Happy Christmas, Even If War Isn't Over Yet

You have no power over me, Yoko Ono!

You may be thinking to yourself, well, duh, of course Yoko Ono has no power over you. Do you even know Yoko Ono? Are you secretly a Beatle and just forgot to mention it all this time?

See, here's the thing. I'm Jewish, but I've always loved Christmas music. Besides, living in North America in December, it's not like I could avoid it if I wanted to. And I have always had a particularly strong reaction to one song in particular: Happy Xmas (War Is Over), which combines John Lennon's probing, vaguely passive-aggressive questioning of the listener ("So this is Christmas / And what have you done") with Yoko's seemingly wordless wailing. I cry every time I hear it, I swear. It's practically Pavlovian at this point. I hear the opening chords and a lump forms in my throat as I think about how the song is about war and war is so terrible and John Lennon's death was so tragic and you know, when you get right down to it, what exactly have I done over the past year?

Except this year. This year, I was prepared. When Yoko started to wail, I was going to look at my delightful little baby and think, this year I had a baby! Ha! Put that in your "life accomplishments" pipe and smoke it! Except it didn't really go that way.

Pregnancy-after-infertility blogging tends to follow a few conventions: there's the post about how getting pregnant doesn't mean you won't always feel infertile and remember your struggle. There's the quick post immediately after the baby's arrival that is followed by several days or weeks of silence and finally followed up with some variation of "wow, I've been really busy!" And then there's the post written a few months later, as the calendar begins to display dates that match up with important events of the last year: one year ago today, I was just starting to stimulate my ovaries/chugging water before my embryo transfer/looking in disbelief at a positive pregnancy test. And you think to yourself, I could never have predicted at this time last year how different my life would be now.

For instance, there was my one year blogiversary, just passed. There's the anniversary of my first Lupron injection. There's the holiday party I recently attended - same venue, same guest list, same menu, but this time the slight headache was sleep deprivation from caring for a newborn, not a side effect of the artificial menopause I was putting my body into. Coming up, we get to celebrate the one year mark from my total and utter freakout about my egg retrieval. There are good memories on the horizon, too, like the Superbowl party I attended where I knew I was pregnant and nobody else did. It was, simply, a huge year.

And that's why I thought that for once, "Happy Xmas (War Is Over)" would have no power over me. Except that I found myself welling up right on cue, this time because I just couldn't believe how massively fortunate I have been over the past year. Look at what I've done, Yoko! A new year just begun, indeed!

I know this is a hard time of year for many people, so before I close I want to say this: you are not alone, and you are not forgotten. Infertility is desperately hard and dealing with illness and disappointment can be devastating. But life can, and does, change. Be strong and be well.

Next Steps and Continued Hormonal Funtimes

Hey, look, we've made it to six weeks! Good job, everybody!

Six weeks means that O is smiling (sometimes), cooing (occasionally), and extremely cute (all of the time.) It also means that I had my six weeks postpartum checkup, which ordinarily would have focused on healing Down There and birth control plans, but was a bit more interesting for me. The endometriosis that got us into this whole IVF mess is a problem that won't go away, so there are a few things we're going to continue to monitor going forward.

First of all, some good news. I passed another milestone this week: I'm off Lovenox! No more enoxaparin sodium for this girl, at least until/unless I get pregnant again. For those of you keeping score at home, this was nearly a full year of daily injections, with a few short breaks here and there. Someday I'll post the total number of needles that it took to get O from theory to reality, but for now I'm content just watching the bruises fade.

Also, the preliminary results suggest that the endometriomas have not recurred (or are pretty small if they did.) The one on the left was 4 cm right before my IVF cycle and we'll see what continued breastfeeding does to keep things quiet. I've seen it described as "natural Lupron," which would be nice since I want to avoid taking that stuff again if at all possible.

Since I had a complicated pregnancy, I also wanted to go over whether I'd have to be concerned about attempting any other pregnancies in the future. Yes, I will likely have to be on Lovenox again, but my risk of placenta previa is only slightly higher than normal and the fact that it resolved this time is a good thing. I also had some weird liver stuff that popped up on my bloodwork at the very end, but that just means they'll be on the lookout for pre-eclampsia as they would for anyone. Overall, I guess I'm not a terribly complicated patient when it comes to another pregnancy, which is nice!

Now for the tricky stuff. The endometriosis which caused my tubes to scar over and my ovaries to grow endometriomas will theoretically get worse every time I have an ovulatory cycle (though how much worse, and how much it will bother me, is kind of a question mark.) Ordinarily I would probably be prescribed a combination estrogen/progesterone birth control pill, but thanks to my DVT, I'm not a good candidate for that. I'm likely headed towards a progestin-only pill or maybe a Mirena IUD - and yes, I really am considering taking the pill despite my earlier protestations about systemic hormones. Why? Well, partially because the side effects are theoretically less problematic than the combined BCP, and partially because I can wrap my head around taking a pill if I know it's only for a short period of time.

All this to say: it's a matter of time before we're back on the IVF train. Don't think I've forgotten about those three embryos on ice, and because of a combination of family and medical factors, we're probably looking at attempting another cycle in a year. Or less. Or maybe a little bit more. There are a lot of moving parts to consider, even though we're committed to giving O a sibling - or at least trying our hardest to do so. We've been so blessed to have him, and I hope and pray that our luck continues!

Well, I Didn't See That Coming

I broke my foot!

Argh. I am such an idiot. I have no good story, I just slipped on some leaves and rolled my ankle. Now my metatarsal has a small fracture, I'm theoretically supposed to be using crutches to get around, and I'm sure that internally little O is shaking his little baby head in embarrassment at his incredibly klutzy mother. Slow clap, Charlotte. At least I don't have a cast!

