Category: Health

Baby G has a seizure
Greg, now 5 years old, had a seizure last Friday. I’m writing this down as detailed as my memory will allow me so that I can refer to it in the future.

The Night Before

I was working late the night before (code release). I was in my room. I could hear Greg and Steve playing as Steve tried to get Greg upstairs to go to sleep. It was so late. Why can’t he ever put him down at his actual bed time? Greg came to my room a few times during the release (which ended at 9:45pm). So I know he went to bed at 9:30 at the latest. Greg was in good spirits and came to my room to say good night. What a sweet baby boy.

That Morning

The next day, Greg came to my room to cuddle with me as soon as he woke up, as usual. He seemed a bit warm, but it didn’t even occur to me to check his temperature (missed clue #1). Greg came downstairs with me. He went to the bathroom and I gave him some breakfast. He said he didn’t want breakfast; his tummy was too full. This is strange for him, but Cheerios and milk have been known to give him tummy aches, so I figured his baby body was now coming around to rejecting it (missed clue #2). I told him I was sorry, and that’s all there was to eat. “I don’t want to eat it” and I said “You don’t have to… but the cheerios ARE getting soggy.”
I have been trying to get some work done before I leave for work in an effort to shorten my commute (leave late, run into less traffic). This was only the second day I managed to do it. So, after leaving him to his food, I went to the kitchen table and kept working.
He came to the kitchen holding the bowl saying “I just had a little bit, not all of it.” I told him I was proud of him for trying and took care of his plate. Then I got him dressed, and left him playing with his Legos in the living room. I went back to the kitchen to work.
After a few minutes, I heard silence. I thought that was weird, but decided not to investigate. 15 or so min later, I shut down the computer and went to get him to go to school: he had fallen back asleep on the couch. I thought this was also strange (missed clue #3), but since I had only started doing this “work before you go” routine, I really had nothing to compare today to. It was perfectly possible that he would be doing this every day that we leave late: get comfy on the couch and sleep a bit more.
I put his shoes on as he slept in order to wake him up gently. He asked if he could bring his favorite blanket and keep sleeping in the car. “Of course you can, baby. Let’s go to school.”
We didn’t listen to any music on the way to school, and he dropped his tablet to the side pretty quickly after we got in the car (missed clue #4). He normally plays his game until at least 10 min before we get to school. This time he wasn’t interested, and he also didn’t ask for music. I had a lot on my mind, so I welcomed the quiet time to put my thoughts together.
When we got to school, he was his happy energetic self. He said hi to all his friends and he helped me put his lunch in the fridge. I gave him a big hug and a big kiss, and went off on my merry way.

The Call

I was at work, doing nothing particularly exciting, when I got a call from an unknown number. I have been getting a lot of those “You’ve won a Caribbean vacation” calls, and I like to pick them up so I can add the number to my “DON’T PICK UP” address book entry. I picked up the phone. Greg’s teacher is on the other end. She said Greg is fine, however he had thrown up all over his clothes and his shoes. Since he didn’t have a lot of clothes at school, she had to let him borrow another boy’s shoes and shorts. My mind immediately went to the stupid Cheerios: his baby body was REALLY rejecting them this time, but I bet he’s fine now that he’s thrown it up (missed clue #5). The teacher said that the vomit was mostly water but there was a lot of it.
She asked whether I would like to pick him up at the park (where everyone was about to go) or at school. I asked her if he could just go to the park and finish the day, I was sure he was OK. She said the policy was that if a child is sick, the parent must pick them up. I looked at the time: 10:52am. I looked at my screen: not doing anything I couldn’t stop doing right then and there. So there was the question: let him go to the park, or not?
Since I knew he was FINE, I expected that if he went to the park with his friends he would perk up and play, making it harder for me to peel him off the fun to go home, not to mention what a waste of my time it would have felt: if he’s FINE, then WHY am I picking him up??? What am I going to do? Work from home the rest of the day? What is HE going to do? Should I drop him off at my mother-in-law’s? You know, it’s best if he doesn’t go to the park. So I told her just that.
I told my coworker what had happened, and he said “Oh, Ina, kids throw up. What’s the big deal?” and I played the opposite argument just to be contrary “Kids don’t just throw up! Do YOU just throw up? Is that something you do???” He laughed and insisted in his point.
I walked to my car thinking what a waste it was to even come in today. What a waste of a commute.
Drove to the school and parked outside at a meter. Normally I would park in their lot in the back of the school, but this was going to be so quick, that I didn’t mind just parking it out front. I left my work computer bag in the front seat, my sun-roof open, and put a quarter in the meter for a whooping 15 minutes, of which I would only need 5, I was sure.
I walked towards the school while playing Candy Crush. I was so distracted I walked right by it…. came back and punched in the code.

