Call Me Iron-Woman

INFeD doesn't look like Dr. Pepper being
pumped into my veins, but it's still thick
enough to cause a noticeable burn.

I'm not the average pregnant woman. My version of morning sickness is low-level nausea that lasts for about two weeks, peaks on one day where I can't stand the thought of eating anything and then goes away never to return again.

What hits me like a ton of bricks in my first trimester is fatigue -- extreme fatigue. I'm in bed by 8 p.m. and my body feels leaden when the alarm goes off at 6 a.m. Once I found out that my state of exhaustion was related to pregnancy and not just my post-35 self having a hard time adjusting to the time change, I didn't give my fatigue much thought.

Then it got worse. Not only was I constantly exhausted but I was having a hard time making it through the day. I had a difficult time concentrating on what normally would have been the simplest of conversations. I had difficulty standing for moderate periods of time and would get winded walking short distances. Even talking would take my breath away and leave me gasping for air as if I had just gone for a run.

I mentioned it to my doctor and a quick set of labs showed that what I was experiencing was more than just first-trimester fatigue. I was anemic -- again. But true to form, I wasn't just a little anemic. I never do anything just half-way. In one month, my total iron count had gone from 27 to -1, and my hemoglobin dropped from 11.8 to 9.4. Though 9.4 isn't quite in the danger zone (that's below 9), 11.7 is the lowest of the normal range so dropping that far that fast isn't a good thing.

This is Kim, my infusion nurse. My teeny-tiny
veins still intimidate her after four years, but
we've become friends through the adversity.

Thinking I could get ahead of the curve, I started taking a double dose of Floradix (40 mg iron), which is a food-based liquid iron supplement. It's not cheap and it tastes dreadful, sort of like rust-covered beets with a hint of berry. Oh...and it didn't work well enough to make it worth the investment. After two weeks, my iron went up to 4 and my hemoglobin to 9.5. At that rate, I'd be anemic until my third trimester.

The thing with anemia is that most people think it's no big deal. They tell you to eat steak and spinach or switch to cast-iron pans for cooking. I'm sure those things work for some people but not for me. The reality is that absorbing and storing iron has been a challenge for me every since my bowel obstruction in 2007.  And true anemia (i.e. hemoglobin level below 11.7) is not something to mess with. Anemia robs your blood cells of oxygen, causing them to shrink in size. That means your vital organs are also robbed of oxygen.

As an expectant mom, if I'm not getting the oxygen I need, guess who else isn't? Many anemics suffer heart damage and cardiac disease at a young age. Some suffer neurological disorders from having their brains starved of oxygen. And to add to the fun, there is no cure -- only treatments.

If you think Benadryl knocks you out in pill form, you
should try it in an IV. Instant spinning room and lights
out. Unfortunately, drugged sleep is not quality sleep. The
hoodie helps with the shivers/chills caused by the other meds.

Luckily, iron-deficiency anemia is fairly easy to treat. For most of the population, a diet rich in iron (eggs, beans, dark-green vegetables, etc.) and an oral iron supplement with Vitamin C and B-12 is all that's needed to boost hemoglobin once again.

And then there is me.

The best course of action when I am anemic is iron infusions. My routine of green juices and green smoothies kept me away from iron treatments for almost two years -- a record for me -- but even drinking the equivalent of pounds of greens each day wasn't enough to offset the deficit caused by growing another person in this body.

So back to the infusion center, I have gone. To date, I've had four treatments in what is likely to be a 10-week series. It's not fun, but it beats a sharp stick in the eye. This time, we're using INFeD, which only takes about two hours to administer. I still need the anti-nausea, anti-allergy, anti-rejection companion medications, which turn me into a zombie. The INFeD burns, but not as bad as Venofer did. The side effects of the iron itself are marginal. Some weeks, the night sweats are so bad, I have to change my clothes two or three times. Other weeks, I don't sweat at all. I get nighttime leg cramps, chills, odd nerve/skin sensations and weird short-term bouts of depression after the infusions. The upside is that all of that seems to be gone within 24 hours and I can resume normal life and normal activities.

As a result, I get a little stronger each week and so does the baby.

Growing a Baby is Hard Work

I am amazed by the speed of fetal development. Above, my 8-week
ultrasound. Below, three weeks later.

At 11 weeks, baby looks like a baby.

Like my first pregnancy, the most noticeable early symptoms I have are extreme fatigue. I mean, extreme. When I was pregnant with Lily, I blamed it on recovering from working on a major event at the office. This time, I thought my body was refusing to adjust to the time change. Of course, the further we got from when time changed, the less likely it seemed that was my problem.

Three pregnancy tests later, and it was clear that my exhaustion was due to my body trying to work for two.

A side note about pregnancy tests: I'm cheap. I hate the idea of paying $20 for a name-brand test that's only going to turn up negative. So, I took a friend's advice this time and picked up two tests at the dollar store. The first one was clearly positive. The second was clearly negative. This did not instill confidence in me on either test's accuracy so I broke down and sent my husband to a different store for one of those fancy-schmancy digital tests. $20 and a clear "pregnant" reading later, and I would say that the $2 spent on the first tests was my only true waste of money.

I'm fortunate that nausea isn't much of an issue for me. It's the fatigue, insomnia and constant trips to the bathroom common in the first trimester that get to me. I don't complain because my pregnancies are cakewalks compared to many women I know, but it's still an adjustment for me to realize that my energy is limited.

In hopes of helping my energy levels, I've been on the following supplement protocol since confirming my pregnancy in November:

• Rainbow Light Just Once Prenatal Vitamin (1 a day)
• 800 mcg Folic Acid (1 a day)
• 50,000 IU Vitamin D (1 a week)
• B12 monthly injection
• 60 mg Floradix liquid iron supplement 
• 2,500 mg calcium citrate (taken in 5 doses throughout the day)

My doctor runs full labs on me every month so we can be sure I'm absorbing whatever I'm taking in is being absorbed by my body and making its way to the baby.

On the exercise front, I've decided to hire a personal trainer to ensure that I can maintain my level of fitness during pregnancy without putting myself in danger. I don't think the average person would need to take such precautions but given that my abdominal hernia is still uncorrected, it seems safer to err on the side of caution.

