November 2007

my grandmother, maxine, turns 90 next tuesday. i learned two days ago that my [insane and uber-religious] family is throwing her a party. on saturday. even with the short-notice-price of an air/hotel/car package, i could only think that in one year i’d be more likely to regret not going than to regret spending the money to get there.

maxine is a remarkable woman. her mother died in a car crash when she was 15; her father remarried within a year and her new stepmother kicked her out of the house. maxine put herself through high school and college and eventually became a high school english teacher. she married and had four children, in two sets of two each, almost 10 years apart. her husband (perhaps my favorite person in the whole world) was not kind to her. he wasn’t terrible — just not kind.

when i was growing up in the 70s i lived with my grandparents a lot, as both of my parents bounced like superballs from spouse to spouse. maxine was my lightning rod for most things that eventually came to matter to me. she used to take me to feminist rallies, where i made art projects out of big mac styrofoam containers, tongue depressors and lots of thick elmer’s glue. she brought home all her high school’s banned books for me to read. she used to go to what my grandfather called “her women’s meetings” despite the complete lack of support at home for her ideas and values.

her favorite thing to ask me when i was little was what i wanted to be when i grew up. “a mommy,” i always said. “a mommy and what?” she would counter. in first grade i conceded that could possibly stand being a ballerina and a mommy. that wasn’t enough. in second grade i was willing to be a stewardess and a mommy. no go. in third grade i decided i would be a nurse. when my grandmother asked me why, i told her it was because i wanted to help people feel better. “then why not be a doctor?”

i spent the rest of my mis-guided youth thinking i was destined for heart surgery. but when i finally grew up i realized that i loved nothing more than reading books and hanging out with kids: two things maxine showed me were worth spending my life doing.

so tomorrow morning, mairin maxine and i are getting on a plane to go visit her great-grandmother and namesake. and the gift? there’s a good chance, given maxine’s age and health, that i will not see her again. and if i were still pregnant with ruby, i would not be going.

from aurelia, commenting on cheek

Diclectin is perfectly safe and wonderful for preventing nausea. It saved me on more than one pregnancy.

aurelia says that in canada women are handed diclectin like pez. here down south, my own v. good dr l recommend extra b6 for my non-stop nausea; he was willing to give me a scrip (don’t know what for) if i felt desperate. constant morning sickness that got worse during the day somehow did not seem desperate enough to me. what is wrong with me?

obviously i have a thing or two to learn from those canadians about how to work the med system.

yesterday marked one year from our non-wedding. s and i have been together for over 11 years, and except for one small period of time when we actually tried to plan a wedding and then got so fed up with family input that we canned the whole thing, we have never wanted to be married. i’ve actually really liked not being married. i like calling him my partner — which i still do, much to his mother’s dismay, who is visibly relieved that she now can call me her daughter-in-law. (she never knew what to call me before that. apparently my name wasn’t good enough.)

but last year at this time i was just going back to work and s had just quit. and then suddenly he needed health insurance.

i have to say, i hated the idea of getting married for the insurance. it seemed to belittle the whole enterprise. i’m not very pro-marriage but i do believe that if you’re going to make a lifetime commitment to somebody you do it in public, in front of the friends and loved ones you are asking to support you in your mutual endeavor. for our part, we had planned so badly — waiting until the very last minute to decide that s would be a SAHD — that there wasn’t really any way to throw the right kind of celebratory commitment party.

so instead, one evening (november 28 2006 to be exact) we took 3-month-old m and went to our friend tb’s house. tb is a minister in the universal life church, and had married several people who were still married. (this was important to us. our friend r is also a minister in the universal life church, but everybody he has married is now divorced. our friend d is also a minister in said church, but she was starting divorce proceedings of her own.)  and stats aside, we don’t really care if divorce is something that most people are doing. we at least didn’t want to go into this with a minister with a rotten history.

anyway, we bundled up m and went to tb’s house. our friends m & t came along as witnesses. we sat on tb’s couch with mairin while tb filled out the paperwork. m & t signed it. s leaned over and kissed me on the cheek and it was done.

no vows. no words of affection. no promises. just somebody else’s signature and a peck on the cheek.

at first i hated being married. it was hard for me to tell s how much i disliked it while still convincing him that it had nothing to do with him. i hated being called “wife.” it still kinda creeps me out; i’m not entirely sure why. but i’ve slowly come around, if not to a joyful welcoming of the wedded state, then at least to a quiet acceptance that it’s the right thing for us.

but i think i still won’t feel really married until i’ve stood up in front of lots of people and said some important and sappy and life-altering things out loud. and i think we’re close to agreeing on the way to make that happen. in 2009, our REAL anniversary — the one we’ve been celebrating for eleven years and i’m not about to give up — falls on a friday. we’re thinking a big weekend bash, with an outdoor ceremony at one of our local parks. lots of food, some music, kiddies and maybe even dogs running around.

