So by now you may have heard about the tactless CEO of AOL, Tim Armstrong, who has a way with conference calls. After previously spontaneously firing an employee on a company wide call, he recently announced the company's (higher than usual) earnings, as well as changes the company was undertaking to their benefits. He talked about the costs of the ACA and how among all their thousands of employees, the costs associated with two million dollar "distressed babies" of employees in 2012 required them to change how their 401K program was funded (which he has since reversed, due to the backlash).
Now a mother of one of these "distressed babies" has written an article in Slate to put a face on their story (full disclosure: the mother is the professional writer/novelist, Deanna Fei, a high school classmate of several friends of mine from college, Drs. Michelle and Veronica). In reading her story, I obviously couldn't relate first hand, since we knew we were high risk and were fortunate enough to have some warning of our impending doom, and were able to have a cerclage and other treatments (bedrest, progesterone and steroid shots, etc.) But as someone who has had a high risk pregnancy and many mom friends (of multiples and singletons) who've both lost late term babies and others whose babies survived and spent months in the NICU, I can understand the fear and trauma that this can cause. It is indescribable. And then to have your child used as a scapegoat for a lousy corporate benefit decision is inexcusable and suggests that not only did the CEO have info on these families he likely shouldn't have, he thought it appropriate to share it with people in an inappropriate way and setting.
Anyway, long story short. In reading Ms. Fei's account, something jumped out at me. She mentions that she had a (barely) one year old son, when she gave birth to her daughter (at five months pregnant). This means that there was a very short gap between her pregnancies. This is naturally becoming more and more common as women wait longer to have families (due to education, career, later marriage, infertility, etc.) and then are faced with squeezing multiple pregnancies into a very short span of time, presumably trying to evade AMA (w/ its diminishing fertility and increased risks).
Now, don't get me wrong, I'm not blaming her for the awful ordeal that happened to her or her daughter. That would be ridiculous. But knowledge is power, and I've been meaning to write for some time about how it is always surprising to me though how often otherwise well educated women who are presumably (like her, with insurance, living in NYC) getting some of the best obstetric care anywhere in the world, seeming are not even remotely aware of the potential impact of short pregnancy spacing on their pregnancy outcomes. She mentions in the article that, to her knowledge, she didn't have any risk factors for premature birth. IMO her physicians failed her here by not deeming her high risk.
"But there was nothing high-risk about my pregnancy. I never had a single risk factor for a preterm birth, let alone one as extreme as this one. Until the morning I woke up in labor, every exam indicated that our daughter was perfectly healthy. In fact, had signs of trouble emerged, such as bleeding or pre-eclampsia, the doctors would have had the chance to mitigate the danger, administering steroids to speed up her lung development or hormones to delay labor. Instead, even with the best medical care available, we had no warnings, and we will never have an explanation for what went wrong. This is why the head neonatologist referred matter-of-factly to our daughter’s birth as “catastrophic.”
I can only guess it was never mentioned to her, not once. It never came up with me, I've only come across it in my own research/reading. My OB did ask at our 6w postpartum visit what kind of BC we were using, and when I told her, it was the end of the conversation. Had I said we weren't using any or something to indicate our plans to conceive, maybe it would have gone differently. Or if we were actually planning to add to our family, as she thinks we should, she would have discussed the risks. But honestly, I think often it is just considered a personal preference without any potential serious negative consequences, save lots of babies to take care of once (which is actually seen by some as an advantage, since you can get the baby stage over with quickly, and have kids who are close.) This is too bad since the costs to women/their families, babies, and society (deaths, divorce, disabilities, picking up the pieces) are significant, and not just monetarily.
Studies, especially a large meta analysis done in 2006, show the worst outcomes (which include: maternal/fetal death, premature birth, low birth weight, etc.) for pregnancies beginning within six months of giving birth, but the negative association exists up to eighteen months after a pregnancy. They believe that the depletion of maternal nutrient stores during pregnancy, extended further through breastfeeding, means there is less available to the baby. Also the physical toll of pregnancy can cause negative outcomes for mother as well. Uterine rupture, placental abruption, etc. are all seen in higher numbers.
I think besides not having it brought up by physicians, people just assume since they know people who have children close in age, as we all do, that if they are fine, then yours will be too. But that is not how risk statistics work, unfortunately.
And for all my infertile friends, while it may seem like a amazing mixed blessing, now that I've seen so so many of them (even those who were told their eggs were crap and/or their husbands had no sperm) who've had unplanned pregnancies post-pg/treatment while not believing it was possible. Trust me, it is. So this is not just a PSA for the fertile. While it is a common perception that infertility, like breastfeeding, is an effective form of BC, it actually seems in my observations that pregnancy, breastfeeding, and generally being overwhelmed by life as a parent is a great boost to one's fertility, which assuming you have even the minimum of the available equipment, is clearly fluid.
There are a great many things about pregnancy that you can't control, but one thing you can, if you try, is when it doesn't happen.