Sequel Makes Big Splash

I can't believe it's been so long since I've posted here. Last year was a whirlwind, and it looks like 2014 is shaping up to be even more eventful. The cat has been out of the bag for some time among family and friends -- it's even Facebook official now, as evidenced by the above cover photo that I copied from my profile. We are expecting a second addition to our little family, and we couldn't be more excited.

I have wanted to be a mom for as long as I can remember, and those of you who have been following Inside Out since the beginning know that desire is what drove me to consider surgical weight loss back in 2004. Doctors told me then my weight was the cause of my infertility. I believed them and made the life-changing decision to slice and dice my insides in order to permanently end my battle with obesity and make my dream of motherhood a reality. I never thought it would take five years, a divorce and a remarriage to make it happen, but it did (All pregnancy posts can be found under the "Oh Baby" tag) . And now four years after the birth of our daughter, we find ourselves eagerly anticipating our second child.

A lot has changed in the past four years. First of all, we're older. That means, I hear the phrase "advanced maternal age" a lot at every doctor's appointment. I'm waiting for them to offer me a walker, because it's obvious the medical community hasn't caught up with the times yet and accepted that women remain fertile long after the age of 30.

That frustration aside, it's been a welcome surprise and we're having so much fun enjoying this pregnancy and Lily's reaction to the idea of being a big sister.

I'm still working out, though my routine looks a bit different. I'm quite surprised at how different this pregnancy has been from my first -- and I think a lot of the differences have to do with being in better shape than the last time around. This time, I started off more than 10 pounds lighter and a whole lot leaner. My pre-pregnancy body-fat percentage was 19.4 percent. That's a far cry from 24 percent when I was first evaluated in early 2013.

My hope is to check in here more regularly. Post-WLS pregnancy is still something that's a curiosity for a lot of pre-ops, and everyone handles it so differently. I have friends whose post-surgery pregnancies are no different than the ones they had before. I have other friends who struggle throughout their pregnancies with weight gain, weight loss, malabsorption issues, nutritional deficiencies and body-image issues. Most bariatric veterans fall somewhere in between but that's a wide spectrum to span.

My journey won't be the same as others, but it will be mine.

The Best-Laid Plans – Labor & Delivery

By my 40th week, stubbornness was no longer an option. My blood pressure, which had averaged 116/64 during my pregnancy, had begun to climb. It was 134/84 at 38 weeks and 140/90 at 39 weeks. Showing no signs of protein in my urine or blood, I didn’t have pre-eclampsia but it seemed like that was the next logical step. The day before I was admitted to the hospital, my blood pressure was 150/94 and I was showing trace amounts of protein in my urine. Official diagnosis: Pregnancy-induced hypertension, referred to by some doctors as “pre-pre-eclampsia.” I wonder if those doctors also work for the Department of Redundancy Department.

Humor aside, my need to compromise wasn’t over. My doctor explained that being induced while still relatively healthy increased my chances of a somewhat natural delivery and reduced my chances of requiring a Caesarean section. Though I come from the school of thought where “natural childbirth” is defined as allowing your body to naturally do its own thing (no induction, no painkillers, no medical intervention, etc.), I found myself compromising yet again.

Hurry up and Wait
I admitted myself into the hospital at 8 a.m. Jan. 21. Since my body was showing all the signs of being ready to deliver on its own, the doctor agreed to be less aggressive and start with prostaglandin gel. The baby’s head was right on the cervix so there was no need for pitocin-induced contractions to bring the baby lower into the pelvic outlet. We just needed to get the cervix opened up so the baby could come out.

The gel did its work on my cervix, and regular contractions began shortly thereafter. The doctor visited me around dinnertime and said that we’d most likely have a baby Friday afternoon. My night-shift nurse decided to administer another dose of gel around 8 p.m., figuring it would cause my cervix to soften overnight while I slept. We called the doula and told her that we wouldn’t need her services until the next day. None of us knew at the time what lie ahead of us.

They Don’t Call it ‘Labor’ for Nothin’
The second dose of gel threw labor into overdrive for me with intense contractions starting at 11 p.m. The most intense contractions alternated between belly and back, indicating the baby was most likely sideways with its shoulder and elbow digging into my spine.

This is when I should have called the doula, but I still believed “hard labor” wouldn’t begin until the following morning and didn’t want to disturb her. Only now do I realize that was the wrong move.

Thinking I should conserve my energy for the hard work ahead the next day, I agreed to the nurse’s offer of a small dose of Stadol to help me sleep. Bad idea. The drug hit me hard and fast, making me just this side of crazy. I swear, I haven’t felt that intoxicated since taking up the challenge of drinking 21 shots on my 21st birthday. I was out of my mind but aware enough to realize I couldn’t articulate a complete sentence and should just stay quiet.

Fear Sets In
Here is where things got a bit hairy. Brian, the doula and I were all prepared for the signs of transition, which has symptoms that mirror severe hypoglycemia. We were also prepared for the possibility that I might have a hypoglycemic episode (blood sugar dipping below 50) during labor. What we didn’t prepare for is that both could occur at the same time, and that none of us would figure it out.

Between the hypoglycemia and the Stadol, I was incoherent. I couldn’t follow simple instructions and kept having flashbacks to my bowel obstruction three years ago. I had a hard time differentiating between past and present. I was terrified and couldn’t effectively communicate.

My blood pressure was escalating, giving readings of 150/99 up to 165/ 104. The nurse suggested an epidural. I fought the idea. I had already compromised my ideal natural birth experience; I didn’t want to compromise further. Yet I couldn’t figure out how I would deliver my baby when I couldn’t even figure out where I was or speak a complete sentence to anyone around me.

Seeking a way to clear my head, I agreed to the epidural. The anesthesiologist arrived at the same time as our doula. But by that point, there was little she could do for me. Instead of giving me a full epidural, the doctor administered a bolus – a temporary dose of medication – with the intention of returning to give me more later. Once the epidural kicked in and the doula began feeding me diluted juice, the fog in my head began to clear. I wasn’t numb from the epidural – just a little tingly. I could feel my contractions but I was no longer in fear. I knew where I was and what I was doing. I was able to put the terror of the bowel obstruction behind me and focus on the task at hand. Once I had enough juice in me, I realized the uncontrollable jitters, nausea and mental fog were due to low blood sugar.

