Pregnant over 40: Weeks Eight through Eleven

Week Eight

I was walking through a picturesque park surrounded by glassy inlets of calm lake water, some still with remnants of ice cast over the surface.  Dozens of people were kayaking and I was eager to join them.  I walked on a narrow strip of grassy land toward a clubhouse like structure about five hundred yards away.  Just then, I ran into a friend from high school. We exchanged hugs and caught up on small talk.  I cut it short, explaining that I was just going to rush to the restroom and then join everyone else kayaking.  I ran over to the clubhouse and found the bathroom after a couple of wrong turns down a few narrow hallways.  I finally sat down to relieve myself and...then...WOKE UP about a second into the process of peeing my pants (thankfully our master bathroom is only a couple of steps from the bed or this morning could have been - ahem - unpleasant.)  Behold the power of pregnancy dreams, people!  Now that I'm in Week Eight, disrupted sleep is already a prominent symptom.  To compensate, I've been making a diligent effort to move my bedtime (and my son's!) up by almost an hour. 

I've had cravings for dairy products, especially yogurt, which I'm happy to oblige.  Fetuses are efficient, and if baby needs calcium, I'd rather suffer a little indigestion to consume it than have it taken from my bones or other stores.  I've had mild aversions to meat and chicken.  The first medical visit entailed a lengthy intake interview with a senior nurse practitioner at my OB/GYN's practice, as well as urine and blood sampling. 

The woman drawing my blood smiled "Oh! My daughter is pregnant.  She's coming in right after you."  A few moments later, a young woman stepped in with a mouthful of braces and the demeanor of someone who just left their study group to donate plasma.  Her coyness and shyness reminded me of a key truth - it is difficult to be on either side of a bell curve.  Women who give birth in their late teens and early twenties are greeted with their own set of assumptions - whereas, people just assume a woman my age postponed kids for a career and then paid up for expensive IVF; people assume that the youngest mothers were irresponsible, unprepared.  Her face didn't wear any of the marks of age, but nor did it wear of any of the benefits - the confidence, the security of knowing you have already faced down decades of adult challenges and experiences.  It seems to me that what many women learn most in their 20s and 30s is how to be an advocate for themselves  - their positions, their beliefs, their perspectives, their rights, their needs.  I'm grateful for the practice, as so much of parenting is about being an advocate for your child. 

Sample Day of Eating:  First Trimester

MEAL ONE:  7 AM

1 cup of raw oatmeal with 1 cup of almond milk, 1/2 cup blueberries or blackberries, and 1 tsp honey

MEAL TWO:  9 AM

3-5 mini "Blondie Muffins" from the Tone it Up Nutrition Plan.  One serving is 3 mini muffins.  I find that my appetite is stronger during the morning, so I gently enhance my portion if needed.

MEAL THREE:  12 PM

4 turkey meatballs and a kale salad with cucumber, chickpeas, sliced almonds, and homemade citrus dressing (orange juice + honey + lemon).  Here is a great recipe for turkey meatballs! For some reason, meatballs have still been appealing to me, even when a lot of other foods - like steak or grilled chicken - have not.   I also like to add a single serving of dark chocolate here.  It's a nice way to score extra magnesium and keep my sweet tooth at bay in advance of the afternoon slump.

MEAL FOUR:  3 PM
 
Dried fruit - prunes, apricots, and apple slices. 

MEAL FIVE: 7 PM

This is always the most challenging meal of my day because I generally go so long between lunch and dinner, mostly because of a lengthy commute.  I've started to carry a Larabar with me on the drive home, in case I need a little something around 5 PM.  That way, I'm not ravenous (or plagued with horrible morning sickness) when I walk through the door.  Lately, my morning sickness has been hitting me hardest in the evenings, so I've been skipping "real" dinners in favor of protein smoothies.  I try to include all of the food groups into the smoothie:  flaxseed for healthy fats, banana and berries for fruits, almond milk with calcium as a "dairy" product, frozen spinach for veggies, and protein powder for protein. 

Week Nine:  Dealing With Migraine Within Pregnancy

Let's talk about migraine during pregnancy.  I've been a lifelong migraine sufferer, part of a genetic legacy that stretches back to my great-great-maternal grandmother.  My migraine profile is as follows:  (a) I get them rarely, a few times per year; (b) My triggers seem to include a trifecta of hormone levels, barometric pressure, sleep disruption and stress; (c) I am part of a very small group of migraine sufferers who have both visual and auditory disturbances during migraine aura (for me, I see what appear to be two-inch sparkling "tadpoles" of light that swim through my entire field of vision at a distance of about twenty-four inches in front of my body and...well...I hear voices.  Not the schizophrenic or "scary movie" kind of voices, but more like a muffled television playing several rooms away down a hallway) (d) I tend to get extreme head and neck pain during the experience, as well as vomiting; and (e) I experience a pronounced prodome as well, which basically means that for about 24-48 hours after a migraine episode, I don't even know what year it is.  If any of this sounds like something you wouldn't mind experiencing during pregnancy, well, you're made of pretty hearty stock. 