Identifying the Seizure

I walked into the school to find it desolate. All the kids and teachers had gone to the park on such a nice day. Only the poor newbie aid (not Greg’s regular teacher) had stayed behind to wait for me.
I introduced myself, and she said she knew me. She made me nervous. She seemed nice, but I had never seen her wearing the school shirt. Who is she anyway? Does she work here? (yes, she did).
I asked where he was. She said he told her that he went to bed late last night, and he was tired. So she took out her nappy stuff and put him down to rest.
I walked into his classroom and found him lying on his side on the nappy mat with his blanket on. He was staring right out into the distance, and his hand was near his mouth. He has the habit of picking his upper lip with his fingers.
I said “hi baby!” and he didn’t respond. I didn’t think much of it. Sometimes I walk into the school and say hi, and he says “hi mami” without even looking at me.
I got closer and closer and gave him a kiss and kept saying hi. He was still not answering me and not looking at me.
The teacher was talking the whole time, but I can’t remember what she was saying. Maybe telling me again that he said he was tired, maybe calling his name. I do remember her saying “Gregory, respond, you are scaring me.”
I pulled up his upper body to sit him up. He was staring into space. I asked him what he was looking at, but I had already started to get scared.
I pulled him up on his feet. I remember his knees being bent, as he stood up. I held his hand and pulled him across the room to where he was staring out. By the time we reached the door, I realized he wasn’t looking at anything at all, and this must be a seizure. He had had one before, but I wasn’t there for it. It had been described to me as exactly THIS.
I immediately tried to pick him up and told the teacher I would be taking him to the hospital now. However, as I picked him up it was like dead weight. I had no idea how I was going to manage to put him in the car seat. Never mind that he might be really sick and I could get stuck in traffic while taking him in. Never mind I had no idea how to get to the hospital from where I was. None of those things crossed my mind. The thought was simple: I can’t get him in the car. I have to call 911.

The 911 call

I got my phone out of my back pocket (fortunately I had not left it in the car like I usually would when I pick him up the normal way). I dialed 911.
I sat him down on a kiddy chair and looked at his face. His eyes were looking up at the ceiling.
I have always thought I would be clear and concise when calling 911. People tend to ramble unnecessary information. I’ve always thought I would listen for questions and answer them as succinctly, quickly and clearly as possible. So I did just that.
{I requested the 911 recording, but have not received it yet, this is just from memory, which is faulty}

911: Where is your emergency?”
ina: 9999 Street name. I have a 5-year old who is having a seizure.
911: …

They had me repeat the address a couple of times. They asked me for my name and phone number. They repeated what I said about the 5 year old. They asked me a few more questions. At the same time, the teacher kept talking to me with things to say (doing that rambling stuff I said I didn’t want to do). At one point I could not hear 911 over the teacher and I had to stop and ask her to be quiet, then got back to 911 and asked them to repeat the question.
Sometime early in the call his body started to shake and jerk. I was holding his right arm with my left hand, while I held the phone with my right. The teacher was holding his left arm in place.
911 asked me repeatedly NOT to hold him down. “He’s on a chair! I have to hold him up so he won’t fall down.” So they asked me to put him on the ground. “In what position?” I asked. Face down. I tried doing that, but told them that he might choke on his own drool. They said to put him on his side. I tried, but I could hear gargling noises. It didn’t feel right, so I picked him up and put him face down on my lap in fetal position, such that the head would be facing down.
Greg started coughing and then throwing up green goo. This felt like went on for a long time. I could see his eyes rolling up in their sockets. I put my phone down on the floor next to me with speakerphone on.
I could hear the ambulance sirens. The teacher said she would go let them in. Good thing she had the presence of mind to do that. I had not thought about how they would get into the school. I was just holding Greg and talking to 911.

