11 Things Never to Say to a Woman with Severe Morning Sickness

So there is morning sickness and then there is MORNING SICKNESS.  AKA Hyperemesis Gravidarum.  All-consuming, debilitating, depressing illness.  Make no mistake – they are not one and the same.

Typical morning sickness comes with some nausea, vomiting, and general not-feeling-well-ness.  Hyperemesis Gravidarum results in severe vomiting, dehydration, trips to doctors, depression in many cases, and pressure to take Zofran (anti-nausea medication for chemotherapy patients).

Neither are fun.

And due to a lack of real knowledge about either of these conditions, sufferers are subject to constant tips and tricks from well-meaning bystanders who may have no idea how serious this can be, especially in the case of Hyperemesis Gravidarum.

So based on my own experience, I’ve compiled a list of things NOT to say to women suffering from severe morning sickness.

1.  Try Saltines.  Unless the mother-to-be is lucky enough to only have a very mild case of morning sickness, Saltines do not work.  They do not help.  They do nothing but ensure that your next vomiting session includes the white salty goo that these turn into.

2.  Try Ginger.  Ginger does not work.  In my case, it makes me even more sick.  After investing in cases of ginger ale, ginger candy, and raw ginger, I quickly developed an aversion that led to nothing but waste.

3.  Try Sea Bands.  I really wanted these to work.  I really gave it a go.  Day in and day out with those little balls pressing into my wrists, leaving indentations and redness.  I will save you the suspense: they don’t work either.  Again, maybe for minor nausea, but for severe sickness – they do nada except mark up your wrists.

4.  Try Acupuncture.  I had high hopes for this.  Heck, if it is good enough for Fergie then it is good enough for me.  I went 4 times, and each time left as sick as I had arrived.  Once I even vomited on the way out.  Now, I will say that the acupuncturist and staff were extremely nice and caring – that was sweet – but as far as any actual relief, well, you know the story.  Did leave a dent in my wallet though.

5.  Try Hard Candies/Prenatal Pops/[Insert Other Consumable Product].  NOTHING like this works.  Nothing.  I have tried it all.  I did succeed in creating some new aversions for myself.  And in trying some new foods.  But none of it helped with the sickness.  And I was a bit offended that well-meaning advice givers were minimizing my all-consuming and debilitating illness to the point that a simple piece of candy or food could relieve it.

6.  It Will Only Last for 3 Months.  How the frick do YOU know????  That’s what I felt like saying every time.  There are certainly stories of poor pregnant mothers who are severely sick up to and even during delivery.  Even if the woman is lucky enough to find some relief after three months, how does three months of misery sound to you???  Imagine a hangover combined with food poisoning that doesn’t let up for THREE MONTHS.  My acupuncturist shared a true story with me: one of her newly-pregnant patients was suffering from some severe morning sickness.  Her not-so-compassionate hubby told her, ah don’t worry about it, it’s only for three months.  That same hubby woke up the next morning with a bout of food poisoning and, as men do, laid in bed all day whining and begging for help.  The wife, every so sweetly, told him “don’t worry Honey, it will only last for three months.”

7.  At Least it Lets Up in the Evenings.  For those living in the dark ages, “morning sickness” is a misnomer.  It does NOT only occur in the mornings.  Unfortunately some of us suffer all day and night.  I would literally wake up in the night to vomit.  When it is severe, there is NO period of relief.  So to imply to a pregnant woman that she has some hours of relief during the day can be completely false and once again minimize the misery she is going through.

8.  At Least You Will Feel Better Once You Vomit.  NOT TRUE!  If you are hungover and vomit, yes you will feel some relief.  If you have the stomach flu and vomit, again you will feel some temporary relief.  The sick joke that is morning sickness ensures that no matter how often or how violently you vomit, there is no temporary relief afterwards.  The nausea is still there as strong as before.  So all the vomiting does is make you tear up, bring up stomach acid, burn your throat, and make a mess.  The woman does not feel one ounce of relief afterwards.

9.  I/My Mother/My Sister/My Friend Never Experienced Morning Sickness.  Well whoopty-do for you.  That’s great.  Really, it is.  But it is not what I want to hear when I am doubled over and heaving into a toilet or sink.  Especially when it’s my 12th vomit of the day.

10.  Just Try Not to Think About It.  My usually-considerate husband had the audacity to mutter this to me one morning.  Lord help him.  You might as well just say “it’s all in your head.”  I promise you, it is not in my head.  I swear to you, if there was any way possible that I could focus on anything OTHER than being so ill, I would be the first one to do so.  Well-meaning advice givers, I can guarantee you, it is not in the mother’s head.  It is not a matter of simply not thinking about it.  It is a real and serious illness which has no cure and only questionable treatments.  Telling her not to think about it is simply ignorant and, frankly, not possible for her.  Do yourself a favor and keep this little tidbit to yourself.

11. [While in Mid-Vomit] Quick, Get Out of the Kitchen/Bathroom/[Fill in Location].  Newsflash: Once the vomiting has begun, it cannot be stopped.  You cannot simply move the woman to another room or away from the smell and expect the vomiting to stop.  That ship has sailed.  Instead, hold her hair, rub her back, comfort her, and help her clean up.  From experience, I can tell you that all you will accomplish by telling a vomiting pregnant woman to “quick – get out” is a pissed-off and exasperated monster who, if you’re not lucky, may decide to aim your way.

So what CAN you say to a woman who is going through the throes of morning sickness or, worse, Hyperemesis Gravidarum?  Nothing.  The key is not to talk.  Not to offer advice.  Just to listen.  Let her vent, let her cry, give her a hug, offer to lend her a helping hand, and check up on her often to see how she is doing.

No advice needed.

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Non-Invasive Prenatal Genetic Testing

Gotta love prenatal testing.  The timing, the blood draws, the more invasive tests, the waiting, and – finally – the sometimes vague results.

At the time that I was pregnant, I had three fetal testing options available to me: Quad Testing, Amniocentesis, and Chorionic Villus Sampling (CVS).  I go into the details of each in my Prenatal Testing post, and the reasons why I selected CVS.  Basically, it was more diagnostic than quad testing, and could be conducted sooner than an Amnio (between 10 and 13 weeks of pregnancy vs. between 14 and 20 weeks of pregnancy).  The one aspect of the CVS test that gave me pause was the fact that it did and does carry a small risk of miscarriage.  Ultimately we decided to move forward with it, but spent an anxiety-ridden few days in bed post-test, hoping and praying that no miscarriage would result.

