The Affordable Care Act and Infertility, Revisited

Several years ago, during the heyday of this blog and my adventure as an infertilite, I wrote a little ditty about how increasing Americans’ access to health care was a good thing, and that the law that would become known as “Obamacare” was particularly good for women.  Little did I know that post would become one of the most read and searched for of all the posts in this blog.

So I’m going to do it again.

On the “verge” of “repealing and replacing” the Affordable Care Act (ACA, aka Obamacare), we face a lot of unknowns about what will actually happen.  A draft of the first version of the bill was circulated just 24 hours ago (notably to news outlets that have been denied entry into the White House Press Room), but it’s still just a draft and there may still be many battles to fight.  Therefore it would be a waste of my time to simply go through the draft and say all the problems that are wrong with it.  Instead, I’d like to give you the information to take to your representatives – local, state, and national – so you can tell them how you, fellow infertilite or concerned citizen, are personally impacted by the benefits of the law.

Are you a woman with health insurance?  If so, you’ve probably noticed that your annual visits to your OB/GYN, mammograms and other screening procedures, and birth control contraceptives are covered.  If you have been pregnant in the last few years, all of your visits pertaining to pregnancy, whether to your general practitioner, a midwife, or MFM specialists, are covered.  The birth is covered, too.  Providing for well-care visits and pregnancy-related care is a national mandate of ACA.  The proposed repeal and replace bill removes the national mandate for insurance companies to cover pregnancy, meaning that it will be up to your state and/or the marketplace to determine how much coverage is provided for and how much you would have to pay out of pocket.  Which means that, should you happen to only have access to plans with minimal coverage, you might have to choose between keeping your electricity on and paying for your hospital stay.  Tell your representatives that providing for pregnancy-related care is a basic human right.

Do you have a pre-existing condition, such as, I don’t know, infertility caused by a uterine abnormality?  Under ACA, an insurance company cannot deny you coverage based on pre-existing conditions.  The draft bill released yesterday keeps most of this part of “Obamacare,” but does limit the kinds of conditions allowed under protection.   Tell your representatives to keep this protection of coverage for all people regardless of pre-existing conditions.

Do you want to wait a few more years to have a child just so you can get a bigger tax break on your insurance?  Currently, the ACA provides subsidies to cover some of the cost of an insurance plan based on your income, so that the burden of coverage is more evenly distributed.  The draft bill proposes that older people, who generally are sick more often and have more medications, would get a bigger tax credit than a healthy 30-year old – almost twice as much.  But where is the equality in this situation when the 30-year old might more likely have one or more dependents who need coverage, and family-level insurance plans aren’t exactly a bargain.  Tell your representatives to keep tax credits for health insurance based on need, not on an arbitrary factor such as age.

Do you think your property taxes are too high?  You might be wondering what property taxes might have to do with health insurance, so let me explain.  Services such as Medicaid are provided by your county in part from federal money that they are granted.  Republicans have talked about creating “block grants” of money, essentially capping the amount of federal money states have access to, which leaves states, counties, and cities in a terrible predicament: do we cut services to people on Medicaid – for instance, do we close nursing homes which would displace seniors and increase unemployment in our community for the doctors, nurses, and workers who worked there – or do we find another way to pay for it?  And they’ll likely find another way to pay for it through your property taxes.  Tell your representative to keep Medicaid expansion.

Finally, I’m going to address the issue of Planned Parenthood, which under the Republican bill would lose all federal funding.  Supposedly because, and solely because, it provides access to abortion services.  What they don’t tell you is that the other 97% of services provided by Planned Parenthood to men and women across the country include preventative health exams, providing contraception, tests and treatments for STIs, Pap smears, breast exams, and outreach to schools and college campuses.  One in five women have reportedly visited a Planned Parenthood at least once in her life (see the link here).  I know abortion is a highly personal topic and questions about life run so morally deep I can’t even begin to illustrate the range of them here.  But I do know that this country was settled by a brave group of individuals at Plymouth who were considered outlaws in their home country for their beliefs and who sought to find a place where they could live as they chose in peace.  Tell your representatives to let us continue to live our life as we choose, to keep our choices for what we do with our bodies our decision, not decided for us by lawmakers, and keep the funding in Planned Parenthood.

I will continue to update the blog as progress on the health care bill continues.

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TMI

When I saw an article last summer about a woman who took to social media to expose and essentially pressure a school to stop asking questions perceived as too personal on a kindergarten application, I didn’t read it.  I thought it would pertain to one school, or just a handful of schools that maybe don’t have it together, and one parent making a mountainous outrage out of a question she could just as easily have ignored.

