Happy Birthday!

Last week I simultaneously reached 40 years of age and 40 weeks pregnant, but with not a single sign that labor was imminent.  Plans were made with my doctor for induction on my due date. When that day came, I delayed a couple of days more in hopes of labor starting naturally.

I spent my birthday awash in anxiety as the hours slowly crawled by without any encouraging signs of labor.  I've been induced twice before - when we lost Jeremiah and Miles.  I do not associate induction with happy endings.

To celebrate my birthday, Q and I went to the hospital at 8 p.m.  After some monitoring of the baby and checking me (zero dilation), I got a dose of the cervix ripening drug Cytotec, just as I had with my losses.

Since I was starting from zero, I expected it to be slow going.  Q went home at 10:00 to be with the kids overnight.  Things progressed slowly for me over the next six hours or so and I was able to doze off quite a lot.  Dilated to a one by about 2 a.m. after a second dose of Cytotec, then to a three by 6 a.m. This is when I reached the stage of labor where I shake violently and throw up - the part where it really starts to suck.

There was no need for further doses of Cytotec or any Pitocin as contractions were steadily two minutes apart by this point.  In fact, they were steady enough to warrant IV fluid to try to slow things down a bit, as well as oxygen and changing positions to try to keep the baby from getting too stressed.  

  

Q and my doctor both arrived at about 7 a.m. as planned.  By then I was dilated to five and struggling to cope with what seemed to be one brutal and unrelenting tetanic contraction. An epidural was sounding pretty good, but not surprisingly, baby was having some serious decelerations.  The focus was on changing my position to see if that would help - first on all fours and then in Trendelenburg position (essentially upside down) so I was working against gravity.  I was only able to assume these positions by force, as I was unable to move myself due to agonizing and constant pain.

Although I was capable of understanding what nurses were saying and formulating complete (yet amazingly expletive-free!) sentences in my mind, the pain rendered me incapable of speech or any other meaningful communication.  In fact, it was the most intense pain I have ever experienced. I could sense the heightened nervousness of the nurses as baby was clearly stressed. It felt like the situation was about to turn ugly.

I was shocked to hear myself yell, "I'm pushing!".  The nurse gave me the OK, but I wasn't waiting for anyone's permission.  I was already getting it done and she was born in a matter of seconds.  I'd gone from 5 cm to baby out in 20 minutes.  No wonder it hurt!

Everything looked good.  Baby was doing great with APGARS of 8/9 and a weight of 6 pounds 11 ounces.  There's nothing quite like the high of going from abject misery to elation instantaneously.  The cord looked fine.  Then as the doctor delivered the placenta, we found that there was a cord stricture.  Again!  You can see it clearly on the video.  Stricture is more common at the fetal end of the cord, as was the case with Miles.  I can't find any reliable statistics on how often stricture ends up being fatal, but whatever the odds we are thrilled to be on the good side of them this time around.

We never saw signs of a problem on ultrasound.  If scans had been more frequent and thorough as they should have been and were with my last pregnancy, would we have seen it?  The entire pregnancy was petrifying as it was.  Day to day functioning would have felt nearly impossible had I known. I would not have dared go to my family's reunion back in June, which was the last time I saw my brother alive. I was at the same gestation as when we lost our boys!  So scary!  Nor would I have dared go to my brother's funeral in September. Of course I'm thankful to have done these things, but how chilling it is now to contemplate what might have happened to my baby girl.

Sitting here holding her tonight, I feel like the luckiest person in the world.  How amazing it is that she was conceived at all! How incredible that she survived to be born alive and healthy! Her name is Nadia, which comes from the Russian "Nadezhda", meaning hope.  

"...Anything can happen, child. ANYTHING can be.”

-Shel Silverstein




THE END
Again.
This time for real.

Life and Death

I'm certain that I think about death a lot more than your average pregnant woman.  In fact, my first thought upon finding I was pregnant again was that this new life will surely die - it's just a question of when and how.  In creating life, we also create death. A morbid thought, but very true.  For me, pregnancy and death are so intensely intertwined that it feels as if I'm hanging out with death for the entire duration of gestation.

