Family, Loss, and New Life

Spoiler alert: the baby and I are just fine. The loss I'm referring to is my grandfather, who left us last week. He had been struggling with his health for some time now and I had hoped he would still be around when the baby is born, but it didn't work out that way. Instead, I've spent the past few days with my extended family thinking a lot about the circle of life (and now you'll have that song stuck in your head, just because I mentioned it - you're welcome!)

My grandfather lived a long and full life. I know that's something people tend to say when a death occurs, and it's often not very comforting when you're grieving a loved one, but that doesn't make it any less true. I looked around at his memorial service and saw so many people - his wife, his children, his grandchildren, his great-grandchildren, his siblings and their children and grandchildren and so on - and I was incredibly grateful for the little one in my belly. I kind of backed into this whole motherhood thing and being at an event like this, which celebrates family and life, made me think more about how the choices we make when we are young have a ripple effect. I feel like I've been wearing my "next few months" glasses for a while now and the truth is that I have no idea what my life will be like long-term now that I've decided to reproduce. None of us do. I'm having a baby, sure. The next few years will be about diapers and playing with blocks and kissing boo-boos and the first day of school. But after that? Really, really far after that? I can't even begin to sketch out what shape our family will take. I can only hope that whenever I die, my loved ones will take as much comfort from each other as I have recently.

Oh, and remember that whole DVT/on an anticoagulant/told not to travel and especially not to fly thing? It made logistics for the memorial service pretty exciting. Let's just say that I spent some time recently appreciating our fair country from ground level and enjoying many regional specialties (barbecue!) and some not-so-regional specialties (McDonald's!) I forgot how much I enjoy traveling, even in less-than-ideal circumstances. In a weird way, it was a nice break from sitting at home in the same environment I've been stewing in for months, and although I would give anything for my grandfather to still be with us, I was grateful for the opportunity to hit the road. This kid better get ready to move!

Childbirth Class

So. Childbirth class. Harry and I went in expecting it to be an opportunity for unintentional hilarity, and we definitely got that. I didn't storm out in tears, which I actually thought was a distinct possibility when the day began, so we will count it as a success.

What did we learn? Well, the class as a whole learned about the stages of labor, techniques for breathing through contractions and pushes, a couple of the interventions that might be used, protocol for births at the hospital where we'll be delivering, and we went on a tour of the facility. The instructor was approachable, knowledgeable, and had a good sense of humor (case in point: laboring by standing with one foot on a chair is colloquially known as the "Captain Morgan" position; laboring by kneeling in front of a chair and hugging it is the "After the Captain Morgan" position. Don't have to tell me twice, lady!)

But what did I learn at this class? Excuse me while I bust out the bullet points:

- Most people have "normal" labors and deliveries. The odds are that I will too, anticoagulation worries aside. Wait, what? The only birth stories that stick in my head are the bad ones, of course. Or are they? What counts as normal? How much intervention can you have and still call it normal? Can I really expect to go into labor at home and spend several hours having mild contractions while my husband keeps me calm and feeds me light, easy-to-digest foods? I put a lot of faith in statistics and it's true, most babies at this hospital are born vaginally with little to no complications, so I have a good chance of being in that group. The cynic in me whispers, "yeah, but most people have normal conceptions too, and look how well that turned out" but it did get me thinking that this might not be a total sh*t show from start to finish.

- Their email notification system is busted. I swear! I made Harry check the website right before we left the house because I thought we might have to bring something and he confirmed that there was nothing about that, and we had a little printout showing that we had paid for the class so we were all good there, so off we went. And then we arrived, and every other pregnant couple walking into the building was holding two pillows, and argh! I. Never. Received. The. Pillow. Email. Not even in my spam folder. And maybe if it's so important you should put this whole pillow thing on the website! (It was totally fine, btw. Another couple lent us one of theirs since you really didn't need two. But still.)

- There is such a thing as labor massage, and some childbirth educators expect you to learn it in a darkened conference room with a bunch of other strangers all lying on the floor next to each other on exercise mats. Props to the guy who, when she turned the lights back on, shouted "What the... this is not my wife!" and broke the tension.

