Three Months Postpartum: Out of the Woods

Well, my baby is three months old, and it looks like we’ve survived the Fourth Trimester together.  It’s around this mark that babies stop being considered newborns and instead become plain old infants, and I can see why– she’s bigger and more independent, we’ve settled into a semblance of a schedule, and overall things are just getting easier and feeling a bit more like normal life.

The first three months were both easier and harder than I thought they would be.  By the time my daughter came along, I had lots of friends with kids and had already heard the horror stories about the newborn days, and I was anticipating long hours of crying, completely sleepless nights, countless 3am walks around the house with a screaming baby.  Luckily, all those things were minimal; my baby isn’t the kind to cry for hours on end for no reason, and she settled into a pretty nice nighttime sleeping routine around three weeks (although, for some reason, that’s regressed significantly in recent weeks).  I was also worried about post-partum depression and wondered if I’d have trouble connecting with the baby, and luckily I didn’t struggle with either of those things.  Those were my biggest worries and they never really came to fruition.

That said, I was not prepared for how difficult the physical recovery from giving birth would be, and how non-stop/around the clock being a new parent is.

I had a long and difficult labor and delivery (48 hours total, a failed epidural after 30-some hours, and an emergency c-section) that left me in very bad shape and in the hospital for longer than normal, and I still struggled physically for weeks after getting home.  Specifically, I lost a lot of blood and my red blood count became very low, and since red blood cells are responsible for carrying oxygen throughout your body, that meant I was very dizzy whenever I tried to walk– for days I couldn’t take even a couple of steps on my own, and it took weeks for me to be able to walk up stairs without becoming dizzy and needing to sit down, and I had a blood clot scare that required extra medical attention.  On top of that was all the normal postpartum crap that all women have to deal with, none of which is pleasant.  For instance, I had no idea that contractions continued after giving birth, so it was the surprise of a lifetime to feel them starting up again the next day.  Those weepy postpartum hormones that settle in about a week after giving birth are no joke, and WHY did no one warn me about the night sweats?

And– unsurprisingly– babies require round-the-clock care, so getting a break to do basic things like eat and shower become difficult.  When my husband went back to work and I started being home all day with the baby, every nap– when she took one– turned into a race against time to try to do whatever various things needed to be done, from feeding myself to putting in a load of laundry to filling out paperwork or answering emails.  Sleep when the baby sleeps?  Yeah right, only if you never have anything else to do.

I found breastfeeding to be particularly all-consuming and challenging, since newborns eat every hour or so, which mean that I felt like I did absolutely nothing for the first six weeks other than sit in my pajamas on the couch with my boobs out and my daughter attached to them.  I had a lot of difficulties in general with breastfeeding and I probably would not have continued if I hadn’t had a good midwife who gave me the guidance and support I needed.  In fact, ALL of this would have been so much more difficult if I hadn’t had her.  One of the best things about the German healthcare system, in my opinion, is that your insurance covers the cost of about 20 home visits from the midwife after you give birth, and this really saved a lot of my sanity.  Without her, I’d probably have been dragging my daughter into the pediatrician every other day to ask if such-and-such thing was normal, or if we should be worried.  (Spoiler alert: most things are totally normal and it’s just new-parent freaking out.)

I also wasn’t prepared for how paranoid I’d be about the baby’s safety.  I’m a rational person but I woke up in a blind panic at least a couple of times a night at first, thinking that something had happened to her, and to check her breathing.  Eventually the “blind panic” part went away, but I still woke up every now and then to check her breathing for the first few weeks, at least.  (Now I hear her fuss in the middle of the night and keep my eyes closed, hoping it will stop…)  I was also really worried about SIDS and overly vigilant about people not putting blankets in her crib, putting her on her stomach, etc.  (Which I still stand by and don’t regret, and still don’t do.)  Apparently this protection instinct is an absolutely normal thing that comes from brain changes that you experience in pregnancy– The Boston Globe has a good article about it here.  Those changes peak in the first month postpartum and then taper off, which has been my experience.

Even with all that, the newborn days are unbelievably sweet, full of snuggles and bonding time.  Babies change quickly and by the end of the first month, my daughter already didn’t like sleeping on my chest the way she had in the beginning, and while I absolutely love the fat, smiley, cooing, interactive three-month-old that she’s become, I already miss how tiny she was (and the pile of baby clothes she’s outgrown continues to grow into a mountain; really, they do grow that quickly!).

Like I mentioned, things are getting easier and more normal, and I’m slowly re-joining the land of the living.  We’re getting out a bit more with the baby– we took her to an art museum and take her out to restaurants sometimes, or to run errands as a family rather than one person staying home and the other one going, and I’ve taken her out a few times on my own to socialize.  It’s not always easy– some days she’s perfectly content to go along for the ride, and other days she cries nonstop, but part of adjusting to having a baby is learning how to deal with those public crying jags calmly instead of letting them stress you out.  Little by little, we’re figuring things out.

