’s age as just one of several other risk factors that might contribute to or lessen their overall risk, this would mean that they were considering the absolute risk. Too many women don’t even know to ask about relative vs absolute risk, and too many providers are not forthcoming with this information.

Pregnant women and their partners should be able to determine their individual, personal absolute risk of complications and what those complications are if they wait to deliver spontaneously at term, as opposed to being encouraged to deliver early via induction at 39 weeks, because their is a relative risk of increased stillbirth for women over the age of 35.

The risk is real, it’s true – but there are many, many other factors to consider in assessing an individual woman’s absolute risk of any complications, not just the risks associated with “Advanced Maternal Age.”

I might be a little bit touchy on this subject, if I’m being completely honest. I mean, I didn’t get married until I was 28. I had my first child at 31. Baby #2 came along when I was 33 1/2. My third was born when I was (gasp!) 37, and the last one came along at the ripe old age of 41.

And while it is true that my relative risk of stillbirth climbed with my age, my absolute risk as a multipara with Baby #4 was probably lower than that of a primipara at a much younger age. Part of that lowered absolute risk has to do with my proven record of straight-forward, healthy pregnancies and deliveries. And part can be attributed to the fact that I was in much better health at 41 than I’d been when I began this whole baby-making enterprise ten years earlier!

The language – older mother, mature, advanced maternal age, elderly, and my personal favorite, geriatric pregnancy – coupled with the assumption that a woman is automatically high-risk because of her age really bothers me! The power of words cannot be understated. And when a woman is told that she is high-risk, strictly because she is over the age of 35, with no other known risk factors, this absolutely affects how she experiences her pregnancy and can have negative implications for her birth! 

So with all of this as a backdrop, I suggested that this Momma do some research and that she might find some good information online. Rarely, do I send anyone to the inter webs for information. First of all – there’s just so damn much of it! How are you supposed to sift through all of the mountains of information that now exist in the world on the subjects of pregnancy, birth and parenting? But in addition to that, there’s just so much out there not evidence-based and that’s really scary!

That’s why I was so excited when I “met” Rebecca Dekker a few years back as she was just starting up her website, Evidence Based Birth. Rebecca wanted to create a resource for expectant families (and professionals!) that would review the latest research on a particular topic in obstetrics and translate the findings into something that someone who wasn’t a clinician or a researcher could actually understand.

She takes her time with each article and reviews everything, making sure to use “good” studies – meaning studies that are unbiased, that used the proper technique, assessment and validation tools, and that have statistically significant results. After she’s written her article, she submits it to her advisory Board to insure that the information that goes “live” on the website is exactly what she claims it to be: evidence-based. I know that if I send any of my families to her website, I can feel comfortable that the information they’ll find there is something I can trust.

How crazy is it that I took a look at the EBB website this afternoon and did a search for “Advanced Maternal Age” and found out that Rebecca was doing a free webinar on that exact topic in exactly three minutes! I know, right? Cue up the woo-woo music!

I quickly registered for the webinar and was happy to hear that the discussion I had with the Momma from my class about relative risk vs absolute risk was exactly what Rebecca would be covering in both the webinar and the written materials that accompany it on the website. I really hope that the Momma from class took me up on my suggestion and checked it out.

After doing this important work of researching, I encouraged her to have some more dialogue with her provider about her particular situation. In the end, she might come to the conclusion that an induction at 39 weeks is reasonable for her and her pregnancy. Or, she might not. But what is most important, is that she will be making a decision with her provider based on full information.

In this day and age, I think we should be encouraging women to know what their absolute risk vs their relative risk is so they can make truly informed decisions for themselves about their pregnancies, their births, and their babies.

In the meantime – can we please come up with another way of describing a woman who happens to be having a baby at the age of 35 or beyond? The terms we’re currently using are demoralizing. And I should know!

Thankfully, it’s not all bad. Based on this article, us “Geriatric Mommas” will have the last laugh: “Women who had their last child after 33 were twice as likely to live to 95 or older, compared with those who had their last child by 29.”

I’m not a math whiz by any account, but if my calculations are correct, this means I will live to be at least 125 seeing as I had my last baby eight years after the magical cut-off  of “33” as quoted in this article.

But before I get my hopes up, I think I’d like to know what my absolute advantage is, not just the relative advantage based on my age.

Know what I mean?

My Third Is Now Eleven. Wait – What?

Supergirl

It is my girl’s birthday today. She has turned 11 years old and I wonder, “How in the hell did that happen?!”

