Barely promoted

Mid-Wednesday update: 40w3d

-- The first paragraph could be just about the same as the last entry. No-one's goin' nowhere, if you know what I mean. There is more crampiness, but it's just not organizing itself into anything effective.

-- Monday my sister-in-law's blood pressure was up, and she'd put on 5 pounds in a week, so there was a brief pre-eclampsia panic. Her bloodwork came back fine, and now they want to see her Thursday. No 4 a.m. e-mail about contractions in my box this morning, so I hope things were calmer for her last night.

-- Somehow the excellent plan of my mother-in-law staying at her vacation cabin (6 hours away) until we called her, and then staying for two weeks, got changed into, my father-in-law grabbing a cheap flight out of Rust City on Monday, and my mother-in-law coming here after dropping him off and staying through September 12. Hmmmmmm. We love her, it's fine, but it does add to the deadline pressure a little. If anything drastic happens with my sister-in-law, she may leave, and rightly so; neither my brother-in-law nor his mother-in-law can take off work if that baby comes early.

-- The freshmen are arriving! I'm always fascinated to watch them with their hovering parents: it's not often that one gets to see adult-size, adult-shape people, grown out of infant blondeness and baby fat, actually walking with both of the people who contributed to their genes. This year I'm the pregnant lady in the ratty paint-stained T-shirt, not the professor, so I feel a little safer just gawking. Of course the matching postures and gestures, accentuated because both sides are new to campus, and generally a bit lost and a bit nervous, just add to the amusement.

And, and this is perhaps a bit awful of me to admit, but, the last couple of years, there had been a pang: will I ever be one of those parents? If I am, will the child be both of ours? One of ours? None of ours? But now, we're so much closer to having a chance to answer "yes" to the first question someday, and, yes, there is a little streak of joy that breaks through when I remember that yes, this child is Beaker's, it did work, and we're almost there now.

Early Monday update

No real change here. Maybe a little lower, a little heavier, a little more clearish mucous, but also a little more sleepy and hungry and generally static. We're starting to get the kind of phone calls Brooklyn Girl (Brooklyn Girl? Yoo-hoo!) complained about, though.

My sister-in-law, on the other hand, whose pregnancy has already been punctuated by eye surgery and a kick in the stomach from a foal (both turned out fine, thank goodness) is having some awfully convincing contractions at 35w. She sees her midwife tomorrow.

From anemia to anomie, via abuse

I. Yesterday I told the midwife I didn't want an IV put in, or a hep lock, until and unless it was necessary. She pulled out my borderline hematocrit from like 24 weeks weeks and said, "Your OB probably didn't tell you, but by midwife standards you're slightly anemic. Have you been taking iron? We're concerned you might need a transfusion if you hemorrage. It's very unlikely, but we'd like you to have the hep lock."

Dr. Pippi-Poisson hadn't said anything about it, although I'd noticed the low number when I read my records. I've just been taking over-the-counter prenatals. We agreed to do another blood workup. Given the engorged pinkness, streaked with blue veins, of most of my body, and my myriad spider angiomas, it's hard to believe my blood is missing anything, but, whatever.

II. Last night, cooking something acidic in a cast-iron pan seemed prudent. I seared a couple of thick pork chops, took 'em out, caramelized onions in the same pan, deglazed with two-buck-Chuck, and threw the chops back in to braise, along with some thyme. Served with rice-cooker quinoa in chicken stock.

This is real Ray food. My grandmother is of the generation that really truly appreciates convenience foods; in her apartment, I learned to love Spaghettios and hate chicken breasts baked under condensed cream of mushroom soup. Ruth Reichl has throroughly covered the risky food that can be produced by bipolar parents; my mother was rarely allowed to cook, and no one ate much when she did.

