24 Weeks

Well, unborn child, we made it. Today you are - probably, maybe, depending on a lot of things - considered viable to live outside of my body. At least, viable enough that we would all fight for you if you decided to emerge today. But I want to make this point crystal clear:

DO NOT COME OUT NOW. DO NOT EVEN THINK ABOUT COMING OUT NOW. I DO NOT WANT TO MEET YOU FOR AT LEAST 12-14 WEEKS. DO YOU UNDERSTAND ME?

You've been holding Tae-Bo and Jazzercise classes in my belly for the past few weeks, and I think they should continue. Isn't it cozy in there? Don't you enjoy waking up every morning with a flurry of kicks when I drink a glass of orange juice? Hasn't it been fun to listen to the muffled sound of my voice as I complain about my back pain to your dad? Rumor has it you have a couple of thumbs in there with you - want to practice sucking them in peace for a few more weeks so you're totally prepped to start drinking milk from my magical boobs in the fall? You can practice your yoga moves and get a nice uninterrupted snooze whenever you like. I can be working at my desk on spreadsheets and you can just nod right off, which is awesome when you think about it, because that behavior will be frowned upon when you get older. I can even work on not sneezing so loudly that it wakes you up (sorry about that!)

Besides, if you came out right now, we would have nothing for you to wear besides this single novelty onesie that's sitting in the top drawer of what will eventually become your dresser. Your room consists of a single rolled-up carpet, a bookcase in pieces, the aforementioned dresser with the onesie in it, and a free bottle I got from the maternity store - it's not nearly as nice as the inside of my uterus, even if there tends to be less placenta on the walls. Now that we have a bit more confidence in your impending arrival, I promise we're going to start getting you stuff like a bed and a carseat. And I will read one of those parenting books I bought. So many projects! We're very excited to meet you.

JUST NOT RIGHT NOW.

My Sweet New Ride

What do you do when you keep bleeding during pregnancy, but nobody can figure out a single cause, and no one wants to go so far as to put you on bed rest but they tell you generically to "take it very easy?"

If you're me, and you find that you really need to go to Target but you're nervous about doing too much walking, you will be thrilled to find that Target offers their customers the option of shopping from the convenience of a mobility scooter. Yes, that's right - I took one of these bad boys out for a spin the other day:

It was really quite awesome. Yes, I got some looks from store employees and other patrons - the "wait, she has all her limbs, why is she in a scooter?" kind of thing - but it saved me a heck of a lot of walking. A word to the wise, however: it makes a REALLY loud beeping sound when you put it in reverse, so you may want to try to turn around by finding a wide aisle and turning the wheel to the side as far as it will go. This may mean that you get stuck against a display of picture frames, but that's life in the fast lane (er, the very very slow lane.) And I was thrilled to note that I'm actually just participating in the latest pregnant-lady trend: Snooki does it too!

Braxton-Hicks Contractions: Fine Family Fun

So, if you happened to read my last post, you will know that I'm kind of uncomfortable with my coworkers' genuine enthusiasm and happiness about all things baby-related. Which is why I'm so thrilled that I just arrived to the office to discover that - hooray! - a different coworker brought in her 5-week-old granddaughter for a visit! She is beautiful, and adorable, and drawing such a crowd that I felt confident slipping away and blogging.

Anyway, where was I? Oh yes, I wanted to mention Braxton-Hicks contractions. It's funny, I obviously like to do tons of research on all things infertility and pregnancy, but I never manage to learn in advance about the complications and symptoms with which I have had the most experience. I'd never heard the phrase "sub-chorionic hemorrhage" before it happened to me, for instance. And when I mentioned on one of my doctor's appointments that my uterus was occasionally tensing up unevenly - as in, one side feels as hard as a rock, the other stays soft, and the whole thing is entirely painless - I was surprised to learn that it was most likely Braxton-Hicks contractions. Wait, what? Don't those happen really close to labor, and people think they're actually labor so they run to the hospital, and then they're embarrassed that it was just a false alarm?

Turns out that Braxton-Hicks contractions can happen as early as the 6th week of pregnancy, although you usually don't notice them at that stage. Thinking back on it, I first noticed that my uterus was occasionally tightening up pretty early in the second trimester, and now that I'm at 23 weeks, I'm feeling them at least once a day. Sometimes it's my whole uterus, sometimes it's just the right or left side (which gives my bump a fun, jaunty, asymmetrical look that's perfect for summer!) and it never lasts more than about a minute. Except, scratch that, there are times that I feel like it's going on and on... and usually a few minutes after that I realize that it wasn't a Braxton-Hicks contraction but gas cramps, or a little of both. According to my doctor, the key thing is that they aren't painful, consistent, or regular. As long as they stay that way, I'm probably okay and it's not an indication for preterm labor. So we're keeping our fingers crossed (as though they weren't before!) and hoping for the best.