I had a moment of feeling like an epic failure at the birth process since I caved to offers of drugs, but that gave way to excited anticipation that I would soon hold my baby in my arms. The bolus began wearing off after a couple of hours and my contractions got more intense. I felt the full force of each, most concentrated in my back, and my doula and Brian coached me through relaxing as each one came and went.

Getting Down to Business
It soon became apparent that the baby would arrive quickly. The nurse called our doctor and said she was on her way, but the baby had no intention of waiting. The urge to push was overwhelming, and the nurse led me through a practice push to see how effective I would be at it. Apparently, I did a great job because her next instructions were to avoid pushing and to breathe through the contractions. Fat chance, I told her. Her response: “Tonya, I cannot deliver your baby. We have to wait for a doctor.” Then she started paging residents.

I don’t know if I said it out loud, but I didn’t care if she wanted to deliver the baby or not. As far as I was concerned, she could step aside and let Brian and the doula take over. One thing was certain, the baby was coming, and I wasn’t holding back. My doula whispered to me that I could push if I wanted. So I did.

Lily Ann was born in the next push. Her cord was around her neck but the nurse calmly took care of that without much distress. She was in my arms as the OB residents entered the room in time to clamp the cord for Brian to cut. My doctor arrived just in time to handle the cleanup, which was pretty extensive given the speed at which Lily was born. But by that point, I had Lily on my chest and I didn’t care. Brian and I were in awe of her. Such a perfect little being that we created, and I birthed into the world. The achievement -- even though it required compromises on my part -- still boggles my mind.

The Best-Laid Plans

I have waited my entire life to become a mother. Seriously, having children is something I can vividly recall looking forward to from the time I was about 6 years old. Raised as an only child, I also wanted a really big family, often telling people that I wanted 25 children. I was about 13 before I realized that it would take me about 40 years to reach that goal unless I had a string of multiple births. By the time I was in high school, I had settled on a much more manageable number: 6, and had a plan to start my family at 25.

But as we all know, planning and doing are two entirely separate things. I never planned to have trouble getting pregnant, I never planned to get divorced and I definitely didn’t plan on getting remarried in my early 30s – yet that’s what happened, and what led to me having my very first baby on Jan. 22.

Lily Ann has 10 fingers, 10 toes, and all the necessary parts to connect them. She’s practically perfect in every way. Yet her debut into this world did not come as I had planned.
Having spent my childhood, teens and early 20s as a paid caregiver for other people’s children, I had plenty of time to plan how I would raise my own. I babysat and nannied for a variety of individuals – granola-munching ex-hippies, modern yuppies, welfare moms struggling to get by, military personnel, etc. – and each experience taught me a little about what I did and didn’t want for my own children.

I knew I wanted to exclusively breastfeed, use cloth diapers and wear my baby 24/7. I also wanted natural birth, with my preference being an unassisted home birth but willing to compromise by having a midwife present.

My pre-existing health conditions – gastric bypass, bowel obstruction, abdominal hernia, anemia, reactive hypoglycemia – caused me to “risk out” when it came to a home birth, meaning that no midwife was willing to take on the risk of assisting me with a home delivery.

Thus began my first compromise as an expectant mom: I would give birth in a hospital, attended by a family practitioner and assisted by my husband and a doula (labor assistant) to serve as my advocate.

Then my health conditions took their toll on my body and on my pregnancy, leading me to more compromises: Ultrasounds and fetal monitoring multiple times per week and early maternity leave.

When it came to my 38th week and my doctor began discussing the possibility of induction, I was a bit like a spoiled child and dug in my heels. I felt that I had compromised enough during my pregnancy, and I didn’t want to budge one inch further. I wanted the natural delivery of my dreams, and I was determined to get it. But sometimes, fate forces our hand even when we want to be stubborn.

Lily Ann Makes Her Debut

Lily Ann was born at 5:12 a.m. Jan. 22, 2010. She weighed 6 pounds, 7 ounces; and measured 18.5 inches. Details to come...

40-Week Update

As my 40th week of pregnancy winds down, reality and excited anticipation are ramping up. I've been having strong contractions since last night in what seems to be proof that Skipolini's Prego Pizza really does what it promises to do. We'll see how the rest of the day goes.

Speaking of rest, that's tops on my agenda for today. They say it's important to reserve energy as much as possible during the first stage of labor to ensure you have the stamina to make it through to the end. I alternate cat naps with birthing exercises on my yoga ball. I've even managed to do a load of laundry here and there. Both Brian and I are eager to meet our little one and I have to admit that I'm eager to experience childbirth.

Though both Brian and I are techno-savvy folks, we are not planning Twitter or FB play-by-plays in the delivery room. Once we get there, we're on a mission and plan to focus on the serious work ahead of us. But until then, it's fun to text friends back and forth with our progress thus far.

I can't wait to hold our little bundle of joy in my arms!

The Final Countdown

The last few weeks have been a whirlwind of activity in our home as we make final preparations for Baby Kubo’s welcome into the world. We’ve washed loads and loads of diapers, blankets and other baby-related laundry, taking special care not to go overboard in case we have a closet full of clothes that the baby will never have a chance to wear.

I have completed my newborn diaper stash with a selection of fitteds, diaper wraps, some homemade soakers from a local woman and a variety of cloth diaper wipes. We also have some prefolds and all-in-ones for future use. I’m still waiting on some custom-made pail deodorizer and wipe solution/bum cleaner to arrive in the mail. My rapid research and foray into the world of cloth diapering is worthy of its own post one day, but today isn’t that day.

We have the co-sleeper set up in our room, and the crib was picked up and assembled today. Brian is a great expectant dad, knowing exactly what to do and when. He even made sure the car seat was properly installed today, which is not nearly as easy as it sounds. Luckily, our brother-in-law is a firefighter and father, and therefore, well educated and experienced in that sort of thing.

