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.

The breastfeeding freakout, part 2: The odds are still against me

Let me start this post by saying that with better support from a caring lactation consultant, I have been able to breastfeed my daughter better than I was my son.  I’ve heard that milk comes in better the second time around.  I also advocated harder for support and knew a little bit more about it, having already done it.  Still, my daughter gets one, sometimes two, bottles of formula a day.  And trust me, it’s not for lack of trying.  I have come to the conclusion that the odds are still against me: my body is just not capable of producing enough milk for a baby.  After a year and a half of wondering, I have two new conclusions as to why that is.

Plenty of websites and medical professionals, lactation consultants included, love to tell you that if your baby fusses while breastfeeding, it’s not because you don’t have enough milk: “It’s just a growth spurt.  Hang in there!”  “Every woman can breastfeed successfully if she tries hard enough.”  “There are very few reasons why a woman couldn’t breastfeed successfully.”  Did you hear that last one?  There are reasons why you wouldn’t be able to breastfeed.  The ones usually stated have to do with the immediate health of the mother – surgery or illness, for instance.  It’s extremely difficult to find any information on true medical diagnoses that might lead to a woman not being able to breastfeed – a diagnosis that she might have known prior to pregnancy and might have been able to seek more support or at least prepare for supplementing, mentally, physically, and let’s face it, economically.  Formula ain’t cheap.

My daughter lost 12% of her baby weight while in the hospital before I began supplementing her with formula, the same as my son.  Her fussying and crying was exactly the same as his.  And the look of relief, “Ahhh!  Food!  Now that’s what I’m talking about!” was the same as my son’s once her father gave her the first bottle and first taste of formula.  It was an easier decision to make in the moment to supplement, having had to do it once before.  Still, all the doctors, nurses, and lactation consultants assured me that I could stop once my milk came in.

A few days later, I began to finally hear the puff-puff noise of my daughter swallowing while feeding.  What a satisfying sound.  Yes, I did it!  I thought.  I am woman after all!  Half-a-uterus be damned.  But by 7 or 8pm, the fussing continued or worsened, and I begrudgingly continued supplementing with a bottle.  She gained back the weight she needed to and passed her checkups with flying colors.  She was perfect, right on track.  No more, no less.  “You can stop with the formula now,” the pediatrician said.

Well, easier said than done.  In fact, there has only been one or two days in the last seven weeks that my daughter didn’t have formula, not including the first few in the hospital.  More than once I broke down in tears after hours of crying, fussying, and sucking: “Why can’t I be enough?  Why can’t I be enough for her?”  I asked myself if she was supposed to be happy between feedings, like the doctor said she would be, why is she still cranky, tired, or hungry?  She’s not colicky, because I can soothe her… with food.

I tried another “nursing vacation” where you do nothing but nurse for days.  And guess what?  As with my son, it didn’t work.

So I started wondering again, Surely this isn’t for lack of trying.  What might be the cause, something that no one talks about because they don’t want to give you an excuse for giving up on the very difficult work of breastfeeding?

The first clue dawned on me one night as my husband brought me yet another glass of water.

What made the second c-section birth better

I was really dreading having another c-section.  Mostly because the memory of the first one is fresh in my mind – how painful it was to sit up, much less walk for the first few days.  I remember feeling helpless in the hospital bed, unable to sit up enough to reach my son who was crying for a diaper change.  It was a terrible feeling – not just the pain, but the inability to move like I wanted to.  Afterward, I wasn’t looking forward to the restrictions – not being able to lift my son, or go up stairs too much, or even drive for a few weeks.  But without an option, I had to resign myself to the repeat surgery and its aftereffects.

I did have the option, though, in hospitals given that my doctors practice in three different area hospitals.  I chose (after discussion with the doctor who would be performing my surgery) the smaller, local community hospital that’s near my town.  With my son I went to a large city hospital with a full NICU unit, just in case there were any issues with my son and his size.  With my daughter, who was growing really well and above average on her weight, I felt less of a need to make sure I had a huge medical facility.  Neonatal care was available at that hospital if I needed it.  And now looking back, I enjoyed that hospital stay much more than I enjoyed the one at the larger hospital.  While I realize my experience is highly specific to these two hospitals, I thought I’d outline some of the distinctions that made my second visit a more pleasant one.