My foster father Ray, despite his 10-square-foot Manhattan kitchen, cooked. Nothing complicated, and only salads during the summer (I still avoid romaine and feta). But he'd pick me up from day care, and we'd stop at the greengrocer, at the butcher, at the supermarket on the way home. Soups and stews and pasta. Chunks of honest meat with honest vegetables next to them. Chops braised in wine, with rice cooked in stock on the side, and lots of herby pan juices over the rice, appeared at least once a week. Even with the change in grain, yesterday was a madeleine moment.

I haven't spoken with Ray since he didn't come to my mother's funeral. I think about calling him almost every day, but I don't do it.

III. Somehow today is sexual-abuse day in my corner of the blogosphere: Dawn links to a powerfully written and horrifying account, while Tertia's readers offer advice on protecting children.

The paranoia of many of Tertia's commenters upsets me. It seems like a perfect recipe for raising little exurban Republicans who'll drive around in locked SUVs and glare at me 'cause I don't highlight or iron my hair. I am glad that at least one commenter brings up studies showing that not everyone who's been abused is permanently deeply damaged by it. Some are, and we have to respect their experiences.

But it wasn't like that for me, okay? It happened. It stopped after I said something in front of a family friend. (Who later testified at the custody hearing.) I then lied about it repeatedly to my blood relatives, to the social workers, to the judge in the custody trial. It didn't matter; the photographs were plenty evidence enough.

My family let me stay with Ray again the summer after 9th grade—I had a job of sorts in the city. I was worried. But nothing happened. Perhaps I was too old, or too independent, or perhaps he was getting enough jollies from the other little girls whose mothers he had befriended and whom he was photographing. The mothers too—he took stunning pictures of some of them, dancers and artists. I wonder who will get the prints, the negatives, when he dies. He's not doing any photography any more.

It was worth it to me to keep up the relationship, because I knew how much I owed him for getting me away from my blood relatives. Because of how he supported my intellectual growth. Because of how he reassured me I wasn't like them.

IV. One of Ray's real heroes was Stephen Jay Gould. He had me reading the Natural History columns as they came out. I read many of the books when I was way too young to actually understand them. I think nothing would have made Ray happier than my becoming an evolutionary biologist, and I think it would have happened if I'd just had my years with him, then gone back to the suburbs for high school: reasonable SAT scores, focus on a good girly science, maybe a college an awful lot like Granolan.

Instead I made it into the ludicrous high school I actually went to, fell in love with a completely different field, and was driven by peer competition to, well, excel. Top university, yada yada yada, until grad school sapped my soul.

V. Andrew Sullivan today links to a sort of odd piece by Charles Murray, the surviving Bell Curve guy. Covering both gender and race, with an oddly apologetic lead-in and a typically vicious conclusion. Defending Larry Summers, and, in the footnotes, attacking Gould a few times. I don't know enough about factor analysis to say anything coherent about The Mismeasure of Man. I do know enough about the Johns Hopkins talented youth studies to cringe whenever they're taken seriously.

It's a little odd reading about "stereotype threat" in an article that also tells me women don't achieve as much as men do because they're both dumber on average, and, you know, distracted by the whole childreading thing—just as I try to hack out changes on one last subsection of the Dr. Wow project, while wondering if these are real contractions yet or not. I have to assume reading this crap is bad for my work. But I can't make myself stop.

39w5d. 'Nuff said.

As I head off to another midwife appointment, I can finally say: I am ready for the next stage. Well, "ready" is probably not the right word. But discomfort and worry are starting to edge out the comforts of the status quo.

Of course, there are no labor signs that I've noticed yet. Perhaps the basketball has dropped a couple of inches—however, oddly, I am more short of breath. But mostly I am large and slow moving and feeling very, well, stretched. Sleeping positions that worked beautifully until two days ago now bring on symphysis pubis pain. The largest and stretchiest of my maternity clothes no longer fit, even though I've stopped gaining weight. My thirst is vicious and all-consuming as soon as the temperature creeps above 80 degrees.

And what if Dr. Intermittent-Cheer was right about IVF placentas just being, you know, hinky? Thank goodness for the vigorous kicks—although I worry too about the constant repositioning. Should I labor in a waiting room chair? They've so far have had amazing results in getting the damn squirmer where she's supposed to be, just in time for her checkups.

