I mentioned she’d told me I had placenta previa.

At the 20-week scan the radiologist had just said I had a low-lying placenta that she sees in 15-20% of all women – I’ll need to be checked on again in 8 or so weeks at which point the placenta will likely not be low-lying anymore.

A few nights later, at 8pm while we had dinner guests arriving, my ex-OB calls, I answer the phone, she says, you have a problem with your placenta, it’s over your cervix, you’ll need to refrain from all exercise, sex, and travel by flying until another scans shows it’s no longer over your cervix, bye-bye and see you in a month. I couldn’t sleep at all that night. A placenta over the cervix is very different from a low-lying one. Even I know that. The next day I called her to get further details, which I did not get – she just repeated what she’d already said, and when I asked her, what’s the exact position of the placenta because this wasn’t what they’d told me at the scan, she said no, it’s definitely over the cervix, then I asked, by how many centimeters, to which she just said with an angry huff, well I can’t tell you that.

That was the first time I thought I seriously need to look for someone else. It sounded… wrong, somehow, and not because I wouldn’t accept a diagnosis I needed to know in order to save my own and my child’s life but because it felt like she wasn’t being straight with me.

So I started looking around and researching and thinking and calling people.

Then I went for my next check-up and asked my ex-OB to look at the scan report again, and tell me what’s on it. She looked really quickly and said, it’s a full previa. Then she gave me some chit-chat about how it almost always clears up by the scheduled c-section date (that sounded wrong: as far as I know complete placenta previas are unlikely to “clear up” because the placenta grows into the uterine wall all around the cervix) and after delivering I can go back to doing anything I want to do.

She got up to leave but when she was almost out the door she turned around and said, oh by the way, you’ve already gained twenty pounds so you’ll need to cut back and watch what you eat. All I could say was, but you told me not to exercise – I couldn’t even finish the sentence, she just said, if you can’t keep your weight gain down, you’ll need to cut out carbs, then whipped around with my chart and left. I was dumbfounded. Not least because she’d tacked two pounds onto my actual weight gain to make her point. Not that two pounds makes such a huge difference but… still.

I went home crying, of course.

First thing I did that afternoon was request a copy of my records from the ultrasound unit I’d been to. Naturally, a couple weeks later they pretended they’d never received my fax. (What is it with American medical institutions that they want to keep your very own medical information a secret from you?)

Then I started making appointments in earnest to interview midwives. We’d already been talking about it endlessly with A, and we felt that if at all possible, a homebirth sounded really, really great to us.

Then yesterday I had my first real appointment with the midwife we chose. It was great. She was here for an hour and a half, talked to me about everything I was curious about, got a more thorough medical history from me than anyone’s taken in, oh, my entire life, was nice to Z, was nice to A (who came back from work to be there for a little while), checked on the baby’s position (head down) and heartrate, and also showed me my medical records, which she’d of course reviewed already. (Getting those records from my ex-OB’s office: THAT was interesting. She left me four(!) phone messages about it, worrying over the placenta and so forth. I did not talk to her. I could not.)

So… the midwives accepted me for their homebirth practice is because I’m extremely low-risk, with a 20-th week ultrasound report that says, and I quote, ‘placenta: posterior, marginal.’

Which is to say, low-lying, just like the radiologist said. My midwife said she’d be very surprised if it was still anywhere near marginal now, 8 weeks later. And if it is, with that diagnosis, even if the placenta stays marginal by the end of my pregnancy, all they’d do is come to the hospital with me (they have admitting privileges) and have me labor there, just in case there’s bleeding.

I looked at the scan report multiple times.

The doctor lied to me. Twice. I have no idea why someone would do that. Someone who’s supposed to be trusted with my unborn child’s and my life.

I can think of a rather sad explanation. There seemed to be something the doctor was impatient and anxious about – I know she has two very young children, less than two years apart, maybe that’s overwhelming – and it was clouding her judgement.

