Health writer investigates a new role: fatherhood
by Michael Schroeder
I knew my wife was pregnant even before she took the test and I knew she was having a boy. I can’t explain my certainty on the latter. But my more-than-a hunch feeling had everything to do with Mary’s familiar symptoms, not the least of which were nausea and food aversion.
A year later, I am distracted by computer wallpaper of our 3-month-old gazing intently at jellyfish from his stroller, a photo taken on his first trip to the zoo. As a new dad, I'm already fulfilling a parental cliché, finding it hard to remember what life was like before Luke.
Mary and I were able to conceive without any problems, but many couples aren't so fortunate. About 9 percent of the population face fertility problems and in recent decades a growing number of people have sought fertility treatments, says Dr. David Adamson, past president of American Society for Reproductive Medicine. Only recently during the recession has the trend leveled off. He cites many reasons for the increase, including improvements in technology and social acceptability, but the rising age of first-time parents also plays a role.
Multiple births have become more common as more couples turn to fertility treatments. A majority see twins as the most desirable outcome, but with multiples the chances of complications for mom and baby increase, Adamson says.
The case of Nadya Suleman, "Octomom," who had octuplets in January after in vitro fertilization, brought the issue to the fore, but doctors have all but labeled it a freak incident. Even without the prospect of multiples, though, some uncertainty is the norm for pregnancy.
The right doctor is key
Mary’s first pregnancy ended in miscarriage after three months, a registered heartbeat and an all-clear first-trimester ultrasound — a painful conclusion to a promising beginning. Estimates vary widely on how many pregnancies end in miscarriage, from one in 10 to half, including those in which the woman didn’t know she was pregnant. As in our case, doctors generally don’t know the cause.
Much to our amazement and relief, Mary got pregnant again about a month after the miscarriage. On prenatal visits with Mary, I found her ob-gyn thoughtful, focused and hands-on. She firmly urged Mary to get a flu shot and on the dark day when we learned her first pregnancy was over, she hugged my wife and advised us with considerable compassion. Needless to say, we were hanging on her every word and nervous during Mary's pregnancy with Luke — which was mercifully uncomplicated.
Getting ready to expect?
Quitting drinking, smoking and recreational drugs are pretty standard preconception tips doctors give.
Dr. F. Sessions Cole, chief medical officer for St. Louis Children's Hospital, also recommends women control their weight — since being overweight can predispose babies to problems such as diabetes.
Some other tips:
• Start taking vitamins with at least 400 mcg of folic acid. "These are important to a healthy pregnancy and baby, and should be taken at least two months before conception," Cole says.
• Talk with your doctor about getting off birth control. "I ask my patients to have two normal cycles before trying to conceive," says Dr. Beth Pantuso Williams, ob-gyn at the Women's Health Center of Lebanon in Palmyra, Pa. "This helps us track ovulation and accurately date your pregnancy."
• See the dentist, Cole advises. Advanced gum disease can lead to pregnancy-related high blood pressure and possibly premature birth.
• Check your immunity to rubella, chickenpox and influenza. "Twenty percent of women lose their immunity to rubella and need to be revaccinated," Williams says. "Rubella can cross the placenta and harm the unborn child."
— Jackie Norris
When picking an ob-gyn, Dr. Donna Block, a highly rated ob-gyn who founded Clinic Sofia in Edina, Minn., recommends selecting one who is board certified. To earn that distinction from the American Board of Obstetrics & Gynecology, doctors must pass a written and oral exam testing their skills, knowledge and ability to treat different conditions.
"Almost as important, it should be someone you feel connected with and can talk to," Block says.
Red flags? Phone calls that aren't returned, lab reports that aren't relayed. Accessibility during off-hours is another consideration, she says. Most doctors' groups have someone qualified to answer questions at all times, such as a nurse, and doctors on-call for more involved problems.