In between clicking over at Jo's...

... you might want to check out Belle Waring's little response to Keith Ablow's (yes, he writes cheesy novels too!) piece in the Times yesterday.

From Ablow:

Although no one seems to talk publicly about the problem, Josh is only one of dozens of men who have confided to me that witnessing the births of their children has made it difficult for them to be attracted to their wives, at least in the short run.

[...]

In the most striking cases, the symptoms that men experience come close to post-traumatic stress disorder [...]

Belle's title:

Would It Hurt If I Called You a Big Pussy?

(Thanks to Kieran, who has fun pointing out how this-all plays (ahem) straight into the gay agenda, for the link.)

Things that annoy me, and that are therefore signs of the impending collapse of civilization

Car seats. Car seat statistics. Car seat regulations for car manufacturers. Infant car seat user manuals. The portions of car user manuals about infant seats.

(Proximate problem: the only remotely reasonable way to install our used Graco Snugride in our snotty European sedan is using the inner outboard LATCH points to secure it in the center of the backseat (scroll down the page for relevant discussion). There are no center LATCH points, quite likely because car manufacturers are not required to intall them. Since the points we're using are 15.25" apart, we're violating the Graco manual. So we're among the 80% of car-seat users with incorrectly installed seats. Where does that number come from? Everyone cites it, and even says it comes from NHTSA, but I can't find the original study anywhere. And what does it mean? Are those 80% of seats totally useless? Would five times as many babies survive crashes if all those seats were correctly installed? Or is the whole mess simply a reguatory and user-accessible-design disaster?)

Health insurance paperwork. Copays. Did I say paperwork?

(Beaker's employer has just decided to start offering its employees health insurance. While this is unquestionably a good thing for the rest of the company, it has the potential to make our lives much, much, much worse. See, Granolan requires spouses whose employers offer coverage to take it; then Granolan's (basically pretty good) plan becomes secondary coverage. So we'll pay two premiums, and sort through awful awful paperwork for double submission of everything, to end up with the same coverage we already have. If we're lucky. God. Just thinking of what it may take to get Beaker's drugs covered—we currently get them through the mail-order pharmacy run by Granolaton's insurer—makes me want to cry.)

Credit card companies, how they don't really want you to send in more money, how their interest rate mechanations are about as transparent (and probably about as effective) as mainstream airline pricing.

(Ever check on whether your credit card company includes the payment address anywhere on the statement besides the payment stub, the part you send back to them? Mine doesn't. Mine has also jacked up my interest rate in response to the ludicrously high activity over the last couple of months—travel, baby crap, house stuff, etc. What's extra-peculiar is that Beaker's card from the same company, which has shown the same spike in activity, but has had a couple of late payments in the last nine months—due to incompetence during periods of geographic instability—has had the rate lowered by about the same amount.)(And yes, abusive phone calls have been moderately effectively in ameliorating both the situation and my mood.)

Stories that shouldn't have surprised anyone

—Chickadees are actually communicating useful information about the presence of predators as they twitter:

Likewise, chickadees relay similar details about the threats posed by predators and the response required. The songbirds' encode the information in their namesake "chick-a-dee" call.

The greater the threat, the larger and more aggressive the feathered mob that forms to harass the predator away.

"It's like they're saying, Hey, there's a perched or terrestrial predator over here, come harass it," said Christopher Templeton, a biology doctoral student at the University of Washington in Seattle. "Subtle variations of the call elicit the level of threat the predator poses."

Templeton and his colleagues say their findings, described in tomorrow's issue of Science, demonstrate an unexpected level of complexity and sophistication in songbird communication.

Susan Smith, a leading authority on black-capped chickadees who was not involved in the study, said she wasn't surprised by the discovery.

In an e-mail to National Geographic News, the Mount Holyoke College biologist said the finding "demonstrates a level of sophistication that I suspect is very common among bird vocalizations."

