Filed under: The Baby Diaries | Tags: American doctors, American medicine, baby blues, birth, British doctors, depression, French doctors, French medicine, insomnia, new infant, post partum, Susan Sontag
Depression is melancholy minus its charms…Susan Sontag
Having a baby triggers a heap of emotions both good and bad – pleasure, joy, enthusiasm, apprehension, anxiety, and, often, depression. Yes, that’s right. I’m daring to talk about the elephant in the room. The one that Brits don’t generally like to talk about and Americans talk too much about. When Brits talk about depression, their views often reflect their ignorance and outdated myths (or repression): it’s a sign of “weakness,” it’s self-indulgent, and one needs to keep their “chin up,” be positive, and all that. One thoughtless English ‘friend’ recently said to me, “Oh, I simply don’t have the luxury of depression!”
Regarding depression following the birth of a baby, rest assured it’s a complication of birth, not narcissism or an inadequacy on the part of the mother. It can happen a week or two after giving birth, it can happen a year after giving birth, or it can happen after nursing stops. Experts no longer regard depression’s cause as being purely physical, circumstantial, or emotional, but, rather, a combination of reasons. Physically speaking, after a woman gives birth, there’s a dramatic drop in hormones (estrogen and progesterone), and other hormones produced by the thyroid also drop sharply. There are changes in blood volume and pressure. Changes to the metabolism and the immune system. The mother’s lifestyle and emotional circumstances also can prompt depression. Perhaps the baby is demanding. Maybe there are other siblings. Perhaps she has difficulty breast-feeding. Or there’s a lack of personal and practical support. Her body changes, she feels less attractive. She struggles with her sense of identity as she feels a loss of control and independence.
The most common form of depression is called “the baby blues.” This lasts for a week or two, and causes the new mom to be moody, anxious, irritable, tearful, and unable to concentrate (though what new mother doesn’t feel this?). The second type is called “postpartum depression.” Symptoms include a loss of appetite, insomnia, intense irritability and anger. Overwhelming fatigue. No interest in sex. No sense of joy in life. Feelings of shame, guilt, and inadequacy. Severe mood swings. Withdrawal from friends and family. Thoughts of harming oneself or one’s baby. Difficulty bonding with the baby. The third type, and the most severe type of postpartum depression, is called “Postpartum Psychosis.” Symptoms include confusion, disorientation, hallucinations, delusions, paranoia, and serious consideration about harming yourself or your baby.
As mentioned, there has historically been a stigma to speaking about depression, so one is understandably reluctant and embarrassed to talk about it. But it is important for your own health, as well as your baby’s health, to talk to your doctor (in the first instance) about any combination of the aforementioned symptoms you may feel. Left untreated, each of these depressions can become more severe in nature and can lead to a chronic depressive disorder. Even when they’re treated, there’s an increase in a woman’s risk for future episodes of severe depression. Also, left untreated, the depression will affect your child negatively: studies show that the children of mothers with untreated postpartum depression have an increased likelihood of developing behavioral problems, such as sleeping and eating disorders, hyperactivity, temper tantrums, delays in learning development, language, and socialization skills.
The good news? It’s not your fault if you’re feeling depressed. And, contrary to the US, where doctors are so used to people asking for help with depression that there is an inadvertent “business as usual” approach, and contrary to the UK, where the whole “keep calm and carry on” myths prevail (it’s ironic to me that this British slogan was first used during WWII, and Winston Churchill was depressive and quite open about this fact), and one must beg for help with depression, the French are incredibly sympathetic, and they believe in a comprehensive approach. One that incorporates modern medicine, such as anti-depressants and sleeping pills, as well as holistic care such as acupuncture, meditation, vitamins, and yoga. So, if you’re feeling bad, and you suspect that you may be depressed, go talk to your local French doctor and read up on the maladie. Discover what it entails and how common it really is – you’ll be surprised at how much better you feel afterward, if only by learning that you are not unique in your feelings after all.
Filed under: The Baby Diaries | Tags: baby, birth, Chamonix, Erma Bombeck, France health, French Alps, healthcare, infant care, midwife, midwives, sage femme, sage femmes, womb
Never go to a doctor whose office plants have died. Erma Bombeck
The sage-femmes (mid-wives) at the hospital were great. Through them, I learned to nurse and to bathe my child, as well as to take his temperature. They were also the ones who would come and relieve me, or check on us during the night, making me feel that my baby boy and I were tended to.
