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It Had To Be You

August 6, 2007: Day 13

Your mother and I were surprised to discover today that you exist. We know you are there, but we don't know much else about you. We don't know if you're going to be a boy or a girl, the color of your eyes or hair, or what your favorite flavor of ice cream will be. We only know that you are.

Know that you were wanted. We planned to make you happen. Your mother had it down to a science. For the past three months, the first thing I heard in the morning was the beeping of the thermometer as she took her temperature, waiting for the spike that signaled ovulation, learning the pattern of her body, learning when was the best time to make you. There were ovulation test strips, ovulation predictors on the Internet, and other things about which I won't go into detail. After all your mother's planning and watching patterns, the first month we tried, we made you. We took a picture of the pregnancy test. It said, "Pregnant." That is the sum total of what we know about you.

We know when you were conceived, to the day: July 25. When you were conceived, your parents loved you and loved each other. I was in love with your mother that day as much as I ever have been. You were created about 12 days ago, and today you are a blastocyst, a tiny ball of cells. In another day or two, your nervous system will begin to form and you will become an embryo, but right now, you have no fingers or toes, no brain, no heart, no awareness. This will all soon change.

I must be honest with you. Life is a constant struggle, but once the ball gets rolling, things take care of themselves, and it gets easier. Why, in the first 12 days, you've overcome nearly impossible odds, and there's a 3 in 4 chance you'll make it until the next month, and a 2 in 3 chance you will be born in the spring of 2008. Those aren't the kind of odds you want to play Russian Roulette with, but just a week ago, the odds were very much against you. I am not a religious or spiritual man, but I do believe in the miracle of life. The miracle is that, despite unimaginable odds, the egg and the sperm that became you managed to meet and merge in the first place. The fact that you even exist makes you incredibly lucky and special. You could easily have been someone else, but it had to be you. That is the miracle of life, your life.

I am a pragmatist. No romantic would fret over their unborn child's odds of survival. Despite my best intentions, you will be exposed to this part of my personality from an early age, I'm sure. All apologies if it makes me seem neurotic, distant, or cold, and I will never forgive myself if it makes you any of those things. In any situation you find yourself, I want you to have a realistic perspective and expectation. There's a fine line between realism and cynicism, however, and constant anxiety and risk aversion are traps I hope you will avoid. When you find yourself up against a challenge, instead of asking "why me?", I hope you ask "why not?" Instead of saying "I can't possibly," I hope you say "I possibly can." In other words, I hope you aren't hindered by the negative attitudes I sometimes have.

Know that your mother and I have always loved you, from the time when you were no more than a tiny ball of cells.

August 8, 2007: Day 15

I told the first person about you today, someone you'll probably never meet or know: my pharmacy preceptor at Samaritan Hospital. His name was Lanny. We were eating lunch in the break room, and I mentioned we were ready to have kids. He asked if your mother was pregnant, and I told him yes, we had just found out two days ago, and asked him to keep it in confidence until we were ready to tell our families. And he did.

August 17, 2007: Day 24

Your heart began beating a few days ago, and you are a little bigger than an apple seed. Your mother's cramps have ceased, and she's taking an omega-3 fatty acid supplement to help your brain and nervous system develop.

When I was born, breast milk and formula didn't go well for me. I was colicky and screamed for six weeks. Distraught, at wit's end, and against doctor's advice, my mother fed me the only thing that didn't make me scream: powdered milk. It's meager on fat, and infants need plenty of fats and omega-3 fatty acids to gain weight and develop a healthy brain and nervous system. I guess I turned out okay, but I'm hoping for better for you.

August 23, 2007: Day 30

Today we met with a nurse-midwife. Obstetricians deliver most babies in the United States, but your mother and I have concerns with the status quo. I find it ironic that your mother, an optometrist, and I, a pharmacy student, as part of the medical establishment, would have such strong concerns with allowing said establishment to bring you into the world. For one, most obstetricians work in a group practice, so when it comes time for the birth, the mother's obstetrician may or may not perform the actual delivery, depending on availability. Second, we believe U.S. healthcare's approach to birth and delivery is overly aggressive, quick to employ interventional techniques such as induced labor, caesarian and vacuum-assisted delivery, and forceps to hasten delivery more in the interests of the healthcare system than in the interests of mother and baby.

Our hopes for a nurse-midwife would be someone who could deliver you in a hospital in lieu of an obstetrician. Sadly, no midwife with hospital privileges is to be found in Lexington. Many cities don't even have professional midwives, so it seems we're fortunate simply to have a nurse-midwife nearby.

