Review: Pregnancy, Childbirth, and the Newborn: The Complete Guide

Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin, Janet Walley, April Bolding, Ann Keppler, Janelle Durham is the last of the general pregnancy books that I had on my list to read. I probably didn't need to read it. Not because I didn't learn anything — I did, and there were several areas where this book was better than the others I read — but I think three general pregnancy books reaches the points of diminishing returns. So now you know =)

But on to judging this book on its own merits! In many ways this was my favorite of the three books. I still prefer the tone of the Our Bodies, Ourselves pregnancy book, but I feel like in content this book combined the best of that book and the Mayo guide. This was, to some degree, at the expense of being about 30% longer than the other two (including appendices).

This book contained good information about alternatives, like the Our Bodies, Ourselves guide and detailed information about things like exercise like the Mayo guide. As far as I can recall, the chapters on breastfeeding and self comfort techniques during birth were more detailed than either.

The book did have a rather strong bias toward a lower intervention birth, so if that's not of interest to you, the book may bug you. If that book is of interest, you'll likely find it very supportive. I enjoyed it, but if you want a more balanced look at the alternatives, I recommend the Our Bodies, Ourselves guide; it's attitude is more "we want you to know that the low intervention route is a viable option, but that it's also perfectly OK to choose interventions. Either way, just make sure you know what you're choosing."

So my end recommendation of books for the pregnant or wanting to conceive couple?

• If you want more insight into how your menstrual cycle works and ways to track fertility, read Taking Charge of Your Fertility
• If you're not sure how you feel about different birth options, read Our Bodies, Ourselves: Pregnancy and Birth for a balanced overview of options
• Read Expecting Better to understand the data behind many of the standard recommendations and get the data to decide for yourself which recommendations are more or less relevant to you.
• If you feel the Our Bodies, Ourselves guide didn't give you enough info about pregnancy itself,
• If you decide you prefer the more standard hospital birth, read the Mayo Clinic Guide to a Healthy Pregnancy
• If you prefer the lower intervention approach (whatever setting), go with Pregnancy, Childbirth, and the Newborn (and, for the philosophical/emotional side of things, Ina May's Guide to Childbirth)
• But note that either will give you lots of substantially different information, including about the alternatives. The difference is mainly a matter of tone.

How our friends found out

Spending time with people before you're ready to reveal your pregnancy is dangerous, especially when food is involved. During our annual holiday party, one of our good friends, Shawna, started to get suspicious, and the next time we saw each other asked, "Do you and Jeff have a secret?"

Although we weren't actively telling people about our pregnancy yet, we were letting people know if the subject came up directly. So I told her and decided to tell the rest of the folks who were over for dinner that evening.

This is how I told them:

Me: "Since Shawna went and spoilered it, I wanted to let you all know that I wasn't drinking saké tonight."

:: silence::

Me: Let me try again. Jeff is not a vampire.

Everyone else: "Congratulations!" "+1"

You see, over dinner, we had just been talking about how in some universe or another, when a vampire and human got pregnant, it was always the vampire who carried the child, regardless of gender.

I love my friends.

Review: Mayo Clinic Guide to a Healthy Pregnancy

I recently finished the Mayo Clinic Guide to a Healthy Pregnancy. Of the books I've read, it is most comparable to Our Bodies, Ourselves: Pregnancy and Birth. I'm not sure which I like better. The Mayo Clinic guide contains more details about pregnancy, including more information about the development of the fetus itself and useful information on gentle exercises to perform during pregnancy.

However, it is missing the key things I appreciated from the Our Bodies, Ourselves book: the sense of educating the reader about the various options available to her and empowering the reader to make the choices that are best for her situation. The Mayo Clinic guide is much more prescriptive, and it spends a lot less detail helping women decide why they might want to follow or deviate from standard practices.

I'm glad I read the Mayo Clinic guide; I did learn some things. But if I had to recommend just one or two books, I'd still go with Out Bodies, Ourselves: Pregnancy and Birth, and Expecting Better combined with an app like I'm Expecting (Android) to provide more details about the week by week development of the baby.

