In Contraceptive Tech, the Apps Guess Is as Good as Yours

Last year, a small Swedish startup made waves with what it called the world's first form of "digital contraception." The company's product, a smartphone app called Natural Cycles, pairs with a thermometer to track women's basal temperature every day, then uses that data to make predictions about ovulation. Rather than curbing ovulation, like an oral contraceptive, Natural Cycles gives women either a red light or a green light on unprotected sex depending on when they're most likely to be ovulating. The app promised a 21st-century update to contraception—one that used algorithms, not hormones; one that lived on an iPhone, not inside of a woman's body.

That promise is now under investigation, after a hospital in Stockholm reported last week that 37 out of 668 women seeking abortions since September had used Natural Cycles as their primary form of contraception.

That's just one hospital, in one city. The app reportedly counts over half a million subscribers across 160 countries. Chances are, more than just a few dozen women in Stockholm have been failed by the app and others like it.

The report from Stockholm is interesting because last year, Natural Cycles became the first app to be certified as a contraceptive in Europe. It raised millions of dollars in investments during a moment when interest in consumer health technology is staggeringly high. So the fact that women are reporting unwanted pregnancies from Natural Cycles already, not even a year after its certification, is not just alarming. It's a miner's canary for a much larger constellation of contraceptive technology.

The Algorithm Method

Before there was Natural Cycles, there was Clue, Ovia, Kindara, and dozens of other apps for charting one's fertility. Some of these apps look like digital calendars of menstruation: They provide a space on a woman's smartphone to log periods and track cycles over time. Others use period tracking, as well as data like basal temperature, to predict ovulation and suggest windows of peak fertility (for women trying to get pregnant) or low fertility (for women trying to avoid pregnancy).

"All these apps are really souped-up rhythm methods."

Reproductive clinician Mary Jane Minkin, also known as Madame Ovary.

It's true that ovulation is cyclical, and tracking data over time can help a woman predict when she's most likely to conceive. At best, apps like Natural Cycles give women space to log their own bodily rhythms and understand when they're most likely to get pregnant. At worst, they take folkloric advice about how to not get pregnant and make it seem more credible by dressing it up as a smartphone app.

"All these apps are really souped-up rhythm methods," says Mary Jane Minkin, a practicing gynecologist and reproductive clinician at the Yale University School of Medicine. "The term for the technique was known for years as 'Vatican roulette.' And the old joke was: 'What do you call women who use the rhythm method? Mothers.'"

Even still, it's not hard to find reasons why women would find a cycle-tracking app appealing. The burdens of contraception are high, and fall largely on women. Hormonal options can wreak havoc on the body, causing all kinds of unpleasant side effects. Without insurance, birth control pills are expensive, and often out of reach for young or low-income women. IUDs can be painful, condoms can be uncomfortable, emergency contraception can be fallible. So it's forgivable that a natural method—something that requires little more than monitoring your own body and downloading an app—seems appealing. Consider the group of women New York Magazine once called "the pull-out generation"—young females fed up with hormonal birth control and interested in understanding their bodies more deeply. Those women gave rise to an ecosystem of apps that claimed to hold all the information—and not just information, but technology, right there on your smartphone—needed to master one's own body.

It's an age-old impulse. Women have practiced "natural" family planning methods for as long as women have been fertile, as a way to avoid pregnancy when contraception wasn't attainable or easy to use. Today, the same methods are just dressed up with technology. Natural Cycles doesn't just follow the days of your period, but your temperature too! Other apps look at hormone levels, or vaginal mucus. Pair all that with an inviting design and a tab that cites research studies, and you've got something that looks more like science and less like folklore. When a technological solution is presented to us, we're more willing to give it the benefit of the doubt.

Quantified Fertility

Natural family planning, and apps that support the method, do have some credibility. Last September, Natural Cycles was the focus of a major study on natural contraceptive methods. The study followed 22,785 women through a total of 224,563 menstrual cycles and found that the app was 99 percent effective at preventing pregnancy during "perfect use," and 93 percent effective during "imperfect use"—roughly on par with hormonal birth control and barrier methods like condoms.

With any gadget or app that relies on self-reported data, the margin for human error is extremely high.

The study results were followed by a surge of $30 million in Series B funding for Natural Cycles. But much of the hype surrounded the success from "perfect use," rather than "typical use." The expectation that women will reliably input data, or even collect that data accurately, on a daily basis in the app seems unlikely. Moreover, the app relies on slight variations in temperature to predict ovulation, but is still finding ways to take into account the many factors that can affect a woman's temperature—sleeping habits, sickness, mood. The app can suggest when a woman is most likely to be ovulating, but cannot accurately warn when ovulation comes a few days early. And, with any gadget or app that relies on self-reported data, the margin for human error is extremely high.

Minkin says the collected data in these apps can be tremendously useful for women who are hoping to get pregnant. But using them as contraception "depends on your acceptance of risk." The exact day of ovulation can be unpredictable—even with a log of past cycles, temperature measurements, and hormone levels—and that can make it difficult to know which days are safe to have unprotected sex. "Very few people consistently ovulate every cycle on day 14," says Minkin. "If you happen to ovulate on day 12 and you've had sex two days earlier, those sperm are going to be around. All you need is one guy hanging around and you're pregnant."

In a statement to WIRED, a spokesperson from Natural Cycles wrote that "no contraception is 100 percent effective, and unwanted pregnancies are an unfortunate risk with any contraception." The goal of the app, the spokesperson said, is to provide greater contraceptive choice to women who wouldn't otherwise be using contraception at all. "At first sight, the numbers [of unintended pregnancies] mentioned in the media are not surprising given the popularity of the app and are in line with our efficacy rates. We have initiated an internal investigation with our clinical department in order to confirm this. As our user base increases, so will the amount of unintended pregnancies coming from Natural Cycles app users, which is an inevitable reality."