So I am delighted to hear about the new non-invasive prenatal genetic tests now available to pregnant women.  Finally expectant mothers can be empowered with knowledge – without any risk of complication.  Ease of administration, decreased costs, and available timing make them even more attractive.

Tests like Sequenom Center’s MaterniT21 PLUS (T21) and Integrated Genetics’ Harmony are up to 99% effective at detecting Trisomy 21 (Down Syndrome), 18 (Edwards Syndrome), and 13 (Patau Syndrome).  Performed around 10 weeks gestational age or later, these tests require a simple blood draw to analyze cell-free DNA in maternal blood for extra chromosomes.  While not technically considered diagnostic tests, they come pretty darn close; and any positive results could subsequently be confirmed with a true diagnostic such as CVS or Amnio.

Test results are typically returned within about 2 weeks, and costs of the tests appear to range from about $0 – $400 out of pocket after insurance (still significantly cheaper than either CVS or Amino – I am hearing $235 as a common copay).  An added bonus?  The test will also provide gender confirmation.

So what are the limitations?  Well, both CVS and Amnio test for a much larger array of potential disorders – these new blood tests just focus on some of the more common.  Also, these tests do not screen for open neural tube defects (only an Amnio will do that).  Some doctors remain skeptical about these new tests, and I’m told that not all offices will offer them.

But for parents without known genetic issues, I think they offer a very viable alternative to more invasive methods.  Much more accurate than traditional quad testing, these tests finally provide women a safe and relatively inexpensive option to better understand potential fetal risks.  I am all for these tests and only wish they had been available when I was pregnant.

10 Myths of Pregnancy

I’m a conspiracy theorist.  Oh, I admit that I fully bought into the pregnancy propaganda sold by my mommy family and friends.  It was the best time of my life, they enthused.  I glowed!  I was treated like a queen!  My hair/skin/nails/[insert body part here] looked amazing!  I really miss it – I wish I were pregnant again.

I call BS.

Now that I’ve been through it, I’m convinced that other mothers purposely, deviously, upsell the virtues of pregnancy to encourage unsuspecting women like myself to take the plunge.  So that they don’t have to suffer alone.  Yes, I was duped.

Now don’t get me wrong – carrying a life is a beautiful, amazing thing.  To think that there is a baby growing inside of you, depending on you for its every need, is incredible.  It’s everything else that goes along with it that blows.

So I’ve compiled a list of the 10 biggest myths that I fell hook, line, and sinker for:

1. You will Glow.  There was absolutely no glowing going on with me.  I may have given off a greenish tint, due to my all-consuming morning sickness.  Or perhaps this “glowing” they speak of is code for the sticky, clammy sheen of sweat that coats your body pretty much the entire 3rd trimester.
2. You will have thick and luxurious hair.  I give them the “thick” part.  But mine was by no means “luxurious.”  It was thick, dry, frizzy, and out of control.  It was so thick I couldn’t do anything with it.  I wanted my regular old un-thick and un-luxurious hair back.
3. You may experience some morning sickness.  Understatement of the century.  See my other post.  ‘Nuff said.
4. Crackers will help with Morning Sickness.  Give it up already.  Nothing is helping.  Definitely not some dry crackers. 
5. You get to “Eat for Two.”  This was probably the aspect I was MOST looking forward to.  Finally!  I don’t have to watch what I eat and exercise like a maniac.  I get to let myself go.  The bigger the bump, the cuter the pregnant woman.  Again, this is a complete crock.  Come to find out, the baby only needs about 300 additional calories a day (and even then, not until later in the pregnancy).  What’s 300 calories!?  A granola bar?  A smoothie?  Gee.  Thanks.
6. You will receive special treatment.  Sometimes.  Sometimes not.  I distinctly recall a gentleman on the plane watching me struggle to lift my carry-on bag up into the overhead compartment.  I took it down and stood to catch my breath before trying again.  He walked over and I fully expected he was going to offer to help the struggling pregnant woman.  Instead, he took my rest break as his opportunity to shove his own duffel bag into the compartment (bumping me in the process). 
7. Your ankles may bloat towards the end of pregnancy.  Try your ENTIRE BODY.  Ankles on up.  And up.  Including the face.  I looked like I had stepped into one of those funhouse mirrors.  And don’t expect any jewelry to fit.  My rings all went on hiatus.  Even my watches were a tight fit.
8. You may have to empty your bladder more frequently.  Ladies, be prepared.  Once the 3rd trimester rolls around, you’re not going anywhere that doesn’t have a bathroom within a 10 step radius.  I literally had times at work that I would return to my desk from a restroom break, only to immediately stand up and head back.  I would plan my drives around distance and restroom breaks.  Even walking the dog became a test of “holding it.”  Don’t say I didn’t warn you.
9. You may be more tired than usual.  What they fail to mention is that you will become a temporary narcoleptic.  It will become a battle of sheer strength and willpower to get out of bed in the morning.  And yes, there WILL be times when you’re talking to friends or family and simply – doze off.  Don’t fight it.  You won’t win.
10. Pregnancy hormones may cause mood swings.  Um, YA THINK??  Expect to lose just about all control of your moods.  Things that would be minor annoyances pre-pregnancy suddenly turn into dramatic rage-filled wars.  Television commercials, magazines, even billboards – will throw you into a weeping tailspin.  From hysterics to fury to maniacal laughter, you will become an emotional mess.

The bright side is that, ultimately, pregnancy ends.  I know it doesn’t feel like it when you’ve got, say, 6 months to go and you’re an exhausted, vomiting, hormonal mess.  But it WILL end.  I found that chunking phases of pregnancy into days and weeks helped me get through the tough times (especially the first 4 months at which point I was just trying to get through each day).

And the prize is so so sweet.  I would do it all again, in a heartbeat, for my beautiful baby boy. 

(And I imagine that THIS is how mommies get suckered into #2…)

Prenatal Testing: Quad Screen vs. CVS vs. Amniocentesis

At some point during every older mother’s pregnancy journey comes the dreaded  Prenatal Testing.  This is when all the statistics and risks we hear about genetic, chromosomal, neural tube, and other disorders come to a head… to provide us a healthy dose of additional worry.