—Pesticide-resistance genes can move sideways, from crop plants to weed plants:

A reviewer of the paper has appended to its front page: "The frequency of such an event [the cross-fertilisation of charlock] in the field is likely to be very low, as highlighted by the fact it has never been detected in numerous previous assessments."

However, he adds: "This unusual occurrence merits further study in order to adequately assess any potential risk of gene transfer."

Brian Johnson, an ecological geneticist and member of the government's specialist scientific group which assessed the farm trials, has no doubt of the significance. "You only need one event in several million. As soon as it has taken place the new plant has a huge selective advantage. That plant will multiply rapidly."

Dr Johnson, who is head of the biotechnology advisory unit and head of the land management technologies group at English Nature, the government nature advisers, said: "Unlike the researchers I am not surprised by this. If you apply herbicide to plants which is lethal, eventually a resistant survivor will turn up."

(The mechanism appears to be ordinary hybridization between two plants so distantly related that the hybridization was thought to be impossible.)

—Patches of skin grown from 14-week fetal cells appear to stimulate burned areas to generate new skin:

Normally, to replace tissue severely damaged by burns, surgeons borrow skin from another part of the patient's body. But that skin regenerates poorly, in a painful and sometimes disfiguring process called grafting. The Swiss researchers had initially hoped that the layers of fetal skin cells might be a substitute graft material.

Instead, to their astonishment, they discovered that the fetal skin panels - which dissolved and had to be replaced every few days - seemed to confer restorative power to the damaged tissue underneath, allowing it to heal itself, against the odds.

"We had expected that the fetal skin would act as a graft and it did not," said Dr. Hohlfeld. "Instead we found that it acted more like a biological bandage that stimulated healing."

[...]

All the children in the study had deep second- and third-degree burns, which would normally be expected to require grafting and to cause serious scarring after they healed. Grafted skin is normally thick and stiff, so it often limits the movements of fingers and joints. It does not expand as a child's body grows, so children who sustain serious burns often need painful, repeated surgeries as they get older.

In contrast, the children treated with the fetal skin were able to heal their wounds with skin that appeared more or less normal, with normal pigment and mobility. "It was supple, there was no scarring or retraction - it was really different than grafted skin," Dr. Hohlfeld said.

And since the fetal skin layers were merely placed on the wounds, the young patients required no surgery. There was no pain, so there was no anesthesia - except for the very young, who needed anesthesia so they would stay still.

Slate has already reminded everyone that Will Saletan recently exhaustively discussed the potential and implications of using tissues from older fetuses.

—Meanwhile, Britain is struggling with a lack of gamete donors, after getting rid of anonymous donation:

"We are seeing longer and longer waiting lists because of the loss of anonymity," Prof Ledger said. "The situation has become so bad, that we are looking at importing anonymous sperm from abroad."

This issue has a poor interaction with the issue of what services should be available to single women, or to same-sex couples. Most NHS fertility clinics work only with heterosexual couples:

But Prof Ledger said the reluctance of many clinics to offer treatment to single women and lesbians and the change in anonymity law had fuelled the rise of websites selling sperm.

"The reason they've sprung up is that we as clinics have failed to meet the need, and as long as there's a shortage of anonymous sperm donors, that will continue," he said.

(The websites, most notoriously Man Not Included, fit through a loophole in existing regulation, since they provide fresh, not frozen, sperm.)

The government there is doing a huge review of how fertility treatment and related issues are regulated. All the questions are hard, and it's fascinating to see how differently they're being handled by another country. Mostly I feel like the U.S. underregulates all sorts of stuff. But, despite the nutsos trying to take over the politics of reproduction, in the U.S. anyone with enough money (and yes, that's a huge, ethically troubling de facto restriction that breaks an awful lot of hearts) can choose just about any reproductive technology that's been figured out.

38w3d: Too much information

I. We met with our doula, Nancy, yesterday. She wiggled around a plastic pelvis and demonstrated the many uses of architectural features of our house during early labor. ("See! You can just hang off this banister, and Beaker, you could sit in a chair right here to help support her...")