1. Convenience.  The community hospital is less than 10 minutes from my house, while the city hospital is 30 minutes on a good day.  With a little one at home, being so close was handy for my husband to run home and take a shower, and for my mother and sister who were helping to care for my son and who don’t know the area well.  For my 6am check-in appointment for surgery, it was nice to only leave 15 minutes early rather than more than half an hour.  And there was no charge for parking.

2. A smaller, quieter facility.  I was the only scheduled section the day I gave birth; and from what I could tell I was one of the only people in recovery for a while.  My recovery room was the furthest from the nurses’s station and entrance – the last one on the floor – so it was furthest from outside noise.  When there was a code red or blue in the hospital, it was difficult to hear from my room.  No one was wheeled past my door.  It was nice.

3. Nurses were friendlier… and they actually came when called.  In the large hospital it might have taken an hour for a nurse to come in when called.  In this case, if my nurse wasn’t available they sent someone else in – which was the case when I wanted to stand up for the first time.

4. Pain control was more of a priority.  Seriously, you should ask about this at any hospital you are considering.  In the bigger hospital, you had to call for your nurse to bring you pain medication – and as mentioned in the previous bullet, that could take an hour before they even showed up to see what you wanted.  This time around, the nurses and the lactation consultant stressed making my comfort a priority – if mom isn’t feeling good, she’s no use to anybody, especially the baby.  The nurses were always concerned about my pain level.  Yes, I did have to call for medications a few times, but they were prompt and sometimes scolded me for waiting so long to call (since I wanted to see if I did need them or not… and I really did).

5. I had more than 5 minutes with a lactation consultant.  Her office was two doors down from me, as a matter of fact.  She asked that I call for her at every feeding while she was on her shift.  She sat patiently with me, reassured me I was doing everything right, and told me how much further along with breastfeeding I was than people are usually.  She checked in before she left to teach a class.  I saw her a lot and I didn’t feel guilty about it one bit (unlike at the other hospital when I was told, “You know, people usually only see a lactation consultant once before they go” after I had seen her twice).

6. I felt listened to.  When I was concerned about my daughter’s weight loss, her constant crying, her constant nursing (to what felt like no avail to me), all of my nurses were patient and explained options to me.  When I described what happened with my son, they listened but reassured me each pregnancy is different.

7. Even the cafeteria workers took pride in their job, even if they realized the food they were delivering wasn’t so great.   They were very kind to me, always offering to make something off the menu if nothing sounded good.  (I never took them up on that offer).  One morning the woman had an extra food tray (like I said, I was at the end of the hall which usually meant I was the last to get food), and she gave it to my husband so he wouldn’t have to go to the cafeteria and pay $3 for yogurt.  Super nice.

8. Between my husband and I, we had a connection to at least two of the nurses who treated me throughout my stay – that we knew about.  One of my surgical nurses during the birth was connected to me through someone at work, and one of the head nurses requested to be my nurse because she knew my husband and his family from high school (she was the nurse there).  While sometimes people might find it annoying to know someone everywhere you go, I can tell you this much – I don’t mind knowing people at a hospital, since I think you’re bound to get better service because if you don’t, then everyone will know about it.

9. I had two anesthetists with me during surgery.  In the large medical center, I had a nurse anesthetist.  She was great, sure.  I flinched during the spinal – actually, I tensed up pretty bad, which you’re not supposed to do – and later I realized it was because I was ticklish on that side on my back.  So the second time, I warned everyone who would listen that I was ticklish, and to please warn me when things were happening with the spinal.  And the second time, I had two people working on numbing me – a nurse anesthetist and the actual anesthesiologist.  They were both phenomenal, but it also added two more people to help talk me through the process and keeping watch over my vitals and state of mind.  It helped they both had a sense of humor and put me at ease.  Whereas the nurse hadn’t warned me during the birth of my son that lightheadedness, nausea, and a sense of panic are all side effects of the anesthesia, the anesthesiologist was very forward in asking how I felt and told me to tell him the minute I felt anything different.  I told him once I started feeling lightheaded, and he put a hand on my forehead and said, “Yep, you’re getting a little sweaty, a little clammy.  Don’t worry, perfectly normal.  We’re going to give you a little something to make you feel better.”  That. Was. Awesome.  I couldn’t have asked for a better team.