Given my age, I was definitely concerned about Down syndrome.  What I was too ignorant to be concerned about, until I was so informed by my doctors, were the host of other  potential problems that could occur – including the various trisomies, fragile x syndrom, neural tube defects, etc, etc.  I remember at one point sitting with a genetic counselor, 2-page list in hand, and skimming all the potential issues and my baby’s risk of having these issues.  Worse, the list was segregated by age group – so I could see that for the younger age group, wherein the risk of a particular disorder might be 1 in 2000, for me it might be 1 in 200.  Scary stuff.

Which is precisely why prenatal testing is so important.  My understanding is that younger mothers are typically tested using simple ultrasound and blood testing techniques (with more invasive measures offered only upon request and doctors’ agreement).  However, in my case, my Advanced Maternal Age prompted the doctors to provide me with 3 separate test options, all with their own pros and cons:

1. Quad Marker Screen:  Between the 15th and 20th weeks of pregnancy, this is a blood test performed to determine the levels of 4 substances within the amniotic fluid.  These levels are then analyzed to see if they fall within acceptable limits; if not, additional more invasive testing may be recommended.  The major pro of this approach is that there is no risk to the baby – it’s just a simple blood test.  The con is that results are not diagnostic; that is, they can only identify certain increased risks of an issue – which would be the signal for additional testing.  They are also not 100% accurate – e.g. not 100% of Down syndrome cases (I believe it’s somewhere around only 80%) can be predicted with this test.
2. Chorionic Villus Sampling (CVS):  Usually performed between the 10th and 13th weeks of pregnancy, this test uses an ultrasound to guide a thin catheter through the cervix or the abdomen to draw a sample of placental cells.  These cells are then tested to diagnose chromosomal or genetic disorders.  The pros of this approach are its levels of diagnostic accuracy (98-99%), the timing of potential diagnosis (very early in the pregnancy), the inclusion of DNA in the sample (allowing for paternity testing if desired), and the nice-to-have ability to determine the baby’s gender very early in the pregnancy.  The cons of this approach are the fact that it doesn’t identify neural tube defects, the elevated risk of miscarriage (somewhere around 1%), a risk of amniotic fluid leakage, and a risk of infection (as with any invasive procedure).
3. Amniocentesis:  Usually performed between the 14th and 20th weeks of pregnancy, this test uses an ultrasound to guide a thin needle through the abdomen to draw a sample of amniotic fluid.  This fluid is then tested to diagnose chromosomal, genetic, or neural tube defects.  The pros of this approach are its levels of diagnostic accuracy (over 99%), the inclusion of DNA in the sample (for paternity testing if desired), and the ability to determine the baby’s gender.  The cons of this approach are a small risk of miscarriage (less than 1%), a risk of infection (as with any invasive procedure), and a rare risk of injury to the baby or preterm labor.

So then comes decision time.  Do we want to go with the no-risk procedure, yet give up complete diagnostic ability?  Do we want to go with a more invasive procedure, yet introduce a risk of miscarriage?  If we do go with a more invasive procedure, do we want to do the more common “tried and true” amnio, or the newer CVS that will provide results weeks sooner?

Then comes the ethical debate… Would we consider terminating a pregnancy depending on the type of problem that was revealed?  If not, then why do anything but the least invasive test?

In the end, we decided to go with CVS testing.  Given our previous miscarriage along with the risk of miscarriage that this test would introduce, it wasn’t an easy decision.  But ultimately we liked the fact that we would know what we were dealing with sooner than later.  Also, we reasoned that the miscarriage risk would go down with an experienced doctor, so I sought out to find the best local one I could.

Fortunately, I was quickly pointed in the direction of a wonderful local doctor who had to date performed over 25,000 CVS procedures.  His success rates were high and past patients raved.  I checked out his error rates and was satisfied.

The first appointment is a genetic counseling session.  We are ushered into a little office with a genetic counselor who questions us and then basically draws out our family medical history on a piece of paper.  She reviews the 2-page RISK LIST, our eleveated risks due to maternal and paternal age, and finally discusses the CVS procedure in detail.  She concludes that we (I) are good candidates for the procedure with no glaring risk of fetal abnormality.  We schedule a date.  I will be 12 weeks pregnant at the time of the procedure.

The night before I’m really nervous.  Praying for no infection, leakage, or miscarriage.  Fortunately, work keeps my mind occupied (the silver lining of a stressful job)?  The procedure is scheduled for a Friday so I can do the required bed rest for 2 days. 

Once we arrive, we’re seen by an ultrasound technician.  The technology here is amazing!  MUCH better than the ultrasounds we have received at my local OB-GYN’s office.  We can see the little bean in 3D, jumping, moving.  He shows me his heart rate.  We hear the heart beating (and all the other noises in there – who knew how loud it was?  No wonder babies love the sound of vacuum cleaners).  He takes brain and other measurements and says that everything looks normal.  He sees that I am nervous.  Reassures.  Says this doctor is the best on the west coast.  It will be fine.

We are then led into a room tricked out with some sort of super-sonic ultrasound machine.  Since the procedure involves EITHER a transcervical or transabdomenal catheter, I ask which one I’m going to get.  The nurse says the doctor prefers transcervical (quicker, easier, less painful) so he will do that.  I agree but internally wish for the other method.  Somehow seems less invasive to me.

The doctor arrives.  Given the number of these procedures he performs, I am expecting a kinda “assembly-line” experience.  A detached persona.  To my surprise, it’s the complete opposite.  The doctor is cheerful, engaging.  Asks about our summer vacation plans.  Shares about his most recent trip, a family gathering in Texas.  Chats while he positions me appropriately (maybe this is part of the plan?  To keep our minds occupied?)  Tells me to BREATHE and RELAX.  That if I am not relaxed, I will start to contract, and that may impact his ability to draw a large enough sample.

The nurse turns on the ultrasound.  Again, I’m amazed at the level of detail.  At only 12 weeks!  The doctor prepares… something… I’m not really in the best position to see.  Then he begins to guide the catheter, watching the ultrasound monitor the whole time.  Relax, he says, breathe. 

He stops.  Okay, you’re starting to contract…  see?  Points to the monitor.  Now I only have this much space.  I giggle sheepishly, nervously.  Oh sorry.  I concentrate on deep breathing.  I know it’s not going to work.

