Monthly Archives: March 2015

“Should I be worried about you?”

The title of this post is a question my husband asked me as we were falling asleep the other day.  I don’t really know how to answer it, because I’m not sure what a normal response is to giving birth to a dead baby 4.5 months into your first pregnancy.  I’ve never met (in person) anyone else who’s been through it.  And I’m sure even if I had, their experience would have differed from mine in important ways.  So how do you know what’s normal, and what’s something to be worried about?

More than six months after her death, I still think about our daughter every day, multiple times a day.  I tear up most days, and sob outright once every week or two.  There are still days when I can’t concentrate on work, and spend hours thinking about her or looking up information about pregnancy loss and various medical conditions on the internet. Pregnancy loss, and our lack of a living baby, is constantly on my brain.

I have trouble dealing with even oblique references to pregnancy — tonight at dinner out with our colloquium speaker, one of my colleagues was ribbing a postdoc about taking advantage of an amazing benefit that my university has for college-age kids of staff.  The postdoc is getting married next fall, so this sort of ribbing is natural, but as the conversation went on and on and ended with “Well, it’ll only take, what, 19 years for your kid to be college age?  And it’ll only take 9 months to get started — what are you waiting for?” and I couldn’t handle it anymore — tears welled up in my eyes and I had to surreptitiously blink them away.  For some people, it does only take nine months.  And for me, after two years, all I’ve got to show for it is one very beautiful but very dead baby.  Earlier this week, I ducked out of a conference organization telecon early because we’d been discussing conference childcare, and the conversation derailed a little while several of the organizing committee members chirped about bringing their babies to the conference.  It was too painful for me to listen to (I’d been planning to bring my baby to the conference this summer), so I just hung up early.  It seems like every few days, something sets me off in a way that is disruptive to my friendships and work relationships.  This is not like me — or at least, it’s not like the person I was before our baby died.  But six months after her death, I’m starting to think that maybe this is just the new me.

These days I find myself wondering when things will get better.  I definitely want to be pregnant again, and I know that would help in some ways (for example, removing my anxiety about whether or not I’ll even be able to get pregnant again), but it would also introduce a whole basketload of other issues — not to mention my uncertainty about whether I could handle another loss.  Holding a living, breathing baby in my arms has been a goal for a long time now, but will things be better then?  Probably, but I imagine that for a while at least I’ll be terrified that the baby will die.  Maybe a few months after the baby is born things will be better?  I just don’t know anymore.  At any rate, “better” sure seems a long way off.

I’ve been worried about my reaction for a while.  A couple months ago, at the suggestion of the MFM specialist, I went so far as to track down a therapist who takes my insurance (I’ve never been to a therapist before).  I went to her for a couple of sessions, but it didn’t seem very useful.  I was very clear about what I wanted to get out of therapy: I wanted help reducing the most disruptive of my grief and anxiety symptoms, including my early-morning awakenings that have been disrupting my sleep, and my inability to concentrate at work.  And I wanted stress reduction techniques to help me manage the stress of dealing with my daughter’s death and trying to get pregnant again.

The therapist did not seem particularly insightful, and some of the suggestions she gave me felt kind of strange.  For example, she told me that I should start holding lots of babies, because maybe my body would just recognize that it felt right and that would help me get pregnant again.  Or maybe I should ask my doctors for things to read about my medical issues instead of seeking things out on the internet — fine, but more reading material is not likely to help me curtail or circumscribe the amount of time I spend reading.  After two sessions, she gave me a little pep talk about how she didn’t think there was anything wrong with me, that I seemed like an intelligent and sensitive person who was responding normally to a really terrible experience, that I wasn’t minimizing or distorting any of what had happened to me, and that she didn’t think I needed to be seen regularly (she did tell me to check in after a month had passed, but I didn’t bother).  At the time, that felt good, because it was nice to have a professional tell me that I wasn’t crazy.  Now, when I’m still having trouble more than six months after my daughter’s death, I’m confused about whether I can or should seek out another opinion.  It was really hard to ask for help the first time, and now that I’ve kindly been turned away I feel like it would be pushy to look for someone else.  And maybe counterproductive.  After all, it’s not as though I want to seek out medical care that I don’t need, and part of me thinks that I should stop looking for opportunities to dwell on my loss and just try to move on with life.  I think I can cope… most of the time I’m more or less OK.  But I do wonder if someone else might be able to help me more than the first woman I went to… and I do feel like I can use all the help I can get.