There’s a misconception among some couples that it’s better to be the parents of the first grandchild, but I have to say that we have benefitted greatly from the fact that Brian’s sister was the first on his side to have children. We’ve been so blessed to learn from them and their experiences over the past few months. We’ve not had to reinvent the wheel, and that’s made for a stress-free pregnancy in so many ways.

I’ve enjoyed practicing swaddle and babywearing techniques on the stuffed animals I’ve kept since childhood. Brian says I’m getting pretty good at it. Of course, we’re both aware that it’s easy to be good on inanimate objects. But at least I’m getting the basics mastered. Next step: Add squirmy newborn.

I’m just beginning my 40th week of pregnancy and am eagerly anticipating signs of labor. As I’ve said before, I’m in no rush to end the experience but I am ready to meet the baby now. We’ve waited a long time to get to this point and it’s exciting to see the end in sight, even if that end is merely the beginning to a whole new experience.

38-Week Update

It’s official, I am almost 10 months pregnant. It’s not until you’re pregnant that you realize it’s not a nine-month experience. I’m surprised more people don’t do the math and realize that 40 weeks equals 10 months. Then again, it’s not uncommon to deliver a baby between 36 weeks and 41 weeks so everyone’s journey really is relative.

For me, it’s been a fast few months. Even planning our wedding didn’t go this quickly in my mind.

It’s hard to believe that just a few weeks ago, I was at risk of pre-term labor and had to make some major adjustments in that arena. Now it appears, it’s all smooth sailing. My belly has grown. The baby has grown. And I have learned the art of taking it easy, which I would have previously told you was impossible.

As of our latest ultrasound, the baby is over 6 lbs and appears to be in position to make his/her debut. We have gotten some fun photos, thanks to a very patient ultrasound technician. Baby Kubo has never felt photogenic and has made most techs go insane as they attempt in vain to capture cutesy keepsake photos. My favorite photo from our last appointment is that of the baby's foot, which at 3 inches long, looks a lot like Brian's.

I’m not in a rush to end my pregnancy. I really enjoy being pregnant and having this little person moving and growing inside of me. At the same time, I look forward to meeting him or her, learning the baby’s personality and seeing how Brian’s and my genes have meshed. We hope the baby gets the best of both of us instead of the worst, but I imagine he/she will have a little of both. I'm also interested to see how accurate the ultrasounds have been. Does the baby have as much hair as it seems? Are the size estimates true or is that "plus/minus 1 pound" margin of error more true to form?

As I look over the photos I’ve been posting, I’m glad we took the time to document the past few months. It’s hard for me right now to remember life before I had a rotund belly. It’s hard to picture my pre-pregnancy life at all. It feels as if I’ve always been carrying around this little being who has required me to alter my eating and lifestyle habits. I’m going to miss this feeling when it’s gone.

Happy New Year!

2010 is officially in full swing, and I am in awe of what's ahead of me this year. I know 2009 was a downer for many. The economy affected many I know through the loss of jobs, loss of homes, loss of credit and loss of loved ones.

A good friend of mine who had a pretty rotten 2009 admitted that she had a rough time when writing out her Christmas cards last year, because the only thing that went well for her family that year was in the area of finances.

"Given what's happened to everyone else in 2009, that's just not the sort of thing you can brag about," she said. So her Christmas cards were general and basic with hopes for 2010 to be better all around.

Brian and I were discussing 2009 over the weekend. We know it was a tough year for the nation in general. But even though we faced our own challenges over the year, it's hard for us to deny the incredible blessings we experienced throughout the year:

• We were married in a fairytale ceremony in the company of our dearest friends and relatives.
• I had the once-in-a-lifetime experience of coordinating media when First Lady Michelle Obama visited UC Merced.
• We discovered I was pregnant, despite being told such a feat was impossible without medical intervention.
• Brian was cast as Cogsworth in Playhouse Merced's production of "Beauty and the Beast," one of the best shows he's been in.

The year was far from perfect, but we really can't complain. We survived it relatively unscathed. And now we're looking ahead to 2010. This is going to be an equally big year for us, with a baby coming, increased involvement in our church and our first wedding anniversary all in the next few months.

I'm not doing resolutions this year but I do have goals. My primary goal is to enjoy life and my family. I love leading a busy life, but priorities are the key to harmony. When everything is urgent, nothing is important. I want to make sure I spend this year putting first things first. Everything else will fall into place after that.

No Rest for the Weary

A full night of sleep has evaded me lately. I'm sleeping well for the most part. I manage to go to bed at a decent hour and wake up rested, but I'm not sleeping through the night.

I have some of the most vivid and wild baby dreams. The most recent one is that I woke up with a baby girl in my arms. Brian looked like he had just finished a marathon but I couldn't figure out where the baby had come from. Apparently, I had delivered her in my sleep. Brian, on the other hand, had been awake during the whole experience and gave me the play-by-play.

Given what I know about the birth experience, I doubt that was a premonition. Most likely, it was just wishful thinking.

Brian says he's also had vivid, unusual dreams. So it seems we both are up and down throughout various times of the night. Suppose we can count this as practice for when the baby arrives. At least we can't say we don't know what it's like to be up every two hours.

36-Week Update

It's hard to believe that I'm in the home stretch of my pregnancy. It feels like just yesterday when I was bowled over by the news that I was expecting.

Brian and I have had a lot of fun over the past nine months, planning and preparing for our family to grow. Just married in March, we've celebrated a lot of firsts as a married couple and lasts as a childless couple. It's been a great time all around.

Now that I'm officially nine months pregnant, there's a collective sense of relief in our home. Though we both hope Baby Kubo holds out until his/her expected arrival date of Jan. 22, we know that s/he can safely enter the world at any point now.

Our twice-weekly doctor visits have been going well, with lots of visible movement and good variation of heart rate. We had a mild contraction during our last visit, according to the monitor. I didn't feel a thing, but the fetal monitor picked it up. If I could figure out how to make it through labor without noticing my contractions, I think I might have it made.

The most exciting thing for me, however, has been the improvement in my lab results. In just one month, my hemoglobin has jumped from 8.5 to 10.5 -- proof that my anemia was caused by both iron and B12 deficiencies.

