Gender, Conducers and Decisions

First of all, that's not my belly. You might get to see my belly in future posts, but it won't be that flawless.

...

So.

It's an innocent enough question of an expectant mom: "Do you know what you're having?"

It's a question I fielded the other day.

Setting sarcasm aside - "Well, yes. I'm having a *baby*. You know, a human baby?" - the answer to the question just *compelled* me to first examine the question and its attending issues.

When most people ask that question, they're asking if the mom knows the baby's *gender* - boy or girl?

And so many expectant mothers know their babies' genders these days that you're hard-pressed to find much other than pink or blue in the Target baby section.

Well, how do we know - or guess - the gender of our babies?

[For the record, there's another compelling issue here: Do we *want* to know or *need* to know the genders of our babies? That one's for another day.]

In a "Little House on the Prairie" episode we have on DVD, a soothsayer swings Ma's wedding ring in front of Ma's belly and predicts, "Boy." (She's wrong, by the way.)

Here's what I read about that at babygenderprediction.com: "This is an easy baby gender prediction method to try. Take a pin, needle, or wedding ring and attach it to a thread or strand of hair. Hold the dangling item over mom to be's belly while she is lying down. If the needle or wedding ring swings in a strong circular motion, you will be having a girl. If it moves in a to and fro motion like a pendulum, you will be having a boy."

Whatever.

Still, there are other non-scientific ways to predict:

> Baby's heart rate. It's said that higher = girl; lower = boy. (The midwives for whom I work sorta cluck and roll their eyes at this one.)

> Drano? Yes. Mix it with a second-trimester pregnant woman's urine, see what color the *toxic* product turns. Darker = boy. Lighter = girl. (Please do not do this.)

> Plain-old mother's intuition. I've seen it work both ways. "I just *feel* like it's a girl," one mom says emphatically. She drapes the room in pink and, in her mind, has her "Hannah" in bows and patent leather. Then this big, obvious *boy* comes out screaming at her. (But there are intuitive others who have been simply *right on* - you know they really *did* know.)

An almost certain way to know would be to sample and screen amniotic fluid - getting genetic markers on the baby. Most care providers wouldn't order such an invasive test ("amniocentesis") *just* to determine gender. But if a woman's having that test anyway, she could find out.

Get on with it, right? I know you're all rolling your eyes and saying, "We *know* how to know the gender, Steph! We get an ULTRASOUND."

Ah, right. That's where I'm headed.

So I said asking "Do you know what you're having?" is an *innocent enough* question because most pregnant women in the United States at least have the opportunity to get a good guess at their baby's gender via ULTRASOUND.

They get, essentially, a sneak peek at their babies and trust the tech or the radiologist to decipher the images well enough to tell - labia or testicles?

In fact, in recent years, routine ultrasound has been rolled into most maternity care packages (not my maternity care package, but I'll get to that). Working women tack their ultrasound prints to their bulletin boards or computer monitors. Many e-mail them or post them on social networking sites for family or friends to play back or look at. I couldn't tell you how many births I've been to where, when I've gone for the second-stage apple juice elixir, I see an ultrasound print stuck to the refrigerator door.

And if I've seen one ultrasound Facebook profile picture, I've seen a hundred.

Ultrasound is not routinely done *just to* guess at gender, though. (And, yes, it is somewhat a *guess*. Techs are usually right, but not always.)

For the most typical maternity model of care, ultrasounds are offered (or "ordered") around 18-22 weeks for, according to ACOG:

Age of the fetus
Rate of growth of the fetus
Placement of the placenta
Fetal position, movement, breathing, and heart rate
Amount of amniotic fluid in the uterus
Number of fetuses
Some birth defects

Sounds about right. Have you ever had one or seen one? They're pretty cool. While the transducer's on your belly capturing images (with goopy gel in-between you and it), the tech rolls this ball back and forth on a computer keyboard, taking measurements of the little guy or gal. The tech measures everything from the simple length of the baby from crown to rump to the space inside the baby's head. It's fascinating.

(For a science nerd's hisory of ultrasound, check out this link.)

But what *about* ultrasound?

Getting an ultrasound is fun, there's no doubt. And it can provide some necessary medical information, sure.

In my second pregnancy, I had several, as my care provider was watching a bleed. I was grateful for the technology then, as it was reassuring to see a pinprick of a heartbeat at 6 weeks and an obvious baby boy - and no more bleed - at about 18 weeks.

But I had no ultrasound with my second baby. Not that I couldn't have. Home-birth CNMs can order them - midwives really do work by more than lamplight and incense - but together we just never could come up with a reasonable enough need to get one.

See, all those things listed above that ultrasounds look for are often either a) usually obvious in other ways (like twins or fetal position) or b) not really necessary to know prenatally (birth defects) or c) *inaccurately* assessed.

Let me step aside for a sec and address "inaccurately assessed." You may never have heard this, but I have dozens of times: "The ultrasound showed I was having a big baby, so I had a c-section at 38 weeks." Only she had ... a 6-pound baby who had a hard time breathing.

Or another I remember: "The ultrasound showed my baby might have lesions on his brain. We worried through the whole last half of my pregnancy. But he was fine."

Needless surgery. Needless worry.

Wow.

Even docs (usually) readily admit ultrasound just isn't always accurate, particularly on sizing and dating.