Anyway, since this is Thanksgiving, I will also share that O has a new holiday themed bib that says "Everyone is thankful for me!" and I burst into tears the first time I saw it because it's so true. I am thankful beyond words to have him in our lives. Seriously, I wake up every morning (after a whole four hours of sleep or whatever) and think to myself, hooray, I get to spend another day with my baby! And now, with this broken foot, I'll have even more hours on the couch to stare at him and tell him how precious he is and how much I love him. Happy Thanksgiving, little man.

5 Things I Didn't Expect About Labor, Delivery, and the Postpartum Period

Little O is almost a month old - I'm so proud of him for thriving, and us for surviving! He's packing on weight like a champ and we're getting better at keeping our household functioning with a newborn as its newest member.

Before the memories fade, I wanted to write down some of the most surprising things about my birth experience in case they're helpful to someone else (or in case I choose to do this again - but that's a different story!)

1. Braxton-Hicks contractions vs. real contractions. 
For most of the pregnancy, I felt not-quite-painless Braxton-Hicks contractions at least once a day. Toward the end of the third trimester, they were very frequent (but never regular, usually coming in clusters a few minutes apart and then easing up for an hour or two.) I spent more time than I'd like to admit looking up phrases on Google like "distinguish braxton-hicks contractions labor" since I was constantly convinced I was about to go into preterm labor. One of the things I read often was that Braxton-Hicks contractions feel like they start low in your uterus and then sweep upwards, but real labor contractions wrap around from your back to your front, or sometimes they seem to move from the top down. As I've written previously, once I felt my first real contraction I realized how different they were, but only in terms of the pain associated with them - every single labor contraction I had went from the lowest part of my uterus up to the top, just like the Braxton-Hicks. They were, however, much more painful and felt very similar to menstrual cramps. If you're trying to make the distinction on your own, I would say that the way you perceive the tightness starting is not the way to go.

2. "You're so tall, maybe that's why the epidural isn't working."
I was pretty clear with all of my caregivers before and during my labor that I wanted an epidural. And I got it, too, which I greatly appreciated. However, several times while trying to fix the window in the lower left quadrant of my belly, the nurses and anesthesiologists remarked that maybe it wasn't working correctly because I was so tall. Huh? For the record, I'm 5'8" (about 173 cm for you metric folks.) I'm tall, but not that tall! I can't imagine I'm the tallest woman who has ever given birth at this hospital, but who knows. Besides, there are lots of risk factors for why the epidural might have been incomplete at first, and it's a common problem that often has a simple solution. In any event, after lots of fiddling and a bolus or two of extra meds, the numbness did spread over my entire contracting belly and I was a much happier mother-to-be. Bottom line: if you find yourself with an incomplete epidural, don't give up - ask for them to do whatever they can to fix it.

3. Careful with that bassinet!
Well, duh, I don't want to drop my precious bundle of joy. Then why is the bassinet so high, and my hospital bed is so low? Once the excitement from the birth had settled down and O and I were moved to a postpartum room, the nurses got me into a nice cushy hospital bed and put O right next to me in what is, let's face it, a modified refrigerator crisper drawer on wheels. Since the nurses and doctors would stand when they checked out O, it made sense for him to be nice and high (think the height of a kitchen counter). And since I struggled a bit getting in and out of bed, it made sense for me to be nice and low. But when I needed to pick up O, things got a bit tricky. I couldn't reach over to get him while still in bed, so I had to either stand up and walk around to the bassinet to fetch him or get up on my knees rather awkwardly while still on the mattress. I tried putting my own bed up as high as it would go, but the nurse got upset at this and came in to lower it because she said I could injure myself trying to get down from there (which, yeah I could, but who would you rather see in a heap on the floor, me or the baby?!) Next time I do this, I'm asking someone to hand the baby to me each and every time, because there's just no good way to get him or her from the bassinet to my arms when I'm by myself.

4. Headlights
Prior to giving birth, I hit up my local maternity store for a nice pretty nightgown that I could wear during my hospital stay since I knew we'd have visitors. I did not, however, pack a nice pretty bra to go with it! I guess that when an infant is spending hours each day sucking on your nipples, they don't exactly go back to their innocuous, soft, no-bra-necessary selves between nursing sessions. Seriously, I looked like I was cold the entire time! I had a sleep bra with me that consisted of a nice, comfy single layer of fabric, but that wasn't enough to preserve my modesty when friends and family started stopping by. Underwires and padded cups are the only way to go, as far as I'm concerned.

5. The sweaty, sweaty night sweats. 
Things were so weird in the hospital that it was hard to tell what was normal and what wasn't, but once I got home, I noticed that during the (very short) times that I slept, I would sweat like crazy. Remember when I was in menopause for a few weeks last winter? It was like that! I thought I was imagining things until I read Mo's post about the same thing, and it turns out that it's a common occurrence after giving birth. Honestly, it wasn't too bothersome (not getting more than 2 hours of sleep in a row was a bigger problem) but it did make it even harder to stay hydrated, which is important for breastfeeding. Keep a glass of water nearby and get ready to do even more laundry than usual, and take heart that it should end soon - for me, it was only about 3 weeks and now I'm back to normal.

Normal... what a crazy idea. Having a baby means embracing the new normal, that's for sure. But I'm saving that for another post!

Birth Story III

Part the Third: Pushing

I had heard stories of women – even other first-time moms – who pushed only three or four times before their babies came out. And the incredible pressure in my personal region made me very motivated to get him out quickly. But with the first push, I began to have some doubts that this would be a fast process. And I was right: it was nearly four and a half hours from the time I started pushing to when O made his big arrival!

I didn’t know that, of course. I kept asking for updates on my progress and hearing that I was pushing just fine, but that they could only see a tiny bit of his head starting to emerge – a dime, then a quarter, then “a handful of change.” My OB said that she expected that each push would move the baby out by one millimeter – argh!

The rhythm of pushing gave me plenty of time to reflect on this experience, strangely enough. You only want to push during a contraction, both to make them as effective as possible (your uterus is also trying to squeeze the baby out) and to save your own strength. You also want to aim to push three times during each contraction, with only a quick break in between to catch your breath. However, when the contraction ends, you get to rest for a moment. If you are me, or you are as exhausted as I was, you may even find that your mind wanders in unpredictable ways and you feel almost like you’re dreaming… until the next contraction starts to build, and it’s time to push again.

