The weighting game

When talking about pregnancy with English friends, and the topic of food comes up, the general tone is something along these lines: “Oh, isn’t it great that you now have an excuse to eat what you like?!” and “Make the most of it – you can lose the weight when the baby is born….”. Take that conversation to Italy and you’re more likely to hear “How’s your weight going? Are you managing to keep it low? No pastries for you now!!”
Pregnant Italians are weight obsessed. Their friends are obsessed on their behalf. Worst of all, your average (already slightly intimidating) gynecologist turns into a fully paid up member of the Nazi party when it comes to diet and nutrition; and when you already weighed 5 kilos over your ideal before the pregnancy….. well, you can imagine.
Don’t get me wrong – I am a strong believer in healthy eating and always have been. I completely understand the importance of good nutrition for your unborn child and I am well aware of the complications brought about by rapid weight gain in pregnancy (pre-eclampsia and diabetes being the big scary ones) but sometimes I can’t help wishing I wasn’t up there in Northern Europe where a pregnant lady eating a mars bar isn’t considered an obscene act in a public place, and the occasional treat (“it’s not for me, it’s for baby”) is perfectly normal, everyday behavior.
My gyno is great – very well qualified, very thorough, very professional. However, she also has that Italian way which makes you think that she might well go home and stick pins in a voodoo doll of you if you don’t do exactly what she says. Her latest offering to me was “If you don’t regulate your own food, I’ll put you on a diet and complicate your life in a way you can only imagine”. My protestations that I’m actually eating really well and being careful already were brushed aside. “Well, if you don’t take my advice you’ll become a diabetic and then you’ll be sorry”. Hoooooly!!! “Eat only fish, meat, steamed vegetables and fruit at meals” was her next piece of advice. “Avoid carbohydrates, sugar, fat, and too many dairy products”.
Hang on a second. I’m 170 cms tall (5’6’’ )and weighed 67 kilos pre-pregnancy (147lbs or 10.7 stone). I am now 72 kilos at four months of pregnancy ( 158lbs or 11.4 stone) weight. I’m no sugarplum fairy, but I’m not obese either. My usual dress size is 14-16 UK (the national average) and I have a generally healthy diet. I put on weight at the start of my pregnancy because the only things I could keep down were crisps and cheese, but we’re well passed that now.. I am actually keeping a food diary of everything that passes my lips, which reads like an anorexic’s shopping list: 11am – ½ a banana. 1pm – small pack of soia crackers. 3pm – 1 pear. And here I was thinking I would be eating for two!!
So, there we are. All is well so far – baby growing nicely, blood tests regular, diet boring. Assuming all goes well (facciamo sempre le corna)…. in 5 months from now I will mostly be drinking tea and eating donuts – just because nobody will be able to stop me!

Prima visita!

I don’t know why, but by the time the doctor called me into her office for my first pregnancy appointment, I was physically trembling and my now ever-present all-day nausea was threatening to throw me over the edge. I’m not good with doctors; I don’t like to be poked and prodded – much less in the old ‘stirrup’ chair (if you know what I mean…) so, having waited the customary 50 minutes (she’s great but always running way behind), it was with some trepidation that I dragged myself into the consulting room and “made myself comfortable”.
The visit started with a half hour chat about how I’m feeling (sick!), what I should and shouldn’t eat (not an issue at the moment as I can hardly bear to let anything pass my lips!), what I should and shouldn’t do, and my fear of the dreaded complication (which shall remain nameless, but which has wreaked havoc for the women of my family for generations…). The doctor was - I have to say - fantastic. She put my mind at rest about a lot of things, saying things like “you don’t have to worry because if you do have complications, they are not your problem anyway; they’re my problem” and (talking about the illness) “if you invite her to the party, she might just come….. If you don’t invite her then she probably won’t bother, but if she does, try slamming the door in her face….”. A quick exam, a pregnancy certificate and a prescription for some anti-bacterial capsules, and I was done. Oh, she also gave me a two-month supply of folic acid to be getting on with, as well as some insider information about what goes on at the local hospitals – just so that I was properly informed. All in all I was pleased with how things went. I now need to organize my 12-week scan in Sardinia (we’ll be on holiday there for most of August and I hit week 12 on the 17th) plus a round of blood tests to do more or less straight away. Next gyno visit if all goes well will be at the beginning of September. Now I just need to get rid of this damn nausea and I’ll be much more capable of functioning like a normal human being…

I'm not ill, I'm pregnant...