But the sage-femme assigned to me by the obstetrician for pre-and-post-birth care was useless. Before my boy was born my husband and I went into her office, and sitting before her little desk, waited for several moments to see what she would do because we had no idea what we were to do. She didn’t say a word. Finally, we asked some tentative questions about the care in the hospital that we should expect, which had already been answered by my good doctor, but we wanted to be polite. She would answer them as an adolescent might, with as few words as possible and giving no opportunity for elaboration. It was a struggle and that 15-minute appointment seemed to last an hour.
Post birth, however, one is meant to go to the sage-femme for ten visits in order to properly recuperate. It’s actually prescribed by the paediatrician at the hospital before you leave, and the l’Assurance Medicale, the health bureau, reimburses you for the visits 100%. This is a very good and holistic approach to the birthing process that I highly commend about the French system in theory, but I’ve gone to this sage femme a few times now, and I still find it useless. On one such visit she put a long towel, sheet type-of-thing around my lower back and near my pelvis, and pulled it tightly around the area. I asked what this was for and she told me it would help ‘reshape’ my womb. On another visit, she pulled out an appliance that looked like a combination between an electric razor and a vibrator and proceeded to put it into my vagina. I asked her what this was for and she told me that it sent out electrical currents that would help ‘reshape’ my vagina and womb. On another visit she had me practice getting down and up off of the floor and doing sit ups. I’d ask her questions that I thought she might know that were relevant to me, such as about the blood blisters on the breasts, and the left breast’s drying up, and the lack of sleep, and doctor’s visits, and she was not able to provide any answers. She doesn’t have children. I could be her mother. Oh! I did find the visit in which she took out the stitches from my caesarean very useful.
Perhaps finding a good sage femme is akin to finding a good psychologist? This is very American of me, the land of people who seek to discuss their problems (and why not? I think the world would be a better place if one could unload all their worries and problems on a person they paid to listen to them and to keep quiet about it all, and who then eliminated the need to unload on your friends and family). Anyway. Perhaps it’s like a psychologist in the sense that if you get a bad one, an incompetent one, then it will turn you off of ever going again to one. I would have stopped going to this sage femme, but at the end of every visit I had with her I felt bullied into making the next appointment, so I would make one in order to get out of the room. After several visits, I decided I didn’t want to go anymore and tried to tell her that it just wasn’t ‘my cup of tea’ and it ‘doesn’t seem to be working for me,’ and I don’t want her to ‘waste’ her time on me anymore. She gave me an angry lecture on how irresponsible I am being to my body by giving up the visits before they’re over! I listened to her quietly, and then suggested we call it ten visits, as prescribed, submit it to the relevant authorities for her to be reimbursed, and I’ll give her the co-pay in cash. To her credit, she immediately agreed.
As much as I’ve appreciated other medical care in France, I’ve found my sage femme visits the least helpful. I will presume that she is an anomaly.
Filed under: The Baby Diaries | Tags: birth, France, French, healthcare, hospital, jaundice, midwives, paediatric, pets, pre eclampsia, pregancy, pregnant, sage femme, vw van
“I learn by going where I have to go.” Theodore Roethke
I ran into a woman at the hospital whom I’d met in a café last summer. It turns out her husband is a friend of my husband’s. She suffered pre-eclampsia with her baby, who is, consequently, down the hall in urgent care. I went to look at her new daughter through the window – she’s tiny, and my new friend says that she’s not been able to hold her yet, as she is so vulnerable and must stay inside the oxygen tent. Apparently, however, the little girl is developing and will eventually be fine. I told her that’s great, as we’ll be able to have play dates with our new babies. Makes me realise that having a little jaundice is not a big problem.
After vacillating the last few days, the doctors told me that we’d be able to go home from the hospital. I actually involuntarily clapped my hands and cried with joy at this news. I am, however, to seat Sebastian naked in the window every day for a ½ hour as you might a plant, and the rest of the jaundice will consequently go away in a few weeks. I packed my bags and nervously my husband and I walked down to the check out area with our new, precious, little cargo. It’s amazing how easy it is to walk out of the hospital with a baby. We literally took the child out of the paediatric ward unchallenged, went down the lift, noticed the check out desk of our own volition, put the wee man on the floor there, got his birth certificate and paid (only 220e for ten days in the hospital, the c section, the paediatric care, the phototherapy, all the sage femmes and nurses…it’s cheaper per night than a hotel in New Delhi) then walked out to the parking lot with no one noticing. Mark and I also feel like frauds because we aren’t quite sure about what to do with the baby once we get home.