He tries again.  Breathe, okay, just breathe.  Now it’s done.  I sit up.  He is looking at the sample.  I’m sorry, he says, it’s not enough.  We will have to go through the abdomen.

Wow – Two For The Price Of One!  I can barely contain my excitement. 

Belly cleansed.  Numbing shot.  Ouch.  Now the needle and catheter.  Don’t look, it makes it worse.  I can’t really see anyway, with my head positioned at a lower angle than the rest of my body.

I feel the pressure of the needle catheter.  He gently guides it up and down to get the sample.  Okay, done.  Good – great sample here.

I sit up as nurses start cleaning up.  Hubby looks shocked.  What?  He wants to know if it hurt.  Then he shares that he is certain he saw the baby on the ultrasound monitor looking towards the needle as it was poking around.  He says the baby’s face had been turned away but then rotated towards the needle and was watching as the sample was being taken. 

Next two days are uneventful.  Bed rest.  No pain.  Just watching watching watching for any bleeding, any sign of miscarriage.  Thank goodness… Nothing.  Start to relax.

We had paid extra for FISH results…  these are not full results, but high level preliminary results that look at a few of the most common chromosomes for issues.  These results would be provided within 72 working hours.  Full results would come about 2 weeks later.

Glad I paid extra for the faster results.  Next few days are excruciatingly slow.  Every time my cell phone rings I grab it to look at the number.  Finally, at the end of a Wednesday work day, I get The Call.

Everything looks great.  No issues with the preliminary results.  Final results will be completed in two weeks but assume that no news is good news – no call means everything looks normal.  Happy.  It appears that she is about to say good-bye and hang up.

Wait – I say.  What about gender?  Can’t you tell gender too?  She pauses, teasing.  Do you really want to know?  YES!  She pauses again, she likes this part of her job.  You’re having a baby boy.

A baby boy!  A healthy baby boy!  WOW.  I can’t believe it.  I’m so lucky!  Bursting.  Already thinking of special ways to tell my husband.

Two weeks comes and goes.  No call.  We’ve just gotten through the first anxiety-ridden phase of pregnancy.  We are happy with our testing decision.

I have friends who have opted for both the Quad Screening and Amniocentesis testing options.  They are also happy with their decisions.  Those who opted for the Quad Screening were comfortable with the level of accuracy and in their philosophy that no matter what the results, it wouldn’t change the direction of the pregnancy (e.g. termination would not be considered), so why go through the risks of more invasive testing?

Those who opted for the Amniocentesis were more comfortable with the fact that it is a “tried and true” procedure (vs. the newer CVS procedure) with a lower risk of miscarriage and also the ability to conduct neural tube analysis. 

So there’s no right answer for everyone – simply what each family is comfortable with.  Ultimately the question you have to ask yourself is what level of diagnosis and procedure risk you would be comfortable with in order to maintain a stress-free (as much as possible) ongoing pregnancy. 

The one thing I did learn was to try not to put too much stock into “The Statistics” for my age.  A statistic is a statistic.  I had to keep reminding myself that even if I had a 1 in 100 chance of a problem, that still meant I had a 99 in 100 chance of that problem NOT occurring.  Regardless of the odds, if you happen to be the person who is 1 in 100 or 1 in 1000000, the statistics are meaningless.  All we can do is try to be as healthy as possible with a little luck thrown in.

California Maternity Leave

Right off the bat, I have to say that I find it deplorable that the U.S. has such poor policies for maternity leave accommodations relative to most other industrialized nations.  In the words of one of my foreign relatives, it is “barbaric” that Short Term Disability only pays a new mother 6 weeks for a regular delivery (8 weeks for c-section).  Compare that to up to 7-12 months PAID in many other countries, and it’s no wonder that many working mothers simply can’t fathom returning to their jobs so soon and, ultimately, don’t.

Fortunately, I live in California, where policies are marginally better.  In addition to Family Medical Leave Act (FMLA) protection, both hubby and I are eligible for additional job protection under the California Family Rights Act (CFRA).  That said, I am convinced that both legislators and companies make the acts as confusing as possible to encourage new parents to give up the headache and simply come back to work!

I am by no means an expert, but after much research and about 30 calls to my company’s Leave Department, I think I have enough of a grasp to help explain the benefits for my particular situation:

• Family Medical Leave Act (FMLA):  This is a federal act that allows for 12 weeks of unpaid job protection (both mother and father) following the birth of a child.  To be eligible, the parent must have worked at least 12 months and 1250 hours at their company, and the company must employ at least 50 employees.  The rub is that if both parents happen to work for the same company, they’re only entitled to a combined 12 weeks of protection (vs. 12 weeks each).
• California Pregnancy Disability Leave (PDL) & Short Term Disability (STD):  This is paid and assuming you take it post-birth, it will run in concurrence with FMLA, so will be job protected.  Only the mother is eligible in a childbirth scenario.  Typically, for a vaginal birth, the mother will receive 6 weeks of STD and/or CA PDL.  For a c-section, the mother will receive 8 weeks.  Payment depends on your company’s policies – in my case, my company pays 100% of my salary up to a certain number of weeks based on my tenure, and then 75% of my salary for weeks beyond that.  I believe that if your company is paying less than 100%, then that’s when CA PDL kicks in to cover the rest.  Note that CA PDL also allows for up to 4 weeks prior to birth at a benefit amount of up to 55% of your weekly salary (capped at somewhere around $1000/week).  However, this pre-birth leave is NOT job-protected and some companies (including my own) will not allow you to take it.
• California Family Rights Act (CFRA):  This is unpaid leave that provides 12 weeks of of job protection in a rolling 12 month period for mother and father.  This runs in concurrence with FMLA but begins after STD ends (for the mother).  This means that if the mother opts to take the full leave under both FMLA and CFRA immediately after the birth of her child, that her CFRA protection will begin once she is released from Short Term Disability, and will subsequently out-run her FMLA job-protection benefit.  Confusing, I know.
• California Paid Family Leave (PFL):  This allows for up to 6 weeks of paid benefit for both mother and father (assuming both take advantage).  You get paid up to 55% of your weekly salary amount, with a cap of somewhere around $1000/week.  This leave is NOT job protected, but can be taken in conjunction with CFRA/FMLA to ensure job protection.

