Pregnancy Medevac

So as I prepare to head back to Manila tomorrow it occurs to me that maybe I can do something useful with all of these crazy medevac occurrences. I know it won't be of much use to my usual readers (aka my family :), but maybe my experiences can benefit my fellow FSers gearing up to go on medevacs (particularly for those going for pregnancy).

While many FS moms choose to give birth right at post, and I have several friends who did so at my current post, State MED actually recommends that mothers to be come back to the US to give birth regardless of where one might be posted. I chose to come back to the US to give birth for a couple of reasons. First and foremost, I had my middle daughter, J, while I was still on active duty stationed in northern Japan. She ended up being an emergency induction meaning that all of our carefully laid plans when out the window. We had no childcare, so my husband had to leave me alone in the hospital while he searched for alternate care for our oldest child. It was also the middle of the day in Japan, which meant it was the middle of the night back in the US, so I could not get a hold of anyone in my family to let them know what was going on. What that all added up to was me, alone, scared to death about what was happening to my baby, did I mention all alone? Of course everything ended up working out ok. J was born with fully developed lungs and only spent a few days in the hospital, but it was still one of the scariest moments of my life and was not an experience I would ever want to repeat. Additionally, we were due to PCS (move, that is) back to the US in May anyway so that I could start language training.* I had already been worrying about how to transition the kids during such an inopportune time (2 months left of school, especially for a freshman!!??), so with the baby due in January it seemed like December break would be the perfect time to transition the kids' to a new school in the US.

FS moms and any children they bring along on medevac are eligible for per diem for 45 days prior and 45 days after the birth (sorry dads, you get zippo). Per diem is quite generous. Moms are eligible for the 100% rate (check GSA per diem rates as it changes by location and month), kids over 12 get 75%, and kids under 12 get 50%. Additionally, after the baby is born, the baby also gets per diem at the 50% rate. Of course, this doesn't mean you automatically get this huge amount of per diem money. The lodging rate covers housing expenses only, so if you don't spend it then it will not be reimbursed to you. The meals and incidentals (M&IE) is yours to keep, but if you're maintaining two households it really doesn't end up being all that much.

There are a couple of ways to make this work. The State Dept has direct bill contracts with housing companies like Oakwood (where we stayed when we first joined the Dept), and if you can make this work for you, I would highly recommend it. The direct bill program means you don't have to worry about paying out any money from your own pocket since the housing company will simply bill the State Dept directly, so all you have to do is file your travel vouchers for your M&IE. Super easy. Another option is to find your own housing, which is what we did. With 3 (sometimes 5) children already, plus a cat and a dog, even the largest offering from Oakwood (a 3-bedroom apartment) is waaay too small for us. We spent a year in Oakwood with 5 kids, and I thought we'd never get out alive! Adding another kid into the mix meant I needed to find more space if only for my own sanity! It was not easy finding housing! I tried reaching out to rental units through the usual methods (Craigslist, realtors, property management companies, referrals from other FS friends), but it was impossible to find something suitable. Luckily, there are several online communities for FS-affiliated folks, and I posted to the two groups I belong to: a yahoo group known as Livelines and a Facebook group called Trailing Houses.** I posted an ad stating what we were looking for (4 bedrooms, yard, proximity to FSI, good schools, etc.), and I was contacted right away by someone looking to rent out their property. This was a real benefit because trying to explain our unusual per diem situation and how the lease has to be structured was almost impossible, so finding someone already familiar with Dept requirements was a lifesaver.***