So as I've considered an ultrasound for this pregnancy, I've asked two main questions:

1. Is what the ultrasound offers - mostly *information*, as ultrasound is for assessment, not treatment - greater than its risks?

2. Related: What are its risks, and has it proven to be safe?

Here's at least an informal party line from ACOG.

"Many parents enjoy having these moving portraits. However, not much is known about the effects of repeated exposure to ultrasound. It seems to be safe, but it is possible that problems could be found in the future.

Moreover, the workers at these centers often are not trained to interpret the images for you. Based on the ultrasound, you may be falsely reassured that your baby is doing well, when in fact there may be a problem."

[If you want to later, you can read the full text here.]

That line, "It seems to be safe, but ..." bothers me. I don't like buts.

I've seen babies visibly cringe at the ultrasound. It is, after all, a barrage of sound waves. (Note, ultrasound is *not* radiation.) I have to wonder if it hurts his or her ears - or other things.

I wonder if it's one of those things - like new drugs can be - that seems harmless. Only years later, as in *retrospectively*, we'll see it did a lot of damage.

In my own case, I would consider an ultrasound - for which I would pay cash out of pocket - to determine the placement of the placenta. After all, I have a cesarean scar, and placentas can stick to cesarean scars, causing hemmorhages.

But I'm not sure the benefit of *knowing* where my placenta is outweighs the risks of ultrasound, which are a bit unclear.

My *emotions* want an ultrasound. Ultrasounds really are fun, and it's such a pleasure for mom - and for dad, especially - to make a visual connection with a largely *conceptual* baby, eh?

Still, I can't see consenting *just* to know something that my midwife and I already know is possible (that the placenta *could be* on my uterine scar). We can just prepare for that complication in case.

And as for gender, well ... I read a study about Orthodox Jews who follow a certain set of Levitical laws regarding women's cycles and marital relations. See, those Jews were having more *boys* than girls, and someone wanted to know why. Turns out, most of the women conceived early in their cycles. I conceived early in my cycle - thus my surprise. Early conception = boy? Dunno.

Next time I'll write about *knowing* ...

Expectations

Sadly, it's been nearly two months (*again*) since the last post. Hmpf.

We'll, I'm here now.

I've assisted at several exciting births, of course - a few older (my age - 35ish) Amish women having their ninth or tenth baby. They sort-of walk around and chatter until they decide they want to lay down. Then we hear a grunt or two - maybe a stifled yell - and leave our paperwork and sweetened garden tea at the kitchen table to catch the baby. I can't think of how these births could be more simple or beautiful.

I won't talk about one birth too openly except to say it was *spectacular* to watch. It endeared the midwife to me even more, though I hadn't thought that was possible. See, my midwife friends routinely spare women from surgery. THEY SAVE THEM FROM SURGERY. If you don't know what a big deal that is - to be spared from unnecessary surgery - ask me, and I'll tell you. Women in the United States get cesarean sections like they're the latest cosmetic procedure. It's awful because c-sections are MAJOR ABDOMINAL SURGERY and should never be done flippantly. To be spared from one because a midwife's willing to put a few more hours in or think creatively is simply *love in action*. (I won't get started.)

Despite the frightening state of the majority of maternity care in the United States, I remain pregnant with wonder, excitement and awe as I consider more birth work in our 1 percent of the birthing world. Oh, and I am also pregnant with child. Yes! I said that! At 38, with three super children already, and having just started school for an RN, I am pregnant.

About 8 weeks. (That's early and puts the baby due in February 2011.)

I decided to put it here because if this pregnancy will be anything, it will be a learning experience for me and others. In fact, that's part of the "vision statement" I put together with the help of colleague and pregnancy coach Deb Rhizal. I feel like a living classroom.

So if you're interested in learning as I go along, feel free to join me. If you have any interest in women's health, pregnancy or childbirth and want a live, willing mother to query, I might be she. In the mean time, I plan to do much querying myself. And when I have questions - the same issues about which I often teach in prenatal classes - I aim to get answers, deep answers, so I might better appreciate and understand this awesome thing happening inside of me.

You'll get to meet my midwife, Kate Shantz, CNM. She's a mentor and friend and a gentle midwife. (But she has short fingers, so we'll see about vag exams.) We'll be taping lots of visits - and the birth. We'll be addressing lots of issues.

So one of my first questions was about caffeine. I *really* like coffee. No matter how hard I looked, I couldn't find and rationale for having three or four cups of strong coffee a day when pregnant. (Don't get on me about it - I know caffeine isn't all that good for you in large quantities no matter what.) Seems the caffeine issue for pregnancy is two-fold: vaso- constriction for mom, which reduces blood flow to important places (like the placenta) and the baby's inability to metabolize caffeine sufficiently. Sigh. So I'm down to one cup a day and have purchased decaf.

Check out this article.

I'll be looking a lot at diet in the next few weeks. I'm curious about the *optimal* pregnancy diet, one that has virtually no sugar and few carbohyrates in it. I'm all for weight gain but not as excited about *fat* gain, and I want to learn the chemistry of how to avoid that and still get the baby what he or she needs. If you have resources you want to share, share!

In the mean time, I'm waiting on two babies. Both are "overdue" ... whatever that means ... and both will probably come within the same day, as I've found birth comes in clusters. I'm anxious to see how I'm affected by attending others' births while I'm pregnant myself. I'm hopeful to be ever-more mindful and compassionate.

I'm expecting big things, here.