I can also think of an extremely cynical explanation. See, with both the baby and me being healthy (the baby’s been checked for chromosomal abnormalities and has no physiological problems, I have good blood pressure, good blood sugar levels, no allergies, no previous health problems), we’re good candidates for a scheduled c-section. Which would mean more money for my ex-OB’s practice and the hospital too.

That wouldn’t ever occur to me if things like it hadn’t happened to me before, even back in Hungary. Once I had hand surgery after an accident in gym class when I was 16, under general anesthesia that warranted, in those days, probably 4-5 days in the hospital. They kept me for a total of two weeks because – my family found out later – that particular department tended to keep healthy patients from being discharged because the government paid a quota per occupied bed and, since healthy patients didn’t need medication or special care, the department then had more money to spend on other patients. Which is a sad state of affairs, and not just because it’s pretty traumatic to be trapped in a hospital ward for a couple weeks, with no way of knowing when you might be let out, or why you’re not being let out. This was not a typical practice but it did sometimes happen. Still does, I’m afraid.

I’m also pretty sure the reasoning was somewhat similar for keeping Z in the NICU for 8 days after she was born, despite test results showing she had no signs of infection or stress or respiratory issues after just 3 days. In this case, I know how much money the hospital got for keeping her there. I paid those bills.

I still feel a ton of guilt for letting that happen to Z: I’m supposed to be the one who protects her and I just abandoned her to strangers and a lot of needles and isolation and not being held when she needed to be held. I shouldn’t have had such blind faith in The System, I should have known better and done my research before it all happened.

I can’t stop turning all this over in my mind. I will, of course, because at the same time I finally feel free to be happy about the coming birth of my child. But right now, I’m flabbergasted that people who are supposed to be looking out for my health could treat me and my unborn child with such disdain.

I can’t help feeling validated though. It felt like my ex-OB was lying to me. And she really was.

You see, I am now with a practice of homebirth midwives.

But let me explain.

A and I went through a lot of discussion about how and what to do differently for the birth of our second child. To this day it makes me sad to think of Z’s birth. My biggest regret is not knowing more about how hospitals typically work in the U.S. One thing I wish I’d realized then is that not only will I not have peace and privacy in which to labor, I’ll get disapproval instead of encouragement for not wanting an epidural, for wanting to walk around, for… wanting encouragement in labor. Which had the effect they’d desired: I got so anxious that my labor stalled completely, after 24 or so hours I did give in and got an epidural to be able to rest, then an hour or two later they put me on Pitocin, and I’m firmly convinced that the only reason I was able to then proceed to a non-surgical birth was because there was a shift change and a nurse with half a brain came on, along with one of my favorite doctors from the practice I was with, and they let A and I sit quietly in the hospital room and wait for Z to be born. The doctor I started with in the hospital just said, I’ve seen it all and I don’t know why any woman would want to deliver vaginally.

But then I had a fever (a not uncommon side effect of epidurals), and Z was slow to start crying (also a possible side effect of epidurals), and it was determined she needed to go to the NICU stat because she might have an infection. In the NICU they started to feed her by IV right along with her antibiotics, and wouldn’t let me breastfeed for more than 5-10 minutes at a time because (and I quote) she won’t eat enough that way. It was traumatic not to be able to take her home with us, not even after various bacterial cultures, lung ultrasounds and whatever other test came back showing she was just fine. No, they insisted on keeping her for a whole 8 days, continuing the IV antibiotics the whole time even though they weren’t needed anymore, continuing her on formula because “she didn’t eat enough breastmilk” (my milk only really came in once we took her home, but then within an hour), not even letting me hold her for more than 30 minutes at a time, every 3 hours. I used to sit next to her isolette just watching her sleep. Once, during the part of the afternoon when the NICU was closed to visitors, I watched through the window as a nurse tried to stuff a bottle of formula into Z’s mouth while she was wailing, wailing, wailing just to be picked up and held. Nothing made her happier than being held.

