i’m not making this up.

A few months ago I was at dinner with friends, one of whom is pregnant. The topic of drinking in pregnancy came up and someone said to me “you just tell people not to drink because you have to, not because it’s really harmful right?” Um…I made that face. That face.  You know. The one where  you couldn’t possibly believe what you heard but, then again, you heard it.  The one where your eyes are big and your mouth is open.  After a pregnant pause I explained that national and now international guidelines recommend against any alcohol consumption in pregnancy.

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We all know that you are never going to get more unsolicited advice than when you are pregnant.  What you can and can’t do including raising your hands above your head or eating peanut butter in the bathtub along with what your baby should eat, how it should sleep, what it should wear and where it should go to college.  Whether or not you should consume alcohol in pregnancy is among that advice.  However, drinking during pregnancy is the most common cause of birth defects in the United States. And while these birth defects are most common among women who drink heavily, there is no safe amount of alcohol consumption for a pregnant woman.  Alcohol use in pregnancy is associated with low birth weight, preterm birth, birth defects and developmental disabilities.  Health care providers are encouraged to discuss discontinuation of alcohol for women who are pregnant and those actively trying to get pregnant.

April is alcohol awareness month. It was established to reduce the stigma associated with alcoholism and increase awareness about alcohol abuse, treatment and recovery.  Excess alcohol use costs the United States about 250 billion dollars per year.  About 5 billion of that is related to alcohol use in pregnancy.  So no, as gynecologists we don’t just say these things because “we have to.”  We say them because we truly want the best outcome for you and your baby.  So if you should find yourself with two lines on that pregnancy test, congrats!  It’s time to take a break from alcohol.  If you are already pregnant and haven’t stopped drinking I would urge you to do so now.  You can tell your grandmother, your best friend, the lady at the grocery store and the dude at the gas station that you are doing everything you can to take care of yourself and your baby.  Really.  We’re not making this up.

the original birth story.

Today is the day we’ve been waiting for.  Or at least I’ve been waiting for.  We light the Christ candle.  It is now Christmas. I don’t know about you but I’ve been anxious for the last 4 weeks.  Anxious to sing the songs and hear the stories and remember the day we celebrate the birth of Jesus.  It is difficult for me to comprehend that God’s people waited through 400 years of silence for the birth of Christ.  I would bet that every time a new king img_2375was crowned, a new country invaded, a new period of famine or drought came they imagined that they were on the cusp of a conquering savior’s presence.  And then they got a baby.

It is easy for us to look at the coming of Christ as a baby and make that sound we do when we see a newborn.  You know it.  You’re probably making it right now. It is the sound of seeing something that makes us feel warm and fuzzy inside.  This is my usual response to Christmas.  The warm and fuzzy feeling of  watching the Nativity.  But today I am keenly reminded of the frailty of Christ’s birth.  In a striking move unanticipated by anyone looking for it, God chose to manifest himself on our planet as the most vulnerable citizen.  We don’t have record of the maternal and infant mortality rate at the time of Jesus’ birth but we can extrapolate based on the earliest data we have available.  Based on early European data and other modeling statistical methods the best estimate is that 300 out of every 1000 infants born did not live to celebrate their first birthday.  That’s 30% of babies.  And their mothers.  Infection and hemorrhage were common.  As many as 25 of every 1000 women died as a result of childbirth during the time that Mary was pregnant.  Compare that to giving birth in the US today where, on average, the infant mortality rate is 6 per 1000 and the maternal mortality rate is about 10 per 100,000 women.  When Mary accepted the call of God to be the mother of Christ not only did she accept the shame that comes with being an unwed mother in her culture but I’m sure she knew the reality that many mothers and children did not survive childbirth in her community.

It begs the question: why would God choose to become incarnate in the form of a baby? Why choose the most vulnerable way to represent himself?  Maybe it’s because God enjoys being subversive.  Maybe it’s because no one would have suspected to look in a crib for a savior.  I suspect it is because He is in the business of demonstrating to us that power
is made perfect in weakness; that He is best found amongst those who cannot raise arms to protect themselves.  Dare I say that if you find yourself looking for a savior who will increase your power, fill your pockets and take down your enemies…don’t look inside the manger.  Don’t look in the manger for a savior who will use violence and destruction and despair to bring about his kingdom.