Thoughts of death extend beyond the baby to also encompass my husband, who has gained a great deal of weight since we got married. Morbid obesity (emphasis on morbid) weighs heavily on my mind every day.

In addition, I have been distraught these past five years about my youngest brother, who has schizophrenia.  For six months when Anastasia was a baby he lived here in Minnesota with my family so he could escape the toxic environment of our parents' house. Following his stay with us, he moved back to our home state, though not back to our parents' house.

Many times in the last few years I've expected to get a phone call telling me that he had died. There have been many hospitalizations, even incarcerations and violent episodes, as well as disappearances and other intense drama.  I was surprised when he survived a particularly rough patch two years ago.

That summer still took a devastating turn when one of my dearest friends committed suicide.  We'd spent the morning together and I was the last person to really talk to her. She went and shot herself in the head while I was watching her young children.  Death is never far, it seems. But my brother survived and went on to have some stretches of relative stability.  Until now.

Last Friday I got the call that he'd shot himself in the head.  This is not at all shocking, but still terribly sad. The great tragedy here is schizophrenia, not death.  As horrifying as suicide is, I cannot say that I'd have chosen differently if I'd been in his situation.  He suffered tremendously and though I'm sad for my own loss, I'm happy that there can be peace for him.

Currently he is in the hospital, but we're told brain death is inevitable.  He is apparently an anomaly in that he is still able to breathe on his own more than three days on. Though he is still technically alive, there is no hope of actually surviving.  For now, he and all the family are in a state of limbo, but we'll soon have to gather for the funeral. Provided this limbo doesn't drag on for weeks, I should be able to travel.

The baby is now at 33 weeks and there's been no indication of problems.  No sign of cord trouble. No sign of growth restriction.  Perfect scores on the weekly Biophysical Profile. This is amazing and wonderful!  There's no way of knowing whether this is the result of being on blood thinners like last time, or simply random good luck.  Whatever it is, I'll take it!  At this point I have great hopes of a cradle for her and not a grave.

So that's where things stand at the moment. An unexpected life still going strong and an expected though tragic death.  Once again, I'll be going to the cemetery and visiting the graves of now three of my siblings and my two baby boys.

UPDATE:  Five days after shooting himself, my brother died. I was able to travel and be with my family for the funeral. Going to that cemetery again has set off a lot of anxiety for me, especially since I had a scare with baby after returning home.  When checking her with my Doppler, I picked up cardiac arrhythmia.  A biophysical profile (BPP) showed no distress for baby, but that did little to lower my anxiety.

"They give birth astride of a grave, the light gleams an instant, then it's night once more."

- Samuel Beckett

Baby Got Back

Weeks 22 through 24:

We are back in Minnesota with baby still alive and kicking at 24 weeks.  I've had one appointment (NOT at the perinatal clinic!) and got pics of the cord finally!  See them here.  I'm supposed to go back again in three weeks.  It's a long time to wait.

I've gotten behind in posting and gone nearly incommunicado even with family & friends since getting back to Minnesota nearly three weeks ago.  The fact is I've been very depressed lately and have been trying to break out of it. This pregnancy is stressful, to say the least, and on top of it we've just rejected a job offer Q got from Texas.  Moving in the middle of this pregnancy seems just too risky and the job itself was not ideal.  Still, we've been trying to move and buy a house for SO long that it was sad to say no!

Gestating on the Beach

Week 21:

After the family reunion in Tennessee ended, we drove to Florida to spend a few days with my sister's family near Jacksonville.  When I say "we drove", I mostly mean Q.  He arranged to work remotely for a week because there was no way I could do all the driving to Florida and then all the way back to Minnesota myself with three contentious kids in back.  I'm no good at long-distance driving, especially in my present exhausted state.  This part of our vacation would not have been possible without Q.  Thanks Q!

We spent 5 days at my sister's and were able to visit St. Augustine, spend some time on the beach, and see some dolphins in the wild.  Q was also able to do some of his work meetings on the golf course.

I am now past the point where we lost Jeremiah.  This baby is a good deal stronger and more active than either of the boys were at similar points in pregnancy, so I take that as a good sign.  Still, I will feel much better (I hope) once we good a good look at the cord on ultrasound.

