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!