Still Quiet, Also Still Deranged

I am thrilled to report that everything seems to have settled down for a few days. No bleeding, lots of fetal movement, and even I can tell that my bump is getting bigger. I am continuing to have Braxton-Hicks contractions (more on that later) but what's worrying me the most right now is something completely unrelated.

On Monday, everyone in my office got the news that a coworker had given birth to her first child, a healthy baby girl. Of course I responded to her husband's email with a hearty congratulations, but I moped around for the rest of the day feeling alternately sad and angry. Everyone kept discussing the little we knew about her labor and delivery (long-ish) and how cute the baby was (very) and how much she looked like both of her parents (eh, sure), and I just - it's hard to explain, but overhearing their conversations just made my skin crawl. I had a long talk with Harry about it when I came home and we reached the following conclusions:

- It's hard to hear people discuss fertility, pregnancy, and babies without any real acknowledgement of how difficult and precarious the whole process can be. Most of the coworkers who wanted to talk about the baby were women, and many of them have healthy living children. Of course you never know for sure, but I would guess that most of them had uneventful conceptions and pregnancies and were assuming that this new mother had the same experience. I got a few comments about being "next in line!" and I just wanted to staple things to their foreheads. I have given them no reason to suspect otherwise, but they have no clue how close I have already come to delivering and how grateful I am to still be pregnant. The blithe assumption that I, too, will reach 40 weeks and be complaining about swollen ankles and tight clothes is tough.

- The speculation about her body, her labor experience, and her delivery was really ick. I am absolutely horrified that I know - I know - they will do the same thing to me regardless of when this baby comes out. I actually think I have a pretty awesome body, and I'm in awe of what it is doing in creating this new life. I have gotten a few stray comments about my changing figure, but I've brushed them off - I could care less if my colleagues are sitting around discussing my hips or whatever. I am much more sensitive about my actual health issues and I'll be furious if I find out that they're discussing my C-section or my perineal tear or my future conception plans or whatever. The obvious solution here is not to give them any of that information, but neither did my coworker, and it didn't stop the gossip.

- I am (deep breath, Charlotte) scared that these people - who are nice, and who I see every day, but who are really just acquaintances - are more excited about my baby's eventual arrival than I am. I'm excited... right? Sure I am. A moderate amount. An amount that still protects my emotional health in a precarious situation. An amount that sometimes, on good days, counteracts the absolute dread I feel about having to make it through the weeks and months and years ahead - dread about waking up one morning in a puddle of blood, about labor and delivery itself, about leaving the hospital with an infant who will be dependent on me for literally all of his needs even in a best-case situation, about still having to deal with endometriosis and infertility when this pregnancy ends. And my coworkers will inevitably boil this unbelievably complex situation down to: baby! Hooray!

So, basically, I took something that was not at all about me and freaked out when I started projecting it onto myself and my experience. And I should say that I'm truly, genuinely happy for the new parents on so many levels. If it were just about them, and I had heard their news in a different environment, I wouldn't have given it a second thought. I was unsettled by this experience because it seems like a dress rehearsal for my own future, which I see as very cloudy. I wish them the best.

MFM Appointment: Legitimately Good News

Despite a super-long wait, my Maternal-Fetal Medicine appointment yielded a host of good news. There continues to be no new bleeding, I'm not contracting, the baby is very active, etc. Here were the main talking points:

- The baby's fine, looking ever-so-slightly larger than average in most measurements, which is good because if he does have to come early we want him to be as big as possible.

- My cervix is still long and closed. They were baffled that I was worried about a measurement of 35mm and said that there was absolutely no reason to be concerned.

- There are still no placental abruptions or sub-chorionic hemorrhages. Thank goodness!

- They did a fetal echocardiogram just for funsies and it was very normal and very boring.

- Are you sitting down? :::pause::: How about now? Okay, so get this: on their very detailed ultrasound machine, looking transvaginally for the most accurate view possible, my placenta is 1 cm away from my cervix. That means it's not a previa anymore.

Whoohoo! Break out the sparkling cider, everybody! Except that means we don't have a good reason for the bleed anymore. I was really leaning toward my OB's guess that it was just the usual previa complication and staying as quiet as possible would help avoid it happening again, but now we're back to square one in terms of unraveling the mystery. My MFM doctor said that he would bet it was somehow related to the original hemorrhage, but also said that there are a million reasons that women bleed in pregnancy and the important thing is that we don't see anything worrisome on the scan right now. This doesn't mean I can start doing back handsprings in celebration (ha! Back handsprings, that's a good one. I think the last time I did a cartwheel was in 1996, and I didn't exactly stick the landing) but it's all good news. It also means that I'm back on the lowest dose possible of Lovenox effective tomorrow morning, yippee.