The practical upshot of all this is that we're actually considering a home delivery. Only two weeks ago, I would have thought it crazy, but now... if you were not a high risk pregnancy... and a maternity hospital only 15 minutes from home in case we needed it... home births being the only method of delivery for thousands of years... I think I'd go for it. But the final decision is your mother's -- she's the one who would have to do this without any pain meds.

In country where 98% of births occur in hospitals, people may think we're taking a huge risk, but the World Health Organization advocates home births for low-risk pregnancies. In the United States, the infant mortality rate is 7 per 1000. In the Netherlands, it's 5 per 1000 in a country where 33% of births occur in the home and most low-risk pregnancies are delivered in midwifery units, not hospitals. On the other hand, in Sweden, with an infant mortality rate of 3 per 1000, over 99% of births are in hospitals. So at the end of the day, I wonder... in a developed country with access to advanced medical care when needed, does home birth significantly impact infant mortality? And if not, then the logical conclusion is that it's safe for low-risk pregnancies, and should be done without reservation if the parents so desire.

So... only time can tell if you will be born at home, but if you were, it was done because of what happened today.

August 25, 2007: Day 32

This is the weekend we're announcing you to our families. Today we told my mother, grandmother, and brother. With the element of surprise, we met my mother and grandmother at grandmother's house, chatted for a while, and gave my mother a baby picture book in a gift bag. The first picture is your positive pregnancy test.

We talked to your grandmother about a birth defect both my brother and I had, anal stenosis. It causes painful bloating and constipation, and requires gradual instrumental dilation of the anus, also painful (at least it was for me, I am told), but the long-term prognosis is good. Sometimes anal stenosis (the mildest form of imperforate anus) is associated with other birth defects in what is known as VACTERL association. I mention this only because my brother also has cardiac congential deformities consistent with VACTERL association. Actually, VACTERL usually requires 3 of the defects, and 2 defects qualifies as "VACTERL-like."

The important thing to know is that VACTERL association does not appear to have a genetic origin, but there is some evidence VACTERL-like does, because cases tend to cluster in families. To add to the rub, though, VACTERL-like is more common in girls, and neither your uncle nor I are.

I mention all this now not only because we talked about it today, but because the defects associated with VACTERL arise from events occuring between weeks 7 and 10 of pregnancy when the embryo reshapes itself from a mass of cells into the characteristic embryo body, a crucial period of time you are about to enter.

I'll be thinking of you often during the next few weeks, hoping all is well.

August 26, 2007: Day 33

Today we told your mother's family about you. Your grandmother had already become suspicious of us. Your mother told your cousin Emma to pull the gift bag out of my backpack and take it to your grandmother. We gave both of your grandmothers the same baby picture album with the picture of the positive pregnancy test. Your aunt April is also pregnant, due about a week before you. We had meatloaf, mashed potatoes, green beans, rolls that failed to rise in the oven, and angelfood cake with blackberries and strawberries for dessert. Between lunch and dessert, we drove down to the creek where your grandfather is building a cabin on stilts in the woods to stay in while he builds a regular-size house not far away in a clearing. Perhaps someday you will spend the night on a camping trip with your cousins in that cabin high among the trees. While you were taking shape in your mother's belly, so was that cabin. On this day, it was still a frame, with only three exterior walls and no roof. After dessert, I took a nap at your grandparent's. It was sunny and hot outside, but shady and almost comfortable in the woods; 2007 was the hottest and driest year in a long time.

I don't know why I tell you all these small details... I think it's so you or me or both of us will read this one day and recreate the event in our minds, for you to see it through your imagination, and for me to hold on to the memory for as long as possible.

August 27, 2007: Day 34

Today I told my father about you. Your mother and I were going to visit him at home when we told my mother and grandmother, but he was at the state fair judging the karaoke contest. Don't ask. Suffice it to say, I had to tell him over the phone. I was driving home from Samaritan Hospital, where I was doing my pharmacy rotation that month. After some chit-chat, I told him exactly as I was driving home on Clay's Mill Road, going through the intersection at Keithshire. I remember looking at the green traffic light passing overhead as I told him, "Rachel's pregnant."

August 30, 2007: Day 37

Today I posted all I've written so far on my weblog.

:: Bryan Travis :: 08/30/2007 @ 18:20 :: [link] ::

Remembering Phil Rizzuto

I didn't know Phil Rizzuto as anyone other than the spokesman for "The Money Store," a bank specializing in second home mortgages. I'll never forget his Brooklyn accented voice saying, "I'm Phil Rizzuto for The Money Store."

The Money Store commercial

:: Bryan Travis :: 08/15/2007 @ 20:47 :: [link] ::