Too fat to give birth here

I’ve been sitting on this post for a fair while now to give myself time to settle down. I think it represents the most stressful thing in my pregnancy so far even including the high risk result. It still upsets and angers me a great deal to think about. When I found out I was pregnant, even before we got back from holiday, I started researching birthing options. The Department of Health site on this topic came up very quickly. After a bit of reading, the KEMH Family Birth Centre started looking like a really good option. It’s a midwife led centre which provides a comfortable and low intervention place to give birth but is also right beside the best maternity hospital in WA. When we got back and started planning visits to check out some options, it was at the top of my list.

It wasn’t until just before we went on a tour that I found out about their body mass index (BMI) limit. We did the tour anyway, it was an amazing place with lovely suites and a huge bath you can give birth in. It looked practically perfect from our point of view. We hung around afterwards to talk to the midwife and ask about the limit. Sure enough, she confirmed that the centre doesn’t take women with a BMI over 35. Furthermore, if their BMI goes over that limit at any point during their pregnancy , they will be bounced from giving birth there! At this point in my pregnancy I was about 12 weeks along and hadn’t gained any significant weight (+/- 1kg). I was just under the 35 cutoff. She told me that if I wanted to give birth at the KEMH birth centre I would need to not put on any weight during my pregnancy. She thought this was doable despite it being essentially a pretty steep weight loss diet.

At birth, the combined weight of the baby, placenta, amniotic fluid, extra maternal blood, breast tissue and other fluids is somewhere around 14kg. This is the amount of weight I would have to not gain while still getting enough nourishment to keep me and the fetus healthy. It didn’t sound feasible to me and I was concerned about the effect of watching my weight so strictly on my anxiety which was already beginning to get knocked around by the stresses of pregnancy.

So after quite a bit of anger and tears and consulting with my doctor, I decided to explore the option of the Community Midwifery Program (CMP). We decided after some more research and consultation to sign up with the program and give birth at Armadale Hospital via the Domino program. This means that our midwife will accompany us to Armadale hospital and provide continuity of care throughout and after the pregnancy. Ironically, despite being effectively turned away from the KEMH birth centre, I am eligible for a home birth if I want one because the BMI cutoff for the CMP is a measure of maternal weight prior to pregnancy.

The BMI issue has raised its head a few times since then. At one point, my midwife advised me that I was over the cutoff to have a water birth. This surprised Craig and I since we’d looked up the relevant policies (or thought we had) and it didn’t look like it would be a problem. I’m keen to have the option of a water birth and Armadale hospital has inflatable pools available for this purpose. That caused another emotional scene over stupid bureaucracy. We asked our midwife to double check the policy and fortunately it turned out she’d been looking at one which had been superseded and I can have a water birth if I want to.

I’m still extremely angry about BMI being used as a sole method of weight based risk stratification in pregnancy. I’m not going to go into the science of BMI here because there’s lots of information about it all over the internet (see here, here, here and here for some examples with varying degree of scientific rigour and readability). BMI can be a useful tool when used across populations, and a lot of dieticians and clinicians like it because it’s easy to calculate. When applied to individuals however, it can be extremely misleading. When using it as the basis of risk stratification (e.g. among pregnant women), it may fail to consider that some women are overweight and obese as a result of being unwell. This can skew both statistics and clinical experience of obesity.

I am obese according to medical definitions. I am also relatively healthy. My blood pressure and blood sugar are low, I’m reasonably fit (I walk an average of ~5km/day even in my 6th month of pregnancy). All of the risks that are supposed to be attendant on obese pregnant women have failed to materialise for me. I don’t have prenatal diabetes, it seems very unlikely that I will develop pre-eclampsia going by my blood pressure results. Also, my ultrasounds have shown spudlet to be in the 52nd percentile of growth for his gestational age meaning he’s bang on normal size. I see my pregnancy as low risk and don’t think my BMI changes that.

