Tag Archive: pregnancy

  1. Stamps

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    The crash woke Joseph John from his sleep. There was not one but rather several crashes, one primary, jarring thud followed by several tremulous echoes that settled into the emptiness of the blue air just before sun-up.

    Presently the chickens, somewhat recovered from the trauma, began to cluck and gulp once again. John ordered his mother to stay in bed as he tested each wall of the house for cracks. After breakfast he deemed it safe to inspect the outside of the house, at which point he and his mother discovered the object itself. It lay by the chicken coop, nestled in a moist indentation of earth: a white column of some hard smooth casing, tapered at one end and flattened at the other to form a spoonlike cavity. The thicker end was an expensive-looking blue.

    “A shell,” John’s mother suggested. She glanced fearfully skyward.

    “Not a shell,” John frowned.

    He lingered by the coop as his mother squinted at the sky with a hand over her eyes. It was clear by now, John’s mother decided, that the white column was not alive. She had seen a tortoise once, at the Duke’s fair. Its shell was hard, but pebbled with growth, not so smooth as this, and the creature had breathed slow breaths inside its pinched-up skin. The white column did not breathe. She went to touch it but John jerked her back. “Careful!”

    She crossed herself in gratitude that the new chicken coop — paid for by her dear boy’s latest weaving — had not been crushed. John was still quiet, hand on his neck.

    She kicked the white column over with a cautious, rapid cuff of her boot, and the object was still motionless. “It’s not alive, Jack,” she whispered. Its underside was white, too, smooth as an  eggshell, but now smeared with mud and grass. The object was utterly tubular, alien. No chicken could have birthed such a thing.

    Jack could make out the letter R under a glob of dirt. R. I. T. And a small circular glass window, under which rested a white paper inscribed with a light blue cross.


    Marni had picked the curtains for their sunflower print. She had imagined, standing in JoAnn Fabric with the bolt of sunflower-print curtain-cloth in her hands, that the sharp morning sunlight would soften through the yellow fabric and fill her bedroom with butter-light as the sun rose over the mountain of her husband’s back. He slept deeply, but she had always been grateful that he did not snore. His shoulders shuddered with each exhale.

    This morning, Marni had been awake for some minutes — 18, in fact. As she lay on her side, facing away from Pete, with her hand wedged in the under-pillow coolness, she rehearsed the past five minutes, as if to ensure that she had followed proper protocol. Open eyes, pull on robe, drape comforter convincingly over Pete’s back, tiptoe to bathroom, open package, urinate in cup, dip stick into cup, wait two minutes — during which, shuffle quickly back to bedside to grab cell phone and set timer for one minute 40 seconds — close bathroom door and use the flashlight function to read the sign in the yellow-tinged window. A plus sign, as it happened.

    “Oh, fuck.”

    She tied the belt of her robe and marched over to the window, which was slightly open to let in the summer air. Pete grumbled from the bed. She slid her wrist through the open slot of the window and in a quick motion, before she could doubt, she tossed the pregnancy test to the bare earth outside.


    At the sight of the cross Jack’s mother crossed herself reflexively. “God help us,” she muttered.

    “Right,” said Jack.



    “What is it, John?”

    “Riiiiiight … aid.”

    He was reading, her brilliant son. She whipped around and pinched his cheeks.

    Thus gratified she returned to the Eggshell, as she was determined to call it. The Egg of God, of Christ — for did it not bear a cross? She cried, “Joseph John, run to the friary and call them to come. Speed, Joe! Speed!” He ran along the path and she crossed herself once again as he vanished behind the hickories. “Speed, Joe! Speed!” Blessings, Blessings be upon them, a Gift of God!


    “It is out of my hands, literally out of my hands,” Marni muttered to herself in the cafeteria.

    “It’s what?” asked Carolyn Bowers from HR.

    “Nothing,” said Marni. She moved her tray down the line. Each carton on her tray reminded her of him. He could fit in each, his muscled arms draped over the Styrofoam edges, his legs splayed — relaxed, jovial even — across the sliced melon cubes. Her Jack.

    At home she prepared Pete his Scotch and settled him by the television. A quick kiss on the cheek and she had fled to the bedroom, torn open the curtains, pushed up the window. Breathless, she surveyed her sunflowers. Her eyes scanned the green flesh of their roots. As she knew it would be, the white plastic stick was gone.