So, after all that… I’m not sure how I should answer my husband’s question.  Of course, I reassured him that I was doing OK, and that we’d get through this.  Part of the problem is that with so few people to talk about our daughter with, I bring it up a lot more with my husband than I would if I had other outlets, so he hears more about it than he otherwise would.  But how do you know what’s a normal part of the grieving process, and what’s something to be worried about?  When will things start to get better?

Happy 2nd adoptiversary to my best furry friend!

Goldie

Adorable, isn’t she?

Tomorrow is a special day, because it’s the second anniversary of the day we adopted the adorable creature pictured at left.

There’s a lot we don’t know about her past, including her age (when we got her there were two different forms in her file, one of which said that she was 1 and the other that she was 2, so we figure she’s about 3.5 by now).  We also know that we’re at least the third(!) home she had in the first 1-2 years of her life, which is sad and also remarkable, because she’s the sweetest, most low-key dog on the planet.  After a slightly tumultuous settling-in period, she quickly became the ideal pet and we’ve never looked back.

There’s a lot I could say about our dog.  I could talk about how her whole body wriggles when I get home from work every day.  I could talk about how I don’t mind getting up early every morning as long as my furry alarm clock is smiling and licking my face.  I could tell you about how everyone, even the vet, is amazed by her soft coat and asks what we do to keep it so silky (answer: nothing.  I give her a bath when she smells, which is every few months).  I could tell you about how gentle she is with little kids, how her doggie kisses are soft and somehow not the least bit drooly, how she became a celebrity when we still lived near campus (students I’d never met would greet my dog by name).  I could tell you about how she can hear the sound of the cheese grater from half a mile away, and waits politely to lick the peanut butter off my knife when I make toast in the morning.  I could tell you some other things too: how she likes to eat poop, how she’s somehow killed two squirrels on walks with my husband(!), how she ran away once and my husband tracked her down for FOUR HOURS until he found her covered in mud and ticks and happier than she’d ever been in her life.  I could tell you all the commands she recognizes: sit, stay, come, down, off, heel, paw, and zombie (or “beg” in normal dog parlance — I taught her the “zombie” command instead because when she sits up her paws stick out in front of her and she looks like a zombie).

But given the theme of this blog, I thought I’d tell you a couple of other things too.  After our daughter died, one of the only things I found comforting was snuggling with our dog — and she kindly obliged me, over and over again.  When I thought I couldn’t get out of bed in the morning, I did it for her.  When I lost all motivation, she still needed to be walked.  Walking outside with my dog was the only part of my day that I looked forward to for many weeks after my daughter died.  After the appointment when we discovered that there was no heartbeat and they gave me the medication to induce labor, my husband and my dog and I went for a walk in the woods at sunset, and I remember it as stunningly beautiful — the last time the four of us were all together.

I’ve read that after a late loss, a lot of women become afraid that they will die too.  But after our daughter died, I had two strong and persistent fears: that my husband would die, and that my dog would die. On walks I kept her on a short leash to make sure she was out of traffic.  I made sure she didn’t get dehydrated.  I triple-checked that her electric fence was working.  I didn’t want to let her out of my sight.

Our dog is incontrovertibly part of our family now.  My husband was a little skeptical at first, since this is his first pet, and I was the one who really wanted her, but she eventually won him over and now he’s at least as smitten as I am.  Sometimes I look at our goofy little family and laugh.  We’re quite a bunch.  The nerds who were late bloomers and thought they might never get married.  The dog that nobody wanted.  But somehow, together, we’ve made something bigger than the sum of our parts, and we’ve survived something that I could not have survived on my own.

When the time comes, our dog will be a wonderful big canine sister.  Until then, she keeps me from taking life too seriously, and reminds me that family you choose can be just as real as family related by blood.

P.S. Happy belated Pi(e) Day!  Have some photos from our celebration today:

pi1pi2

On to April — and a little bit of juggling of probabilities

Not pregnant again this month.  On to April.