Mayo Clinic on pregnancy spacing
The Alpha Parent on age gaps (w/links)
Public health resources on birth spacing (CA)
Now a mother of one of these "distressed babies" has written an article in Slate to put a face on their story (full disclosure: the mother is the professional writer/novelist, Deanna Fei, a high school classmate of several friends of mine from college, Drs. Michelle and Veronica). In reading her story, I obviously couldn't relate first hand, since we knew we were high risk and were fortunate enough to have some warning of our impending doom, and were able to have a cerclage and other treatments (bedrest, progesterone and steroid shots, etc.) But as someone who has had a high risk pregnancy and many mom friends (of multiples and singletons) who've both lost late term babies and others whose babies survived and spent months in the NICU, I can understand the fear and trauma that this can cause. It is indescribable. And then to have your child used as a scapegoat for a lousy corporate benefit decision is inexcusable and suggests that not only did the CEO have info on these families he likely shouldn't have, he thought it appropriate to share it with people in an inappropriate way and setting.
Anyway, long story short. In reading Ms. Fei's account, something jumped out at me. She mentions that she had a (barely) one year old son, when she gave birth to her daughter (at five months pregnant). This means that there was a very short gap between her pregnancies. This is naturally becoming more and more common as women wait longer to have families (due to education, career, later marriage, infertility, etc.) and then are faced with squeezing multiple pregnancies into a very short span of time, presumably trying to evade AMA (w/ its diminishing fertility and increased risks).
Now, don't get me wrong, I'm not blaming her for the awful ordeal that happened to her or her daughter. That would be ridiculous. But knowledge is power, and I've been meaning to write for some time about how it is always surprising to me though how often otherwise well educated women who are presumably (like her, with insurance, living in NYC) getting some of the best obstetric care anywhere in the world, seeming are not even remotely aware of the potential impact of short pregnancy spacing on their pregnancy outcomes. She mentions in the article that, to her knowledge, she didn't have any risk factors for premature birth. IMO her physicians failed her here by not deeming her high risk.
"But there was nothing high-risk about my pregnancy. I never had a single risk factor for a preterm birth, let alone one as extreme as this one. Until the morning I woke up in labor, every exam indicated that our daughter was perfectly healthy. In fact, had signs of trouble emerged, such as bleeding or pre-eclampsia, the doctors would have had the chance to mitigate the danger, administering steroids to speed up her lung development or hormones to delay labor. Instead, even with the best medical care available, we had no warnings, and we will never have an explanation for what went wrong. This is why the head neonatologist referred matter-of-factly to our daughter’s birth as “catastrophic.”
I can only guess it was never mentioned to her, not once. It never came up with me, I've only come across it in my own research/reading. My OB did ask at our 6w postpartum visit what kind of BC we were using, and when I told her, it was the end of the conversation. Had I said we weren't using any or something to indicate our plans to conceive, maybe it would have gone differently. Or if we were actually planning to add to our family, as she thinks we should, she would have discussed the risks. But honestly, I think often it is just considered a personal preference without any potential serious negative consequences, save lots of babies to take care of once (which is actually seen by some as an advantage, since you can get the baby stage over with quickly, and have kids who are close.) This is too bad since the costs to women/their families, babies, and society (deaths, divorce, disabilities, picking up the pieces) are significant, and not just monetarily.
Studies, especially a large meta analysis done in 2006, show the worst outcomes (which include: maternal/fetal death, premature birth, low birth weight, etc.) for pregnancies beginning within six months of giving birth, but the negative association exists up to eighteen months after a pregnancy. They believe that the depletion of maternal nutrient stores during pregnancy, extended further through breastfeeding, means there is less available to the baby. Also the physical toll of pregnancy can cause negative outcomes for mother as well. Uterine rupture, placental abruption, etc. are all seen in higher numbers.
I think besides not having it brought up by physicians, people just assume since they know people who have children close in age, as we all do, that if they are fine, then yours will be too. But that is not how risk statistics work, unfortunately.
And for all my infertile friends, while it may seem like a amazing mixed blessing, now that I've seen so so many of them (even those who were told their eggs were crap and/or their husbands had no sperm) who've had unplanned pregnancies post-pg/treatment while not believing it was possible. Trust me, it is. So this is not just a PSA for the fertile. While it is a common perception that infertility, like breastfeeding, is an effective form of BC, it actually seems in my observations that pregnancy, breastfeeding, and generally being overwhelmed by life as a parent is a great boost to one's fertility, which assuming you have even the minimum of the available equipment, is clearly fluid.
There are a great many things about pregnancy that you can't control, but one thing you can, if you try, is when it doesn't happen.
Mayo Clinic on pregnancy spacing
The Alpha Parent on age gaps (w/links)
Public health resources on birth spacing (CA)
Thank You for saying this. I just had a friend have a uterine rupture and subsequent delivery of her 30 week old daughter (she is doing well) due to close pregnancies.
ReplyDeleteI am infertile, but chose to get an IUD after my son was born. I knew there was a low chance of pregnancy w/out it, but after a c section I felt I owed it to my body to recover longer.
We have been TTC without success for about six cycles now and although I most likely will never have another bio child, I have no regrets for preventing pregnancy until my son was 18 months old.
So sorry about your friend Jen. Glad to hear she is doing well. Best of luck to you! :)
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