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The Nesting Instinct Explained and My Grandma’s Buttermilk Biscuits

Today is finally my due date… although my baby apparently did not get the invitation, which is why I’m typing a blog post from my living room rather than heading off to the hospital.

Throughout my pregnancy, I kept hearing about this “nesting instinct” thing, where women apparently go crazy cleaning their houses to prepare for the arrival of their babies.  I was never too sure what to make of it.  We moved to a new country at the halfway mark of my pregnancy and into a new house right before I reached the third trimester, so cleaning and organizing wasn’t really optional for me– we were starting everything from scratch, so I couldn’t call it an instinct as much as a to-do list.  The whole house needed a thorough, deep cleaning when we moved in which took several weeks to achieve, and then we needed to add furniture to each room, organize everything, etc.  Our new house is significantly bigger than our last apartment (one of the main benefits of moving from a city of 15+ million people to a town of 8,000) and it took a long time to get everything in order.  Sure, part of that was preparing for the baby, but we would have had to do most of this stuff anyway even if I wasn’t pregnant.

Now, in these last couple of weeks, I get it: the nesting instinct isn’t some innate maternal drive to provide for our young, it’s because waiting to go into labor is BORING and DISTRACTING and DEAR GOD, WHEN WILL THIS BABY SHOW UP?  It’s considered normal to go into labor anytime between weeks 37-42 (with the start of week 40 being the “official” due date), and five weeks is a long time to wait around and see when the tiny human you’ve been carrying for 9+ months will deign to make their appearance.  These weeks especially feel long when signs of early labor can come and go frequently without actually progressing into full labor.

So, I’ve been cleaning and cooking, a lot.  Things are already more or less in place for the baby to get here, but I keep finding things to do around the house because 1) it makes me feel productive, 2) it distracts me from all the waiting, and 3) it doesn’t require many brain cells, of which I have none at this point.  I made a whole freezer of meals (something I wasn’t planning on doing until I decided to one day, and then banged them out in a three-day rampage this past weekend), I’ve vacuumed floors and scrubbed tubs and rearranged furniture and done endless laundry and flipped and rotated the couch cushions.  I even mopped the damn bathroom walls, and lately I’ve been eyeing the dusty electrical sockets and radiators around the house, thinking that they need a good cleaning too, and there may or may not be a chance that I’ll re-organize the spices in my kitchen.

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Freezer: stocked

And I’ve been baking.

I’ve really grown to love baking in the past couple of years.  I like cooking too, but sometimes it can feel like a slog, especially when you’ve had a long workday and still have to come home and make dinner.  Baking, on the other hand, is strictly a “just for fun, when I want to” hobby– no one HAS to get home from work and make a tray of brownies at 8 p.m.  (Barring a bake sale or other timeline-sensitive obligation.)

That said, baking can be a kind of a hit-or-miss thing for me, in part because I end up doing a lot of substitutions.  This is usually because I’m making an American recipe and can’t find the requisite ingredients in whatever country I’m living in (such as brown sugar, which a lot of recipes call for and isn’t available in either Turkey or Germany), and sometimes because I just don’t have something in the house and don’t feel like going out to get it (like eggs– I sometimes have them in the house, but I often don’t when I need them and end up substituting 1/2 a banana in its place).  I also don’t have American measurement tools, like measuring cups or teaspoons or tablespoons, and there is no easy conversion to the tools available to me (since American recipes tend to measure by volume and European ones measure by weight) so I end up winging the measurements, which works well when cooking but is less reliable when baking.  Usually the things I make turn out fine, although sometimes the texture or density is a bit off (even if the taste is good) and then occasionally I make something that is downright inedible.

Earlier this week, I decided I wanted to make my mom’s coffee cake recipe, a childhood favorite of mine.  I had to sub out the brown sugar and wasn’t sure how it would turn out, but was pleasantly surprised that the end result was actually pretty close.  I could tell a slight difference, but everything I love about the coffee cake– that it’s light and airy, that the topping is crumbly and dense, that the flavors are balanced and not too sweet– was there.

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My mom’s coffee cake

While going through some old recipes looking for the coffee cake one, I found the recipe for my grandmother’s buttermilk biscuits.  My grandma was a great cook in general, but her biscuits were what she was known for, that everyone always asked for when we ate together, practically begged for.  (Well, the biscuits and her green beans.)

She passed away in January, less than a month after my husband and I moved to Germany.  We were close and her death was very difficult for me, in no small part because I couldn’t go home and be with my family during it.  I still miss her every day and I can’t imagine that ever changing.

When she was alive, I asked her many times when I was home to teach me how to bake these biscuits and it always went the same way: she’d tell me to come over around maybe 8 a.m., and then when I got there, she’d already have made them and would just serve me breakfast.  She had a lot of chronic pain late in her life and a lot of trouble sleeping (I’m sure the first influenced the second, although I’m not sure if the sleeping problems predated her pain issues or not) and she would often wake up for the day at 3, 4, or 5 a.m., so I can understand her not wanting to wait around until 8 to make breakfast.