The EMT and ambulance

The EMTs arrived and immediately took him off my lap and put him face up, reclined at an angle. The shaking stopped shortly after and he started shivering.
The EMTs put an oxygen mask on him and started an IV of fluids. They asked me a few questions, but I don’t remember what they were. After just a little bit (time unknown) I called my husband to tell him what happened, and to stand by for hospital name.
The EMTs asked me where to go. I said Children’s Hospital, and the decision was made. I sent a text to my husband to meet us in the ER.
I was asked to pick up Greg and put him in the stretcher. Although he wasn’t responsive, he was definitely awake and disoriented. Kept pulling all the wires off of him and did not like it when we tried to strap him to the stretcher. I kept talking to him saying mommy loves him and it’s going to be OK. There was no sign of him noticing this.
We got on the ambulance and I started singing songs to him. There was no response. His eyes opened up wide and he started pulling at all the wires. He even managed to remove his IV from his arm. We held him down as best we could.
When we got to the hospital, I took a video of it. I wanted to show it to him later. The driver saw me and asked if I was the mom, and I explained I was recording the video for him. He asked me if I wanted him to turn on the ambulance lights. I was so thankful for such a thoughtful request. This is how that turned out:

My husband was waiting at the ambulance bay doors. He looked like he had been crying.

The ER

We were taken to an exam room and Greg was put on the bed. His face was tired. He was wide awake, but unable to speak.
We saw a doctor (and her same-named first-year medical student) almost right away. The doctor tried to ask him questions and run tests. I do not remember everything, but I do remember him not even looking at me when the doctor asked him who his mommy was and to point to her. I kept hugging him and putting my face really close to his. His response was to caress my arms and my face very gently, as he always does. Almost instinctively or reflexively. Without speaking, he seemed to remember his sweet loving nature.
We tried talking and singing, but he would not respond to us. He could look at us now, but no words came out.
The doctor must have explain what “post-ictal” state is, and expressed that this kind of length of time without speaking was not a usual symptom of a classif febrile seizure, and she would need the neurologist to come and evaluate him. This is the point where Steve and I almost lost it. He left the room and the doctor asked him if he was ok, he answered he was light headed, and I started to feel it too. Having has syncopes as a teenager, I knew what to do: I lied down on the filthy hospital emergency room floor and put my feet up. I remember Steve pointing at me and telling Greg “look how silly mommy is being!” and Greg looked at me. I smiled at him, but he didn’t smile back. That was the moment when Steve and I both realized Greg could be left with permanently damage, and it was too much to take.

Speech

It took Greg approximately 2 hours to recover his speech. At first he would only grunt/hum if he was asked a question, or he would press his lips together and blow through them (like a raspberry). He never cried. He simply could not talk.
Eventually he started saying “mamamamamamamamama.” It almost felt like he was learning to talk all over again, like a baby. I was right there with him and would just reply “baby baby baby…”
I have listened to enough podcasts about the brain to understand that songs and speech belong in different areas of the brain, so I started singing to him. At one point I sang to him and he responded:

ina: Watch me whip…
greg: whip.
ina: Watch me…
greg: nay nay

I was OVER THE MOON. He was speaking words! He wasn’t smiling or having fun, and he didn’t do it again even when I asked him to do it for daddy. But it was there! Then, when they put the IV in, he said “Ow Ow Ow!” which is what he normally says when something hurts. We had speech!
Slowly his words started coming back. Once he was able to ask me why we were here, I knew we were out of the woods. All I could think about in those moments was all those times I thought I had a perfect child, and how easily that could change.

By the time the neurologist saw him, he was already speaking. The neurologist believed the description of the seizure did not match with classic febrile seizure, and we needed an outpatient EEG to rule out epilepsy.

