Wide variety of healthy and normal in pregnancy

I predicted a few weeks ago that by the time I would be 6-7 months along, I'd get comments from strangers wondering whether I'd have the baby any day now. Yes, I carry obviously, with each of my pregnancies, pretty much from the time I get a positive pregnancy test. No exaggeration, I actually had to unbutton my jeans when I was sitting down, for several days before I got my positive pregnancy test this time around (and I had no idea I was pregnant), and have been wearing maternity clothes since about 8 weeks along.

There's such a wide range of normal! I wish more mothers--and America in general--understood and accepted this. People seem to have a very narrow idea of what is normal, but people come in all shapes, heights, builds, weights, and more--why wouldn't there be such a wide variation in healthy pregnancies as well?

So long as both mom and baby are faring well, there's nothing wrong with a mom carrying so "small" that she's barely showing, nor anything wrong with a momma who gets asked if she's having twins every time she leaves the house (even if she's carrying a singleton). Let's don't undermine another mother's confidence by questioning whether her size/appearance is too big or too little (unless you happen to be her care provider).

Take my friend Christy and me, for example. In this pic from this weekend, Christy is nearly 37 weeks along with her 4th baby (that is to say, she could go into labor any time between now and a month from now), and I'm 23 weeks along with my 5th. We're both healthy and fine.

My friend Trebor is due with her 5th baby around 2 weeks after I'm due. Just wait until later in our pregnancies and the difference will be photo-worthy, I promise.

Sarah 22 weeks, Trebor 20 weeks

In summary, here is a list of things nobody should ever say to a pregnant woman:

If you think mom looks "too big":

• "Wow, you're huge!" (Does this sound like it could EVER be a good idea to say to a woman?)
• "You look like you're ready to pop!"
• "Are you sure there's only one in there?/Are you sure it's not twins/triplets?"
• "I hope you don't go into labor right here and now!"
• "Are you sure you're not due for 2 more months?" along with
• "There's no way you're going to make it to your due date, since you're so big now." (The mom might go early, on due date, or 2 weeks late. How she carries/looks is not a predictor or indicator of how long baby needs to gestate. You'll either have her worried that she'll end up with a premie or disappointed if she gets her hopes up that she won't go all the way to her due date but then goes "late.")
• "You had better not eat/drink that!" (This is sometimes said to a mom with a dessert or coffee in her hand. The observer has no idea what the rest of her diet looks like, not that it's any of their business.) 
• "Your baby is going to be HUGE!!!" (Even if the mom has successfully and healthfully delivered 10 and 11 pounders already, this is NOT what a mom wants to hear. It's not encouraging.)
• "How much weight have you gained?" (This is NEVER a good idea to ask a woman, unless you are her care provider.)

If you think mom looks "too small":

• "You're so tiny you don't even look pregnant!" (This one can be especially upsetting for a mother who has lost one or more babies in the past, who might be concerned whether this baby will grow to full term healthfully.)
• "Are you sure you're due that soon?" (No mom wants for people to imply that she needs several additional weeks/months to gestate, beyond the biological norm.)
• "You'll probably have a teeny tiny baby." (No mom wants for anyone to imply that she'll probably end up with a premie or sick baby.)
• "You should eat more." (No mom wants for random strangers to judge her diet. She might be eating the most healthful diet possible, and this is just the shape her body takes. Or she might be eating only junk. Either way, it's nobody's business but hers and her care provider's.)
• "How much weight have you gained?" (See above.)

Here are a few starters for acceptable things to say to a random pregnant woman:

• "You look great!"
• "How do you feel?"
• "Congratulations!"

Mommas, are/did you carry "large", "small," or in between? Did you receive any comments from people who thought you were carrying "too large" or "too small"? What affect did that have, if any? What positive things did people say about your pregnant appearance that encouraged you (or what do you wish had been said)?


**** UPDATE****

October 11, 2011

Remember how I told you that belly comparisons with my friend Trebor would be interesting over time? She's due two weeks behind me, with her 5th pregnancy this far along as well. She and our friend Eileen (3rd baby) share the same due date, and we three all have the same midwife. (This should be an interesting competition for who gets our midwife, and when. We're hoping we don't go into labor at the same time!)

L-R: me (Sarah) at 29 weeks; Trebor and Eileen at 27 weeks

************** UPDATE  Nov. 6, 2011 *************

Sarah at 33 weeks, Trebor at 31 weeks

Sarah at 33 weeks, Trebor at 31 weeks.

Can I say "I told you so" yet?

************ UPDATE December 1, 2011 *************

Same 3 mommies, same 3 bellies, a bit closer to due dates.

I'm on the far left. I'm 36.5 weeks along. Trebor and Eileen are both 34 weeks along. Yes, I'm aware that my belly is roughly 1.5 times the size of Eileen's and twice the size of Trebor's. You may also notice that Trebor and Eileen are a good 4 inches taller than me (I was wearing wedge heels; Trebor and Eileen were in flats).  When you're as short as I am, with a short torso, there's nowhere for baby to go but *out*.

Belly photo at 22 weeks

22 weeks along with our little boy and feeling pretty good. Yay for the middle trimester!

The Back-up Plan? Not so much.

I've heard so much about the homebirth spoof scene in The Backup Plan that I had to get it on Netflix DVD to see for myself. I knew it would be bad, and I was prepared for the fact that if homebirth appears in mainstream movies, it is almost universally made fun of. What I *wasn't* prepared for was the main character's sister's anti-child, anti-birth, anti-breastfeeding agenda.