Last night, she feigned interest in listening to me read some Harry Potter to her younger brother, attempting some wacky dance moves instead. But she gave herself away when she shared, “I love it when you give all the characters different British accents!” (Well, how else are you supposed to read Harry Potter? I mean, seriously!)

After the chapter was over, I drew her in close and told her the story of her birth. You would think that given the fact that my whole professional life revolves around birth that this is something I’ve been doing with each of my children since they celebrated their first birthdays – but you’d be wrong. It’s not that I haven’t shared their birth stories with them, it just hasn’t become an annual birthday thing.

But even so, my daughter supplied the last line of her story which is: “I came out just like “Supergirl” And she did, with her hand and arm outstretched over her head, like she was flying through the sky. The memory of this makes me laugh now – but at the time, it wasn’t so funny. While a newborn’s closed fist is pretty tiny, let’s just acknowledge that in birth every centimeter counts, and I didn’t necessarily appreciate her grand entrance… although this has proven to be something that she’s quite good at.

This led me to wonder again about the topic of nature vs nurture. And I can’t help but think that the essence of who we are already seems just about fully formed before we even make our entrance into this world, grand or otherwise.

I think back to when Lucía was yet to be born. She was an eagerly anticipated baby and my pregnancy had been pretty smooth. Her older siblings were 6 and 3+ years and with one in Kindergarten and one in Preschool, I didn’t have much time to sit and dream about this little peanut growing inside of me. I was a very busy Momma already! Thankfully, I had a straight-forward pregnancy and I was boring and healthy throughout. Sure, she caused me some pretty bad heartburn (cum gastric reflux), but otherwise I was able to exercise well into my pregnancy and I felt great.

I had anticipated going past my due date with her, as I’d already done that 2x before with her older siblings. Apparently, all my babies all like to bake from somewhere between 40 and 41 1/2 weeks. (*Fun Fact- Did you know you can feel your baby’s hiccups best through the their back?) I knew from where I felt the increasing hiccups with baby #3, (due to my increasing sweet tooth!) that when I went to bed the night before my due date, it was with a baby in the best possible position for birth: head down.

During the middle of the night, I woke up, completely startled and awake, but by what? I didn’t have to pee (for once!), so I settled back to bed thinking that maybe it had been a bad dream. That bad dream became a reality when I realized the next morning that my baby had flipped overnight into a head up position – and that’s what woke me up!

I can’t even tell you how angry I was in that moment. “You have got to be kidding me!” I thought. I marched upstairs and grabbed a bag of frozen peas and promptly put it on what I thought must be her head. Then as they thawed, I switched out the peas for a bag of frozen corn, and back and forth – peas and corn, peas and corn –  all day long. But that wasn’t all! Oh, no! That night I propped myself up in this crazy position in bed with my butt waaaaay up in the air so that her head would be extremely uncomfortable compressed in my ribcage and – I waited. This was going to be an epic battle of wills.

I could tell this little person was not one to be trifled with, but neither was I! Sure enough, after a few hours, I felt a huge sea change happening and she settled back into my pelvis – head down. “Hah!” I thought, “Sometimes you have to teach them who’s boss even before they’re born!”

But, seeing as I’ve already spoiled the ending, you know that it was she who got the last laugh as she was born. I guess she showed herself to be a little bit of a boss that day as well.

And the two of us have had that kind of relationship ever since. It’s not bad, it just gets complicated from time to time. If we were dance partners, it would be to disastrous results because we both want to lead, all the time. I have come to find that this daughter who is so unique and absolutely her own person is also the one who is most like me – and as it turns out, parenting oneself can be mighty challenging at times.

She got a lot of my good stuff, but unfortunately, she also got some of my bad stuff,too.

She’s a lot of fun and really funny. But she’s also impatient and unwilling to ask for help. She is intuitive and one of the most street-smart and savvy kids I know. She’s compassionate to a fault but wants love and affection – on her terms only. I love her fiercely, but I’m only allowed to tell her that when she’s in the mood to receive it. She’s going to do big, big things with her life – as long as she doesn’t burn out in a blaze of glory first!

Lucía is but one of the four reasons I get to hold the title of “Momma.” She pushes my buttons – sometimes all at once! But she is also the one who teaches me the most on a daily basis about how to try and do this mothering thing better than I did the day before.

She is my Supergirl. And she is 11 today. How the hell did that happen?!

What about you and your babies? Do you think they are the same little people on the outside that they were when they were in utero? How much of who they are reflects nature vs nurture? I’d love to hear your comments about this! Please leave them here.