in the meantime, we’ll go on quietly celebrating our two anniversaries. this year our real anniversary was marked by the sadness of having just lost ruby. we spent our technical wedding anniversary with a very crabby m, who did not sleep until 3:30 a.m. and who needed her mama DURING THAT WHOLE TIME to hold her and kiss her and sing to her and rub her tummy.

since she’s the reason we got married anyway, perhaps there is some kind of poetic justice to that.

comments from my coworkers, in ascending order of inanity:

from my secretary, a woman who just took two weeks off to spend with her two-week old grandson, when i asked her how her holidays were:

oh great, just great. i mean, the baby is sooooo cute. he’s 13 pounds already! but he had an infection and had to spend two days in the hospital. gosh, that was really hard. but everything’s great now. how are you? are you feeling great too?

from the president, whose first grandchild was born about two weeks before ruby died, and who saw me yesterday carrying m in the late afternoon:

oh, well, look at her! she is just adorable. now, is this the big…[awkward silence]…one?

and from another colleague who saw me with m (s had a job “interview” on campus yesterday, so i was on mommy-duty for an hour or so), and who knew i had been pregnant, who had seen me very visibly pregnant, who even talked to me about being pregnant:

oh, she’s beautiful. just beautiful. she must be the light of your life. is she your only child?

i was actually so fed up by that point that i looked her in the eye and said “only if you don’t count the dead ones.”

i’ve heard lots of women talk about the kind of person grieving mothers become, at least for a period of time when their grief is raw. i like cecily’s description — because i fit it:

That is what grief does to you; it makes you alternately gracious and kind, and also small and mean.

a bit of me, especially (and unfortunately) at work, is in small and mean mode.  maybe i should try being small and mean with my mouth closed.

when i was pregnant with mairin i had a lot of anxiety about having a daughter. in part i was worried that i would lose her, as i had lost her older sister. but once that seemed unlikely, i was simply worried about raising a girl. more precisely, i was worried i would raise a floozy.

every time we go to a park and i see little girls running around in frilly skirts with nail polish (invariably chipped, because manicuring a 3-yr-old’s nails can NOT be an easy thing to do) i cringe. at summertime parties when i see girls in grade schools wearing belly-baring halters i look away. i mean, really. what are their parents thinking? who let the girls out the door looking like that? and worse, who made such outfits possible in the first place? don’t buy it for the kids, i reasoned, and they won’t have a chance to wear it.

even gifts of clothes can require careful management. a good friend of mine who travels regularly to italy brought m back an italian bikini. the top is the classic two-triangles-over-the-breasts style; the bottom is a thong. A TODDLER THONG! that’s just not right. but i dutifully took the bikini with us to the beach this past summer, and one day even put it on m. all the sane people on vacation with us agreed with me that it was a little creepy — a little too sexualized for a young child. (luckily, the diaper underneath the thong made it more funny than weird. but still.) m did NOT leave the house until she was wearing her jaunty, surfer-inspired outfit, with all her little baby girl parts appropriately covered.

well. my fears and failures — those that are obvious as well as pending — are here to haunt me. on a recent expedition to buy m an extra crib sheet i decided to have a look at shoes for her, since her older cousin handed down a lovely red velvet holiday dress that m can wear this year. now, m is a rough-and-tumble, robeez-wearing kinda kid. she falls a lot, and rarely cries while she picks herself up and toddles off. there is nothing demure about her. nice dresses and fancy shoes are not her thing. but every girl needs a party dress, right? and since all great outfits are built from the shoe up,  we needed to check things out.

as we looked at various shoes — a novelty for m, who typically gets little to no say in what she wears — she became enraptured with a pair of black patent mary janes. ok, i thought to myself. that’s kind of classic: red dress, white tights, black shoes. i can live with that. so we find a pair in her size, i take off one of her yellow-sunflower robeez, and i slip on one of the mary janes.

and that was that.

m would not let me take the shoe back off. i mean, i COULD take it off, but i was certainly going to hear about it. even the magic snack bag — a baggy endlessly supplied with cheerios, raisins and cheddar bunnies, and which makes all bad things seem bearable — did nothing to assuage the poor kid. she eventually had a meltdown in the baby-bedding aisle, the kind that requires you to hold the screaming child and rub her back while she snots and blub-blubs all over your shoulder. she eventually calmed down and was willing to sit back in the cart…as long as she could wear one of her shoes.

so ok, i think. it’s a bit of a novelty for her, she’s come down with a cold from her cousins over thanksgiving, and she’s suffering from massive holiday-craziness-induced sleep deprivation. she’s not herself. we’ll get home, we’ll show daddy the shoes, and when she’s ready to have them taken off we’ll put them away. all will be well.