In the first few minutes of the movie, J Lo's character explains how badly she wants a baby, but doesn't have her sister's support. Her sister has 4 kids and tries to talk J Lo out of having children. She says they "ruined her life" and destroyed her vagina (if that were true, she had very difficult, atypical births; this is not the physiological norm). She actually said "I hate them" (referring to her children)--within earshot of them. Wow, nice.

A few minutes later, she tells J Lo that breastfeeding will ruin her breasts and turn them into drooping "tubes" (total myth--it's PREGNANCY that can potentially affect perkiness/sagginess, NOT breastfeeding), and that childbirth will destroy her bladder (again, not the biological norm).

I'm sure the homebirth scene later in the movie would have been a hoot, but I didn't have the patience for it. I gave up after I had heard more than enough myths perpetuated for one night, let alone the horrible attitude the sister had toward children. I know it's just a "comedy," but I don't think it's funny. Someone is bound to believe those things when they hear them perpetuated in the mainstream. Not many people are likely to look it up for themselves to see what's true.

Cord blood banking vs. delayed cord clamping

A reader wrote in, "Sarah, What can you tell me about cord blood donation, I have heard so many different things on the contribution and I just want correct information to make an informed decision. Thanks for any information you can share."


I'll put together a link roundup so that each family can decide what's best for their situation.


Before we look at cord blood donation or banking as an option, let's first consider the importance for baby to receive his/her own cord blood immediately after the birth. There are options for collecting cord blood for donating or banking that *are* compatible with delayed cord clamping. 


If you haven't yet seen Academic OB/GYN Dr. Fogelson's Grand Rounds on Delayed Cord Clamping, it's well worth the 50 minutes to watch. He touches upon volumes of data supporting the importance of delayed cord clamping, including the effects of premature cord clamping that is common in the US, namely baby losing approximately 40% of his or her blood volume and the oxygenation from that blood. Baby also receives that rich store of his or her own stem cells, which is sometimes called "Nature's first stem cell transplant."  


The World Health Organization supports delayed cord clamping as well. Specifically, WHO states, "The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless, approximately 3 minutes or more after birth." 


The World Health Organization continues with these reasons for the recommendations:

• "For the first minutes after birth, there is still circulation from the placenta to the infant, the majority of which occurs within 3 minutes, generally coinciding with the end of cord pulsations.
• "Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores. Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight infants and infants born to iron deficient mothers being at particular risk. Up to 50% of infants in developing countries become anemic by 1 year of life, a condition which can negatively and perhaps irreversibly affect mental and motor development. According to one longitudinal study, Costa Rican children with chronic iron deficiency in infancy had 10 to 25 point lower cognitive test scores at 19 years of age, when compared to similar children with adequate iron status. Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency until other interventions—such as the use of iron-fortified foods—can be implemented.
• "For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage, and late-onset sepsis. In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure."

Australian midwife Rachel Reed's blog "The Placenta: essential resuscitation equipment" is well cited and helpful in understanding the crucial roles the placenta plays immediately after birth. She also explains how delayed cord clamping need not be at odds with neonatal resuscitation, should that become necessary. In many other countries, resuscitation equipment is on wheels and is brought close to the bed so that baby can continue to receive oxygenated blood while medical teams administer oxygen or other helps. 

Here's an article from the UK: "Trolley saves lives of newborn" with a description of a mobile bedside resuscitation unit that is currently used in 3 UK hospitals and may become standard in all UK hospitals. Here's a news clip that shows the Trolley and describes its use.

Here's an FAQ page on cord blood donation at marrow.org. Their page does not appear to address the need of each newborn to receive his or her own cord blood before considering donation for other purposes. It does state "No blood is taken from your baby, only from the cord and placenta after the baby is born," but this is only true if delayed cord clamping is done first. Otherwise, up to 40% of baby's entire blood volume IS taken from baby, only a small amount of which is donated for useful purposes, and the rest of which is disposed of as medical waste.


It's easy to find materials promoting the potential benefits of cord blood banking (many of which are industry advertisements for private banking). I don't currently have any bookmarked links on any solid independent research weighing the pros and cons of private cord blood banking. I do, however, have this article from an Irish newspaper titled "Stem cell storage can put lives 'at risk''. An excerpt: "‘‘In the vast majority of cases, the costs of storage are therefore not justified and the rationale being used by commercial companies recommending storage is misleading," said Sullivan. Sullivan said there was insufficient evidence to recommend its practice in Ireland except for a small number of at-risk families with rare blood diseases, malignancies or bone marrow failure... Collection of cells usually happens within minutes of a baby being delivered, ‘‘where there is a risk of post-partum haemorrhage and when both mother and baby require one to one care’’, Sullivan said.The harvesting of stem cells at this time led to added complications that might actually put the lives of mothers and babies at risk, he added."

For those who feel that cord blood banking or donation is right for them, Science and Sensibility posted an excellent article on the skill of some care providers to accommodate both delayed cord clamping AND cord blood collection after the birth of the placenta. This would mean that baby receives all of the blood that he or she needs, and that cord blood would be collected from the "excess" after the cord quits pulsating. It's not always possible as sometimes the cord blood has begun to coagulate by that time, but it's worth a try, if you would like to have the best of both worlds. Here it is for more info: "Journal of Perinatal Education 20.1 Feature Article: Umbilical Cord Blood: Information for Childbirth Educators."

See also my previous blog "Photo illustration: delayed cord clamping vs. immediate cord clamping"


As I collect more research on the subject, I'll add more links. I hope this helps as a springboard for more info.

UPDATE:

Nurturing Hearts Birth Services posted this fantastic series of time lapsed photos of an umbilical cord transitioning from full of blood immediately after birth, to thin, limp, and empty in fifteen minutes, after which time the cord was clamped and cut. If you are wondering how you will know whether the cord is ready to be cut, this is a great resource. Magic Umbilical Cords