If it is at all possible, I cannot stress enough how much I recommend the direct bill program. It is so much easier than trying to get reimbursed. But, if you do choose the private rental route for the love of all that is holy take the maximum advance possible! The Department allows someone going on pregnancy medevac to take up to 80% of the potential per diem. I say potential because if the baby comes early the pre-baby per diem clock stops and you only get the 45 days postpartum per diem. For example, say you medevac at 8 weeks before baby comes, but the baby is born a month early. You will only be reimbursed for 2 weeks of pre-baby per diem (per diem starts at 45 days before baby is born). This is the potential trap because if you take a large advance and then lose those per diem days you will still be responsible for paying back the entire advance amount to the Department. But, wait, Pu, you still recommend taking the maximum amount of per diem possible? Why? Because, my friends, the opposite also holds true. If you don't take the advance you can count on not having your request for reimbursement paid out in time for you to pay your rent! For example, I took an advance of $10K. That combined with our liquid savings was plenty to cover our first month and a half of rent (half of Dec, all of January) with the idea that I would file my voucher and get reimbursed in time to pay our second months rent.  Hahahahahaha. I forgot who I was dealing with. It is particularly silly because I have worked for the federal government my entire adult life, so you think I would know the cardinal rule of getting paid. When you owe the government expect that the debt will be paid in full immediately even if it leaves you with a $0 paycheck (as happened to me once when AF Finance realized it had been overpaying me and immediately rectified the issue). When the government owes you, you better take out another line of credit because you are going to get paid in their own sweet time. I have been waiting for 8 weeks to get paid for my second voucher (my first voucher was misallocated to pay back the entire advance leaving me with no cash to spare). God only knows when my third voucher will get paid out.

A pregnancy medevac can cost as much as $50K or higher (per diem amounts will vary depending on location and time of the year, as well as any dependent children you might be bringing with you). Trust me when I say it is better to roll the dice and take the advance than it is to be stuck explaining to your landlord how you don't have the money to pay them rent. In our case I was extremely fortunate to have wonderful, loving parents who were in a position to be able to lend us a large amount of cash, but it was an extreme measure that I really did not want to have to take. Regardless of what you decide, the Department will eventually have your back.

*We had hoped to have the baby during home leave between departing post and arriving at language training, but I got pregnant far more quickly than we had anticipated!
**You must be a member of AAFSW to join Livelines and a member of the FS to join Trailing Houses.
***If you do decide to find a rental option with a landlord unfamiliar with per diem lease requirements, there are also sample leases listed under the files section of the Livelines yahoo group.

The Name Game

We went through this with J and it.was.ugly. J almost didn't have a name thanks to her early arrival. We literally decided on a name as we were headed to the fateful doctor's appointment where they turned my world upside down.*

Not so much with A, since I was pretty adamant that this was the name I had always wanted to give my son should I be lucky enough to have one. With the Pu family propensity for birthing girl babies, I was pretty sure we'd never have to deal with this again, but now the name wars have reared their ugly head once again. Husband has the absolute worse taste names. If it were his choice alone all of our children would be named after old, fat Italian New Yorkers. And I just cannot imagine having a baby named Frank. Or Jimbo. He, natch, cannot stand any of my names choices. I like names like Nicholas, Ethan, and Isaac.

J likes the name Peter because Peter Pan, Mom, duh!

Of course, if it were up to A, we would name the baby Farticles McJumpJump, so I guess there are always worse options.


On a totally different note, wtf is up with this? My nose isn't located anywhere near my fucking uterus, so I'm not sure what the connection is, but it is really fucking annoying.

*Plus side being that J came out just fine and even had perfectly functioning lungs.

Embracing the Bump

***Warning: pregnancy bitch ahead****

I am trying so hard to embrace the bump, but it seems at odds with me. I would like to meet these crazy women who don't know they're pregnant until the baby falls out because they must be the most fucking clueless people in the world. I'm only in month 4, and already I feel like an enormous cow. My thighs have definitely expanded, my arms are softer, and I have no waist to speak of. My skin, never a smooth, clear palette, is rebelling against me by erupting all over the place. Cause, you know, the weight gain alone is not enough to make you feel unattractive. My hormones are all over the place, one minute I'm fine and the next I'm blubbering about toothpaste commercials or giving my husband the evil eye.* I can't do any of my workouts because the minute my feet leave the ground I feel like I'm going to pee.** Half the time I feel like this baby is about to fall through my pelvis even when I'm just sitting around. And did I mention that it's only month 4??!! Ugh.

