Wednesday, October 6, 2010

My IVF story: after conception, being preggers

This is the second post of four on my experience with IVF and pregnancy, and my thinking on its broader meaning to the public and to anthropology. Find the first post here.

ResearchBlogging.orgPreggers

A few weeks after the positive blood test, I had my ultrasound where we saw a tiny little bean and a beating heart. During this time I was having what felt like bad menstrual cramps. The nurse told me this was quite normal, but I still spent a lot of mental energy fretting over it. The rest of the first trimester was pretty uncomfortable. In addition to being exhausted, I was nauseous. I didn’t want to eat vegetables. In fact, all I really wanted was toast (gluten free, of course). I concocted a pretty awesome smoothie that I would drink once or twice a day, made of chocolate almond milk, peanut butter and ice cubes. It settled my stomach, and it’s probably because of those smoothies that I only lost four pounds.

At this point we also transitioned from medical doctor care to a midwife. At first we were just given to the next available midwife in our practice. But when it became clear that in order to stay in that practice we’d have to have a hospital birth, we transferred to the Cambridge Birth Center in Cambridge, MA and the midwives there.

Where to give birth and why

The Cambridge Birth Center is a stand-alone birth center associated with (and across the street from) the Cambridge Hospital. There are no doctors, but you can get into the OR in four minutes for an emergency C-section if you need to (yes, they practice and time these things). So I was completely confident that, if I had a straightforward, low-risk pregnancy and labor, I would be best suited to the birth center, and if anything went wrong I was minutes from a doctor.

We were a bit nervous about this decision, because of the stigma attached to IVF children. Do IVF pregnancies lead to more difficult pregnancies or labors? Are we going to have a child with greater or fewer limbs than the average? The reality is that, while the egg was fertilized in a rather special manner, a fertilized egg, then blastocyst, trophoblast, and so on that makes it to become a fetus, and then makes it trouble-free through the first trimester? That fetus is very, very likely to be healthy and normal.

The other reason we were firm in our decision is that a number of interventions that are automatic upon entering a hospital are not physiologically necessary, and even increase the risk of later interventions. Pubic hair shaving is still a common practice in some hospitals, which is just plain dehumanizing. More common are continuous fetal monitoring and putting in an IV immediately. Continuous fetal monitoring is more likely to find false positives, which means it’s more likely to find pathology in a fetal heartbeat that goes up or down but resolves on its own naturally. IVs restrict movement and lower the barrier for a doctor to suggest, and a woman to agree to, pharmaceutical interventions. This is in addition to the many other criticisms I could launch but won’t because I find it all so exhausting.

The biggest issue, for me, is that if you walk into a hospital you have at least a 33% chance of having a Cesarean section, and the reasons behind that are largely related to the ratcheting up of interventions as one intervention necessitates the next one. A C-section is major abdominal surgery. It takes a long time to recover. It is hard to breastfeed, it is hard to pick up your child, and you spend more days in the hospital. These are days when your sleep is more disrupted than when you’re home, and you increase your and your child’s chances of infection by being in a hospital, and extra days when you as a family could be figuring out a routine at home to make sure the mother isn’t the only one bonding to the new baby.

Then there are indications that C-sections create health concerns for the baby as she gets older. Babies of C-sections have higher rates of allergy (i.e., Roduit et al 2009), asthma (i.e., Davidson et al 2010) and Celiac (gluten intolerance) (Decker et al 2010). I am a C-section baby myself and I have severe allergies, allergy-induced asthma, and gluten intolerance (a trifecta of awesomeness!). Given that I’ll be passing on some of the genetic proclivities for these things, I wasn’t too keen on giving my child the environmental components that would also increase her risk if I could avoid it.

So we started seeing a midwife, and I got to know a different part of Cambridge better than I’d known before. I really fell in love with Inman Square.

Going meta

Throughout my pregnancy, I devoured popular books on pregnancy (good: anything by Sheila Kitzinger, bad: What to Expect When You’re Expecting) but also searched for a lot of information on PubMed and kept an Endnote library devoted to my results. I read about the craptastic relationship between symphysis-fundal height measurements (this is when they use measuring tape to measure the size of your belly) and birth weight (i.e., Johnstone et al 1996) – even in those studies that found a statistical correlation, SFH often explained very little of the variance in birth weight. I read about exercise during pregnancy (de Groot et al 1994) – and I played soccer through my first trimester, jogged through my second, and worked out five days a week through the whole pregnancy, up to the day before my due date. I read about meconium, I read about fetal monitoring, I read about maternal stress. When I wasn’t working I was reading, and when I wasn’t reading I was exercising. All the other time I was in prenatal appointments or sleeping.

Of course, as excruciatingly long as the pregnancy felt, as boring and normal and yet delightful as it was, it did eventually come to a close. Family flew in from out of town to be around for my due date, and there was a lot of pressure – joking, but pressure nonetheless – to produce offspring before everyone left. When my due date brought with it the occasional half-hearted contraction, nothing I hadn’t felt before, I went to bed disappointed.

The next morning I woke up, got out of bed, and my water broke all over the bedroom floor.
* * *

Next time, I’ll talk about the joys of drug-free labor.