One more thing. You know how I had unexpectedly lost five pounds as of Monday? On MFM's scale, I had actually only lost two. The nurse said that it was probably just normal variation and I should keep doing what I'm doing. In other words, perhaps I shouldn't have made this Mocha Icebox Cake yesterday? Oh well. I make no apologies. It's delicious!

OB Appointment: Still Hanging On

Yesterday's OB appointment went about as well as expected. Overall, I'm not experiencing any new bleeding, my cervix remains long and closed, I am not contracting, and the baby (yes, everyone needs to say this as soon as they start the ultrasound) is "very active." My OB's best guess about what happened is that it was related to the placenta previa - after all, painless bright red bleeding is the classic presentation and in the pre-ultrasound days it was evidently how they found out about previas. She thinks that the placenta probably bled a few days ago internally, it formed a clot, and then the clot made its dramatic escape on Friday night. She also said that stopping the Lovenox was the best thing I could have done right now.

So it was a good report, overall. However, there were still some things that were ever-so-slightly worrisome:

- Finally, someone did a transvaginal ultrasound to measure my cervical length. They could see it pretty well transabdominally, but I knew it wasn't an accurate measurement, and even though I have no risk factors for Incompetent Cervix, of course I'm worried about it. The good news is that the transvaginal ultrasound confirmed that my cervix is "long and closed." The bad news, according to this chart, is that my 35mm long cervix is still below the 10th percentile for singleton pregnancies at 21 weeks. I know, I know, it could be so much worse. And it seems like most OBs consider anything above 25mm to be fine. But now I've got that on my mind, too.

- The transvaginal ultrasound, even though it was as gentle and noninvasive as possible, dislodged enough of the bleed that it started up again. (That's why you apparently never want to touch a cervix with placenta previa - even a small amount of activity can disrupt the fragile blood vessels right above it.) It was pinkish-brown and I actually showed some of it to a nurse on a tissue after they told me to clean myself off and she said it was nothing to worry about. Still, for the rest of the day, every time I went to the bathroom, there it was. The mental torture of seeing more blood was the worst part of yesterday, because I just kept waiting for it to turn into a full-on hemorrhage... even though it didn't.

- Finally, here's one for you to puzzle over. Yesterday the intake nurse who did my blood pressure and my weight (and obviously hadn't looked at my chart) said "Oh, looks like you've lost five pounds since your last visit, congratulations!" To which I replied, "Um, I'm actually pregnant... aren't I supposed to be gaining weight?" Awkward pause. I then had two separate nurses as well as my doctor ask me, all polite concern, "Are you eating?" And my response was yes! Yes, I am eating! I had a burger for dinner last night! I haven't had any morning sickness in weeks! I'm lying around on the couch all the time doing as little exercise as possible! My bottom should be the size of Brazil! How entirely bizarre. I mean, at any other time in my life, my reaction would have been - unexpected weight loss, score! But now I'm just baffled more than anything. Why on earth would I be losing weight? My doctor didn't seem terribly worried and said that it was more important to just watch the trend, and Dr. Google doesn't seem to have many resources on this particular problem. I mean, I want to gain weight in the healthiest way possible, so noshing on a tube of chocolate chip cookie dough seems like rather an immature response, but I will admit it's tempting. How often am I going to have this opportunity, really?

That's all for now - hopefully today will be quiet, and then tomorrow it's off to see the Maternal-Fetal Medicine doctor. There's no Yellow Brick Road leading the way there, but fingers crossed for at least one wizard who can make all of this better.

Another Bleed, Another Midnight Trip to the Hospital

Headline: I am okay and the baby is okay. For now.

So there I was, minding my own business, lying in bed wasting time on the Internet when I should have been making progress on my book club assignment, the cat curled up next to me, and it occurred to me that before I nodded off to sleep I should use the bathroom. I'd had a huge glass of water earlier, and who likes to wake up an hour after they fall asleep to go pee? I went, and I looked at the toilet paper, and... no. NO!!! Red blood. A goodly amount of it. And, a moment later, a clot about 1/2" across.

I walked back into the bedroom and was about to look up my OB's number when I realized I knew it by heart. The answering service took down my name and information and put me in touch with a very nice doctor in their practice who I'd never met before. I was oddly, supernaturally calm as I explained what was going on and gave her the ten-second history of this pregnancy: G1P0, 21w1d, tubes blocked from endometriosis, subsequent IVF, DVT at 5 weeks, SCH at 9 weeks, complete placenta previa, red blood and a clot, blood seems to be slowing down, should I go to the Emergency Room? No, she said. You should go to Labor and Delivery.