The good news is that my migraine occurrences tend to decrease during pregnancy, which is common for a lot of women.  The bad news is that "decrease" does not mean "zero."  So, as I entered my ninth week of pregnancy, a combination of stressful news (e.g. a massive mistake made by my mortgage company resulted in them deducting my mortgage payment FOUR TIMES over two weeks and a dear childhood friend passed away after a long struggle due to a stroke); barometric pressure changes (the temperature this morning was "one degree;") and hormones (week nine correlates with peaking HcG hormone levels) led to one miserable night.  Acetaminophen ("Tylenol") is regarded as safe during pregnancy, but frequent doses have been correlated (that does not mean they CAUSE) minor cognitive delays in female offspring.  For this reason, I have no qualms taking it, but I definitely test the limits of human suffering a bit before doing so.  During pregnancy, my rule is that medication should be treated as a last resort and used judiciously. 

Being pregnant, options were limited, but I eventually found relief through the following: (a) a 15mg dose of my son's liquid Tylenol; (b) an ice pack; and (c) deep breathing exercises and mantras.  It goes without saying that my nutrition and exercise were completely messed up over the weekend.  I'm restoring my body today with a ginger, pineapple and veggie smoothie and banana/peanut butter flatbread. 

First Ultrasound

Week Nine brought the first ultrasound and meaningful interaction directly with my OB/GYN.  There were a couple of noteworthy discussions that took place because of the fact that I am over forty.  First, he spent a little bit of time emphasizing that for many women over forty, conception is not as difficult as pregnancy maintenance.  However, before I could balk at the statistics, he reminded me that the risk of not carrying to term is pretty high even for most twenty-year-olds (let's say the risk evolves from 20% chance to 30% chance over the course of your twenties and thirties).  As so many women know firsthand, pregnancy loss is so much more common than our utter lack of cultural vocabulary for it would imply. 

However, once a heartbeat is detected and normal fetal development confirmed at eight to nine weeks, the risk drops to 5%.  Those are odds that I will take!  I noted that he was much more forthright about the risk of loss than he was the first time, and I think that stemmed not from his concerns, but from those of his typical over-40 patients.  It's the elephant in the room and he gets it out of the way quickly.  He was also more forthright about genetic testing, and spoke in more detail about the difference between NIST and more invasive (but informative) tests like amniocentesis.  Again, I never felt that he had specific concerns about my pregnancy, just that (again) genetic testing is another elephant in the room for the over-40 crowd and he addresses it up front and with candor.   He mentioned that many doctors will recommend baby aspirin to over-40 patients, as a preventative measure against preclampsia.  Since I had no history of preclampsia with my last pregnancy, he said that he would not require the baby aspirin at this time. 

For those who are curious, I am opting to have an extensive panel of the MaterniT21 test by Natera performed in two weeks (the genomic panel instead of the standard panel).  If this test is returned without abnormalities and fetal development continues to appear normal via ultrasound, I will abstain from amniocentesis. 

Amniocentesis is a wonderful procedure and provides genuine diagnosis (as opposed to just a "screening test,") as well as information about possible infections or fetal lung development. However, it's not without risks, so I am not willing to undergo the procedure unless a factor other than my age dictates its necessity.  The challenge with the approach that I've chosen is that, if amniocentesis appears necessary, I have to wait longer to have it (i.e. the length of time for the screening tests to be completed, plus scheduling). 

This appointment was really special, because I walked away with my first picture of my baby!  He or she measured at exactly nine weeks and three days. 

Ten Weeks:  Exploring Maternity Benefits

This week, I took time to sit down with the Benefits Administrator at my company.    Frankly, I have very mixed feelings after that meeting.  First of all, I work for an extremely ethical company that strives very hard to provide excellent benefits and competitive salaries to its employees.  I feel very grateful for these efforts.  Moreover, I view my workplace as being fairly progressive.  We go to considerable lengths to ensure that women and minorities are not just given employment opportunities, but leadership opportunities.  So, it came as a surprise to be disappointed after a review of the company's maternity leave, short term disability and FMLA leave policies.  Basically, for 30 days after delivery, I receive my full salary via short term disability.  After that 30 days is up, I am eligible for another six weeks of paid leave after a vaginal delivery or eight weeks of paid leave after a C-section.  The catch is that these latter weeks are covered at only 66% of my present salary. 

About two years ago, our family made the decision to have my partner stay at home with our son and focus on continuing his education (key to a mid-career shift).  If he was working, we would be able to offset these costs with relative ease.  However, that is not our present reality.  My current salary is well budgeted, but with two cars, (public) preschool, two phones, a mortgage, two sets of moderate student loans, two sets of moderate consumer debt, and regular contributions to retirement investments, we often cut it pretty darn close each month.  We are not living frivolously at all.  My debt to income ratio is generally regarded as healthy and hovers around 25% total.  We also didn't get here by overspending (at least not in the materialistic sense.)  We got here largely because modern life is exceedingly overpriced for value in many arenas.  For example, over the last few years, we often paid more for quality part time child care and preschool than for the mortgage on our 1252 sq.ft. home ($994 versus $887 for those who are curious.)