Finally, I wrote down her best approximation of the recipe she used, even though she didn’t really use a recipe and generally just kind of threw it together.

Today I read over the recipe before making it– it has exactly three ingredients, and I didn’t have any of them.  I decided to try anyway.  I didn’t have self-rising flour so I made my own with white flour, baking powder, and salt; I didn’t have buttermilk so I added a bit of vinegar to regular milk and let it curdle.  My husband couldn’t find shortening in the supermarket here– according to the internet, it’s just called “das fett” (the fat) in German, but he didn’t see it with the baking stuff so I used butter instead.

I was nervous when I started the recipe, but to my relief, they turned out at the very least edible.  They’re not as good as hers– not as fluffy or as flaky, perhaps due to the substitution of butter for shortening– and not as thick as hers, and I’m not sure if that means I didn’t use enough baking powder in the flour or if I just need to double the recipe and not roll them as thin.

Either way, it was an improvement over the one and only other time I attempted to make them, when I was 21 and completely inexperienced in the kitchen and trying to guess the recipe on my own after some vague comments from her and they turned out so hard that they squeaked when I tried to cut into them.  I think I might have forgotten the baking powder completely that time. I’ll make some adjustments next time, and again after that, and hopefully I’ll get closer and closer to how hers tasted.

I wish, just once, I had gotten up extra-early and gone over to my grandparents’ house at 5 a.m. and made biscuits with her, drank coffee and eaten breakfast before the sun was up.  I’ve been waking up pretty early myself these past couple of months– common in late pregnancy, when you’re huge and uncomfortable and have to pee constantly– and often sneak downstairs for an early breakfast.  Then, I usually sit down with my coffee and read a book with only one lamp on, the way she always started her day. There is so much I picked up from her– a love of crossword puzzles and reading and storytelling and card games and (I like to think) my sassiness– and every now and then I find myself acting like her without even noticing. I’m not looking forward to waking up early again tomorrow, like every day, hauling my enormous self out of bed and waddling downstairs when the sun has barely begun to rise, but I’m glad I’ll have some biscuits to eat when I do.

Spring Break Trips, 2009-2018

Most of my absolute favorite trips have been in late March/early April.  I always forget this but each year Facebook’s “On This Day” function reminds me, when all my memories from those couple of weeks include amazing vacation photos one after the other from some of my favorite destinations.

Some of them have been for actual spring breaks– since I’ve spent most of my life as either a student or a teacher– and a couple of times it’s just been a coincidence that it’s lined up during those weeks, usually because I was able to find cheap plane tickets somewhere or had some other sort of compelling reason to travel.  It’s always during the time of year when the weather is just starting to warm up, but you never know if you’re going to get sunshine and flowers or days of nonstop rain, or both in one trip.

Here’s a look back at my last decade of spring break trips.

2009: Venice

In spring of 2009, I had been working at a financial firm for about two years when it was bought out and my office was closed (the company had another, bigger office in a different state and everything was consolidated there).  I had recently been accepted to grad school and had already planned my exit, and was actually pretty thrilled that I got a decent severance pay from being laid off rather than just quitting.  When I found a very cheap flight to Venice (cheaper than what I normally paid to fly from Boston to Virginia to visit my family), I took it and went for a week, staying at a hostel and wandering the city by myself.  This was one of the trips where I had gorgeous, sunny spring weather for the first half and then torrential rains for the second half, resulting in the city flooding, which was an adventure in itself.  It was the first time I traveled solo internationally and one of the best decisions I ever made.  Venice remains one of my favorite cities in the world; I’ve been back once since and will go back any chance I get.

 

 

2010: Charleston, South Carolina

This was during my first year of grad school.  My budget was rather, uh, tight at the moment, but I wanted to get away for a few days and clear my head, so I drove the five hours to Charleston and stayed in a hostel there.  (Travel doesn’t have to be expensive!)  I really didn’t do much other than hang out, walk around, read in the hammock on the hostel’s balcony, and met up with an old friend from college once or twice who happened to live in the area.  It was so relaxing.  I’ve been to Charleston three times and it’s a beautiful city with some gorgeous architecture.

 

 

2011-2014: No spring break trips!

I was defending my graduate thesis and working on exams at the time in 2011, and then I started teaching and spent those weeks off in the following years visiting my family in my hometown.  Sometimes you just need to go home and lay on your parents’ couch for a while to recuperate… or maybe that’s only for those of us who work with teenagers.

2015: Santorini

By this point I was living in Turkey and a couple of my friends from college got in touch to say they were going on a ten-day tour of Greece, did I want to meet up with them while they were there?  The answer was YES.  So at the end of their trip, we met up for a long weekend in Santorini, which is just a hop, skip, and a jump away from Istanbul.  I absolutely LOVE the Aegean coast/islands (we go to them each summer in Turkey) and Santorini did not disappoint.  It was a few days of gorgeous sunny weather, lovely views, great food, and fun hanging out with old friends.  (Again, to reiterate my point that travel does not have to be expensive, my hotel room in downtown Fira was only $30/night.  It didn’t have a sea view but it was big, clean, and up-to-date.)