    “What’s the meaning of this?” He was standing on the windowsill, panting.

    “Jack,” she said. He was glaring, though. His stubble had grown out since she’d seen him last; she imagined the tiny roughness of it on her fingertip.

    “You threw something. Right Aid.”

    ”Rite Aid. Yeah.”

    “She’s sent me to the friary.”

    “The friary? Why?” She scooped him into her palm.

    “It’s of God.”

    “The pregnancy test? Oh. The cross.”

    “You haven’t thrown anything before.”

    True, she had not. She had always been gentler, cognizant of her size. A forceful shove would kill him, a squeeze could crush his ribs. She nearly had crushed him, the first time, when he was climbing up her sunflower curtains like an oversized cockroach all those months ago — at her screech he’d fallen: a man, lithe and dark-haired with delicate eyes and a white linen shirt split to the collarbone, sitting — lounging, really — in the palm of her hand. “Hello,” he’d said.

    Now she set him on the boudoir and sat in her green-upholstered chair (an engagement gift from Pete’s mother).

    “Did you mean to crush the house?” he asked softly. His hand rested on the crescent of her thumbnail, tender. “Did you mean to attack me?”

    “I didn’t attack you.”

    “My mother, then?”

    “No, Jack! Did you even read what it said?”

    “The white stick? Right Aid. The right aid.”

    “Rite Aid. You sounded it out, then, Jack?” She abandoned her severe expression long enough to communicate, through a tiny crinkle by her eye, that she was proud of him. The hours he’d spent in her breast pocket at work had paid off. (“Manaaaaaaagggg,” he would sound out, in her ear, from his perch in the crook of her neck. “Yes, very good,” she’d whisper back, soft enough that Susan, the next cubicle over, could not hear. “Manaaaaaggggmmehhhh…

    managggmen….” a quiet, rumbling drone as he held on, tenderly, to the curve of her ear lobe, balancing on those nimble booted feet. “Management,” she finally revealed. “Management consulting, Jack. Glencorps Management Consulting. See the pear? Our logo.” And he demanded to know what a logo meant, and she told him, in tiny giggles that subsided into stern throat-clearing when Susan glanced over, perplexed).

    “I sounded it out, Miss Marni,” he replied. “Rrr rabbit Iiii ice Tttt table Eee egg Aaaa apple —”

    “I told you not to call me Miss Marni,” she said. He crossed his arms. It made her feel old, he knew that. She’d be 30 in four days, and he was what? 19? He claimed his mother couldn’t remember but for the rains that accompanied the summer of his birth. It had been months before she could convince him to call her Marnina and even longer — till December, at least — before he called her Marni. She remembered that night, the way he sleepily mumbled “Marni” as he lay in the fold of her nightgown on one of those nights when Pete was far from home.

    “I’ll call you what I please,” he said now.


    “You dropped a holy cross on my house.”

    “It’s not a cross, Jack. It’s — plastic.”


    Rehearsing the moment, Marni had never considered the complications. “I’m pregnant, Jack,” she’d say, matter-of-factly, and then demand — what? They had never really taken his assets into account. Chickens, she knew. And the cow, but he’d sold her to get the alchemist’s sunflower seed that he’d dropped in the wood, that pushed up all verdantly muscular into her sunflower patch one day.

    And here he was, unable to comprehend plastic. Her lover, whose entire body measured the length of the pregnancy test itself.

    “It’s plastic, Jack,” she explained, again. “It’s not eggshell. It’s man-made.”

    That confidence that puffed his small chest up — how she adored it, the way he’d plant his feet on her stomach and recite poetry to her, after one of their Reading sessions sequestered in the corner of her room. She was a goddess, he proclaimed. He listened to her soft descriptions of the tea shop she’d like to have one day, the stamps she’d like to collect. They spent afternoons curled in the warm square of sunlight, her body a castle around his, Jack leaning on his arm, his tiny bicep popping. Every so often he would look up, from The Cat in the Hat, to gaze at her with those limpid eyes. At the end, she’d let him pick a stamp from the glass case. They were the size of paintings in his hands, and his fingers would explore the crenellations. He’d never seen such art. When Pete’s car pulled into the driveway, she would lift him to the windowsill and watch him climb down the sunflower stalk, the stamp blowing over his shoulder like a square and colorful cape.