For any type of birth control, "typical use failures are significantly higher for any method that involves timely intervention from the user," says Aparna Sridhar, an obstetrics and gynecology clinician at UCLA. That's why IUDs are less likely to fail than a birth control pill, and a birth control pill is less likely to fail than a natural planning method.

More information can certainly be useful: Women who track their menstrual cycles, basal temperature, or hormonal levels over time might have a clearer picture of their fertility than women who don't, and mapping out the expected days of ovulation can decrease the likelihood of conception. But as with so many health-focused apps, wearables, and devices, that information can only go so far. Relying solely on a smartphone app to prevent pregnancy might be like wearing a Fitbit to prevent a heart attack. The data can offer valuable information. But information alone can't change the outcome.

Correction appended 11-19-2018 at 2:15 PM EST: This story was updated to include a statement from Natural Cycles.

High-Tech Hype

Read more: https://www.wired.com/story/natural-cycles-contraceptive-apps/

Serena Williams Shocking Near-Death Childbirth Experience Isnt as Rare as You Think

While feminism has made leaps and bounds in the last year, from feminism being dubbed word of the year to the success of#MeTooand the launch of#TimesUp, one thing hasnt changed. It is the stereotype that happy, healthy women must marry and have children to be happy and healthy. But perhaps more damaging than that stereotype is this one: that motherhood should be a non-stop, glamorous, pain-free joyfest. Which is why Serena Williams candor in discussing her health challenges after childbirth in a Vogue cover story is not just brave, but revolutionary, and may just save the lives, as well as sanity, of other women.

Celebrity moms are touted on magazine coversa week or two after giving birth, showing off their incredible post-baby body! (Usually looking better in a bikini right after giving birth than most of us do on an average day.) While my friends and family who have given birth bemoan sleepless nights, and barely enough time or energy to take a shower, celebrity moms are back on red carpets in stilettos looking like a million bucks in no time flat.

But just as postpartum depression used to only be whispered about until celebrities like Brooke Shields and Adele began bravely sharing their own stories, the physical toll childbirth takes is rarely discussed publiclyand certainly not by celebrities whose livelihood often depends on the illusion of perfection. Discussing the realities of childbirth is about as messy and imperfect as you can get.

While Serena Williams near-death experience following childbirth may sound extreme, its not as shocking as you may think it is in 2018. According to the CDC,approximately 700 women die in America annually from pregnancy or childbirth complications. Some researchers put estimates as high as900 (a lack of government funding for accurate compilation of data at the state level is an underacknowledged element of reproductive political and policy battles). This means America has the highest maternal mortality rate of any developed nation. Black women are particularly vulnerable, with an analysis by NPR and ProPublica finding black women are 22 percent more likely to die from heart disease than white women but 243 percent more likely to die from childbirth than white women. As tragic as those deaths are, far more women are injured, many permanently, by childbirth.

An analysis by Cosmopolitan magazine of a number of studies found childbirth injuries to be widespread. It noted that a study of 1,500 mothers published inthe journal PLoS One found that 49 percent had urinary incontinence a year after giving birth while 77 percent had ongoing back pain. Cosmo also cited a study of 1,200 women published in the British Journal of Obstetrics and Gynaecology that found that 24 percent reported lingering pain during intercourse a year after childbirth.

But those were just the most commonly reported long-term effects. Other women experience more serious problems from losing control of their bowels to ongoing pain when walking or exercising. A cottage industry has actually emerged to address some of the medical problems facing new mothers, including one recently dubbed a vaginal facelift.

Based on the numbers, some of the women injured are most likely celebrities. But if your job is to be glamorous for a living, discussing incontinence is probably not at the top of your to do list. Yet not discussing the messy and painful realities of childbirth means that most women end up suffering in silence, embarrassed, and believing they are aloneor worse: that there is something wrong with them if they cant make it through pregnancy, childbirth, and motherhood with the physical and emotional ease that supermodels and superstars seem to.

Pretend for a minute that men could get pregnant. Do you think if Tom Brady had recently won a Super Bowl and was in the prime of his career, that any reporter would ask him when he was planning to get pregnant and have kids?

In the Vogue profile, Serenas husband refers to her body as one of the greatest things on the planet. Anyone whos seen her knows that is true. Which is why the fact that she is admitting that even she became physically vulnerable thanks to childbirth may give other women peace of mind. The fact that she came out on the other side, healthy, happy and radiant, on a Vogue cover no less, may give some women hope. But heres what Im also hoping her admission will do: change the way society, and men in particular, talk about pregnancy and motherhood.

Heres what I mean.

Pretend for a minute that men could get pregnant. Do you think if Tom Brady had recently won a Super Bowl and was in the prime of his career, that any reporter would ask him when he was planning to get pregnant and have kids? Im pretty sure the answer is no, because most men would think of it as insanity for him to even consider intentionally putting his body through such physical trauma at its peak. My guess is the judgment and whispers about certain female celebrities, accused of hiring surrogates, out of so-called vanity, would be a non-issue. Doing so would probably be hailed as smart business.

While Serena has clearly embraced the joys that motherhood has brought into her life, she did note in the interview that her peer Roger Federer has two sets of twins and hasnt skipped a beat career wise, something that would be unlikely for her, or although she doesnt say this, really any woman.

Which is why I find it so baffling that with all of the physical risks and dangers still associated with childbirth, citing physical well-being is still not viewed as a socially acceptable reason to eschew motherhood. When recently mentioning to a couple of educated feminist male friends of mine that this was among a number of reasons motherhood has never been on my bucket list one breezily said of the childbirth process, it doesnt last that long, clearly not realizing that the aftermath can last a lifetime.

