Women's Bodies, Women's Wisdom (98 page)

Probably the biggest factor that contributes to this unhappiness is the fact that a woman’s fertility peak also coincides with the time when she is developing her career. And so her feminine nurturing values often are pitted against the masculine traits she must employ to get ahead at work—all of which results in enormous guilt unless she realizes that this problem is far bigger than she is. It’s why so many women eventually drop out of corporate America and start their own businesses or work from home. In 2009, women were running more than 10 million businesses with combined sales of $1.9 trillion.
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And over the past thirty years, the number of women working for themselves has doubled. Today, 35 percent of all self-employed workers are women.
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This dilemma was what drove me to start a different kind of practice back in the 1980s. There was simply no way to balance my family and my career in the corporate structure in which I worked. And for many women, this is still the case.

OUR CULTURAL INHERITANCE: PREGNANCY

Pregnancy as a “Condition” to Be Overcome

During my mother’s era, pregnant women were not expected to go outside their homes much or travel. Maternity clothes, which included that anathema, a maternity girdle, were ugly and did not enhance women’s body image. Many women lost their jobs if they became pregnant. And for women who didn’t lose their jobs, there was no formal pregnancy leave, even as late as the early 1980s. As the first physi cian in my former practice to have a pregnancy leave, I experienced some resentment from a few of my colleagues, who felt that pregnancy should not be treated the same way as a broken leg because it was, after all, a “chosen disability” over which I had some control. We’ve certainly come a long way since then, but pretending that a pregnant woman is just like everyone else and has no special needs is shortsighted and puts her and her baby’s health at risk. Our culture can’t seem to find a happy medium.

But we need to support women in their pregnancies, for their sake and for the sake of their children. Prenatal influences set the stage of a child’s state of health for her entire life. A baby’s gene expression is powerfully shaped and guided starting in utero. Thomas Verny, M.D., D.Psych., a psychiatrist and psychologist who founded the Association for Pre-and Perinatal Psychology and Health, writes, “In fact, the great weight of the scientific evidence that has emerged over the last decade demands that we re-evaluate the mental and emotional abilities of unborn children. Awake or asleep, the studies show, they are constantly tuned in to their mother’s every action, thought, and feeling. From the moment of con ception, the experience in the womb shapes the brain and lays the groundwork for personality, emotional temperament, and the power of higher thought.”
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Studies have shown, for example, that suboptimal conditions in utero set the stage for adult diseases such as high blood pressure, cancer, depression, heart disease, and diabetes.
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Therefore, pregnancy needs to be treated as a special (and crucial) time that requires a woman to proactively make some arrangements for increased rest and care, or at the very least change any negative thoughts or feelings she has about her pregnancy. Otherwise, she may experience increased fatigue, premature labor, and toxemia.
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Studies have shown that women who aren’t supported or are highly stressed in their pregnancies have a higher incidence of adverse outcomes, and so do their babies. On the other hand, even women who have high-risk pregnancies have been shown to have bigger babies and healthier outcomes if they are optimistic.
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An Obstetrician Gets Pregnant

When I became pregnant with my first child, I had recently com pleted my four-year residency training and by then had worked with hundreds of pregnant women, providing them with prenatal care, labor support, and assistance with delivery of their babies. I had been a pro ponent of natural, drug-free childbirth throughout my residency, and I was very optimistic about my own. After all, the vast majority of preg nancies end with a normal baby—I had seen the truth of this firsthand.

My attitude toward the pregnancy was one of watching an experi ment with the uterus. Wasn’t this interesting—to see the changes my body was going through! I realize now that I didn’t allow myself what I then considered the luxury of excitement and anticipation, though mine was very much a planned and wanted pregnancy.