    “When’s the baby born?” he asked softly. His rage had subsided. He sat, arms crossed, on  her powder box.

    “November, I imagine,” she replied. She’d counted the months on her fingers.


    Pete had been very regretful to be in St. Louis for Valentine’s Day. He tried not to show it to his wife, as he didn’t want to aggravate her anxiety — the therapist had recommended “taking things slowly” after their intake session, during which Marni confessed that she had been talking to herself. Generalized anxiety disorder, the therapist nodded understandingly. He spoke with Pete a few times, separately, and urged him to “be gentle. It seems Marni’s going through a hard time.” Why, Pete could not say. So he’d left her a note on February 13, on his way to the airport, and a box of chocolates on the kitchen counter. She’d been very supportive of his trip, actually. Very affirming. It was a good sign.

    Jack told his mother he was going to the market that day, to sell his latest masterpiece. The Duke had initially thought the spiked white edges of Jack’s tapestries a bit odd, but the Duchess adored them. No one else in the country made such art! The Duke conceded that the “37” in the corner of each had a certain charm. He ordered the tapestries hung along the Great Hall, the better to impress his royal guests. Even when the Duchess pressed him, Jack wouldn’t reveal how he produced such smooth fabric, which increased the allure of his mysterious work. Even the castle weavers could not distinguish one thread from the other. Once he had brought  a tapestry of a green lady, an ancient sculpture, who held a burning torch aloft and wore a crown of daggers. The friar blessed it. “Forever,” Jack had woven into the corner. And on another, “USA First Class.” The friar declared him touched by Christ.

    On the fourteenth of the month, his mother waved goodbye and Jack sprinted to the woods, through the February cold. He wrestled up the great green stem. One mitten fell to the earth, spinning downwards in the freezing wind. In her giant bedroom, Marni had lit candles. She lay on the bed, her breasts draped in red lace. From where he stood on the windowsill, across the room from her warm dusky-shadowed skin, she could be his size.


    By the time the evening news concluded, Pete was quite anxious. Marni’s voice had crescendoed to a point, and he now heard the distinct hiccups that signaled dry sobs. He clicked off the television — CNN spiraled into a white dot — and sighed. Her Xanax was in the bathroom cabinet. Maybe he should encourage her to take some time off work, get ready for the wedding in July. Glencorps could do without her for a time, yes?

    He stood outside the bedroom door.

    “You don’t understand!” she said, her voice trembling. “I can’t do this. I meant it. I meant what I said, that you should go. You should go.”

    Oh, God. He gingerly fingered the doorknob.

    He heard the sound of a pillow being thrown. She gasped. “I’m sorry, I’m sorry. I didn’t mean to throw that.”


    “I can’t have a baby.”

    Pete’s fingers clenched. Marni—?

    A soft noise. Was the radio on? Her sniffles. That sniffle she made after  a long day at work, when her wrists were sore. Marni, Marni.

    “No, I don’t think God would—”

    A pause.

    “He can’t know.”

    A pause.

    “You must go, you must go. You mustn’t come back. No, I won’t throw anything. I won’t do anything. Take them—take them. Take the one with the Canada goose, you’ve always liked that one—” she was babbling now— “and this one, take this one for me, take it, yes, take this 42 cent, this 42 cent, this Forever. Take this Forever for me and go, go, go.”

    The sound of the lock on the glass case—and a long, soft wail from Marni—and then the window shut.


    Pete’s mother took some time to come around to the smaller wedding, which she regarded as rushed. Pete ignored her disapproving glances when the baby arrived a mere seven months later. He paraded the newborn around the maternity wing, admiring his son’s delicate features, the way he was so rounded and smooth-skinned and perfectly proportioned even if he weighed only three and a half pounds. Marni lay in bed and dutifully swallowed her antipsychotic medication. How lucky she had been treated, how lucky. How lucky they all were. A new chapter, a new life. Pete resolved not to hold her episodes against her, or to ask why, when he had been weeding the garden, he had found the sunflower patch outside the bedroom window littered with stamps.

