German Birth Vocabulary

I speak primarily English with the midwife who'll be attending my upcoming birth, but because 1) German is fun! and 2) middle-of-the-night insomnia, I have spent some time lately learning fun fun German words related to pregnancy and birth. I thought I would share some (with genders and plurals, because learning German nouns without their accessories is sacrilegious).

NB. I am not a native German speaker, so if I get something wrong chime in. Also, no guarantee that these are the best or most common words for actual use. Like I said, this is a list for the purpose of fun fun German times.

• der Mutterkuchen, die Mutterkuchen This is the most interesting of several word choices for placenta. It literally translates to "mother cake." I would be remiss to not include a link to this picture at this point. Go on.
• die Gebärmutter, die Gebärmütter Continuing the mother theme, this is a word for uterus. One could translate it literally to "birth mother." The -bär- part is cognate with English bear, as in to bear children. You also get der Gebärmutterhals, die Gebärmutterhälse as a freebie - that's "birth mother neck," aka cervix.
• das Becken, die Becken Pelvis! It also means: basin, bowl, cymbal, and various geological features with that ol' pelvisy shape. I will prove it with a selection from the images.google.de hits on 'Becken':

• das Gebärbecken, die Gebärbecken I am totally messing with you now. Birth pelvis? No, this is a birth pool.
• die Fruchtblase, die Fruchtblasen If you're as happy about all this as I am, hold onto your hat. This one is good. Literally fruit bladder. Any guesses? Yes!- the amniotic sac. I think this is the only term for it, too, not just the funny/colloquial one.
• "My water broke" (kind of funny in English too) = Die Fruchtblase ist geplatzt.
• das Fruchtwasser, literally fruit water, is amniotic fluid. Yummmm.
• (Ok, in fairness, die Frucht, die Früchte can mean progeny, yield, and embryo, so I imagine it has a slightly different spin to a native German speaker. But fruit is definitely the primary definition.)
•  die Nabelschnur, die Nabelschnüre This one is straightforward, but more fun to say in German. Nabel is cognate with, and means, navel; Schnur is just cord or string. Hence: umbilical cord. But watch this:
• abnabeln Our first verb - to cut the umbilical cord. Look, the German is so concise.
• die Abnabelung, die Abnabelungen And a matching noun, meaning the cutting or clamping of the umbilical cord.
• der Kaiserschnitt, die Kaiserschnitte Cesarean section = emperor/kaiser+cut. Again, straightforward but still funny somehow.

I'll let you know if I discover more ...

Two Personal Thoughts on Electronic Fetal Monitoring

As mentioned in my last hiatus-breaking post, I am pregnant! This pregnant:

Which is pretty darn pregnant. It's neat! I have had a really easy, enjoyable, and interesting pregnancy this far, and I want to write about it more generally sometime soon.

For the moment, though, I have two thoughts to share about electronic fetal monitoring (EFM). Until yesterday, EFM was a topic I was familiar with only from second- (third-, fourth-) hand knowledge and my professional interest.

Close to 90% of people laboring and delivering in American hospitals have continuous or near-continuous electronic fetal monitoring (1). The practice persists despite evidence showing that intermittent fetal monitoring accomplishes the same good effects without the negative side effects (higher cesarean section and instrumental delivery rates as well as decreased mobility, increased discomfort, and a shift in focus from the person in labor to the machine and its output) (2).

Like many aspects of pregnancy, experiencing EFM myself has given me a richer and different kind of understanding. My primary caregiver here is a midwife. However, I needed a prescription for Rhogam, so I went yesterday for a brief visit to a Frauenärztin (OB/GYN).

After peeing in a cup and a brief stint in the waiting room, the nurse brought me back to a pleasant exam room with "CTG" on the door and said they'd be taking about 10 minutes of CTG recording (me: huh? turns out, electronic fetal monitoring = Cardiotokographie auf Deutsch).* I don't actually know if this use of EFM is common in US prenatal care or not. Anyone?

She strapped on the two monitors while I was semi-reclining and left the room. I had gotten my book out to read, but I was very distracted and uncomfortable. I noticed two aspects of being hooked up to the EFM that either I had never read or heard about (or more likely had never really thought about until it was my own body):

1. I was uncomfortable lying flat on my back, but afraid to shift around too much and mess up the recording.

Obviously, I wanted a good recording so as not to create false worries. Rationally, I can't imagine that slight shifts in my position would have made a difference, but the thought remained and thus so did I. In labor — hypothetically, as I will be having periodic doppler checks rather than EFM — I have to imagine that what I know about the benefits of moving around would overcome my fear of messing up the recording. Still, it was interesting to me just how constrained I felt, and I imagine this feeling is hardly unique to me.

2. I couldn't touch my own belly.

My favorite part about this stage of pregnancy is holding onto my belly and communing in this way with my fetus. I cannot ever get enough of feeling it kick and squirm around. When Aaron is talking loudly, it often starts moving around wildly, and it seems like it sometimes responds to my voice too. When the EFM process was stressing me out a bit, I wanted nothing more than to calm us both down by holding and stroking my belly, but I couldn't because of the straps and monitors (and the transducer goop). It was incredibly frustrating being held at length from my own body in this way, even for a short period of time. I can't imagine how much worse that would be in labor.