 

 

2016: Istanbul

We did a lot of international travel in 2015/2016, so for spring break, we stayed close to home and hung out in Istanbul and its surrounding locales.  Sometimes it’s fun to play tourist in your own city– you make time for all the relaxing and cool cultural stuff that you never do because you’re too busy working and doing mundane things like grocery shopping.  We went to some museums, visited the tulips at Goztepe Park, and did day trips to the Black Sea, Polonezkoy (nearby Polish village), and the Adalar (the Princes Islands in the Sea of Marmara).

 

 

2017: Çanakkale/Bozcaada/Assos

Last year we did a road trip from Istanbul to check out part of the Turkish coast we’d never been to before.  Our first stop was Çanakkale, a seaport city on the Dardenelles Strait which was the site of a major WWI battle at Gallipoli (Russell Crowe made a movie that takes place there a few years ago called The Water Diviner), and also home to the ancient city of Troy just outside the city limits, so most of our time there was visiting historical sites.  From there, we spent a couple of days on Bozcaada Island (Tenedos in Greek) in the Aegean Sea, where we visited castles and took advantage of the local wineries.  Afterwards we drove to the Assos ruins, where Alexander the Great and Aristotle used to hang out, and did some exploring there.  I’ve always said– and still say– that the Turkish coast is the most underrated vacation destination in the world.

 

 

2018: Italy/France

Now that we’re living in Germany, a whole new region of easy travel has opened up to us.  At eight months pregnant, aka my due date just around the corner, this year we decided to road trip down to the coast of France for a babymoon, stopping in northern Italy on the way to break up the drive.  Italy is one of my favorite countries to visit and I’ve been multiple times, but it was only my second time in France, and the weather was beautiful.  It turns out that Easter/spring break traffic in Europe is no joke so the drive took a lot longer than we anticipated, but it was nice to get away for one last trip, just the two of us, before the baby arrives.  It was especially nice to get some sunshine after a very long, dreary fall and winter in Istanbul and Germany.

 

 

Next year will obviously be different, when we’re a family of three, so who knows what we’ll end up doing– but whatever it is, it will probably be an adventure.

Pregnancy: A Reading List

There a million resources on pregnancy available, either in the bookstore or online.  A lot of them are great; a lot of them are terrible.  (Beware, especially, of getting any sort of medical information online– there are a lot of websites and blogs that are written by people with zero medical training, with a lot of blatantly false information.)  Here is a short list of things that I’ve found interesting and/or helpful either before or during my pregnancy.

How-To Books

What To Expect When You’re Expecting

Okay, let’s start with the most basic.  What To Expect has been around forever and is equal parts loved and loathed, although it seems like they listened to reader feedback and have made some pretty significant changes and updates in recent years.  I personally found this book to be super helpful, in part because it’s so comprehensive.  You can read about each month– baby developments, symptoms, physical changes, and commonly asked questions– as you experience it, plus there are separate sections for things like pregnancy complications, labor and delivery, and the first six weeks postpartum.  Chances are you can find most of your worries or curiosities addressed here.  However, some of the information seems a little outdated, which brings me to…

Expecting Better: Why The Conventional Pregnancy Wisdom Is Wrong by Emily Oster

This is by far the best, most helpful book I read for pregnancy.  Go out and buy this book if you’re considering getting pregnant.  Read it before you get pregnant.  Read it again after you get pregnant.  And go back and skim through it during your pregnancy.

Emily Oster is a professor of economics at Brown University and a Harvard-trained statistician, and she tackles common pregnancy advice by going to the actual published, peer-reviewed medical studies and analyzing them.  Some of the conventional advice turns out to be absolutely true– there actually are harmful (to pregnant women) bacteria in cat poop, although you’re just as likely to contract them by gardening as by cleaning out the litter box– and some not so much, like the fact that there is actually zero evidence that bed rest is beneficial to pregnant women.  She also does a great job of statistically breaking down risks so that women can decide for themselves what they want to do.  So much of the advice for pregnant women is based on fuzzy or outdated medical studies, and certain things we take for truth (like the fact that you shouldn’t eat sushi) are not actually all that clear.

As someone who likes fact- and science-based approaches to things, I really appreciated this book.

Ina May Gaskin’s Guide to Childbirth

And then on the other end of the spectrum, we have this book.  I… did not like this book.  It was recommended to me by a lot of people but I couldn’t finish it.  Basically, Ina May Gaskin is a midwife who provides natural, unmedicated vaginal births at her Farm Midwifery Center in Tennessee, and has been since the 1970s.  This is great!  I am all for women taking this approach to childbirth, if they want to.

However, the way the book was written– all focused on the personal experiences of the women, rather than the medical side of things– didn’t work for me.  This might be exactly what some women want/need to read about childbirth, but I felt it really was lacking in actual information.  I stopped reading maybe a third of the way through the book when one of the women referred to her cervix (at least I’m guessing it was her cervix) as “the gate of life.”  It’s completely a personal preference, but this was not the childbirth book for me.