The Tests

Our doctor ordered the first set of tests: a CT scan of the head. They wanted to make sure there was no mass or bleeding. All clear.
Blood tests only revealed a slight increase in white blood cells, indicating there may be an infection somewhere. Now it was time to find the cause.
The doctor felt his stomach and thought she felt the liver being enlarged. Our handy family member pediatric nurse let the doctor know that he suffers from chronic constipation and it was possible that it was just poop pushing on the liver. The doctor felt it once more, and Greg said it hurt. Next test: x-ray to find out why the tummy was tender. All clear. Just poop mass. Liver was fine.
After the tests, Greg fell asleep. During his sleep, his oxygen levels dropped to 77 (other nurses saw it go down to 88, 84 and 82). The doctor wanted to admit him in case he could have a seizure in his sleep. We were put on a list to go up to a room.
The doctor now thought that perhaps he could have pneumonia. It would explain the shortness of breath. Greg had xrays on his chest. All clear.
In the meantime, Greg spent time with his favorite people: mommy, daddy, nana, appa and auntie momo. We showed him videos, made a puzzle and he even got a DVD player from the ER to watch a Spider-Man movie.

The doctor thought of one more thing: intussusception. It’s a condition in which your intestine telescopes into itself, which is known to cause seizures. Greg was sent for an ultrasound. All clear.
They also tested Greg’s urine, but nothing came of it either.
By the time we got out of the ultrasound, it was 9:30pm. We finally made it to a room and were ready for bed by 11pm. Everyone went home but I stayed in a cot next to Greg.

The Emotional Turmoil

Both Steve and I had a moment of unrelated drama which set us off. Some time the next morning I went to the first floor to get a security badge. When I came back to the floor, I found that the door had a sign saying to try another door. But no other door seemed to go my way that would accept my badge. So I stood in front of the door staring at it and I started to bawl. Some guy found me there and helped me find someone who would let me back into the unit. I was crying inconsolably. I felt so fragile.
For Steve it was after we had been discharged and I told him I’d get him McDonalds. I had misunderstood him over the phone and didn’t get him a Coke. That was the last straw for him.

The Next Day

We met our doctors as soon as we got to the floor. Dr Zhu was very nice, as was Dr Raju (the one that took over for Dr Zhu in the morning). They explained everything to us step by step and did not make us feel stupid for asking the questions we were asking.
We asked why they didn’t do a lumbar puncture or a blood culture to rule out meningitis or a blood disorder. Answer: none of the tests indicate that Greg is actually sick, plus the fact that he has regained his old personality and is in good spirits indicates to them that there isn’t an underlying condition. What he had was probably caused by a virus. We should keep an eye on him until the virus goes away.
We were comfortable with the answers and took him home to recover.

The Day after Next

The day after the discharge Greg was still not keeping water or food down. We called his PCP and they recommended he go back to the ER if he hasn’t been able to keep food/drink down by 6pm.
Here’s Sunday’s log:
- 4:30am drink water, bloody nose (right side)
- 8 am drink water (multiple times)
- 8 am pipi
- 8:30 temp 99.5
- 8:30am throw up
- 9am tiny bite of toast, drink water
- 9:45 am throw up
- Refuses to eat
- Good spirits. Playing with dinosaurs.
- 10am temp 98
- 11am temp 98
- 11am eat pretzels
- 11:20 no throw up! Temp 98. Ritz crackers. Tiny bites.
- 11:40 stomach does not feel hard
- 12 had some pretzel bites
- 1pm down for a nap
- 3:30 awake from nap
- 4 lunch: sweet pot, chicken, bread
By 6pm, he was back to his old self. I showered him and noticed his arms were all skin and bones. I weighed him and he appeared to have lost 2 pounds (5% of his weight).

I decided to keep him home on Monday with me to keep watching him.

The End.

ina
September 25, 2016
Women’s Health Associates Midwives – Our Regretful Experience

We thought Women’s Health Associates (173 Worcester St, Wellesley, MA) was the place for us, and then they did the unthinkable: they dropped us as clients based on ONE meeting, ONE question, and a lot of judgement from ONE midwife in the practice. We shared our story with family and friends and the outrage has been unanimous.

I have been chronicling our steps every week, so the following write-ups were written on that week.