We put S in our trusty old VW van, and carefully drove home. Upon our arrival, we put the sleeping tot on the floor for our beloved cat to get used to. He walked around the seat, and then began tentatively sniffing and batting it. It’s a good job my husband had regularly brought things S had worn from the hospital so that the cat could get used to his smell, because Oscar took to him pretty quickly after the first few moments. Breathing deeply of my home, I went upstairs to take a nap in my bed while my husband looked after our new charge. I marvelled at the fact that it felt as though a part of me was physically missing…as if I now have a phantom limb. The distance from our bedroom to the living room is the farthest I’d been from S for nine months. It was anxious, lonely, and poignant. Even so, I fell asleep pretty immediately.
What is anxiety provoking now is that no one at the hospital, or our good doctor, had told us what we do now. I’ve been given ordinances (prescriptions) for several sessions with a sage femme and a physiotherapist, respectively. This is very civilised in terms of postnatal care and adopting alternative therapies into recovery, but I trust conventional medicine. I know the sage femme is the one who will remove my stitches in the days to come, but no one has mentioned what to do for any health issue S may have – even a check-up on the jaundice he’s had to make sure it goes away. Do we go to our regular doctor? Is a different doctor assigned to S by mail or something? Do we go back to the hospital? When are we meant to go for a check up on the wee tot? Maybe the sage femme, or even the physio, will know the answer to these questions…
Filed under: The Baby Diaries | Tags: birth, c-section, caesarean, France, French, iodine wash, midwives, newborn, sage femme, skin, surgery
“A very small degree of hope is sufficient to cause the birth of love.” Stendhal
I had my baby. His name is Sebastian Leo and he weighed 4 kilos. He’s healthy (passed some post birth test with flying colours which measures and grades signs of health, such as number of fingers, toes, lungs, breathing, organ functions, on a scale of 1-10).
For my caesarean, they wheeled me on a gurney through a maze of hospital halls and left me outside the operating theatre for a bit. Then I went in, and nurses spoke to me from above as I lay on my back, like a David Lee Roth video, which was disorienting, especially as everyone spoke French and I was having trouble concentrating. They gave me an epidural then laid me back down and pinned my arms to my sides like Jesus on the cross. That freaked me out. I could feel the surgeon performing the c section, which was bizarre: a sponge across my belly, cutting slowly and surely, pulling the baby out of my uterus and through the small incision as though pulling a sleeping bag from its storage sack. But it didn’t hurt. When Sebastian was born, one of the nurses held him to my face (I was still pinned) and he was mewling. I didn’t feel that love at first sight thing that many have said they feel. Instead, I kind of distractedly looked at the little baby and spoke softly to him, telling him it was okay and not to be afraid. I remember being charmed that he immediately responded to my voice by quieting. Then they took him away to my husband and wheeled me into a recovery area. The French strongly believe in skin-on-skin after birth, so when the mother has had surgery they give the baby to the father (or grandmother, or sister, or brother, or whomever is there to support the mother), have him take off his shirt, and instruct him to hold the baby close to his chest, speaking softly and caressing him. It’s really quite a beautiful and sane idea. That said, when my husband took Sebastian into his arms, the little one immediately tried to suckle him (“Not gonna find anything there mate!” my husband quipped). Meanwhile, I was lying prostrate in an area in which I was separated by other patients by a provisional curtain, and slowly feeling my body come back to a sensation other than complete numbness. My good doctor told me I wouldn’t be hungry for about 24 hours after I had the surgery, but I was starving! After an hour or two in the recovery area, I started asking if it was possible to have some food. The nurses got exasperated with me and I could hear one of them place a call and I heard her saying to the person on the other end “The American is hungry! I know…should we move her up to her room?”