So why is BMI used in pregnancy? Especially when you’d be expecting women to gain weight as part of a normal pregnancy? It appears to be part of the increasing medicalisation of pregnancy which is predominantly coming from, surprise surprise, the United States (where medical care is big business). Caesarian section rates in the US and Australia have exceeded 30% of live births as more people see doctors for the birth of their children. Doctors/obstetricians view patients through the lens of pathology. Pregnancy and childbirth isn’t a disease, it’s a normal human process which like many processes can vary from person to person. Doctors however are trained to look for and treat anomalies. This can lead to a pathway of increasing intervention which more often than not results in a C section.

Don’t get me wrong, if anything goes awry with my pregnancy I intend to seek medical attention (and have done so to date). If something goes wrong during the birthing process, I’m not going to eschew medical treatment (including a caesarian if it comes to that). However I prefer not to borrow trouble. It concerns me sometimes that I’m being sent for so many extra tests based on my BMI (when by other measures I’m healthy) and I’m mindful that I don’t want any of this to snowball into unnecessary intervention just because a doctor who doesn’t know me or my medical history just wants to be extra careful.

I’m a person, not a number. I’m not stupid and I am capable of making decisions about my own health and that of spudlet. I am very glad that modern medicine exists, but I strongly prefer that medical decisions be made based on up to date evidence based research rather than out of date practices with little to no science to back them up. This is why I am, and will continue to be critical of the BMI as a individual measure of wellness.


The big reveal

How do you tell people you’re pregnant?

It’s really hard actually. I worry that people will judge me, that they’ll be weird about it. Mostly they have been great so far but that’s because we’ve just been telling close friends and family. That being said, I’m bad at big secrets, especially when the secret is mine. I feel like I’m betraying people by not telling them, I want to tell people, but I don’t.

We decided not to tell most people until we get the results of our first trimester scans back. I’ve been nervous for a while about my age and the possibilities of chromosomal abnormalities, having a degree in genetics really doesn’t help with this. Not telling people makes me feel weird and isolated though. People at work have commented how I don’t seem to be very excited about my engagement. Of course I’m not, it pales in comparison to the pregnancy, but they don’t know that. I so badly want to talk about the pregnancy, to get more feedback about my fears and anxieties and just not to have to keep it a secret. But I know I really really don’t want to have to tell everyone about a miscarriage or worse yet, a medical abortion.

My best friend is funny. I told him and my other best friend in Sydney via a quick phone call from the airport. He’s so excited he keeps messaging me on Gchat every few days just saying something like “OMG you’re preggers!!!” This can pop up on my screen at work at quite inconvenient times! I’m worried someone will see it who shouldn’t! It’s pretty cute though, and interesting that he’s still processing it as well.

So where I’m at now is that I want people to know, but I don’t want to tell them and go through all of the excitement, fussing and possibly judginess behind my back. If I could insert the knowledge into people’s heads, I think I would do that. It would save some angst. We would like to announce the news to our friends at our engagement party, but unless we get cracking and organise one soon, that won’t happen. I have no idea how I will tell work people. Maybe in dribs and drabs the way I did with the engagement. We’ll see.

In denial

On holiday I was ok with being pregnant. It was inconvenient at times, especially when morning sickness hit, but most of the time it was just there in the background. We were so busy exploring Europe and hitting a city per day that we didn’t really have much time to think about it. I did a little research at night on my iPad using hotel wifi, but that was pretty much it. I figured I had plenty of time to come to terms with it, research and make plans when I got home.

Getting home was a relief. The holiday had been wonderful, but long and I was missing my own bed. It was even good to go back to work, hang out with my friends and enjoy the spring weather in Perth.

But, I was pregnant. This changed everything.

My mother has always talked about how much she loved being pregnant. How good she felt and how much she enjoyed it. Without realising it, I’d bought into the happy pregnant glow ideal. But that wasn’t what I was experiencing. From early on my breasts were SORE. As long as I’d had them, my breasts had pretty much been inert lumps of meat on my chest. They weren’t sensitive and I was fairly indifferent to people playing with them. Suddenly they hurt, especially when taking off my bra. Now my tummy was also feeling weird and painful. It was tender to the touch and I couldn’t bear to wear any pants with zippers. At night even having a sheet resting on it could feel quite uncomfortable. I didn’t want to be touched most of the time, this was very hard for Craig who likes cuddles and wanted to be part of the experience, but it was just too uncomfortable for me.

