bookmark_borderProbability is hard

Our 20 week ultrasound revealed a healthy, growing baby, but there was one worrisome characteristic. Baby had a skin fold on the back of its neck whose thickness was enough to indicate a correlation with an increased chance of Down’s syndrome.

Jeff and I considered not getting any screening — even with this indicator, the chances of Down’s syndrome are pretty low — but in the end, we decided to do a maternal blood screen. Unlike an amniocentesis, this test does not provide a certain answer, but it also doesn’t post the very small but non-zero risk to baby that the amnio does. A blood screen is also more comfortable for me. 
But it does have its drawbacks. The screening has a 99% detection rate and a 0.1% false positive rate[1]. That sounds pretty good, but running the numbers, you’ll see why probability is non-intuitive. 
Given my age and the skin fold measurement, the baseline probability for Down’s is between 1:100 and 1:150. So out of 10,000 babies in this group[2]:
  • 100 will have Down’s syndrome. Of this 100, 99 will be detected by the screen. 1 will be missed.
  • 9900 will not have Down’s syndrome. Of this, 9.9 will be incorrectly be above the risk threshold for Down’s syndrome in the screen. The other 9890.1 will be correctly diagnosed as not having Down’s.
Combining these, if the screen comes back as a “no” there is only a 1:9891.1 chance that baby has Down’s. But a “yes” on the screen indicates a ~90% chance of Down’s and an ~10% chance of not. In other words, a “no” leaves you pretty confident, but a “yes” still has a lot of ambiguity. 
All-in-all, the screen seemed like a better option for us, but these decisions aren’t easy. 
By the way, the results came back negative. Yay!
[1] As claimed by the test provider, but these sorts of measurements are themselves rather difficult to do well.
[2] By the way, this may be completely wrong. Probability was not my strong suit in mathematics. Math with numbers is hard.

bookmark_borderIt’s a… secret!

You may have noticed that the last post didn’t mention baby’s gender. We did choose to find out the gender (verified two ways, in fact), but we’re not telling anyone.

Why? Stereotypes. From pink vs blue to trains vs princesses to selective praise of strength or kindness, even in tiny infants, we start stereotyping children before they are born. Nature vs nurture hardly gets a fair evaluation when almost everything an infant does is perceived through a gendered lens. We can’t stop that, but we can delay it a tiny bit.

Plus, aren’t surprises more exciting? =)

bookmark_borderUltrasound

Baby at 14 weeks (too early to tell gender)

Look! It’s out baby! It looks just like… a generic ultrasound picture.

But still, it’s our generic ultrasound picture, and it’s kind of funny how much of a difference that makes. When you know that the video feed you’re seeing corresponds to a little baby’s movement inside of you, it become more than just another grainy black and white image. It becomes the excitement that baby really does have arms and legs and a heart and brain and everything, just like a real baby!

So, hello baby! You look exactly like I imaged you’d look.

bookmark_borderDear Mom

Dear Mom,

This day is hard every year, but this year there’s an new element to my sadness. Jeff and I having a baby, and you won’t be there to meet it.

I wonder about all of the little experiences and conversations I’m missing because you’re not around. What were your pregnancies like? How did you feel when I first fluttered about inside of you? What was it like to see me for the first time? All of these experiences of becoming and then being a mother that every mother experiences, but which would have a special poignancy when coming from you to me.

I think about how much you would have loved baby, about how excited you would have been. Baby will get lots of love, but it will never get to know you, and you’ll never get to know it. We’ll make sure baby knows about you, but that can never be the same as knowing a living, loving human being.

I miss you, and I love you.

Erika

bookmark_borderArticle share! Science vs technology in birth

It’s from a couple years ago now, but this is an interesting article about how we’ve conflated science and technology in determining what makes a safe birth experience. The author isn’t saying that women shouldn’t have interventions, but the author is saying that for a normal, low risk birth interventions that can be life saving in critical situations can actually lead to worse outcomes than not intervening. Thus, if the reason a woman is getting an intervention is fetal or maternal safety — and there are other reasons to get interventions — but, as I said, if the main motivation is safety, then the intervention may not, in fact, be the best choice.

Epidurals are a good example. If a woman is experiencing her labor pain as suffering, then she should certainly get an epidural if that’s what she wants. But under normal conditions, epidurals should not be considered a way to make the birth safer.

We tend to think — at least in the US —that more technology is better, but that’s not necessarily true. Technology is awesome, but it’s also very limited, especially when applied to the human body which is always more complicated than our current understanding necessarily gives it credit for.

bookmark_borderBeing sick sucks

It’s never fun to have a head cold — at least, I’ve never heard anyone say so — but it’s even worse when you’re pregnant.

First, your immune system is compromised. As awesome as the immune system is, it is not, apparently, so good at detecting the difference between a head cold and a baby. So to, as far as we know, prevent the body from rejecting the baby, a pregnant woman’s immune system is weakened. The practical upshot of this is that I get sick more easily, and when I get sick it hits me harder.