- I am on the high-maintenance end of the spectrum when it comes to patient involvement. (Raise your hand if this is coming as a surprise. Yeah, that's what I thought.) Case in point: the instructor mentioned two common interventions and how they work - breaking the amniotic sac and administering a Pitocin drip - and presented the Pitocin thing as a decision that the doctors would make if they thought you needed it, even though it would make your contractions longer and stronger. Nothing about discussing it with the patient beforehand; it seemed from her description like they might just come in and hook up a bag of Pitocin and then your head could start spinning like in The Exorcist. So when she asked for questions, my hand went right up. (Be glad I didn't run to the front of the room Jerri-Blank-style and yell "I've got something to say!") I wasn't as coherent as I would have liked, but my point about how patients need to give informed consent to interventions ultimately came across. It's kind of strange since this is a basic tenet of health care, and at first she started to reply that the doctors and nurses just wanted a good outcome, and I had to say again that actually, there are specific guidelines about interventions that can be performed without patient consent. Obviously everybody shares the same goal of a healthy baby and a healthy mother, and the goal is always a mutual decision based on a thorough conversation between the patient and caregiver, but yeah. That informed consent thing will get you every time.

- I think I can expect some of the compassion and hand-holding for the delivery that I didn't get, and really could have used, during my IVF conception. I've written extensively on here about how much I freaked out during my cycle, in part because I felt like my diagnosis of infertility was a huge and horrible bombshell and I wanted my reproductive endocrinology clinic to acknowledge that. I wanted them to say how sorry they were that I had to use their services and how they would do everything in their power to keep me as comfortable as possible during my treatment. Instead, I had some pretty impersonal (and literal) get-in-line-with-the-other-infertiles experiences and a legitimately painful and upsetting surgical procedure. On the other hand, the tour of the hospital's Labor and Delivery floor revealed that it had been recently renovated to make it feel more comfortable and homey. They talked to us about exercise balls, hot showers, and jacuzzi tubs. Nobody is going to make me take out my contacts, shave my personal region, or require me to have an enema. The kicker was when we were encouraged to bring in pictures, other decorative items, and - get this - air fresheners to make it seem less like a hospital. Before my IVF experience, I probably would have scoffed at hearing this, but now it actually made me feel much better. It's not the tubs or air fresheners that matter, it's the realization that someone cared enough to make them an option, and if they care about how the place smells, they probably care about me as a person, too.

In summary: yeah, I probably am going to have to give birth in the not-so-distant future. It has a shot at not being a terrible experience. And if I show up in active labor and am told I should have received an email about bringing along two pillows, I am going to march right on down to the IT department and give them a piece of my mind!

And Then There Was One (Complication)

Up until now, my Maternal-Fetal Medicine appointments have fit into one of two categories:

1.) Establishing that my existing complications are still going on
2.) Finding that a complication might be resolving, but discovering a new one

I am thrilled to announce that last week, I discovered that there was a third category:

3.) Learning that my complications have continued to resolve, not finding any others, and getting bumped down closer and closer to "normal pregnant woman" status!

Seriously, the visit couldn't have gone better. My placenta previa, which we already knew had technically resolved by a small amount thanks to a scan at 21 weeks after my last bleed, has moved farther and farther away from my cervix. It was barely 1 cm away at 21 weeks and at 26 weeks it was between 1.5-2 cm depending on how they measured it. The doctors said that they expect it will keep moving (though they were careful to make sure that I understood it's not the placenta that moves, it's the uterus that grows, and as the uterus grows the placenta stays put so it keeps "moving" farther away. Got it, guys. Trust me, I've looked up how placentas work by now!) Oh, and my cervix is holding strong at 3.7 cm.

The other good news is that there continues to be no new bleeding, either that I've noticed or internally. So the sub-chorionic hemorrhages from my first trimester appear to be well and truly gone (oh please, please, please let that be the case!) Perhaps the 21-week bleed was the last hurrah? Man, if I had known that, I would have thrown a party to celebrate rather than lying on the couch all weekend in terror!