This Saimg_0059-jpgvior, the one found in the manger, will be “God with you” always.  He will be with you despite your words, despite your actions, despite your selfishness. This Savior will stay close to you in your suffering, He will walk with you in your grief and He will rejoice with you when life is gracious and good.  He will ask you to forgive your enemies, to lay down your weapons, to love someone who believes differently than you.  He is the Light that breaks through all darkness.  If you dare to look for the savior born long ago out in the cold this is what you will find.

May your life be filled with the light of Christ as today we light the Christ candle.  May every baby you see today and this week remind you of the vulnerable God who sends a baby in order to bring peace healing and hope to your life.  Merry Christmas friends!

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photo credits: Pastor Jason, yours truly, shiftworship.com, and the internets.

 

love is more than a sentiment.

Well friends, Advent is in full swing and we are fast approaching Christmas Sunday!  And guess what?  Christmas Sunday is….on CHRISTMAS!  Traditionally we celebrate Christmas Sunday on the Sunday that falls closest to the 25th.  But next week we will celebrate the morning of Christmas.  And I’m excited.  But today is the 4th Sunday of Advent.

We light a candle in celebration of love.

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In the Advent Scripture from Isaiah today we are reminded that God comes to us as Immanuel.  “God with us.”  We have come to that time in Advent when we begin to really anticipate the birth of Christ. Most of you will be familiar with the story.  Mary, the mother of Jesus, is engaged to Joseph. Except then she is pregnant.  And it’s not Joseph’s baby. You can imagine the drama that this would create. It’s a story we want to romanticize.  We like to paint a picture where both Mary and Joseph are overjoyed at the thought of having a baby but I have to believe that they both understood the hard work, the shame, the isolation they would face.  They had enough faith to bravely accept the ways in which God had chosen to use them and follow wherever this path would lead.

The reality is that God comes to us in one of the most uncomfortable stories of all time. Single mother. Unglamorous birth story.  Weird visitors. If it happened in my hospital today people would look the other way or maybe roll their eyes.  But it leads me to believe that maybe God is at His best “Immanuel” in times when we are most uncomfortable. The difficult part is being able to recognize the Immanuel in our own lives. We tend to move away from the uncomfortable spaces, to stay quiet when we see something that isn’t right, to ask how others are doing with the expectation that they should say all is well.

God loved us enough to have Christ come into the most uncomfortable spaces in our lives. If we are to be His people then we must love in the same way.  There is a lot to be uncomfortable with.  Watch the news, read the headlines, get on social media. Aleppo. Violence against women. More gun violence.  Road rage. Sexual assault on our college campuses. Cold and dark days of winter.  But, because Immanuel, we can speak out against violence.  Because Immanuel we can speak out against oppression and injustice. Because Immanuel we can sit with someone in their despair. The Immanuel allows us to sit in anger, bitterness, sadness and frustration with our lives and He doesn’t move away, He moves closer.

If we truly believe that God is with us today as He was way back then, then you must know that God will move with you into the darkest of spaces and that He calls you to move with someone else in the same way. It won’t be easy.  It will feel uncomfortable. It will mean we have to move out of our daily self-centeredness and begin to notice the world around us. And it will be exhausting. Is it worth it?  Honestly, some days I have no idea.  The Pastor and I have spent lots of time in uncomfortable spaces with people. The return on investment is small; sometimes it’s nothing.  But when I am at my most uncomfortable I want nothing more than to share my burden with another and believe in God as Immanuel. Like Mary and Joseph, we are called into the uncomfortable and God goes with us.

rohr

 

O09.521

If you don’t recognize it, the number above is the ICD10 code for “Supervision of elderly multigravida, first trimester.”  So what is an ICD10 code?  It is the International Classification of Diseases, 10th Edition.  The World Health Organization (WHO) owns the ICD system and it is adopted by the US Healthcare system.  Basically, these ICD10 codes are how we tell coders, insurance companies, government regulators and so many other what diseases or diagnoses a patient carries as well as what procedures were done for the patient.  Each version gets more detailed, and therefore, more complex.

