Wednesday, November 21, 2012

One of the Elephants


After I told my parents that I was pregnant with Balthazar, my father sent me an email in which he said that I was very brave but that since he was an optimist he would expect a good outcome.

The email left me irritated in a vague, all over way, like a mild flu. Since my father and I communicate infrequently, parsing his communiqués requires close reading approaching biblical exegesis. I got to work.

First of all, I mistrusted that word, 'brave'. I mistrusted it absolutely. It seemed to praise but it was meant as criticism. My father was suggesting that what I was doing was so dangerous that it required foolhardiness. I didn't have to ask why he claimed to think I was brave but really thought otherwise. It was because I was forty years old and pregnant.

I didn't feel brave at all. I had no interest in feeling brave. In the southeast quadrant of Portland, OR, where I live, no one told me I was brave. Late motherhood is more the norm here than the exception. In fact, most of the mothers I hang with at the elementary school are a few years older than I am. Many had children while in their forties.

The attitude of my forty year-old midwife, who was trying to get pregnant at the time, was mindful but not fear-mongering. Being forty was like coming into the pregnancy twenty pounds overweight or having a family history of diabetes. It didn't signify anything by itself, and until and unless something came up, it was just a fact.

Second, my father calling himself an optimist is like Mitt Romney calling himself pro-woman. It is absurd on its face. If the major premise of his statement was false and the minor premise was also false, what did that do to the conclusion? If I were a lawyer, like my father, or had taught logic and rhetoric at Columbia I would have known, but I suspected it was nothing good. He was telling me that he believed that something terrible was going to happen.

*

As ridiculous as it seems to me when I examine my mortgage-paying, school-volunteering, flats-wearing life, I am far and away the risk taker in my family.

I moved to New York when I was twenty-four to go to graduate school in creative writing. There is so much wrong with that sentence from the perspective of a cautious person that I don't even know where to begin. New York in 1995 wasn't the crack den it had been in the '80's, and to the housing administrator's annoyance I insisted on living on the west side of Broadway, away from Morningside Park, but even she struggled to pretend that it was safe.

I went into significant debt to go to graduate school, which even then was understood by the sane and sober to be a gamble. I went into debt to get an MFA. No bookmaker at Belmont Park would take those odds.

On the other hand, I have gone to great lengths not to live without health insurance. I do not own a motorcycle, or a gun. I don't smoke, gamble or drink and drive. I will not let my son play football. I believe in vaccinations and carseats. I wash my hands after handling raw eggs or chicken.

From my perspective, having Balthazar was a calculated risk. It was not quixotic. It was not reporting live from Tahrir Square or jumping out of an aircraft from space. It wasn't even riding a bike without a helmet. Still, I tried to be reasonable about my expectations. 'The chances are good that I will miscarry,' I told myself when I found out I was pregnant. 'Forty percent of pregnancies end in miscarriage.' But then we saw the heartbeat at nine weeks, and the chance of miscarriage went down to something like four percent.

The odds of Down's syndrome increase dramatically after thirty-five, and again after forty. So I tried to steel myself against that. But then the nuchal fold ultrasound combined with the triple screen indicated that the risk of Down's syndrome was 1 in 5,660, which was the risk of a twenty year-old mother. The risk of miscarrying after an amniocentesis was 1 in 200, and so, to my great relief and on the advice of the perinatologist, we didn't have one.

After that I worried about preterm labor. I even went to labor and delivery at twenty-seven weeks, thinking I might be leaking fluid. It turned out to be a false alarm. And then I was in the home stretch, with only stillbirth to worry about. 

Because the risk of stillbirth increases with age, I was told early on that I would be induced at 39 weeks. The prenatal yoga teacher, who seemed to disapprove of everything about me from my choice of Baby Bjorn over another carrier (because it was what I already had) to the fact that I was not planning a home birth, shook her head and said it was a shame that the medical establishment had these rules. I said I didn't mind, and I really, really didn't. I never bought into the idea that I should become heavily invested in my own experience of the birth. I was old enough and had seen and heard enough not to be cavalier about the risks. I didn't really care if the birth wasn't perfect or peaceful or whatever the fuck all the hippies thought it should be. I just wanted everyone to live.

*

My father always thinks something terrible is going to happen; that's the way his brain is wired. Many, many other times he has been wrong. This time, he was right. I had a baby the day after I turned forty-one, and he died. The odds were in my favor, but they were less in my favor than they would have been if I were thirty-one.

Then again, I am the oldest woman in my perinatal loss book group. If age were to blame, you would expect the room to be filled with geriatric mothers. Most are in their early thirties. One, I believe, is twenty-seven. What, exactly, did she do wrong?

I just filled out an online survey that is being administered by the StarLegacy Foundation, to try to pinpoint risk factors for late stillbirth, defined as a pregnancy loss after 33 weeks. As I filled it out, I saw all of the bases they were trying to cover. No, I didn't smoke, or live in a house with a smoker. No, I didn't use drugs, or have even one drink. I was physically active before the pregnancy. I was physically active during the pregnancy. I had no medical problems before the pregnancy. I had no medical problems during the pregnancy. I could tell that I had nothing to offer them, nothing that would help them to develop their screening tools, except my age.

But age isn't a reason. I had assumed that a large part of the risk of having a child later is that many health problems, including diabetes, high blood pressure and heart disease, have begun to show up in many women by age 40. I thought that by being extremely healthy I could get around that. I also thought that if a woman's body couldn't handle the pregnancy, it would become clear at some point: her placenta would conk out or her amniotic fluid would get low, her blood pressure would rise or her cervix would collapse. I didn't think I'd find myself sitting in the perinatologist's office to hear him say, "It shouldn't have happened."

Years ago my brother told me that he wanted his wife to be done having all of their kids by the time she was thirty-two. Because he is a pediatric geneticist, and looks at statistics and calculates risk all day long, it was hard not to take him seriously. Because I had my first child at thirty-four and then conceived another six years later, it was hard not to feel judged.

After Balthazar died he surprised me by telling me that he wished I'd just get pregnant again. That he felt strongly that what happened was a one-off. A genetic disaster of some kind that wouldn't be repeated. I was amazed and touched. At that point the "I told you so's" hung in the air like tear gas, but he made me feel like someone who has had something very bad and unforeseen happen to them, not someone who was doomed from the start, not someone who had it coming.

This year three forty-one year-old women of my acquaintance have had babies. Uma Thurman had a baby. What risk did I take that hasn't been successfully taken by many, many others?

Maybe age had something to do with it. Maybe it didn't. It's just the only thing that anyone can find to blame me for.

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