Clear as mud??  I found that the most important thing in trying to clarify the best plan for us was to first identify our top priority – Time or Income.  Were we looking to take the longest job-protected leaves possible, regardless of income during that time?  Or was income during our leaves the larger concern?  In our case, we chose time, so the following illustrates a rough example of how we were able to maximize our job-protected leaves:

1. Prior to baby’s due date, I took 1 week of Paid Time Off (required by the company as a “waiting period” for Short Term Disability).  Please note that many California companies will allow you to take advantage of up to 4 weeks of California PDL prior to the baby’s due date, paid at up to 55% (capped) of your weekly salary.  By “allow you,” I mean “job-protect you.”  Mine unfortunately was one that would not.
2. After baby’s birth, I received 6 weeks of Short Term Disability for a vaginal delivery.  Additionally, the FMLA job protection clock started ticking the day the baby was born.  Hubby concurrently took 3 weeks of company-paid time off upon the baby’s birth.
3. Once I was released from Short Term Disability at 6 weeks postpartum, the clock began ticking under CFRA (if you’re keeping count, I’m now 6 weeks into my 12 weeks of FMLA job protection; now an additional 12 weeks of CFRA is running concurrently with my remaining 6 weeks of FMLA).  In addition, I received 6 weeks of payment under California PFL (up to 6 weeks of payment at 55% of my salary – capped at about $1000/week). 
4. Once my California PFL benefit ran out after 6 weeks, I began my final 6 weeks of UNPAID job-protection under CFRA.  My full FMLA benefit of 12 weeks has now run out so I am only protected under CFRA for the remaining 6 weeks.
5. Once I have exhausted all job protection, I will use 2.5 weeks of accrued Paid Time Off (PTO).  At the time that PTO begins, I am “reinstated” back at work and am no longer on leave.
6. Once I return to work, hubby will begin his 12 weeks of job-protected leave under CFRA.  Like me, his first 6 weeks will be partially paid at 55% of his salary (capped).  His final 6 weeks will be unpaid.

In a nutshell, this puts us both back to work when our baby is about 7.5 months old (exhausting all job protection and PTO).  That’s a total of about 5 months of leave and PTO for me, 3 months for hubby.  Of this time, we are receiving 6 weeks fully paid by STD/CA PDL, 3.5 weeks fully paid by PTO, 12 weeks partially paid (55% of salary) by CA PFL, and 12 weeks unpaid.

For those in California looking to maximize income during leaves, the plans would be different.  If you are looking to continue receiving full pay throughout your leave, you would rely on 6 weeks of STD/CA PDL after the birth of your child (8 weeks for c-section).  Beyond that, you would have to use company-paid PTO or vacation time.

If you decide to sacrifice some, but not all, income, you can take your 6-8 weeks of fully paid STD/CA PDL following by an additional 6 weeks of CA PFL paid at 55% of your salary.  The baby’s father could then also receive benefits for an additional 6 weeks of CA PFL.  This would put you at 18 weeks postpartum (assuming vaginal delivery) before taking into consideration any company-paid PTO or vacation time.

Bottom line is that our maternity accommodations here are dismal.  I can’t even imagine what it would be like in some states outside of California where the job-protected leave is limited to 12 weeks total under FMLA (all unpaid except for concurrent STD).  I think change can come, but it will be a long time coming.  In the meantime, do your homework and begin your leave plans well ahead of time to ensure a financial safety net as well as a full understanding of your rights and limitations.  Good luck!

Exercise During Pregnancy

I’m a runner.  Not the marathon runner I once was, but a runner nonetheless.  And I always just assumed that my running days would be temporarily over once I got pregnant.  I always hear of pregnant women being told to “take it easy.”  I always see pregnant women “eating for two.”  The good news is that isn’t fully true. 

The bad news is that things DO change.  Quite significantly towards the end of my pregnancy.  But I was able to continue my workouts up until 3 days before giving birth.  And, many days, these workouts were the only link to my pre-pregnancy self; the only activity that made me feel like ME again.  Hey, I’m all in support of becoming a vessel of life, but sometimes you just need a break from it.

I talked to my doctor about continuing workouts immediately upon becoming pregnant.  She was all for it.  She said to basically listen to my body, and not push the limits.  Now wasn’t the time to be shooting for personal records.  If I was tired, I was to stop vs. pushing through it.  I was to not elevate my heart rate too significantly.  A little sweat was fine; drenched and dripping was not.  So off I went, smug in the knowledge that I was going to gain a mere 20 pounds this pregnancy and spring right back into shape a week after giving birth. 

Fast forward  12 months… Well THAT was a humbling experience.  Not only did I not gain 20 pounds (it was 36), it is taking much much longer than expected to now take the weight off (6 yo-yo-ing pounds to go at 15 weeks postpartum). 

But back to pregnancy-time.  I admit I did give up my exercise routine altogether sometime around the end of the 1st month.  I was simply too sick to work out.  I guess the so-called silver lining of that is the fact that I was also too sick to eat.  So they canceled each other out? 

The second trimester comes along.  Still sick.  Then, somewhere around the 4th month of pregnancy, it begins to improve.  Slowly.  So I tentatively creep back into the gym one day, head hung, and suspiciously eye the Stairmaster.  It’s mocking me.  I step on it and begin a light workout (light as in 8 levels lower than my normal starting point).  I set an easy goal of 30 minutes, but achieve only 20.  But that’s okay – I did it!  And I didn’t vomit!  Good. 

Next day, I attack the Stairmaster again.  This time I do the entire 30 minutes, albeit at an even LOWER level.  That’s okay.  I didn’t vomit.  I didn’t even have the urge.  I feel extremely happy with myself.

Next comes the treadmill.  My nemesis.  I start to jog, again very slowly.  I’m doing it!  Shockingly, the jogging is easier than the Stairmaster.  I crank up the speed a bit.  I get into a comfortable rhythm.  I feel great.  The jog ends, I am sweaty (but not drenched), and I feel fabulous.  For the first time since becoming pregnant, I feel a trace of my old self.  Sweaty and satisfied after a good workout.  Endorphins.  I’m back!

After that, I stepped right back into my regular workout routine.  But with a few twists.  Every cardio workout was completed at a lower rate and lower intensity.  When I felt tired or lazy, I stopped.  It was quite liberating, actually.  We always train to push through those times and to simply listen to my body and give myself permission to stop was freeing.  I drank tons of water.  I took more days off than I normally would. 