The drive back to Minnesota was looong.  We spread it over four days and were able to see a Civil War battlefield and visit with Q's family along the way.  Overall it was a great trip and spending these stressful weeks on vacation with family was vastly better than spending them in Minnesota!

Into the Woods

Week Twenty:

Baby and I have successfully survived a reunion with my family.  This consisted of my parents, their 11 grandchildren, and their six surviving children who gathered from six different states to spend six days in Tennessee.

Remarkably, there was no drama of any kind.  At the same point in my last pregnancy, family relations were in a very sad state and got even worse before finally improving.  I was a bit nervous about the prospect of spending this very stressful time in my pregnancy in the company of my family, particularly my mother.  She remains addicted to placebos and fervently believes in a great deal of nonsense, but has mostly given up trying to convert the rest of the family to her quasi-religious views.  Happily, this and all other controversial issues were successfully avoided by all parties and everyone had a great time hiking, rafting, and relaxing together.

I am relieved to be past the 19w2d milestone where we lost Miles.  Of course we're not out of the woods yet.  Next I hope to pass the 21w2d milestone where we lost Jeremiah and then if we get very lucky again, continue on to another happy ending.  It still doesn't seem real that any of this is happening.

Bear feet in a tree
Great Smoky Mountains National Park

Into the woods
Great Smoky Mountains National Park

The Idiot

Week 19:  I went to the perinatal office for the thorough mid-pregnancy ultrasound just two days before we were leaving for a family reunion.  My hope, of course, was that we could see that the cord looked normal and thus have a more relaxing vacation.  Having the vacation during weeks 19 to 21 of the pregnancy was far from ideal given that we lost our boys at 19 weeks and 21 weeks.

I saw a different doctor this time, but unfortunately he too absolutely refused to do ultrasound of the cord.  Everything else looks lovely - heart, other organs, growth, etc.  That's good obviously, but did nothing to alleviate my concerns about the cord.  The doctor and I had a lengthy discussion about this refusal to look at the cord.  I should point out that I was very cordial and non-confrontational.  He was a good deal more affable than the last doctor, but still managed to take a condescending tone.  And these are the same doctors at the same clinic that I saw last time!  It makes absolutely no sense!

My view is why the hell would you NOT look at the cord given my history of recurrent cord-related losses? It's not as if it's hard to look - they're doing the ultrasound anyway and getting paid a hefty sum for it.  I cited Dr. Collin's work on recurrent cord pathology.  His reply was that they will not be ordered around by patients or other doctors.  He also argued that since nothing could be done at this point if the cord is malformed, there's no point in looking at it.  I countered that I'd at least like to know what the situation is given the fact I'll be traveling out of state during the same time period we had our prior losses.  And also that we want to know the state of the cord before telling our kids that I'm pregnant.  He said something along the lines of "these are issues a psychologist is more qualified to deal with".  I am so done with this clinic!

Clearly, there was no way for me to win here, so I left with the satisfaction of having wasted far more of his time arguing (30 minutes) than he would have spent just doing the ultrasound (1 minute). And he doesn't get a penny more for the extra time spent.  Ha! Shame I don't still have Doctor Dammit - he would have gotten a well-deserved beating.

The next couple of days were busy preparing for the trip.  Our first day's drive took us as far as Illinois, where we picked up our oldest daughter who had been staying with Q's parents for two weeks.  She asked if I'd been exercising much while she was gone.  Good thing we'd already made plans to tell the kids our news - it's obvious I'm getting bigger!

 I'd made Anastasia a shirt that says "Jie-Jie" on it.  That's Chinese for big sister.  When she showed the older kids there was confusion at first - "But she's not a jie-jie!".  And then they got it.  We had wanted to wait longer before telling them, but since the kids have already noticed my increased girth and our family reunion will involve swimming suits, we felt forced to tell them now.  So they know and we just hope for the best.

Mei-Mei is very excited about being a Jie-Jie!

"Another sister?!"
"Another SISTER!!"

