Monday, January 27, 2014

Week 19: Insurance Saga, Part 1

Since my husband entered graduate school, our insurance situation has been a bit dicey. It changes every year, every pregnancy, and every new massive-healthcare-law-and-associated-regulations-passed.

With my first pregnancy, I was on my employer's insurance plan. There was a deductible, there was a co-pay, and I'm certain we achieved out-of-pocket maximums that year, but they weren't especially high.

With my second pregnancy, I carried my husband's student insurance plan as my primary and held Medicaid as secondary. Little did I know, but carrying two insurance plans is apparently a *major* pain for your doctors. Also, little did I know, but Medicaid is apparently a major pain for doctors, too. In fact, it's such a major pain that I called 22 doctor's offices and only one of them would accept Medicaid patients. I drive 45 minutes each way for my appointments.

In 2011, at the end of the first year of my husband's Ph.D. program, the school dropped dependent coverage for their Ph.D. students. This was a bit of a crisis for us. I signed up for an "open enrollment plan" through Blue Cross Blue Shield. It cost us $500 per month, and the premium increased by about $50 per year each year I was on it. The deductible was high and the out-of-pocket maximums were high, but fortunately most doctors accepted this plan. Unfortunately, the plan did not cover maternity costs.

So when we conceived our third child in the fall of 2011, I went back on Medicaid. My OB's office administrator confessed to me that it had been such a disaster to bill Medicaid as secondary insurance the last time they had me as a patient that they were no longer willing to do so. Medicaid would have to be primary, or they wouldn't accept it. I had difficulty explaining to the Office of Family Services why my private insurance couldn't really be considered primary for the pregnancy (since it didn't cover maternity). And although I never followed up on all this, it seems to have been resolved satisfactorily to all parties. In the process, I also learned that private insurance pays about $3,000 for a vaginal delivery. Medicaid pays only $900.

When I became pregnant this time, we were expecting that the roll-out of the healthcare law would give us more options. My private insurance premiums had increased yet again, and I was paying $600 per month. I also learned that Blue Cross Blue Shield in Virginia had decided to voluntarily cover all abortions, for any reason, under their new plans. The new plans also all covered maternity expenses, but they were going to cost us more per year than we were currently paying (the difference of about $1,000-$1,500 per year). Given our income level, I would have certainly qualified for a subsidy, but I applied and never heard back. I went on the website twice and got kicked off twice. I've had so many bad experiences trying to get answers from the Office of Family Services about anything that I decided it was not worth the anxiety of waiting months and months and months to finally be told, "Please send us more information about your income," in spite of the fact that I submitted all the information they asked for (and more) the first time.

We finally decided to make the jump to Christian Healthcare Ministries. This means that I will be paying only $150 per month for "coverage," but all my routine diabetes expenses will be out of pocket. This includes prescriptions, doctor's visits, and bloodwork. Unless it is an unexpected complication of my diabetes, hospitalization, or new diagnosis, my medical bills will not be eligible for "sharing" through the program. 

This sounds frightening, but when I calculated the actual costs of my routine diabetes care without insurance, it came to about $7,500 per year. If you add $1,600 for the Christian Healthcare Ministries program to that, it's about $9,100. The insurance premium plus deductible for the plan that I was on already cost about $9,000 per year, and the new insurance plans I was looking at (without subsidy) cost about $10,000 to $10,500. So I will now be paying roughly the same, or perhaps a little bit less. I know that some healthcare providers (pharmacies, etc.) will also charge a little less for people who are paying out of pocket, because then they don't have to deal with crazy insurance company billing rules. I'm hoping that, between these two things, I will at least break even. I also won't be paying for abortions, nor supporting an insurance company which is taking upon itself the task of making abortions seem like routine health care, rather than the intentional killing of another very small human being. 

Saturday, January 25, 2014

Week 18: Endocrinologist, Round Two

My husband and I recently decided to switch to Christian Healthcare Ministries, rather than signing up for a new insurance plan. This affects the way I seek medical care, because all preventive and/or maintenance care for pre-existing conditions is not covered. (Medical emergencies related to the pre-existing conditions are). This means that trips to the endocrinologist, prescriptions, and routine bloodwork are not covered, and I have to be careful about the way I spend my dollars on these expenses.

Since my endocrinologist has asked me to come in to see him every month ($190), and also have blood drawn each time (not sure how much this total is, but at least $55 or more) for an A1C, this will be a significant burden. I've never thought it was necessary, though I played along as long as someone else was picking up the bill. But that is no longer true. 