So for those of you keeping track at home, we've now gone from three potentially disastrous complications to one. That one is, of course, the Lovenox I'm still taking after my deep vein thrombosis very early in the pregnancy - and it won't go away because I will be at risk for additional clots and need to stay on blood thinners right through 6 weeks after delivery. But with this in mind, my MFM doctor recommended that we change my labor and delivery plan slightly from "induce no later than 38 weeks" to "induce no later than 40 weeks." I now feel like less of a fraud when people ask my my due date and I respond "October 18th!" Inwardly, for the past few months I've been cringing inside as I said it, knowing that the babe was medically indicated to come out no later than Oct. 4th, and quite possibly earlier than that. Now he has a shot at truly, genuinely, just-as-nature-intended making it to term. I hope he does, even if it means I need to wait a bit longer to meet him!

Of course, all of this "you're a normal pregnant woman and can possibly anticipate a normal delivery" has me a bit freaked out. Which brings me to my next topic... CHILDBIRTH CLASS. I'll save that for another post, but highlights include forgetting to bring our pillows, learning to give a massage under dim lights in a room full of strangers, and me getting all high and mighty about patient consent. Fun!

The Belly Button of Doom

It's coming.

Every day it's poking out a little bit more.

It's...

MY BELLY BUTTON! SHRIEK! COVER YOUR EYES IN HORROR!

(I don't have tails - yet - but I'm pleased to see that Melusina, 

inspiration for the Starbucks logo, also had an outie.)

And no, Vanessa Minnillo, I don't think it's like having a third nipple. But then I also didn't pose for any sunset babymoon pictures, either. That's cool though. Yours look great.

In other news, has anyone else read the article on IVF that was in the New York Times this morning? I feel like it isn't particularly controversial - in fact, for those of us who have been through this process and know how it works it's downright boring to read - but I'll be intrigued to see if it comes up in conversation today with the NYTimes junkies I know. For the record, 22 follicles, a mild case of OHSS, three frozen embryos, and one pregnancy later, I'm not sure they could have sold me on low-dose IVF at the time of my cycle. I'd rather get all of the unpleasantness over with as fast as possible, especially if insurance picks up the tab. But knowing what I know now about the risks of hyperstimulation? Hmmm. Maybe. Anyway, back to what's really important here - my belly button. I think it needs its own theme music, like in a horror film, so people know when to run screaming from the room! (It's okay, belly button. I still think you're pretty great.)

Birth Plan! Ha!

In case anyone has missed it, over the past few weeks this amazing (parody) birth plan has been making the rounds: Jamie and Jeff's Birth Plan. It is hilarious, and wonderful, and made me wonder if I should create an actual birth plan of my own now that this whole placenta previa thing may be resolving to the extent that I'm able to attempt a vaginal delivery. After I had laughed at Jamie and Jeff's plan for the millionth time, I headed over to BabyCenter and printed this worksheet. But when I began looking it, I realized that this was, um, not really geared toward me. Demographically I'm probably likely to want the Jamie-and-Jeff spiritual and unmedicated experience, but personally, that sounds terrible to me. Nothing, and I mean nothing, has been remotely spiritual or low-intervention about this conception and pregnancy to date. So when I'm asked questions about dimming the lights and using self-hypnosis, I roll my eyes. It was traumatic getting pregnant and I have no expectations that it will be anything other than traumatic to get this baby out of me. Not to mention that even in a best-case scenario, I'll still have this blood clotting thing to deal with when I deliver, so I would be kidding myself to think that I wouldn't need interventions like an IV or continuous fetal monitoring.

That is not to say that the birth plan exercise didn't raise a bunch of important questions that Harry and I discussed in advance of my OB checkup yesterday (everything looks great with the baby, by the way.) Here are my top three birth preferences, which raised my doctor's eyebrows quite a bit when I went over them:

1. As much pain relief as possible. I know, I know, lots of women decide in advance that they want to get an epidural (or a spinal, or narcotic pain meds, etc.) I'm one of them. I don't want to be in pain. I readily admit that I am scared of the pain of childbirth. I don't care if knowing this makes you think less of me. But I'm also still epically pissed about my experience with egg retrieval and being awake for that painful and humiliating surgical procedure. And knowing that the heparin I will be on after 36 weeks gives me a 12-hour window where an epidural literally isn't possible makes me even more anxious that I will be begging for relief and it will be denied.