A brief word on labor pain for a moment. My epidural had a “window” when it was first placed where the lower left quadrant of my abdomen was still feeling the pain of the contractions. It was fixed initially but at some point during the pushing I began to feel it again, only a brief twinge at first, but then more and more. I wasn’t able to communicate very eloquently at that point, so I started just saying “quadrant!” when it was hurting. Thankfully, the anesthesiologist was able to adjust my epidural again, and after a few minutes the pain went away so I was only dealing with the overwhelming pressure, and I started once again pushing with all of my might.

While we’re on the subject, I remember at childbirth class that we were told that pushing was the hardest physical work we would ever do. Ummmm… I’m not sure about that. I don’t want to toot my own horn here, but I’ve definitely had harder workouts! (Or maybe I’m just sufficiently out of shape so every workout seems really hard – take your pick...) It’s hard, don’t get me wrong. It’s more like weightlifting than true aerobic exercise in that you really need to psych yourself up between sets, and because I didn’t know how long I would need to push, I didn’t know how much more psyching-up I would need to do. That was the hardest part, not knowing how much longer it would last and hearing that I was only making infinitesimally small gains with every push.

Time dragged on. One hour, two hours, three hours, four… and as O started to crown, two things happened. First, I tore just from the prolonged pushing, and second, O’s heart rate got pretty low. Nobody panicked and it wasn’t very dramatic, but my OB suggested an episiotomy to help get him out as quickly as possible. On the next push I heard and felt the snip, snip, snip of her little scissors, but when he didn’t immediately emerge, I began to seriously lose patience. We went through IVF, a complicated pregnancy, and I consented to an episiotomy for this? Oh, HELL no.

On the next contraction, I pushed – and pushed – and pushed – and the contraction ended and I still pushed – and the nurse and my husband tried to hold my chin to my chest and I refused – and I kept pushing – and I felt a new and sharper kind of pain that could only be crowning – and then something unbelievably large slithered out of me – and that something started crying – and I opened my eyes to see my OB holding a baby between my legs! O was here! Everyone was relieved and smiling and my husband’s eyes were a tiny bit misty and then there was a seriously pissed-off baby on my chest. His tiny hands looked like miniature versions of my own and in between wails he opened his eyes enough for me to see that they looked exactly like his father’s. 

We were a family.

Birth Story II

Part the Second: Active Labor

I had thought the that the instructions to eat a good meal and take a shower the night before the induction were because it was going to be my last opportunity to do so for a while. But with the morning came a shift change, and my new nurse made it her mission to see me freshly bathed and fed. The shower was no problem but, man, I did not want to eat. My stomach was already upset by the long night of contractions and by the time my scrambled eggs arrived, it was all I could do to choke down a few bites.

They started the Pitocin drip around 8:30 AM. The dosage started low and slow and gradually ramped up, and the nurse said that her goal was to get me contracting regularly every 2-3 minutes. That sounded pretty quick to me and she confirmed that in a naturally occurring labor it would take much longer to get to the 2-3 minute mark, but in an induction, they usually only saw significant dilation with the quicker contractions. Great.

At this point, I got a chance to play the role of “laboring woman,” just like you see on TV. First, I walked the halls (wearing two hospital gowns, one covering my back and one covering my front like a kid in art class) pushing my IV along with me. Then I lay around on the bed in different positions, trying to sleep between contractions. Then I got in the rocking chair and rocked my way through them. I asked for ice chips and breathed the way I had been taught in childbirth class. The only thing I didn’t do was get into the Captain Morgan position – everyone deals with pain differently, but for me, just getting through the contraction took all of my energy and I had to stay as still as possible to concentrate on breathing. I even commented between contractions that I had no idea how I would possibly get into any of the positions on the poster in class!

Around noon, two things happened simultaneously: the OB on call decided he wanted to break my water, and I decided it was past due time for an epidural. And this is the only part of the story where my fears about needless pain and lack of control in labor nearly came true: I told the doctor that I wanted an epidural prior to my water being broken since the contractions were likely to get a lot stronger after the membranes were ruptured, and the OB said back – I swear – “We’ll see. You know, we do this a lot. You need to trust us.”

My husband, my mom, the nurse (who knew my concerns), and I all exchanged glances. Or so I’m told, because I actually had my eyes closed as the next contraction started. I squeaked out something about being afraid that a painful and traumatic labor would affect my ability to bond with my son, and mentally began preparing to actually have the argument I had been dreading since my IVF days. But the compromise we struck was that he would check my dilation before we did anything else, so I staggered back to the bed and lay down just as another contraction began…

Pop! went something inside me, and I felt a warm gush between my legs. I knew instantly that the amniotomy would be unnecessary and managed to say “water – gone – ruptured” or something like that. The OB was there to see the fluid come pouring out just as he established that I was 5 centimeters dilated, and confirmed that it was clear (that is, free of signs of meconium or infection, though evidently pretty bloody.) And, blessedly, the next step was to call anesthesia.

What was it like getting the epidural? Painful in a new and exciting way, I suppose, but not terrible. It was actually kind of fascinating to feel sensations and nerves in my back that I had never known existed. The worst part was actually that as the anesthesiologist began her work, I was hit with a serious wave of nausea and puked up my breakfast from earlier that morning (um, I told you eating a big meal was a mistake!)

Once the epidural kicked in, I felt much better… on about 75% of my belly. The lower left quadrant wasn’t covered at first, but a few tweaks of the catheter and a bolus of Fentanyl later, I was really quite comfortable. I was talking and joking with everyone until – it’s hard to describe, but something changed. The epidural had gotten rid of the belly pain but not the pressure of the contractions, and that was manageable, but all of a sudden it moved lower and got very intense.