As she was leaving, I mentioned that I was seeing an ENT today about the dizzy spells. "You really should have that checked out! After you deliver, they may want to do an MRI—my sister had a pituitary tumor just growing! Of course, it was benign, but..."

II. Today started with midwife visit, with Elise again. This baby has already figured out how to impress authority figures: she was apparently asleep in perfect occiput anterior when palpated. Of course, I know she's twisting 'round three or four times a day still... blood pressure went back to 120/70-ish (went up 10 points last week, grrr), weight is up three pounds (visibly all in my ankles), and somehow I left without finding out fundal height or urine dip results—will call. No internal, either. (That may have been a too-little-information visit.)

III. The ENT consult started with a hearing test. I was confused to be clearly flubbing the low frequency beeps: isn't standard age-related damage supposed to hit the high end? Dr. Abrupt came in, looked at the results, started reading the little narrative I'd prepared about the spells, and said, "I think you have hydrops, fluid in your middle ear. It's a nuisance condition, it sometimes comes on during pregnancy, and the low-frequency hearing loss is very typical. Come back in three months. If you're still having trouble then, you'll go on a very low sodium diet. I can't give you any drugs now."

"Is there anything we should be worried about during delivery?"

"Well, you may get dizzy."

Thanks, doc.

IV. Before going to my bookgroup, I managed to do a little websurfing. I hadn't been particular scared after the meeting with Dr. Abrupt: he seemed fairly sure that whatever this was, was pregnancy-related and might go away, and could be treated if it didn't go away. But pages like this one had me envisioning growing old in this isolated small town, progressively more deaf and more afraid to drive.

Deep breath: real live doctor was matter-of-fact. The worst of my spells have been nowhere near as bad as described on these pages. No tinnitus, no vomiting. They're not apparently stress-related. And my body is currently hanging onto extra fluid like no-one's business.

But why doesn't this seem to happen to anyone elsse during pregnancy?

V. My bookgroup threw me a surprise shower. Except that Beaker had up and told me about it back when they'd asked him some questions. But it was still lovely. The whole time both ears felt slightly full, though.

VI. When I got home, Beaker reported that his cultures came back, well, resistant. So resistant that they're not even going to bother with some of the antibiotics they were going to try. (Now, he's almost certainly developed the resistance all on his own—he's been on a lot of drugs. A lot of drugs. But, if you know any general practitioners who are giving out Cipro or Zithromax like candy, please slap them for me.)

Deep breath: there are still two drugs he can take at home, and he will. And the insurance company just rolled over like a dog wanting its belly scratched when he placed the order, instead of demanding novelistic documentation of just why he needs to inhale drugs sold for injection.

Still, the back of my brain is envisioning that isolated deaf and dizzy future, alone.

NOTE: Yes, I'm wallowing in self-pitying worst-case scenarios right now. It's been a really long day, and it's been weeks since I had a good cry.

Everyone's dizzy, apparently

Most of you who'd be interested have probably already read (and participated in!) the fantastic discussion going on over at Jo's (as we all wait for her to pop). I don't have much to add: we've made as many decisions as I think can be made beforehand, and what will be, will be. But I wanted to point out some relevant-ish things I've seen elsewhere recently.

• Today's huge Times front-pager on how difficult many people have found making more of their own medical decisions:

  A generation ago, patients argued for more information, more choice and more say about treatment. To a great extent, that is exactly what they have received: a superabundance of information, often several treatment options and the right to choose among them.

  As this new responsibility dawns on patients, some embrace it with a sense of pride and furious determination. But many find the job of being a modern patient, with its slog through medical uncertainty, to be lonely, frightening and overwhelming.

  I know many otherwise healthy infertiles have first encountered this during treatment: you read something somewhere, you come in and ask your RE, and he or she says, "Well, sure, we can try that!" And it's sort of shocking.