Here’s our story:

Week 17 of Pregnancy

This week I had two “interview-like” pre-natal appointments scheduled: one with the Newton-Wellesley Hospital midwives, and one with the Cambridge Birthing Center midwives; however, after going to the former, I decided to cancel the latter. WHA is the midwifery group that services Newton-Wellesley Hospital. The midwife we saw was Midwife A. The practice has 3 midwives in total, which is great, because that means I’d only have to go through the trouble of meeting two other midwives in preparation for delivery (any one of them could be on call that day, so it helps to know all of them personally). Midwife A sat us down and started explaining their philosophy: most women come to them because they are interested in a drug-free delivery, and that is their specialty. She calculated that about 25% of women receive an epidural when under their care (making for a 75% success rate with natural deliveries, which was encouraging). She was very patient with all of our questions, which ranged anywhere from “can I eat liverwurst?” to “I want to stop taking pre-natal vitamins.” I told her that my biggest fear around hospitals was that because the epidural would be THERE, I’d be inclined to ask for it, even though that is NOT what I really want. I told her I really needed a strong support team around me to help me through this. She said that, although the epidural IS there and they will not deny it to anyone, they will probably take my request and ask me something like “well, why don’t we try this position for the next couple of contractions?” things like that, to try to keep me away from the drugs. That’s EXACTLY what I wanted to hear. Her response was very reassuring. She also explained that, because they don’t work directly at the hospital as staff, they are able to stay with you for most of the time you are in labor (this is different from other hospitals, where the midwives have multiple deliveries going on at once and might pop in once every couple of hours). She made us feel great and like this was the right place for us.

Week 25 of Pregnancy

We visited midwife #2 (of 3), Midwife C. I do have to say we got off on the wrong foot. First off, I wanted to have some time to discuss our birth plan, just like we had done with Midwife A on our first appointment, but Midwife C was in a rush saying we only had 20 min for our appointment and that there would be “plenty of time later.” This threw me off a bit, because I was expecting to have more time. So I just jumped to my first question: can I have a say on when the cord is cut? Her answer, No, they have their own policy to cut it once it stops pulsing. I asked her what if I wanted it to stay on for 15 min. She said No, because there is a risk of hemorrhage, to which I responded that that didn’t make any sense. When you cut the cord has NOTHING to do with when/how the placenta is delivered (which is what she was referring to with the bleeding risk). That’s the point when she got defensive and basically told us that they have their policies, and if we didn’t like them, then we should probably just have a home birth, and by the way, don’t even think of having all your pre-natal appointments here if you are going to end up having a home birth in the end, “we don’t do that.” At this point I was crying. I did not feel taken care of, and I wanted to just walk out and have a home birth. But Brian, with his completely leveled head, told her that our information is coming from Nancy Wainer, and she’s got to understand that we need her help to balance out the information we get from Nancy. To this, Midwife C responded that all midwives crinch at the mention of Nancy’s name, and they disagree with a lot of the things she does, and she’s surprised that she hasn’t convinced us to have a home birth yet.
At the end, Midwife C was trying her best to smile, and said she would do some research regarding the hospital policy about when to cut the cord, and that we should call her this weekend.

Week 26 of Pregnancy

Called Midwife C back. I had my script down: “I think we got off on the wrong foot, we really don’t want a home birth, we want to make this work, and we need your help to balance out the information we get from Nancy.” I was hoping she’d be more open, but she continued to go off on her rants. She even got to the point of explaining to ME why natural birth was better than not, and how their practice was the best “middle-point” between doctors and home births (ummm… hello, we already did the research, you’re preaching to the choir here). And she also added (repeatedly) that maybe a home birth would be best for us. I had to just cut through the unnecessary and useless fluff with a machete as if I was walking through the rain forest, tried to ignore her remarks, and I tried to focus on my questions: “please explain what you mean by ‘active management’ of ‘3rd stage’ delivery,” or “you mentioned jelly beans, are those regular store-bought jelly beans?” and other technical things like that. I stayed away from any other controversial questions, but she continued to lecture. She made her agenda very very clear, and I did not appreciate it one bit. Midwives are supposed to help you with YOUR agenda, not impose their own onto you. She was even saying some scary stuff about how I should not be selfish and I should put my baby first at all cost, etc (which is scary because that’s the kind of orthodox phrasing that doctors use to convince you to do C-sections). I know she’s against surgery, but her obvious strong opinions about every single topic and every single test was made very obvious, and I did not feel listened to, taken care of, or even taken into account in the process. She had said to come back in 4-6 weeks when we were in her office, and now she was saying I should make my appointment for 2 weeks from now. I asked her why the change, and she said they don’t usually see people who “are off doing their own thing” that often. So basically, regardless of what we were telling her, she had already written us off as “these people are not good for US” and sent me packing to not come back but in a month or so. I was furious at this. I made the decision right there that I might not have any say on who’s on call on the day of the delivery, but I do have a choice on whom to have my pre-natal appointments with, and I do not want to see Midwife C again.