I had learned very well how to separate my mind from my body, so I decided that I didn’t want to bond much with my baby until after the pregnancy was well along and I knew that the baby was normal—something I would be assured of only
after
he or she was born. Notice the paradox in my thinking here. I felt strongly that everything would be normal, yet I didn’t want to make such an investment “just in case.” I had watched some women furnish entire nurseries as early as their third month of pregnancy, when the risk of miscarriage is still one in six. I didn’t want to go through that kind of grief. I thought that their emotional investment was premature. Years later, I learned that babies know what’s going on in utero and hear, feel, and experience emotions long before they’re born. When their mothers are detached and not in vested emotionally, babies sense this.

Back then I didn’t realize for myself, though I taught it to my pa tients, that a woman’s process of bonding with her baby starts when her pregnancy test is positive. At this point, women usually start fanta sizing about the baby, thinking about names, and looking at baby clothes and other items. (With the advent of early ultrasound, the bonding process is now earlier and more intense than ever before.) I had never been very interested in babies and could not understand the behavior of women at baby showers—events that I could barely stand. Oohing and aahing over baby clothes had never appealed to me.

When the nurses asked me, toward the end of the pregnancy, if I had the baby’s room ready, I said, “No, I don’t even have a T-shirt.” I had no baby stuff at all, not even a diaper. My husband was completing a fellowship in orthopedics and was, as usual, busier than I was. He certainly wasn’t up for baby shopping. Although I was clear that I didn’t want a baby shower, luckily some nurse friends ignored my adamancy. Though I was mortified at the time, I was grateful later, as I didn’t have a clue as to how to go about buying baby things.

At the same time, however, instead of reading parenting guides, I trusted without question my ability to mother. Sentimentality about babies was not, in my opinion, a prerequisite for good mothering. My own mother had been a “li oness” type, with excellent instincts most of the time. She didn’t give in much to “experts”—a trait for which I’ll always be grateful.

As my baby grew, I watched my body change with interest. I learned a great deal about morning sickness, pain under the rib cage, constipation, excess gas, and heartburn. I’d heard women complain about these things for years, and now I could see why. Although my husband thought my changing body was beautiful, I wasn’t convinced. I was concerned about gaining too much weight. How was I supposed to
enjoy
a disappearing waist, puffy cheeks, and increased fat on my hips in a culture that worships quasianorexia?

I now regret that I have no pictures of myself while I was pregnant. I was amazed at my patients who showed me entire photo albums of themselves during pregnancy and delivery—they were proud and unashamed of their bodies. At the time, these women seemed like spec imens from a different planet—didn’t they get it that the culture (and I) didn’t think they looked all that great? Two decades have brought about fabulous changes in this area. Now women are justifiably proud of their “bumps.” And maternity clothes are fabulous.

During my second pregnancy, I lost my waist almost as soon as I conceived and looked pregnant almost immediately, a common event. This time, I was busier than I had been during my first pregnancy, but I remember taking more time to talk to my baby (although, since she was much more active than my first, I made a sexist assumption and called her William for nine months). Toward the end of this pregnancy, I had difficulty walking because of separation of my pubic bone, which happens so that the baby can fit through the pelvis, but by and large, it was a completely normal pregnancy. Though my belly got a lot bigger, I gained the same amount of weight— twenty-five pounds—in both pregnancies.

I once met a sophisticated professional woman in her late thirties who was in the middle of her first pregnancy. She had finally conceded that she needed to purchase some “ugly clothes” because it had be come too hard to “hide” her pregnancy and she had to modify her polished executive look of slim skirts and high heels. Her attitude that pregnancy was something to be endured, ignored, or tolerated used to be all too common—and I was guilty of it myself to a degree. The less pregnant you look, the better everyone tells you you’re doing: “Oh, you’re so little, you look great—I can hardly tell!” A prenatal-vitamin advertisement in one of the medical journals from the mid-1980s shows a very thin, tall woman who doesn’t look at all pregnant, running around taking pictures, working out at the gym, and staying late at the office. The caption reads, “Pregnant, but she won’t slow down.” The ad reminds me of my own attitude during my pregnan cies, when I ran up the hospital stairs to do C-sections or surgery. I didn’t want the pregnancies to interfere with my life in any way.