Then I took my kids to the dentist, and I was asked during the intake process if there were any complications with the pregnancies.  Not exactly the place I’d expect to ever get that question.

I’m not opposed to answering questions like this when it comes to my children – not in a protected privacy setting like the doctor’s office.  After all, there’s lot of research that what happens in the womb and even during birth can have lasting lifetime effects on children – from chance of obesity to reaching developmental milestones – which is presumably why there’s a question on the kindergarten registration.  But teeth?  Really?  And, who cares?  Teeth can be fixed, right?

So when I’m asked the question, I quickly dust off my elevator speech.  “Intrauterine growth restriction.”  The nurse, who was sweet, kind, and only asking questions as they popped up on her computer screen, continued, “Do you know what caused it?”  “I have a unicornuate uterus.”  I could tell by her pause that she hadn’t heard it before.  “I basically have half a uterus,” I finished.  She smiled and thanked me for the explanation.  No more questions.

Now, I still kind of doubt that a dentist would really need to know about that but maybe there’s a reason for it.  And why wouldn’t a school want to know if a child is coming in at a disadvantage compared to other kids, particularly if that child might need additional services?  And wouldn’t you as a parent want to advocate for your child?

I think if I were to put this into perspective, imagine for a moment that it’s 1985 and the question on the form was instead, “Did you smoke while pregnant?”  A loaded question, for sure, but at the time lots of people still smoked around kids and didn’t think there was anything wrong with it.  Three decades and lots of research later we know better to the point that legislations abound protecting kids from second hand smoke and a horde of other ills; but would you have blamed phys ed teachers in the 80s for wanting to know if a kid might have asthma?

So I went back to read the New York Times article after my experience at the dentist.  If suddenly people are probing into your kids’ health history as far back as birth then maybe there’s more I need to consider.  And it seems that the author of the article saw the question as an egregious invasion of privacy and didn’t like that the registration form wasn’t kept locked up under lock and key.  Okay, maybe that’s a valid point.  But is that really more egregious than search engines using information they know about you to sell customized ads and make money?  More egregious than apps on your phone wanting access to your identity, pictures, text messages, and location?  How do you think Google knows when stores are busy, or Instagram knows when one of your friends creates an account, or your phone gives you coupons for the supermarket you just pulled up to?  Is anybody wondering how secure any of that information linked to you is, where that is stored?  And I think my pictures, my messages, my email, my location are more valuable to me to protect than knowing if my kid was born through a C-section or not.  Especially if said information can actually help my child.

Here’s the original article about the kindergarten questionnaire.  And yes, my school district’s questionnaire asks the same question.

Participate, educate, and be heard

Yeah, so that Affordable Health Care Act review isn’t going to happen. I have a million excuses to use, most of which include my kids, but which also includes the daunting website itself. I underestimated the amount of free time I would have. But free time starts out as a fantasy with a newborn and increases exponentially as they get older.  And it’s only worse with another toddler added into the mix. So it’s a no-go… at least for now.

Fortunately we are only less than two years away from choosing the next president. This is a chance for you, as a voter, to ask whether policy makers will support your reproductive rights, support funding for treatment of your diagnosis, and support ARTs.  For an idea of where potential candidates stand on this issue – because for most politicians, and probably for a great deal of the general public, “reproductive rights” is a euphemism for right-to-life/abortion rights – you’ll probably have to dig a little deeper into their speeches and voting histories.  I just Googled “where does Marco Rubio stand on infertility treatments” and got a big fat nothing, though there is already some chatter about whether he’ll stick with the Catholic Church’s doctrine on that.  But it’s early in the campaigning and if someone, somewhere, asked anybody about anything it’s probably going to be documented somewhere…

…And it might also be spun somewhere.  So while we’re learning about what Hillary is going to do for the little people (aka. the village raising the children), or how Dr. Paul is going to get government out of the way for people, remember that there are few independent unbiased voices in the fray.  Media outlets – conservative and liberal alike – don’t always tell the entire story.  Candidates – heck, even senators, representatives, and probably your mayor if s/he’s running for reelection – are coached to say words that sound like answers but are really vague statements that are either so eloquent or so obtuse that we forget what the original question was in the first place and by the end we are ready to move on.  It’s kind of like looking at a Jackson Pollock.

One: Number 31, 1950

It’s substantive.  It’s impressive.  And it might even make you feel something, although this one makes me feel dissonance, like my eyes are listening to static.  Then you feel, “But is it art?”  And then you wonder if that was his message all along, and we’ll never know, because once art is viewed it becomes an experience shaped by both the viewer and the artist alike.