[insert maniacal laughter here]

yesterday morning i got a call at work from s, telling me that m had cried and cried when he tried to put her brown robeez on her. she gave him sad face and the ASL sign for “all done” — what don’t you understand, daddy? i DO NOT WANT TO WEAR THOSE SHOES! she kept whining and reaching for the mary janes, which s dutifully put on. m spent the rest of the day gleefully clomp-clomping around in those stiff-soled shoes.

when i came home from work she came to show me her shoes. i took some pictures. (so what? a little enabling never hurt anyone.) then eventually it was dinnertime, and then bathtime, and then jammy time, and then…NO. NO BOTTLE. MUST HAVE SHOES.

the mary janes are NOT made to fit over fleece footed sleepers, but m would not rest until both shoes were on her feet. i wanted to win the small victory of at least not taking off  her pajamas. so we crammed and squeezed and shoved until, lo and behold, the kid was walking around in flowery-blue fleece jammies with black patent leather mary janes on her feet.

i didn’t even try to take them off until after she was asleep. i put them out of sight. i was not going to repeat this nonsense tomorrow.

alas, when it was time to put m’s robeez on this morning, she fussed, whined, looked completely forlorn, and practically screamed the “ALL DONE!” sign at me. she reached and reached for her shoe shelf, even though she could not see the shoes she wanted.  i caved. i pulled out the mary janes and put them on her feet. she was instantly as happy as, well, as a toddler who got her way. she clambered down off my lap and joyfully clomp-clomped her way around our second floor.

so there it is: mary jane as gateway drug. this is undoubtedly the beginning of a long and tortured relationship between my sense of propriety and m’s insistence on being her own person, dammit.

now how i do i make sure she doesn’t turn out to be a floozy?

“Midtrimester amniotic fluid matrix metalloproteinase-8 (MMP-8) levels above the 90th percentile are a marker for subsequent preterm premature rupture of membranes.”

Abstract: Objective: We sought to determine whether midtrimester amniotic fluid levels of matrix metalloproteinase-8 were associated with subsequent preterm premature rupture of membranes.Study design: We conducted a case-control study examining 57 asymptomatic women who underwent genetic amniocentesis from 14 to 21 weeks’ gestation and subsequently had preterm premature rupture of membranes (<35 wk) and 58 women with subsequent term delivery. Measurement of total matrix metalloproteinase-8 level in amniotic fluid was conducted using a commercially available enzyme-linked immunosorbent assay and association with preterm birth due to preterm premature rupture of membranes was assessed. Results: The overall distribution of matrix metalloproteinase-8 concentrations was similar in women who had preterm premature rupture of membranes and term controls (median 2.39 ng/mL, 25th to 75th percentile 1.1-10.1 vs 2.37 ng/mL, 25th to 75th percentile 1.5-4.7, P=.94). However, 26% of women who had preterm premature rupture of membranes had a matrix metalloproteinase-8 concentration above the 90th percentile (8.7 ng/mL), compared with only 10% of term controls (odds ratio 3.1, 95% CI 1.1-8.7; P=.03). Elevated matrix metalloproteinase-8 remained associated with preterm premature rupture of membranes after adjustment for maternal age, race, parity, gestational age, and year of amniocentesis (odds ratio 3.4, 95% CI 1.2-9.9; P=.03). Conclusions: The overall distribution of midtrimester amniotic fluid matrix metalloproteinase-8 levels did not differ between women who had preterm premature rupture of membranes and those delivered at term. However, marked elevations of midtrimester amniotic fluid matrix metalloproteinase-8 were highly associated with subsequent preterm premature rupture of membranes, suggesting that the pathophysiologic processes that contribute to preterm premature rupture of membranes may begin in early pregnancy.

and this:

Human neutrophil collagenase (matrix metalloproteinase 8 ) in parturition, premature rupture of the membranes, and intrauterine infection


Perinatology Research Branch, National Institute of Child Health and Human Development, ETATS-UNIS
Department of Obstetrics and Gynecology, Wayne State University/Hutzel Hospital, ETATS-UNIS
Department of Obstetrics and Gynecology, Seoul National University, COREE, REPUBLIQUE DE