A and I felt like our child was stolen from us and we were powerless to get her back from the Institution. And we were both, independently, firmly convinced that there was nothing really wrong with her. Except of course who were we to say so? Would you risk your newborn on the off chance that your gut feeling is wrong? I wouldn’t. But… what a waste. Of a time in my family’s life that should have received much more respect. And, not least, a waste of medical resources spent on a mother and baby who more than likely did not need them. (Ever wonder how on earth the U.S. can spend so much on medical care yet do so badly according to most international health statistics, especially ones that pertain to maternal and infant health? This is how.)

I remember how numb I felt after that experience, and how it all seemed to be, somehow, not right. For a long time I tried to explain to myself that it was necessary but in the end I never could believe that it was.

And what happened was so simple: I needed someone to hold my hand and speak kindly to me, someone whose presence would also have reassured A, someone who knew what was going on and paid attention and knew when things were right or wrong, and wouldn’t have been shocked and slightly panicked when I dilated fully because she would have known what was going on with me, not just the fetal/contraction monitor.

I didn’t get anyone like that, not until the very end of labor when the lovely doctor was there. Instead I got pissy nurses and hellishly uncomfortable continuous fetal monitoring and having to stay in bed and being stabbed several times to place a hep lock. And disapproval. I had a doula so first I got disapproval from the nurses for that. And later I got disapproval from the doula that I wasn’t tougher, that I couldn’t resist the anxiety better and wasn’t able to get myself into a mental place to labor effectively. I asked A to send her home.

Turns out I just don’t work that way. I need real human contact and understanding and sympathy. I need being touched and spoken to kindly.

With this pregnancy, I began seeing an OB whose practice very strongly advocated natural childbirth, and has super-low c-section rates, and is on the faculty of a hospital with an in-house birthing center. It started out well – I really liked the OB for the first few visits. Then, starting with the third visit, I started to feel like she was lying to me. Maybe that’s putting it too strongly: maybe all she was doing was trying to influence my behavior in a way that she felt is most likely to lead to the outcome I desired. I am not completely sure of this yet… I have to get a good look at my medical records, which my midwives now have, before I’ll feel like I know what really happened. But whatever her intentions were – and I’m entirely willing to assume she meant well – what I felt is that here’s someone who’s lying to me in order to bully me. And that feeling alone was enough to give me so much anxiety that I had to face the fact that even if the OB was right, I would have a fairly troubled pregnancy and birth if I stayed with her practice. Because that’s how my body reacts to anxiety: it begins to mess things up that it could otherwise do without any problems.

I began looking at midwives who deliver in hospitals first but I kept getting the feeling they were uncomfortable with the idea of perhaps having to contradict an MD and, more disturbingly, seemed more concerned with following hospital policies than doing things that really make sense.

At this point, I’ve read enough international studies about maternity to be fairly certain that U.S. hospital policies are pretty far from infallible, and in many cases make fairly little sense. I’m sort of past the point of resenting that I have to do all this damn research because it’s actually quite interesting. But I’m going to save that for another post because Z is set to come back from the playground in 10 or so minutes and then I won’t have time to finish this post, at all.

I know two (now three) people in person and a bunch through blogs who did planned homebirths. It always seemed so… unrealistically lovely to me. The part that seemed especially lovely, though, was the prenatal care. That the midwife would actually look at them and not just their chart. That there was more to their pregnancy than the number of pounds they gained between visits. That – and this is the best part – their midwife talked to them and knew them by name.

I began to research homebirth in New York City and it seems there’s kind of a great community of homebirth moms here. Eventually I settled on a practice of two midwives, both of them amazingly lovely, who incidentally also have priviliges at a hospital 10 blocks from our apartment, and are backed up by some very good doctors. Given that I have a low-lying placenta which needs keeping an eye on, this seemed important: if it stays low enough I will need a scheduled c-section. Odds are it won’t – and in any case I need to get to the end of the pregnancy feeling supported and cared for, not bullied.