On top of all that this is our last week with the s-kids, so Husband is a moody bitch, and it's raining like crazy so there's not a whole lot we can take them out to do. I'm working on how to best arrange my preggo medevac back to the States, and just found out that I have to identify a dr and hospital before they can cut my orders. Not having given birth in the DC area, I don't even know where to start. The other 3 kids are back to school, thank goodness, but that means parent-teacher meetings (all of which have to happen sometime during work hours, natch), learning support meetings for A, and all sorts of other appointments that take me away from the office. High school kids here are required to have a laptop (cause in order to afford going to this school we must all be rich, right?) so we got her a cheap one that turned out to not be compatible with some of the software her teachers are using (like the special software for her Chinese class that only seems to be compatible with Mac). So we had to return it and shell out a shit-load of cash for a used Mac anyway. Because what I really wanted to do while buying all new baby gear*** and a short notice ticket and hotel arrangements for Husband to go back to DC to take the FSOA is shell out a thousand dollars for my 14-year old to get a new laptop. *sigh* Wah, wah, wah, wah!

Anyway, the good thing is that we're definitely on the slide out from out Manila adventure and getting ready for our next chapter.**** As much as I complain, I am so excited about this baby. I have so missed having a newborn, and I cannot wait to finally have a baby in my arms again. I am blessed to be healthy and active, and everything with the pregnancy is going along swimmingly.***** Things seems to be falling into place. W've made all the big decisions about who is going where and when in terms of medevac-ing and PCSing. I've made my list of things to do (as overwhelming as it is), so all that's left is to start crossing things off. And we've got a whole slew of trips already paid for in the wings. In two weeks we head to beautiful Malapascua, and while I won't be able to dive down to see the Thresher Sharks, I will be able to hang out, sans kids, with some very dear friends in one of the most gorgeous places on earth. Then we head up to The Farm for 3 days of pampering (a birthday gift from Husband) before we jet off for a family vacation with some dear friends and their kids at the Shangri-La Hotel in Cebu. And that's just in September, yay! We are determined to get in as much travel as possible before we leave the Philippines for good. :) Husband is getting ready to take a very challenging test/interview for a great job, but even if he isn't successful, he has an almost guaranteed job wherever we go thanks to his special designation with the State Department. We are very fortunate to be in such a position, as stressful as it may be sometimes.

See, I don't take my good fortune for granted, but that doesn't mean that I can't bitch a little...or a lot...if I want to.


*Even though he totally deserves it most of the time.
**and sometimes I do, so fuck off.
***after al, it has been 6 years, 2 counties, and 4 states since the last time I squirted one of these little monsters out. 
****Hong Kong here we come!
*****Genetic testing says: low risk for abnormalities

Singapore Fling

So I've jetted off to Singapore for a few days on my medevac and immediately began my love affair with this beautiful, wonderful, amazing city. Although I've only been here for a day, I can already tell that this is a place I would love to live. From the moment I stepped off the airplane into the gorgeous, clean, quiet airport* to the lovely greenery and parks that whizzed by as I took my clean, sleek cab down traffic law-obeying streets and through the working infrastructure of an Asian city that clearly works. It was like Japan except everyone speaks Chinese. Yay! Actually, I shouldn't say everyone. True there are many Chinese speakers here, but I have been astounded at the multi-culturalism I've encountered. In my hotel I've already had pleasant exchanges with other visitors from Japan, Australia, India, Brazil, and the UK. Jus in my small doctor's office I heard French, English, Chinese, Hindi, and Japanese. I loved it!

Today was mostly full of doctors appointments and a quick visit to the Embassy here to get my medical clearance back.** I did a lot of walking up and down Orchard Street, which is the main shopping drag but also the street where my hotel and the hospital were located. Tons of high end stores like Gucci and D&G mixed with other smaller malls touting more reasonably priced good and hiding tons of little food courts. Malling here is even more of a national sport than in the Philippines! After my walk to the Embassy, I stopped by a grocery store in one of the malls and had a bit of sticker shock (a liter of milk is about $10!). I did splurge on some cheese and cold cuts, though, because you simply can't get them in Manila. I also picked up a delicious spicy tofu soup from one of the food hawker stalls, which was just what I needed for dinner. Despite the tropical weather*** I was just really craving soup. French picnic and spicy Korean soup, sounds like a perfect pair, right?