Review: A Baby At Last

It was just as I finished reading A Baby at Last!: The Couple's Complete Guide to Getting Pregnant--from Cutting-Edge Treatments to Commonsense Wisdom by Zev Rosenwaks, M.D., Marc Goldstein, M.D. and Mark L. Fuerst that we discovered we were pregnant. However, before that point, I was thinking that background in dealing with infertility might be something very valuable for us.

Generally, doctors say that a couple is infertile if they have been trying to get pregnant for a year and have not yet succeeded. We'd been trying for nearly a year and a half, and during that time, we had observed that I had extremely irregular menstrual cycles — the shortest were about 40 days and the longest over 100 [1]. Even though we weren't planning jumping straight from there to high tech fertility treatments, we did want to understand what the different options were before we started talking to our doctor about fertility issues.

A Baby At Last seems quite thorough. It is generally optimistic about a couple's chances of conceiving through fertility treatments, but it is also realistic about the risk factors involved, especially age. The book is rather technical at times, but that's overall a good thing, since it helps the reader understand when different options are applicable. The book also has a number of chapters on specialized subjects — e.g., fertility issues for cancer patients — which I just skimmed but which seem like they would be valuable for those in the specific situation.

The book contained a chapter on alternative medicine techniques. The authors managed to say, in a way that wasn't too condescending toward those considering such techniques, that there is little evidence that they work and that when they do show some positive effect, it seems like it's more or less due to general stress reduction. This seems much more useful than the insulting and condescending attitudes adopted by many folks speaking up against alternate techniques. Yes, they are pseudoscience, but rudeness isn't going to convince the people who don't realize that.

Although I don't have other books to compare this too, overall, this seems like a good resource for a couple who wants to understand their options for fertility treatments.


[1] As an aside, one thing that was frustrating on our journey to pregnancy was that our doctor encouraged us to wait a year before coming back and talking about fertility, even though, at that point, I had only had one period in the six months since I went off the pill, and I probably (based on temperatures) hadn't ovulated. Statistics are hard to come by, but such a pattern generally indicates some sort of issue.

We're pregnant!

Temperature above the coverline for 17 days, and things are looking suspicious. However, my ovulation pattern has always been a bit unpredictable, so that doesn't necessarily mean anything. However, a positive home pregnancy test and a follow-up confirmation test with my doctor (at an appointment I initially scheduled to discuss next steps on our potential fertility issues), have confirmed what we have been waiting for: we're pregnant!

The downside of tracking my temperature and home pregnancy tests is that I strongly suspected I was pregnant before I even was sure I missed my period. Why is this problematic? Well, the risk of miscarriage is still pretty high in week 5 of pregnancy[1]. Estimates vary because gathering the data is a bit tricky, but a common number is that at this point 10% — 1 in 10 —pregnancies will still end in miscarriage.

That said, we are excited, and cautiously optimistic.

[1] For those doing some confused math, yes, I can divide by 17. Pregnancy is counted from the time of your last menstrual cycle — or if you're like me and have extremely irregular cycles but do track other fertility signs, pregnancy is counted from two weeks before ovulation.

Waiting

Based on my temperature shift, I ovulated nearly 2 weeks ago. Am I or am I not pregnant?

One of the hardest parts of trying to conceive is the waiting. Every single menstrual cycle, there is a small window of fertility, then we need to wait a couple weeks before we can tell whether or not we succeeded. When you have irregular cycles — mine ranged anywhere from 35 to 100 days, compared to the regular 28 — this is even harder, because you don't know when that window of fertility will happen, and you don't know how long it will be before you have another.

Even the early pregnancy tests become vastly more accurate if you wait until you would have missed your period to take them, so all you can do is wait and wonder — even a negative test doesn't mean you're definitely not pregnant. You start analyzing every little twinge and feeling. Some women start getting breast tenderness as early as the end of the first week after fertilization, my breasts might be tender. Is that maybe a bit of spotting from implantation? I feel funny, I think, maybe that's because I'm pregnant? Or maybe I'm just paying more attention than usual.

So we wait, and we check, and we hope. Because that is all we can do until we succeed or find it's time to try again.

(Note: I could have written this post nearly anytime in the year and a third we spent trying to conceive — in fact, I did write various parts of it over time. I've chosen to date it relative to when we actually conceived because I had all these feelings then just as much as other times.)