I had to force myself to stop silently competing with everybody who stepped onto the treadmill or Stairmaster or spin cycle next to me.  I never realized what a motivator that silent competition was.  I wished that my “competitors” knew that I was usually much faster/stronger than this, that I was pregnant and that was why I was so slow.  I had to swallow it. 

I had to deal with my growing belly.  I had to modify my running gait so that it wouldn’t bounce as much.  My calves started to burn with the increasing weight.  I started to feel sharp twinges in my belly and pelvic area, and would have to stop as needed.  Reflux and heartburn were not my friend during these workouts.

I had one run where I felt extremely strong.  I ran much longer and faster than I probably should have – but I felt so great, I wanted to continue.  Afterwards, I was drenched.  And continued sweating.  And sweating.  And sweating up to two hours later.  I was really scared I had done some damage.  I promised myself at that point that going forward I would always stop well before the point of exhaustion…  and I did.  I didn’t experience that again for the remainder of my pregnancy.

Then along comes the third trimester.  My belly is huge.  My ankles are swollen.  I can drink gallons of water and still not quench my thirst.  But the running still helps me maintain my sanity.  I am going much much slower now.  I compensate by increasing the incline.  That makes my calves BURN BURN BURN but I rationalize that they’re going to be so strong and running is going to be so easy once I give birth (I was wrong, BTW). 

I get looks.  A few women commend me on staying fit for so long into my pregnancy.  A few give me dirty looks (what – am I expected to be holed up at home eating bon bons?)  Men are scared to look at all. 

Then – Sciatica.  This is no joke.  I can barely roll out of bed nor make it up the stairs, never mind RUN.  By this time, I am working from home so it is all I can muster to simply take the dog for a walk down to the end of the street.  I’m embarrassed by my limping.  It really hurts. 

But now, more than ever, when I’m miserable and just “over it,” is when I need my workouts.  Simply to feel sane.  The treadmill is out of the question now.  I try the Stairmaster and elliptical machines, and I can’t do those either.  The only thing that saves me is the cycle.  I love that I can multi-task (iPhone + cycle makes for a fun workout).  I read my pregnancy apps and ask my pregnancy forum questions while on that bike. 

So I begin cycling every day.  I ball up my towel and stick it behind the small of my back for better support.  I cycle, cycle, cycle.  Never mind that it takes me upwards of 10 minutes to waddle up the gym stairs and over to the cycle, as long as I can sit down and cycle and break a sweat, I feel good. 

Then the day before I go into labor arrives (although of course I don’t know it at the time).  I am MISERABLE.  Swollen, sore, in pain, and I swear I can feel a little head just pressing pressing pressing down into my pelvis.  Now I’m really over it.  I’m not hitting the gym anymore (even I am embarrassed now by my limp/waddle/wincing gait) but I want this baby out.  Doctor says MOVE.  So we go to the mall.  It must take 30 minutes just to walk INTO the mall.  But hubby is patient.  It’s not as embarrassing with him there.  We stop at pretty much every storefront for a rest break.  We linger at the food court for far too long.  Hubby keeps checking watch and tapping foot.  He helps me up.  We walk from one end to the other and now I am REALLY sore.  But hoping it helped.  I collapse into the car and don’t want to get out to go into the house.

Sure enough, 2:30am the following morning, labor begins.  And I will say, during labor, I am SO glad I had worked out.  I can’t imagine doing it without that “training” per se.  I had a pretty long labor (think: 24 hours with 3.5 hours of pushing) and I’m glad, at risk of a potential c-section, that I didn’t poop out.

So my advice is to continue the workouts.  Slow them down and stop when you’re not feeling it, but continue.  It’s no longer about maintaining a “girlish figure” but rather maintaining some semblance of self during the long and arduous pregnancy journey.  Ignore the looks, embrace the compliments.  Simply celebrate the wonderful expanding YOU.

First Trimester “Morning” Sickness

For me, the first trimester was a surreal time.  You find out you’re pregnant.  You begin the routine of doctor appointments, blood testing, ultrasounds, and prenatals.  You don’t quite believe it yet.  At first you feel completely normal.  You don’t believe that there is anything growing inside of you.  You stop drinking.  You stop eating sushi and sashimi.  But nothing else has really changed.  Until it suddenly does.

MORNING SICKNESS.  This is my single most vivid memory of the first trimester – in fact, the first 4 months.  Couple things.  First of all, it is not simple “nausea.”  Secondly, it does NOT only occur in the morning.  This is a tidal wave of all-consuming illness that lasts all day, all night, 24/7 for (at least for me) the first four months of pregnancy.  This is far worse than any stomach flu or hangover.  IT DOESN’T END for weeks and weeks.  Nothing helps it.  The psychological aspect of knowing there is no end in sight is almost as bad as the sickness itself. 

I tried everything.  Everything.  The wrist bands (nothing).  Ginger (nothing).  Belly Bars, Gummies, and Lollipops (nothing).  Crackers.  Which I was so sick of people telling me to eat – what, you think I haven’t tried this??  Let me save you the suspense.  Nothing helps.  If you’re one of the unlucky ones who has miserable morning sickness, there is simply nothing you can do.  Vomiting DOES NOT HELP (at least if you have the stomach flu or are hungover, it provides you temporary relief).  Certain smells will make it worse.  Foods and even water will make it worse.  Prenatals definitely make it worse.  Heck, even toothpaste made it worse.

I have vomited or nearly vomited at home, at work, at the gym, in the car, and on the bus (commuter bus to work).  In fact, workouts were stopped after the first month of pregnancy until after the 4th month of pregnancy when the sickness started to ease up.  There is nothing worse than being in a public place, or sitting on a bus, and concentrating with all your might – do not throw up, do not throw up, do not throw up.  I withdrew from my friends.  I stopped walking the dog.  I stopped eating.  I basically spent those first few months in bed, on my couch, or in my office chair.  I grew depressed.  The ongoing sickness begins to take over and overshadow everything else, and depression during this phase of pregnancy is very real.  I became ambivalent about the pregnancy.  I told myself this was it, never again.  I started to second-guess our decision.  Hubby felt helpless, unable to relieve me, and took over the household chores, etc.  Not a fun time for either of us.