Enough about ICD10.  The real point of this post is to discuss this awful designation of ELDERLY multigravida.  ELDERLY.  Sounds depressing, huh.   So what makes a pregnant woman elderly?  Get this…being over the age of 35.  No, seriously.  35. Most OBGYN’s refer to this as “advanced maternal age.”  It’s nicer.  Apparently the WHO is not nice.  But even then, when did 35 get old?  I just turned 38 and I still feel like I’m trying to figure out my life.

About 15% of women in the US give birth at the age of 35 and older and are considered AMA (advanced maternal age.)  Less than 3% give birth at age 40 and older.  Why the big deal about age?  Well, age comes with some risk.  Women who give birth in the US who are AMA have an increased risk of stillbirth compared to women under the age of 35.  Additionally, women in the AMA category are at increased risk for miscarriage, an increased risk for chromosomal abnormalities, an increased risk for high blood pressure, gestational diabetes, growth restriction of their babies, c section and other complications of pregnancy and delivery.  Once a woman reaches the age of 40 each of these risks sharply increases.  For women over the age of 40 we have special protocols to monitor their pregnancy and recommend they deliver by their due date or sooner.

So why would anyone have a baby after the age of 35?  And who are these nutty women having babies after the age of 40?  Surprisingly, I don’t hear this question a lot.  What I most commonly hear is “when should I stop having babies?”  I always ask the patient if they want my personal or professional opinion, or both.  If you know me, you know my personal opinion.  I love babies…when they belong to others.  Two of them was more than enough for me.  But seriously, what I tell the patient really depends on where they are in life and how many children they have.  When I am seeing someone who is over 35, has no children and wants to start a family I try to carefully counsel them on the small risks of complications for their age.  What about women approaching the age of 35 who already have one or more children and want to have “just one more”…or just two or three more?  Again, I counsel them carefully on the risks of their age.  This includes risks to both the mother and the child.

Last week I was asked “in your personal and professional opinion, what age is TOO OLD to have a baby?”  I loved it.  I told her that personally I am WAY TOO OLD AND TIRED to have any more kids (can I get an AMEN from Pastor Jason??).  Screen Shot 2016-07-10 at 4.44.26 PMBut then I went on to tell her that I think someone should carefully consider whether or not they want to have children once they reach the age of 40.  I think when most women think about having a baby over the age of 40 they think about the possibility of having a child with Down Syndrome or some other chromosomal problem.   But for me it’s all the other risk factors that make me nervous for my patients.  You see the risk of a chromosomal problem is about 1 in 70.  (For more information on screening for chromosomal problems go to a podcast found on perinatal quality.org ) That’s something I can personally live with.  But the increased risk of high blood pressure, diabetes, stillbirth and c section…that’s what gets me.  So what did I tell my patient?  I told her that if she wanted that “one more baby” I would advise her to be done by age 40.  What if she had no children?  Well, that’s a harder conversation for me to have.  I want her to know the risks, but I also want her to know that I support her strong desire to have a child despite life’s circumstances that have not allowed it to happen before the age of 40.

My best advice?  Try never to call a pregnant woman “elderly.”  Secondly, don’t ask women when they are going to be done having babies or if they are going to have babies.  But if you are considering when to begin or when to end your childbearing, ask your OBGYN or your MFM (high risk OB specialist).  I’m sure they will be oScreen Shot 2016-07-10 at 4.43.49 PMpen and honest with you and support you in your decision whether or not to enter the “elderly pregnancy” category.  You see, we all make different choices in life.  When we have kids and how many, where we send our kids to school, what we like on our pizza.  Some of these decisions are trivial, some have important consequences in our lives.  But we all deserve to be given compassion and understanding.  May we strive to understand our opposite, those that would choose a strikingly different path than us.  The kingdom will come near when put aside our differences and see each other as we are: people just trying to make the best in a world full of hurts.