I hope you will be able to ask some tough questions and take a critical look at your birthing center, wherever it may be, and think about what’s important to you.  Privacy, quiet, pain control, accessible nurses…  You may think you know what you want – if you’re like me you think you don’t want a lot of pain medication, but then you do – so just keep an open mind, and I wish you the best of luck.

No formula for formula

The hospital pediatrician who told me my 2 day old baby had higher than normal, but not critical, bilirubin levels and was approaching jaundice, was also hesitant to recommend us formula feeding to help him along.  “No more than 1 or 2 ounces,” he said.  “But continue breastfeeding.  You don’t want him to think it’s too easy.”  Meaning it’s easier to suck on a bottle than it is a human nipple, so don’t let him get into the habit early.  But all along there had been no nurses encouraging me to breastfeed, no doctors monitoring us, just a daily check-up for the little one to find out of he’s thriving or not.  And he wasn’t, so of course I had to breastfeed more.  A nurse gave me lanolin lotion for my cracking nipples and I waited hours for a lactation consultant to tell me if I had milk.  She poked the top of my breast and said, “Oh yes, your milk is coming in.”  Then she discreetly rolled in a breast pump and walked away.

I’m telling you this story because as well prepared as I was for pregnancy and labor, I felt horribly underprepared for parenthood, especially what to do in the 72 hours or so following birth.  It doesn’t help that they pump you full of narcotics (the nurse had to get special permission to give me a half dose because I didn’t want the whole thing) to help you cope with the pain.  And there were so many decisions that had to be made I never really thought to prepare myself for.  Like how best to feed the baby.  I was going to breastfeed, right?  Sure.  That’s what they say to do.  “Breast is best” is the message on posters in every OB/GYN office.  If it’s so natural how hard could it be?  Surely I didn’t need a class for that.  Yet at the same time I had registered for bottles, because that’s what everybody does and eventually I knew I’d be returning to work, so the little one would have to get fed somehow, right?  Right. 

Turns out breastfeeding is hard – very hard, in a physically taxing kind of way, not in an intellectual way – and I should have taken that class.  The popular media, from magazines to websites, tout how healthy it is for you and for the baby.  You’ll burn extra calories and lose your pregnancy weight that much quicker.  You’ll pass along valuable immunity to your baby, reduce his chances of ear infections, allergies, and other illnesses.  You’ll bond with your baby that much sooner.  Breast is best. 

Tell that to someone who’s been a mom for 48 hours with a screaming infant lying skin-to-skin on her chest, red-faced and screaming, his mouth so dry from dehydration his lips are chapped, lips which in turn chap the mother’s skin on her breast, making breastfeeding a horrifying experience.  While you don’t have milk the first few days after labor, you do make something called colostrum, and your baby will extract about a teaspoonful of that stuff, because that’s all he needs and can digest.  I guess most babies are happy with a teaspoon.  I either didn’t have a teaspoon or my LO’s metabolism needed more than what I was giving him.  Which led to the whole formula supplementing thing.  Except I didn’t know anything about what to do with formula, either – I just had a shelf full of samples of different brands that had been arriving for the last few months.  I knew my labor coaches would have wanted me to throw those “artificial baby milk” products out.

Throughout the first month of my son’s life, every doctor seemed to have a different theory or approach to adding in formula.  The nurses at the peditrician didn’t judge, and sent me home with boxes full of samples.  One pediatrician asked that I nurse regularly before every feeding; another said to nurse exclusively and only give formula “if things get hairy.”  Which they did.  My OB asked if I was breastfeeding, and when I said I was supplementing she said, “That’s okay, it’s not for everyone.”  (Her acceptance/non judgmental attitude is one of the main reasons I chose her to deliver my son).  Does that mean breastfeeding is not for me? 

I looked for validation of my choices where everyone else does – on the internet.  Was it okay to be doing what I was doing?  Was I a failure, or had I given up too soon on breastfeeding?  Would my son suffer long-term ill-effects for it?  There are plenty of haters out there who say yes, I’m a failure; I’ve given up; I’m selfish for not breastfeeding.  And sure, there are people who say it’s okay to formula feed – of course, it seems like there’s always a medical condition that excuses that woman from breastfeeding.