Second, pregnancy already causes some symptoms which just get worse when a pregnant woman has a cold. I’m already fatigued — bedtime these days is generally between 9 and 9:30. Throw on top of that the fatigue that sickness brings, and I was ready to go to bed by 7:30. Even worse, because of my increased blood volume[1], I already have slight nasal swelling compared to normal[2]. Add to that the clogging and swelling that comes from a head cold, and breathing becomes a chore. A miserable miserable chore.

Third, you can’t take most cold drugs. There are pretty strict restrictions on what drugs are advised during pregnancy, and most common cold drugs are on the “should not use” or “should only use if really necessary” list. Now, I don’t take a ton of drugs while sick, but a nice nasal decongestant when my head feels like it’s about to explode from sinus pressure is something I generally appreciate. But nope, not for me.

Finally, there’s the psychological effect. I know that women get common colds during pregnancy and it’s just fine for the baby. But still, I couldn’t help but wonder if the baby was okay. Was I getting enough liquids? Enough food? Do I have a fever? Ack!

But I’m all better (for now).

[1] Blood volume generally increases by 40-50% during pregnancy.
[2] I get bloody noses extra easily. Also blood gums when flossing.

bookmark_borderYes, I call it baby

Because there is a tendency to shy away from the word baby in the pro-choice world, I want to take some time to talk about why I call our baby “baby”.

If used in a technical legal sense, then “baby” is indeed problematic. Baby implies person. While for many — myself included — personhood is irrelevant to whether or not a woman has a right to control her body, for many others it does make a difference. Thus, when we’re talking legal jargon, it’s better to stick to the term fetus. No matter what your position on abortion, a fetus is not legally a person (although there have been attempts to declare it one).

Ethically, the line between personhood and non-personhood is hard to draw. Legally there is a bright line: birth. But ethically, what makes a person? This is a debate millenia old — and confusing even when you leave the unborn out of it. So as far as ethics is concerned, your view of whether or not it’s appropriate to call a fetus a baby depends heavily on what definition of personhood you subscribe to.

But, when it comes down to it, neither of those is particularly relevant most of the time. When I’m talking about my pregnancy or talking with a person about their pregnancy, we’re in the realm of emotions. And when it comes to emotions, it is your baby whenever you feel like it is your baby. Our baby was baby before it was even conceived. “Baby” is the label which captures our hopes and desires. Calling it baby has nothing to do with how physically or mentally developed it is. It has to do with love.

bookmark_borderAck! Basic bodily signals are confused

As my uterus begins to take up more room and push around my other organs, I’ve noticed that I have to relearn how to reinterpret my basic bodily signals for hunger and urination. It’s not that the signals don’t exist anymore. They’re just different.

Urination I expected. Everyone knows the “pregnant women always feel like they have to urinate” meme. But hunger is more interesting. Because of the compression of my stomach, I always feel somewhat full, which means I have to be much more conscious of what hunger feels like and, when I eat (especially since I can’t eat as much at once) more conscious of what full feels like (the consequence being a stomachache and/or nausea).

I think I’ll figure it out, but it sure is odd.

bookmark_borderReview: Epidural Without Guilt

Epidural Without Guilt: Childbirth Without Pain aims to offer the reader an alternative perspective on epidurals. It is also super short and has a free Kindle version, so I decided to give it a read. On the plus side, the author does a good job of describing what an epidural is and why they are not harmful to either mother or baby. On the other hand, he’s a bit overly enthusiastic by epidurals — he thinks that every laboring woman should get an epidural as soon as she gets to the hospital.

The thing is the author may be right, for the type of birth that he expects a woman to be having, but he assumes a fairly standardized hospital birth experience which does not involve a lot of movement on the part of the mother. He discusses how walking epidurals don’t completely immobilize the mother — depending on the strength of the epidural, the woman may still be able to walk around and, regardless, should be able to get to the bathroom, change positions occasionally, and feel herself push. However, many birth positions and intermediate coping techniques would be hindered by being attached to a bag on a pole. The author might claim that these coping techniques are unnecessary if the woman isn’t experiencing pain, but the author did not address the point directly.

The other weakness of the book is that the author equates pain and suffering. Unlike the author’s claims most of the materials I read don’t try to make women feel guilty about getting epidurals[1], but they do try to distinguish between the sensation of pain and the mental experience of suffering. If you are suffering, the general opinion seems to be, of course you should get an epidural. But if you’re not experiencing the pain as suffering, you can try these other techniques. Not because the epidural is bad, but because it changes the birth experience in a way that some women don’t want.

This is probably a good book to read if you worry about feeling guilty if you get an epidural. If what you want is a discussion to help you decide for yourself if and when you want an epidural, then this book, with it’s flat recommendations, is not for you.

[1] That said, I don’t read pregnancy forums and the like.