It's amazing that it's taken almost five years after having gastric-bypass surgery for me to find a doctor willing to give me B12 injections, but I'm glad I have. Those weekly B12 shots have really turned things around for me, increasing my stamina and energy, in addition to raising my hemoglobin. Double-digit hemoglobin is important. Anemics aren't just at risk for pre-term labor, but many require blood transfusions after childbirth. Not a procedure I'm interested in if I can avoid it.

What is "Ready"?
People keep asking Brian and me if we're ready for the baby yet. We're definitely ready to meet the baby, to learn his/her personality and to have the reality of parenthood fully confront us. But I find that most people aren't really curious about the emotional side of parental readiness. When they ask that question, what they really want to know is whether the nursery is in order and if we have all the baby's stuff washed and ready for action.

The answer to that is short and sweet: Nope. Not even close.

There's a lot we'd love to do in the house before Baby Kubo makes his/her debut. There are a few things we'd still like to buy. But we also know that babies are very simple creatures with simple needs for the first few months of life. They don't need skillfully decorated nurseries or perfectly arranged outfits when they come home from the hospital. They need love, attention, food and warmth. That we have covered -- everything else is just icing on the cake, so to speak.

So from now on, when people ask if we're ready, I think my answer will be short and to the point. We're as ready as we'll ever be -- and we'll adjust as needed. Baby Kubo probably won't know the difference between ready and not, and I'm pretty sure s/he won't remember much about the first year. I think we can safely relax, knowing that as long as we cover the basic needs, we're doing everything Baby Kubo expects and requires.

Feeling Photogenic

Ever since I was a child, I have looked forward to the experience of being pregnant. As I've said before, it can be the most perfect time in a woman's life. When else is it socially acceptable to stick out your belly, eat as much of whatever you want and be treated like Cleopatra by all who surround you?

My pregnancy experience, however, has not matched my childhood predictions. I have enjoyed the experience with minimal unpleasant side effects, but I'm not "big as a house" like I thought I'd be. In fact, most people enjoy telling me that I "don't even look pregnant," which is irritating, because I could swear that my belly doesn't usually extend past my bustline -- but maybe I'm delusional.

For the most part, I've been able to accept that my pregnancy journey is specific to me and enjoy the process. Though I was unable to feel the baby move until much later in my pregnancy than most, I still enjoy the quiet moments in the morning and right before bed when the baby is most active and I can feel the flutters and flips inside my belly. I love guessing which body part is where and seeing how the baby reacts to external stimulus. The baby loves kisses from Daddy and the loud music at church. The baby is not so impressed by the fetal monitor at the doctor's office.

Of course, I realize all of these interpretations are guesswork. I assume the baby enjoys something when s/he is more active in response. I assume the baby doesn't enjoy something when s/he kicks or punches something inside me that hurts. Even if I'm wrong, it's fun to guess.

Where I've had a hard time adjusting, though, has been in the case of photography. Being that I've always envisioned having this ginormous, round pregnant belly, it's been really hard for me to get excited about taking photos. I had always wanted a professional maternity shoot, but I kept holding off on scheduling it because I wanted to wait until I "popped," which moms I knew swore would happen "any day now."

When I looked at the calendar last week and realized that "any day now" could also bring a baby, I accepted that it was now or never. At first, I figured I'd just have a quick photo taken of Brian and me for our Christmas cards and to mark the memory of our first Christmas as a married couple and last Christmas without children.

A brief conversation with one of Brian's former coworkers led us to a Saturday morning photo shoot in a local park. The quantifiable end result is a collection of photos by Donavan Garrison that will serve well to document the upcoming birth of our first child and also ensure friends and family get a Christmas card from us before Valentine's Day.

But the end result that can be seen or measured is my full acceptance that I am who I am, and regardless of how that compares to the others in the world, it's perfect and normal for me. I'm thankful for the experience Donavan gave us that allowed me to embrace my figure for what it is and to truly get excited about meeting the little person growing inside of me.

Showered with Love

Cake made by Mary Reis of Hilmar; lavender-scented bath salts made by the fabulous Amber Tucker.

I have the most incredible bunch of friends and relatives, all of whom have blessed me beyond belief for my entire life. Having them come together for my recent baby shower was so much fun, I can hardly stand it.

Brian's family hosted a shower for us on Thanksgiving, which was a great way to remind us to be so grateful for the blessing we're about to receive in the form of our first child. Then my best friend, Amber, hosted a shower at the beginning of the month that was absolutely perfect. We had an amazing mix of people present: Former coworkers from the Tracy Press, college friends, UC Merced friends and colleagues, Mary Kay friends, family, and just about everyone else I've met along the way in life.

We had amazing food. Amber's spinach quiche (find recipe in Comfort Foods post) was devoured in about a minute. My mother made sure we had an impressive selection of Hilmar cheese with crackers. For those who didn't need to watch their sugar intake, Amber also made a sausage-and-egg casserole, cheesecake bites, macadamia nut coffee cake and baked french toast casserole. We had cake, too!

The best part of the day, though, was being able to see people I hadn't seen in ages. My AXiD little sis Amy Lee was there with her 15-month-old twin boys. I hadn't seen Amy since she got married! Her boys are so adorable. My college roommate, bridesmaid and all-around-amazing friend Allison Buck brought her mom, Claudia, who I hadn't been able to see since Allie married Brook in Riverside close to a decade ago (boy, do I feel old!).

Nothing compares to the feeling of love and joy you get when surrounded by an enclave of women who love and adore you -- and the advice they each shared was invaluable.

I've been too way too many baby showers that have morphed into parenting gripe fests or worse, labor horror story share-a-thons. Mine was far from that. I was surrounded by a room full of women who focused on sharing positive tales with me.

Here's a brief round-up of my fave bits of wisdom:

• Soothies are the best pacifiers ever! -- Amy Lee
• Don't get caught up in perfection; what works for you is perfect for you -- Amber Tucker
• Breastfeeding is cheap and easy; give it a try -- Hannah Chevalier
• When all else fails, just love your baby -- Stacy Escobedo
• Give God thanks daily -- Edna Overstreet
• BumGenius Organic Bamboo Diapers are great -- Wendy Sparks (via Allison Buck)
• Get rid of all the chemicals in your home; they aren't good for you or the baby -- Aunt Bina
• You're going to be the best mom ever -- Debbie Luiz (would you expect anything different from my own mother?)