Choosing formula versus breastfeeding, as with dealing with infertility, is something that women tend to beat ourselves up for, and judge each other harshly for.  We should be more supportive of each other, not tearing each other down.  And from my discussions with other moms, the number of women who choose to use formula with or instead of breastfeeding seems to be much much greater than the media would have me believe – so why doesn’t it feel that way?  Are they too embarrassed or ashamed to speak up?  Remember when women had to fight to be taken seriously in the workplace?  (Some would argue we still do).  Women who fought for you to get 6 weeks away from your job to recover and take care of an infant, without penalty to you?  Women who protested in order to make it a choice for you to be a stay at home mom, not the expectation?  What would they say to a petty bickering over how a woman chooses to feed her child?  As I read in one article helping to defend women who choose formula in any capacity over breastfeeding, there are worse ways to parent a child than to choose to keep him or her well-nourished with formula.

The infertilite and the breastfeeding freakout

If you have a c-section, you’re already at a little bit of a disadvantage for getting breastfeeding established as well as a vaginal pregnancy.  First, unless it’s an emergency section and you were already in labor, you very likely didn’t have the pitocin or oxytocin hormones running in your veins telling your body “Okay, it’s time to have this baby!”  Instead you got an IV in the OR, not only to help contract your uterus back to its tiny misshapen balloon shape, but also to cue your breasts to start getting ready to feed someone.  And as we all know, sometimes those kinds of medical interventions are not nearly as efficient at getting things started as mother nature is.

Second, you lose the ability to having the same immediate skin-to-skin contact with your baby as in a natural birth.  While you eventually get that chance in the recovery room an hour later, you’ve theoretically lost that first hour of baby “imprinting” on your boobs, which again would get your milk production started that much more quickly.

Third, you’ve got a lovely incision at just the spot where you’d either rest a baby while sitting or while lying to breastfeed, which means you’ve got to learn all kinds of alternate poses to hold your baby to breastfeed.  And you likely can’t move very much, at least in the first 24 hours, no matter how many meds they give you.

Fourth, if you have an epidural or spinal block, your baby is affected by those pain medications as well, making him super sleepy for the first 24 hours.  Great for catching up on your sleep; not so great for making sure he can latch properly.

Needless to say, by the time I had figured out that the baby had latched well and was trying to feed, I had two cracking nipples with blood blisters and a screaming baby who lost nearly a pound in two days and was beginning to get jaundiced.  By the time he was 48 hours old, he had started crying at the level of a scream and seemed inconsolable.  The crying only got worse whenever I tried to nurse him, and he would bob his head on my chest in frustration.  After a few hours of this, and having not gotten much sleep over the last two nights, my husband and I looked at each other exasperated.  Around midnight, we called in our nurse and asked her what we could do to calm and console our baby.  The nurse’s suggestion was a supplemental nursing system (SNS), which essentially attaches a small tube to your nipple and would introduce a small amount of formula to the baby while he nursed.  Reluctantly, we agreed.

One hour later, I was covered in formula and still had an inconsolable, starving baby on my hands.  We called the nurse in again.  This time she said she could bring a nipple for the formula and we could feed him an ounce.  My husband and I discussed this possibility, and I broke down.  Not only had I battled over a year of feeling incompetent and incomplete as a woman, but then I had spent every day of my pregnancy worried about its outcome and knowing the odds of preterm labor and other complications.  Now I could not feed my baby, a baby who, thanks to UU-related intrauterine growth restriction, did not have the same fat reserves on his body to burn while waiting for my milk to come in, as other 8+ pounders that are today’s average sized babies do.

It took a week for my milk to come in, and a month later every feeding starts with nursing but ends with a bottle.  After trying a “nursing vacation” (which is nothing like what it sounds), my supply still isn’t enough to satisfy the little squirmy one for five minutes, much less the two hours everyone else seems to get out of it.  I spent a lot of time wracked with guilt, too, thinking that this is something I should have taken more seriously, should have been more aware of, should have planned for better.  Was it something I did, or didn’t do, that nursing is not enough to feed my baby?  I will never know because we’re past that point.  The only thing I can do is bear the brunt of judgment, “Oh, you’re supplementing,” from doctors, friends, and strangers, never knowing if having a small uterus has anything to do with it, like creating an imbalance of hormones.  But blaming it all on the UU is taking the easy way out, because there is a part of me that wouldn’t do things differently.  A part of me likes being able to allow someone else to feed my baby and give me a break.  A part of me isn’t thrilled about attaching myself to a pump at work just so I don’t miss a feeding – and only getting 1 ounce of breastmilk out of a pumping session if I’m lucky.  Most days I’m okay with my choices, but every now and then I doubt myself and feel every bit a failure as a woman as I ever have. 

