Category Archives: health insurance

Infertility and academia

We often talk about how and when to combine having babies and an academic career, but we don’t often recognize (at least openly) that having babies is not something you can always plan. I was fortunate enough to not have to struggle to have my two children, but I have seen the pain and suffering that infertility causes very closely. This week is Infertility Awareness Week and TenureSheWrote has a great post about dealing with infertility as an academic scientist. Go check it out!

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Filed under academia, baby, health insurance, postdoc, pregnancy, science, women in science

I wanted this and now it’s almost over

From when I just started grad school I knew I wanted to do a post-doc in the US. I understand that many disgruntled post-docs will laugh when I say that being a post-doc was my dream job; not many kids will answer “post-doc” when asked about what they want to be when they grow up. It’s also not something very permanent. But what appealed to me is that it was an easy way to live in the US for a while. America. The country I knew from watching The Simpsons and Beverly Hills 90210. The country that made me realize that Sim City was based on actual cities, because to a European it seems weird that you can start a totally new city from scratch. Unless it was bombed in WW2.

So we did it: my husband (boyfriend at the time) and I moved to the US and became post-docs. Fast forward 4 years, some papers, a baby, a wedding and another baby and we’re almost ready to move back to the homecountry. I guess this extended maternity leave time gives me some space to reflect and made me realize: this was what I wanted and now it is almost over. I have a husband, children (saying this in plural still feels weird) and I lived in the US for 4 years. I guess now the rest of my life starts. (I know, I’m ‘only’ still a post-doc, there’s so much more after this, but stopping and realizing this makes me feel both appreciative and a little shocked about how time goes by as well).

So now these last few weeks that we’re here I am extra mindful of the squirrels outside (we don’t have those in the homecountry), the homeless people falling over after taking opiates (we don’t have those either; at least not visible), the potholes in the streets, the public bathrooms everywhere, the American flags on every building (in the homecountry you only put the flag up when a member of the royal family has their birthday or when you kid graduates high school) and the easy commute by car that leaves your hair like you did it at home (the homecountry is the country of bikes, but also that of tons of rain… not the best combination).

But this is also the country where quitting your job means no health insurance anymore, and where people go bankrupt because of medical costs. You call that freedom, I call that scary. Coming from a country of lots of social security (although I notice that in a crappy economy that is the first thing to go), that is something that I value more than I thought. Also, this is not the country where all of our family lives. And after BlueEyes was born, we quickly decided that eventually we were going to move back. And eventually will be in 3 weeks. Three weeks. I’m going to need new dreams.

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Filed under advice for foreign post-docs, baby, cultural differences, cycling, disgruntled postdoc, health insurance, marriage, observations, postdoc, safety, travel

Why I decided not to have a home birth

This blog post has been in the making (in my head at least) for months if not years. Normally I write a blog post in 10-15 minutes after having thought about it for a while, but this one has taken me way longer. It has had different titles and different angles, but I think this is the final version.

When I was pregnant with Little Brother I was debating whether to have him at home. I wanted to blog about that process but I was afraid that my search of where to give birth would turn into a heated debate and I didn’t feel like putting on my meat pants. So I kept this search to myself. I do however want to share the process after the fact.

“Why would you consider a home birth?” one might ask. I think for the majority of women having a home birth in the US it isn’t about putting videos of your birth on YouTube. It’s about looking for an environment where you feel safe and have your wishes respected where possible. I considered a home birth for what you might call selfish reasons: wanting to sleep in my own bed after having given birth, not wanting a nurse to have to take my temperature while I was pushing a baby out because that was exactly an hour after she had last taken my temperature, not having to drive to the hospital while already in labor, because otherwise contractions might stop on the way in. So I asked my midwife (CNM, not CPM) at my first visit when pregnant with Little Brother whether she thought a home birth was an option (the CNMs in this practice attend births at a hospital, not at home). She told me that even though she thought I would be a good candidate (young, healthy, relatively smooth first birth), she couldn’t refer me to any CNMs because there are no CNMs attending home births in my area.

So I turned with my question to the lady who was my doula at BlueEyes’ birth. She was also the person who gave a child birth class, not hindered by much scientific knowledge (for example explaining how the cervix is a sphincter, which it’s not). And, as an important aside: this is what I hate about the current “child birth industry” as you might call it in the US: it is nearly impossible to find people to educate you about what kind of choices you can make regarding birth, and especially unmedicated birth, that are driven by scientific evidence rather than personal opinions.

So my former doula sent me an email with a bunch of names of CPMs in the neighborhood. I googled them and found some of their names on a listserv talking about learning to suture at someone’s kitchen table. And since I had a third degree tear with BlueEyes birth, that was too difficult for my midwife to suture and required the trained hands of the head of OB/GYN at the hospital, I started to get a bit hesitant about having a home birth attended by someone who learned to suture at someone’s kitchen table.

-For those of you who are going to say that if I wasn’t in the stressful environment of the hospital I wouldn’t have had a third degree tear: I don’t think that was true. I was laboring on my knees without anyone telling me how to push (which seems to be better for your urodynamic factors) but BlueEyes came out in one push with his hand next to his face. Little Brother’s birth taught me that even with very gentle pushing, a super comfortable environment, and my midwife having her hand on my perineum, a hand next to the face still meant a second degree tear in my case.

