How Many? Update

DH saw my "How Many?" entry on the blog and decided to cross post it as a Daily Kos diary. He thought someone over there might have more information on how many women end pregnancies for medical reasons per year. (Thanks, DH!)

So far, there have been a couple comments worth passing on:

First, my condolences for your loss. I know it is a deep grief and I'm glad to know that there is a support group for people who have made this difficult decision. My stats are completely anecdotal as a person working in an OBGYN department at an academic hospital. I ran a quick report on the CPT codes our residents use when indicating that they have performed an induced abortion for medical reasons and came up with 66 for the past year. Our hospital has about 2300 deliveries per year, so that's about 3%. Keeping in mind that we are a smaller, rural area, I don't think the 6% figure you used would be far off the mark. I know that we have a full time genetics counselor who meets with families to discuss their options and that she sees about 20 patients per week.

And also:

A 2004 study by the Guttmacher Institute shows that 12% of women report terminating because of maternal health problems and 14% report terminating because of potential problems with the health of the fetus:

http://www.guttmacher.org/...

These findings are based on self-report and include a wider array of fetal and maternal "indications" than most health restriction laws (proposed and actual) would allow: debilitating morning sickness, preclampsia, use of illicit drugs during early pregnancy (which leads to concern that fetal health has been compromised). But, unfortunately, there aren't many good stats out there about the % of abortions that started as planned or wanted pregnancies ....

So, the 78,000 terminations for medical reasons estimate I came up with doesn't seem incredibly outlandish. Depending on what gets counted, it might even be on the low side.

How big is 78,000? Well, I looked up the latest government data tracking death estimates for cancer. In 2007, breast cancer is expected to take the lives of 40,000 women. Leukemia will likely kill 22,000, while 12,000 will succumb to brain cancer. All those cancer deaths combined are still less than my estimate of the number of pregnancy terminations for medical reasons.

Once again, WHY is nobody talking about this?

How Many?

In the early days after my loss, I joined an online support group for women who have ended a pregnancy for medical reasons. When I joined it the site was a little over a year old, and had perhaps a couple hundred members. Recently there was a sad milestone there when the 600th member joined.

The fact the site counts its members got me thinking about abortion statistics for people like me. It has always bothered me that nobody seems interested in quantifying how many people are making devastating choices regarding wanted pregnancies. If people generally don't want to talk about infertility and pregnancy loss, then the thing they most don't want to talk about within that arena of topics is termination for medical reasons. People get so, so judgy and uncomfortable about everything to do with this subject.

Yet even without any official stats, my experience online has shown me that what I initially thought was a heartbreaking fluke of an experience must not be nearly as uncommon as I thought. The stories I've heard are all different, yet eerily the same. We were overjoyed at the pregnancy, but then a grave problem was discovered. And we all did what we thought was best to deal with that unfixable tragedy after that. Second trimester procedures are unfairly represented as the last refuge of disorganized floozies who get their pregnancy dates mixed up. ("Whoops! It's December and I forgot to get that abortion two months ago!") This characterization is a huge injustice to the women caught in the crisis of trying to decide what to do when severe health issues come to light in the second trimester.

I for one would like the choice I made to be counted for what it is. And I would like to know how many other people went through that same choice. I think that number would be a very powerful picture of the true state of pregnancy in the US today. Because if six hundred people have found their way to a support website via word of mouth in the past couple years, I have to guess that this is just the tip of the iceberg, in terms of what is happening in both the US and world at large. If abortion numbers for poor prenatal diagnoses and maternal health problems were available, then people might begin to apply the risk of this to themselves. They might start talking about it in real terms, rather than cartoonish black and white scenarios.

So, back to the original question: How many of us are there who have done this? Today all I can do is make a really rough guess. The most commonly cited stat for all types of abortions occurring in the US is 1.3 million per year. Of those, I have seen statistics that report around six percent of abortions are due to a medical factor either in the mother or baby.

Six percent of 1.3 million is 78,000. Seventy-eight thousand times a year a woman opts to end a pregnancy due to some sort of medical reason. Holy crap, that's a ton of women! Why are people not talking about this more?

Has anyone else seem stats on anything related to this? If so, I'd love to see them ...

Preschool!

Big Changes! This week Big A made the switch from in-home daycare to preschool three days a week. Some related observations:

1) Peer pressure is good. Big A has always equated pig tails with a heinous method of torture, so her hair is almost never done up. But once she saw the other girls wearing their hair pulled back, suddenly she was willing to sit still while I combed, braided, and barretted to my heart's content. Is there anything cuter than a 3 year old in pigtails? I'm in mommy heaven.