Mary and I never talked about involving a midwife or doula in the pregnancy or afterward but a growing number are. Certified nurse-midwives and certified midwives attended 7.4 percent of U.S. births in 2006, according to the latest National Center for Health Statistics data.
Most midwife-attended births occur in the hospital with just 1 percent taking place at home. Home births have drawn criticism from some medical organizations, which contend hospitals and qualified birthing centers are safest for labor, birth and recovery.
Unlike midwives, doulas aren't medical providers and they don't deliver babies. Most specialize in either birth or postpartum, providing support during labor and delivery and helping new parents in the first few weeks after birth.
Sorting through the choices
As the months passed, Mary’s stack of pregnancy and baby books piled higher next to our bed. So much to consider, so much to decide. Mary chose to breast-feed, joining an increasing number of young mothers doing it — at least initially.
“There are many, many, many studied benefits for the baby and for the Mom, primarily disease prevention,” says Dr. Sheela Geraghty, a pediatrician and medical director of the Cincinnati Children’s Center for Breastfeeding Medicine.
Babies who are fed breastmilk are better equipped to fend off disease than those fed formula, breast-feeding helps Mom bond with baby and breastmilk changes constantly to meet the baby’s needs, Geraghty says. But some women — because of a medical condition or medication they’re taking — simply can’t breast-feed. Geraghty notes, “We are very lucky that formula does exist” — as an alternative source of nutrition.
Another choice women face is whether to have an epidural or natural birth. The primary benefit of an epidural is, of course, pain control, Block says. This affords the woman time to rest and recuperate during labor and can lead to less angst for Dad and Mom. That's assuming Dad doesn't see the big needle (thankfully I didn't).
The epidural can cause bruising, a dip in blood pressure that can be addressed with medication, and nerve damage, Block says, though she emphasizes she isn't talking about severe damage or paralysis. Estimates on the chances of permanent damage vary but the most recent research indicates it's an unlikely proposition. Like so many pregnancy decisions, it's a touchy subject that elicits strong reactions.
C-sections are another. Dr. Hope Ricciotti, a Harvard Medical School professor and the vice chair for medical education at the A-rated Beth Israel Medical Center, a Harvard teaching hospital, says that less than 1 percent of her patients request a C-section. "But," Ricciotti adds, "it's certainly a growing trend."
She notes there isn't enough data to say whether vaginal birth or a primary C-section is riskier: "Right now, we don't know, so women get a choice." The catch is that doctors aren't bringing up the choice when there's no medical reason to do the procedure, because there's not enough data to demonstrate risk levels are the same either, she says.
They are, of course, talking to patients about it when they believe it's medically necessary. C-section critics say some doctors are too quick to advise this option, exercised in about one of three U.S. births, and cavalier in scheduling it for their convenience.
Mary was induced a couple days after her due date. She pushed for less than 30 minutes and the nurse actually had to tell her to break so the doctor could make it in on time. Then Luke arrived, glistening and pale bluish-white. He began crying, his milky blue eyes tiny saucers doused with tears. Seconds old and so alert — he couldn’t absorb enough of his new world.
These days, I find myself wondering what Luke's wondering when Mary and I stroll him around the neighborhood.
"There's loads of mystery still remaining," says Dr. Stanley I. Greenspan, a Bethesda, Md.-based child psychiatrist and an authority on early social development. Greenspan created six research-based developmental levels, or stages, of the mind.
"Emotion basically is at the heart of cognition and intelligence," he says. "Without it we wouldn't have the ability to think. In his first days, it's emotion that helps the baby coordinate sights and sounds."
Greenspan has done a great deal of research on autism and doesn't discount the role of biology in development. But he emphasizes the importance of playful parent-child interaction and I'm convinced that simply loving Luke will make him smarter.
This draws me back to an earlier conversation with my wife, when I asked her to describe her attachment to our son — an oxytocin-driven, biological bond unlike anything else I can imagine.
"The only other time I've felt anything like that was when I was falling in love with you," she tells me. Unprompted. Score 1 for Luke and me.