Review: Expecting Better

Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong-and What YouReally Need to Know by Emily Oster is the result of an economist (Oster) wanting to understand the actual risks behind the common advice given to pregnant women during her pregnancy. She doesn't just present to the reader her own view of the various recommendations, she presents the data so that the reader can decide on the risks and trade-offs on her own.

The largest take away theme is that many of the common recommendations to pregnant women are based on sparse or inconsistent data, often because it is difficult or unethical to do true randomized studies during pregnancy. Because Oster is exploring the data herself and because she does not take recommendations at face value, this book provides the reader with a framework for deciding which advice to take at face value and which to take with a grain of salt.

It's worth noting that there are a lot of negative reviews of this book on Amazon from people who are outraged at the suggestion that a very moderate amount of alcohol during pregnancy may not be harmful. I'll just note that Oster does not advocate for drinking during pregnancy. Rather, she points out some weaknesses of some of the studies that have shown harm and points out other studies that showed no observable harm. She personally concludes that a small amount of alcohol during pregnancy is OK, but she agrees that there is also no reason to drink if you are worried about the risks.

For women drowning in a sea of inconsistent advice — or who just want to understand why they are told to do or not do certain things, Oster's book is an incredibly valuable resource. While, of course, this should be paired with a book that is more detailed about pregnancy itself, I highly highly recommend this book as one to look at if you are pregnant or interested in the topic.

Review: Cracked Open

Cracked Open: Liberty, Fertility, and the Pursuit of High Tech Babies by Miriam Zoll is not my normal sort of book. In fact, I kind of disliked it. It's in the genre of self discovery memoir, in this case centered around the author and her husband's quest to have a child.

What I disliked about it is that while emotions are important in a book exploring the emotional roller coaster of excessive promises and failed expectations that are so common — and so rarely talked about — in the fertility industry, Zoll rather overdoes it. Do we really need the long diversions into the author's childhood or her brother's ongoing life as a deadbeat? Do we need to hear about her journey to find her animal totem? While some mention of the author's background is necessary to understand the emotional process the author was going through, it seemed like every chapter was more than half general musing about the author's past, family, and insecurities. The book could have been half the length and still have painted an effective, personal, and emotional picture of the author's journey.

That said, the book contained a lot of information that is valuable to anyone who is curious about the fertility industry — and since my husband and I have been trying for a year and a half to become pregnant with no success, we certainly had curiosity.

The largest lesson is that the media and general societal attitudes have hugely misinformed women when it comes to their fertility. A woman's fertility drops dramatically after her mid-thirties, precipitously after age 40, and even the best technology relies largely on luck for a woman whose body is just no longer going through the right physiological processes to support egg production and pregnancy. Birth is not impossible — not even uncommon — but it is much more difficult. The various fertility assistance techniques, in vitro fertilization (IVF) and donor eggs in particular, have a much lower success rate than our societal folklore would lead us to believe.

The second largest lesson is that the fertility industry is just that, an industry, and it does not — or at least did not for Zoll and her husband — do a good job of supporting the emotional experience of the couples involved.

Overall, this was a worthwhile read, although I suspect that there is a book out there — written or to be written — which can convey much of the same experience without being so annoying.

Review: Ina May's Guide to Childbirth

Although this book contains much factual information about pregnancy and childbirth, Ina May's Guide to Childbirth by midwife Ina May Gaskin is just as much a book on childbirth philosophy as it is a book about the process of birthing a baby.

The heart of the book is a number of birth stories, sometimes in the words of the women who gave birth and sometimes in the words of Ina May. While some of the women further toward new age woo than I think is quite reasonable, for the most part, these are powerful stories of women finding in their bodies and minds the power to give birth in a way that doesn't treat birth as a medical problem to be fixed. One thing I appreciate about these stories is that they don't exclusively describe normal, uncomplicated births. A good handful of the stories contain births that were difficult.

One thing Gaskin does well is demonstrate how many of the birth interventions that are sold as conveniences can hamper birth and lead to further interventions that the woman did not originally want. For example, the labor inducing drug Pitocin (synthetic oxytocin) can force the body into labor before the pelvic region has finished preparing for birth which, in turn, leads to higher levels of cesarean sections. This isn't to say cesarean sections are bad. The point is that a woman may choose one intervention — induced labor — and end up with another which she may not have personally wanted — a cesarean section. Another example is epidurals to kill the pain of birth can lead to higher levels of perineum tears because the woman giving birth is unable to feel when she is pushing too hard or too fast.