  How does birth fit in? Snugly, of course. The article points out that women's health activists were among the first pushing for patient autonomy. There's a huge information oversupply, and we have to decide who to trust. As Jo's commenters have pointed out, the options available depend heavily on location and (insurance) wealth; perception of options depends heavily on education and class. Just like for cancer, or...

• Today's smaller Times magazine piece on a developmental psychologist who's trying to make NICUs into, well, more womb-like places for their tiny inhabitants:

  In a series of innovative studies, she has shown that a gentler environment in the N.I.C.U. can alleviate many of the complications of premature birth. ''You have to watch the baby, to listen to the baby,'' she says. ''The baby is a partner in everything you do.'' Als argues that N.I.C.U.'s must become quieter, darker and more responsive to a baby's desire for comfort and movement; ultimately, they should be as reminiscent of the womb's nurturing environment as doctors and nurses can make them. She has helped to institute many of her reforms at the hospitals where she works in Boston, and she has trained a cadre of others to carry her message across the country and to Europe and South America.

  However,

  Thus far, parents, who might seem to be Als's natural allies, have not been demanding better care for their premature infants. Few realize that N.I.C.U.'s are not what they could be, and even fewer are aware of Als's own work.

  Most parents of preemies don't get any time to prepare; the situation is thrust upon them, things must be done, and fast. They have little choice about trusting their doctors.

• A peculiar story in Spiked, reporting on a study which found that bottle-feeding mothers feel, well, oppressed:

  These research findings suggest that a process of cultural transmission has turned provision of health information about the benefits of breastfeeding into a campaign against formula use. The effects of this upon women, babies, and health professionals, are very problematic.

  The main recommendation that can be made on the basis of our research is that use of formula milk needs to be depoliticised and treated objectively as a routine aspect of baby care, rather than as a moral issue. Politics need to be taken out of communication with women regarding the health benefits of breastmilk. While women need to know the health benefits of breastmilk, informing them about this nutritional issue needs to be detached from negativity about formula use.

  Now, I wish that the study hadn't been sponsored by an association of formula companies infant and dietetic foods manufacturers. Or picked up by Fox News. And I think it's interesting that, all of a sudden, it's conservatives who are worried about how people feel.

  Yet, there's a deeper level of faux naivete here. Let me preface what I'm about to say with a clear statement that I don't know if I'll be able to breastfeed easily, or well. Perhaps my nipples are slightly inverted; perhaps my baby will be gently clueless; perhaps getting the feedback loops will just be too hard, especially if the birth ends up being traumatic. Even if I establish well at the beginning, the combination of work and future IVF cycles means I'll probably stop before I'd like to. And thanks to all of you out there, I know there are a lot of stories that can happen.

  But, but, but: is there anything bad to say about breastfeeding, from an infant health point of view? Ever? If medical professionals, and other people advising new mothers, tell the truth about what they know—and if those new mothers want the best for their children— how can they avoid making people feel guilty?

  And how can hypernatural birth hippies, who scare me, but whom I love when they're the ones throwing around the phrase "evidence-based," avoid making mothers who have gone through heavy interventions, for whatever reason, after whatever deliberations, feel bad?

  And, in both cases, isn't it just the pits that it's the women who have thought the most beforehand who can end up feeling the worst?

I think I'll keep "avoiding bitterness" on my very short list of birth priorities. Right after "healthy baby" and "establishing breast feeding." I'm not sure anything else is on that list, actually.

Rainbow blankie II: Design improvisation, scale woes, currency arbitrage.

What colors should the Hoover blanket be? I wanted a cream border, which settled over half the problem. My first idea was to have several runs of narrow stripes in each of five jewel tones, separated by wide cream bars.

I wanted to start working, but the Weatherwood knitting store didn't have many colors to choose from: greens, blues, purples, and lots of cream. The proprietor kindly let me study a Rowan color card. I selected colors to order later online and bought a few there. Since the store was in Weatherwood, the only circular needles carried were Addi Turbos.

Two huge questions: total yarn consumption? total time consumption?