Then I look down at my nearly 8 pound full-term baby and think, “Yeah, I did that.”

The infertilite and the c-section

Yes, the arrival of my beautiful baby boy is here!  He was delivered at 39 weeks 5 days via scheduled c-section because he remained breech with his head fully engaged in my ribs.  Even though all the other birthing “experts” said “Oh don’t worry, there’s still time, he’ll turn.”  Well, he didn’t, because little did they know he barely had room to grow.

It was a minor miracle that he was delivered at 6 pounds 10 ounces given that he had a unicornuate uterus for a home for nine months.  Getting him to that size was no small feat on my end, and required me to eat a lot of protein, a lot of calories, and a lot of fat.  And as the time came near, and the specialists dismissed me from their care because he had gotten far enough and at a big enough weight (at 6 pounds they were no longer concerned), there was nothing left to contemplate by the actual birthing process.  Which, granted, I knew wouldn’t be a vaginal birth.  I spent nearly two months petrified of going into early labor, constantly checking in with myself about possible contractions.  It was no solace when an OB told me that due to the nature of my uterus I was “likely to fell things differently anyway.”  For the record I recall only two contractions, and both were at night and were excruciating back labor pains.  Some of the worst pain in my life.

I was still in denial about having a c-section when I had to schedule it.  I was told to meet with the surgery scheduling secretary of the OB group one day after my NST, and when I walked in I had been frantically texting my husband about what was happening.  The secretary started the conversation with, “Well, it looks like January 2nd, 3rd, or 4th.  What’s better for you?”  Really?  What’s better for me?  How bizarre; I felt like I was in another world.  Although I thought it might be “fun” to have my son’s birthday be 1/3/13, I ultimately chose the 4th for two other factors: 1. the doctors who were available that day, 2. I wanted him to stay in as long as possible so that he had the best chances once he was delivered.  What if all the doctors were wrong?

It turns out that scheduling a c-section creates the same kind of pause in others as much as a story about infertility, or about using IVF, to conceive.  There’s always this uncomfortable silence, like, “Oh why would you do that?  That’s so unnatural.”  It’s enough of a silence to make you feel like less of a woman, that your body is not capable of doing what it is biologically created to do.  I couldn’t help but think of even 100 years ago, before all our modern medical trappings, that a woman like me would probably have recurrent miscarriages, stillborn babies, and be at a higher risk of dying during childbirth, and I felt so utterly sorry for all of those women who didn’t have the luxury of scheduling a surgery.  So whenever someone asked about when the date was coming, or when I was able to start telling people that unless he came early the 4th would be his birthday, many times the news was greeted not with joy or happiness but of confusion.  Even among nurses that I encountered in the hospital, when I explained it was a scheduled c-section, they would stay quiet and I could tell they wanted to ask – but I guess so many people elect the section out of convenience they’ve stopped wondering why people do it.  So I fill it in for them – “He was breech.”  “Oh.”  And I can almost hear their brain ticking as they silently forgive me for not being woman enough.

The only person who seemed to take me and my condition seriously was, appropriately, the doctor I had chosen for the surgery.  She had been supportive during my OB meetings with her, and was equally supportive during and after the surgery.  And she used the opportunity, with me still open on the operating table, to show the entire staff in the room just exactly what a unicornuate uterus looked like in the flesh.  “You read about it in textbooks, but you’ll never forget it once you see one in person,” is what I distinctly remember her introduction as.  I wish I could have seen it too.

As a side note, my doctor confirmed the left-side uterus diagnosis, and discovered that my right ovary had a non-functioning/non-connected tube and was actually slightly smaller than the left ovary.  “But you only need one!” she said later.  I don’t think she remembers I ovulated from the right side.

At the same time, I wish I wasn’t awake for that part, since I couldn’t see but could sense all those eyes in the room peering over my belly, staring at the remains of my uterus and fingering a limp infertile ovary.  I should have felt proud, to live what I preach here, to help educate those who can do the most good with this information – those on the front-lines working with patients – by being a living example, but with a few stitches being the only things keeping me from joining my husband and baby in the recovery room at that moment all I wanted to do was get the hell out of there and meet my son.