Books on Raising Kids

Bringing Up Bebe by Pamela Druckerman

This book, about an American woman raising her kids in France, got a lot of attention when it was published in 2012.  It’s an in-depth look at how French culture treats pregnancy and child-rearing differently than American culture, and it turns out that there are a lot of very big, very stark differences (including the claim that French babies sleep through the night at three months, which sounds amazing, but I remain skeptical).

As someone who has lived in three countries and seen how parenting is handled differently in each country– and as a teacher who has seen the results of different styles of parenting– I find stuff like this fascinating.  At the very least, I think it’s good to read differing perspectives on parenting because it can make you look at common ways of doing things and ask, “Why?”  I recognized a lot of the things about American parenting that she criticizes in the book, and those are things that I think most American parents don’t even think twice about.  You don’t necessarily have to read it as a curriculum on how to parent, but I found it interesting and thought-provoking.

Achtung Baby by Sara Zaske

This is the German version of Bringing Up Bebe, published just in January of 2018.  I kept hearing about it and since I just moved to Germany and am having my first baby here, I thought it might be useful.  Again, I found it interesting and thought-provoking, and also very, very informative to learning more about my new adoptive culture.  It talks specifically about how Germans strive to instill a sense of independence in their kids from a young age.

It also talks extensively about the German daycare, kindergarten, and education system, which is drastically different from the American one, and that was useful to me as a soon-to-be-parent and super interesting to me as a teacher.  In my opinion, the strongest part of this book wasn’t the parenting advice, but more about how so much of what we’re doing with education in the US is having the opposite effect than we want, and showcasing another way of doing it.  I think anyone who has young, school-age kids should read this book to get a clearer understanding of why subjecting five and six year olds to standardized tests, or giving them lots of homework, can do more harm than good in their educational life.

Books About Motherhood

Black Milk by Elif Şafak

Elif Şafak (English: Shafak) is a well-known Turkish novelist and Black Milk is her memoir about postpartum depression.  I read this years ago, soon after moving to Turkey, and loved it.  It’s imaginative and funny and paints a vivid picture of someone who loves her child but struggles with early motherhood, and also how having kids impacts her sense of self, since shifting from “writer” to “mother” is a profound change in identity.  (Something another essay I mention below talks about as well.)

The Art of Waiting by Belle Boggs

A book about infertility might not seem directly relevant to your situation if you find yourself pregnant, but this nonfiction book is a beautifully written look into many facets of parenthood, how it feels when you can’t achieve something that you badly long for, and the various emotions and logistics tied up in things like IVF and adoption.  It’s well-researched and does a great job of combining the informational with the personal.  Several of the chapters of the books are available online as essays, which you can find at the author’s website here.

Essays

Writer, Mother, Both, Neither” by Belle Boggs

Another one from Belle.  (Actually, just check out all her writing, she’s great.)  This is an essay she wrote discussing how becoming a mother has complicated her professional life, and the lengths that working mothers are forced to go to in order to juggle both a career and motherhood.

The Size of a Memory, the Size of a Heart” by Laura Giovanelli

“I am going to be a mother, and all I can think about is my father.”  A beautifully written personal essay about how becoming pregnant made the writer reflect on her relationship with her estranged father.

Websites

Pregnant Chicken

This is a fun website with lots of different articles and blog posts on pregnancy and having kids.  Again, I don’t recommend using any medical information you find online without fact-checking it against a reliable, peer-reviewed source, but this is a good website to waste some hours and is low on the bullshit scale.

Alpha Mom’s Pregnancy Calendar

Alpha Mom has a week-by-week pregnancy calendar and out of all the ones available out there, I found this one the most informative and entertaining.

National Institutes of Health

I don’t recommend googling anything medical-related while pregnant, because it inevitably will just scare the crap out of you; however, that said, everyone will give into it at least a few times, so be sure you’re using reliable, scientifically-sound resources.  The NIH website has articles and published studies that are all written by doctors and peer-reviewed.  Whatever you do, DON’T go onto the pregnancy/mommy discussion forums, because everyone and their sister will be spouting anecdotal evidence and old wives tales and claiming they are true, and making you believe that you have cancer, shingles, and rare blood diseases all at once, and that your baby will be born with two heads or something.  Just don’t do it.

 

Happy reading!

 

 

 

 

 

 

 

Maternal Care in the US, Turkey, and Germany: General Overview of Healthcare Systems and Parental Leave, Plus Statistics on C-Sections, Maternal and Infant Mortality, and Postpartum Depression/Anxiety

As I’ve previously mentioned, two big things have happened in my life recently: my husband and I moved to southwestern Germany at the end of 2017, and we are expecting our first child in May.  These are both pretty significant life developments and I feel like I’ve really hit the ground running this past month, between trying to settle into a new country/culture and suddenly panicking that the third trimester is right around the corner and I actually need to start, like, preparing to have and take care of this baby.