Because of this, Gaskin advocates letting women's bodies do their work and turn to interventions only as needed. The medical interventions that doctors have available to them today are wonderful lifesavers, but by treating them as conveniences that can standardize birth, we start down a chain of interventions in way that are not always desirable.

Beyond the philosophy, this book also contains a lot of information about the birth process that emphasizes how to let the process of birth happen in its own way: let the birth take time; stand up and move around to help the baby into the right position and let gravity help you push it out; laugh or let your partner sexually stimulate you to relax you and help to loosen your muscles; etc. These aren't magical incantations to make the birth process pain free and fast, but they are ways of working with the birth process rather than against it.

You shouldn't read this book expecting a neutral presentation of non-medical birth, but you should read it if you want a book that focuses on birth as a normal process not something to be medicated away.

Review: Our Bodies, Ourselves: Pregnancy and Birth

Our Bodies, Ourselves: Pregnancy and Birth was the first book about pregnancy I read so, of course, it is going to influence me more than books I read later. That said, it still stands out as a good book on the topic of pregnancy, labor, and the early postpartum period.

I appreciate the balance the authors of this book struck between being clear as to which choices they considered best but still discussing multiple options and the situations under which those alternatives might be best. One example prevalent throughout the book is the preference for vaginal, minimally medicated birth over more heavily medicated or cesarean births. The authors described both why they preferred less medicated vaginal births and discussed the situations under which other options were reasonable or necessary. With this background, I feel more confident in my ability to try to make the right decisions for myself without feeling guilty about not having the "perfect" birth experience.

Another aspect of this book that I liked was the clear focus on empowering and advocating for women. This book did not try to limit itself to just the birth process. The authors were not afraid to discuss policies they considered bad or advocate for change.

One aspect of this book that may be considered a weakness, depending on what you are looking for, is that it focused on breadth more than depth. The authors gave just enough detail to enable you to ask further questions. Thus, while it's a great first book about pregnancy and birth, those who have read other books with similar scope will likely not encounter as much new material.

Primary Fertility Signs

Most women are not going to be measuring their hormone levels daily, but fortunately, we don't need to do so to be able to tell where in our menstrual cycle our body is. The hormonal changes that cause ovulation also cause other observable effects. Although everyone woman's body has its own idiomatic ways of signaling ovulation or menstruation (mood, cramps, and breakouts are the classic examples), there are several signals which can be used by most women to understand their cycle.

Of course, these signals are not perfect, which is why in an earlier post I mentioned that they are incredibly valuable for a woman trying to achieve pregnancy and useful, but not as useful for women trying to avoid pregnancy. Depending on the regularity of your cycle, monitoring these signals may or may not be sufficient for avoiding pregnancy, and if you are in a situation where avoiding pregnancy is imperative, you should use other methods of birth control. That said, whether you are trying to achieve pregnancy, avoid it, or are not sexually active at all, tracking these signals can be a valuable way to learn what is and isn't regular for your body. I personally wish that in my teenage years, when I had an incredibly irregular cycle, I had been educated about tracking and had spent some time understanding what my body was doing instead of being put straight on the pill to avoid the uncertainty of an irregular cycle. I expect I would have still chosen the pill eventually, but I would have had a much better idea of what to expect when I eventually wanted to achieve pregnancy.

Waking temperature

Back to the signals. The first signal is your waking temperature. After ovulation, a woman's waking temperature shifts up by over half a degree. Given that the daily variation is generally within a few tenths of a degree, the shift is generally fairly easy to spot on a graph of temperatures. The temperature shift is due to the progesterone that is released after ovulation. Temperatures fall again when you start to bleed.

However, taking your temperature has a few weaknesses. The biggest is that your temperature shifts after you've ovulated. Thus, unless you have a regular cycle, this signal will not be useful for predicting when you are going to ovulate. Temperatures also can be effected by fever, alcohol the previous evening, shifting waking time (including adapting to changing time zones), and other shifts in your normal routine. Thus, waking temperature is most valuable as a confirmation that you have ovulated: once you see consistent elevated temperatures, you can conclude that you've ovulated, and may be able to pinpoint when, based on the quality of your data.