I went through maybe three contractions like this, but before anyone could come see how dilated I was, I discovered what pushing felt like. Why? Because I started to do it involuntarily. It was the craziest feeling and I was worried that I was doing something wrong, but within minutes, my OB showed up and checked my cervix. I’d never been so happy to see her in my life, especially when she said excitedly that I was fully dilated and ready to start pushing!

Birth Story I

For several days after arriving home from the hospital, during the rare occasions that I found myself drifting off to sleep, the events of O's birth kept replaying themselves in my head. I was tired beyond all recognition, but I couldn't drift off without trying to process everything that happened to bring him into our lives.

My entire labor and delivery took place in one room over a single 24-hour period, but in my head, there were three distinct phases and they might have taken place on three different continents for all I know. This is going to be long - of course - so I'll split it up into three separate posts.

Part the First: Early Labor
There was a fair amount of drama about when I would be induced. We were given a window of five possible days that we might receive a phone call in the afternoon that would ask us to come in to the hospital that evening. Mentally, we prepared for a long wait, which is why I was shocked to look down at my phone at 11:00 am on the very first day and see a missed call from the hospital. Harry and I stared at each other as I listened in disbelief to the message. It was happening. I needed to check in to labor and delivery by 8:00 pm that night. The heparin shot I had taken that morning was to be my last. I should shower before coming in and eat a substantial dinner, and prepare to stay in the hospital for a few days.

Naturally, with all of this advance notice, Harry and I arrived at the hospital right on time. Ha! Of course we were running late, enough that we got a little bit of side-eye from the receptionist. Still, they let us in, and Harry and I started exploring my new digs - there was already a bassinet in the room with two tiny hats, one blue and one pink (just in case)!

I was scheduled to be induced using a Foley catheter, though if the catheter didn’t work we would use misoprostol as a backup. The trick with the Foley was getting the balloon inserted into my cervix, which was still only a little over a centimeter dilated. It was, frankly, not the best experience. The doctor who placed it seemed surprised at how difficult and bloody it was to get the balloon in, and apologized at how painful it had been for me. He said that I would have some cramps from the initial placement, but – famous last words – “don’t worry, they will stop after a few minutes!”

I didn’t feel anything until the door shut behind the doctor and nurse, and then almost immediately I had – oh wow, I had forgotten all about this – a menstrual cramp! No kidding, it was so instantly familiar that I almost wanted to laugh. Nine months without them (longer, really) and all of a sudden the endometriosis memories came rushing back. It was painful, sure, but nothing out of the ordinary… with one exception. The cramps didn’t stop after a few minutes. They didn’t stop after three consecutive late-night episodes of “Friends.” They didn’t stop, in fact, all night long. And I couldn’t take my usual handful of Advil to help numb them. According to the monitors and the pain in my uterus, the contractions continued at irregular intervals ranging from 6-9 minutes apart. Not enough to count as active labor, said the nurse. I could really go for some Advil right now, I said, only half-joking. How about some Benadryl instead, she offered. I accepted and got about 4 hours of not-great sleep.

At 6:45 AM, I gave up on the pretense of trying to rest and got up to use the bathroom. Sploosh went the catheter, and the little swollen bulb fell into the toilet along with a surprisng amount of blood. I expected to feel some relief, but my sore belly kept on contracting every few minutes and an exam revealed that my cervix was dilated to approximately 3 cm. It still wasn’t active labor, said the nurse, but the good news was that I was officially no longer being induced: I was being “augmented!”

Baby!

He's here! Our son, who shall be referred to as O on this blog, has emerged into the outside world and everyone is happy and healthy. Photographic evidence appears below:

Pics or it didn't happen!

I really want to write down the birth story (to quote one of my favorite bloggers, it was not too long and not too awful) but with parents and in-laws arriving today, I think that will have to wait for a bit. Turns out having a newborn keeps you pretty busy, who knew? Anyway, thanks to everyone for your support and well wishes, and I'll write more soon!

How I Learned to Stop Worrying and Love My Induction

So - we're there. Despite a few positive signs that my body is considering going into labor on its own, the time for my induction is almost at hand. Not that long ago I would have fought an induction tooth and nail because I wanted to do everything as naturally as possible, but that has changed, because of one giant reason:

By inducing labor in the hospital, I get to have the same pain relief options as a woman who isn't on heparin - up to and including an epidural.

For the past nine months, I've been worrying about being in agony during labor while doctors and nurses deny me pain relief. I think I would have always been worried about this, but after my experience with my egg retrieval during IVF, it became an obsession. The idea that I might be told (for very good reasons!) "no, we can't give you an epidural right now" was bringing back all of the panic, anxiety, and anger from back in January. There are plenty of things that can still go wrong with an induction, but complications from an ill-timed heparin shot at home won't be one of them. I get to concentrate on meeting my baby instead of worrying about his birth, and that is a gift that has absolutely no price tag.

Catch you on the flip side!

A Month of Sundays?

First of all, I refer you to this website for updates on my current condition: http://haveyouhadthatbabyyet.com

That's correct, I'm still waiting around for something to happen (something amazing, I guess!) In the meantime, I'm "enjoying" maternity leave as much as a person can enjoy being off work while in a constant state of hyper-awareness about one's body and whether it may, at any moment, send one into spasms of pain/release amniotic fluid from between one's legs. I am convinced that if I'm one of the 15% of women whose labor begins with ruptured membranes, it will start while I'm standing in a check-out line someplace, partially because I feel like I'm spending all of my precious free time in check-out lines. They really do move so much slower during the weekdays. It's crazy.