2) Peer pressure is bad. Every day as we leave school, Big A tries to slide down the banister (of DOOM!) on the long outdoor staircase that leads to the parking area. When I tell her no, she whines "But other kids are doing it!" It is the first time ever she's used that argument with me to get what she wants. Unfortunately, I suspect it won't be the last ...

3) When I asked her teacher if Big A was shy on her first day, the woman snorted and said "God, no!" So, I guess BA hasn't morphed into a wallflower, despite the newness of everything.

4) H&M rocks. Seriously, Target-esque prices but their children's clothing is just so much cuter than bargain basement.

I just wish I could pull off the adult H&M clothes. I saw a coat that seemed tasteful and not too Forever 21 on the rack, and so I tried it on during Big A's shopping spree. Imagine my surprise when I found Jerri Blank reflected in the mirror:



Yikes!

Awkward in the Neighborhood

I was volunteering recently in the local park, pulling ivy from long-neglected paths, when I ran into a woman from one street down. My neighbor gazed at Little A, who was waving her arms and bah-bah-bah-ing in the stroller while Big A spun circles around us.

"She's almost eight months old," I said, even though the woman had not asked the question I was answering. I tried to look her in the eye, but she stared at her feet and then left a few minutes later.

I don't need to be told how old her children are. Her daughter is just a few months older than Big A. Her son is just a few months older than my baby with trisomy 18 would have been, if the baby had been born on time. This neighbor and I were pregnant at the same time in 2005. We'd casually exchanged pregnancy info that fall at a block party, both of us innocent and hopeful about what lay in store for us at that moment in time.

The next time I met her was Halloween, 2006. She stood at my door, costumed baby and older daughter happily clamoring for candy. I was home alone, too ill to go out trick or treating with DH and Big A. Little A's pregnancy was kicking my ass. It was the beginning of the third trimester and I was round as a pumpkin -- exhausted, haggard, obviously pregnant.

I had not seen this neighbor in awhile. Yet I assumed she'd heard about my dead baby. It was ten months since the loss and I was no longer guarded when I ran into people on the street. Nobody offered condolences or stared at me anymore.

"Where is your little one?" The neighbor asked lightly.

I froze. God, she didn't know about the dead baby. The only words that sprang to mind were completely inappropriate to say in front of her kids. Like, can't you COUNT? If I'm very pregnant this Oct. AND was pregnant last Oct., how could that be, unless I'd lost the first baby? Are you an IDIOT?

"Oh ... Big A is out with her father trick or treating," I finally stammered.

"Yes, we just saw them. But where is the BABY?" she asked again, clearly not catching my drift.

What the fuck? Do I just look fat? Or does she think this is some kind of a costume -- tired suburban pregnant lady is now a character you dress up as?! Exasperated, I pointed at my belly. "I'm not due until January," I said firmly.

It was too dark to see if she blushed, but she finally got it. She thanked me quickly for the candy and hurried away. I leaned against the door, bowl of M&Ms propped up on my belly, feeling a whole new level of bad that night. In fact, I think that I switched off the porch light and stopped giving out candy after that.

I wonder if she'll ever actually be able to look me in the eye again?

Done, Part 2

This weekend SIL brought the nieces down to our house for a sleepover. Despite the fact everyone is mega tired today, it's always fun to gather the girls together. Between the two of us, SIL and I birthed four kids in three years. And that is just the successful pregnancies, as SIL miscarried once and I ended one pregnancy for medical reasons in those same years. Needless to say, SIL and I have been in the same phase of life: gestating, lactating, and trying to juggle a little bit of work with a whole lot of nose and butt wiping for the under-three set. So we usually can understand what the other one is feeling.

I told SIL how strange and sad it is for me to be done with having children. She sympathized, but when I asked her if she thought she would like another baby too, she looked horrified. Adding a second kid had really kicked her ass, she said. She hadn't expected how difficult the juggling would be, and since her first kid was easy going, she'd been shocked to learn how different the baby stage can be when you have a more demanding baby. All in all, it was a bumpy family adjustment after the second birth.

The good news is that now that niece #2 is 18 months old, life is much better for SIL. She likes that the girls are older and a smidge less dependent on a moment-to-moment basis. And she loves that she is now back to work three full days a week, in a job she enjoys, with the kids in preschool/daycare part time.

"If I had another I think I would lose myself," she said. "So I'm definitely done."

All of this made a lot of sense to me, and also jolted me out of my "no more babies" funk a little bit. It is good to be reminded of the positive things that come with being done. It's good to see SIL clearing out her old spit-up-upon clothes and trading up for modern styles that -- GASP -- sometimes might actually not be wash and wear!