Cervical mucus

Cervical mucus, also called cervical fluid (because apparently some people think mucus sounds icky), is a more predictive but harder to interpret fertility signal. Rising estrogen levels eventually cause the release of the egg, and they also cause your cervix to release better quality mucus. Better, in this case, meaning a healthier environment for sperm. This is important, because after ovulation, the egg dies off rather quickly. Thick "egg white" cervical fluid allows sperm to live 3 - 5 days, so it can be ready and waiting when ovulation occurs.

Essentially, the gooier and more lubricative the fluid is, the better an environment it is. For most women, their mucus varies from nothing (dry or damp vagina), to dry and sticky, to creamy (like lotion), to egg white (which is often stretchy). The best days to have sex if you are trying to conceive are those when you have egg white mucus. If you're trying to avoid pregnancy, you should avoid having unprotected sex when your mucus is creamy or egg white. And even if you aren't having any sex, you should know that it's normal for your vaginal discharge to change quite substantially.

Cervical mucus can be detected before you've ovulated, so in that sense, it's more predictive than waking temperature. However, it has its own difficulties. It generally takes a few cycles to get a good sense of the different mucus qualities — the first time around, the difference between "creamy" and "sticky" is mostly guesswork, especially for women who have a small quantity of mucus.

The other difficulty is that your body can both over and under signal. One symptom of my irregular cycle was that I would have my mucus quality increase and then drop repeatedly without a temperature shift. Thus, while higher quality mucus was still a good signal of when it would be good to have sex to increase the odds of pregnancy, it was not a good sign of ovulation. On the other hand, while ovulation would always occur after my peak mucus quality, sometimes my peak was at creamy, not egg white.

Cervical position

In addition the releasing mucus, your cervix changes position in preparation for pregnancy. As you approach ovulation, your cervix goes from firm to soft, low in your vagina to high, closed to open, and non-wet to wet (because of mucus). If you can actually reach your cervix and tell from feel alone the difference between the two states, you can use this as another signal to correlate with cervical mucus. If you have ambiguous mucus, like me, this can be valuable, because there are only two states to distinguish. However, it also takes a lot of practice, and after several cycles, I did not feel like my observations were very reliable.

Conclusion

Tracking your primary fertility signals is incredibly valuable if you want to understand what your body is doing. It is also reassuring. When I would go for 50 - 100 days between periods, it helped to know whether or not I had ovulated yet, and once I finally did ovulate, to know when I would have my period. It's also empowering to realize that your body is not just some random, unpredictable thing. You can understand it and its cycles.

Primary source: Taking Charge of Your Fertility by Toni Weschler

The menstrual cycle

If I've learned nothing else in my various debates about abortion, it's that many people have absolutely no idea where babies come from, beyond the sperm plus egg basics. At the extremes are people who say that birth control pills work by causing abortions, but many who are not spreading misinformation — whether pro-choice or pro-life — seem to have at best a shaky understanding of fertility.

So, since it's important to anyone wanting to achieve pregnancy and interesting to anyone who cares about reproduction at all, I want to give a bit more background on a woman's reproductive cycle.

The menstrual cycle can be divided into two parts: the part before ovulation and the part after. Pregnancy can only be achieved for in the 3 to 5 days preceding and including the day of ovulation (more on that later). Once ovulation has occurred without the egg being fertilized, pregnancy cannot occur.

But that's jumping ahead of ourselves. First, a hormone called Follicle Stimulating Hormone (FSH) causes some eggs to mature in each ovary. Eggs are encased on follicles, hence the name of the hormone. Once one follicle is large enough, your estrogen levels trigger the release of Luteinizing Hormone (LH), which causes the winning egg to be released. The rest disintegrate.

The egg that makes it moves into the fallopian tubes, which connect the ovaries to the uterus[1]. The follicle which formerly held the egg collapses and starts to release another hormone, progesterone. Progesterone prevents other eggs from being released and prepares the uterus for pregnancy (although sometimes more than one egg is released, which, if fertilized, results in fraternal twins). The 12 - 16 after ovulation are called the luteal phase after the corpus luteum, the name for the collapsed follicle.