I was pretty sure I wasn’t pregnant yesterday (temps, spotting), so while I’m rather resigned to the arrival of my period today, I got most of the tears out of my system yesterday.

I did also take a proactive step yesterday, though: I called my RE’s office and asked them how long I should be trying on my own before coming back for help.  The nurse I talked to was reasonably helpful, and said that given my history, she thought probably 3-6 months of trying on our own would be plenty.  She suggested I make an appointment in May, which I gladly did.  That’ll be 9 months after the loss of our daughter, and we’ll have gotten in five tries of our own (with help from OPKs and BBT charting) before then.

It’s immensely comforting to have that date on my calendar.  I keep telling myself we haven’t been trying long, and it still might work out, but things just feel different than they did before I became pregnant with our daughter.  The lack of any implantation spotting even though it happened both times we timed things properly before I got pregnant.  Lighter periods, even compared to my already-light pre-pregnancy periods.  The new element of intrauterine adhesions.  These things are scaring me.  It’s nice that most of our pre-pregnancy infertility workup was normal, so there are a lot of things I know I don’t need to worry about (my husband’s fertility, for one — since our workup, the only thing that’s changed for him is that he’s a year older!).  Right now I’m mostly worried about two things that might have changed since before the loss of our daughter: (1) the potential for tubal scarring, and (2) the possibility that my endometrium might be damaged more than they realized by the late postpartum D&C.  Maybe I’m worrying unnecessarily… and maybe I’m not.  Either way, I’d really like to ask my doctor about it.  Having the date on my calendar makes me feel that my efforts will be finite, that help is on the way.

I did a little calculation the other day.  I’ve found several references that give average probability of conception based on how many days before ovulation you have sex, including this paper.  I’ve got my dates of ovulation for the past several cycles pinpointed pretty well by a combination of OPK and BBT monitoring, and I have records of which days we had sex.  So far, we’ve managed to have sex on the highest-probability day (one day before ovulation) for each of three cycles. If you take the average between the two studies listed in the paper linked above, a couple with average fertility would have approximately a 35% chance of getting pregnant each cycle if they have sex on the day before ovulation.  That means that there’s about a 73% chance (that’s 1 – 0.65^3) that we should be pregnant by now, if we have average fertility — or, looking at it the other way, there’s a 27% chance that a couple with average fertility would not be pregnant by now, so we may just be the unlucky 1/4.  That doesn’t seem too improbable.

If we keep timing things properly, though, those probabilities start to drop pretty steeply.  By the time we see our RE after 5 tries, there’ll be only about a 10% chance that we’re consistent with a couple with normal fertility.  If we then go through a month or two of testing, bringing us to 7 well-timed tries, that brings the probability down to 5% that we’re consistent with normal fertility.  Even if you take the lower-probability study as gospel, with a 30% chance of success given sex one day before ovulation, 6 months of trying still gets you to the p < 0.1 level (0.7^6), and it only takes a little more than 8 tries to get to p<0.05 (0.7^8). Of course, there are plenty of reasons to believe that we have less-than-normal fertility anyway, but that’s all the more reason to ask for help sooner rather than later.  May will also be almost exactly two years after I first tossed my birth control pills, so it seems fitting to go back to the RE around then.

Most of the magazine articles you read give a couple a 20% chance of success each cycle, but I think they’re probably assuming that you’re just randomly having sex every 2-3 days, not approaching baby-making with all the precision of an intercontinental ballistic missile.  At that more relaxed rate, a year of trying makes sense, because it’s only after a year that you cross the p<0.05 threshold.  But we are long past the relaxed approach stage.  (It almost killed me this week when I saw a colleague/friend who is 6 months pregnant with her second and she happened to mention that “we weren’t even really trying yet, and I didn’t realize I was pregnant until I was halfway through the first trimester!”  Ugh.)

Anyway, I was worried that my RE’s office would tell me to go away for a year, but thankfully they didn’t.  Having an end to our solo baby-making efforts in sight is providing me some comfort as I deal with the miniature loss of the idea of our Thanksgiving baby.