Since my endocrinologist fired me at the end of last pregnancy when I wouldn't come in on his monthly schedule, I decided to be up-front this time, and explain my situation. I'm not sure how he'll feel about it, but the diabetes educator I met with at his office today said, "I don't think he'll budge." So here's the note I sent to her explaining our situation, which she said she would discuss with him:

"We signed up for a health insurance alternative called 'Christian Healthcare Ministries.' They don't cover maintenance or preventive care for chronic or pre-existing conditions. If I were only coming 4 times a year, like normal, we calculated the cost and figured this might actually save us money, but coming once a month will cost too much.

"As my doctor knows, I feel very comfortable managing my blood sugars, since I've learned a lot in my last three pregnancies. I would be happy to come every other month (or, perhaps I could come every month, we could do bloodwork every other month, and he could cut the charge of the office visit in half). My OB could also order whatever bloodwork is required, and I imagine Medicaid would likely cover the charges submitted from my OB's office.

"Alternatively, I could see him on an as-needed basis, with whatever waiver/disclaimer he needs me to sign for legal purposes so that he is not on the hook for a bad outcome with my health or the baby's. He knows me well, the office staff is friendly and competent, and kindly accommodates the strangely high number of toddlers who accompany me to my visits. It's always nice to have someone to call when you have strange symptoms or need some diabetes advice. 

"I understand that both of these situations might leave your staff inadequately compensated for the time spent reviewing my blood sugar readings every week, so I am content to forego that service.

"Hope to see you again soon! If neither of these situations works, I'll probably try to find another doctor just during the duration of the pregnancy. But if he'll have me as a client again in July, I'd happily come back."

I tried to understand where they were coming from, but also give a reasonable explanation for how I think things could go during this pregnancy. I really hope he doesn't drop me again, but I finally decided that it would be better for me to be dropped and have to find someone else than continue to pay for services where seem rather unnecessary to me.

UPDATE: They did not drop me, but they did make me sign a waiver releasing them from all liability regarding my outcome or the baby's.

Friday, January 24, 2014

Your labor and delivery is a marathon - are you training?
My friend Liz had a midwife during her first (of three) pregnancy. Her midwife explained to her that giving birth is like running a marathon.

There is no way that you are going to have a good experience running a marathon if you just show up the day of the race and start running. If anyone has had a good experience doing this, keep it to yourself! I have ran and was glad that I trained. I hear from endless women who made little to no effort to prepare for their baby's actual birth. They planned for the nursery, the clothes, their diets, their maternity leave but completely left out the birth. I've heard pregnant women say "I'm just going to show up and get that wonderful epidural" or "my doctor is going to step me through it". I know no one in these situations who looks back on their experience as beautiful and being in control of their body. So here's the issue with those thoughts.

That epidural is usually only given during certain stages of labor. You have to be laying down and cannot move naturally to let the baby fall with gravity. Just picture which way gravity pulls. Yep, the woman's body is designed to let the baby fall vertically and not to projectile shoot horizontally. My friend Liz found herself to be in a painful position unless she was on her hands and knees. Then the pain was gone and it was just the pressure of the baby pushing out. I enjoyed laboring while dancing with my husband (actually that is the last time that I danced with him!). The epidural doesn't even alway work. I know many annoyed women who got the epidural only to find out that they could feel everything and were stuck in a bed that did not feel good to be laying in. Since it causes you to go against your body's natural flow and changes your bodies natural hormones, you are at high risk of having a longer and more complicated birth thus a longer recuperation time. All of this snowballs and causes you to have a less positive experience and less success at breastfeeding. Here are some great epidural free positions.There are many women who had to resort to epidurals during their labors but they were educated and waited until the last minute in case the baby changed positions. If they were prepared and educated then they asked their caregiver the right questions and were okay and accepting of their birth and their body. Here are some Hidden Risks of Epidurals from Mothering Magazine.

I've heard all about your great doctor that you have had since your first period. You have a vision of that caregiver by your side coaching you through every contraction. Really you should be at home until the contractions get rather close and who is coaching you there? Your caregiver might be on vacation in Hawaii and then who is filling in? Doesn't your caregiver have a whole hall of pregnant women that he or she is tending to? Good birth planning programs take weeks to finish and entail a good amount of study and homework. Here are some good birthing classes. I very much recommend a doula for first births, home births, births in need of support, and for you and your loved ones to feel less stressed and more in enjoyment with your labor and birth. My husband and mom enjoyed the massages that my doula gave them.