Being given Sebastian once I was ensconced in my private room (maybe 25 euro per night, the rest is covered by the Carte Vitale – so civilised) was marvellous and scary. I didn’t think he was mine ‘cause his eyes were slits and he looked Chinese. I actually entertained the idea that I’d been given the wrong baby. Luckily, after a day or two his eyes opened and then he was the spitting image of my husband. Apparently, newborns look like their fathers so that the father will have empathy towards them, own them and protect them, rather than leave them in the woods or discard them as they might have in ages of old. I think that newborn babies are akin to vampires in the sense that they are designed to attract: they look adorable and they smell good, for example. It was very strange to nurse him. Particularly as I had 3 sage-femmes (midwives) instructing me at the same time on how to do it, standing very close to my breasts, and intermittently squeezing my nipple or massaging my breast rather abruptly and roughly! I thought it was strange how this little creature cannot move, yet to get to my breast he’ll wiggle and move like a wee worm to get there.
OMG, the C-section hurts! I can’t believe that I actually wanted one and said I’d opt for it electively if my doctor didn’t already order it (as 25% of women in the UK and USA do). I can’t move. I have to have a bedpan and it hurts to get on and off the pot. There’s a bandage and goo on the cut and they come and clean and change the dressing. I take 2 pills every few hours for pain and infection. I have to raise my bed all the way up and the back rest straight up in order to get to the top of the baby’s hospital crib (which rolls and is like a plastic bubble square), then sort of reach into him and roll him/move him onto me and then up to my chest. I have no stomach muscles. Never quite realised how much I used them now that I don’t have them to use. I dread going to the toilet or walking, but apparently that’s in the cards for me tomorrow!
Filed under: The Pregnancy Diaries | Tags: birth, c-section, caesarean, Chamonix, France, iodine, midwife, midwives, sage femmes, Sallanches
“Don’t tell your kids you had an easy birth or they won’t respect you. For years I used to wake up my daughter and say, “Melissa, you ripped me to shreds. Now go back to sleep.” Joan Rivers
I’m actually in the hospital room in Sallanches waiting for them to take me to the operating theatre for my C-section. My husband and I got to the hospital at 6am with the operation scheduled for 8:30. I had an iodine shower, necessary in France before my procedure, and not one of my finer moments. I felt like a prisoner being scrubbed. My husband did the iodine as I’m too huge to bend and can’t see my nether regions, so it was a very practical wash. While he was doing it in this little bathroom to the side of my hospital room, there were nurses, sage femmes, and the cleaning woman, who came to the door of the bathroom to enquire about this-or-that, inform us of something, or simply to take the rubbish bin.
My good doctor with the great ham hands who has overseen two of my three pregnancies, came in from Chamonix to do the procedure. While I’m sceptical about the size of the incision he’ll leave with his huge hands, I am touched that he bothered to do this because he’s so busy. It’s weird to see him outside his office and particularly in scrubs. He tells me that I’ll go into the operating theatre. I’ll be given an epidural. The incision line will be so tiny and low that I’ll be able to wear a bikini again “if you lose your baby weight,” he notes. The baby will be pulled out and he’ll sew me back up. I will not be given the baby after the operation. Instead, it will be given to my husband while I go into a recovery area for two or three hours. The French believe in the importance of skin-on-skin after birth, so my husband will be asked to hold and keep the baby against his bare chest while I am in the recovery area. Knowing my incompetence regarding babies, he assures me the sage femmes will instruct me how to do everything from nursing to changing his diapers. I let him know that I’m prepared – I brought an eye mask, earplugs, and sleeping pills.
It’s 9:30am now. There is apparently some kind of emergency that takes precedence over me (imagine!). As a result, my good doctor is arguing with the staff and trying to arrange a new time. He’s just informed me that he will have to return to his office and begin his workday. He’ll leave me his mobile number. “You’re going to leave me with all these Frenchies? I don’t know anyone here!” I start to panic. His manner is calm, competent and jovial. “I’m going to have a baby by the end of the day for god’s sake!” I remind him. “Peut-etre…” he jokingly replies. Grumpily I say, “Forget your office hours. This has been two years in the making.” He smiles and reminds me that he’s French and they’ll take care of me or else have him to answer to or worse yet, a lawsuit waged by an American woman. A man with a thick gold chain around his neck and a lot of dark chest hair unfurling upwards from his white coat walks in. My good doctor introduces this man and tells me that he will be doing the procedure and he’s a very fine doctor. I’m too stunned to even catch the gold-chained-doctor’s name and too scared to ask him to repeat it. He doesn’t speak any English. He’s wearing a gold chain for god’s sake! And that chest hair doesn’t seem hygienic! I have to do an iodine scrub and this man has a bale of black hair emerging from his whites? I’ll also have to concentrate on French at the same time a baby is being pulled out of my womb like a sleeping bag from its case. Rather rudely, I smile up at him, tell him I have no questions other than to be informed of when it will happen, and continue typing on my laptop. I hope he views this as typically French behaviour and doesn’t go light on the pain relievers in retribution.