It's exciting to know that I have such a phenomenal network of women to rely on when my little one makes his/her entrance into the world. We're already so blessed!

33-Week Update

33 Weeks -- Full face shot

I had been feeling great during my pregnancy until a new phenomena developed, which I labeled "Good News Tuesday; Bad News Friday." The doctor had taken to monitoring me twice a week and requesting ultrasounds weekly to monitor the growth of the baby and the maturity of my placenta.

Apparently, us WLS women don't have the nutritional reserves to grow placentas with staying power so the doc wanted to be very careful and watch me closely. No big deal. "Watching closely" involves me seeing the baby more during ultrasounds and spending close to an hour hearing its heart beat while hooked up to a monitor. Sounds like fun to this expectant mom!

But then I realized something aggravating: The schedule I was one for these appointments meant that my doc would see me on Tuesday with no new information and then see me on Friday after receiving the ultrasound results. So, I'd walk in on Tuesday to good news: Everything looks great; you're amazing. And then on Friday, it would be time for bad news: Baby isn't growing; your placenta is getting old; hope you're not attached to working much longer.

I was taken off work at the beginning of the month because the baby was assumed to be super-small. Some women with this problem have seen radical growth once they stop working their office jobs, because stress plays a big role in baby development.

It was unexpected, but I've been able to roll with it for the good of the baby. Then came suggestions that I not drive too far from where we live and that I sleep more. If you know me, you know I'm not much of a sleeper when I'm burning the candle at both ends -- much less when I'm not.

Ultimately, all of this impresses one major fact upon both Brian and me: We are not in control here.

When it comes down to it, you can try to align the planets perfectly in a multitude of ways, but when you are expecting a baby, that little, tiny baby is the world's tiniest dictator -- in control of every minute detail. And if you want to maintain your sanity, you'll realize that, accept that, and move on. So my mantra of late has been to accept that which I can't control and focus on that which I can. Sounds simple enough. Hard to put in practice, though.

28-Week Update

Where has the time gone? I realized when I had my OB appointment that we never got around to taking profile photos of me during the second month. Though I still get told I don't look anywhere near seven months pregnant, you can definitely see that my belly has expanded since the last in-home photo shoot!

It's amazing to me to document the changes in my body -- just as amazing as it was when I documented my weight loss back in 2005 when this blog was published as a series of columns in the Tracy Press.

It can be challenging at times to see the scale drift in the opposite direction, especially when I've spent the last 4-plus years focused on losing and maintaining weight loss. However, the knowledge that I am growing and nurturing a baby prevents me from feeling as if I'm just eating my way past the tool of gastric bypass.

Speaking of eating, I've been ravenous for the last week. I can't seem to get enough to eat. I'm learning quickly how to balance that by eating small meals throughout the day. Not only does that help manage my hypoglycemia but it also prevents me from biting the heads off of my coworkers during hunger-induced temper tantrums. Seems everyone benefits from making sure I'm well fed.

I have to say that I am really happy with my choice of medical provider. Not only is she local, but she truly understands the risks associated with my medical history and current pregnancy. She's not an alarmist, but she's definitely thorough. She orders a full metabolic panel every other month to check my nutrient absorption. So far, iron and vitamin D have been my only deficiencies. I'm hoping that my hemoglobin is on the rise, given the two iron supplements and liquid cholorophyll I've been taking for the past 60 days. If there's no sign of improvement, we'll have to figure something else out.

She's also testing my blood sugar level. Because of having gastric bypass and reactive hypoglycemia, I can't have the glucose-tolerance test that most pregnant women go through to test for gestational diabetes. Other doctors I had interviewed felt this minor detail meant I had to be labeled high-risk throughout my pregnancy and put on bed rest (not sure what bed rest can do for blood sugar but it's an interesting concept). Dr. Schill was the only one who didn't consider it that big of a concern and felt that careful monitoring would be sufficient. It feels good to be treated like a normal patient vs. a surgically altered freak.

As I await my lab results, I'm enjoying the feeling of the baby's movements. At 22 weeks, I just felts taps and pokes. Now I can discern the difference between kicks/punches and flips/twists. It's definitely a miraculous experience. And to think that I never thought it would be possible. Boy, am I glad modern medicine doesn't know everything!

Au Naturale: A New Kind of Supplement

One of the many perks of having a doula, or labor assistant, care for you before, during and after the birth of your child is that you become aware of options that exist outside of the mainstream.

Our first meeting with Dawn was a little on the daunting side. As a lay midwife, it’s her job to get a sense of my medical history in order to figure out the best way to support me in the birth experience of my choice and also to be prepared for potential complications that may arise.

I’m not sure if all of Dawn’s consultations are over two hours, but mine was. It took me a solid hour just to explain my medical history and laundry list of current ailments. I felt like one of those retirees who shares their trials and tribulations with anyone who shows the poor judgment of asking, “how are you today?” To her credit, though, Dawn did a great job of keeping a straight face.

We discussed my previous surgeries and the residual effects of each. I explained reactive hypoglycemia and my desire to labor at home for as long as possible because I’m concerned that the hospital’s protocol on limiting birthing women to ice chips and minimal clear liquids will put me at risk of an episode that could lead to an unnecessary C-section. We discussed my anemia, my vitamin D deficiency, my body’s tendency to retain water, my hospital anxiety stemming from my last surgical experience and just about everything in between.

We spent a lot of time discussing how I manage my hypoglycemia and which foods work at which stages. She encouraged us to make sure the fridge is stocked with all of those items by my third trimester so we can be prepared. She also gave us a variety of natural remedies to consider taking during the pregnancy to improve my outcome.

Chlorophyll for Anemia
For my anemia, she recommended liquid chlorophyll. Natural health experts believe chlorophyll to be molecularly identical to hemoglobin with the exception of the center atom. In hemoglobin, the center atom is iron; in chlorophyll, it’s magnesium. The thought is that this means chlorophyll can actually help do the job of hemoglobin (important for women like me who don’t have enough). The side effect of this is more energy and general well-being. Chlorophyll is also known to detoxify blood and increase the number of red blood cells in the body. It’s also known as a natural internal deodorant.