Besides rolling my eyes in check-out lines (all I need are file folders and pens! I'm not setting up an entire home office like the woman ahead of me! Why does she have to order furniture from the only open cashier? There should be a dedicated furniture-ordering desk so people like me don't have to wait for 20 minutes to buy their file folders and pens!), I'm treating this downtime like I would an idle Sunday afternoon. There are chores to be done around the house that I've neglected for months, and they're really satisfying to get done. I've dropped off pictures to be framed, cleaned the bathroom including the molding, and any moment now I'm going to sit down and write the thank-you notes from my baby shower, I swear. Yesterday I even made this and it was very tasty:

The problem is what will happen when I run out of chores and have to decide between starting a new, honest-to-goodness project and catching up on reruns of "ER" and "Designing Women." My next doctor's appointment isn't until Friday, so I won't know for another two days whether all of this hip pain and general physical discomfort has actually resulted any measurable progress towards labor. Over the weekend I swear the baby dropped even further - my bump looks like it's about to enter a "how low can you go?" limbo contest and I really think I have a baby head crammed into my pelvis since my waddle went from decent to comical - but there's been no more bleeding since last week, no identifiable mucus plug, no regularly-spaced contractions, nothing. So we're still waiting, and making pies. I think today's selection will involve pears...

1 Down, 9 More to Go

Centimeters, that is! Whatever happened on Sunday night, it resulted in my cervix being 1 cm dilated and 50% effaced. You know what that means? It means that things are really happening! My body is getting ready to give birth to a baby. Insane.

Now, my doctor was quick to mention that it doesn't mean I'm about to go into labor. There are women who walk around at 3-4 cm dilated for weeks without making any other progress. However - remember back in February when the Maternal-Fetal Medicine doctor first mentioned induction to me? And then in July, when they changed the plan a bit and said that I could probably go to 40 full weeks and then be induced, as opposed to doing it early? Well, my feelings about inducing labor have been mixed from the very beginning. Inductions apparently work best when your body is beginning to go into labor a little bit already (when your cervix is, ew, "ripe"), and have the highest rate of complications when your cervix is still long and closed and the induction process has to start from scratch. My OB had warned me that if we got to 40 weeks and the baby was still just hanging out in my belly with no indication of busting out anytime soon, he might not want to start an induction because the last thing we want is (and this is a direct quote) "a long, hard labor followed by a c-section." Um, yeah, let's not plan for that.

But! As of yesterday, we know that my cervix is already beginning to change and my body is tentatively getting ready to give birth. I wouldn't necessarily want to induce today, but I'm already in a better position for an induction than I could have been at this stage. And I might go into labor on my own anyway, who knows...

When the Time Comes, You'll Know?

As of Sunday night, we have officially entered a new phase of this pregnancy: LaborWatch 2012! What kicked it off? Well, there I was, cooking dinner and watching Lady and the Tramp on ABC Family (which, FYI, if you are a dog owner expecting your first baby, brings on some major guilt). I went to use the bathroom and, for the third time since getting knocked up nine months ago, saw some blood. It wasn't much - not nearly as much as the bleed I had at 9 weeks or the bleed I had at 21 weeks. It was really just some spotting, and for once I didn't immediately panic. It could have been my mucus plug/bloody show, which is entirely normal to see at 37 weeks. Normal, but perhaps an indication that I was about to go into labor? Yikes! Quick, grab the hospital bag!

In the end, despite some frequent Braxton-Hicks that night, everything stayed quiet and I haven't gone into labor yet. At least, I don't think I have. Who really knows? There's active labor, which by all accounts is hard to miss, and then there's early labor, which apparently can go on for quite some time and be practically indistinguishable from false labor. Near as I can tell, nothing has really started yet, although I have started paying more attention to the timing of my Braxton-Hicks contractions. And so we wait. Here's what my waiting looks like, by the numbers:

Amount of times per day I really, genuinely believe that I'm about to go into labor: 3-4
Amount of times I have actually gone into labor: 0
Amount of times I have talked myself into thinking I'm about to go into labor because I just really don't want to do some chore at work or at home: Many

Number of Braxton-Hicks contractions I have each day: 15-20
Amount of times these Braxton-Hicks contractions have had a distinguishable pattern: 0
Number of "real" contractions I have felt: 0? I think? Who knows! Apparently sometimes they feel the same as a Braxton-Hicks!

Number of birth videos I have watched, or re-watched, in the last few weeks: 10, maybe?
Amount of education I now have about the birthing process: High
Level of comfort I continue to have with the idea that I am shortly going to be asked to push an infant out of my personal region: Exceedingly Low

If anyone needs me, I'll be over here obsessively staring at the clock!

I Guess the 37th Week is the Cupcake Week

Oh, memories. This week I started the official paperwork for my maternity leave. I get no cell service at my desk, so I had to step out of the building for a few minutes to call our HR system to kick off the process, and as I sat down on the bench in the patio I realized that it was almost a year to the day to when this whole mess started. Last October, I was calling HR to work out how many consecutive days off I could take after my surgery to remove the endometriomas on my ovaries, and I had forgotten that when you call the first thing you hear is the automated message: "If you are calling regarding a pregnancy claim, press 1. For all other claims, press 2." It was tough to hear that last year, knowing that I might never get pregnant. This year, even with my unborn child doing his best to tap out messages in Morse code from inside my uterus, it was still bittersweet.

What else is new? Well, my hips have started hurting in a way that simply cannot be ignored (and, like Shakira, my hips don't lie.) It's probably that the ligaments are starting to relax in preparation for, gulp, delivery. I've also switched over from once-daily Lovenox injections to twice-daily injections of unfractionated Heparin. They are incredibly uneventful, especially since I've had so many months to refine my technique (don't pinch the skin too hard as you inject!) and the bruises have been kept to a minimum. It is kind of daunting to inject, look at the clock, and think "well, if I go into labor right now, how many hours before I can get an epidural?" Oh! And last week's ultrasound confirmed that the little one is indeed vertex, or head-down, so there's nothing to worry about there. No transverse presentation here.