Taking a 33% reduction in salary at this point seems like a monumental undertaking.  Added to this is the fact that even the best health insurance available through my employer covers only 80% of labor and delivery costs.  That sounds pretty good, but since this is my second child, I know all too well that medical interventions related to labor and delivery can easily escalate to $20,000.00, twenty percent of which is four thousand dollars.  You could have a pretty fantastic vacation to Hawaii for four thousand dollars.  If you are on a budget, like my family, four thousand dollars represents the emergency fund that you are always trying desperately to maintain, or meaningful updates to our most significant asset (our appliances are all in their "twilight years" and this could replace each of them.)  Instead, this money is essentially being thrown out a window for our insurers to gather up from the front yard.  If I felt that this money was going directly to the amazing people that provide my medical care, I wouldn't have such cynicism.  In reality, we all know that a significant portion is simply lost to administration. 

For the privilege of giving birth to both of my children in a hospital setting, I expect to pay approximately eight thousand dollars out of pocket.  Had I invested this eight thousand dollars with even a fairly low interest rate of 6% over 20 years, I would have had $25,657.08.   Even eight thousand dollars on its own would do well to fund anything from a semester of online education or about three weeks of conservative living in the South of France.  I've spent too much time as a corporate attorney not to be miffed at this lost opportunity cost. 

Considering that many middle class families struggle to save even modest emergency funds (e.g. $500 - $1000.00), this could be a catastrophic expense that could move a family into credit card debt, personal loans or delinquency.  Without cash on hand, where else would the money come from?  Thankfully, I already know that payment plans can be established with most reputable hospitals to offset the jarring nature of waking up on the same day with both a new baby and new four-figure debt.  

The most disappointing fact is that it is an absolute privilege for me to even whine about this online.  I am exceedingly fortunate to have both gainful employment and the means to acquire excellent health insurance through my employer.  Millions of Americans do not have the privilege of either of those things.  One of my friends gave birth to her son in 2003 without the benefit of insurance.  Her uncomplicated, unmedicated vaginal birth cost her approximately $10,000 out of pocket back then.  In 1978, Good Housekeeping concluded the average cost of childbirth was around $1500.  This inflation has hardly slowed down.  I suspect that if my friend gave birth today, the cost would be much closer to $15,000.  If the "Average American" brings home a salary of $55,000, that's about 27% of income.   Most people don't part with 27% of their annual income to put a down payment on a house!

When my partner and I discussed all of this last night, common refrains were "Maybe we should have the baby in Mexico where the costs of delivery will be cheaper!" and "The maternal health outcomes are probably be better there anyways" and (from my partner, who has a bit more candor than I do in most situations) "Fuck this country."  To be honest, I can't help but feel that any country that makes it this hard for middle class families to spend even three months with their newborn children deserves every single ounce of his ire and disgust. 

Eleven Weeks

While I may not look all that different (thanks to a couple of strategic wardrobe choices), I am still navigating a plethora of physical symptoms.  I'm grateful to keep food down, but continue to struggle with morning sickness for most of the day.  It is still worse in the evenings, so many nights "dinner" has just consisted of avocado on Triscuits or a smoothie.  Of all the cravings, I've been eating tabbouleh by the bucket.  Go figure!  Out of curiosity, I looked up the nutritional profile of tabbouleh, and discovered that it is actually a fantastic food during pregnancy.  Parsley contains twice as much iron as spinach, as well as a lot of vitamin C, vitamin A, manganese, calcium and potassium.   Cucumbers are not just refreshing, but a fantastic source of B vitamins, as is lemon juice.  The addition of olive oil even provides heart-healthy fats.   We have an amazing Lebanese or Middle Eastern restaurant on every other block here in Metro-Detroit,  so I shouldn't run out of this superfood anytime soon. 

This week, I've also been greeted with a crazy symptom of pregnancy that I was definitely not expecting:  my complexion has reverted to that of a tragically unlucky fourteen year old.  I usually don't have any blemishes at all.  This morning I counted nine.  Since many effective treatments for these kinds of issues are prohibited or questionable (e.g. retinol products, benzoyl peroxide, and saliciylic acids), I'm facing this down with a little bit of humor, Dr. Gross Alpha Hydroxy Peels, St. Ives Apricot Scrub and Micellar Water.  I've also been doing a clay mask a couple of times per week. 

Due to the general fatigue and malaise that is so common as the First Trimester comes to a close, I've struggled to work out lately.  Instead of weight training, I've focused on just walking or riding our stationary bike every day for 20 minutes.  My weight has actually remained fairly steady for the last couple of weeks.  I seem to be one of those women who gain a lot right out of the gate and then level off as the Second Trimester approaches.  I have a feeling that will change soon, so I made sure to pick up a couple of additional maternity items - a cute dress, pair of leggins and shirt ($14 each at H&M.)

Tomorrow will be a big day:  I will have blood drawn for the MaterniT21 genomic panel.  It can be terribly nerve wracking to consider whether the test will reveal chromosomal abnormalities, so instead I'm focusing on an ancillary benefit of having the tests performed:  They reveal gender!  We should know whether this little Seamonkey is a boy or girl weeks earlier than if revealed by an ultrasound (although I'll be having one of those tomorrow as well!)