2. Authority to kick people out of the room (yup, even medical staff). Residents, medical students, pediatricians waiting to take our kid to the NICU - fine. No problem. Grab a chair and stay awhile. But in the event that any member of my care team makes me feel, even for one instant, like I am being judged for any single one of my choices, I want that person to leave. No, excuse me - that person will leave the room in a hail of verbal abuse. If someone tries to scold me that I'm not pushing right/is skeptical of my decision to pursue pain relief/makes an ill-timed crack about IVF/laughs at my suffering, they're likely to be at the receiving end of the months and months of anger that has been building up in me.

3. I want to be called by my actual name. I noticed when I went to Labor and Delivery at 21 weeks for my most recent bleed that nobody bothered to learn my name. Or, maybe they did know who I was, but they all referred to me as "mom." I do not find this cute, or endearing, or exciting. When the nurse that night said "Oh, that's mom's heartbeat we're hearing," what I heard was "I have no idea who you are. As far as I'm concerned, all you are is yet another woman about to give birth." Why is this okay? I have never heard an oncologist refer to a patient as "cancer lady" or a surgeon call someone "bypass guy." (Well, not to their faces, anyway.)

How did my OB react to my (very politely presented, I might add) list of requests? Um, not terribly well. She can't guarantee any of them, which I knew would be the case. Nobody knows how my labor will progress and if giving me an epidural could paralyze me by causing bleeding into my spine, that's a pretty damn good reason not to do it. She also hasn't really encountered many patients who come in to give birth really, genuinely concerned in advance about personality conflicts with the staff. And when it came to the not-being-called-mom thing, she gently explained that most of the time people are just excited and happy for the delivering woman, and it's coming from a good place. Which I get, and which doesn't change anything about how I feel. She's going to make notes in my chart about my preferences and encouraged me to express them again as soon as I get to the hospital, and offered to set up a meeting with one of the anesthesiologists for me to discuss pain relief options for anticoagulated patients in more detail. And, um, she suggested that I meet with a counselor. You know, the "let's explore your anger" type of counselor. Which I have declined.

So... there's a lot going on here. In a way I think I'm just as protective of my "birth experience" as the fictional Jamie and Jeff, because I've already seen what happens when I have a negative interaction with the medical community. And the stakes are higher this time. What's at risk is not just my ability to sleep and eat and function like a normal, non-sobbing human adult, but my relationship with my new son. He is the very definition of innocent in this whole crappy situation and he deserves the best possible start in life. If this goes badly, and there are a million ways that it can, I honestly don't know how I will be able to get past it and start bonding with our baby. And what can I do in advance to prepare for this, realistically? Nothing. Except maybe practice saying "What's my name, bitch!?" to someone during a chaotic experience in bed, which I have never done... something to look forward to, I guess?

And Now, A Few Words About Infertility and Unhappiness

Everyone who writes about their experience with pregnancy after infertility seems to say, sooner or later, that the excitement of actually gestating a tiny human being doesn't erase the experience or memory of the treatment that got them there. Not wanting to be left out of this trend, I have mentioned this feeling around fifty bajillion times. And I have no plans to stop anytime soon.

Today, I want to follow up on a post I wrote way back in January - and I want to offer an apology. Longtime readers (all three of you) may remember when I posted about a study on exercise and IVF. I seized, laughingly, on the lead author's assertion that running during an IVF cycle was counterproductive because it makes your body think you're being chased by a bear. That lead author was actually Alice Domar, Ph.D., Executive Director of the Domar Center for Mind/Body Health and the Director of Mind/Body Services at Boston IVF. And if you ever read this, Dr. Domar, I heartily apologize for making light of your exercise recommendations. Rereading the article now, I'm guessing you said about 200 other things to the interviewer and the bear comment was the one that got printed. Happens all the time, and I mean, you have to admit it did make for some entertaining reading.