I'll pause for a second to let you take that in. Labor and Delivery. At 21 weeks. As I drove to the hospital, hating every song the radio station played because I knew I'd forever associate it with this moment, I got ready to hear: There's nothing we can do for you. We've made a certificate with the baby's footprints for you to take home. Would you like to speak with the Chaplain?

Harry met me at Labor & Delivery and, mercifully, led me right back to the triage unit where they were expecting me. They led me to a little room with a whole bunch of monitoring equipment that I could just tell was meant for a much larger bump than the one I sported. A nurse came in with a Doppler and tried to find the baby's heartbeat - over and over, putting it on different spots on my belly, and distinctly not hearing the familiar thumpthumpthump that my OB has always been able to find on the first try. Harry and I were quiet, me thinking silently "But I can feel the baby moving, he can't be dead! Oh G-d, maybe this is what early labor feels like! Or maybe I've been wrong the whole time and that's not fetal movement at all!" Finally I said out loud, "Is there any way we can check with the ultrasound? The suspense is killing me." She agreed and brought in the ultrasound, which was turned off so we all sat there as the machine booted up. Seriously, I guess it runs off Windows because it was going through all the screens and hourglasses and everything, and I have never hated a computer more than I did at that moment.

The ultrasound showed within seconds that the baby was fine. His heartbeat sounded strong and regular, he was just curled up against the top of my uterus. Oh, now he's moving around and his heartbeat can be heard over here. Wait, now he's over here, try this spot. By this time two separate doctors had seen him on the ultrasound and they both remarked that he was a very active baby! Sigh of relief #1. They also saw, wonder of wonders and miracle of miracles, that there was no placental abruption and my cervix was long and closed. I wasn't contracting (I hadn't felt any pain the entire time, which obviously was a good thing) and the bleeding appeared to have stopped. Sigh of relief #2.

The final doctor who examined me was the OB I had called earlier that night from my practice. She did a speculum exam (don't want to irritate that cervix further by rooting around in there!) and said that everything looked okay although there was still a small amount of blood visible. It could have been any number of things that caused the bleed, ranging from a random event aggravated by the Lovenox to a final clot coming down from the original sub-chorionic hemorrhage to the classic problem of placenta previa: painless bleeding caused by the cervix dilating slightly. Basically, there's no good answer. I didn't bring it on by doing anything (for heaven's sake, I was lying around reading blogs and watching YouTube videos, about as sedentary as it gets) and the only thing they could recommend was that I take it very, very easy over the weekend. I'm off the Lovenox for now so nobody was willing to actually say the words "bedrest," and they emphasized moving around my legs as much as possible without using my abdominal muscles or exerting myself in any way. And, just like that, I got to go home. Total time door-to-door: 2 hours.

I left Labor & Delivery with my baby still alive inside me and an appointment with my OB on Monday. Not a bad outcome given what I was steeling myself to face earlier that night, but who are we kidding, this was not a good thing. Do I need to tell you that bleeding in two different trimesters significantly raises my risk of any number of other complications, including preterm delivery? Do I need to mention the statistics surrounding complete previa when the first bleed appears at 21 weeks? Should I cite the research about infant survival at a gestational age of 24 weeks (my new so-close-yet-so-far-away, crossed-fingers-and-toes goal)? Probably not.

This entire experience has been such a rollercoaster. I didn't know that my infertility blog would turn into a complicated-pregnancy blog, and I'm trying to prepare for the possibility that it'll turn into a pregnancy loss blog in the next few days or weeks. We had about five weeks recently where things were stable and we started seriously thinking about having a baby come fall - planning a shower, signing up for a birth/parenting class, actually buying a onesie. I was beginning to visualize myself with a giant belly, fantasizing about holding our son for the first time, wondering if the previa might clear so I'd have a shot at a vaginal delivery. Now my best-case scenario involves CPAP, an NG tube, surgery for ROP, cerebral palsy. And my worst-case scenario, well, I can't even bring myself to type it. I really, really don't know which way this will go. But I'll let you know as things unfold.

Break Out the Steak, I'm Anemic

Now this is a problem I feel I can handle: my recent bloodwork came back that I am, technically speaking, anemic. I do not have enough iron in my body. Oh noes! Weeping and gnashing of teeth! What does it all mean?