A few things I did learn though:

• Prenatals: take them at night.  Don’t get me wrong, you will still feel sick all day, but the urge to vomit immediately after taking the prenatal will occur right before bed, in the comfort of your own home, vs. when you are rushing to get ready for work, driving to work, or sitting in your office.
• If it doesn’t smell good, get the heck out of there.  FAST.
• No big meals.  In fact, no real meals at all.  Small snacks all day long seemed to help me keep it down.
• Stop the workouts.  Second only to feeling like you have to throw up on a moving bus is having to run off of a Treadmill or Stairmaster to make it to the gym restroom on time.  A bit embarrassing to say the least.
• Sleep.  And then sleep some more.  Besides being simply exhausted, those hours will provide you a temporary reprieve.

And trust that it WILL end.  Maybe not for 4 months, maybe not for 6 months.  I’ve even heard stories of poor women who suffered all the way up until their babies were born.  But there IS an end in sight.  Just get through the next snack, the next meal, the next day.  Take care of yourself. 

And if you’re one of the lucky ones who has little to no nausea, ENJOY IT!  Round Two you may not be so lucky.

Take Two

So now we’re worried about maintaining a pregnancy.  We decide, given that we are now convinced that we are going to have issues, to try again immediately.  Well, “immediately” as in after the 1-month waiting period recommended by my doctor. 

Boom.  What do you know?  The first month we try we get pregnant.  Wow.  I expected more of a fight.  This time the reaction is cautious.  A tentative excitement.  We say things like “I won’t get excited until the 3 month mark” or “I won’t get excited until we can feel it move.” 

We go for the first appointments and ultrasound.  The doctors are now treating us with an extra sense of priority, I presume because of our age and previous loss.  We see the little bean on the screen.  Literally looks like a bean.  A jumping bean, bouncing all over the place.  We try not to get excited.

We go in for another ultrasound.  Then a third, then a fourth.  I’m told this is not typical.  The doctor is doing this to reassure us that yes, this pregnancy seems viable and the little bean is growing.  And growing.  Now we can make out limbs.  And it’s still jumping around all over the place.

My HCG levels rise normally.  In fact, they get pretty high.  We worry about twins.  But try not to get excited.

I’m terrified of losing another pregnancy.  I read somewhere that baby aspirin has helped some mothers maintain pregnancies.  One of hubby’s family members confirm that this worked for her.  I ask the doctor – she says, it can’t hurt, it may help, go for it.  So I begin taking 1 baby aspirin daily in addition to my prenatal.

Morning sickness doesn’t subside this time.  In fact, it becomes worse, all-encompassing.  Bittersweet.  I take this as a positive sign, having heard that the sicker you are, the “stronger” the pregnancy.  Of course, the flip side is I am utterly miserable.  Those pregnancy books, which spend a sentence or two describing “slight nausea in the morning” as a first trimester pregnancy symptom can SHOVE IT.  More on this later.

More blood tests, more ultrasounds.  We now decide “not to get excited” until after either an amnio or CVS testing.  I’ll describe this later.  Still haven’t shared with anyone besides my sister.

But every day, I become sicker.  My belly begins to swell.  My workouts change.  Everything starts changing.  And I know, that this time it’s happening.  Happy.

Let’s start at the beginning…

I decided that if I was going to write this blog, then I was going to be completely open and honest.  Why bother if I was going to hide parts of my experience?  Not everything has been roses and rainbows.  There has been heartache.  And I’ve swept that under the rug, kept it from most, and it got me to thinking…  Why?  Why are we as women societally pressured to hide our negative pregnancy or motherhood experiences?  Does it make us feel like we are lesser women?  Isn’t that when we need support the most?

My first pregnancy resulted in a miscarriage.  It feels strange to even type that.  It has been such a hush-hush topic for some resaon, I still don’t understand thoroughly why, yet it still seems foreign to share.

Anyway, we could never decide whether we wanted children.  Yeah, we reasoned it might be fun, but we loved our lives.  The freedom.  The financial flexibility to do what we want.  The travel.  The DINK (Dual Income No Kids) lifestyle.  Why ruin a good thing?

But then that biological clock started ticking.  Well no, I take that back.  MY clock didn’t start ticking, but others were winding my clock for me.  Don’t you want kids, they would ask.  Do you realize that at your age, you only have an X% chance of getting pregnant (I can’t remember what it was exactly, although I do remember it being dismal).  You’re missing out.  What?  You’re not a “kid person”?  It will change once you have your own.

So yes, it started to get to me.  WERE we missing out??  What about when we were older, wouldn’t we want adult children and grandchildren to share experiences with?  Could I even get pregnant in the first place?

So – I stopped taking the pill.  The pill that I had been on since 19 years old.  It didn’t mean we were making a decision, I reasoned.  It just meant my body would be “ready” IF we decided to go for it.  Oh and let me tell you, my body didn’t adjust too well to being off the hormone it had been on for years.  Hot flashes, sweats, mood swings, bloating, horrible menstrual cramping, acne, you name it.  Yes I know.  I had heard all those things about losing 10 pounds once I got off the pill too.  Nope, not me.  I gained.  If nothing else, I figured this was a good cleansing exercise for my body.

Months went by.  We continued living our DINK lifestyle.  And the “should we have kids” debate somewhat faded from the front of our minds.

December 2010.  We are on vacation in South America (a wonderful trip to Peru and Chile).  We’re in the taxi shuttling us from Lima to the airport to begin the second leg of our journey.  I’m reading a travel brochure in the backseat.  Suddenly it hits.  A wave of nausea so strong I have to momentarily hold my breath.  Put the brochure back on the seat; guess I shouldn’t read while driving.  The nausea continues.  Waves and waves.  I stare out the window at the dirt roads and dilapidated buildings and concentrate concentrate on the horizon.  Not working!  OMG I’m going to throw up in this cab!  Glance at hubby in earnest.  He’s oblivious.  Swallow down a bit of reflux.  FINALLY.  We’re at the airport.

Fast forward 6 hours.  We’re at dinner in Santiago.  A cute little Italian place.  I asked for someting carb-olicious and distinctly NOT South American to help settle my stomach.  I must have eaten something, caught a bug.  Not the first time this has happened on my travels.  Even the wine isn’t helping.  Dinner’s over and we’ve walked the plaza.  Can we go back to the hotel?  I want to sleep this off.