The more prepared that you are and the more positive planning that you have put towards anything in life, will make it a better experience. Knowledge is key.

Thursday, January 23, 2014

Week 17: Letting Go

I am finally learning to release the anxiety I have about my blood sugars. I am learning that anxiety does no one any good. Every time I have a high or a low one, I take the most reasonable course of action (correction, up or down), and then I wait. I don't immediately start changing my basal and bolus rates to prevent the problem in the future. I try to reflect on what I could have done differently. I observe whether it's a pattern over a few days, or just an isolated incident. And then I trust that whatever will be, will be...and know that the One who cares for us now will not abandon us in trouble. I pray almost every time I feel the anxiety creep up on me, and this has helped.

It is freeing to be able to approach the matter this way. It's still true that I will strive to spare nothing of myself. I will avoid eating those things which I have identified as problematic, and I will avoid eating at times when eating may be problematic, and I will push myself to go out on walks with the kids, and so forth. But I will not worry when all my best efforts fail me, or even at those times when I do fail to exert my best (God's mercy is great!). This way is best.

Tuesday, January 21, 2014

Week 16: Life Within!

This week marks the first time I felt the baby move this pregnancy. What a relief! I have recently heard two stories of women who miscarried late - at 15 weeks - and was sincerely hoping that my child hadn't passed from life to death inside my womb and was waiting to also pass out of my body. In my first three pregnancies, I felt movement absurdly early: 9 weeks with my first, 10 or 11 with my second, and 10 with my third. So this was normal given the pattern of most pregnancies, but atypical for me. The midwife at my doctor's office suggested that it might reflect a different placement of the placenta (anterior instead of posterior).

I also went on retreat with the Sisters of Life this week. Their work is to promote the sanctity of human life through prayer, but they also run a few mission houses where they serve women with crisis pregnancies and women who have had abortions. Women may come and stay with them during their pregnancies, up to a few months after the baby is born. It's a beautiful work, and you should check it out!

In any case, a lot of mostly hidden anxiety came out about this pregnancy while I was reflecting on my life. There's something about silence during a retreat that really helps to focus your attention on the fears within your heart. That certainly happened for me this week, and my greatest fears these days seem to be about my blood sugars (especially the low ones).

I should probably preface this by mentioning that earlier this week, a few days after Christmas, my blood sugar was very low when I woke up one morning. I became very stubborn when my husband tried to help me. It happened several days in a row, these severe lows, and I was very discouraged by it. It's one of the only reasons my endocrinologist can point to justify why he believes I shouldn't have more children (which is something he says almost every visit). At least I didn't almost drown myself in a bathtub this time, but I think I rather disturbed my spouse!

So lows are a continual challenge. It's interesting to note that it was about the same time of year, same time of pregnancy, when this happened last time around. Most of the time I think that I just need to get better about dealing with the lows (which is true!), and then sometimes I wonder if it really might be wiser not to have more children. I'm not sure the answer is all that clear-cut, given how awesome babies are. But I do know that, at least this time around, I just have to play the hand I've been dealt and manage the lows as safely as I can.

How do you and your family deal with your stubbornness when your blood sugar is low? I told my husband to just keep repeating the same words over and over: "Your blood sugar is 34. Can I help you? Your blood sugar is low. Would you like me to bring you something? Your blood sugar is 34. What can I do for you?"

Sunday, January 19, 2014

Week 15: Christmas

After the blood sugar management failure of the last couple of weeks, Christmas was actually a surprising reprieve. I have been dialing back my insulin levels, ever so slowly, to combat the overnight lows. I have been able to bring my eating back to a healthy level, and have not gained any more weight. Fighting through the weakness of hunger can successfully get me through the 2-3 hour postprandial slump, and back into a reasonable amount of energy until the next meal time (or low blood sugar).

This was actually part of our plan all along. We wanted Christmas to be a time for low-stress blood sugar management. We often travel across the country with our kiddos to visit my in-laws for Christmas. It is something we usually all look forward to, especially my husband and the boys. I felt bad, but I made the request that we stay home this year, for the sake of my blood sugars. It's hard enough to manage them when you are pregnant, and hard when you are traveling, and hard during the holidays. The hat-trick of hard is all three, and we've done that twice now. And I've learned, the hard way, that my disease really does need special accommodation sometimes.