Week 27 of Pregnancy

This week I reached a breaking point. You may recall my rant on this blog (called The Stress-free Natural Birth Paradox) last week where I expressed frustration at all the mixed information. I was depressed and I would cry without warning. My poor husband was at a loss. He didn’t know what to do to make me feel better. Our interaction with Midwife C was making me feel devastated, confused and unsupported.
Our next stop was to make an appointment with the 3rd and final midwife, Midwife B for our 28-week check and hope that appointment would go smoother. However, considering the amount of stress I had been feeling rooted on our last visit with Midwife C, we decided to make our next appointment with Midwife A instead. She’s the first midwife we met who made us feel so comfortable and supported.
And then we got this letter (click to enlarge)

Letter from Women’s Health Associates

They bumped us!!!!! All based on ONE meeting, ONE question, and a LOT of judgement on Midwife C’s part. We plan on reviewing them on the Better Business Bureau, Angie’s List, Yelp, and anywhere else where we can reach critical-thinkers who are looking for a supportive practice.

To read my full pregnancy journey, start at The First Trimester.

Read our review on Yelp!

ina

June 17, 2011
Check… me… out!

Warning: boring self-indulgent post. Enter at your own risk.

I have been battling a debilitating hormone-induced mini-depression (defined, by me, as lethargy with no tears) for a few weeks. I’ve tried a few things to get my mood back up, and here’s my latest attempt: I have decided to crawl back to my old gym and beg them to take me back.

After losing my gym bag and membership card altogether mid-last-year (and taking months to even realize I had), I decided to stop contributing funds to the gym (aka my favorite charity) and quit. Well, I was happy to see that they hadn’t forgotten about me, and that they were happy to have me back. The prodigal son had returned.

I had been looking forward to exercising all day long. I even escaped a meeting that hadn’t ended yet so I could dutifully make my regular train home. Well, the gym did not disappoint! To start, I did some warm up exercises (following the video below):

[youtube http://m.youtube.com/watch?gl=US&client=mv-google&hl=en&v=nrpaAfmVzCc]

2 things to clarify: 1) no, I’m not that big yet, and 2) this warm up was a lot harder than it looked before I tried it!!!

And then I proceeded to spend a whole hour on the treadmill walking at a brisk pace of 3.5 miles/hour!

Proof of workout

Then I got home and made an AWESOME light capellini Carbonara with chicken (sans bacon, sans vermouth, replace asparagus with broccoli). It was delicious! Recipe here.

Tonight I think I’ll practice some piano and then go next door to celebrate my neighbor’s bday over some awesome Norwood Express Pizza and an awesome game of Settlers of Catan (if you’ve ever played, and if you’ve ever had good pizza, you understand what an awesome night awaits).

Oh, AND it’s a long weekend! Could this day get any better??? Doubt it! Oh wait, I brought left overs for lunch from dinner last night… I guess the day CAN get better!

Happy President’s Day Weekend, everyone!

ina

February 18, 2011
Fertility Awareness: An Education
In today’s world, a woman’s fertility is a mystery that is mostly only fully understood by OB/GYNs or women who are trying to get pregnant. I am here to let the proverbial cat out of the bag, and to shout from the rooftops how fertility works.

Whether you are a woman trying to conceive, a woman trying to find alternate natural methods of contraception, or a man wanting to take an educated and responsible approach to sexual activity, this guide will give the reader a good understanding for fertility.

Disclaimer: I am not a medical professional, and I do not dispense medical advice. This is an experience-based post with some information extracted from different websites and from my own experience with the topic. Experiences vary from woman to woman and from month to month. For more detailed information, please research on expert sites or consult your physician.

Let’s get started!