Two weeks later.  Back home.  This damn bug just isn’t going away.  I should be better by now.  Working at home.  Over lunch, run to the drugstore to pick up something to help (not sure what).  Walking the aisles.  See the pregnancy tests and also pick up a box of those in the event that we decide to start trying.

Home and still have some time left for lunch.  I pull out the pregnancy tests.  So weird it can tell by a stream of urine!  Read the directions.  There are 3 in the box.  I wanna try one!  To see how it works.  Awkwardly figure it out and then leave it on the toilet seat.

End of day.  Hubby will be home in an hour or so.  Walk back into the bathroom – oh yeah, the pregnancy test!  Pick it up.  Two lines.  I must have read it wrong, I thought one line meant you weren’t pregnant.  Huh.  Wait….  oh no….  wait…..  where are those damn instructions.  Read.  Read again.  Compare to the diagram.  WHAT WHAT WHAT.  Hands trembling.  Sweating.  TERROR.  Look in the mirror and I’m white.  No.  No.  NO way.

Call sister.  DO 2 LINES DEFINITELY MEAN….??  Let me send you a picture.  Are you sure??  The one line is a bit lighter.  Are you sure???  Okay good idea.  Hang on, I’ll do it again.  Five minutes later, oh no.  Oh no.  Why are you so excited!?!  I have to go.

Husband home.  Show him.  Assure him that maybe there is a mistake.  I will call the doctor and go in tomorrow.  Do not sleep the entire night.  Not a wink.  In to the doctors’ office.  Pee in a cup.  Yes, you’re a “little bit” pregnant.  What does that mean??  You’re not far along.

Next few nights are sleepless and spent trolling the web for any and all information pertaining to pregnancy.  We agree not to tell anyone else.  We aren’t ready.  Fear.  Didn’t think it would really happen.  Do we really want this??  We’re not ready.  We are not ready.

Next appointment.  I am going to take your HCG levels.  Go home and manically Google “HCG.”  Human Chorionic Gonadotrophin.  A hormone produced after conception by a developing embryo (and later produced by the placenta).  Okay.  Doctor calls a few days later.  Levels look good right now.  We’ll test again during your next appointment.

Start imagining a baby inside my belly.  Start wondering if it’s a boy or a girl.  Start discussing due date and leave plans.  Start listing out all the home renovations that need to be completed beforehand.  Start adding a new line item to the weekly budget for “Baby Savings.”  Start coming to terms with the fact that we’re going to be parents.  Fear turns into nervousness turns into jittery excitement.

Third appointment.  How are you feeling, she says.  Actually much better.  The nausea has almost totally gone away.  I’m lucky!  Good – let me take your HCG levels again.

Next day – Christmas Eve.  Doctor calls.  I think there is a lab error, she says.  Your HCG levels have dropped to 9.  What does that mean??  It means you’re not pregnant but I have never seen such a significant drop; it’s not really possible for it to drop so fast so quickly.  It might be a lab error.  We’ll test you again after the holiday.

Holidays are longest ever.  Am I pregnant or not?  Days spent Googling “HCG levels and miscarriage.”  It appears she is right.  It’s not normal for it to drop so quickly, even in the event of a miscarriage.  And look at all these stories about lab errors.  Must be a lab error.

Finally tested again and results back.  It was a lab error.  HCG levels are normal, on the low end but normal.  Relief.  Relief.  Wow – Maybe we really do want this baby?  Back to planning.

Next appointment and callback.  HCG levels are not increasing how we would like.  Let’s have you come in for an ultrasound.  Okay.  Ultrasound day.  It looks like the pregnancy is “not viable.”  What??  Why??  We don’t know why.  It is very common.  We can either see if you miscarry on your own or schedule for its removal.  I guess let’s schedule it.  If it’s not viable I don’t want to continue this.

I don’t believe it.  I see online so many stories of “not viable” pregnancies making it.  I am not bleeding.  I feel fine.  I keep taking my prenatals.

I am in the gym the next morning and break down (right out of the shower, no less).  I share what’s going on with my friend.  She is wonderful, encouraging.  Her husband is a fertility doctor.  She insists that I go see him to ease my mind.  He will do an ultrasound and give me his thoughts.  I feel bad, I say no, can you just have him look at my levels and see if they are normal?  Just go see him, she says.  It’s fine, I promise.  I get dressed and she is on the phone with his office telling them to fit me in that morning.

I go see him.  He and his staff are wonderful.  He does the ultrasound.  He confirms the pregnancy is not viable.  He explains why – gently and in detail so I can accept it.  On the way home from that visit, I begin bleeding.

My D&C is the next day.  After the visit with my friend’s husband, I am calmed.  I have accepted that there is no possibility this pregnancy will work out.  The procedure is uneventful.  I spend the next couple of days in a painkiller and tearful daze.  I ply my doctor with questions about future risk of miscarriage.  About 25%.  That still means I have a 75% chance of carrying a pregnancy to term.  I am told miscarriage is very, very common.

So why does nobody talk about it?  Why are we scared to share with each other?  Now that time has passed and I have done some reading, I realize that it IS common.  I would have loved to have truly felt that when we were experiencing it ourselves.  It’s hard for women.  I felt as if something was wrong with me.  I am so fortunate to be able to do so many things in my life, yet the one thing I am “supposed” to be able to do wasn’t working.  Am I defective?  Am I a “real woman”?  Why did this happen?  Because I exercised?  Because I drank in South America?  Because I ate salmon?  Or is because I was so scared?  Because I didn’t really think I wanted this when I first found out?  Is that why?  Are we being punished for those thoughts?  Guilt.  Regret.

The few people I shared it with didn’t really want to talk about it.  I get it.  What can they say?  Yet I wanted to talk.  Talked to husband, talked to sister.   And talked.  They grew tired of it.  Wished I could talk to others.

Doctor said we could try again.  Wait one month, then start trying.  Do we want to try?  What if this happens again?  What if we fail?  But the questions are different now.  There is an assumption that we actually DO want this.  We were terrified, then accepting, then excited.  My sister put it beautifully when she said that this was Nature’s wake-up call.  “You never knew if you wanted kids; you were scared when you got pregnant.  Now you realize you want this and you are ready.”

That is the blessing I will always take from this.  Round Two came along and there was no terror, no uncertainty, no regret.  Joy.  Tentative joy given our past experience, but joy nonetheless.