A big part of that has been figuring out the German healthcare system and learning what is available to me here, and how things are typically done.  This is an ongoing process that has involved some research on my part, talking to doctors and midwives, and asking tons of questions to women in the area (sometimes in person through meet-ups, and also through a local mom’s group I joined online).  It’s also made me more curious about maternal and infant care in general, so I’ve been asking my American and other foreign (ie, non-American and not-living-in-Germany) friends about their experiences too.

The answers I’m getting are incredibly interesting, and I’ve noticed one huge pattern specifically:

The vast majority of the women I talk to in Germany about their pregnancy, childbirth, and postpartum experience are incredibly positive about it.  Most talk about what a calm and wonderful experience it was, and how great their care was– before, during, and after birth.

The Americans I talk to, on the other hand, are all incredibly stressed out.  Most seem fairly neutral about the actual care they received in the hospital during delivery (there are exceptions to this– I have a few friends who had great experiences with their doctors, and a few friends who had absolutely horrible experiences) but money issues, insurance issues, lack of postpartum care, and issues with maternity leave make this period a really stressful time for almost everyone, it seems.

General Overview

Here is what I know about the various healthcare systems of the countries I’ve lived in, as they relate to maternal and infant care (disclaimer: I am not an expert by any means, and if any of this is incorrect, please feel free to let me know):

America: The US is infamously the only developed country that doesn’t require employers to provide paid maternity leave.  (As a personal example, the public high school where I taught in North Carolina before moving abroad offered zero paid maternity leave.)  New parents are entitled to twelve weeks unpaid leave via the FMLA (Family and Medical Leave Act) if they’ve been working at the company for more than one year, and if the company has at least 50 employees; otherwise, they are entitled to six weeks unpaid leave via FMLA.  You have a hospital bill you need to pay after insurance; people I’ve talked to have mentioned bills that were fairly low, to several thousand dollars.  Midwives don’t seem to be especially common (I think I know one person who has used one?, and I know several people who said they wanted one but their insurance didn’t cover it), postpartum care seems virtually nonexistent after the 2-3 days in the hospital, and follow-up postpartum appointments can be hard to get.

Turkey: You get four months of paid maternity leave, two weeks of which are required to take before your due date; however, you get paid this money at the end of the four months, not in monthly installments like you would your normal salary.  After that, you can take another eight months of “breastfeeding leave” where you work 3/4ths of your hours for full pay (so basically, part-time).  It seems like most employers let you take up to two years maternity leave unpaid, with job protection; I don’t know if this is a law or just common practice.

One thing that was not great about the Turkish system is that private health insurance won’t cover anything maternity-related until you’ve been on one specific plan for a minimum of one year.  I didn’t know this.  I had switched jobs and was only on my private insurance plan for either ten or eleven months when I got pregnant, therefore they wouldn’t cover any of my pregnancy care.  I could have used the public insurance to see a state doctor, but since I really wanted/needed someone who spoke English well and also wanted someone who was a proponent of vaginal births (the c-section rate in Turkey is astronomical), I chose a private doctor and we paid for my prenatal check-ups out of pocket.  It wasn’t cheap, but it was manageable (and significantly cheaper than non-insured, out-of-pocket care would be in the US).  That said, I really liked my doctor and was happy with the care I got there for the first half of my pregnancy.

I know the cost of birth there can differ dramatically depending on what hospital you give birth in, your doctor, and what kind of birth and care you have.  I don’t really know many details about this, but the top of the range seemed to be around $5,000 USD, with cheaper options available.  I’m not sure about midwife or postpartum care, but midwives seem more common than in the US.

Germany: You can have either public or private health insurance; either way, you pay one fee per month for your insurance and all care is covered 100%, meaning you don’t pay anything for prenatal check-ups or for giving birth.  You can choose either a public or private hospital regardless of which insurance you have.  (I have public insurance but will be giving birth in a private hospital.)  Midwives are common– it seems like everyone has them, and they check up on you for several weeks after birth with home visits.  Hospitals offer birthing and prenatal exercise classes when you’re pregnant, and postpartum classes for you and baby (including things like pelvic-floor-strengthening-class and baby yoga).  All of this is covered by insurance.

There is maternity leave (only available for the mother) at 100% pay that covers six weeks before birth and eight after.  On top of that, there is parental leave that can be taken either by the mother or father, or a combination, of up to fourteen months after birth at around 70% pay.  (So, the mom can take all fourteen months, the father can, or they can split it between themselves with one person taking, say, eight months, and the other taking six months.)  It also seems like you can take those fourteen months in three separate chunks during the first eight years of your child’s life– so if you know you’ll need to take some time off later, you can save some of those months.  However, I might be wrong about this, since it’s something that I’ve come across in my research but haven’t confirmed with anyone who’s done it.