Of course, I'm a long way off from being able to wear nonsensible clothing. Little A spits up if she's even in the same room as a dry-clean-only tag. But, someday I'll get there. And it'll be nice.

Done

While I harbor definite neatnik tendencies, having two children requires a laser-focused diligence to keep the clothing, toys, and paraphernalia down to manageable levels. The baby stage is especially difficult to remain uncluttered in, because the little buggers outgrow things so rapidly that every corner of the house tends to store something recently indispensable but now obsolete. This wouldn't be a big deal if baby items were small and cute, or if I lived in a mcmansion the size of Walmart. But the gear tends to be over sized and designed by the same people responsible for casino carpets. And we are keeping it real here in Oakland, living in a tiny two-bedroom 1950s-era house that doesn't have space for extra crap.

In the past few months I have been reasonably good about dragging unused items down to the basement and garage, but quite bad about getting them completely out of the house. At first I chalked it up to lack of time -- going to Goodwill with a carload of boxes is a pain when you've got two kids to cart along. But the other day a friend said she was trying to conceive again, and I know that in her first pregnancy most of her maternity clothes were borrowed from a sister who took back her things when she recently got pregnant again herself. So here is an obvious situation where my friend could use some free maternity clothes, and hey, I've got boxes of them in the basement. While I'm at it, I should also give her the infant stuff Little A has outgrown so far. Yet in the basement everything remains. I just haven't been able to utter the words, "come pick them up" yet.

So, I guess the clutter in the basement is about lack of time, but not in the way I originally thought. I'm just not ready to let go of pregnancy and babydom. Not yet. I only just started down this path in life three and a half years ago, and now I'm done. How did that happen?

With Big A, when I finished a big stage all the related physical items that went with the era got carefully packed away. Sure, I might have felt a little misty at how fast she grew while I did it, but there wasn't anything truly sad about putting stuff away. I knew pregnancy and infant care were cycles I'd loop through again in the future. That bouncy seat was still needed someday. So were those stretchy pants. Saving everything was an affirmation of the dream of a bigger family. Saving things was fun.

But now every time a onesie is outgrown or the baby loses interest in a toy, it just reminds me that there is absolutely no need to keep those things. There will be no more babies for us, ever. Saving things under these circumstances is stupid, and yet that's what I've been doing.

Probably we would have stopped at two kids even if pursuing the second one hadn't turned into such hell. We are out of bedrooms in the house and out of money for raising more. But the fact that my uterus ruptured in Little A's pregnancy just makes accepting this more difficult. Because there isn't a choice anymore. We were told by several doctors and too many nurses to count that my rupturing at home was an amazing case of bad luck/good luck: Terrible for it to actually occur, but freakishly fortunate that Little A wasn't brain damaged from lack of oxygen, and that I didn't bleed to death. In light of that, it's just too dangerous to ever try again. In fact, DH got a vasectomy recently. Because we knew that if we accidentally got pregnant, we would want to try to keep the baby. All rational reasons regarding safety and fairness to "The As" (who deserve to keep a mom) would go out the window in a real pregnancy situation. So best to avoid all chance of it ever happening, we decided.

Oh, the heart is a greedy, irrational thing. It always wants more.

Twinkle twinkle, little shoes

I have always been a sensible shoes kind of lady. Not only because I lived halfway up one of the innumerable hills of San Francisco for nearly nine years and wearing dainty spike heals there could send you sliding off a curb to your death (though that certainly bolstered my tastes). It's just that I've always had a finicky arch on my left foot, and wearing any sort of fancy shoe tends to give me chronic foot cramps. So I ended up with a closet full of trail sandals, hiking boots, and walking shoes. The few dress shoes I own are decidedly boring.

Which is why I can't believe that I just bought a pair of fancy shoes that I am excited about. It all started when I went to Nordstrom Rack to hunt kid clothes. These Via Spiga shoes called to me from the shelf across from the children's section. They are flats, but not dowdy. They make my ankles look skinny, and are so, so pretty. I was uncharacteristically smitten. And when I tried them on they actually felt comfy!


The only problem was that Nordstrom Rack only had one pair, and while they were my size, one of the rhinestones was missing from one shoe. But I couldn't stop thinking about those stupid shoes. They were twinkly toe stars. I am still in a state of post-baby body pudge, and so clothing doesn't do much for me these days, in terms of making me feel happy to get dressed. These shoes did, though. So last night I broke down and looked them up online. They are quite possibly the most money I have ever spent on a pair of shoes, and given that I now work part time out of the house AND hardly ever have the cash or a babysitter for a night out, it seems absolutely ridiculous to have them. But I just couldn't resist.

Ahhh, retail therapy. And I guess I can always wear them to the supermarket.