Midnight mass on Christmas morning also happens to be a great way to check your overnight basal rates (when you wake up, while you're at mass, and after mass)! (Turns out mine were too high).

Friday, January 17, 2014

Bye Bye Pregnancy Back Pain in 15 Minutes

Busy while waiting for an overdue baby #3.
I was pregnant and having discomfort going from sitting to standing. I had to support myself and scoot to the edge of the seat to get up especially from low things like the couch. Yep, I was pregnant. I had to do a little waddle just to go from sitting to standing. Some people would say that this is just part of being pregnant. I say, I am too busy to deal with pregnancy crap like this! I learned a trick that made the discomfort go away in 15 minutes.

My third pregnancy was really rough on my body. I was non-stop carrying a toddler everywhere. Our toilets are in the basement and on the second floor so I was always carrying a kid up or down a set of stairs. I had to bend all sorts of ways to snap two kids into carseats. I was walking or doing yoga almost daily to keep myself limber so my body could adapt to the changes that were happening. 

Then it happened. I started having to stand up like a pregnant lady! Not me! I had to do the wiggle to the edge of the seat, brace myself on something and do a side-slide to get up. It was uncomfortable. This was extremely annoying and I am not one to get annoyed so I took action.

For the first time during a pregnancy, I went to a chiropractor. I went to a doctor who I knew and was pregnant with her second baby so I knew that she would understand. The moment that I laid down, the chiropractor pointed out that my hips were 2 inches out of alignment! It caused one leg to physically be 2 inches longer than the other. Of course I was having issues standing up.  Since I was pregnant and she couldn't just pop me back into place, she used a special massaging tool that massaged the bones and joints back to where they belonged. Instantly I felt normal (not pregnant). I went home and could sit and stand perfectly without support or scooting to the edge of the seat.

That's how I got sold on chiropractors and ditched my pregnancy pain!

Week 14: Advent Was Supposed to Be for Fasting

When we became Catholic, I learned that Advent - approximately four weeks before Christmas day - are supposed to be a time for penance. Almost like Lent, except not that serious. But it's the same liturgical color (purple) and everything! Fasting and almsgiving and preparatory prayers are recommended the same way they are in preparation for Easter.

So this year, I made firm my resolve to abide by the eating habits I laid out a few weeks ago: eat only at regular meal times, normal portions, and when my blood sugar is low. No snacking without a strict need.

Talk about best-laid plans sometimes failing. Or a lot of times failing. I don't know *what* happened, by my lows got really bad over the last few weeks. I have been ping-ponging all over the place. And besides that, I've just been so hungry that I'm eating at all the wrong times. And ugh...all the slow weight gain I was trying to achieve, for the sake of my health and the baby's, exploded from 3 pounds up to 10 pounds when I last stepped on the scale. (I haven't been able to bring myself to do it since).

I have learned a lot about Divine Mercy in the last few years, and God continues to teach me. Failure, in the face of our best efforts, is so painful. Trust in mercy, trust in the Goodness of The Plan, trust in the face of uncertainty and pain is so hard! I am so afraid of and overwhelmed by failure. Each day, the hardest thing I do is resolve to try again, trust in His help, not fear His anger. And so I do. Because caving in to the fear is no way to live.

What do you do when you've failed with your blood sugars and you're afraid to fail again? How do you shore up your resolve to do better next time?

Wednesday, January 15, 2014

Week 13: Sticking to My Guns

I know it's a little thing, and I probably shouldn't be so bothered by it. A really small thing, and most women probably don't even notice the difference. But I've always been a detail person, and this happens to be a really important detail: the due date.

Very early on in pregnancy, I estimated that my due date was probably June 22. This was based on when I believed ovulation to have occurred (September 28), so it was even more accurate than simply knowing the date of intercourse. Conception, after all, does not often happen on the day of intercourse (unless you have impeccable timing!). Conception occurs when you ovulate. That egg, it's precious. All the sperm are just lying in wait for it to be revealed.

(I don't think I would ever say that out loud to someone that I didn't know. I probably don't know you. This has now become slightly awkward.)


Anyway, so this is what I had figured out. When I had my surprise ultrasound at 5 weeks, guess what? She said that, by her measurements, my estimated date of ovulation and due date were right on. RIGHT ON. What I heard was: "you are a natural family planning genius."