Statistics

C-section rates (source)
America: 32.8% as of 2012
Turkey: 47.5% as of 2011
Germany: 30.3% as of 2009

Maternal mortality rates as of 2015 (source)
America: 26.4 deaths/100,000 live births
Turkey: 15.8 deaths/100,000 live births
Germany: 9 deaths/100,000 live births

(I would be remiss here if I didn’t mention that maternal mortality rates in the US are sharply divided along racial lines, with Black women 2 to 6 times more likely to die during or shortly after childbirth, even when controlled for other factors like education, lifestyle, and income.)

Infant mortality rates (source)
America: 6.1 deaths/1,000 live births
Turkey: Not found
Germany: 3.4 deaths/1,000 live births.

Postpartum Depression and Anxiety

While thinking about all this, my mind turned to postpartum depression and anxiety.  I’m lucky in that I’ve had several women in my life who have been very open with their experiences with PPD/PPA, so I was aware of it long before getting pregnant, and a lot of these women have become advocates for better PPD/PPA care in the US since experiencing it themselves.  However, PPD/PPA is notoriously difficult to get properly diagnosed and treated in the US; if you need proof, read this story about Jessica Porten, who told a nurse at her first postpartum check-up (four months after giving birth, the first appointment she could get!) that she wanted to talk about treatment options for her PPD.  The nurse called the cops on Porten and she was taken to be involuntarily admitted to ER, held for ten hours, and then released without ever seeing a doctor or getting her PPD addressed.  (The link above is to an MSN article but you can read Porten’s original post there as well, and I recommend you do.)

It seems to me that the mere existence of better postpartum care, and of midwives doing frequent postpartum home visits, would really go a long way towards helping new mothers dealing with PPD/PPA.  Most of the women I know who experienced PPD/PPA did not have it properly diagnosed and treated until their babies were around five or six months old, and a lot of it came from feelings of being completely overwhelmed by taking care of a newborn or from some sort of specific issue they were having trouble with and didn’t know how to fix, like breastfeeding.

And if you have someone who is qualified stopping by to check in you regularly– a professional who can answer your questions, give advice and guidance, assure you that you’re doing a good job, and who is trained to look for signs of PPD/PPA– it has an enormous potential to alleviate a lot of the aforementioned feelings of being overwhelmed or anxious before they spiral into full-blown PPD/PPA.  Of course, preventative measures aren’t perfect, and having a good system in place for diagnosis and treatment is an important aspect, too.  (As is, OBVIOUSLY, not criminalizing or stigmatizing it; see above, re: what happened to Jessica Porten.)  I was very pleased recently when I picked up a packet of brochures in English at a birthing information session at a hospital and it mentioned PPD on the very second page of the first brochure.

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Page 2 of the brochure packet from the hospital

So I got curious and looked up the PPD/PPA rates by country.  I couldn’t find a resource that listed PPD/PPA statistics by country, unfortunately (although this is is an interesting academic article from the NIH that talks about cultural factors that can engender PPD/PPA, with rates being significantly higher in Asian countries); however, digging around a bit, I did find individual statistics for countries.

According to the CDC, PPD rates in the United States are anywhere between 1 in 9 to 1 in 5 (so, between 11-20%).  This was corroborated by a few other sources I found, some of which averaged the range and landed on a rate around 15%.

According to the NIH, PPD rates in Turkey are around 21% in developed cities and 25% in developing areas, averaging out to about 23.8%.

In Germany, according to a 2008 study done at Heidelberg University, PPD rates were around 6.1% in and PPA rates were around 10.1% in the sample community.  However, the study self-reports the limitation that it was conducted in a predominantly middle class community.  This report by the NIH lists PPD rates as being around 3.6%, and their conclusion of the study was that there is a high acceptance of for the management of PPD from healthcare professionals.

Honestly I was surprised at how difficult it was to fine reliable statistics on postpartum depression.  Regardless of the country, this is obviously something that needs more attention.

As mentioned earlier in the post, I’m not a healthcare expert or a statistician; I’m just someone who finds this kind of stuff both interesting and important to understand.  I can’t claim with any sort of confidence that there is definitely a direct causation, rather than just correlation, between any of this.  But as a pregnant lady who has experienced all these systems, it’s information that I’m glad to know.

 

 

 

 

 

 

 

A Sunday Walk in Odenwald Forest

One thing that has taken some getting used to since moving to Germany is that everything shuts down on Sundays here.  All shops and malls, including grocery stores and little corner shops that sell essentials, close their doors for the day.  (I had a panicky moment the other week where I was terrified we would run out of toilet paper on Sunday and not be able to buy more– if nothing else, it’s a lesson in planning ahead!)  Literally everything but the occasional bakery or restaurant is closed, leaving the question: what do we do with ourselves?

Yesterday my husband and I decided to get outdoors for a bit.  One thing I really like about Germany is how easy it is to get some fresh air; there are walking and biking paths everywhere, through neighborhoods and random fields and alongside every major road.  Where we live is also surrounded by forests, so we did some Googling and headed out to Odenwald, found a random parking lot beside a twisty mountain road, and set off.

