Commentary Maternity and Birthing

Just Have the Baby? A New Mom Reveals Why There Is No ‘Just,’ and Not Necessarily Any Justice Either

Natasha Chart

Just have the baby? Only if you want to. Because no one else can take on any of the pain or risk, and it's rare that you'll be helped significantly with the costs—something I think anyone capable of becoming pregnant understands all too well and that forced pregnancy activists work very hard not to acknowledge.

My husband and I just had a baby.

My first two trimesters weren’t easy (though they could have been worse), and then it got harder after I had my baby. So I have a lot more to say about the many reasons why this pregnancy has further revealed to me why it’s wrong and inhumane to make light of how difficult it is to “just have the baby,” as anti-choice extremists say everyone should have to do.

Two more months of decreasing mobility and shortness of breath weren’t the worst part by far.

On the less serious, but financially inconvenient, side, I’d started expanding past even the maternity clothes I bought early in pregnancy. By the end, none of my shoes fit over my swollen feet. It’s not a medical concern, but not everyone can readily afford to just turn over a wardrobe twice in less than a year, especially when there are all these exciting new expenses for baby clothes and supplies.

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Nearly a month after the birth, I still can’t fit into my pre-maternity clothes or bear to wear a real bra, and I’m really glad that I don’t have to show up anywhere looking professional for a little while yet. If I can’t be somewhere in an outfit that includes a nursing tank right now, I can’t be there.

There were also worries about gestational diabetes. Pregnancy can give a person temporary diabetes, and if it does, it elevates their risk of getting full adult-onset diabetes after the pregnancy. There are also risks to the developing fetus, including too-rapid growth before birth, an increased risk of diabetes throughout its life, or stillbirth.

The results of my first glucose tolerance test were high, so they wanted to do a follow-up. Since a three-hour glucose tolerance test after fasting seemed like a bad idea for a patient with a history of passing out during blood draws on an empty stomach, my doctor had me test myself four times a day at specific times and follow a meal plan for gestational diabetics so they could settle the question.

I turned out not to have gestational diabetes, but the exercise was a huge hassle. When was the last time you picked out your lunch based on how many servings of meat, starches, fats, vegetables, and fruit it contained? Would it be easy for you to take the time and find a clean, stable place to stick a needle in your finger and test your blood four times a day? Then I found out on a pharmacy trip that a pack of 25 test strips, which I was supposed to use at the rate of four a day, cost $138 without insurance.

I asked my doctor what real diabetics do when they don’t have health coverage. She said that if they survive at all, they usually end up on Medicaid. And, well, of course they would.

So here’s another risk to pregnancy: getting an expensive, chronic, permanent health condition that imposes daily hassles and can significantly decrease life expectancy if you can’t afford to manage it well.

I’m sure the last month of pregnancy would have been all kinds of interesting, but I wasn’t going to find out. Friday, May 24, I had a prenatal checkup where everything seemed fine and my doctor was unconcerned about the weekend train trip my husband and I were taking to New York City. Monday, May 27, at about 3 a.m., I suspected that my water had broken. The medical advice line directed me to go to the nearest hospital at once and not to try to get home to Washington, D.C.

The doctor in the labor and delivery triage unit doubted that my water had broken because I wasn’t dilated, but an ultrasound confirmed that there was practically no amniotic fluid left around the fetus. They told me that if I didn’t start labor they’d have to induce to prevent infection. They admitted me. I went into labor, and delivered my son about 26 hours after my water broke.

The hospital bill was over $24,000. The anesthesiologist’s bill for the epidural was over $9,000. The presiding obstetrician’s bill was around $4,500. Those are just the bills we’ve seen so far, and we’re lucky that our insurance is going to pick up the majority of it. I do not know the full range of what happens when you get a set of bills like that and you have no health coverage or little to no income, but it can’t possibly be good.

The baby came out face up, which makes for a difficult labor, and had a large head for a six-pound baby that came five weeks early. If someone had wanted me to show up at a job site that week, they would have been out of luck, and I might have been out of a job. Until last week I couldn’t even sit up on a chair without serious medication and I still feel bruised, because why wouldn’t I?

While there are some people who are up and about like nothing happened just days after a normal vaginal delivery, and some who have significant birth injuries, it usually takes about six weeks to recover from giving birth if everything goes well. Since there are millions of parents in the United States who can’t even get a day off for the flu, it’s not hard to figure out that birth itself causes a lot of immediate job loss.