A Raising Up

I named my rainbow baby Anastasia because I loved how the meaning of the name is so pertinent to what we had to go through to have her.  The meaning is usually said to be "resurrection", but there is more to it than that.  Anastasia comes from the Greek word anastasis, which also means "a raising up" and "a recovery from a debilitating condition".  She has been all of this and more for our family.

For me, the depression and anxiety documented earlier on this blog lifted completely once Anastasia was born, just as I expected it would.  What I didn't expect was the great improvement in health I've been enjoying.  It is well known that pregnancy and breastfeeding can put endometriosis into remission.  To my surprise, it has stayed that way even after she was weaned.  The pelvic pain that plagued me for a DECADE, sometimes causing constant pain lasting for months, has been entirely gone these last four years!  This has been a lovely surprise and has enabled me to do things that were difficult before.  For example, I used to be unable to sit for long periods without pain, which made things like traveling and watching movies unpleasant. Now, to Q's great joy, I am capable of sitting around for hours at a time.

Good thing I can sit around, because this pregnancy is kicking my butt like no other before it.  I am utterly exhausted much of the time. My age is surely to blame at least in part, and severe anxiety doesn't help either. My house is often disgusting since I can't keep up with the dishes, laundry, cleaning, etc.  Also I only make real dinners a couple of times a week.  The rest of the time we rely on convenience foods from the supermarket.  It's great to have this option, but it is not good for the budget nor is it as appealing as a home cooked meal.  

The anxiety with this pregnancy has been very much like last time, but with other added stressors thrown in as well.  With my last pregnancy, we knew what we were in for and simplified our lives to make it easier to handle.  Can't simplify so much this time around.  

The biggest difference with this pregnancy is that I'm coming at it from a very different angle.  Last time I was starting from the bottom, climbing week by week out of an abysmally deep depression and finally being raised up even higher than I'd dared to hope.  The view from the top is stunning.

With this new pregnancy I begin at the top, which is obviously a plus.  However, when I peer over the edge of the cliff and see the dark depths where I was not so very long ago, I am filled with a terror that is beyond words.  To fall from such a height would surely be...well, it's probably best not to think it.

This is where I stand at nineteen weeks. Miles died at nineteen weeks.  Jeremiah died at twenty-one.  My next appointment is on Wednesday, when I hope to get some good images of the cord.  Friday I leave for a family reunion.  The timing is less than ideal in my mind, but hopefully it will be a good distraction so I won't feel stalked by death every single moment.  If I run away fast enough and go far enough, maybe death won't find me this time!

The Physician Menace

I am so fed up with doctors I could just cry.  I fact I have.

Things have been very tense around here lately and the pregnancy is just part of it.  I'm at eighteen weeks now and have been feeling the baby move for a couple of weeks now.  Hopefully this is a sign that all is well with baby and that it will continue this way.

I had an ultrasound last Tuesday at 17 weeks 1 day.  I had to beg and plead with the perinatalogy clinic to get this appointment because they were quite insistent that I wait until 20 weeks for another appointment.  I was quite insistent that this would not do AT ALL.  I was able to talk with Dr. Collins and he thought it was absurd that my clinic was being difficult about this.  This is the same clinic I saw when pregnant with Anastasia.  At that time they did weekly doppler scans of the cord starting at 16 weeks. They were only too pleased to take my money then and I just can't understand why they are taking this radically different approach now.   

So I went to the appointment and had the ultrasound, which showed baby's growth is on track.  They also did dopplers of the cord, but refused to do any other scanning of the cord, such as trying to look at it in 3D or trying to measure the coiling.  Q and I talked to the doctor and she said the dopplers looked OK to her.  She seemed generally dismissive of our concern about the cord despite our explanations about this being a recurrent problem for us.  We also explained that we want Dr. Collins to look at the pictures since he is an expert in this issue.  She then gave us a disk with our pictures on it and we went on our merry way.

When I put the disk in my computer at home, however, I found that we had only 4 pictures - one of baby's profile and 3 of her legs.  This does me no good at all.  I called the clinic when they opened the next day (Wednesday) and was told there's nothing anyone could do until at least Friday when the particular satellite clinic that saw me Tuesday would be open again and could try to get the cord pictures off the ultrasound machine they used.  So I waited until Friday and after several phone calls, was told I could come pick up a disk of the cord photos at the clinic after 2:00.