(This is where I feel like I have to mention that “wald” means forest in German, so saying Odenwald Forest is a bit redundant, like saying PIN number.  But, sometimes clarification is nice.)

The parking lot had five different trails branching off from it.  We didn’t have a map– and there were none around that we could see– and four of the trails went pretty steeply downhill over wet rocks; at six months pregnant, I decided I’d rather go for the fifth path that was wide, flat, and gently sloped uphill.

The scenery was stunning.  When we first started walking, the weather was a bit wet and misty but the path was clear, with fog hanging out in the trees on each side, and the woods were quiet.  The trees were so dense and dark that we both wondered out loud if we were in the Black Forest.  We looked it up when we got home and we weren’t, but the Black Forest is very close by, and I can see where the name most likely comes from.

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Start of the hike

While walking, we passed many other people of all ages out doing the same thing, as well as many mountain bikers and– wait for it– mountain unicyclers.  Yes, you read that right.  We saw multiple people riding unicycles through the woods.  I can’t remember the last time I was that simultaneously amused and impressed, and all of my hobbies suddenly seem incredibly boring in comparison.

Also, we discovered that Germans are bit more interactive in the woods than in regular life.  The lack of eye contact/interaction with strangers is something that both of us are adjusting to, but towards the beginning of the hike, we passed a group of twentysomething guys on mountain bikes waiting beside the path, and they smiled and said hello to us.  This kind of thing never happens normally– when I use the walking paths in my neighborhood, the people who pass each other literally pretend the other one doesn’t exist– so we thought, “Huh, maybe this is a thing when hiking.”  I know in the US that it’s customary to greet other hikers in the woods, so we decided to at least make eye contact and nod or smile for the rest of the hike, and there was about a 75% success rate of people nodding or saying hello back.  Not too bad!

As mentioned, we didn’t have a map on us and didn’t know where the path led, so we walked uphill for maybe a mile before turning back.  The higher in elevation we got, the denser the fog became until it eventually shrouded the path.

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Odenwald: a neighbor to the Black Forest.  You can see the condensation on the trees at this elevation.

At that elevation, dew was sticking to everything; even my husband’s mustache and beard suddenly had visible drops of condensation on them.  The occasional wind gusts that came through the treetops sounded like cars on a highway.  It truly felt like we were in another world.

We weren’t out for that long but it was a nice first foray into a local forest, and we will definitely go back.  In some ways, everything being closed on Sundays is nice because it forces you to take a breather and make some time for yourself, and hiking is a really nice way to do that.  It’s hard to beat the combination of fresh air and endorphins.

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All in all, a really great Sunday, and I’m looking forward to the next one, hopefully this time with a map.

 

Turkey vs. Germany: Initial Impressions

An outsider’s perspective after 3.5 years in Istanbul and 1.5 weeks in southwestern Germany.

Interacting with cashiers

Turkey: Ah yes, here is an obviously foreign person, I shall talk to her with minimum expectations of her knowing Turkish.  Oh, she speaks some Turkish!  What a pleasant and unexpected surprise.  I will laugh gleefully in her face at how cute it is that she’s trying.

Germany: Here is a normal German person, I shall speak German to her… wait, what is she saying?  Is she trying to speak German?  Are the words coming out of her mouth a known human language? *narrows eyes* Is she foreign, or perhaps just very, very stupid?

Hard liquor in grocery stores

Turkey: There is one tiny shelf behind the cash register, please request what you want and then provide your life savings, dignity, and firstborn child’s soul as tender.

Germany: Feel free to peruse our aisles of booze at your leisure, or if you are pressed for time, grab one of the many travel-sized bottles located near the cash register for your convenience, that will be €1.79, enjoy 🙂 🙂 🙂 🙂 🙂

Weather

Turkey: 45°F (7°C) and rainy

Germany: 45°F (7°C) and rainy

Passing strangers in the aisles of stores

Turkey: You in my space, BITCH?  YOU WANT SOME OF THIS? *takes off gloves, throws them on the ground, prepares for sparring and body checks*

Germany: No eye contact, ever

Saying goodbye

Turkey: Many Turkish phrases repeated several times, multitudes of cheek kissing and waving at the door

Germany: Awkward eye contact

Green spaces

Turkey: Oh, you want to keep your forests undeveloped?  Bwahahahahahaha!  You’re HILARIOUS.

Germany: YOU get a forest! And YOU get a forest!  EVERYBODY gets a forest!!!!

Windows in apartments

Turkey: Silky, draping, sumptuous curtains; fantastic for adding ambiance and elegance to your home

Germany: Very functional, industrial-style electronic blackout shades; fantastic for pretending you live in a cave

Language

Turkey: Tuna Can and Ufuk are TOTALLY legit and normal names; also, let’s make the words for “bread” and “man” almost identical so foreigners can embarrass themselves by asking for fresh, hot men at the bakery

Germany: Let’s just go ahead and put the word “fahrt” on all our traffic and pedestrian signs