Tomorrow is basically a free day. They make your medevacs for 3 days just in case there is a problem and they need to do additional testing. My appointment went smoothly. Everything looks good, healthy. They were not able to do the test I had originally come here for because it turns out I am too far along! The test is supposed to be done between 11-13 weeks. According to the ultrasound, I am 14w2d today. So they had to do a different set, an older test, which is only 60% accurate, which ups my chances of needing am amnio (which I had wanted to avoid) should the results come back positive, which is a bit of a bummer. I won't get the results of that test for another week, so it's more uncomfortable waiting I'm afraid. So I'll console myself by trying to enjoy as much of this lovely city as possible in the time that I have here. I'm excited to go explore Chinatown and Little India tomorrow and maybe to scout out some neighborhoods where we might consider staying the next time we come to Singapore.**** Orchard Street is very nice, but it's quite high end and not so much the down and dirty, street food experience we'll be looking for next time around.

Anyway, it was so cool to get my 3D ultrasound today. When I had my first pregnancy they could barely tell the sex at 20 weeks. Today I saw everything! That baby looked like a little freaking baby, not some crazy alien blob. It was so cool. Oh, and we do know the sex now. :) It made me a little sad seeing all the other couples in there, and I was the lone singleton sitting in the room. We just couldn't justify shelling out the cash for the Husband to accompany me, particularly when we just got back from our R&R, so I came here sans family. I really wanted him to experience getting to see that ultrasound, too. But then, everything seems to bring out the tears in me now, and it reminds me that I haven't posted anything even remotely funny in a while. My last pregnancy brought out the sarcastic wit in me, but this one seems to be making more more emotional and nostalgic. Sappy posts are great every once in a while, but no one wants to read sad things all the time. For realz, I just watched a McDonald's commercial (in Chinese, oh I'm so rusty!) with a grandma and her granddaughter and started crying. I need to get my shit together, people! So here's some funny kid stuff that I keep meaning to post but never get around to randomly thrown into this post for no real reason at all.

J: Want to play doctor?
C: Sure, whatever.
J: *tugs on C's left ear* Does that hurt?
C: No.
J: *tugs on C's right ear* Does that hurt?
C: No
J: *hauls off and smacks C right in the face* Does that hurt?

A: I want oatmeal, please.
Me: Would you like it with raisins and brown sugar?
A: I would like it with all the oatmeal things...except pickles.

J: I want the blue bowl!
A: Can I have the red bowl?
Me: *sarcastically* No, J will be get both bowls.
A: I have to eat off the table? Cool!!


*A total 180 from the gross chaos that is Terminal 1 at Ninoy Aquino International. It was like stepping into a dream!
**Turns out when you medevac for any reason (even just for routine testing) you automatically lose your medical clearance, so I had to see the Regional Medical Officer to get mine back before I head back to Manila.
***Nowhere near as oppressive as Manila but still pretty dang hot, especially if you've been walking around all day.
****Already planned in Dec when my the 'rents are visiting.

Officially T2

Today marks the official first day of the second trimester. At least according to my What to Expect app it is. So it must be true, right? So why am I still so freaking tired!! Ugh! I'm so tired of being tired. I went from exercising 6-7 days a week for 60-90min a day to exercising, well, kind of whenever I have the energy. I can no longer get up in the morning, it is just too damn hard. I cram in a 30min walk & light weights at lunch (45min max) on days when I'm not feeling nauseous or light-headed. I do usually manage a workout on the weekends, but it just feels like such, well, work.

I am so looking forward to the "honeymoon" phase of T2 when the nausea and fatigue fade but the big boobs remain.* I'm still far too small for maternity clothes but have long since outgrown my normal clothes. Thank god for belly bands, but even those don't help solve the problem of regular shirts making you look like you've eaten a few too many doughnuts. We're not making any official announcements at work, which makes me a wee bit self conscious about people looking at my growing belly. This is mostly because I just don't care but also because I find that most people don't seem to know how to react when you say you're pregnant with #4. The responses have ranged from, "Was this an oops baby?" to uncertain looks while people wait for my cue to indicate whether or not we are happy about this development. The only people to react with genuine excitement are the couple of friends who knew we were trying and one friend who already has 6 kids of his own! It's a little off putting, actually, so I just decided I'm already cranky enough and I'd rather just not deal with it at all. I suppose people will figure it out on their own eventually. :)

*Don't judge me, for some of us, this is our only shot of big boob-dom. 

I Am Four

Or six, depends on how you count it. Either way it looks like there's a new Pu heading into the world. I guess we figure with one on the way out of the house, we needed to bring one in.