The Basics

Let’s start with a brief and colloquial glossary:
- Uterus: Women have a uterus, men don’t. It is a hollow organ where a baby would grow.
- Eggs: Like all our fellow mammals, we females have eggs whose whole purpose is to become fertilized and make a baby. Eggs are fragile things: after they have reached maturity, they only live from 12 to 24 to 48 hours (at the most) before disintegrating into nothingness.
- Ovaries: ovaries are the egg factories. A woman has 2 ovaries which have millions of eggs in storage. The ovaries are located on either side of the uterus, connected to the uterus by tubes called the “Fallopian tubes.”
- Ovulation: Every month, a single egg reaches maturity and begins its descent from the ovary to the uterus through the Fallopian tube. The process of traveling down to the uterus is called “Ovulation” and it only happens once a month around day 14 (ballpark — the exact day varies from woman to woman and from month to month) of the menstrual cycle.
- Fallopian Tubes: the tube that the egg travels through to go from the ovary to the uterus. It connects the ovaries to the uterus.
- Period or Menstruation: Approximately 12-16 days after ovulation, the lining of the uterus, together with some blood, gets shed out of the uterus to the outside of the body via the vagina, which is directly connected to the uterus.
- Vagina: it’s the tract that connects the uterus to the outside world. Normally penetrated during intercourse, and through which a baby would travel to be born. I know most people think they know what the vagina is, but I have heard of some confusion between the vulva, vagina and urinary tract. As a side note: women do not pee through their vaginas! They have a separate urinary tract that is connected to the bladder.
- Cervix: this is a “valve” of sorts that exists right in the intersection between the vagina and the uterus.
- Menstrual Cycle: the entire fertility process, starting on Day 1: first day of menstruation (or period), and ending approximately a month later on the day before the next period begins. Length of a cycle is said to be 28 days on average, however this length changes from woman to woman and may vary from month to month.
- Phase I of the Cycle: This is the timeframe starting on Day 1 of the cycle, and ending on the day of ovulation.
- Phase II of the Cycle: This is the timeframe starting on the day of ovulation, and ending the day before the next period begins.
- Basal Temperature: a woman’s body temperature changes depending on which phase of the cycle she is in. Phase I is characterized by a “low” temperature, while Phase II a “high” temperature. The exact temperature varies from woman to woman, but the high and low temperatures differ by half of a degree to a full degree (Farenheit). This temperature is recommended to be taken at the same time every day, and when a woman has not gotten out of bed yet to minimize variation from measurement to measurement. Basal temperature may be taken orally.
- Sperm: Sperm is packed with tons of spermatozoids, which race to meet the mature egg for fertilization (that’s their calling in life). Sperm may live anywhere from 3 to 5 to 7 days (at the very most) inside a woman’s body.
The Process

Now that we know the terminology, let’s do a brief recount of the order in which events happen during a menstrual cycle:
- Day 1: The period comes! Yeah yeah, yuck yuck, get over it. This is when the uterus sheds its lining and some blood. The length of the period varies from woman to woman, but it can last anywhere from a couple of days (lucky girls) to a week. On this day, a woman’s basal temperature is “low” (baseline varies from woman to woman).
- Day 14: Again, this is not an exact day for every woman or for every month, it varies, but at around this day ovulation will occur. Right after ovulation happens, a woman’s temperature rises to the “high” temperature. Super regular women may find this day to be the same every month, while irregular women may find this day to range anywhere from day 10 of the cycle to day 26, or they may observe even wider ranges in some cases!
- Day 15/16 (or 12 to 48 hours after ovulation has occurred): The mature egg that was released to the uterus disintegrates into the lining. A mature egg lives anywhere from 12 to 24 to 48 hours (at the very most). After 72 hours from ovulation have passed, the chances of being fertilized drop to nearly zilch.
- Day 28: This is the last day of the cycle. The exact day varies from woman to woman and may vary from month to month. However, it is usually pretty standard for it to be 12-16 days after ovulation regardless of when ovulation actually occurred.
So… when IS a woman fertile?

Now that we’ve gone through the biology of how a woman’s body works, let’s tie this to fertility.