To the other option, a nurse I was talking with over the weekend said it took her a month to recover from her c-section to the point where she could even lift her ten-pound son after he was born. They didn’t make the incision large enough, so they still had to vacuum the baby out and she lost two liters of blood in the process. She said she wasn’t back to full strength yet, even though it’s been over a year.

That’s not something I had to go through, but it’s a good reminder that it’s offensive to talk about having a c-section as if it weren’t major abdominal surgery. Like other kinds of surgery, some people recover quickly and well, but some people don’t. It’s monstrous to expect an exceptionally quick healing response from everyone after getting their abdomen cut open and sewn up.

To say “Just have the baby” is to say “Just risk a prolonged illness, surgery, and the loss of your income when you have a lot of new expenses.” It’s to tell someone casually that they should sign up for the possibility of experiencing more physical pain and agony than they thought a person could live through, and maybe having a great deal of it continue for days, weeks, months, possibly even years.

The reason I was talking to a nurse was because I’ve been in and out of the neonatal intensive care unit (NICU) of the local children’s hospital since Friday. This is my son’s third stay in a NICU since he was born.

My son spent his first night of life in the NICU because he had a breathing problem at birth, though that corrected itself very quickly. When he was four days old, he was back in a NICU room for intensive phototherapy to treat his jaundice and he stayed for three days. Then early last Friday morning, we noticed a little blood in his diaper and were told to bring him in to urgent care the next morning. Because a serious bowel infection couldn’t be ruled out from his x-rays, they took him off any food by mouth and started him on an intense antimicrobial cocktail that was continued until yesterday, though they might have kept him on it for as long as ten days.

His first NICU stay cost over $1,000 a day. Our insurance will again pick up most of the tab, which is why we didn’t hesitate to bring our little boy to a doctor at the first signs of trouble, signs we might have talked ourselves into downplaying if we were worried about making our rent or affording food next month.

I remember reading the story of a little boy who died of a tooth infection right here in D.C. years ago, because his family didn’t have dental insurance and they waited what ended up being too long to seek treatment. Having lost molars because I couldn’t afford a dentist’s visit at the right time myself, I understand the calculation, it just worked out better for me.

It’s not about knowing whether something is wrong. It’s about living in a household that has a hard time affording things like diapers and second-guessing yourself about whether the situation is really as urgent as you thought. It’s just that babies and young children can get so sick, so fast, that hesitation can be even more dangerous than for adults.

And if a family can’t get good medical care when they do seek treatment, then they may end up with a child who has an expensive long-term health condition.

On Sunday, when we told the cab driver that we were going to Children’s National, he told us that he’d spent a lot of time there recently. Then he launched into the story of the birth of his twin daughters. He said that, as a new immigrant at the time, his wife ended up delivering at a teaching hospital eight years ago. The first girl came with her umbilical cord around her neck, her skin dark from the lack of oxygen. The doctor handed her to a room full of students, none of whom knew how to resuscitate a newborn, to continue attending the birth. It was ten minutes before someone came and revived her, from which she’s suffered lifelong brain damage. He said he tries not to compare her to her healthy sister, but it’s hard, and he wishes he’d sued the hospital to cover her therapy.

We should get to take our baby home tomorrow. Whatever was wrong, and they can’t know for sure because it didn’t get bad enough to need surgery, it seems to have gotten better.

The one- and two-pound preemies in his ward aren’t going home for a long time yet, not until after they’ve topped five pounds, at least. Many of them have been there well past the point when a working-age adult can afford to sleep near them every night in the rooms’ torturous reclining chairs.

The very tiny preemies’ parents visit when they can, leave them things from home that might be comforting, touch them if they’re able. Some of the smaller babies are too weak to feed very fast, too sick to try to feed, or too susceptible to infection for anyone to be allowed to put a bare hand on them.

It’s a visit to a special kind of hell when you must listen to your baby scream when they insert an IV or draw blood, and not to be able to make it stop, or to be terrified that you’ll dislodge that IV when you hold them, starting another round of heartbreaking cries. It’s horrid to perhaps not be allowed to directly feed or pick them up because they’re too ill, and you, and everybody really, knows that they desperately want to be fed or picked up.

That can be part of parenting, too, one of the risks you take on: that a pregnancy doesn’t mean you’re going home with a healthy baby. And after three nights on the recliner in my son’s room, my own not-quite-healed body just gave out and started hurting like it was two weeks ago all over again. So I’m at home for a break, trying to get better and rest, while missing our little boy so much that I can’t really relax.