Some words about hope, despair, and love

blackbringerI have two friends with whom I’ve been reading and sharing books for more than half our lives.  We met in high school, and have stayed friends since then.  Our reading tastes tend towards the much-maligned genre of Young Adult (or YA) fiction, since those are the sorts of books that cemented our friendship a decade and a half ago (and since there are some really wonderful YA writers out there!).  One of the two friends recently had her own YA novel published, and we are so, so proud of her!  It’s been amazing to see her writing develop — sometimes she would share her stories and books with us when we were still teenagers, and just last year I got to hold her first published novel in my hands.  Amazing!

Anyway, the book we are reading for our book club meeting in a couple of weeks is called Blackbringer, by Laini Taylor.  I finished it yesterday and really enjoyed it, which is not a surprise since I also love Taylor’s more popular series, beginning with Daughter of Smoke and Bone.  Although it perhaps seems unlikely in a fantasy novel about faeries and djinni, I came across a beautiful section discussing hope, love, and despair, that I thought was appropriate for this blog:

“Her beautiful face was a portrait of longing, of loneliness and need.  And her eyes were the eyes of one who knows exactly where the border lies between hope and despair and who has stood before it many times and looked across…

“What was it?  She’d called it obstinacy, but even Magpie, who had but a sprout’s understanding of it, could see that it was love, and it shivered her.

“Love.  She’d always thought of love as… affection, the look that passed often between her parents, or the feel of their arms around her.  But wasn’t it this too, the core of iron in someone’s soul that made them capable of impossible things?  It seemed a terrifying force.”

For all those of you out there who teeter on the brink between hope and despair, and for those whose love is the core of iron in their soul that makes them capable of impossible things.

Early Pregnancy Symptoms… or Lack Thereof

Predictably, at 9dpo, I’m driving myself crazy.  You’d think I wouldn’t be.  After all, this is only our second try since I had surgery to remove intrauterine adhesions, or our third perfectly-timed try since the loss of our daughter (we tried once early on, before the MFM suggested we put the brakes on things).  But I’ve been so desperate to be pregnant again, and so distressed by the enforced waiting period, that now that we’re actually trying I’ve got a lot of pent-up excitement about the possibility that this could finally be the month.

This month I’ve been obsessing particularly about implantation bleeding.  In the 11 months after I went off birth control and started paying attention to my cycles, until I got pregnant with our daughter, I experienced it twice: the only two months (at the end) that we used digital OPKs and finally got our timing right despite my wacky cycles.  It was classic implantation bleeding: light, only lasting for a couple of days, starting a week after ovulation.  The first time didn’t result in a detectable pregnancy (I suspect a blighted ovum), but the second resulted in our daughter (who died from a placental abruption 4.5 months into the pregnancy, for anyone who’s new here).

Of course, now that I’ve been pregnant once, I’m driving myself crazy looking for signs that are just like the last time.  Or looking for evidence from other women on the internet that different pregnancies are different. (I have googled “implantation bleeding in one pregnancy but not another” in approximately 50 variations, and I’d love to hear any relevant stories from anyone reading this!)

In the three tries using digital OPKs since the loss of our daughter, there hasn’t been even a hint of implantation bleeding, and it’s freaking me out.  Why did I get it both times I used a digital OPK before I got pregnant, and zero of three times after?  Are there yet-to-be-discovered complications from my first pregnancy that are preventing me from getting pregnant again?  Aside from the intrauterine adhesions, I mean… something else?  Were my tubes scarred along with 10% of my uterus?  Are we just spinning our wheels?

Or is it a good sign that I’m not experiencing implantation bleeding this time?  Neither of the cycles with implantation bleeding resulted in a live baby, so maybe it’s good that things are different now?  (Assuming I ever do get pregnant again, I suspect this will be a recurring theme for at least the first 4.5 months of that pregnancy… I can’t trust any of the experiences I had the first time around, since they all ended in disaster, but anything new is also suspicious because it’s new!)  There’s plenty of anecdotal evidence on the internet that women who’ve experienced implantation bleeding in one pregnancy sometimes don’t experience it in subsequent pregnancies, so maybe it’s no big deal.  Or maybe it is.