Also, this happened:

:-)

Posts I Didn't Get Time to Write

As I mentioned in my last post about the non-stress tests, last week was a bit, oh, busy. Scratch that - last week was insane. It was the culmination of a two-year long project at work and I am thrilled to say that everything was finished as of 6 PM on Friday night, but it left very little time for anything else, including sleeping, eating, and blogging. That didn't stop me from composing blog updates in my head, however, so without further ado, here are the things I've wanted to tell you from over the past week:

My uterus isn't the only one who's feeling irritable
The non-stress test last Tuesday morning was only slightly eventful - most of the time I sat there with the elastic bands over my belly (one is a Doppler that measures the baby's heart rate and the other is a pressure sensor) and sipped apple juice or water. The baby performed marvelously by kicking or fidgeting occasionally and his little heart rate would go right up by about 10 beats per minute before settling back down to baseline. My uterus, however, was not as compliant. The monitor showed a series of minor peaks and valleys, kind of like gentle waves on a breezy day out on the water. Apparently, I am having some light contractions about once every minute and I'm not even conscious of them (I did not get a Braxton-Hicks contraction during the test, which would have been interesting to compare since I am definitely aware of those!) However, they don't appear to be making any differences to my cervix, which remains long and closed. The diagnosis: irritable uterus. The treatment plan: none, since it's apparently normal at this stage of pregnancy.

But who else was feeling irritable? Why, that would be me, every time I had to sneeze or cough or blow my nose from the awful cold I came down with last week. Perfect timing, as ever; sleep went from difficult to impossible and I had no way of taking any time off work to try to recover. The weekend was helpful in that regard although I think I'm going to have to give in and take a Mucinex since my lingering cough is a little scary to bystanders.

Breastfeeding Class, or as we called it, Boob-Food Class
Breastfeeding class turned out to be held in the same room where we attended childbirth class, so Harry and I settled right into the same seats and had our pillows ready (seriously, we brought two after the last debacle, and this time we didn't need them at all. Of course.) The instructor went through a Powerpoint presentation that was only slightly preachy, we practiced holding baby dolls in some of the recommended positions, and we watched an amazing video about the rooting reflex and how babies instinctively find the nipple. I do feel more prepared to breastfeed now, and it was worth the $30 registration fee. But.

Why does everything with women's health have to become politicized? Seriously, I want to breastfeed. I will admit that it's not something that I'm particularly looking forward to doing. (Feed a person every 2 hours using my body? On the surface it just sounds less fun than many other activities - it's not like someone is proposing I eat a slice of pie every 2 hours.) But it seems intuitively like the best choice for my child, and I like how natural it is, and many women have no problems with the actual process so why start worrying proactively. What I really don't like about the pro-breastfeeding message is that I feel it overestimates how good it is for the baby, and it underestimates the value of women's time. Sure, the research is there that breastfeeding is better than formula feeding... but only in a very few, highly specific ways, and even those advantages may not be as impressive as first stated when the research came out (such is the difficulty of doing large-scale randomized controlled double-blind studies on infants and nursing mothers.) And it is free to breastfeed, but only if a woman's time is free, and for many women that's just not the case. I feel torn between wanting to validate the importance of motherhood and childcare and breastfeeding, and wanting to stand on the side of the working moms who balance many different obligations and ultimately choose formula as the best overall choice for them and their families.

Your bump looks different
On Friday afternoon, a colleague said in passing that my belly looked different. I glanced down, saw nothing immediately out of the ordinary, and laughed about eating too much pizza for lunch. Later that night, I went into the bathroom at our house and looked in the full-length mirror, and... wait a minute. I turned from one profile to the other and then called for Harry to come up and verify what I was seeing. The baby has definitely dropped - my bump is much lower than it was 24 hours previously. His little foot used to be kicking right under my ribs, and now it's consistently about 2 inches lower; the bulk of his body seems to be a little lower, and I'm peeing even more frequently than before.

Naturally, Harry and I both panicked that I was about to go into labor, so we packed the hospital bag we had been meaning to put together, started a load of laundry, took the dog out, etc. Turns out the baby can drop up to 4 weeks before your due date (and I was at 36w1d when we noticed it) so it was actually a nonevent, but it was a good reminder that we need to get a little serious about this. Part of getting serious was heading back out to our friendly neighborhood maternity store, since I realized I had basically no breastfeeding-friendly clothing besides one bra and a few sundresses that weren't going to cut it as we move from fall into winter. I had also been freezing at work for the past two weeks (cf. the aforementioned sundresses, which were starting to look and feel comically impractical on crisp 50-degree autumn mornings.) I have a new pair of pants, some tights, a few nice pajamas for my hospital stay, and a bunch of tank tops with snaps so I can flash onlookers anytime I want. Remember buying clothes just because they were cute? Yeah, me either.

In conclusion, I'm pretty sure I'm not going to go into labor before my maternity leave starts on Oct. 5th, but we'll see. That's a story for another time!

These Non-Stress Tests are Stressing Me Out!

My appointment with the OB went well, although since I have an ultrasound scheduled for next week (more on that in a moment) she didn't weigh in on the transverse/vertex question. Sorry everybody, we'll just have to keep waiting - what incredible suspense, right!?!

However, she said something that I hadn't been expecting to hear: apparently, since this has been a somewhat eventful pregnancy, she wants me to start having Non-Stress Tests at 36 weeks. Which is, um, next week. Which is also a HUGE week for me at work (the culmination of a two-year-long project) and I had previously made sure to schedule absolutely nothing to conflict with it. Basically, since the beginning of my pregnancy I've been keeping one eye on the calendar to make sure that I would be available to do whatever I needed to at the office in order to meet this deadline on Friday Sept. 21st. The only way I should be missing work next week is in case of a dire emergency or if I go into labor, which of course could totally happen, so it's going to be a nail-biter to the very end.

I mentioned to my OB that I really couldn't come in at that time, especially toward the end of the week, and she was very understanding and suggested that I go right out to the front desk after my appointment to talk with her scheduling staff and find as convenient a time as possible. Except that the staff weren't able to help me at that exact moment - one person was at lunch, one person wasn't picking up her phone, etc. - so I left my phone number with them and they said the scheduler would call me as soon as possible to discuss my predicament.

