On cutoffs

Probably because I will hit 37 weeks tomorrow, I woke up this morning thinking about cutoffs.  On this side of some arbitrarily imposed line, you’re in Box #1.  On the other, Box #2.  And in pregnancy as in life, it can often be incredibly hard to transfer out of a box once you’re there.

If I had the baby today (I won’t, full moon last night notwithstanding), she would officially be premature and my medical record would be flagged forever as having had a “preterm birth.”  This designation would immediately (in the US, at least) send me down a different path of management options for any subsequent pregnancy, since I would have fallen into a “higher risk” category.  But if I had the baby tomorrow, no mention would ever be made of this “normal” pregnancy and “term delivery” and I would be offered a different, “standard” set of management options.  The biological difference between the two?  A few hours.

I faced this same sort of dilemma with my age when I first got pregnant.  One reason that husband and I rushed this pregnancy was that we knew that I was getting old, and we thought that me being this side of the *magic* age of 35 would be a good thing, even if I was just sneaking in under the wire (ok, another was that we really thought it was going to take a while to get and stay pregnant, but we were - somewhat humorously - wrong about that!).  However, there was that line again.  In the eyes of both the medical establishment and the insurance companies, being just shy of 35 is absolutely no different from being 20.  What that meant in real terms was that I simply did not qualify for any tests routinely offered to pregnant women who are 35, even though my biological risks for all of sorts of things were vastly more similar to someone who is 35 than someone who is 20.  I had to fight tooth and nail to get the tests that I did, and in the end, there were a number of them that I missed - that I would have liked to take, and worry every day about not having - due mainly to lack of coverage. 

Box #1, Box #2.

Now I’m not saying that if I had it to do over again, I would make a different timing decision - that’s (literally) an impossible question.  I’m just saying that the quantitatively savvy biologist in me really does not agree with this all-or-nothing, discrete approach to health care in a land where risk is decidedly continuously distributed.  It ignores data, which offends my sensibilities.  People are not getting the best health care they could in this country, and this particular issue is an incredibly minor one in the scope of all that’s wrong with the American health system.  But income cutoffs, age cutoffs, weight/BMI cutoffs, pre-existing condition cutoffs (this one only now finally fixed) - these binary choices swirl around my head like blowing leaves across the flowing landscape of continuous variation in risk.  I don’t have easily implementable solutions, just a vague uneasiness this morning as I try not to take anything for granted.

But because I hate ending blog posts on a negative note, even when I’m feeling grumpy, I’ll end with some happy thoughts about Thanksgiving instead.  My parents arrive in one week (yay!!!), and boy are we planning a feast :)  I’ve never hosted a holiday at my house before, as husband and I have always made it a super high priority to be at one family’s house or the other at least within a few days of every T-day or Christmas every single year.  We’ve also been very, very fortunate to have always been a (fairly) easy plane or car ride away from everyone.  But this Thanksgiving, we are tied to a 1 hour radius of our hospital - so my parents are coming here!!!  Thus, we’ve been slowly accumulating extra kitchen gear (who on earth actually owns a gravy boat if they never host holiday dinners?!?) and planning a menu over the last few weeks, and it’s been loads of fun :)  So no photos again with this post, but you can bet after my parents arrive, there will be more than anyone cares to see :)

Off to finish cleaning the house!