And did our little story finally end happily?  Of course not.  At 1:00 the clinic called again to say don't bother coming in because actually they can't give me the pictures after all.  Suddenly it's against their policy to let patients have any images except a few "just for fun".  I assume then that if recurrent leg problems were an issue with my children, I would not have been given the three "fun" leg pictures I now have and may instead have gotten some "fun" cord pictures.  I made clear that this was entirely unacceptable.  When I made the appointment I stated that the purpose was to get pictures of the cord to send to Dr. Collins.  I also discussed this with the actual doctor when the ultrasound was done.  She didn't say one word to indicate this was a problem, but now she is the one who "made the call" not to let us have the images.

Next, I got to speak with the actual doctor.  I do not not take kindly to know-it-all, condescending, patronizing doctors and was very direct while still remaining civil.  Where we stand now is that I'm supposed to be able to get the images from the clinic on Tuesday (tomorrow) when they are open again.  Doing it that day was apparently just too much for the overworked staff.  You know how hard it is to transfer .jpg files onto a disk.  

If that doesn't happen, I am making an appointment at my regular OB office to get pics of the cord.  They don't have the expertise to interpret such pictures, but they've said they do have the capability of at least giving them to me.  I am supposed to go to Tennessee for a family reunion in two weeks.  I will be twenty weeks - the same time frame when both Jeremiah and Miles died.  My stress level is 

at Severe already and I want to know what Dr. Collins thinks about these images before I hit the road.

And on top of all this, Q has a job offer in Texas to consider.  This is a VERY dramatic decision, especially given the timing.  

Also, I will run out of Lovenox tomorrow despite my best efforts over the past two weeks to acquire a new supply from a mail-order pharmacy as required by my insurance.  Just found out I will not be getting it in time from them and now have to fight with my insurance to let me get it at a retail pharmacy locally, if  I can find one that actually has it in stock.  

After that, I will spend the rest of the day taking kids to the mall and the beach because it's summer break now.  We're going to have fun, dammit!  One of the most exhausting things about the current situation is trying to act as if everything is perfectly normal.  

Inconceivable

Due to lack of time, I haven't been able to document this pregnancy like I did for the last one, so I'm just going to have to summarize the last three months and try to do better going forward.  Let's hope there will be five more months of going forward.  Here's the timeline so far:

March 3-8:  Family vacation in Texas.  Besides visiting tourist sites in San Antonio and Dallas, we also met with a couple of friends, including Cindy (see here), her husband, and two youngest kids!

March 10:  Back in Minnesota, I realize that my period is late.  Although I expected my period during the trip, it didn't happen so I just figured I must have miscalculated.  There could be no other explanation, right?  Wrong.  I bought a pregnancy test.  Positive.  One might think I'd be overjoyed to get pregnant without trying after years of infertility and I do hope to get there in time.  But if one knows what recurrent pregnancy loss is like, then one knows why I said A Very Bad Word.

The first item of business was to inform Q, who unfortunately could not be reached by phone at that moment.  So I sent him the following text:  "Turns out it wasn't the Whattaburger that made me feel ill."  This is in reference to the time I felt a little sick after eating a Whattaburger in Texas.  I thought it was just the result of days of eating meals that featured few fruits and veggies and precious little fiber.

Also sent Q this photo, because what man doesn't appreciate getting a message
like this in the middle of an important meeting at work?

After spending years of our lives and tens of thousands of dollars on fertility treatment, we had been enjoying the compensatory benefit of saving tens of dollars on contraception for these last few years.  We thought that pregnancy was inconceivable for us and this news is shocking beyond expression.  

After calling my sister and talking to Cindy, I called my doctor.  With my last pregnancy, I had to do a little doctor shopping to find someone willing to prescribe Lovenox from embryo transfer instead of making me wait until week six or seven weeks when a heartbeat could be seen, which is standard practice.  Luckily, no one gave me any crap this time about starting Lovenox right away.  I started about two weeks later than I did with Anastasia, but about two weeks earlier than it would normally be allowed.  Also, I am taking the same vitamins/supplements as before (baby aspirin, folic acid, calcium, vitamin D, prenatal vitamin).   