  2. Scales and Sutures: One Doctor’s Fight For Safer Pregnancies in Obese Women

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    On a chilly evening in early March, I stepped through the doors of the Yale-New Haven Hospital. Wide-eyed and exhilarated, I was on my way to observe Dr. Katherine Campbell deliver a baby.

    I was soon to learn that this delivery was unlike ordinary ones, the deliveries often marked by the predictable but remarkable anticipation of a newborn. This delivery would shift everything I knew about medicine.

    “Today, I and a team of surgeons will deliver a baby for a woman who is obese,” Campbell explains as we head toward the patient’s hospital room. The physician-nurse team considers this patient high-risk because her obesity is a threat to not only her own life, but also that of her baby.

    After wrestling into an over-sized set of sea-green scrubs, I continue on with Campbell into the maternal-fetal medicine ward of the hospital. An energetic married mother of twins, Campbell is an obstetrician-gynecologist who treats New Haven women with high-risk pregnancies.

    She knocks on the door of the patient’s hospital room and enters. The patient is a young Latina woman, who lies listlessly across the hospital bed, clearly in pain. Her family surrounds her with worried expressions. I would soon see this woman stripped, anesthetized and limp on a delivery table with bright lights, physicians and technicians taking the place of her family members.

    Campbell, the other surgeons and I would soon be witnesses to the battle between obesity and this woman and her child’s life.

    * * *

    The only part of the patient I see is her pale belly bulging out of the opening of blue surgical drape sheets. Campbell and the other surgeons use scalpels to peel away her skin, muscle and fat to perform the cesarean section. Blood oozes over their gowns, settling into the mass of towels that are strewn on the bottom of the operating table.

    Campbell is intensely focused. As she later puts it, delivery for an obese patient can be strenuous for both doctor and mother. There is more skin and muscle tissue to cut through, and more strength is required from the surgeons to heave through in order to reach the baby.

    “We get tired,” she says.

    Obese women are also at a greater risk for blood clots during delivery, along with diabetes and hypertension, according to Campbell. Because these illnesses can produce severe complications before, during and after childbirth (hemorrhage, stroke, anesthesia problems, surgical wound infections), Campbell and her team are on their toes, waiting for warning signs such as a drop in the baby’s or mother’s heart rate.

    After a flurry of activity, a newborn baby finally emerges. The surgeons hand over the infant to the technicians to be cleaned and taken to the neonatal care unit. Because Campbell has to attend to another patient, she leaves the other surgeons in charge to suture up the incision and whisks me away. My adrenaline high dies down.

    For Campbell, this kind of surgery has become routine. As a physician, she’s made it her personal mission to combat the risks involved in obese pregnancies. But the intense, and often emotional, complexities of the problem extend far beyond the operating rooms of Yale-New Haven.

    America’s fat problem is hardly new news: Each year, obesity costs the U.S. $150 billion a year and causes 300,000 premature deaths. But obesity takes on an entirely new set of dangers for pregnant women — and with one-fifth of pregnant women in the U.S. currently obese, Campbell’s work is more urgent than ever.

    * * *

    Campbell and I meet again on a cool morning in early October at Yale-New Haven’s Primary Care Center. Once inside, she eagerly introduces me to “the team” of the day: Elizabeth Miller, Dr. Lydia Shook, Dr. Lisa Zuckerwise and Dr. Stephanie Bakaysa, a group of women aglow with enthusiasm.

    Today, there are 20 patient visits scheduled for ultrasounds and non-stress tests, a measure for heart disease in the patient. These meetings serve to keep the team members up-to-date on what diseases the women have had, what diseases they now have, and what they need to have for a healthy pregnancy.

    Dr. Bakaysa scans a patient list while placing a hot, steaming spoonful of oatmeal into her mouth. She begins to speak with a thick Boston accent, running off a series of medical conditions of the first patient of the day. “Obesity, congenital heart disease, anxiety, depression, suicide attempt, GERD …” she says, waiting for her audience to ask questions about the patient’s current and past treatment.

    “This baby is going to be very sick when it’s born,” Campbell declares abruptly. Questions and comments erupt from the other physicians and the nurse, bouncing from one person to the next. It becomes clear that Campbell is the leader of the group.