To say “Just have the baby” is to tell someone they should just casually take on what can be an experience where you’re thrust into both love at first sight and devastating fear, anguish, and possibly heartbreak in a very short period of time. A time, no less, when you may be at the very end of your physical and emotional endurance.

There’s no “just” about having a baby. And not necessarily any justice, either.

None of the babies in the NICU has done anything to anyone in their short lives that could justify what they go through being there every day. Every NICU nurse we’ve met is kind, gentle, and even loving to their tiny patients. But they still have to put them through painful medical procedures, and they can’t make up for a baby’s need to be held and to bond with the people who’ll take care of them as they grow up.

Just have the baby? Only if you want to. Because no one else can take on any of the pain or risk, and it’s rare that you’ll be helped significantly with the costs—something I think anyone capable of becoming pregnant understands all too well and that forced pregnancy activists work very hard not to acknowledge.

Update, June 28: We did finally get our baby home, where he’s proceeded to eat as though he’s been starving his whole life. Anyway, he seems to be in working order once again.

My husband was also able to stay in the hospital every night with the baby, even when I couldn’t, so he always had a parent nearby, and brought him home when I was hurting too much to want to get in a car. He was able to do that because when he told his employer last Friday that the doctors thought the baby might need a week-long hospitalization, they offered him another week of paid leave on top of the four he was just finishing up. Most families in the United States aren’t nearly so lucky, as this country is the only industrialized nation (and one of only four nations in the entire world) that doesn’t mandate paid maternity leave, and forget leave for dad. Too many fathers in the United States are discouraged from taking leave if it’s even offered.

We got the complete bill in the mail yesterday for the baby’s first three-night NICU stay, and it topped $23,000. He was there six nights this time, with more tests performed and more complicated treatments administered.

News Politics

Clinton Campaign Announces Tim Kaine as Pick for Vice President

Ally Boguhn

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

The Clinton campaign announced Friday that Sen. Tim Kaine (R-VA) has been selected to join Hillary Clinton’s ticket as her vice presidential candidate.

“I’m thrilled to announce my running mate, @TimKaine, a man who’s devoted his life to fighting for others,” said Clinton in a tweet.

“.@TimKaine is a relentless optimist who believes no problem is unsolvable if you put in the work to solve it,” she added.

The prospect of Kaine’s selection has been criticized by some progressives due to his stances on issues including abortion as well as bank and trade regulation.

Kaine signed two letters this week calling for the regulations on banks to be eased, according to a Wednesday report published by the Huffington Post, thereby ”setting himself up as a figure willing to do battle with the progressive wing of the party.”

Charles Chamberlain, executive director of the progressive political action committee Democracy for America, told the New York Times that Kaine’s selection “could be disastrous for our efforts to defeat Donald Trump in the fall” given the senator’s apparent support of the Trans-Pacific Partnership (TPP). Just before Clinton’s campaign made the official announcement that Kaine had been selected, the senator praised the TPP during an interview with the Intercept, though he signaled he had ultimately not decided how he would vote on the matter.

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Kaine’s record on reproductive rights has also generated controversy as news began to circulate that he was being considered to join Clinton’s ticket. Though Kaine recently argued in favor of providing Planned Parenthood with access to funding to fight the Zika virus and signed on as a co-sponsor of the Women’s Health Protection Act—which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services—he has also been vocal about his personal opposition to abortion.

In a June interview on NBC’s Meet the Press, Kaine told host Chuck Todd he was “personally” opposed to abortion. He went on, however, to affirm that he still believed “not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm. They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As Rewire has previously reported, though Kaine may have a 100 percent rating for his time in the Senate from Planned Parenthood Action Fund, the campaign website for his 2005 run for governor of Virginia promised he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

As governor, Kaine did support some existing restrictions on abortion, including Virginia’s parental consent law and a so-called informed consent law. He also signed a 2009 measure that created “Choose Life” license plates in the state, and gave a percentage of the proceeds to a crisis pregnancy network.

Regardless of Clinton’s vice president pick, the “center of gravity in the Democratic Party has shifted in a bold, populist, progressive direction,” said Stephanie Taylor, co-founder of the Progressive Change Campaign Committee, in an emailed statement. “It’s now more important than ever that Hillary Clinton run an aggressive campaign on core economic ideas like expanding Social Security, debt-free college, Wall Street reform, and yes, stopping the TPP. It’s the best way to unite the Democratic Party, and stop Republicans from winning over swing voters on bread-and-butter issues.”

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.