Also: what would I do if I switched to a CPM for a home birth but my baby would be breech or it would otherwise not be a low risk birth anymore? Then I could probably not easily switch back to my wonderful CNM practice. And would I trust this CPM to know if my baby was breech? And, the most important factor in my decision: you can’t argue with data. The recent release of the home birth death rate shows the home birth death rate in the US is 450% higher than hospital birth. (although these data weren’t there yet when I was deciding whether to have a home birth or not).

Another important reason was that in The Netherlands, where many low risk births happen at home, a significant proportion of women need to transfer at some point during or right after birth (sorry I can’t find this stat anymore, will keep looking to link to it!). What would happen if I would need to transfer in a country where this isn’t happening on a daily basis? Would the CPM dare to go to the hospital or would she be hesitant to take me there because of her fear of a law suit? Would I be in time? And how would the OB on call react to someone having attempted a home birth? What would my insurance say?

I have no answers to these questions because this is where I stopped my search and decided to have Little Brother in the hospital, with the same midwife practice as BlueEyes. It is a great practice where they encourage you to express your wishes and try to adhere to them as much as possible within the boundaries of science and reason. Looking back I don’t even know why I went on this quest of deciding to have a home birth or not but I guess it was necessary to feel that I made the right choice. I might have decided otherwise if I had lived in my homecountry or if my midwifery practice hadn’t existed.

Unfortunately, my midwifery practice is having a hard time staying in business. Not because they have too few patients -they are flooded with patients- but because apparently hospitals are hesitant to have women come in with birth plans and doulas. As Emily Willingham wrote better than I can say it:

“The obvious solution to the controversy is to offer choices that reduce perinatal stress, minimize interventions, and personalize birth—the great appeal of home birth and midwives—while ensuring a safe outcome with well-trained attendants and access to emergency facilities. The absence of options in the United States leaves this solution elusive, especially where hospitals lack a homey, low-stress environment and local midwifery care fails to meet the gold standard. Strange, isn’t it, that our nation, in the 21st century, can’t offer more uniformly safe choices for a low-risk pregnant woman seeking a healthy, low-stress birth for her child … and herself?”

I really wish the kind of care that I had was available for anyone.

I avoid the words “childbirth experience” because it makes it sound like you’re looking for the thrill of a rollercoaster ride instead of the safe and supported process of having a baby. I also avoid the words “natural childbirth” as a synonym for a pain-mediation free birth because what is natural these days? Can you drive your car to the hospital for a natural childbirth? Can you eat GMO-containing food after your natural childbirth and still call it that? I think it’s a weird word. 

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Filed under baby, birth, cultural differences, decisions, doula, health insurance, pregnancy, safety, science

Do as I say, not as I do: advice for foreign post-docs in the US – part I

I have been in the US for nearly four years to do my post-doctoral training, and now that we’re almost moving back, I feel that I have a lot of useful information to share with the internet. Even though 90% of my readers are in the US, I hope that there are enough people out there that can benefit from the things I’ve encountered. And maybe it’s useful for USians as well. Because with many things, I realize now that I could have done things differently, hence the title.

For this first part, I want to talk about the thing that is on my mind right now: maternity leave. In my homecountry, women get 16 weeks off around the birth of their child. This is mandated by the government, so there are no differences in policies per university like in the US (where there is no such thing as paid maternity leave mandated by the government). When I talked about this on twitter today I discovered that for many, many graduate students and post-docs, there are no regulations regarding maternity, paternity or adoption leave at all. This leaves people very vulnerable, because it is up to your advisor to determine how long your leave can be and whether it is paid or unpaid. So if you’re looking for a post-doc and you have the intention to start a family in the near future, it might be wise to VERY CAREFULLY try to find out what your future PI’s view on leave is.

Some positions, like my current position, make you eligible to apply for Family and Medical Leave under the Family and Medical Leave Act (FMLA). However, you might want to study this before starting your family, because it requires you for example to be employed for longer than a year before you have a baby and to work a certain amount of hours to be eligible. In my homecountry, there’s really not a lot you need to do to apply for this type of leave, but here in the US I found that you need to carefully follow the rules and make sure you are eligible before applying. This is especially important because if you don’t get paid during your leave, you still need to pay for your health insurance that is normally taken out of your paycheck. In my university, when applying for FMLA you first need to finish all your sick, annual and personal days before the unpaid leave starts. So when you’re considering having a baby it might be worth trying to save as many days as you can to make sure the unpaid portion of your leave is as short as possible. One might ask: but then what do you do when your baby is sick after you’ve gone back to work and you have no days left? I have no clue at all… Which brings me to the following question from twitter:

Please comment if your university or institute does, because others might be able to change this at their institute!
So as with many things my most important advice about maternity, paternity or adoption leave is: READ TEH FUCKING MANUAL!!

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Filed under academia, advice for foreign post-docs, cultural differences, health insurance, life in the lab, maternity leave