    “The practice of medicine has had to change so much to accommodate our obese patients,” Campbell later explains. She describes how, although vaginal deliveries are safer than cesarean sections, she often has to quickly decide to perform cesarean sections on obese women. Campbell and her team do these urgent cesarean sections oftentimes because of dystocia, “when the baby is unable to fit down and out the birth canal.” Obese women face a greater risk of dystocia because they have extra soft tissue in the birth canal.

    Furthermore, she says, when an obese woman is scheduled to go into the operating room, the labor and delivery team (made up of nursing, anesthesia and surgical teams) must change its protocol for many factors. They must plan for the extra time needed to transfer her into the operating room, the time it takes to position and prepare her for surgery and the time required to administer anesthesia. Most importantly, they must prepare for the added strength and concentration needed to move from making skin incisions to delivering the fetus.

    For Campbell and other doctors, when it comes to delivering the child of an obese woman, time is of the essence.

    But time can also be their biggest enemy when a baby is under distress, experiencing inconsistent breathing levels and low heart rates. In such cases, the child needs to be delivered quickly, and a slower cesarean section is dangerous. Ultimately, any wasted time in the womb could be fatal for the child.

    “We don’t want to be in a situation where we say ‘we need to deliver this baby right now,’” Campbell says.

    She contrasts this with the practice for non-obese women whose babies are undergoing similar distress during delivery. She explains the episode of a thin, 160-pound patient who insisted on having a vaginal delivery rather than a cesarean section. When the patient went into labor, the baby’s heart rate began to decelerate abnormally. Campbell and the other surgeons waited for the protocol time of half an hour so that the baby’s heart rate would stabilize and the vaginal delivery could proceed.

    It’s a luxury that doctors cannot afford for obese women.

    “If this patient had been obese, I never would have waited,” Campbell says firmly.

    * * *

    It’s 11 a.m., Campbell’s typing information into the electronic system, and I step away for a moment to get a cup of tea. On my way into the break room, I run into Katie Sullivan, who coordinates the diabetes pregnancy program in the maternal-fetal medicine department. As a nurse practitioner, Sullivan works to control and treat diabetes in obese pregnant women.

    I speak with Sullivan for a while, who tells me that when treating these obese pregnant women, “it’s all about education.” Sullivan believes, above all, that education and communication are the most effective ways to minimize risks in the pregnancy. Further, education and communication ensure that obese pregnant women not only understand their own condition, but also the dangers it poses for their future children.

    To educate patients, Sullivan is upfront: “The way you eat is the problem.”

    If this is true, what is Campbell doing to educate her patients about the risks they face? She introduces me to a patient whose case illustrates just how crucial education is in lowering the risks of obese pregnant women.

    * * *

    Don’i Caesar is the most glamorous pregnant woman I’ve ever seen. A pink bandana garnishes her head, green eye shadow glitters her eyelids and floral pants and animal print acrylics add a special touch to her ensemble. She is 34, single and 22 weeks pregnant. According to her chart, she’s also clinically obese.

    On a Tuesday in mid-October, in a room in the back of the Tompkins clinic, I sit down with Caesar to talk.

    A school bus driver in the neighboring town of Milford, Caesar had five children before this one, all boys. “My 6-year old and 3-year old were both born early,” she explains. “26 weeks for the 6-year-old, and 30 weeks for the 3-year-old. The one who came out at 26 weeks weighed two pounds.”

    A full-term baby is born anywhere from 37 to 40 weeks into the pregnancy and weighs five to eight pounds. In many ways, the startlingly low birth weight of Caesar’s child was to be expected: preterm birth is one and a half times more common in obese women than it is for normal weight women.

    Caesar tells me her children are all healthy today, but when the 26-week-old boy was born, “he couldn’t keep his body warmth.”

    This is because Caesar had preeclampsia, which occurs when a pregnant woman develops high blood pressure. Sometimes it can cause the baby to grow slowly, and it can lead to more life-threatening outcomes. Obese women have six times the risk of developing preeclampsia compared to women of normal weight.

    “They gave him a 10 percent chance to live,” she recalls. “They said that his lungs were underdeveloped. They thought he would be handicapped, but now, he doesn’t have any issues at all. The only thing is at nine months, he developed asthma.”