Also, I’d always imagined myself bonding with a growing baby inside of me. Singing to it, caressing my belly, all of the clichés, but that wasn’t happening either. I didn’t really feel anything for it yet. I thought about it a fair bit and I started reading books (Up the Duff etc) but I didn’t feel the maternal glow I felt I should be. I tried singing to it a few times but I felt a bit silly. I started to wonder what was wrong with me.

Then there was the research side of things. I found out that when I got back from our holiday, 8 weeks pregnant that I was already lagging behind. If I wanted an obstetrician (I don’t), I was probably already too late. The birth options that I thought would be straightforward really really weren’t and a lot of things I cared about were out of my control (a topic for another blog post). Even buying things for baby was a veritable minefield. I got Craig to take me to a nearby baby warehouse to have a look. We left feeling bewildered and overwhelmed. There were so many options and so many things I hadn’t even heard of before (a bin which seals each nappy in a separate bag!) I was beginning to wish someone could just give us a list of the essentials, especially with the strict time limit that we couldn’t change.

Work was another problem. I love my job, I’m very passionate about it and it takes up a lot of my life. Suddenly I had a big secret that I had to keep from most of my friends at work (only my best work buddy and my boss knew at this stage). Also, work was taking so much of my time and headspace that all of the pregnancy research and questions were getting pushed aside and clamouring at me in the small hours of the night. I didn’t want to make any phone calls to hospitals etc from work in the fear that someone might overhear. Even doing internet research was hard in my open plan office. Having only two people at work I could talk to about all of these changes, was really difficult as well (fortunately those two were fantastic). It was doing my head in. Eventually, they persuaded me I should take a day of personal leave to sort some of this stuff out. I was very grateful for the suggestion.

So, I’m still feeling weird about being pregnant. I’m hoping that I will get some glow as I enter into my second trimester and begin enjoying the pregnancy a bit more. I’m honestly feeling guilty that I’m not. I wanted this and looked forward to it, now I feel ungrateful that it’s not what I expected. Still, I’m very thankful that I have so much support from Craig and my friends and family that do know. That makes a huge amount of difference.

Emesis Gravidarium (Or how I learned to relax and love corn chips)

Morning sickness. I didn’t think it would happen to me, mostly because my mother didn’t have any. Honestly I hadn’t thought much about it with the holiday unfolding around me and taking most of my attention.

Then it happened. On a long, stuffy bus ride to Naples. We hadn’t had time for a proper breakfast that morning due to the early departure but the hotel had packed us little breakfast bags. We were sitting in the back of the bus because it was mostly full when we got there, the aircon wasn’t working very well and I was feeling grumpy and out of sorts.

I thought I could fight the rising nausea, but apparently not. Craig heroically interpreted my desperate glance and grabbed the bag of snacks off me, upended it over the floor of the coach and handed the empty bag back just in the nick of time. He gathered up the food while I heaved into the (thankfully hole free) plastic bag. It was misery.

Soon afterwards we had a ‘technical’ (toilet) stop which gave me a chance to dispose of the evidence and wash my hands and face. I eventually found the tour guide and let her know I was unwell, the look on her face was priceless but she procured some more plastic bags for me.

The rest of the day is a bit of a blur in hindsight. I was fortunately able to eat lunch and Pompeii was amazing but the long bus rides were sheer hell and I was sick again on the bus before we arrived back to our hotel.

The next day we were catching a train from Rome to Milan. I was sick again in the morning  but managed to have a little breakfast. The next major problem was bags. We had two each, a huge backpack and a merely large backpack that we typically slung in front, plus the glass we had picked up in Venice. Now I couldn’t bear to have anything rubbing against my tummy and I wasn’t up to carrying much. It was a problem.