I have had more than one female friend share that the impact on their bodies has been a key factor in their decision to limit their family size and yet they have said they have been scolded by othersincluding other womenfor this reasoning. As if the choice to forgo childbirth because you dont want to risk incontinence is somehow less worthy than forgoing it because you dont want to risk your financial security.

To be clear, Im not saying women should avoid motherhood. I am saying it should no longer be treated the way it long has been: as the default choice for all women. Instead it should be treated as what it is: a really serious choice that should involve consideration and contemplation because giving life is a big deala big, risky deal. So just as we applaud those willing to donate organs to save the life of a stranger but dont judge ones humanity on her decision to do so, we should stop judging womanhood on whether or not one embraces motherhood.

We should celebrate women brave enough to face the challenges of pregnancy and motherhood. But we should also celebrate women like Serena Williams who are brave enough to tell the truth about motherhoods pitfalls, and celebrate women courageous enough to make the decision to challenge societys definition of womanhood by saying motherhood isnt for me.

Read more: https://www.thedailybeast.com/serena-williams-shocking-near-death-childbirth-experience-isnt-as-rare-as-you-thin

The truth about having sex while you’re pregnant

Nine months would, for many people, be a long time to go without sex. Understandably, the prospect of such an extended dry spell may make the newly pregnant feel some anxiety.

So can you have sex while pregnant? Of course, according to the Mayo Clinic, so long as your doctor hasn’t advised against it due to a complication. Know that the fetus is cushioned by amniotic fluid in the amniotic sac, as well as your uterine muscles. It won’t get poked or crushed or jostled by a penis or toy or anything of that ilk—don’t worry. 

And with that, here are some answers to other commonly asked sex-during-pregnancy questions.

What you should know about sex while pregnant

When should I abstain from sex while pregnant?

Before you undertake sex during pregnancy, definitely consult a doctor rather than the internet alone. For most people, provided they aren’t experiencing complications, pregnancy sex isn’t likely to end in miscarriage or (despite what you may have learned on Friends) speed along labor.

Some things that might indicate it’s time to abstain are, according to BabyCenter.com: vaginal bleeding or unusual discharge, a dilated or shortened cervix, premature labor, a low-lying placenta encroaching on your cervix (a condition called placenta previa), the presence of untreated sexually transmitted infections, and a genital herpes outbreak, either yours or your partner’s. In any of those scenarios, speak with a healthcare provider before getting down to business.

Photo via Pixabay

What about oral or anal sex while pregnant?

Of course, vaginal sex isn’t the only option: According to the Mayo Clinic, oral sex is a safe bet during pregnancy so long as your partner is very careful not to blow air into the vagina, which sounds like a good thing to avoid regardless. Apparently, it can trigger pregnancy complications serious enough to threaten the fetus’ and your existence.

Anal sex, on the other hand, is perfectly fine so long as it’s comfortable. Be cautious and don’t switch from anus to vagina without washing the penis or toy first. That can introduce infection-causing bacteria into the vagina, which is not fun when a person isn’t pregnant and becomes potentially dangerous when they are.

Hormonal and bodily changes might also mean you simply aren’t interested in sex during portions of pregnancy, which is totally fine. Breast tenderness, back pain, a general feeling of unwieldiness—these are all things that could understandably make a person feel less sexy than usual. You should have sex, while pregnant or otherwise, only when you want to.

Photo via Pexels (CC-BY)

Can you have unprotected sex while pregnant?

Unprotected sex during pregnancy isn’t necessarily a bad idea, but the only time we can responsibly recommend abandoning a condom is when you and your partner have both been recently tested for and cleared of sexually transmitted infections, and when you’re in a mutually monogamous relationship. If there is any chance at all that your partner might have an STI, and/or if you are having sex with a new partner while pregnant, use protection. Contracting an infection while pregnant can have a number of health-threatening effects on both the mother and the fetus, and can mean that the baby is born with that infection.

Photo via Pixabay (CC-BY)

How long can you have sex while pregnant?

Personally, I am not sure if this means “for how long can a pregnant person have sex during a single sex session” (to which I would say, to completion if it feels good) or “for how long into a pregnancy is it safe to have sex.” Assuming it’s the latter, you can have sex until you go into labor, again, provided your pregnancy is free of complications. And as BabyCenter.com warns, if you do not have herpes (oral or genital) but your partner is positive, it’s advisable to abstain from sex (oral, vaginal, and anal) for the duration of the third trimester. For reference, that starts at week 28.  

What happens if you have bleeding or cramping during sex while you’re pregnant?

The American Pregnancy Association is adamant that nothing—neither tampon nor penis nor sex toy—be inserted into a bleeding vagina if its owner is pregnant. While bleeding is far from atypical during the first trimester, during the second or third, it’s cause for concern: bleeding and cramping can be signs of miscarriage or an infection.

The APA advises that, if you bleed after intercourse during the first half of pregnancy, it’s probably because of cervical tenderness, but sex should still be avoided until you’re cleared by a doctor. If you’re bleeding in the second half, consult your physician right away.

Photo via Pixabay (CC-BY)

What are the best sex positions while pregnant?

The best sex position is the most comfortable sex position, and what’s comfortable will change as the pregnancy progresses. Early on, when you haven’t yet begun or are just beginning to show, a pregnant uterus won’t be much of a barrier to any position. Parents.com advocates the intense-sounding “sit and stare”—straddle your seated partner and stare at one another’s eyeballs—for heterosexual couples, along with doggy style and side sex. Missionary and other such supine positions apparently put pressure on the aorta as the uterus expands, which could potentially restrict blood flow to the placenta and thus, oxygen to the baby. The farther along you get, the more advisable it is to have vaginal sex from the side (spooning) or behind, with the pregnant party on top or perched on the edge of a bed or a counter or a sturdy table.