But what sealed the deal for me was that I got in touch with one of their former clients, a fellow Hungarian woman, who gave birth to two of her babies with them, and described her experiences as both peaceful and comforting (albeit hard and occasionally very painful), as well as reassuring in terms of the midwives’ medical knowledge. Not to get into details but they have the skills necessary to resolve things that would have become emergencies in a hospital – before they become emergencies.

Homebirth is… not well-received in Hungary, to put it mildly. This despite the fact that countries in the EU that have the best maternal-child health statistics, and the best birth statistics, like the Netherlands, actively encourage prenatal care and birth with midwives and giving birth at home, whenever possible. Actually, the Netherlands actively discourages birthing with OBs and in a hospital, when not medically necessary. So I have no idea how much my family will flip out about our plan: they are Hungarians to the core, and roughly one-fourth of my extended family is made up of doctors of various specialties. But… they practice in a way that’s totally different than is typical here. No four-minutes-if-they’re-lucky-per-patient visits for them: they consider taking the time to make their patients feel comfortable with them important to the healing process.

From my point of view, getting my prenatal care from the midwives we chose is a super-important part of the process. I may not end up being able to plan an actual homebirth and won’t know for sure for a while yet but in the meantime, I’ll be cared for in a way that feels comforting. And then if the placenta doesn’t do what it’s supposed to – we’ll go from there. And it’s not as though I won’t need professional handholding if I need to plan a c-section. I’ll need it even more, I think.

The one irony: our current insurance, as per their efforts to “lower medical costs,” doesn’t cover midwifery care. Because we all know how much cheaper doctors and hospitals are, right? I’m going to be appealing this, of course.

So… here’s the gist.

Early last October we moved to Manhattan, through a stroke of good fortune so huge that I still spend at least a few minutes of every day marveling at it and just… enjoying it. As best I can tell, one should enjoy the things one loves when one is right there with them, not least because everything can be gone in an instant. I don’t sit here anticipating that instant, of course.

I love city life. Adore city life. And I can’t even participate in it as much as I would like right now, for reasons I will get to in a moment. I love that we have neighbors we can be friends with because we live in SUCH a wonderful building. I love that A’s daily commute to his studio has gone from 3 hours by train and car to 3 minutes on foot. This, possibly, is the very, very best part. I love that if ever I feel a tiny bit gloomy, all I have to do is take a quick walk outside and it’s all better right away.

Walking has also become one of Z’s favorite things to do: like me, she LOVES the city’s hustle and bustle. Luckily we live on a block that gets real quiet at night and on weekends. Although… I have to confess that most city noises don’t bother me. On that note: bizarrely, Z sleeps better than ever. Though Z’s also had a cold lasting a month-ish, or perhaps several colds one on top of the other, because she goes to an indoor playground every day, one it’s really hard to drag her away from.

There’s a new kitty in our household: we adopted a lovely, very dog-like cat from a shelter this Christmas. His name is Cinco, because he’s the fifth member of our household. Cinco and our dog get along shockingly well, aside from a few spats about who gets to sleep where and a decided preference for the other animal’s food on both their parts.

We also have a Hungarian-speaking nanny a few mornings a week, partly because this way Z can practice her Hungarian and partly because, at the moment, I can’t do some of the things with Z that she needs someone to do with her.

Which brings me to the biggest news of all: I am pregnant with our second daughter. Sadly, I have a touch of placenta previa that may yet resolve but that’s caused my doctor to bar me from a fair amount of physical activity. I vacillate between thinking she’s overly cautious and believing I really need to be super-careful. And then I end up being super-careful anyway. So I need help with Z on playgrounds because I’m not supposed to do any exercise, and taking a toddler to the playground is, I think, a fair amount of exercise – hence the nanny. But I’ve slowed down a great deal also just on account of being pregnant. I get tired very quickly, just like I did when I was pregnant with Z. It’s starting to be painful to walk because, like with Z, I’m carrying on the low side. There’s a bit less than four months left that this baby needs to stay in me and, besides envisioning that goal quite frequently and refusing to contemplate the alternative, I really just hope I don’t have bedrest in my future.