I found a moderately priced liquid chlorophyll supplement at Raley’s in the natural foods section over the weekend. I started taking it on Sunday and have faithfully drank two tablespoons a day ever since.

I expected it to taste similar to wheatgrass juice, which is known to be high in chlorophyll, iron and vitamin K. I like wheatgrass juice a lot, but jaunting to Jamba Juice every morning is neither practical nor cost effective. This bottled supplement from Raley’s seemed like a decent compromise.

I bought the “natural flavor” (mint is also available), and I also bought a bottle of acai juice as a chaser just in case it was dreadful. Initially, the chlorophyll is very sweet and finishes with a flavor I can only describe as “mud.” It’s like you just chowed down on some grass – dirt and all. You’re even left with bright-green lips as a reminder. The acai juice definitely helps afterward. All in all, though, it’s not the worst thing in the world. I have found it tastes better cold than at room temperature, and I’ve survived so far.

I have noticed increased energy during the day and possibly some reduced fluid retention. I feel different enough to continue taking it. We’ll see how my next set of labs come out to determine whether it’s truly effective in improving hemoglobin and red blood cell counts.

Red Raspberry Leaf Tea for Uterine Toning
Vitamin D deficiency is a side effect of the malabsorptive nature of the type of gastric-bypass surgery I had in 2005. Recently, scientists have linked vitamin D deficiency with an increased occurrence of emergency C-sections. Though no research has yet been done into why vitamin D deficiency can result in C-section births, the current hypothesis is that it’s due to muscle weakness.

Vitamin D is known to promote muscle strength. The uterus is one giant muscle that must contract repeatedly in order to bring a baby into the world the ol’ fashioned way. If a woman doesn’t have enough vitamin D, it’s possible she won’t have the uterine strength or stamina to birth a baby naturally.

Red raspberry leaf (commonly consumed as a tea) is known to strengthen the uterus. It’s often found as a primary ingredient in herbal teas marketed to expectant women. I found a box of 24 tea bags at the Vitamin Shoppe for $4.99 – lower than what prenatal teas typically cost (about $6 for 14-16 tea bags). I now drink a mug of red raspberry leaf tea each morning. It doesn’t taste bad, but I wouldn’t call it delectable either. It is what it is.

Dandelion Tea for Liver Health
Detoxifying one’s body is always a good idea, but when you’re pregnant, your body has to handle a lot of extra waste until the baby develops organs stronger enough to supports its own systems. That’s one reason pregnant women retain excess fluid.

Dandelion tea is known to be a strong detoxifier, particularly for the liver. I’m now drinking a cup a day of this (right after the raspberry leaf tea) as well. It’s not pleasant, but I’ve survived so far. I can’t describe the taste other than to say it’s not good. But I found it at the Vitamin Shoppe for an affordable price, and if it truly works, I would say it’s worthwhile.

So far, that’s the extent of the supplements I’ve tried. Dawn also recommended alfalfa, garlic and fish oil, but I can only take so many pills a day before I’m not longer able to fit food in my tummy. And the available pill space is currently taken up by my prenatal vitamins and iron supplements. So we’ll see how the next few weeks go, and then proceed from there.

Seeking Assistance

Brian and I met with a doula last week. We were referred to her by my sister-in-law, who used her services when she had our nephew in April. Walking in, our plan was to take Bradley classes from the doula but pass on her other services.

It may be hard for longtime readers of this blog to believe, but I am typically private when it comes to medical stuff. I don't like people to see me when I am sick or in pain. I don't like an audience when I'm not up to par. I don't like hospital visitors or even visitors to my home when I'm recovering. Given what I have heard about childbirth, it seemed that I wouldn't want more people than absolutely necessary in the delivery room. Truth be told, I wouldn't even have Brian there if I thought I could get away with it. I'd just retreat to a cave and do it all myself.

Brian isn't budging on being in the delivery room so I'm warming up to the idea. Having a doula, or childbirth assistant, on the other hand, seemed to be unnecessary and smothering. But then I met Dawn, and I began to see the benefit of having an experienced professional join us in the delivery room.

Highly Recommended
Dawn Brown is the most experienced doula I have heard of in the Merced area. She comes highly recommended by midwives and former clients. And in her line of work, reputation is everything. Since doulas are lay people, they only have their reputation to support them. They aren't like doctors who can hide behind insurance coverage or hospital contracts. If they don't meet their clients' needs, doulas quickly find themselves out of work.

My sister-in-law describes Dawn as "very earth mother." My best friend would say she's "crunchy," meaning she's a granola muncher. I would describe her as a gentle spirit who seems more concerned with the desires of expectant moms and dads than her own. I like that a lot.

Dawn definitely has her own belief system, and it's apparent with one look around her home. She homeschools her children, practices attachment parenting and I would almost guarantee she still share a bed with her kids from time to time. But in our consultation with her, it was all about us -- and I like that a whole lot.

Dawn's way of working is to ensure that each couple gets the labor experience of their dreams -- whether that means all natural all the way, medicated and artificially assisted, or somewhere in between.

When seeing medical professionals, it's all about them -- all about hospital protocol, insurance requirements, policies and procedures. Only after those bases are covered do you, the consumer (or patient) count. It's a sad fact of life in current society. Sad but true.

Full-Service
After meeting with Dawn for about two hours, both Brian and I saw the value in the service she provides. First and foremost, we get her focused attention. At my OB appointments, I tend to wait for an hour to see my doctor for 10 minutes. With Dawn, we are her only priority at that time. She also makes house calls. I might not be so hesitant to visit doctors if they were all as willing to come to my home as she is. It's a nice benefit.

We'll meet with Dawn at least four times before the baby is born. During visits, she'll do her own basic OB exam to get a sense of what is normal for my body (vital signs, fetal growth, fetal heart beat, etc.) and also for our baby. This will enable her to better assess me when I'm in childbirth.

Dawn, a longtime Bradley Method instructor, will also handle our childbirth preparation classes. Though no longer a certified Bradley instructor, Dawn has years of experience that I think will come in handy as we make our plans for natural childbirth.