If you know that sperm may live inside a woman’s body for 3 or 5 days, and you know that a woman’s egg can only live for 12-48 hours, that gives a woman about a week’s worth of fertile time in the month. See how that worked? A woman may be only fertile for up to 48 hours (time the egg is alive), but if there is sperm left over from sexual activity from 5 days prior to ovulation, then there is still a chance of conception (because there might be some live sperm left over inside the body by the time the egg comes along), even if the sexual activity did not occur during those 12-48 hours. That is why they say that if no contraception is used, there is a 25% chance of pregnancy in a given month (in a 4-week month, 1 week is 25% of the time).

So we got our window: a woman is fertile about 7 days in the month. Ballpark! Again, this may vary by woman.

Got it! But WHICH 7 days???

So how does a woman know when she ovulates? I’ll only cover the most practical and “mathematical” one: basal temperature. Others, which I won’t go into, are: observing the texture of the cervical mucus, using a fertility calculation device, or observation of the safety calendar.

To find out when a woman’s body normally ovulates, it’s important for her to track her basal temperature and become familiar with her own body’s ovulation routine. For instance, set an alarm at the same time each morning before she usually gets out of bed, take a temperature using a basal thermometer (a regular thermometer may work too — it depends on its sensitivity), and track it for several monthly cycles. Watch the temperature go up in the middle of the month, and go down on Day 1 of the cycle. Nifty tip: women who do this can actually predict the day they will get their period by noticing that the temperature was “low” that morning!

By doing this, a woman can get a sense for how regular her ovulation days are, what her standard “low” temperature is and what her “high” temperature is.

When the temperature is observed to be “high,” that means that ovulation has already occurred! So if the last time she took her temperature was the morning before, her egg may have been released anytime in the past 24 hours.

This is the reason why women who are trying to conceive are advised to have sexual activity the day prior to their average ovulation day. That way sperm will be alive and around by the time the egg comes down. If the woman waits until her temperature goes up to try to conceive, the mature egg may be up to 24 hours old, and it may have disintegrated by then.

So which 7 days?… it will depend on ovulation day! Won’t know that answer exactly until a woman becomes familiar with her own ovulation pattern.

How can this be used as contraception?

Here’s a step-by-step way to use this as contraception:
- Step 1: Track basal temperatures every day for at least 6 months (12 months is recommended). This should give a woman a good idea for how her body works. Beware: if she is on the pill or any other hormone-based contraceptive, these temperature patterns will be VERY different from what they would be if she wasn’t, since the pill tends to regulate the menstrual cycle.
- Step 2: Create a calendar system for sexual activity: if she is 5 days (or more, depending on how “safe” she wants to be) away from her regular ovulation day, stop sexual activity. If she is 3 days (or more) past ovulation, sexual activity may be resumed. This is also called the “calendar method” and there are many resources online to find out when a woman’s “safe” day is depending on the minimum and maximum length of her periods for the past 12 months. For maximum safety, it’s recommended to pad the calendar method’s suggestions by a day or two to account for any unusual irregularities in the cycle. I recommend googling “calendar method fertility awareness” for more information.
- Step 3: Our hypothetical woman now knows the day when she normally ovulates (from Step 1), which are her high temperature and low temperature (Step 1), when her period normally comes (Step 1), and which days are safe and which aren’t (Step 2). The last step is to keep an eye on the actual ovulation day every month so she remains informed every month of where in the cycle she is and avoid surprises. There’s no need to take the temperature every day at this point, she could just take her temperature around the usual ovulation day so that she knows every single month when ovulation occurred. This is the main safety net. Knowledge is power.
Is fertility awareness contraception for me?

Fertility awareness is a recognized and widely used method of contraception. It’s 100% natural and, when used properly, has the same success rate as the pill. However, it is not for everybody.

This method requires discipline and it’s not for the faint of heart. Misuse and misunderstanding of the method is common. Those who use this method correctly and strictly enjoy the benefits of a hormone-free and safe contraceptive. On the flip side, as there is a timeframe when sex is not safe, sexual spontaneity and frequency may be compromised.

So, maybe it isn’t for you, maybe it is. The most important point of this whole article is to educate, and to not let a convenient contraceptive method (like the pill) prevent you from knowing about human fertility and how your body (if you are a woman) works. It is actually very empowering to know exactly what is going on, when it’s happening and why.

I hope this guide helped at least one person out there learn at least one new thing! 🙂 My work here is done.
ina
January 5, 2011