References

Davidson, R., Roberts, S., Wotton, C., & Goldacre, M. (2010). Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study BMC Pulmonary Medicine, 10 (1) DOI: 10.1186/1471-2466-10-14

Decker, E., Engelmann, G., Findeisen, A., Gerner, P., Laass, M., Ney, D., Posovszky, C., Hoy, L., & Hornef, M. (2010). Cesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in Children PEDIATRICS, 125 (6) DOI: 10.1542/peds.2009-2260

de Groot LC, Boekholt HA, Spaaij CK, van Raaij JM, Drijvers JJ, van der Heijden LJ, van der Heide D, & Hautvast JG (1994). Energy balances of healthy Dutch women before and during pregnancy: limited scope for metabolic adaptations in pregnancy. The American journal of clinical nutrition, 59 (4), 827-32 PMID: 8147326

Johnstone, F., Prescott, R., Steel, J., Mao, J., Chambers, S., & Muir, N. (1996). Clinical and ultrasound prediction of macrosomia in diabetic pregnancy BJOG: An International Journal of Obstetrics and Gynaecology, 103 (8), 747-754 DOI: 10.1111/j.1471-0528.1996.tb09868.x

Roduit, C., Scholtens, S., de Jongste, J., Wijga, A., Gerritsen, J., Postma, D., Brunekreef, B., Hoekstra, M., Aalberse, R., & Smit, H. (2009). Asthma at 8 years of age in children born by caesarean section Thorax, 64 (2), 107-113 DOI: 10.1136/thx.2008.100875

6 comments:

  1. "stigma attached to IVF children" - my first reaction to this was to say 'really?' And yet I am going to post this anonymously because my wife doesn't wish everyone to know that our second child came via IVF; so I guess there is some residual stigma (although I think in this case not for the kid, but because she feels, very sadly, somehow less competent for needing intervention). This greatly saddens me. [The closest equivalent I can think of for me might have been the fact that I was extracted via C-section to avoid strangling myself with the umbilical cord; would there be folks who think that I should have been allowed to die? Yeah, maybe.]

    One of the simultaneously wonderful and slightly sad mementos of our IVF is the picture of the two 8-cell spheres prior to implantation. We were so proud of their 'grade A' status :-) - and I know my wife wonders to this day whom that second one might have become. Not a worry I share - my views on when life begins are very different to hers, for one thing - but the whole process of being able to manipulate and direct our bodies in order to produce our now 2 year-old is pretty cool. And apparently working in an animal lab gave me enough experience with i.p. injections that it was far less painful when I did them than when either she or the nurses gave them, which was a nice way for me to be involved!

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  2. Anonymous, I'm so pleased you commented. And I was completely surprised by the stigma, or at least the viciousness of it, until my CNN.com story came out. While it's a tiny percentage of the population, there are actually people out there who think our wonderful kids are sub-human and think that we are overpopulating the world by having kids in this way. In my last post on this topic I will have a lot more to say about some of the hateful stuff I saw there, but for now I'll say: I was surprised, and disappointed, too.

    As our embryos were maturing, there were of course a few that didn't make it. And we still have two frozen ones that we'd like to try and use one day. I think of the ones that died, and the ones that are waiting for me, every time a bill comes in the mail from the folks who are cryopreserving them :). But there is also a part of me that realizes that I could choose to be sad about the eggs I ovulate, endometrium I slough, etc, and then it changes my perspective.

    My husband also had experience giving injections from his job, which is what helped a LOT when we were doing the progesterone in oil through the first trimester (which I forgot to mention in the blog post, but also was editing for length so my other posts wouldn't be the monster the first one was!). I think he liked being involved in that way as well!

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  3. Thank you for noting the associations with allergies, celiac disease and c-sections - such interesting stuff.

    -Liz

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  4. Thanks, Liz. I think we can all agree that when C-sections are used in emergencies they are absolutely amazing, and I would certainly choose to have my child live and have allergies than not live. But given the huge number of C-sections that are a result of too many interventions, or incorrect sizing of the fetus leading to an incorrect diagnosis of macrosomia (where they think the baby will be too large to birth vaginally), etc etc, more people need to understand the long-term health risks. And that's on TOP of the health risks to the mom, from abdominal surgery, and the health risks a mom who's had a C-section faces if she wants to have another child.

    Since I suffer from all of the major conditions whose risks are increased with C-sections, I certainly feel like it's good information to have!

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  5. Monica BhattacharyaOctober 8, 2010 at 3:40 PM

    Hey Dr. Clancy,
    This is an amazing series of posts, first of all. It's very informative and I'm very glad you are writing it. I have a little question, though. You said that you stopped seeing a medical doctor and switched over to a midwife. How early did you do that? And do you think that there's any thing about the risk level of a pregnancy that a doctor might be able to recognize that a midwife might not? Also, do you still get ultrasounds, etc. with a midwife? I guess I'm not sure what exactly the difference is between someone who has a medical degree and someone who doesn't in pregnancy and giving birth; could you tell me a little bit about that?


    Thanks!
    Monica

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  6. Thanks, Monica. I switched to a midwife around nine weeks gestation. Certified nurse midwives are nurses by training and have extensive prenatal, labor and postnatal experience, sometimes a lot more than your average obstetrician. They are at least as capable as doctors at determining risk, and yes, we did get several ultrasounds over the course of the pregnancy. My prenatal care was identical with a midwife versus a doctor in terms of all of that stuff.

    The difference, to me, is that midwives are specifically trained in the management of low risk births, in addition to high risk births or complications. They learn a lot about non-pharmaceutical interventions and management. They learn a lot from each other. They also are generally VERY interested in the mother's birth plan and creating an experience in line with what she and her family wants.

    You can probably Google this and find out a lot more information, specifically from midwives!

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