Again, when it comes to matters of medical concern, doctors are always a better source of information than the internet.

Editor’s note: This article is regularly updated for relevance. 

Read more: https://www.dailydot.com/irl/sex-while-pregnant/

Reality shrivels. This is your life now: 88 days trapped in bed to save a pregnancy

The long read: Months before she was due to give birth, disaster struck for Katherine Heiny. Doctors ordered her to lie on her side in bed and not move and gave her a 1% chance of carrying her baby to term

When I was five years old, my parents decided they could no longer watch the nightly news. Or rather, they could no longer watch it if I was in earshot. The coverage of the attack at the Munich Olympics had caused me to have such an intense fear of being killed by gorillas that I couldnt sleep. No matter how many times my parents explained the difference between terrorist guerrillas and primate gorillas and that there were no gorillas in Michigan anyway I remained sleepless with worry late into the night for weeks. My parents eventually gave up and subscribed to the afternoon paper as well as the morning one.

The problem is not just that I am a champion worrier. Its that I court worry I seek it out, I invite it into my home, never remembering how hard it is too dislodge it from its comfortable chair by the fire. I watch true-crime documentaries when Im alone. I Google photos of black widow spider bites. I know the statistics about paracetamol overdoses. I have memorised the beaches with dangerous riptides. I have installed a carbon monoxide detector in every house I have ever lived in. And when I got pregnant with my first child, I bought What to Expect When Youre Expecting and the chapter titled What Can Go Wrong was the one I read first.

Retained placenta; umbilical cord prolapse; foetal arrhythmia; toxoplasmosis; preeclampsia; placental abruption; gestational diabetes; cytomegalovirus: I read about all of them, and learned the warning signs. Perhaps to other women, these complications remain obscure, shadowy threats during pregnancy, but to me they were hard, clear, immediate dangers. When my obstetrician told me that mine was a perfectly normal pregnancy, the very first thing I said was: Are you sure?

And yet I was surprised when disaster struck. The things you worry about arent supposed to happen thats what worry does. Its a preventative. And my disaster happened quickly, without fanfare or drama. One second, I was a nice, normal, happy pregnant married woman of 32, walking across my bedroom to my desk while my husband made lunch downstairs. And then the warm fluid gushed out of me, soaking my clothing and leaving a little wet spot on the pale green carpet.

I yanked down my jeans and pants, expecting blood, but there was only wetness. I knew it was very likely that my waters had broken, but I was barely 26 weeks pregnant. It didnt seem possible. I stepped out of my clothes and went to the top of the stairs to call my husband. He stood on the landing with his hands all sticky from making hamburgers, and I told him what had happened. We discussed it for a surprisingly long time. Was it really so bad? How much fluid? Maybe a cup? Was there blood? Was the baby still kicking? Should I call my doctor? Yes, we decided.

I wrapped a towel around my waist and called my obstetrician. He was a man in his late 50s with a perpetual hangdog expression, and for this reason, my husband and I called him Doggie B. I loved Doggie B. Nothing ever surprised him, nothing ever alarmed him. I could not picture him giving me bad news, and because I could not imagine it, I felt it wouldnt happen.

I want you to meet me at the hospital, Doggie B said. Go to the maternity ward. And I want you at Georgetown Hospital where they have the neonatal unit.

I put on fresh pants and jeans and my husband and I drove to the hospital. It was 29 January 2000, and an ice storm was just beginning. Something happened to me on the way to the hospital: my mind split in two. One half was convinced that that this trip was unnecessary, that, of course, my water hadnt broken, that I was just fine. The other half was just as sure my waters had broken and that I would almost certainly go into labour and give birth to a baby too young to live. The two halves of my mind rotated inside my head like the lights of a lighthouse, the worried part flashing and then disappearing, replaced by the calm one.


At the hospital, a doctor who looked just like Andie MacDowell performed a pelvic exam and took vaginal swabs. A nitrate test was done on one of the swabs for the presence of amniotic fluid. (Its presence would have meant membranes containing the baby had ruptured three months prematurely and would most likely cause me to go, disastrously, into labour.) The other swab was for sent off to the lab to check for the presence of arborisation, otherwise known as ferning, because amniotic fluid produces a delicate, leafy pattern under the microscope. Both tests were negative, although they were running a repeat just in case. I began to feel a little ridiculous.

The Andie MacDowell doctor told us that there was no evidence that I was leaking amniotic fluid, but that they were going to admit me, she said, on the strength of my story.

The strength of my story! I was appalled. Im a writer of course I told a strong story. Maybe I didnt need to be here, I told my husband, as nurses wheeled my gurney into a private room. Maybe I should just tell an equally strong story about how nothing was wrong and go home.

The doctor came back. I just saw the ferns, she said. You have definitely ruptured. Well try to delay labour as long as possible.

Three months? I asked.

Yes, thats the hope, she said.

I wouldnt have been so scared if it werent for the look on her face.

Dom
Illustration: Dom Mckenzie

Nurses came into my room and began to bustle around me while the doctor explained that my condition was called preterm premature rupture of membranes, or pPROM. The two most dangerous (and most common) complications of pPROM are extreme pre-term birth and chorioamnionitis, a bacterial infection of the foetal membranes. Both are devastating for the foetus. I reached for my husbands hand.