Fortunately our hotel was not far from the main train station. Craig was able to do two trips to get the bags there while I took just the boxes of glass. I survived the train trip in some misery but without actually vomiting. We’d planned to do some more sightseeing in Milan before catching our plane the next day, but all I could do when we got there was lie in bed and feel sorry for myself.

I called my mother and sister in misery to ask for advice. This was the first my sister had heard of the pregnancy so she was rather excited but she had experienced a little morning sickness herself. I’d done some online research and she confirmed what I’d heard about getting some snacks and grazing so that my stomach wouldn’t get empty to help with the nausea.

I was freaking out at this point because the next day we were due to get on two flights totalling 20 hours or so. The thought of being stuck in a small space for that length of time, being sick was just horrific.

After a while I was feeling well enough to go to some local grocery stores. We stocked up on dry crackers, ginger drinks, sour lollies, mints and corn chips. We also found a pharmacist who spoke a little English. I was desperate at this point so threw myself on his mercy. Even so, I said a firm no to the offer of homeopathic remedies. He did give me some stuff called Biochetazi. It specifically mentioned emesis gravidarium on the pack and I looked it up when I got back to the hotel. It was basically an electrolyte drink and perfectly safe. I felt so much better just having something!

By the day of the flight, I was starting to get the hang of the constant snacking. Corn chips were my new best friend (and I have to say, they have some really nice corn chips in Italy!) I was even waking up a few times in the middle of the night to have a few corn chips and stop my stomach from getting empty. It was working and I didn’t throw up that morning. The other thing that was helping was sniffing my migrastick (a roll on containing lavender and peppermint essential oils).

When we got to the airport, I confided my fears to the lady at the check in desk. To my eternal gratitude, she’d experienced morning sickness herself and was very understanding. She managed to change our seating reservation to a block of two seats at the end of a section. This meant we wouldn’t have another person sitting next to us for the long haul flight and made a huge difference to both of us.

I ended up telling flight attendants on both flights that I was pregnant and experiencing morning sickness. They were great and brought me ginger ale and made sure I got the meals I wanted (without seafood). I didn’t get sick on either flight which was a great relief. Having a bag full of my trusty corn chips and keeping the migrastick close to hand did the trick. We arrived in Brisbane feeling rather tired but incredibly relieved.

After this, regular snacking kept the morning sickness at bay until it subsided a few weeks later. I didn’t throw up at all after the first few days. Initially I was so miserable and scared, being in a strange place and facing a long flight feeling the way I did. I’m so glad it all worked out. Craig was an absolute trooper, carrying too many heavy bags and still managing to look after me. All in all it was a rather ‘interesting’ experience for us both.

Pregnant… in Paris

The name of this blog is a bit of a giveaway. Paris was where I got my first convincing positive pregnancy test result.

I already suspected I might be pregnant before we left for our holiday. My breasts were sore and that was entirely new to me. I’m used to them being fairly inert, so tenderness was a bit of a giveaway. I’d also done two previous pregnancy tests but not really had much in the way of results.

In Paris on the other hand, the stripe was clear and dark. It was the first full day of our holiday and I was knocked up! Astonishingly for the first time in my life, I’d actually bothered to record the dates of my last period so I could calculate how far along I was (4 weeks).

The pregnancy was planned, but happened unexpectedly quickly. We’d only been trying for two months. One piece of very good luck is that my close friend Tanya was visiting Paris at the same time as us. Tanya was pregnant with her second child, so of course I told her and then picked her brain.

I bought my first things for the baby in Paris, a Le Petit Prince spoon and bowl.

I also did some reading, but didn’t have time to do a whole lot of research (or thinking) because of the holiday. This was a good thing in many ways as it stopped me from getting overly anxious about things. I was moderately careful about what I ate (fortunately I don’t like most of the forbidden foods and I don’t drink so it wasn’t much of a hardship).

In terms of symptoms, other than the breast soreness there wasn’t much to begin with. I did get a head cold on our second day in Paris but other than that and a bit of tiredness I was feeling ok. But what a place to find out!