This endless back-and-forth is what’s been going through my mind for the past several days.  With both pre-pregnancy cycles I experienced implantation bleeding at 6dpo, so if it were going to happen it should have happened by now.  So it’s likely that I’m not pregnant this month.  Unless I am.

I talked with my mom (who also happens to be a women’s health nurse practitioner), and she reassured me that implantation bleeding is not common, doesn’t always happen in different pregnancies for the same woman, and is not a reliable indicator of pregnancy.  She also reassured me that we probably don’t need to wait for a full year before going back to the RE, since we’ve got so many other complicating factors (diagnosed oligoovulation, intrauterine adhesions, and FVL) — she said that if I were her patient she’d send me back after six months.  That was the most reassuring of all, honestly.  I do feel like I can make it through three more months of trying without driving myself totally batty, but I would feel better if our attempts were overseen by our RE so we don’t waste too much time unnecessarily.  I know some people reading this have been through way more than I have, but I do feel that we’ve been through quite enough to ask for some help.  I’ve hit enough super-low-probability problems at different stages of this process that I don’t trust my body at all anymore.

So I’m waiting, and trying not to obsess about every early pregnancy symptom (was that a cramp I just felt?) or lack thereof (where is my implantation bleeding?!).  It helps that I’m on a work trip this week to the Pacific Northwest, where it is beautiful and springlike with tree blossoms and sunshine everywhere.  I’m too busy to obsess too much, too jetlagged for charting to be useful, and I didn’t bring any pregnancy tests in my suitcase.  Take that, obsessive brain!  I get back late Wednesday night, so if my period doesn’t arrive by Thursday you can bet I’ll be pulling out the tests Friday morning, but that’s about the worst I can do.  We shall see.  For now, I’m enjoying the sunshine and lack of snow!

One Small Step Towards Tenure

phd072011s

That’s me in the middle.

Today I went through my second-year review, which is the first step on the path to tenure.  (I’m actually half a semester into my third year, but details…)

I’d been stressed out about it, because it was supposed to happen last semester and didn’t, and I’d been bugging my department chair at progressively shorter intervals because as time went on I started to fear that something was going terribly, terribly wrong.  He kept reassuring me that it wasn’t, and that everything was fine and he was just busy, but as my colleague / carpool buddy quipped, “Great, but can I have that in writing?”

Well, after two failed attempts at scheduling my review, it finally happened today.  And as my department chair had told me, there was nothing to worry about.  He had nothing but positive things to say, including the interesting statistic that apparently I have the highest teaching evaluations in the department (I had no idea!).  Really the only constructive criticism I got was that I could lighten up on my students a little, since they all rate my classes as “strenuous” even though they also rate my teaching as “outstanding.”  That, I can do. 🙂

It was really nice to hear from my department chair how well things are going from their perspective, and how much they appreciate having me in the department.  My brain had been coming up with all sorts of possible criticisms they might make, but they didn’t make any of them (and when I asked about some of them at various points during the review, he reassured me that they were not important or even relevant).  I still have worries about the tenure process (that’s my personality, and it would probably be a bad thing if I didn’t), but now I’m much more able to put them in perspective.  It helps to have a nice official glowing letter, written by my department chair and signed off by the administration.

The loss of our daughter came up once, obliquely, during our conversation.  The three pillars of tenure are research, teaching, and service.  I was a little bit worried about the service category, since I haven’t yet served on any major university committees — I was elected to one last year, but after I requested parental leave for this semester they decided to remove me from the committee… but only a few weeks later, our daughter died and the point became moot.  I could probably have asked to be reinstated, but I didn’t (I had other things on my mind…).  I was worried that it might look bad for me to have been elected and then not to serve, but he reassured me that it wasn’t a problem (a bit too emphatically — obviously he knows the reason, but I know not everyone looking at my case will).