So I was a bit dismayed that I could not convince the sonographer who did my 11-week ultrasound that I already knew my due date, and that her date was too early (she came back with June 18, based on her measurements). I explained to them about ovulation (I can't believe they didn't know, I can only assume they thought I didn't understand it well enough). I explained to them about the early transvaginal ultrasound (but I'm certain it was in my chart). I even explained to them that my husband is unusually tall, and all of our children so far have been unusually long at birth (my quack theory about why my due date keeps getting pushed up with each pregnancy). Alas, to no avail. It goes in my chart as June 18.

The reason I care about this so much is because I know that at 37 weeks, they are going to start asking me about induction. It's so predictable that it's almost funny, except not, because I've had one, and induction hurts. My children are not born before 40 weeks. They just aren't. And I have a stronger bargaining position if I simply refuse induction until my due date! Oh well. I'm sticking to my guns on this one, bargaining position be darned.

Monday, January 13, 2014

Week 12: First Ultrasound

I had my first ultrasound this week! The sonographer said everything looked great. I had all three boys with me, and they were great, too.

Because I had the boys with me, I asked her not to do ultrasound transvaginally. I thought a transvaginal would a) be awkward with a 4-year-old male child in the room, b) make it more difficult for me to calm the 1-year-old male child in the room with us, and c) not be necessary given the transvaginal I had at 5 weeks and the fact that I was already far enough along to see things clearly on an abdominal ultrasound. I would not have thought this would irritate her, but her demeanor was clearly annoyed by the request. Sonographers of the world, I beg of you: please don't be offended when a pregnant mother of three toddlers asks for a simple favor! We are adults and sometimes even think for ourselves, in advance, about what treatments might be good for us at any particular time!

The other thing I spent a lot of time talking to the doctors about was the genetic testing for Trisomy 18 and Down's Syndrome. I'm very skeptical of prenatal testing, not least of all because of what happened with the Statesman. In the end, he was a very healthy boy who happened to be missing a kidney. So anyway, I guess there's a blood draw they can do between 11-13 weeks that gives them a pretty good risk assessment for those diseases (although it's not a definitive diagnosis). I went back and forth, considering the alternatives, but ultimately decided not to do it. Here's why:

  • First of all, it's only a risk assessment, not a diagnosis. This means that there could be a false positive or false negative. Even though these rates are not very high, it's a big heartache for nothing if it is.
  • The ultrasound looked very normal - good, even. If it had not, perhaps there would be a reason to investigate further.
  • The reason they suggest and push the prenatal testing is so that you have the information, and can be prepared. For some patients, this may be code for, "so you can get an abortion." But I would not kill my child to spare him (or us) pain: that would be an ultimate embrace of the power of death to ruin us. No, not that.
  • So there is a value to having information before a baby is born, planning for medical needs, etc. But I realized last time that prenatal diagnoses change and develop many times over before they are finalized, so plans cannot really be made until the third trimester anyway. Not to mention, there are so many things that must be revealed about the child's health that cannot be revealed until birth. In short, we will have to be flexible at birth, whether the child has extraordinary medical needs or not. Only birth will tell us definitively what the needs are.
  • The cost. It was going to be $223 to maybe tell me something that might be true, or not, and might help us plan, or not. Since I'm paying for these things out of pocket until Medicaid kicks in? Not worth it! We're happy to live with the uncertainty for a little while longer, knowing that all is in a kind God's hands.
Did you do early prenatal testing? What did you think? And has anyone ever had a sonographer give them attitude about the transvaginal/abdominal choice? Why does this keep happening to me?

Saturday, January 11, 2014

Week 11: Thanksgiving

I am proud to report that my plan from last week, not to overeat and to only eat regular meals at meal times or when my blood sugar is low, went swimmingly well over the Thanksgiving weekend. As you all know, this is a tricky time of year.

I also went to visit my endocrinologist this week. He had to think long and hard, and look at me for a few moments, to figure out whether I was joking, when I told him that I was pregnant. After the usual heckling, he asked me seriously:

"Do you all have a number in mind?" (Read: are you ever going to just stop having babies?)
"No, there's no number. We'd like to have as many as we reasonably can. We also recognize that life is highly variable."

Right now, my husband and I are really learning to surrender our lives to our children (ages 4, 3, 18 months, and in utero). We are enjoying them more each day, when we used to spend more time being irritated and feeling inconvenienced by them before. But we are also feeling the pinch and the pain of so much responsibility. Our attentions only go around so far, the crying can really disturb everyone's peace, and we are exhausted and physically in pain and grossed out with great regularity. We are also continually uncertain about whether we are addressing the right need at the right time and in the right way.