I won’t write about A’s car being nearly totaled by a particularly able-bodied deer, or my car being difficult to sell, or almost having to sue our old landlord to get any part of our deposit back, or my having eight colds since getting pregnant because all of those things are kind of yucky and I don’t feel yucky so why write about yucky things?

The moral of the story that the numbers tell once seemed straightforward: if there are fewer jobs for people with Ph.D.s, then universities should stop giving so many Ph.D.s—by making it harder to get into a Ph.D. program (reducing the number of entrants) or harder to get through (reducing the number of graduates). But this has not worked. Possibly the story has a different moral, which is that there should be a lot more Ph.D.s, and they should be much easier to get. The non-academic world would be enriched if more people in it had exposure to academic modes of thought, and had thereby acquired a little understanding of the issues that scare terms like “deconstruction” and “postmodernism” are attempts to deal with. And the academic world would be livelier if it conceived of its purpose as something larger and more various than professional reproduction—and also if it had to deal with students who were not so neurotically invested in the academic intellectual status quo.

I couldn’t agree more. And wasn’t something like this the original purpose of a liberal arts education?

I love Manhattan.

To the woman with blood clots…

Call your insurance company and ask for their Appeals department. You want to file an expedited appeal. (Expedited appeals are different legally than regular appeals. The company is required to get you a decision generally in less than 24 hours, but it depends on your state’s laws.) In most cases, even if your coverage only carries generics, if there is no generic, they have to cover the name brand. You just have to know how to make them.
Contact your doctor and let them know you’ve requested the appeal so that they can be ready with the medical records.
Look up your state’s Office of the Insurance Commissioner (OIC). They should have a lot of information about patients’ rights. Contact them if you get the run around from your insurance company.

I work for an HMO, and work closely with our Appeals department. It is their job to make things like this right. But the likelihood of anyone at your insurance company telling you this is an option is low, so you have to ask.

No, dear commenter, you’ve got this quite wrong. No patient should EVER have to appeal anything at all when it comes to their healthcare. No patient should ever need to research if there’s a generic or not for the drug they need, whether to survive or just to be comfortable. No one should ever need to contact their state’s Office of the Insurance Commissioner about patients’ rights because insurance companies should simply respect those rights by default. No one, no one should ever have to worry about whether their doctor is prescribing an affordable treatment, whether it be medication or not. No one should ever, ever have to figure out how to make someone pay for the treatment they need, especially not if that someone is legally obligated to pay for it.

And don’t even get me started about preexisting conditions. Is there a human being alive, I mean someone older than a second-old baby, who doesn’t have some preexisting condition? Seriously.

The biggest problem with healthcare reform as it stands today – given the chance that there will be no public option – is that it will be overly complicated and most of us will have no idea how to figure out all the stuff that we’re entitled to get from our health insurance companies, stuff our health insurance companies will surely continue to try not to give us. And so most of us will continue to do what we’re doing now: we won’t go to the doctor unless we absolutely have to because god forbid the thing we’re at the doctor for is something our health insurance won’t cover. I mean if we are lucky enough to have health insurance to begin with. Which means that overall, healthcare costs will remain high because people will go to the doctor only when they have something unavoidably bad and therefore expensive to treat. In no other developed country does spending lots of money on healthcare actually result in worse health than in the United States.