Between Hope and Despair, I Choose Hope

Hope:Darkness

I’ve been away from my blog for almost two weeks. I could claim that my absence from writing is a result of being on a family vacation. I could claim that even though I’ve been home for five days, I’m still struggling with a serious case of jet lag. I could also claim that I had to work all weekend, empty the luggage, wash mounds of laundry, and pack two kids off to sleep-away camp. And all of these claims would be true.

But I think my real resistance to writing is that in the wake of all of the shootings this past week (An aside: is anyone else terrified by the thought that we, as a country, will begin to regard these events as regular, ordinary, life as usual in these not-so-United States of America?) I found myself moving between two emotional states: either numb, in a state of shock, tears  ever at the ready or enraged and dumbfounded that almost 50 years after the assassination of Martin Luther King, Jr. we seem to have made such little progress. I just couldn’t think of anything worth writing about as I found myself frozen in despair about the state of our country.

But, the work I am honored to do with expectant parents over the weekend coupled with reading this post from the wonderful Suzi Banks Baum, helped me to shake off a little bit of this feeling and rediscover what my heart usually gravitates toward: hope.

I have a deep and abiding hope that love is bigger and stronger than hate. That compassion can be cultivated to combat indifference. That injustice can be rooted out at its core as long as enough people are shaken out of their complacency and moved to act. And it saddens me that it takes horrific events like those that have happened recently to move us (hopefully) from talk to action.

I taught a class this weekend that was a little bit of a nightmare from and educator’s standpoint. There were 30 couples expected at 9:00 am and at 8:45 I was still trying to rig the AV system in the auditorium so that we would have audio! But when it was time to introduce myself, I looked out into our assembled audience and saw something really beautiful: a wonderfully diverse group of families.

Families of all ethnicities were represented and there were many families whose babies would be like my own: of mixed descent. (Although, to look at my own children you can’t tell that they’re half-Puerto Rican. Based on their skin color alone – such a limited and simplistic way of labeling a person – no one would guess that they were Hispanic or Latino. They’re labeled as White.)

I’m well aware that if my children had darker skin they would be treated differently in this country. If they looked “more Hispanic” (whatever that means) and with their last name being Suárez, my children could expect to be treated more like their brown-skinned brothers and sisters of Hispanic descent.

If they had more melanocytes, the skin cells located in the basal layer of their epidermis that produce melanin, a brown pigmentation of the skin that’s responsible for skin coloration and acts as a protectant against the harmful effect of UV light – because that’s all that our skin color is based on, how many melanocytes we have – I might have to parent them differently.

I might have to talk to them about how to avoid being the target of violence. How to avoid eye contact, how to speak with a certain level of deference to teachers, police officers and others in authority, how to always be on their guard because their beautiful brown skin is seen as a threat.

I am well aware that my children, half-Hispanic though they are, are able to walk through this world with all of the privilege that their white skin affords them. And I am equal parts grateful and angry. I am grateful that I don’t have to fear for my children’s safety. But I’m also angered by the injustice of all of this. It makes absolutely no sense to me!

We talk to our kids all the time about what it means to have the skin color that we do. How this gives us a level of power and protection that is as unfair and unearned as the powerlessness and lack of protection is for the brown and black members of our communities. We try to raise our children to be aware of the level of injustice that exists in this world and encourage them to see this injustice and work against it – not just through talk but action.

My deep, abiding hope lies in the fact that I know I’m not the only Momma out there talking to her children about the state of our world and how we must all work harder and together toward a better future for our children and for our children’s children.

Sometimes it feels like we should already be there, that this is taking too long, that we’re never going to see the day when children will be not be judged by the color of their skin but by the content of their character. But as I stood in front of this group of families that seemed to represent so many different ethnicities – the beauty and strength that is our country – I saw in all of them the common desire to be the best parents they could be. And I realized anew how more alike than different we are in our humanity.

We all want our children to grow up in a world where they can expect to be treated fairly; a world where healthy nutrition and safe drinking water sources are the norm; a world where a public school education is a great education – no matter what city or county you live in; a world where injustice is a thing of the past, and where the dreams of children, no matter their skin color, can be realized.

It’s sometimes a scary thing to find yourself pregnant and bringing a baby into a world that can seem so dark and broken. But, when faced with the choice between hope and despair, I will always choose hope. Hope that each one of us charged with parenting the next generation is working to heal what is broken and to shine a light on the darkness.

That is my hope.