Dawn is also available to us 24/7 -- for questions, concerns or even just to talk. Can you imagine calling your doctor in the midst of a hormonal breakdown? Not likely that he/she would even take your call.

When the time comes that I feel I'm in labor, Dawn will come to our home and help me labor in the privacy of my own home until the time comes for me to go to the hospital. More time at home means less anxiety for me. My last hospital experience was not a good one. I don't look forward to being on the receiving end of hospital care again. But I also know that in this instance, it's necessary. I am not a good candidate for home birthing. It's in both mine and the baby's best interests to be in a hospital, but limiting my time in the hospital will enable me to stay calm longer, I think.

Worth Every Penny
Most doulas charge a flat fee for their services. Dawn's is $1,000. Sounds steep at first, but when you think about it, it's not much at all. Bradley classes cost around $350. Though Dawn is not Bradley certified any longer, you can't tell me all that knowledge suddenly fell out of her ear just because she didn't renew a piece of paper. Using her services means we don't need to seek out private childbirth preparation classes. Since she's on call 24/7, we can pick up the phone anytime something doesn't seem right and get immediate answers without having to trudge into the hospital ER on a fact-finding mission that might end in a diagnosis of "it's nothing" or "that's just false labor." ER visits cost about $100 each under my insurance plan if I'm not admitted to the hospital. Just in the final stages of my pregnancy alone, it's easy to see how fast that could add up.

So, though we originally met with Dawn for a small portion of the services she provides, we ended up contracting with her for full care. I'm excited at the prospect of working with her, and so is Brian. I think we're a good match, and I think she's going to enrich our labor and delivery experience -- something that is very important to me.

21 Weeks and Counting

5 months

4 months

3 months

It's hard to believe I'm halfway through my pregnancy already. Seems like only yesterday that I was staring at a digital pregnancy test in disbelief, waiting for "NOT" to appear in front of the word "Pregnant."

Now we're halfway through and talking baby registry, home repairs, childbirth education and everything else under the sun that is baby-related.

I had my 5-month check-up Monday, and the baby seems to be perfectly normal (at least until he/she is born and takes on personality traits from his/her parents -- at least we know we're weird). The baby's heartbeat is strong, and he/she appears to be growing at a perfectly normal weight.

I, on the other hand, have a few pregnancy-related challenges that I'm working to overcome. My doctor is diligent is monitoring my vitamin levels. I'm still deficient in Vitamin D, but my anemia has become more aggressive.

It's funny. Between WLS and the bowel obstruction, I've learned a lot about reading doctors. There's a definite difference between getting a call from the doc's nurse who reports, "Umm...looks like your iron is a little low," and getting a call from the doc herself saying, "Uhh...yeah...I just received your lab results and your iron is quite low. Did you run out of vitamins?"

The silence on the other end of the line was deafening when I said that no, I had plenty of vitamins, was still taking them and didn't realize there was a problem.

So now, I'm on an even bigger cocktail of supplements. I'm combining chewable and tablet prenatal supplements, and combining my SeVate with a standard ferrous sulfate supplement. I'm learning to disperse my doses throughout the day to avoid stomach upset and to improve the opportunity for absorption, but it's a work in progress.

Brian is a great helper when it comes to reminding me. This "prego brain" phenomenon I keep hearing about makes it easy for me to lose track of which pills to take and when. But I'm getting better.

My other no-so-fun pregnancy side effect is water retention. My legs, ankles and feet are swelling to the size of tree trunks! Despite a dear friend's assurances that tree trunks are considered sexy in some countries, it's disturbing to watch one's formerly cute feet get bloated and distorted by excess fluid.

The doctor assures me there is nothing to worry about. My blood pressure is steady around 110/67 so preeclampsia isn't a concern. She says that this is just how my body is reacting to its newest resident. That's the upside. The downside is that there isn't much that can be done about it. Reducing sodium during pregnancy has been proven detrimental to expectant mothers so that's out. Mint Bliss lotion helps the swelling subside overnight, but it never goes away completely.


The doc's best advice? Elevate whenever possible. Lie down whenever possible. Drink lots of fluid. Avoid long car rides or any activity that requires sitting for prolonged periods of time.

Eventually, the swelling is likely to impede mobility, so we're already planning for my medical leave to take place in early December instead of early January.

I'm trying to look at the extra time off as an early Christmas present -- more time to plan/prepare for Baby Kubo's arrival. I imagine by that time, I'll probably relish the break and the excuse to loaf about all day.

We shall see.

Reality vs. Expectation

I have a confession to make: Pregnancy is not what I expected.

I know every pregnancy is different. Some women throw up for nine months straight while others never even feel queasy. Some women get crampy and irritable while others glow and have the best time of their lives. "Normal" is relative to your personal experience.

I have always viewed myself as progressive and modern. In the years that I was dreaming of being pregnant and trying to get pregnant, I had great fantasies of what I would do and how I would act when my dreams came true.

As someone who used to be the size of a small house, I always looked as pregnancy as the one time to be able to let go. I figured I would embrace my curves, the roundness that is supposed to be there. Nobody lectures pregnant women on what or how much they eat. It's the one time in a woman's life when a protruding belly is a good thing and not an object of scorn.

I always envisioned myself to be the girl in the form-fitting clothes, even baring a little taut rotund midriff now and then. Naked preggo bellies are so cute to me!

Alas, my dreams have not matched my reality. Instead of rockin' my baby bump, I feel more like the girl immortalized in the "Rockin' the Beer Gut" song that I hate so much. I don't feel voluptuous and curvaceous. I feel frumpy and awkward.

I have cute maternity clothes, but they are all far from the sexy styles of what celebs like Gwen Stefani and Nicole Ritchie have worn in their prenatal stages.

I'm not miserable by any stretch of the imagination. After all, my only experience with morning sickness was about 10 days of feeling like I was on a boat in stormy waters. I don't have half of the maladies that other pregnant women get. Pregnancy is truly an enjoyable experience for me. I feel like myself -- only better.

I just don't feel like a sex symbol. And that's perfectly OK. It's not what I expected, but it's who I am right now. I might feel differently as the pregnancy progresses or during my next pregnancy. But for right now, I'm just learning to accept the changes my body is undergoing and embracing my form as it emerges.