Well, the gynecologist was 50 minutes late arriving at her office, so our 15:30 appointment was actually at 16:20. No problem, but she could have called her secretary so that we knew that she was on her way, but didn’t. Ho hum. We didn’t really get any further to be honest – she answered a few of my questions, said there was no point in doing another “official” pregnancy test as I’d already done two, and that if I wanted to become her patient, that was fine but she’d be on holiday starting in two weeks’ time and had no free appointments before then. So that told me basically. I left feeling not much more informed or looked after than before and, the next day decided I would cut my losses and go back to my previous gyno who, despite being the most expensive in the city and not connected to a hospital, would at least provide me with a decent level of care. Just a few hours later, having sent her an “It looks like I’m pregnant, what should I do now?” email, she got back to me with a long, detailed response which I received at 11pm. Now that’s dedication. In fact it was the first of 3 consecutive evenings at around that time, during which I received further communication from her about which blood tests to do and when to book my first appointment with her. Friday morning I battled the nausea to do my first bHCG test, which is the pregnancy hormone, and which is supposed to double every 3 days or so, indicating “normal” progression. So, tomorrow morning I will drag myself off for the second one, hopefully feeling a little better than I do today! They say pregnancy isn’t an illness, but when the slightest movement makes your head pound and your stomach churn, it’s quite hard to believe!! Now where did I put my ginger biscuits…??

The storm after the storm....