• first, she got hold of and spilled and broke my coffee cup. My fault: it seems today she’s rather taller than, say, yesterday, and my brain seems to be having a slow day because I typically remember not to put anything breakable where she might reach within the next year or so. But today I managed to set my coffee cup down where she could easily have reached it a week ago. But also? She’s surprisingly fast. I took my eyes off her for, oh, 2 seconds and oops! went the coffee cup. I proceeded to clean up the mess and she proceeded to walk around the house leaving a long trail of blood: she cut her toe on a shard (small cut, nothing left in wound). She didn’t cry at all except once we cleaned her up and bandaided her toe, at which point she got really pissed off that she wasn’t allowed to rip the bandaid right off. That pissed her off several more times during the day but it’s a real nice secure big bandaid. She seems to be developing a taste for tantrums because later on she got really angry when I wanted to use the laundry basket for laundry instead of pushing her around the house in. And I’m sorry but the laundry (and mommy) won. Z and I made peace later with a nice fruit smoothie and some Thai food, which I made because I decided I want to learn to cook Thai because finally there’s someone besides me in the house who is all about the coconut milk. Not that I can do much cooking while the miniature tornado is awake and tornading around with her bloody toe.
• Then, then! A half hour later Z and I are in the bathroom, and she turns to the tub, chucks in her pacifier, then jumps in headfirst after it. Happened so fast I didn’t even have time to react: I was standing an entire foot away. She wasn’t hurt (very low tub) but my panicked reaction kind of scared her.
• I don’t know, either I’m an awfully careless mother or she’s super-suddenly super-fast. I vote for the latter.
• But I learned two important lessons: one, a cut on your toe doesn’t necessarily hurt but bleeds something awful if you walk around with it, and two, falling headfirst into a tub really scares your mother but can otherwise be construed as fun.
• I need some beer now.
• Oh but yesterday? Z tried to lend her pacifier to another little girl in the park. How sweet, no? And before that she tried to put it into her lamb puppet’s mouth.
• This next item is also not, strictly speaking, an adventure of this morning but nevermind: Z can say book (she’s suddenly starting to show more interest in books although mostly picture books, in particular one: Good Night New York), she can say ladybug, ball, lamp, car, lamb. Or I should say she’s trying to say these words, with varying degrees of success, as of a few days ago, and given the right context you can sort of begin to recognize them. She also seems to like shoes a lot, which makes me wonder if shoe will be her next word. All her words thus far are Hungarian.
• A couple days ago she decided that dogs barking sound mostly like slightly tipsy hyenas. At least in her interpretation. It’s hilarious.
• It’s also very similar to what Z sounds like when she sings. Which, believe it or not, she tries to do sometimes.

I shan’t say more about it because I don’t want to jinx it. But this, this that could happen? It’s been a fantasy, unattainable, for a long time. Now I must go knock on wood for the rest of the day because I might already have said too much.

Also? I think I’m going to cook some lamb stew.

This is more of a challenge these days than it sounds because Z is extremely good at walking now. She is also extremely good at being a tornado. Which requires closer supervision than ever and our house is, basically, wrecked anyway. No one can do anything while Z is awake these days. Except play with Z, of course. Because on top of the walking and the tornado-ness she’s decided that henceforth everyone must play with her AT ALL TIMES and do nothing else ever and acts deeply and loudly offended when people fail to comply.

But Z is taking an uncharacteristically long nap, which means I am free to chop vegetables to tiny pieced and, just possibly, do a load of laundry or two. I am embarrassed to say I’m quite excited about these possibilities.

And, and! She understands a bunch of words in Hungarian, some in English, and knows some phrases, mostly having to do with determining where, for example, her head is, which she also knows in English. A pretty cool party trick, incidentally: your baby showing everyone where her head is in two languages.

But, also! I’m pretty sure Z’s now trying to SAY a few words. She can say bye-bye (or, well, the Hungarian baby-form of it: pah-pah – close enough though), I’ve heard her say something very close to ‘ball’ (labda) at a ball several times now, and today while driving home from the dry cleaner’s we stopped at a red light and I heard her say something that sounded suspiciously like ‘head’ (fej) and when I turned around to see her she was looking straight at me and smiling, holding her head. So… I think she said ‘head’ and then to emphasize her point, she showed me where her head was.

Sadly, we’re now also entering a phase where she freaks out completely when I leave her with anyone else. Which always makes me feel sorry for those someone elses although I’m always quite certain my child will survive until I get back and feel somewhat less sorry for her. Cruel, I know. I can’t deny I feel flattered, in a bittersweet sort of way. Never again, for the rest of her life, will she think I am so irreplaceably awesome.