*When we were talking about the upcoming visit, my midwife said they would definitely offer a full ultrasound, and possibly also an internal exam. She encouraged me to accept or decline these and other proffered care based on my personal feelings and clarified that I would not be required to accept them in order to get the prescription. I really appreciated this information as I know next to nothing about patient rights in Germany (especially compared to my understanding of that topic in the US, which is a source of generic confidence for me in receiving medical care there). I had decided ahead of time to decline both of those options, and was caught off guard by the expectation of sitting on the EFM for 10 minutes. Would I have declined if I'd thought ahead about it? I'm not sure. Maybe? Fetus Turon had been blorping about all morning and my next midwifery visit (at which she listens to fetal heart tones with a doppler for 30-45 seconds) is next week, so I was not short on other ways of knowing that everything was fine. If I had to make another OB/GYN visit for some other prosaic reason (e.g. not reduced fetal movement or something where EFM would be important and useful) I would decline it.

(1) http://www.childbirthconnection.org/pdfs/LTMII_report.pdf
(2) http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006066/full

Quick Hit: #IOMbirth

I've been watching and livetweeting the IOM Workshop on Research Issues in the Assessment of Birth Settings. I have a too-long-to-tweet thought and so am breaking my nearly-year-long blog silence to get it out (Woops! Hi! I did my practicum, got pregnant, graduated, and moved to Germany, so things are a little out of date around here! More later!).

My thought is about the one-way traffic that characterizes birth settings in the US. As you can see in the infographic IOM made for the occasion, a scant 1.2% of US births happen in out-of-hospital (OOH) settings. I don't know that there's good data on how many more people start out their pregnancies planning on OOH settings - let's be generous and say 5%? It can't possibly be more than 10%, right? Giving us 90% starting out in-hospital?

But the moves that happen during prenatal care (I'm not talking about tranfers/transports here) are almost entirely going to be from that already-small OOH group to hospital settings. People "risk out" and get moved (appropriately, in many cases) to settings designed to deal with higher-risk situations.

What doesn't happen: people attending prenatal care in a hospital being told, "You know what? Your pregnancy is totally normal. This is overkill. You should be at a birth center (or at home) instead." This despite that the numbers are totally disproportionate in the opposite direction (e.g. those who start in OOH settings and should move to hospitals are a tiny fraction of those who start out in-hospital and could (should?) move to OOH settings.)

Of course, what I'm leaving out here is the same thing that the IOM has totally left out of the Workshop (as Jill pointed out weeks ago) - patient voices, preferences, and rights. Think about this issue (the fact that the status quo has a huge percent of childbearing persons starting out and remaining in-hospital to give birth) from a patient-consumer perspective. Unless you're part of the 1.2% (or 5%, or whatever) fringe that happens to a) know about OOH options and b) be realistically able to access them, you'll give birth in the hospital. There's no system in place to get you to the most appropriate care, unless you're in the bitty percentage of folk who start OOH and get risked out.

That's not fair to anyone - not to hospital providers who treat a population that is overall vastly too healthy to take proper advantage of their medical expertise, not to OOH providers who end up working in an antagonistic system with an artificially limited patient population, and certainly not to patient-consumers who too often end up overtreated and iatrogenically harmed.

(All this having been said, I do want to affirm that choice in place of birth is an important right. While at a system level, referrals should happen in both directions (OOH->hospital and hospital->OOH), individuals should retain the right to opt for one or the other. The two possible mismatches here have different characters: people with uncomplicated pregnancies who want to give birth in hospital (sure! go for it!), and people with complicated pregnancies who want to give birth OOH. Finding the right solution for the latter group is HARD, mostly because of effects on providers (I believe the patient's right to choose is absolute in theory but at some point the state has a role in restricting risky practice on the part of providers). Too big and messy of a topic to get into here, but note that this group has been getting a disproportionate share of the IOM conference attention compared to the superset of all people giving birth or suited to give birth OOH.)

One for the 'Language Matters' files

Here is a geographer talking about once and future plans for how to redevelop an area:

“The debate about the footprint is history now,” Campanella says. “You can’t reintroduce that question six years later, given that the city, the state and the nation as a whole has already committed recovery dollars to rebuilding houses and fixing utilities. To go back and reopen the wound — it’s too late. The baby’s already born. Maybe next time we could revisit this. I hope there isn’t a next time. But of course there will be.” (emphasis added)

He's from Tulane, talking about the Lower Ninth Ward in Louisiana - the state with the highest cesarean rate, 39.7% in 2010. I was reading this article through quickly (fascinating, by the way) and thought, haha, funny mixed metaphor. Wounds, babies. Except on second thought, I think the metaphor here is a actually a c-section, functioning as the unmarked concept.