OBJECTIVES: The mechanisms by which microbial invasion of the amniotic cavity leads to membrane weakening and rupture are poorly understood. Recently, endogenous host enzymes have been implicated in this process. Matrix metalloproteinases are a family of potent enzymes that degrade components of the extracellular matrix. Collagen type I provides the main tensile strength of the fetal membranes. Matrix metalloproteinase 8 (MMP-8), or neutrophil collagenase, degrades interstitial collagens, acting preferentially on collagen type I. This study was undertaken (1) to determine whether MMP-8 is present in amniotic fluid and whether its concentrations are changed in preterm and term labor and membrane rupture with and without intra-amniotic infection and (2) to determine whether the amniotic fluid concentrations of MMP-8 in labor at term are different in the lower and upper uterine compartments. STUDY DESIGN: A cross-sectional study was conducted and transabdominal amniocentesis was performed in women in the following categories: (1) midtrimester (n = 25), (2) preterm labor in the presence and absence of microbial invasion of the amniotic cavity (n = 86), (3) preterm premature rupture of the membranes in the presence and absence of microbial invasion of the amniotic cavity (n = 51), (4) term patients in labor and not in labor (n = 51), and (5) term premature rupture of membranes (n = 20). Additional paired samples of amniotic fluid were retrieved by transabdominal amniocentesis (upper compartment) and transvaginal amniocentesis (lower or forebag compartment) from 14 term patients (28 samples) in spontaneous labor with intact membranes. Amniotic fluid MMP-8 concentrations were determined with a sensitive and specific immunoassay. RESULTS: MMP-8 was detected in 95.4% (249/261) of all samples. (1) Spontaneous human parturition was associated with a significant increase in amniotic fluid concentrations of MMP-8 in both term and preterm gestation. Term (no labor median, 3.3 ng/mL; range, <0.06-38.6 ng/mL; vs labor median, 16.6 ng/mL; range, 0.33-1650 ng/mL; P <.05). Patients with preterm labor who delivered preterm (in the absence of microbial invasion of the amniotic cavity) had a significantly higher median amniotic fluid MMP-8 concentration than those with preterm labor who delivered at term (preterm labor, term delivery median, 3.1 ng/mL; range, <0.06-415.1 ng/mL; vs preterm labor, preterm delivery median, 32.5 ng/mL; range, <0.06-6006.6 ng/mL; P <.003). (2) Spontaneous rupture of membranes in preterm gestation but not in term gestation was associated with elevated amniotic fluid concentrations of MMP-8. Preterm gestation (preterm labor, intact membranes median, 3.1 ng/mL; range, <0.06-415.1 ng/mL; vs preterm premature rupture of membranes median, 35.1 ng/mL; range, 0.71-1184.1 ng/mL; P <.05). Term gestation (intact membranes median, 3.3 ng/mL; range, 0.24-38.6 ng/mL; vs rupture of membranes median, 5.6 ng/mL range, 0.22-19.8 ng/mL; P =.9). (3) Microbial invasion of the amniotic cavity was associated with a significant increase in amniotic fluid MMP-8 concentration in patients with preterm labor and intact membranes, as well as in patients with preterm premature rupture of membranes. Preterm labor (no microbial invasion of the amniotic cavity, preterm delivery median, 32.5 ng/mL; range, <0.06-6006.6 ng/mL; vs microbial invasion of the amniotic cavity median, 208.1 ng/mL; range, 4.2-14,600 ng/mL; P<.001).

American journal of obstetrics and gynecology (Am. j. obstet. gynecol.) ISSN 0002-9378 CODEN AJOGAH

and a bit of help from wikipedia, on “metalloproteinase”:

The collagenases are capable of degrading triple-helical fibrillar collagens into distinctive 3/4 and 1/4 fragments. These collagens are the major components of bone and cartilage, and MMPs are the only known mammalian enzymes capable of degrading them. Traditionally, the collagenases are #1, #8, #13, and #18. In addition, #14 has also been shown to cleave fibrillar collagen, and more controversially there is evidence that #2 is capable of collagenolysis. In MeSH, the current list of collegenases includes #1, #2, #8, #9, and #13. #14 is present in MeSH but not listed as a collegenase, while #18 is absent from MeSH.

so now i know that there may be a genetic factor (mthfr) and/or a physiological factor (the proteinases are enzymes) at work. the genetic factor can be tackled by folic acid. but the enzymes? no idea. must ask more about collagen structure and ways to strengthen it. and about enzyme testing — if such a thing exists and/or is possible — and at what stage.

the most interesting tidbit i gleaned while reading is that amniotic fluid is typically without white blood cells, so any response to infection (maybe only if the sac hasn’t broken? that makes sense, but i don’t actually know) comes from the baby. it’s such an interesting glimpse  into the mother/baby relationship during gestation.

“The Buddhists believe that babies lost before they live are souls that have already taken many turns on this earth, and they have already endured all the suffering they needed to. They merely needed to touch on this earth one last time long enough to be loved, and they get to stop being reincarnated and go straight to Nirvana. I love that. I love the idea of my boys in Nirvana. I hope they are happy.”

thanks cecily!

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