    I turn the focus of the conversation to Caesar herself. “Do you have any health problems?” I ask.

    “I’ve had diabetes for eight years, and high blood pressure for three years,” she tells me. “I take care of the diabetes with insulin, but now that I’m high-risk and pregnant, I can’t take anything for the blood pressure.”

    Caesar tells me the diabetes “goes up and down, but lately it’s been good.” She also says that her high blood pressure has been fine recently.

    Although I don’t know Caesar well, I want to know her answer to a critical question. What is she afraid of with this pregnancy?

    “Having another baby early,” she says quietly. “Some babies are born with a lot of complications.”

    Caesar is well informed. She tells me Campbell has been teaching her “a lot” about her condition, and she frequently uses to internet to look up information. She also tells me that she has been following Campbell’s instructions and watching what she eats, avoiding starch and bread and trying to be active.

    Caesar seems to have a thorough understanding of her situation, but does she consider herself as obese?

    “I would probably say I’m overweight,” she says.

    The clinical definitions of “obesity” and “overweight” are different. While overweight is defined as having a BMI as over 25, obesity is defined as having a BMI of over 30.

    Campbell tries to dispel these misconceptions — the definitional difference between “obese” and “overweight” — from the moment she meets a new patient. She undergoes a thorough education session with each of her obese pregnant patients at the beginning of their pregnancies. In this session, she defines obesity; explains the patient’s increased risks for diabetes, preterm birth, stillborn birth, blood clotting and wound infection; talks about optimal weight gain during pregnancy; and explains the proper eating and exercise habits.

    Despite all this education, obesity is still a tough issue to discuss.

    “Sometimes it’s hard to talk about [obesity], or patients may not have the same language. For example, Don’i may not fully understand the word ‘obese’ and think that ‘obese’ and ‘overweight’ are interchangeable,” Campbell says.

    Still Campbell says Caesar “had insight into her risks.” Most of her patients understand that their pregnancies are more complicated than other pregnancies, even though they may not like talking about it.

    “Some women embrace the necessary changes during their pregnancy and do a great job, but some women are not as organized as that,” she says. “It’s very hard to change your diet, especially if you grow up in a household where you eat a certain way.”

    But others are less successful, and many of these patients are faced with myriad economic and social factors that may limit their understanding or capacity for change, she adds. The frustration that comes from attempting to lose weight, while also naturally gaining weight from the pregnancy, leads many women to give up entirely. Furthermore, Campbell says that her obese patients often live and work around other obese people, clouding their understanding of where their weight falls on the spectrum.

    Both nurse Katie Sullivan and Campbell agree that, while they can provide the education and support needed to make these changes, it’s up to the patients to follow through.

    “Ultimately the patient makes their independent decision … whether they are going to buy the whole grain pasta or the cookies,” Campbell says. “It’s two-sided — we’re a team and they have to meet us in the middle.”

    According to Campbell, such is what makes Caesar’s case particularly encouraging. Caesar’s efforts have proven, above all, that her methods for minimizing risks of obese pregnancies are “making a visible difference” in the lives of her patients.

    * * *

    A couple of months after my conversation with Caesar, Campbell informs me that she delivered a premature baby.

    Under the lights of the operating table, Caesar was the portrait of a woman who heeded the advice of her doctor, taking every precautionary step to ensure the safe delivery of her baby. For Campbell, the preparation was as thorough as possible, with every preventative measure fulfilled. But even with all these bases covered, and then some, the severe risks of an obese pregnancy remained. This reality speaks to the larger cultural problem of obesity, one that Campbell and her team consistently must face during each day, each delivery.

    The pregnant and obese women who file into these operating and consulting rooms are soldiers; they carry their fears on their backs like a rucksack, unpacking their loads in the hearts and minds of the physicians, nurses and receptionists who wait on them every step of the way. But as Caesar shows, many are open to learning about their risks, eager to change their habits to improve their own health and the health of their future children.

    Campbell understands that for the most part, the roots of obesity are beyond her control.

    “Every patient has the potential to change,” Campbell says. “And as a physician, it’s my job to unlock that potential for my patients and let them see that they are capable of making changes to improve their health.”