It’s 12:30. I’m starving but they won’t allow me to eat before my procedure. Dangerous to leave a hugely pregnant woman hungry like this. I’ve been here for six hours and I haven’t eaten since yesterday’s dinner. I might bite someone’s hand or sneak (not too stealthily mind you) down to the candy machine to get a Snickers. The doctor with the gold chain has just come in. They’re going to give me a C-section at 1pm. He indicates a gurney in the hallway and asks me to get on top of it. It’s time. I hope to whatever fates and gods there are that the baby is fine and that all goes well. I’m scared. It hits me that I’m about to deliver a baby. So much can go wrong. And now I don’t have my good doctor there and my husband is not allowed into the operating theatre. Tears have started rolling down my face. “Be strong, Victoria. Try to have faith that things will turn out well,” my husband tells me (easy for him to say). I’ll close my laptop and say “good bye” for now.
Filed under: The Pregnancy Diaries | Tags: alpine, alpine guides, birth, Chamonix, climbing, France, mont blanc, mountain cimbing, outdoor life, pregnancy, risk in pregnancy, risk sports, single mothers, summer sports, winter sports
‘Courage is rightly esteemed the first of human qualities…because it is the quality which guarantees all others.’ Winston Churchill
Most of the women I’ve met in Chamonix are here because of their husbands. Sure, they may like it here and have some semblance of a community, but it’s because their husbands are keen outdoorsman, or simply want to be here, that they live and remain in Chamonix, away from their families. My circumstances are the same. Within this breed of women in the Chamonix valley, are the alpine guides’ wives. The guides work very hard throughout the winter and the summer. Their primary work is hauling ‘punters’ up and down the Mont Blanc. They’ll be gone for several days at a time for a given tour, sleeping in huts and climbing by day. Then they’ll return home, unpack, rest a little (though many of them are so avid they go out and cycle or ski, depending on the season), re pack, and do it again. What this means is that these women are, for all intents and purposes, single mothers.
Not my bag at all. An apartment dweller throughout my adulthood, I still feel that I live on some sort of farm by living in a house in the middle of nowhere, with necessary ‘chores’ to be performed each day to keep the house going. But my chores are nothing compared to these women. They’re chopping wood with an axe, changing gas for their hobs, fixing fuses, shovelling snow, on top of all the daily things. They’re the ones collecting and dropping their kids at school always, organising their children in the morning, shopping for groceries, carrying groceries, cooking, getting their kids to bed, day after day, alone. Most of them say, “it isn’t nice…but what can you do but get on with it?” A typical English ‘chin up’ thing to say. One woman has a quote from Churchill on a postcard prominently displayed on her fridge that reads, “Keep calm and carry on.”
On top of these daily trials, there are the perils that a guide faces: death, skin cancer, injury before an already early retirement (then what?!). I saw a study online conducted by German doctors. It states that ‘for reasons of their outdoor work, mountain guides are heavily exposed to ultraviolet radiation.’ In their study of 283 men, precancerous lesions were more frequent in guides than in the general population (25% vs. 7%). I then tried to find some statistics on death by climbing in various places, but the information online is disparate – there doesn’t seem to be one central information source, an organisation that oversees such matters. What I did find is that according to the American Alpine Club, there are only 25 climbing deaths on average a year throughout the U.S.A. When I asked a guide here about this, he snorted and said, “Humph. Amateurs. That many die in a winter here. Mostly in avalanches.” Of course he was joking, but it’s not far off. I’ve read in the local newspapers over the last couple of winters in Chamonix repeated reports of folks dying up on the mountain. I’ve seen the rescue helicopters carrying a body on the outside, in a flat plastic gurney, which isn’t a good sign. That said, one of the ‘8000’ers, (mountains above 8k meters), Annapurna in Asia, a desirable mountain for climbers to try out, has a death rate of 38%! That means 38% of those who climb it die. But that’s not Mont Blanc. And most of those who die here are not guides, though the general consensus is that it’s about three or four a year who do lose their lives.