When I was pregnant with my second child and had to get up at night to go deliver babies, I was so tired that I occasionally walked into walls while I was getting dressed. (My first child, once born, didn’t sleep through the night until she was five, so I was up at night for years, whether I was on call or not.) But no one suggested that I slow down. Besides, I was
still
trying to prove myself a worthy professional—especially now that I’d had children.

Unfortunately, studies have shown that not slowing down is sometimes associated with increased health risks. A pilot study of stress and pregnancy in pregnant physicians and nurses showed that certain stress hormones (catecholamines) produced by the adrenals and other tissue under physical or mental stress increased by 58 percent (as measured in the urine) during work periods, compared with nonwork periods. The pregnant physicians’ cate-cholamine levels were also increased by 64 percent over those working non-physicians’ control groups of similar gestational age.
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Higher catecholamine levels increase cellular inflammation, which is a setup for all birth complications. Sylvia Guendelman, Ph.D., a professor of public health at the University of California, Berkeley, has shown that taking maternity leave before delivery can reduce C-section rates fourfold. Again, this is because rest and sleep are the very best ways to metabolize and also reduce secretion of stress hormones, thus decreasing cellular inflammation.
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Woman literally illustrates the ongoing life pattern of how energy
becomes matter through pregnancy, labor, and delivery.

—Caroline Myss

Program for Creating Optimal Pregnancy
and Decreased Risk of Complications

The common pathway that leads to nearly all pregnancy complications, including preeclampsia, low birth weight, and prematurity, is cellular inflammation. Happily, cellular inflammation can be curtailed in many different ways, all of which complement one another. The following program will increase your chances of a healthy pregnancy.

1. Eat a low-glycemic-index diet that keeps blood sugar stable and contains adequate protein, essential fats, and micronutrients.
(See
chapter 17
.) Such a diet will also help ensure that weight gain remains within healthy limits.

O
PTIMAL
W
EIGHT
G
AIN IN
P
REGNANCY

Weight gain in pregnancy is becoming an increasingly important factor, now that 55 percent of women between the ages of twenty and thirty-nine are overweight, with approximately half of these overweight women meeting the medical definition of obese. New guidelines released in 2009 by the Institute of Medicine and the National Research Council recommend a narrower range of weight gain during pregnancy for obese women. The new guidelines, based on World Health Organization cutoff points for body mass index (BMI) categories, recommend keeping weight gain within the following ranges for optimal health of both the baby
and
the mother: from 28 to 40 pounds for underweight women, from 25 to 35 pounds for normal-weight women, from 15 to 25 pounds for overweight women, and from 11 to 20 pounds for women who are obese.
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2. Stop smoking and avoid cigarette smoke.
Smoking deprives the fe tus of oxygen, resulting in slower growth and therefore low infant birth weight. According to the 2001 Report of the Surgeon General, smoking accounts for 20 to 30 percent of low-birth-weight infants, up to 14 percent of preterm deliveries, and about 10 percent of all infant deaths. The report also states that even healthy, full-term babies born to women who smoke may have narrowed airways and curtailed lung function. Other studies have shown that smoking during pregnancy is associated with learning disabilities and behavioral problems for the child later in life. Many of the same risks apply when partners of preg nant women smoke around them during their pregnancy.

If you think the risks are overstated because you’ve seen healthy children born to mothers who smoke, consider this story from a nonsmoking colleague: “My mother smoked all during her pregnancy and while I was growing up. I weighed 7 lbs. at birth so I was not small, and I was born after forty weeks so I was not early, and I had no learning disabilities (I graduated from college Phi Beta Kappa with high honors). But when I took up scuba diving, the instructors were amazed at how much oxygen I needed. My tank always ran low well before the others’. They said I must be running underwater to use up that much air, and the joke was that I wore Nike fins!” (For support to quit smoking, inquire if your local hospital has a smoking cessation program; see also chapter 17.)