The nurses put me in Trendelenburg, meaning my hospital bed was tilted so that my head was 20 degrees lower than my feet. (I thought it was some long German word that meant head below feet on the side of a mountain.) A nurse wrapped a foetal monitor to my belly with a thick strap, explaining that it could be read from the nurses station, and they would know immediately if I began having contractions. Another nurse slid a pair of puffy compression leggings on to my legs. They inflated and deflated every other minute with a whooshing sound. It was like having Darth Vader breathing at my bedside. I was told to lie on my side in order not to put pressure on my vena cava, which would lower the babys oxygen supply. Yet another nurse poked a needle into my arm to start a line for intravenous antibiotics.

The doctor gave me a shot of steroids to help develop the babys lungs, in case the baby would shortly be needing those lungs to breathe. Arent steroids counter-indicated in pregnancy? I asked.

Yes, but its more dangerous to go without, she said.

Doggie B called the hospital to stay that he couldnt make it in because of the ice storm. In his absence, the doctor ordered the nurses to give me a shot of terbutaline, a medication that can delay preterm labour for up to 48 hours.

Please, I begged. I dont want any more shots. Im not in labour. This could be so bad for the baby.

From the moment I learned I was pregnant, I had divided the world into things that were OK for the baby, and things that were bad for the baby. The first group included rice, poached chicken and yoga, The second group included alcohol, secondhand smoke, deli meat, smoked seafood, raw eggs, soft cheese, pt, caffeine, unwashed vegetables, diet soda, eggnog, x-rays, aspirin, ibuprofen, antihistamines, nasal decongestants, cough syrup, librium, valium, sleeping pills, castor oil, vitamin A supplements, paint fumes, insect repellent, acupuncture, cats, hair dye, altitude, saunas, reptiles, tick bites, microwaves, electric blankets, rollercoasters, bikini waxes, stiletto heels, hot dogs and tap water. I trusted no one but myself and Doggie B to categorise items, and certainly not a doctor I had met 10 minutes before.

They gave me the terbutaline anyway. It made me dizzy and cold, though it makes most people hot. They piled more blankets on top of me. My hands shook uncontrollably.

The neonatologist came to talk to us. He had thick glasses and he talked in percentages. It was clear that he was not interested in offering comfort; he was there to convey information. He told us that for babies born at 26 weeks, the survival rate is 50%. Of the surviving half, one-third had major disabilities, and are likely to be dependent on caregivers for ever. It was common for them to have breathing problems, cardiac disorders, brain bleeds, cerebral palsy. Brain damage, deafness, blindness. Another third had more moderate disabilities: spastic muscles, significant hearing loss, impaired vision without blindness. The final third (the best we could hope for, apparently) had milder learning disabilities, anemia and digestive complications.

I watched him dispassionately, not really listening. He was so stereotypically nerdy that I couldnt get over it. Why was he telling us all this scary shit anyway? I wasnt going to go into labour. The baby wasnt going to be born yet. Why couldnt anyone understand that?


The first night was longer than I would have believed possible. Visiting hours ended and the nurses chased my husband out. He drove home on streets that crackled and shifted with ice. I was not allowed to stand, or even sit. I was served a dinner that I was too nervous to eat. And I learned about bedpans. Peeing into something the size and shape of a casserole dish while lying in bed with your head angled toward the floor is messy and awkward.

But that is not the worst thing about bedpans. The worst thing is the other people involved. Having to ask someone to bring you a bedpan, having to make conversation with that person while you use it, having to apologise because your aim is a little off and now theres a wet spot on the sheets, having to ask that person to wipe you, having to ask her to wipe you again because you still feel damp and sticky, having to thank the person, and you do really thank her, you are so grateful, its just that two hours ago you were an upright person with a little dignity, and now youre not.

The hospital lowered the lights in the hall, just like on a transatlantic flight. Nurses went by on squeaky shoes. I lay on my side and gripped the metal railing of my bed. The lighthouse in my mind revolved, and for one instant the room was flooded with cold, bright, white fear for the baby. Then it was gone. Certainty that the baby would not be born early stole over me, and I gathered that certainty close. I lay awake and watched the sleet falling outside my window. It occurred to me that I could not see the ground.

Doggie B came to see me the next day.

Can you believe this? I said to him. Me, your most paranoid patient!

He didnt bother to deny that I was his most paranoid patient. When he spoke, his voice was mild and unconcerned. He said that I would remain on bed rest, and unless infection forced us to act sooner, he would deliver the baby at 33 weeks, when the greatest risk was over.

I didnt want to have the baby at 33 weeks. I wanted to have the baby at 40 weeks, like everyone else. I knew the risks. But I had also been told the risks of preterm infection: a baby born with brain damage, cardiac defects, limb abnormalities, microcephaly, hydrocephalus, paralysis, bone lesions, eye lesions or possibly no live baby at all. I refused to weigh the risks; I would simply not go into labour, nor would I develop an infection. That was all there was to it.

I frowned at Doggie B. Why 33 weeks? Why not go to May 10? That was my due date.

He shrugged. OK, May 10.

He was a much better liar than the Andie MacDowell doctor.

After Doggie B left, the nerdy neonatology doctor came to my room again. He wanted me to go down to the neonatal intensive care unit (NICU). You need to see what a preemie looks like, he said, pushing his glasses up his nose. You need to prepare yourself.

The Andie MacDowell doctor was there, too. A three-pound baby takes some getting used to, she said. You dont want to see one for the first time in the delivery room.

To both of them, I turned a deaf ear and a sullen face. I was not going into labour. I was not going to go to the NICU and no one could make me. Conversation was cut short when another nurse came in and told me that my monitor had showed slight disturbances, and gave me another shot of terbutaline.