Well, we’re off to a typically Italian start (and that doesn’t mean a good one...). Having allowed myself one full day of shock absorption Wednesday, on Thursday morning I thought it might be a good idea to get in touch with my doctor and see what had to be done. Despite the years of imagining and vaguely planning what my childrens’ names might be, I found myself on ‘pregnancy day 1’ with no clue as to what to do or who to go to. In England you’d wander off to your family doctor, who would probably do a blood test (or maybe get the nurse to do it for you), and they’d give you one of those NHS information packs with week-by-week instructions, together with a copy of “Emma’s Diary”. Since I am in Italy I am well aware that I will be writing Emma’s Diary for myself (ironically), creating my own information pack and following my own instructions. They’re not big on “customer care” here, and the medical world is by no means an exception. So, my very first experience of the pregnancy process in Italy was this:
I woke up early to call my doctor. As with most Italian doctors, there is no secretary or receptionist and office hours are something like Monday, Wednesday Friday 8:30 – 10:30 and Thursdays from 15:00 to 16:00. Not having a secretary or receptionist, her (landline only) phone pretty much always rings and rings, and voicemail / answering machines don’t appear to have made it here yet, so getting an appointment is a bit like nailing jelly to a tree… Oh, and many doctors don’t even offer appointment times; you just have to turn up and wait with 20 or so elderly patients lining up to get their dodgy feet checked out, whilst you (genuinely sick / pregnant person in need of attention, with an impatient boss sending “Where are you?” emails every 15 minutes) are forced to spend 2 or 3 hours in a hot, smelly waiting room. Anyway you get the picture.
So, I started calling around 8:30 and it just rang and rang. 3 or 4 attempts later and the CLEANING LADY picked up (I know this because I asked if she was the doctor and she answered abruptly, like I should have known better “No, Signora. I’m the cleaning lady!” – sorry, my mistake….), telling me that the doctor was on holiday and would be back in 2 weeks. I asked if there was a substitute and was told “You can go to Dr Tacchini until noon”. “OK, so can you give me his address and phone number?” I ask. “How should I know?!” is the response I get. “He’s the one with the office opposite the pharmacy”. I explain that I’m not familiar with this particular area as I live in the next village along, so could she please give me the name of the street that the pharmacy is in, but she doesn’t know it and is obviously thoroughly fed up of talking to me, so the conversation ends there.
Feeling rather disillusioned, I decide to take myself off to the women’s clinic in Pavia. I’ve heard they’re an excellent resource and will provide you with at least some basic information, even if they can’t fit you in with a doctor, so I get in my car, drive, park and find the place. It’s pretty chaotic, but then it is a free clinic, so I try not to be overwhelmed by the number of immigrant ladies chatting away in foreign languages, with 3 or 4 screaming kids each, and take a seat in the waiting room. After a few minutes, one of the office doors opens, and out comes a lady with a clipboard, so I try to take the opportunity to find out what I have to do to talk to somebody. She looks confused and asks my name. I tell her she doesn’t have my name yet as I haven’t spoken to anyone. She asks me why not. I think I might cry. She tells me to wait until the other office door opens and ask the lady in there. People come and go from the other office and finally it appears to be my turn (who knows??) so I duck into the room before anyone can stop me and speak to a very kind nurse lady. I am convinced that she’s looking at me like I’m crazy to begin with, but she’s probably just trying to work out where I’m from and why I look so terrified (not quite sure myself!). She gives me a piece of paper with a list of standard tests to do and the weeks in which to do them, telling me that unfortunately I need to get an “impegnativa” (referral) from my GP in order to do these or any other tests and, indeed in order to make an appointment just to get my pregnancy “confirmed”. So, I leave the clinic, jump back in the car and leg it back to the village where the temporary doctor is, intending to find the pharmacy and make enquiries from there. I’m feeling very proud of myself when, 10 minutes before midday I stumble upon Dr Tacchini’s office without any local assistance. The positive vibes soon dissipate when I’m told that he already left for the day (10 minutes early!! The cheek!!!). So, determined to see someone – anyone – today, I call into the pharmacy to ask whether or not they have the names and numbers of other local doctors. I shouldn’t have bothered. The perma-tanned (literally, she’d been tango-ed), liposuctioned, drag-queen of a pharmacist stared at my blankly like I’d asked whether or not she could point me in the direction of little green men. “We don’t have that sort of information, Signora!! OF COURSE we don’t!! This is a PHARMACY!!!”. OK, fine, I get your point. I give up. I’ll just go and see if my regular doctor has put up a sign or something. So, being evidently completely unreasonable in my demands, in a last ditch attempt to get some help, I innocently ask the bitch of a pharmacist whether she can tell me the name of the street that Dr Baietta’s office is in. “She’s YOUR doctor and YOU don’t even know where her office is????!!!!! I can’t believe it!!!” is the answer I get. MORE FOOL ME FOR ASKING. Thoroughly defeated and with tears streaming down my newly-pregnant (but who even knows?) cheeks, I drive around aimlessly until my surroundings start to look familiar, and finally manage to find the place. A sign on the door states that Dr Baietta is away and that her patients should call Dr Dreher. I do, and to my delight I discover he’s just around the corner and can see me straight away! Finally my luck is changing! I arrive at his dirty, smelly, fly-filled office and curse myself for having been so optimistic. Dr Dreher was obviously counting on an early lunch because our exchange goes something like this:
ME: “I’ve come to see you because I did 2 pregnancy tests from the pharmacy and they both came out positive, so I need to know what to do now”
HIM: “Go and buy a sterile cup, pee in it and take it to the laboratory around the corner tomorrow morning between 7:30 and 8:00. Here’s a referral.”
ME: “But don’t I need to do a blood test?” Or maybe see a gynecologist?? I have a few questions, who should I ask?”
HIM: “You can talk about all of that with Dr Baietta when she returns on Monday”
ME: “But on her door it says that she’s away until July 8th”
HIM “So you can talk to her about it then”.
OK, so I know we’re in Italy, I know everything is 20 times more difficult than it should be, I know that healthcare “professionals” here have no bedside manner and that you just have to look after yourself, I’ve been in the system for 7 years now and I’ve done that, got the t-shirt and everything. But, COME ON!!!
So, in desperation I write an email to the head of gynecology at Pavia hospital (following a long, hard search of the internet to get hold of his contact details), and I ask him WHAT THE HELL I NEED TO DO AND WHO THE HELL I NEED TO TALK TO. I’m not crazy, honest, but I might not be far off… He replies a couple of days later with a very kind email explaining that for now I should just be sensible, not eat cured meats, take folic acid, and make an appointment with the hospital for a few weeks time to get my first tests done. It’s a good job I’m already super informed and have been taking folic acid supplements for the past 3 months, just in case. Anyway, in the mean time I had done some research on the internet and made myself an appointment in the private studio of one of the hospital’s gynecologists, so tomorrow I will go along with my list of questions and hopefully I will get some information and feel a bit more relaxed about the whole thing. I know it will be an uphill climb, but I’m determined not to be beaten by the system, and most of all, not to let it get to me. Yesterday I ordered a pregnancy exercise and relaxation DVD from Amazon (by my favourite Davina McCall!) and I’ve been eating more healthily than ever before in my entire life. There are some things I know I won’t be able to control, but those things that I can, I will – and that’s as much as I can do right now…