That is why I was mildly annoyed when the scheduler called me the next day and began rattling off a list of dates and times that I need to come in for these 3-hour long appointments (yes, you read that right, apparently this takes 3 hours. My OB's practice does the NST first, then an ultrasound, then you meet with one of their docs to discuss the findings, so it's basically half of the workday when you factor in travel time. Does every doctor do this, or am I just lucky?) The first test was scheduled for Thursday, Sept. 20, exactly when I most need to be in the office helping complete this project. I don't envy this person her job - scheduling these things day in and day out must get frustrating - but I kind of feel like as the patient, it's not unreasonable for me to expect that my schedule might be included in the mix as well. I mean, if I can't get to the appointment, how will the party actually get started? And in this specific case, I was very clear at the outset that coming in at any point that week would be problematic, so it was particularly irritating that she just assumed I would be free. No, she said, there were no other appointments so this was the only time they could see me. Click.

I went back and forth over this for a while. Am I a selfish mother for putting my work first? Should I be doing everything I can to monitor my baby even though everything appears to be fine? My MFM didn't think NSTs were necessary at this stage, so is this a second opinion kind of situation? How bad is it if I just cancel the appointment and say "sorry, guys, see you at 37 weeks"? What if I keep the appointment on the books for now, and wait until that day to decide whether I can make it after all?

In the end, I sent my doctor an email, her nurse returned my call, I explained my situation, and this very kind nurse and I are now having a date on Tuesday morning where she will personally run my NST. It's not ideal, but it's a lot better than having to cancel 20 minutes before the Thursday appointment, which was a real possibility. All's well that ends well, but it did get me thinking about the many difficult choices faced by working parents, and how I'm about to be a working mom myself. If I had skipped the test and something bad had happened to the baby, I might never have forgiven myself. But if I had skipped work on such an unbelievably crucial day and the test revealed nothing out of the ordinary, I would be mad about that too (plus I'd be facing the wrath of my coworkers.) There's no perfect solution.

Coming soon: Breastfeeding class! Maternity clothes, part 2! Unrealistic expectations for my upcoming leave!

Okay, Now I'm Just Making Stuff Up

Baby boy and I appear to be doing fine. He likes it when I eat sweet things (at least, if one can interpret kicking and flailing limbs as "I like this") and I'm doing fine as well (my ankles aren't even that swollen!) And he's even been vertex - a.k.a. head down, the preferred position for a vaginal birth - for some weeks now. I was so proud of him when they told me that after my last scan, especially since they said he's so big now that he's unlikely to move out of his current A+ configuration. I just knew that my kid was a GENIUS.

Except... on Thursday, he was really really active in there. Huge, sweeping motions that were hard to interpret. And when I went to bed that night, I spent some time lying on my back and poking around trying to figure out what the various lumps of baby that I could feel through my belly might indicate. Is this a head? Is this a bottom? Maybe! Probably! Sure, why not?

Based on this highly unscientific analysis, I am worried that the baby is no longer vertex but actually transverse. Or am I? He still has time to turn, if he really is transverse. And so what if he stays transverse for the rest of the pregnancy? It means I'll have to have a C-section. Big deal. (Yes, yes, I recognize that this would be a very big deal to a woman planning a minimal-intervention vaginal birth; I am more on the side of "there's no good way to get this baby out of me, so let's just see what happens.")

I have an OB appointment coming up this week and an MFM appointment with the fancy ultrasound next week, so we'll have our answer soon. In the meantime, if anyone wants to place any bets, just let me know...

Gobble Gobble, Waddle Waddle

This is a picture of a turkey! Not of me!

No, sadly, this is not a post about my amazing turkey impression. (I wish. I'm secretly super jealous of people who can do a realistic gobble sound.) This is a post about how I can't stop eating, and I have started to waddle when I walk. Fun times.

About three weeks ago, I noticed that I was beginning to walk a bit differently than I usually do. That's not to say that I normally do the model walk with one foot directly in front of the other, my hips swinging my designer dress from side to side (ha!) It's just that my gait is now ever-so-slightly wider than it has been, edging over into a distinctive late-pregnancy waddle. And I still have up to 7 weeks to go, so this should be interesting! If I get round enough, do you think I could start rolling places instead?

Around the same time, I began to notice the return of the pregnancy food cravings. For months I've been smugly telling people that I did have cravings that were tied in with my morning sickness, but after that resolved near the end of the first trimester, I've just been eating normally. NOT ANYMORE. I want huge amounts of food, and I want what I want when I say I want it. There was one memorable day that I was obsessing about brownies and spent hours looking up recipes online before I came home and baked a big pan of them, but in general, I've wanted food with lots of protein and a measurable amount of fat. I dream of roast chicken (with gravy!), meatloaf topped with a ketchup crust, bananas slathered in peanut butter, whole lobsters straight off the grill, etc. I also drink like crazy (water, you guys. Come on now.) I want my protein and I want my ice water and I start to get legitimately irritable if I can't get these things, which makes me even more fun to live with than usual.

But at least I'm getting exercise, right? Um, yeah. I'm going to start back up with my prenatal yoga DVD any day now, I swear. Just as soon as I'm done waddling to the kitchen and back.

The (Fake) Name Game

Now that I'm very visibly pregnant, it's pretty much the first topic of conversation with everyone I meet. Close friends, acquaintances, and perfect strangers all tend to ask variations on the following three questions:

1.) When are you due?
2.) Do you know if it's a boy or a girl?
3.) Have you picked out a name yet?

The first two are easy to answer, but the third has presented me with a few problems. My standard response is "not yet!" and most people end the conversation there, but there have been a couple who try to force the issue. I know, I know, it's one of the biggest things that people talk about regarding babies, and many people are comfortable sharing their name choice ahead of time. We are not. We don't want to invite commentary on our son's name prior to his arrival because we don't want it to appear that we're asking for opinions or approval, and if I can be honest, I think we're also a bit superstitious. Once he's breathing air and not amniotic fluid, then we can announce his name with a ticker-tape parade for all I care.