Why the about-face? Well, remember that podcast I brought up a few months ago? I was listening to it the other day at work, not paying much attention, when I realized that the interviewee was none other than our friend Dr. Domar. I will admit that I rolled my eyes when I heard the title of the show, "Can You Be Happy Even While Infertile." And then Dr. Domar started talking, and my productivity level began to drop. At one point I was actually wiping away tears and hoping that nobody would come by my desk until I could compose myself. She said a ton of things that resonated with me, but this exchange is worth repeating verbatim (it starts around 21 minutes at the link below):

Domar: [The caller's] second question was, how can I be happy when going through infertility?
Host: Is it realistic to expect happiness, yeah.
Domar: You know, I don't think - most infertility patients are not happy as they go through infertility. And I wouldn't expect, I mean, if someone came in and said that they were happy as they were going through infertility, I'd want to test them for mania. So, do I think you can be a happy person as you go through all of this? No, I don't. I think some people are relatively resilient, and stay the same, but no, I don't think you're going to be happy as you go through infertility. But I think it's still possible to have moments or days of happiness, you know, ice cream is still going to taste good, and your husband or partner is still going to be attractive to you, and Paris is still going to be gorgeous, and the springtime when the flowers come up is still going to be amazing... Is your baseline going to be different during infertility than it was before infertility or after infertility? It probably will be. But you're still going to have highs and lows. There are still going to be things that make you feel good.

Listen to the entire interview here - no, really, go listen to it:
Creating A Family: Can You Be Happy Even While Infertile

I wish, wish, wish that I had heard this statement back when I was preparing for and going through IVF. It was bad, guys. It was really bad. My surgery last fall kicked off the absolute worst time of my life and, like many of us, I was struggling not only with the physical implications of my diagnosis but a tidal wave of upsetting emotions simply because I would need this treatment. Every time that treatment hit a snag, I totally lost my sh*t (and have continued to do so through a complicated pregnancy, though not as dramatically.) I hesitate to use the word "depression" even now, because I think that clinical depression should be diagnosed by a doctor and not WebMD, but all of the symptoms and warning signs were there. And I categorically refused to seek any kind of treatment for my unhappiness, which know might be hard for some people to understand, but the only time I have regretted that decision was when I heard Dr. Domar's interview. If I had been told by an expert back in November, or December, or January that it was normal for my mood to take a big hit when faced with this news - that it would have been odd for me to take it entirely in stride, that everyone struggles, that a diagnosis of infertility is just as emotionally devastating as a diagnosis of cancer or heart disease - I think it would have made a huge difference. It couldn't have stopped it, but it could have helped me put it in context, and I would have worried less that I had some sort of crippling mental deficiency on top of being infertile.

One final thought - she's right about finding things that make you happy even when something else in your life has taken a turn for the worse. Ice cream is still going to taste good. Ice cream is always going to taste good. (Unless you have morning sickness, but that's a story for another time.) There will always be ice cream, and Paris, and flowers in the springtime. And there were flowers this spring. There were!

P.S. My armpit infection is doing fine. It was markedly less sore and red about 8 hours after my first dose of antibiotics and has continued to clear up ever since. See? I told you it wouldn't be a big deal. On to the next challenge!

I Kind of Have a Staph Infection, But It's Totally Cool

First of all, "staph infection" should be taken with a big grain of salt. I don't actually know what has infected the lymph node in my right armpit, but it could be staph, and it could be related to a tiny cut I got around there from shaving, and since I've had this happen before and it actually was staph I wanted to act fast. Staph, after all, acts very fast. It takes no prisoners - well, unless you never give it a chance because you hit it with antibiotics at the first sortie. I don't know why this particular lymph node gets infected relatively easily (this is the 5th time in about 15 years) but it does, and even though I try to keep the area clean and make sure I don't nick the skin in that area when I shave, every so often I notice some soreness and I wonder. My armpit got sore yesterday, it looked slightly red last night, this morning I could feel a hard little pea-sized bump underneath the skin in the painful part, so it was off to urgent care. A mere 2 1/2 hours later (!) I walked out with a bottle of antibiotics and the dream of a staph-free future. Or an infection-free future, anyway.

By all accounts, this had nothing to do with the pregnancy and the antibiotic I was prescribed is about as safe as it's going to get for us knocked-up humans. It was just another fun medical way to spend a morning. And it's an excuse to post this picture of a staph toy - maybe I'll get it for the little one to play with!

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