…See what I mean?  Back to the point – voting is only democratic when it happens in the aggregate.  Like choosing organic at the supermarket – alone you might feel like it doesn’t make a huge difference, but if enough people do it we begin to see change in choices.  Voting with your money is yet another way to use your voice. And infertilites already have voices on the outskirts of the mainstream.

Participate, educate, and be heard.

 

News about what’s next

I realized that over the last year, while I haven’t had much time – or even infertility-related news, considering – to keep up on the blog, that my most popular posts aren’t even the ones having to do with medical conditions. I guess with unicornuate uteruses being rare to begin with there just isn’t a huge demand for information for it. No, instead some of my popular blogs have been product reviews and, strangely enough, about Obamacare. It seems weird to me that of all places on the internet, this website is a popular hit among people wanting to find out whether or not Obamacare covers infertility treatmets. And my initial posting on that was rather vague, given that Obamacare hadn’t been rolled out yet. But now we’re almost approaching one year of Obamacare being available, so it’s time to update the post.

I plan on continuing to provide product reviews and updates. I still have a few more posts to go about my experiences with my now five-month-old, and my new life as a stay-at-home-mom (temporarily!). But my next big focus is going to be delving into more details about Obamacare. I personally don’t know a lot about it, only what I’ve heard about in the news or what friends and family have told me about their experiences with it. And in order for me to really be able to answer the question, “Does Obamacare cover infertility treatments?” I’m going to have to do a lot more learning about it. I am not going to be the expert. But I feel I owe you, the reader – and perhaps you, the person who used Google to find me, you who are new to the land of the infertilite – a little more in the way of navigating the answer. It’s going to take me a while, but I hope to have something substantial by the time I’m through. In the meantime, expect some more reviews and updates from me. Thanks for reading and happy fall!

Yes, my boobs are weird…

So remember how I said that I keep reading that “there are few medical reasons” why a woman couldn’t breastfeed, but never saw any references for what those might be? Well, here’s one: hypoplasia.

Hypoplasia is a term most often used by plastic surgeons to describe breasts that haven’t developed fully. Sometimes described as “empty sacs,” hypoplastic breasts don’t look full and round. And the tissue that doesn’t develop during puberty may have trouble producing enough milk later.

I don’t think that hypoplasia and Mullerian anomalies are partners in crime, but hypoplasia can be caused by estrogen-mimicking chemicals like BPA and parabens in fragrances, shampoos, and other girly things. Good reasons to avoid them.

So I don’t know for sure that I have hypoplasia. Most obgyns don’t talk about it because it is truly more aesthetic than medical in its implications – that is, until you start breastfeeding. In fact, in one report I read it’s mainly women with hypoplasia who sign up for breast augmentation, feeling something was “off” about their breasts. If I asked a plastic surgeon I’d probably get an answer. Until then, this is all self-diagnosed – but with the photos available on the internet I’m pretty darn sure I’ve got this.

The main symptoms, if they can be called that, are:
Widely spaced breasts, over 1.5 inches apart (check)
Breast asymmetry, with one breast larger than the other (check)
Stretch marks on the breast (check)
Tubular breast shape (um, check?)
Really big areola
Absence of breast changes in pregnancy or post-partum (kind of)

Big breasts and little breasts alike can be hypoplastic. It’s the shape and placement that matters most. Finally, an explanation for why I always felt like a grown woman with a 12-year-old’s chest. Let me put it this way – I was always jealous of the way my friends could fill out shirts. A good push-up bra often gave me little cleavage, cleavage that usually went up, not together, making my boobs look like lumps of fat and not desirable objects. In fact, in order to get the kind of cleavage where my boobs would meet in the middle, I’d have to really force them together to the point of pain, and still I’d get nothing more than a line.

Don’t get me started on the lopsidedness. It’s only gotten worse with the pregnancies, and it would make me laugh more if it wasn’t so sad-looking.

“But you’re breastfeeding now, so why does this matter to me?” I’ll tell you why this matters. Consistent with the theme of this blog, know your body, your medical history, and get a thorough evaluation especially if you have trouble TTC. Some women with hypoplasia can successfully breastfeed, but not as easily as “normal” women. They need more support: physical, emotional, and moral. Their lactation consultant will want to be more aggressive about feelings, or be open to discuss supplementation if needed. And she will need to forgive herself for something she cannot change or control.

“So, is this it?” and other awkward second-baby questions

The experiences of the infertilite in the fertilite world are often befuddling.  I have had such strange advice about having a second child, and even stranger questions, that I usually have to keep from cocking my head to the side and thinking out loud, “Is that really how normal people feel?”  Here is some of what I’ve had to contend with and, in some cases, explain in polite terms.