Had my 1st ob appt last week and also discovered that Husband's super sperm did not fail us. Turns out I'm further along than I had originally thought.* Baby 4/6 is due at the end of Jan not in Feb as we had planned for. This opens up a whole new set of challenges for us to figure our way through as we navigate through the decisions that face expat moms and FS moms who give birth abroad: do we stay here or medevac (medically evacuate)? What does this mean for our other children? If I medevac, do I take the kids with me or leave them here? What do I do about genetic testing? It's par for the course in the US that moms over 35 get certain genetic tests since the likelihood of having a child with special needs is much higher as you age and your eggs get old and crusty.** But they don't do genetic testing here in the Phils, so I'll have to take a trip to Singapore if I decide that's something we want to pursue. Basically, there's a lot to think about.


*which, on a totally vain note, made me feel so much better since I have already outgrown my pants!
**Or at least that's how all the pregnancy literature makes it sound. It's like you hit 35 and all your eggs shrivel up. 

A's Birth Story (Finally!)

So, on Sunday (June 3rd, my lil' sis' b-day) I kept having this wierd feeling, umm, down there. Like I was leaking or something, but there was hardly any fluid at all and I had had so many false alarm feelings before. I didn't want to send the girls to the sitter and trek on down to the hospital for just a false alarm, so I figured it was better to take the wait and see approach. If the contractions started coming, I'd surely have enough time to get to the hospital! Anyway, this went on all day with no contractions, so I chalked it up to me just wanting it to happen versus anything actually be labor-icious about it. (I did call my mom just in case, and she changed her plane ticket to arrive on Monday instead of Tuesday, which was when I was supposed to be induced). So we went about our day and went to bed as usual. At about 2am I woke up to a terrible contraction, but I figured it was just a BH and tried to go back to sleep. But they just kept coming In fact I was starting to get a little pissed because I couldn't get back to sleep thanks to my contractions! Finally, I got the brilliant idea to just get up and start timing them. So I went downstairs (so as not to wake the Hubs) and got on the computer to do what any woman in my situation would do: Google for signs of active labor. Of course I didn't find anything particularly helpful, but it was comforting to think I was doing something rather than just sitting there. After about an hour of my contractions coming at very regular intervals of about 5min apart, I starting thinking that maybe this wasn't another false alarm. So I went upstairs to let Hubs know. Unfortunately, I may have cried wolf one too many times.
Me: I think I'm going into labor.
Hubs: (muttering sleepily) No you're not. Go back to sleep.
Me: (a little indignantly) Um, I'm pretty sure about this. My contractions are coming every five minutes apart.
Hubs: (sleepily) Mmm hmm. Just get back in bed.
Me: (getting angry) No, I'm serious. In fact I'm getting one right now. Ow, OW! Now get your ass out of bed and take me to the hospital!
Hubs: (yawns) Can't it wait until morning?
Me: Only if you want me to have this baby on our new bed.
Hubs: (springing out of bed) And off we go!

So, we woke the girls up and packed a quick overnight bag and took them over to BS's house. J seemed very confused and a little scared about the whole situation. She didn't even want to get out of the car when we got to BS's (and she loves it over there), but C was pretty nochalant. She is a heavy sleeper no matter what, so I don't think she cared about anything except going back to sleep. Then we headed off to the hospital. We arrived and parked in the emergency room parking lot (it was only about 3:30-4am so the front doors were locked). Immediately we were directed to Labor and Delivery on the 3rd floor. I, being the person in labor, was concentrating on being able to walk through the pain and neglected to listen to the directions from the front desk staff. My Hubs also neglected to listen for reasons I have yet to figure out. Luckily most of the doors around us were locked, so we were able to navigate ourselved to the right elevator by process of elimination.