But then I saw something that put all this danger into perspective again – the British government assembled these statistics when comparing various activities:
* Maternal death in pregnancy 1 in 8,200 maternities
* Surgical anaesthesia 1 in 185,000 operations
* Hang-gliding 1 in 116,000 flights
* Scuba Diving 1 in 200,000 dives
* Rock climbing 1 in 320,000 climbs
* Canoeing 1 in 750,000 outings
* Fairground rides 1 in 834,000,000 rides
* Rail travel accidents 1 in 43,000,000 passenger journeys
* Aircraft accidents 1 in 125,000,000 passenger journeys
Mountain climbing isn’t even on the list! And note what IS the highest rate of casualty – and with a huge frequency! Geez, here I thought I’m lazy, giving all these sports and dangers that those around me encounter, and yet I’m being courageous by trying to bring a life into this world!
Filed under: The Pregnancy Diaries | Tags: American families, babies in France, birth, birth rates, France, French families, Ireland, Jean de la Fontaine, life in France, pregnancy, Raising Arizona
“Tall oaks from little acorns grow.” Jean de la Fontaine
The other day, a girlfriend I know in Paris told me that she’s expecting her third child. This surprises me. We knew each other at film school in Los Angeles and she was not the type of woman you’d imagine with a child, let alone three (she was so single-mindedly ambitious and talented). Then, oddly enough, another girlfriend here in Chamonix told me over coffee the other day that she had “finally” convinced her husband to have a third child. I mentioned these bits of news to my husband at breakfast and to my surprise, he suggested we try for three, also! I reminded him that I’m only a couple of months into the present pregnancy, so not a good time to talk about more pregnancies. Also, technically, I’ve had three pregnancies in two years – perhaps this is my allotment? Besides, I said, I never intended to have children at all, so one will be great. At his look of dismay, I joked that he could try for two more with his next wife.
I started to think about the people I know with kids stateside and those I know in France. I’m one of three children – I have a brother and a sister. Aside from my siblings, who each have two children, everyone I know with kids there has just one child. The same is true of my friends in England. Then I got to thinking about the people that I know in Chamonix with kids, which is about a dozen. In fact, I only know a few people here without kids. And, everyone I know here has two or three (after I miscarried the second time, I told my husband that I couldn’t live in Chamonix childless because it’d be too depressing for me). After discussing it with several of these friends with ‘only’ two children here, I discovered that a few of them are intending to have another pregnancy; a couple of them are unable, lamentably, to have a third child; and a couple of them are happy with two.
So I looked into statistics to see if my ring of acquaintances is distorting my perception that folks in France have more children than folks in the states. Much to my surprise, it isn’t. According to the U.S. Census Bureau, the average number of children to a U.S. family is .94. This makes sense. In addition to the fact that almost everyone I know there has one child, the rest of those I know have none. According to Eurostat, part of the European Commission, France is only second behind Ireland. All jokes about the Catholics and Jonathan Swift’s A Modest Proposal aside, this came as a surprise to me. France is the only other country, besides Ireland, in the European Union to report a fertility rate “in excess” of 2.0 per woman. The lowest fertility rates are in Eastern European countries, such as Latvia and Hungary, with an average of 1.3 per woman.
The reports that I perused said that in the 1970’s through the 1990’s, birth rates – at 3.8 per family post WWII – declined. According to these statisticians, this is attributed to an increased use of birth control, women having careers, higher education in general, and women having children at a later age. Currently, in the U.S. one out of every 12 women who are having their first child are 35 years old plus! In Europe, the age is 29.8. But, if increased birth control, women having careers, higher education in general, and women starting families later are the reason for lower fertility rates, in general, then why are France’s numbers rebounding? Is it the fact of stellar healthcare? But other E.U. countries have great health systems. Is it a reflection of family values? But what about Italy with its notion of the family being of primary importance? Is it a simple trend, here? A ‘Keeping up with the Jones’ sort-of-thing? Perhaps my pregnancy, and the birth of my child, will reveal more?
Victoria Jelinek 