I was also worried about it in a different way that I didn’t bring up during the review, namely the gap in my CV that I can see even if nobody else can.  I not only turned down three invited talks, but I avoided those conferences entirely, just because I couldn’t bear the thought of the conversation that might result if I put in a contributed abstract after I’d turned down an invited talk because I was supposed to be on parental leave.  So I missed out on some serious professional visibility.  I also did approximately no research last semester, while I was picking up the pieces of my life and dealing with the medical fallout (tests, treatments, surgeries), which will show up in a couple of delayed publications and some proposals I didn’t find the time to write.  And I completely flaked out on a couple of professional service activities I’d agreed to do — also not good for my professional reputation.  The impact is real, if most likely insignificant in the long run.  My chair reassured me (in a general way) that I am exceeding the departmental expectations in the research category, so hopefully it won’t be an issue in the end (because wouldn’t that be an awkward annotation to my tenure package…).

But it made me think about how many people probably have similar issues that aren’t accommodated in academia: a prolonged or serious health issue, for themselves or a spouse or parent, a divorce, a death of a sibling or parent… we’ve all got issues.  I guess it mostly evens out in the end.  But it would be nice if there were some official way to annotate significant gaps in a CV that happen for some reason other than a parental leave to care for a living baby.

Anyway, I’m very happy that my review went so well, and relieved that it’s finally over, and that I finally have in writing what my department chair has been casually alluding to every time I’ve mustered up the nerve to badger him about my review.  It was also nice just to have a formal opportunity to ask questions about the tenure process that have been nagging at the back of my mind for a long time — everything from “Does it matter if my PhD advisor is a minor coauthor on most of my papers?” (we’re in a very small and team-oriented field so it’s hard to avoid him even if I wanted to; the answer was no, as long as there’s evidence that I’m responsible for driving my own science and being recognized as a scholar in my own right) to “Are there other materials I should be assembling for my reappointment review [now only five months away], and can you please go over that process with me?”  I left it feeling pretty good about how things are going, and a little more relaxed about some of the things that had been stressing me out.  All in all, a win.

And then I left work a little early for my second volunteer shift at the barn, my first as a horse leader instead of a sidewalker.  Tacking up a horse for the first time in over a decade, leading her around the arena, giving high fives to her grinning rider, and coming home dirty and covered in horse smell was a great way to end a beautiful spring break day.

I hope spring has sprung where you are!

Due Date Detective

Calendar_0Quick poll: How many of you already know what your due date would be if you got pregnant this month?  Basically, I want to know how crazy I am along this particular dimension.

Today I thought about it, told myself I wasn’t going to do it, and then did it anyway — I checked my hypothetical due date.  Thanksgiving!  How poetic!  Last month was Halloween.  I’ll probably be gunning for a Christmas baby next month.

When you’re keeping close track of ovulation anyway, and you always know exactly how many DPO you are (5 for me today, in case you’re not keeping track), it’s hard not to be curious.

Thanksgiving would be very sweet, although again not so awesome with the whole academic calendar thing (not that I care!).  Our daughter was due on my birthday, and I’ve written before about how excited my husband and I were about that due date — since his birthday is not quite two weeks after mine, we were going to be a February family.  My grandmother’s birthday was the day before mine, and I always loved that bond that we shared.

A couple of weeks ago, one of my coworkers (who has three kids under the age of 7) was in my office chatting and somehow the subject of his kids’ birthdays came up.  He mentioned that when his daughter was due close to his birthday, he suddenly felt very protective of his birthday, like he didn’t want to share it with her.  I don’t think he remembered that my daughter was due on my birthday, but it made me feel sad, and not a little bit jealous, to think about how I felt about my daughter’s due date compared to how he’d felt about his: I would have been thrilled to share a birthday with my daughter (not that the odds were high — I know the chances are tiny of giving birth exactly on your due date).  I would gladly have yielded all birthday celebrations to my little girl.  But as with all of these thoughts that pass through my mind, I didn’t feel like I could say anything.  There was an awkward pause, and the conversation moved on.

So now every month, even though I know it’s silly, I check, and I daydream a little.  Maybe we’ll have a living baby to be overwhelmingly thankful for this Thanksgiving.  Maybe I’ll be huge and uncomfortable and my husband will have to be the one helping my mom with the cooking the way I usually do.  Maybe someone else will have to make the hard sauce this year.

Or maybe we’ll still be trying.  That would be around the time we’d hit our 1-year, back-to-the-RE date: officially secondary infertility.  Let’s hope it doesn’t come to that.  For now, I prefer to daydream about our Thanksgiving baby.