I cant believe terbutaline makes you cold, this nurse said as she took blankets from the blanket-warmer and I shivered beneath them. Out in the hall I heard her say to someone: That one is so contrary.

I could see remotely that all these doctors and nurses knew something I didnt. I found out much later that what they knew were the odds. Fifty per cent of women with pPROM go into labour within 48 hours, and 95% deliver within one week of rupture. Four of the remaining 5% deliver within two weeks. One percent of women with pPROM experience spontaneous resealment of the membranes and go on to carry the baby to term.

One per cent.


Do you knit or crochet? one of the nurses asked me early on. Lots of bed rest patients find that helps them pass the time. No, I read and I write, I answered, pretentiously. And untruthfully, because I have always watched a great deal of TV.

I couldnt write because I couldnt sit up. I also couldnt write because if I focused too much on my situation, the lighthouse in my mind would revolve and the worried, scared part of me would rush out, gibbering with alarm, baying, screaming, howling that the baby was going to be born too soon, the baby was coming now, the baby was going to die. How could I write with that going on?

I had a headache from being in Trendelenburg. I couldnt remember what it was like to look someone in the eye, so long had I now spent gazing up at everyone from thigh-level. When I ate, it was one wobbly, precarious forkful at time. After a while, I just gave up and if I couldnt eat it with my fingers, I didnt eat at all. I drank through a straw, until everything tasted the same: like the plastic of the straws.

I couldnt write, so instead I read. Constantly. Ceaselessly. I had to hold the book open in front of me sideways, like someone gripping a large steering wheel. My husband brought me books and I stacked them on my overbed table, and as I read each book, I held the next book in my free hand, with my finger marking the start of the first chapter so that as soon I finished one book, I could immediately start another. I must have read dozens of books while I was in hospital, and I can only remember one of them.

Only one book held my interest. I told my husband exactly where to find it on the bookshelf near my desk and he brought it to me: Steven Callahans Adrift, a memoir of the 76 days in 1982 during which Callahan had survived in an inflatable life raft after his sailboat sank. I had fallen in love with the book when it was first published, in 1986. It seems like a strange choice of reading for a teenage girl, especially one as studious and non-athletic and seasickness-prone as I was. But I have always been drawn to survival stories: they dovetail nicely with my chronic fear of disasters.

Callahan spent more than two months in a rubber raft in the middle of the Atlantic, spearing fish to eat raw, using solar stills to distil water, and making endless, desperate makeshift repairs to his patched and leaking vessel. I had read Adrift many times over the years, but now I read it again, and was inspired by his suffering and ingenuity in a new way. I was in a hospital bed where nurses brought me meals three times a day, and I slept in a bed on clean sheets and was in no danger of drowning. I could do this. I could.


You dont sleep in hospital. You cant sleep. Too many people coming and going. A nurse comes every four hours to check your vitals: temperature, pulse rate, blood pressure, babys heartbeat. Another nurse comes in every two hours to make sure you are doing your kick-counts. Meals come three times a day, plus a night-time snack for pregnant women, which means four times someone comes into your room to deliver a meal, and four more times someone comes back to collect the tray. A nurse comes every time you need to use the bedpan. An orderly comes every morning to take you for an ultrasound. Your obstetrician comes by every day to check on you, and you dont want to miss his visit, because he is the only one who tells you what you want to hear no, theres no sign of infection; yes, Im sure youll carry to term. The hospital chaplain stops by once a day. She was a mousy woman with a perpetually scared expression. Its not a good look on a hospital chaplain.

So thats more than 30 people coming to your room and interrupting your sleep. And then theres the physical part of it. If you are confined to bed, after you lie on your side for a few days, it begins to feel as if your hip sockets are lined with metal shavings, as if the sheets are covered with shattered glass. Before long, red, rough, scaly patches the size of saucers appear on your hips and your shoulders the beginnings of bedsores. The compression leggings chafe your thighs.

You forget how to sleep. The line between waking and sleeping used to be as clear and sharp as the line down the middle of a road, but after two weeks, that line has blurred and is almost invisible. You stagger back and forth across it like a shambling drunk, until there is no more sleeping and waking; there is just this dim, dull, soupy consciousness. Your reality shrivels down into one long, hazy, beige-tiled tunnel. You used to worry, but it has gone beyond that now. Worry used to be inside you, but now you are inside it. Worry is a dome that has descended over you and trapped you. This is your life now. This is your world.

Every day about 10am, an orderly arrived with a gurney and I carefully scooted on to it and then the orderly pushed the gurney through the hospital halls to the prenatal department.

Two weeks had gone by, and I hadnt gone into labour. This seemed to surprise everyone but me and Doggie B, who began, cautiously, to speak of resealment. The nerdy doctor came by and gave me a whole bunch of new statistics about what the babys chances were at 28 weeks, at 30 weeks. He didnt go beyond 30 weeks, though. They removed my IV. Everyone talked about something called BP as though they were speaking of the Rapture. (Bathroom Privileges.) The atmosphere in my room became positively springlike, despite the snow outside.

Doggie B said the first step would be for me to get up and take a shower. A shower! Nothing could have been more tempting. He gave me a date. Now it was something to look forward to. I had my husband bring in a bottle of my favourite shampoo and a bar of coconut soap. The day finally came. A nurse removed my circulation leggings. I sat up slowly and swung my feet to the floor. The nurse took my arm and helped me to stand. I stood there, swaying. Amniotic fluid poured out of me and splashed to the floor. The nurse let go of my arm in surprise. I lay back down and turned my face to the wall.