“I was a surprise, too, and I turned out okay.”  I didn’t hide the fact that I didn’t plan on getting pregnant so quickly after having my son.  But I didn’t plan on it because, as you know, I didn’t think I’d be able to beat the odds for a second time.  As in ever.  So yeah, surprise!  But how do you explain that to someone who doesn’t know the whole history or background, without getting into it and turning it into a weird and awkward conversation?  You don’t.  You just go with it and move on.

“You must have been in shock when you found out [that you were pregnant].”  A close friend asked me this about a month ago while we were having lunch.  And I admitted that yes, yes I was – for the reasons mentioned above.  “You have to remember,” I said to my friend, “I spent most of my maternity leave coming to terms with the fact that I’d have to be satisfied with one child.  That as much as I didn’t want my son to be alone and without siblings, the reality would be that he very likely would.  And that’s when I got pregnant.”  My friend’s eyes went wide as he threw down his sandwich and leaned back in his chair.  “Holy crap!” he said.  “I never even thought of that!”  Yeah, so that’s men for you.  He really didn’t have much to say after that.  I’m pretty sure he’s still processing that information.

“So, is this it?”  This from a nurse, her eyes darting between my 15-month old son and my ready-to-explode belly.  “God bless you,” she said, shaking her head and smiling, as if to say that she felt sorry for me and for the next two years of my life.  But I don’t know how to answer that question, “Is this it?”  I don’t even know how to answer that to my husband.  When one of the OBs in my practice asks me, “And are you having your tubes done, too?” and I say, “No,” even I have to wonder why that’s my answer.  And the best reasons I could think of are this: after years of struggle, heartache, rationalizing, hoping, hurting, and celebrating, it feels like the wrong answer to say “Yes, that’s it,” at this point.  It feels like a huge disrespect to my body, which has given me two incredible gifts after it seemed to have failed me for so long.  In theory, I really don’t want to be pregnant again.  In theory, there are lots of other ways to make sure that doesn’t happen that doesn’t involve further severing an already flawed organ.

Plus, it’s a little gauche to say, “Do I get a discount if I only have one tube tied?”

Oops, I did it again

At my two-month checkup after giving birth earlier this year, my OB/GYN told me I could get pregnant again before I even got my period back.  I kind of rolled my eyes at her and said, “Are you serious?  Yeah, I don’t think that will be happening.”

“You’d be surprised,” she said.  I countered by reminding her it had taken me two years to finally get a pregnancy to stick.  “You never know,” she said.  I dismissed her advice.  Given the fact that I had beaten the odds with my son at every turn, as I’ve detailed throughout my early pregnancy, I really didn’t think I’d have the luck to beat the odds again.

I spent the first few months as a new mother panicking about the idea of raising an only child.  I worried that he would be spoiled, unable to socialize with others, not having any playmates growing up.  I worried that in old age he would be solely responsible for my husband and I, that he would have no one else to confide in.  I thought about my relationship with my sister, and my husband’s with his siblings, and I wanted those same bonds to exist for my son.  And I dismissed my feelings and resigned myself to being a great mom even if that meant only being a mom of one.

Well, here I am, 12 weeks pregnant, against all odds.  I am still holding my breath, as if none of it seems real.  And knowing what lies at the end of the road, I’m a little more nervous about another c-section.  Sometimes ignorance is bliss.  My OB/GYN group this time around is taking a wait-and-see approach to my care; “It’s possible you just make small babies,” one doctor said.  “That’s just how your body works.”  At this point I feel utterly clueless about how my body works.  Why now and not four years ago?  What about my body is so different?  It’s older now; I thought you were supposed to be more fertile when you’re young?

I’m already fielding questions, again somewhat unexpected, that seem somewhat insensitive to the infertilite journey.  “Well, I heard your body is more fertile after being pregnant,” said one nurse.  This doesn’t seem like a statement of fact to me; and she’s a nurse.  “Are you still considered high risk even though you’ve already been stretched out?” said another person.  And my answer: “Yes, I am,” because the uterus returns to its usual size after pregnancy, which for me is the shape of a deflated balloon.  A little deflated banana balloon.

Here we go again!  I will be tracking both responses to my pregnancy as well as observations going through this for a second time.  For me it is all about getting through one day at a time, and being thankful for the family I’ve been blessed with.  And my wish for you is to give you Hope, that though it seems preposterous, though it seems far-fetched, though it’s something you might roll your eyes at, it’ll happen for you and sometimes when you least expect it.