So, what have we been telling the nosy but well-intentioned people who really want to discuss name possibilities with us? Fake names. Let me demonstrate:

"Do you know what you're going to name the baby?"
"Yes! We're just trying to decide between Pubert and Bort."
:::silence:::

Okay, so not everybody gets the joke. (Although I do find the occasional person who immediately gets the Simpsons reference and mentions Bort license plates!) But it tends to derail the conversation long enough to distract the questioner, and often they start suggesting their own fake names to add to our list.  Besides Pubert and Bort, we have also been experimenting with:

Kenmore
Dyson
Seiko
Agador Spartacus
Darth
Danger (as a middle name)
Spiderman

If anyone has any suggestions for additions to the fake name list, by all means let me know! I'll just be over here singing "The Name Game" to see which one sounds best: Bort Bort bo Bort banana fana fo Fort...

Photographic Proof... Maybe

Dearest readers, I am thrilled to be able to present you with this exclusive new image of our unborn child:

Wait, what's that? You don't see a baby in this picture? It looks like a bunch of random... stuff? Well! Let me help you out a bit:

So, you see, this could be anything! But I'm told it's probably a picture of our unborn child's face. Part of his face. We think. I feel confident that we're looking at one nostril, at least. And it is an ADORABLE nostril.

In other news, everything looked fine on the rest of the scan. Hooray! Onwards!

Linea Nigra and Stretch Marks

Sigh. I knew I was unlikely to be in the minority of women who escape stretch marks in pregnancy, but I had high hopes. After all, I hit 30 weeks without incident, but I knew I was on borrowed time since evidently they often don't show up until the 3rd trimester. And, sure enough, there is some weirdness happening to my bump now that wasn't there a week ago.

It still isn't a traditional stretch mark per se - the long jagged lines that are already all over my womanly curves from past weight gain are what I think of as "classic" stretch marks. This is more of a stretch spot. It's an area about the size of a pencil eraser, red and shiny, approximately a centimeter above my distended belly button. And when I say I'm getting a linea nigra, it too doesn't have the presentation I had expected. It didn't start coming in until the 7th month, and it's slowly getting darker from the bottom up. Honestly, my bump is so big now that I rarely see it, although that makes it kind of startling when I do glance in the mirror.

Between the line, the weirdness of my belly button - which is only partially an outie, and partially a flat area of some funky-looking skin - and this new red patch, I will say that my belly is beginning to truly not look like my belly anymore. Up until now it was still recognizably mine, just bigger, but now the alien takeover is moving into a new phase. The fact that it often moves in unpredictable ways of its own accord doesn't really hurt the general out-of-body feeling it has going for it. (Seriously, what are you doing in there, unborn child? Redecorating?) And I can't wait to reread this post in a few weeks or months and see how much more it has changed!

The Pregnant Lady Olympics

Last night, while watching the Olympic women's gymnastics coverage for the millionth time, Harry said "you know, there should be an Olympics for pregnant women." And I agree! We can compete in areas like:

- Picking something up off the floor
- Standing
- Eating a burrito with no heartburn medication

Of course, I take my hat off to the actual pregnant ladies who have competed in the Olympics, including this totally badass shooter who is currently 8 months along and still made the trip to London. I bet she'll have an amazing scrapbook for her daughter to read one day!

Apropos of Nothing, Here's an Update on my Fingernails

I've been on prenatal vitamins for a long time now. At some point back in 2010 I ran out of my Women's One-a-Day and bought a big bottle of generic prenatals instead. I didn't expect miracles, of course, but based on the movie Juno, I figured my fingernails (and hair, maybe?) would start doing amazing things. No such luck. I don't pay too much attention to my nails, but I can tell you they didn't do anything special.

Except now. I feel like they actually are growing faster than usual - I cut and file them so they're nice and short, and I turn around, and all of a sudden I'm FloJo. I'm having trouble typing since they're dramatically longer than they were a few days ago! Evidently this is not unheard of, but this BabyCenter article seems to imply that basically anything can happen with your nails: some get softer! some get harder! it's nail pandemonium out there!

Ha - like these are my hands! I think the last 

time I got a manicure was for my wedding.

Anyway, not much else to report (you have to figure that if I'm taking the time to talk about my fingernails, nothing particularly interesting is going on, right?) Coming up on 30 weeks this Thursday - go, baby, go!

I Like Glucose and Glucose Likes Me

I passed my glucose screening test! Hurrah! Of course, I studied really hard and took lots of practice tests and had a great tutor. Nah, just kidding. It's sheer dumb luck that I didn't develop gestational diabetes, and I'm surprisingly impressed with my body for not dropping the ball on this one. Good job, pancreas!

In preparing for the one-hour test (called a Glucola test by my lab) I read a lot of people's comments online about their experience. "Oh, the stuff they have you drink is so sweet! I felt nauseous the entire time! I was so bored!" Errr... this was actually a total non-event for me. Regarding the drink, let me ask: have you ever been on an airline? Maybe a budget airline? And you asked for juice but instead were handed a little nondescript cup of vividly colored sugar water? That's all this is. I drank it, I sat around for an hour in the waiting room with my laptop doing work, and then I had a blood draw just like every other blood draw. No big deal.

Now, I didn't do the 3-hour test, which involves fasting, a sweeter drink, and a longer time spent hanging around the lab waiting for consecutive blood draws. I suspect the fasting would make things harder to get through - for the record, I ate an omelette that morning (with cheese!) in an effort to keep things from getting too carbtastic, and it was fine. I mean, I wouldn't start off the day by consuming a 5-pound bag of sugar, but they did tell me that eating beforehand was allowed and it ended up being no problem.

My final number was 108 (130-140 is the cutoff for requiring further testing depending on who you talk to.) So that's one more pregnancy-related hurdle I have successfully jumped, though to be honest, at this point I kind of feel like approaching the tasks ahead the same way this guy does:

Hurdles? What hurdles! BAM!

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!