It took me a while to regain my strange equilibrium, especially considering that the doctors now suspected I had been leaking continuously since the first rupture. Rupture of the membranes is considered prolonged (and therefore dangerous) when more than 24 hours passes between the rupture and the onset of labour. My waters had broken more than 300 hours ago. The risk of sepsis was very high.

Katherine
Katherine Heiny. Photograph: Leila Barbaro

But still, two days maybe three and the stubbornly optimistic side of my personality fought its way to the forefront and re-planted its battle flag. The Andie McDowell doctor wrote in my chart: Patient needs to understand that resealment is highly unlikely at this time and that preterm birth is almost a certainty. Yeah, well, thats what she thought. This baby was not coming early. I simply wouldnt allow it.

Another week in bed went by. Every once in a while, they had me stand up, and every time I leaked amniotic fluid. But still I didnt go into labour. Nor did I have a fever or abdominal pain, the two greatest indicators of infection. Life as I now knew it went on.

After I had been on bed rest in the hospital for 25 days, there came a time when I stood up and no fluid gushed out of me to splatter on the floor. The nurse and I looked at each other in amazement. Go take a shower, quick! she said. Ill change the sheets on your bed.

It was not the slow, luxurious shower I had dreamed of, but I can tell you this: it was pretty fucking nice. They didnt allow me out of bed again that day, but I was finally taken out of Trendelenburg. I stood up the next day and again there was no leak. I took another shower.

When Doggie B came to see me next, I was sitting in a chair to greet him, radiant, both my pride and my belly enormous.

I had done it. I had resealed. I was in the 1%.


Doggie B wanted to send me home. I fought him. I had been in the hospital for almost a month at this point, and I was pretty much institutionalised. Go home? Without the foetal monitor? With no nurses to listen for the babys heartbeat every four hours? No daily ultrasound? Uh-uh. He was crazy if he thought I could handle that much responsibility. I told him that I needed to be in the hospital near the NICU. I pointed to my chart where it said Severe Risk Pregnancy in big scary letters. Doggie B stood firm. He discharged me and my husband drove me home.

Steven Callahan writes of seeing the first food after his rescue a cake of chipped coconut topped with a dot of red sugar and how he looked at it in wonder and thought: Red! That was exactly how I felt when I saw my house again. Green! Blue! Lilac! My hospital room had been unrelentingly beige.

I was still on almost total bed rest, allowed up for 15 minutes twice a day. A shower in the morning and dinner at night. Out of the hospital, the lighthouse in my mind revolved faster and faster, unchecked by the nurses reassurance. I counted constantly how often the baby kicked, and took my temperature five times a day. The amniotic sac had resealed, but the rupture had been extremely prolonged, greatly increasing the chances of an infection reaching the baby. Even feeling the babys movements could not quell my worry. Doggie Bs receptionist learned to put me straight through to him when I called.

Time ground slowly by. My husband brought me breakfast in the morning before he left for work. Our housekeeper brought me lunch. My husband brought me dinner and we ate at the card table he had set up in the corner of our bedroom. Then I crawled back into bed and worried until I fell asleep, woke up, and started another day. That was my routine, and I never varied from it. I dont mean I never varied from it significantly; I mean I never varied from it at all.

Thirty-one weeks. Thirty-two weeks. Thirty-three. Still I didnt go into labour. I lay in bed and stroked my abdomen with my fingertips. Thirty-four weeks. Thirty-five. March ended and April began. A blizzard of cherry blossoms replaced the snow outside my bedroom window. Thirty-six weeks. Thirty-seven weeks. I no longer watched TV or pretended to read books. I knew nothing but my belly and the endless waiting. Time had softened and stretched like taffy, pulling itself into long, gooey ribbons. Thirty-eight weeks. Thirty-nine. I was certain that the baby would be born on 21 April, the same day Steven Callahan was rescued. But 21 April came and went. And then one day I got up to take my morning shower and felt the slightest trickle of fluid run down my leg. My waters had broken for the last time.


Our son was born 12 hours later at Sibley Hospital in Washington DC. We named him Angus. And so my life changed again in another minute, another second. The two halves of my mind fused back together. I went from severe-risk pregnancy to healthy new mother. I was totally unprepared. For so long the goal had been to stay pregnant I had almost forgotten that a baby was the end result. I knew nothing about newborns, nothing about breastfeeding or burping or vaccinations. The nurses had to show me everything. One them said, in a careful voice: Ive heard about you, I think. I could tell that whatever she had heard was, at best, a mixed review. Didnt you rupture very early and do a lot of bed rest over at Georgetown?

I felt a stubborn thump of pride. Thirty days at Georgetown. Eighty-eight days altogether.

Wow, she said. I bet you never want to see a hospital again.

I didnt know how to tell her that almost the opposite was true. It wasnt just that I knew about hospitals now, and knew I could survive a long stay in one. I was a different person from the one who had been admitted all those weeks and months ago: a tried person, a changed person. Very few experiences transform your view of the world and yourself, but bed rest did that for me. I had beaten nearly unthinkable odds. All the things I have always meant to fix about myself but had never got around to my stubbornness, my hypochondria, my inflexible nature had turned out not to need fixing. Had, in fact, turned out to be survival skills.

Twenty-four hours went by, and I cried because I never wanted Angus to get any older. The impossible had happened: time had speeded up.

Six months later, I arranged to speak to Steven Callahan by phone. I told him how much his book had meant to me, how much he had inspired me. We discovered that we had both been obsessed with numbers, with calculating and re-calculating the days of our progress. I told him that my ordeal had altered me in some fundamental way, that sometimes I even missed the mind-bending, terrifying force of it. He agreed.