If fertilization does not occur, the egg dies, and eventually the uterus disintegrates, resulting in your period. However, if it is fertilized, after about a week, it will implant in the uterus. Although numbers are hard to get, ultrasound studies indicate that 50% (or more) of fertilized eggs fail to implant[2]. However, if the fertilized egg, now a multi-cell embryo, does implant, it will cause Human Chorionic Gonadotropin (HCG) to be released. This is the hormone that home pregnancy tests detect, hence why are not not effective until 10 days or more after ovulation — about a week for implantation plus several more details for hormone levels to build up enough to be detectable in your urine.

That's what's going on behind the scenes. In a later post, I'll explore the observable changes caused by all these hormones, which are valuable for a woman trying to achieve (and to a significant but lesser degree, avoid) pregnancy.

Primary source: Taking Charge of Your Fertility by Toni Weschler

[1] Interesting factoid: There is actually a gap between the ovaries and their respective fallopian tubes. This gap serves no purpose — in fact, if a fertilized egg falls into that gap, it can be fatal for the woman. This gap is taken as a bit of evidence in favor of evolution since it's useless but can be cleanly explained by looking at the fallopian tubes as an addition to a reproductive system that laid eggs directly in the water. From Why Evolution is True by Jerry Coyne.

[2] Libby Anne over at Love, Joy, Feminism has a post that discusses what this statistic means for those who think the pill is bad because it causes abortions: How I Lost Faith in the Pro-Life Movement

Review: Taking Charge of Your Fertility

Before trying to get pregnant, it seemed appropriate to learn more about how female fertility works. For that, I chose to read Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by Toni Weschler.

The first, and perhaps most important, thing to know about this book is that it is a book every woman should read. Whether you want to get pregnant or avoid pregnancy, whether you're taking birth control pills or attempting more manual methods of contraception, if you're a woman who cares about how her body actually works, you should read this book. (Note: I use "you" and "your" throughout this review because it's more conversational. I acknowledge that this may a bit awkward for any men reading this. Consider it an exercise in what it's like being in a situation whose "you" is not, in fact, you.)

It amazed me, when I started reading this book, how little I knew about my own fertility. While I think that birth control pills were the right contraceptive option for me during the years I wanted to avoid pregnancy — my ovulation cycle has always been much too irregular to depend on my physical signals — I am, in retrospect, sad that I spent a over a decade taking a drug without understanding the system it was regulating. Now that I am trying to become pregnant and having a hard time, I regret accepting the explanation from my doctor that the pill would "fix" my extremely irregular cycles. Yes, it suppressed the symptoms, but now that I actually want to get pregnant, I still have the same issues and no more knowledge of them than I did as a teen. (By the way, Weschler also wrote a book targeted at teens, which I haven't read.)

Now to the book itself. This book is centered around the Fertility Awareness Method. This can be seen as a natural birth control method or a technique for helping achieve pregnancy. I see it as a way to understand how your own body works. Part one discusses these different perspectives and encourages women to take charge of their own fertility. Part two contains background on a women's reproductive anatomy, menstrual cycle, primary fertility signs, and various types of irregular cycles. Parts three and four apply knowledge of the primary fertility signals to, respectively, birth control and pregnancy achievement. Part five discusses other practical benefits of charting your cycle, even if you don't care about the other two.

In subsequent posts, I'll cover some of the most important background for understanding the menstrual cycle.

As a final note, if avoiding pregnancy is absolutely vital for you, I cannot recommend the Fertility Awareness Method as a standalone method of birth control. Even if you're extremely regular normally, stress, sickness, alcohol, and other life factors can make your signals less reliable. But I still recommend reading the book.

Introduction

Welcome! Pregnancy is discussed in many blogs, forums, articles, books, and just about every other media type. So what makes this blog different? Mostly that it's mine =)

I wanted a place where I could talk about pregnancy as a emotional, physiological, and social issue. I am not going to be hesitant about expressing my opinions.  So if you expect "this week, baby is the size of an orange!", you'll get some of that, but you'll also get discussions of pregnancy and privilege.

The name of the blog is loosely based on neko koneko from the anime Azumanga Daioh and the it's-too-late-to-think game my friends and I call "I have a thing". 

One last note, the early posts in this blog are all backdated to approximately when I wrote them. For obvious reasons, I didn't want to start publishing the blog before we announced the pregnancy.