So we don't make commitments about the number of children we'll have, because we love them so much but life is also more complicated because of them. The only commitment we make is to love each and every one, to the best of our ability, from the moment of conception onward!

Friday, January 10, 2014

Are you going to or did you already circumcise your baby boy?

Like many parenting and health topics, circumcision is a very personal decision. Once it is done it will affect your boy for the rest of his life.

Kenyan boy taking part in is circumcision ceremony.
image: BBC

This is a non-judgemental page.

Researching circumcision is entertaining! It is traditionally a religious or cultural decision where the historical reasoning is conflicting. Some circumcised to increase sexual pleasure (now known as a myth) while others circumcised to decrease sexual pleasure and decrease masturbation.

The world is very polarized on this topic. Even within Kenya where I witnessed the circumcision ceremony of teenaged boys, the decision is tribal. Some tribes do it and some don't. In the United States, the rate of circumcision changes based on where you live. The west coast has low instances while the east coast has high instances of circumcision. My town is very divided. Most of the moms that I know chose not to circumcise but I know that there are many others that did.

Of the many moms that I know, I have met several with sons who have had botched circumcisions requiring pain and follow-up surgery months later. Some of these moms even told me that they didn't know that circumcision was optional at the hospital. 

How common is circumcision?
"The World Health Organization (WHO) has estimated that globally 30% of males aged 15 and over are circumcised, with almost 70% of these being Muslim. 
Male circumcision is most prevalent in the Muslim world (near-universal), parts of Southeast Asia and of Africa, the United States, the Philippines, Israel, and South Korea. In contrast, it is rare in Europe, parts of Southern Africa, and most of Asia and Oceania. In Latin America, prevalence is universally low. The WHO states that "there is generally little non-religious circumcision in Asia, with the exceptions of the Republic of Korea and the Philippines". Estimates for individual countries include less than 2% in Spain, Colombia and Denmark; between 0% and 7% in Finland; 3% in Cambodia; 7% in Brazil; 9% in Taiwan; and 13% in Australia....Citing three different data sources, most recent rates for the U.S. were 56.9% in 2008 (NHDS), 56.3% in 2008 (NIS), and 54.7% in 2010 (CDM)."  []
Why circumcise?
The reasons I found are for religious reasons, or to "look like dad".

Why skip circumcision?
It is medically known that the foreskin is a nerve and that removing it decreases sexual pleasure. Despite conflicting claims Dr. Sears points out how there is no medical evidence of circumcision being helpful. The foreskin acts as a protective barrier like our eyelid. There are also the ethical questions of doing such a procedure without the child's consent.

History of Male Circumcision:

Myth vs. Fact:

What was your #1 reason to circumcise or not circumcise?

Thursday, January 9, 2014

Week 10: Hunger

Morning sickness drags on, but my blood sugars have (mercifully) been very normal. Somehow, they always seem to be even a bit more even-keel during the first trimester. This is either a special grace of God, or a result of changes in my eating habits. Or perhaps both.

As for changes in my eating habits, this pregnancy, I will basically try to do the same thing I did last time: Eat at regular meal times and only at other times when my blood sugar is low. Low blood sugars happen surprisingly frequently during pregnancy, with tight control over my blood sugars, so this really shouldn't be too much of a problem. And yet, I become like a little baby when I feel the weakness of even mild hunger! This weakness strikes about 2 hours after eating, whether my blood sugars are low or not. If I can push past it to 3 hours past eating, I can usually make it to the next meal time without hearing too much feedback from my body.

When I was pregnant with my first son, I was under the tutelage of people who assumed that, whenever you are pregnant and hungry, you should eat. This might be true, if I were willing to eat carrots or celery at these times. But instead, I would eat rich foods, thinking, "if I can't do it during pregnancy, when can I?"

In reflection, I think this was actually a bad idea. I gained 50+ pounds with my first son. He was a modest size, but it was hard to lose the weight, and I was very uncomfortable by the end of that pregnancy. I gained a similar amount of weight with my second son, and he was not in any danger of being too small at birth. This was all well and good, but then I noticed that babies tend to get bigger with subsequent pregnancies. Since I knew my doctors would not be too keen on my having a 10 pound baby (even though I wasn't especially worried), I decided I needed to rein it in a bit.

With my third pregnancy, I worked hard, and kept my weight gain to about 35 pounds. Voila! Healthy, 8 lb 5 oz baby, not too big, not too small. So that's what we're shooting for this time, too.