Sometimes I feel a loss, he said, in terms of the fact that few if any experiences I will ever have again can equal the intensity and importance of that one. You try to mine the precious elements of the experience, but they slip away from you, and thats another loss. You try to appreciate this enormous gift youve been given, but eventually you just get on with it.

The precious elements of my experience were fading, too. I took my bathroom privileges for granted now. I slept on my back again. I went for walks. I worried about traffic jams and deadlines and love handles, just like a normal person. I got on with it.

Angus is 17 now, taller than me, taller than my husband. He has the beginnings of a moustache and a voice as deep as James Earl Joness. He knows how to do laundry, and make spaghetti. He can take the Metro by himself, and he learned to drive this summer. Its possible he watches porn on the internet. (Its extremely possible.) I have new fears and worries, about teenagers. The bright, icy terror of the hospital is behind me, but it has taken a long time.

One day, when Angus was about three years old, I cleaned out a closet and unexpectedly found the plastic water pitcher that had been by my hospital bed. In an instant, the lighthouse in my head revolved, and everything went white and cold. I was certain that the baby was in danger so certain that I had to run to the bathroom and vomit. I dont know why this surprised me, or why I thought I would be different, immune to the after-effects of my ordeal. All survivors have scars.

Main illustration by Dom McKenzie

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Read more: https://www.theguardian.com/lifeandstyle/2017/oct/24/88-days-trapped-in-bed-to-save-a-pregnancy-bed-rest

How Much Sex Should You Have If You Want To Get Pregnant?

The announcement that sex leads to pregnancy is ten thousand-year-old news, but Indiana University scientists have given it a new spin by confirming the suspicion that sex throughout the menstrual cycle increases the chance of conception. Besides helping those struggling to conceive, the findings could have implications for wider understanding of the immune system.

“It’s a common recommendation that partners trying to have a baby should engage in regular intercourse to increase the womans chances of getting pregnant even during so-called ‘non-fertile’ periods although its unclear how this works,” said Dr Tierney Lorenzin a statement.

It sounds like anexcuse for people who really just want to have more sex look we need extra practice but Lorenz is the lead author of two papers released in the last month showing the advice has substance.

Sperm, and the fertilized egg, run the risk of being rejected by the mother’s immune system as foreign objects, so it makes evolutionary sense that there might be a trigger to make the body’s defenses less hyper-alert when pregnancy is a possibility.

Previousstudies have produced contradictory resultsabout changes to women’s immune systems during the menstrual cycle. Lorenz suggests this may be because they failed to ask about sexual activity. Certain changes might be expected, only in women who are reproductively active that is, regularly engaging in sexual activity, she and her co-authors write in Physiology and Behavior.

As part of the Kinsey Institute’s Women, Immunity and Sexual Health study Lonrenz tested biomarkers in two groups of women, half of whom were sexually active, throughout their menstrual cycle.

In Fertility and SterilityLorentz reports that the mix of helper T cells ratios changed during the luteal phase,immediately after ovulation. Helper T cellsmobilize the immune system cells responsible for killing material identified as foreign. Sexual activity increased levels of type 2 helper T cells (TH2)during this phase, while decreasing type 1 cells (TH1)relative to the rest of the cycle.

The Physiology and Behavior paper reports a similar change in the mix of immunoglobulin antibodies in saliva. Sexually active women had higher levels of the antibody IgG,common in blood. On the other hand levels of IgA,a different antibody the authors describe as the body’s first line of defense against invaders, were lower among those having sex most often.

The combined effect is to temporarily give sexually active women an immune system more open to conception.

Lorenz told IFLScienceThere were a number of very puzzling findings from her research that will need more work to unravel. Most notably, she is not sure why IgG rises with sexual activity. She noted that the study was done by testing saliva, and said, I do think we are seeing an example of immunoredistribution, when the immune system sends certain cells and antibodies to where they need to be, so when we look elsewhere we find them in smaller numbers. Thus an increase in antibodies in saliva may reflect a decrease in the vaginal tract, making it easier for the fertilized egg to survive.

The sample sizes, 32 in one study and 30 in the other, are also small enough that the results should be treated with caution, despite achieving statistical significance.

“The female body needs to navigate a tricky dilemma,” Lorenz said.”In order to protect itself, the body needs to defend against foreign invaders. But if it applies that logic to sperm or a fetus, then pregnancy cant occur. The shifts in immunity that women experience may be a response to this problem.”

“We’re actually seeing the immune system responding to a social behavior: sexual activity,” Lorenz added.”The sexually active women’s immune systems were preparing in advance to the mere possibility of pregnancy.”

Sexually active women experienced the same immune system changes when they used condoms, but to a lesser extent, leading Lorenz to suggest there might be multiple mechanisms, of which ejaculateexposureis only one.

Read more: http://www.iflscience.com/health-and-medicine/more-sex-gets-you-pregnant

Photo Of Baby Lying Next To Moms C-Section Scar Shows Us What Mothers Go Through

Pregnancy and birth happen as they do, yet many women are openly judged if a “not natural” option is chosen. Recently, photographer Helen Aller, from Guernsey, UK, took this intimate photo of a mother and her three-day-old baby boy next to her caesarean incision. The woman, who did not want to be identified, had decided on a vaginal birth, but was forced to have an emergency caesarean due to complications. She wanted a picture taken of the operation that saved her and her baby.

“I photographed this mama’s pregnancy a while back and she was telling me how terrified she was of having a c-section,” wrote Aller on Facebook. “Well last week she went into labor but had to have an emergency c-section after complications. She asked me to come over this morning and shoot this particular image as her worst nightmare proved to be what saved her and her child’s lives.”

“[She] wanted something to show that her biggest fear was what in the end saved both of them. I think she will see that scar and appreciate the life they were given”