Shootin' Up!

April 7 - 8, no 9 weeks along

This was my first doctor appointment.  It was supposed to be on April Fool's Day, which seemed apropos since the whole thing still feels like a joke. However, after realizing that prenatal care is no longer covered as "preventive care" under our insurance, I decided to see my regular OB rather than the high-risk clinic at least for now, since there's nothing anyone can do right now if things go wrong. Might as well save some $$$.

At this point my hope was that either A) everything goes well with this pregnancy and I get to bring home a live baby or B) I miscarry early - the risk at my age is over 20%. Although I'd obviously prefer scenario A, I feel I could live with either of these.  What terrifies me is the possibility of suffering another late loss.  Having done it twice before does not make me better prepared for this. More knowledgeable about the process, yes.  But better at doing it?  No.  NO!!  Burying babies is not something one gets better at with practice.

In the ultrasound room, we see that not only is baby alive, but also measuring a full week ahead!  My due date gets changed to November 9 and I am officially nine weeks along.  Nice to have an extra week under my belt that easily.  This means that I successfully produced a mature, viable egg by day 7 of my cycle, a feat I never managed previously even with the aid of powerful drugs.  Also, Q managed to produce sperm capable of going the distance and finding that egg, and this despite his very low testosterone levels.  Inconceivable!

April 24 - almost 12 weeks

Another ultrasound.  Baby is measuring on track.  We did a blood test which extracts fetal cells from my blood to determine the presence of Down Syndrome and other chromosomal defects as well as gender.  The baby is a GIRL and has normal chromosomes!

My survival mechanism so far is denial.  I've been sick and tired in the first trimester, but that hasn't made it seem real.  Also, I thought doing injections again would drive home the point that this is happening.  It was a little weird taking up needlework again, but only for a couple of days.  It had been so much a part of my life for so long that it really does seem like a perfectly normal thing to do.

Alas it's midnight and so I'll have to finish later!

Next time:  Annie Argues with Stupid Doctors 

A New Hope

So it appears that improbable things DO happen to me after all.  A full eight years after Q and I were last able to make a baby just with tools we have around the house, I found out that I am pregnant again.  How did this happen, you may wonder?  I'll tell you when you're older.

Where I am now is 14 weeks along.  What we know so far is that the baby is a girl, she has normal chromosomes, is measuring on track, and the due date is November 9, which is the week of my fortieth birthday.  What we don't have any idea about yet is the state of the umbilical cord.  If you know of my history, you know this is a critical matter.  Until more is known about the condition of the cord, I hardly dare imagine what the future holds.

When I was pregnant with Anastasia, my older two kids were in school, so I had a little discretionary time each day.  I tried to compartmentalize all things pregnancy-related into that time - appointments, finding baby's heartbeat with the doppler, writing this blog, and worrying.  Of course, I was unsuccessful at compartmentalizing the anxiety, but it was nice to have free time for the other things.

This time I don't have any regular free time for myself and when school gets out in three weeks I'll have to cut back further, and that's really going to hurt.  In the past, I was able to write and read other blogs frequently and thus became part of a community of bloggers.  This time around, I'm simply writing for myself and to update friends and family, as well as for the benefit of anyone who suffers recurrent cord-related losses like mine.

My kids, who are now 12, 10, and nearly 4, know nothing of the pregnancy so far.  One of the most difficult things about our situation is the need to hide the pregnancy until it is far enough along that we feel there is some hope that the baby will live.  We have a high-level ultrasound scheduled at 19 weeks which we hope will yield good enough news that we could tell the kids.  I look back at how fun it was a few years ago to tell them I was pregnant with Anastasia.  But then I also remember when I was pregnant with Miles, who died just days before we were going to tell the kids I was pregnant.  This could go either way.  Not having much free time to think about this is not such a bad thing after all!

? at 11 weeks because the 14 weeks pics are even fuzzier!