Eh, not much, it turns out. The fact that they took a week to get back to me indicates that it's not anybody's biggest concern. I'm only slightly out of the normal range, and I stopped by the pharmacy for some over-the-counter iron pills that I'll take once a day that should help resolve the problem. I also stopped by the grocery store and made last night burger night, and I'll try to get more iron-rich foods into my diet overall. The funny thing is that in my normal life, I tried to eat vegetarian more days than not, and I've unconsciously continued that habit in my pregnancy. Especially now that the weather's getting warmer, I'm craving lots of cold salads (chickpeas! white beans! chopped hard-boiled eggs on lettuce with ranch dressing!) and meat seems somewhat unappealing. Mmmm, who wants a big bowl of beef stew? Uh, not me. I think I'll try to grill as much as possible.. after all, isn't that what our new Weber is for?

The Root-e-Toots

As a rule, I try to avoid TMI (Too Much Information) on the Internet. But this is kind of a public service announcement, so today I am going to talk about gas. And no, not the kind you put in your car or use in your stove to boil water.

Pregnant women get gassy, or so I hear. And I have this really good friend who is at the exact same point in her pregnancy as I am, and she says that she's been waking up every single morning for a week now with some seriously painful trapped wind. In fact, on more than one occasion she has talked herself into thinking she's experiencing preterm labor (she's totally paranoid and worried, just like me.) Let it hereby be known that sometimes, an intestinal cramp is just an intestinal cramp. How might you tell the difference? Well, um, give it a few minutes... try walking around a little bit... the answer will probably become embarrassingly clear.

The second thing this very good friend has told me about gas and pregnancy is that there are times that you might feel a lot of activity in your belly - the type of activity you would ordinarily associate with an impending unpleasant gastric event, and which would get you searching for the nearest private bathroom. However, don't let your brain trick you here: it might just be the baby moving around. Gurgle, gurgle, gurgle doesn't automatically mean what it used to, so relax. And stop looking up so many stories about preterm labor! After all, Jessica Simpson had a lot of pregnancy gas, and she turned out okay.

Other News of the Moment

Obviously, we are beyond thrilled that our anatomy scan went so well. Finding out that we have a normal-looking baby, and that he's got some little-boy parts, was wonderful. But... what about all the other crazy things I've been diagnosed with over the past few months? How is that stuff going?

Sub-Chorionic Hemorrhage This is the best news we got: it looks like both SCHs are gone, all gone! The tech hadn't seen me for any of my earlier ultrasounds and didn't even know this had been a problem for me until I told her. Happily, in an hour of moving the wand all over my belly, she saw no evidence of any hemorrhages or placental abruptions. I'd like to give a shout-out to the very first OB I talked to on the night of my big bleed, who said that these things often didn't fully resolve until 18 weeks. At the time that seemed unimaginably far away, but true to form, it did clear up sometime between 15 and 20 weeks!

DVT and Clotting Issues My leg hasn't bothered me since February, even though they insist on checking it at every appointment, and knock on wood I have had nothing to suggest another clot at all. However, when they test my Lovenox levels - which involves making an appointment at the lab exactly 4 hours after I inject myself and then skipping the line of irritated waiting people who didn't know they could make appointments and who then give me the hairy eyeball - they have consistently come up higher than would be optimal. We're adjusting my dose, which right now means that I have to squirt a little Lovenox into the sink and hope that I'm getting something close to 30 mg. I should also mention that the bruises have almost entirely subsided, so injecting myself doesn't make me anywhere near as depressed as it did in the past. We'll keep testing this.

Placenta Previa This could still go either way. The good news is that most of my placenta is now over on the left side of my uterus, which also explains why I haven't been feeling much kicking on that side. If it's now a side placenta, could it keep pulling away from my cervix as my uterus grows, thus resolving the problem? Maybe. Maybe not. Right now it's still covering the cervix entirely, so I'm on the same restrictions for complete placenta previa that I've been on since April. However, I'm considerably more optimistic about it becoming a partial previa or even just a low-lying placenta than I was after April's gloom & doom diagnosis.

Everything else is going pretty much according to plan. My cervix is long and closed, though they didn't bother with an internal ultrasound to measure it precisely; they could see enough transabdominally that they weren't at all worried. With the exception of a few bad moments in May (I think I threw up three times?), my morning sickness has disappeared. I get round ligament pains just about every day, on both sides, but if I sit or lie down for a few minutes they ease up. My belly is growing and I'm keeping up with the cocoa butter in a vain effort to avoid stretch marks - none yet, but I'd be shocked if I avoid them entirely. And our unborn son would like to add to this list: he says, and I quote, "KICK! Kick kick kick! [pause] Kick kick KICK!" I'll leave you to interpret that however you want.