Once we got into L&D, they hooked me up to the machines, measured my cervix (3cm) and started measuring my contractions. They were looking pretty wimpy on the monitor, but, by this time, I was absolutely sure I was in labor because they felt so strong. After about an hour, my nurse checked my cervix again and I was up to 4cm, so it was determined that I was, in fact, in labor. (Me to Hubs: "Told you so!") So I was transferred to a delivery & recovery room and given a permanent nurse (her name was Cam Cameron, no really!) who was really awesome. They asked me if I wanted my epidural now or if I wanted to wait. Having done the whole brave thing in the past (and not having one for C's birth), I immediately said yes. L&D apparently wasn't too busy that night b/c the anesthesiologist came in right away (yay!). The epidural was fairly easy, although I did get some pain in my right lower back, which kind of freaked me out. Then my blood pressure started to drop (this is a normal reaction to an epidural), which makes you feel very dizzy and faint and can actually be a little scary, but they put some shit in my IV which made it stabilize and pretty soon I was just sitting there, happily numb, waiting for my baby to come. After what seemed like a very short while, Cam checked my cervix again and announced that I was already at 8cm. Although they had paged my doc, he obviously wasn't going to get there in time, so the doc on call came over to deliver me. Hubs held my hand and I pushed for about 15 min (same as with C) and out popped A.

So, after my crazy experiences with C (extremely long and difficult labor) and J (scary labor worrying about her health), I finally got the "normal" experience I was hoping for. And, it was really quick! I woke up at about 2am with the start of my contractions, and A was born at 8:36am, so I was only in labor for about 6 hours. Not too shabby! The recovery this time around did seem harder, though. I had a lot of joint pain (horrible feeling like your joints are bing pulled apart), so it was difficult to even get in and out of bed. Plus, Hubs had to go back to work right away, so it was just me and the kids after my moms left (thank god she was there for the 1st two weeks and basically did everything!). I've posted before about A being a difficult baby, so I won't repeat all that here but that has definately added an extra level of stress to the whole experience. Luckily it seems like his constipation is clearing up and his stuffy nose has finally cleared up, so I can stop stressing out about his breathing. Also, we moved his bassinet downstairs and out of our room, which seems to have helped quite a bit with his sleeping (and mine!), so I get at least a couple of hours at a time.

So that is my story. I feel like it is so boring after all the excitement of C and J's births, but I am so happy to have had the whole experience of going into labor on my own (even though it wasn't nearly as exciting as I thought it would be!). Hope you all enjoyed it!

He's Here!

Sorry I haven't posted in a while, I was busy having a baby! Alexander John-Francis Podolny was born at 0836am on June 4th (uninduced!). He weighed in at a whopping 6lb 2oz and 19 3/4" long. I promise pictures and a birth story will be forthcoming, but you'll have to give me some time to adjust to being a mom of 3 (eek!).

The World is Progressing, the Future is Bright and No One Can Change This General Trend of History

Mo' Baby News

Went to my final dr.'s appt yesterday, and I am finally dialated! 1 1/2 cm over here, folks. That's right, this baby could just fall out of me at any moment. Run in fear of my cervix! (Of course, as soon as I mention this to Hubs, he gives me this horrified look and says, "You mean it's open down there?"*) Then he makes the even bigger mistake of saying, "Well, you can't have the baby yet. I am soo busy at work." Oh, really!! You're busy at work?? Well, I'll just cross my legs until next week if it's more convenient for you. Poor Hubs, he really has been having a rough time at work. His company is expanding rapidly, but they haven't hired enough people yet to deal with the workload, so he is doing the job of 4 people and trying to interview new hires all while worrying about when I'll go into labor. Of course, I am just totally occupied with getting this baby out, so I have a hard time mustering up any sympathy for his predicament.

*Seriously, you would think this man had never had children before!

Still a Pregnant Beeyotch

On a totally bitchy note, I am getting really tired of all those people who, once they hear how far along I am, say things like, "Oh, you're all belly." Okay, people, I know how much I weighed before I got pregnant and I know how much I weigh now, and there is no freakin way all that weight went straight to my belly. There is also the fact that my butt has expanded to nearly twice its normal size. I know they're just trying to be polite (I mean, seriously, no one ever says "Wow, you're all thighs and ass!"), but, really, it's not necessary to tell such obvious lies!

More Randomness Inspired by Boredom

Is it really sad that I think this guy is totally cute?
This is how life will be in the near future. Is it strange to think of your future in claymation?
Kobe finally asked to leave the Lakers. Can I have a minute to laugh my ass off?
I just like the word "moronitude."
Les aventures de Babar: Babar falls in with the wrong crowd.


**In the spirit of X & E's blog, extra points to anyone who knows where the title of this post came from.