Monthly Archives: July 2015

When to reveal a pregnancy after loss

First, I should say that I’m so grateful that I even get to consider this question. 🙂 We went in for another quick heartbeat check this morning at 11w1d and everything was still looking great.  So now we’re starting to seriously consider when and how and to whom we will start spreading the news.

We’re naturally “staggered revealers” anyway.  Both times, we’ve let some people know right away (I called my mom the same day we got the positive pregnancy test, and my husband let his parents know also within a day or two).  Both times, we’ve let a few close friends in on the news early in the first trimester.  So it’s not as though nobody knows — at this stage, my mom, my cousin, and my husband’s parents and sister know, plus a very small handful of our close friends (including H who is the only person I know in real life with whom I’ve shared this blog.  Hi, H! ❤ ).

One of the odd silver linings about having a very public loss at 4.5 months is that we now know who is supportive and helpful during a loss and who is not (there were surprises in both directions).  That made it even easier this time to spill the beans to our loved ones who had been super-supportive through our previous infertility and loss, because we knew they’d be supportive if it happened again — and golly, would we ever need their support.  But that’s not the hard part.

The hard part is the rest of the world.  Here are some of the categories I’ve found tricky:

Acquaintances that I see on a regular basis — Mostly this category is made up of people I work with.  This is the trickiest category, partly because I’m showing much, much earlier than last time around.  I hate to make everyone pretend that my increasingly obvious belly is not there.  I’m quite certain at this point that it’s not just my imagination — I caught my department administrator doing a double-take when I walked past her the other day.  It was really obvious, but she didn’t say anything.  I do want to wait until after our nuchal translucency ultrasound on Thursday, but then I think I’ll have to start telling people in my department, before it gets absurd.  For the rest of campus… there are a few others that I’ll be itching to tell at the end of the first trimester because they were unusually supportive after our loss (one of my fellow faculty in another department was the only person who wrote to acknowledge me on Mother’s Day this year), but I think otherwise I’ll just let the news slowly percolate out naturally.  I’m a little worried that everyone else will be too much on eggshells to ever bring up the topic, but I’m sure something will work out.  If random acquaintances don’t want to talk to me about my pregnancy at all, that’s just fine — I’m enough of a basket case as it is!

Family and good friends who are far away — As an academic and a recovering academic who moved cross-country 2.5 years ago, we have a lot of these.  For friends and family who were sympathetic but not unusually supportive with our first loss, it’s hard to know when to tell them.  There’s no particular urgency, but we want to balance their feelings of being kept in the loop and part of our lives with our desire not to have to deal with a lot of burdensome communication if something else goes awry.  We also want to avoid accidentally having these people find out via some impersonal means like Facebook that I’m pregnant again.  We’ve basically decided that we’ll tell any friends we see in person from here on out (including the 8 adults and two children descending on us for an awesome weekend of fun with my close college / grad school friends starting today).  For the rest of this category… I think we’ll wait until after our the point of our first loss, which will be in late September of this year, and then start emailing/calling.  Since our friends and family know our history, I think they’ll understand if we share a bit later this time around.

Friends who didn’t know about our first loss — This one actually has two subcategories: (1) People whom become friends with since our daughter’s death 11 months ago, and (2) Facebook friends who have been important parts of my life at one time or another but with whom I am no longer particularly close.  The thing is, at some point both these categories of people will presumably find out that I have a baby (preferably a live one this time!).  And honestly… I feel weird about them finding out that news without knowing the context of this pregnancy.  There are a couple of reasons for that: (1) It feels like dishonoring our daughter to announce her sibling’s (impending) arrival without acknowledging her existence.  And (2) I know exactly how painful the apparently effortless, out-of-the-blue Facebook pregnancy/baby announcements can be when you’re going through infertility and loss, and I don’t want to whitewash our experience by only posting the happy side without at least acknowledging the rest of it — and potentially providing some relief or hope to the acquaintance who is going through infertility or loss and hasn’t told us.  We never posted about our first pregnancy on Facebook, which wound up being a relief after we lost our daughter.  But eventually we will talk about the pregnancy or our baby on Facebook, and I want it to be honest. Figuring out how to do that is tricky.

Students — The first time around, I told my research group at the end of the first trimester, notified my advisees at the beginning of the fall semester that they would need to identify a new advisor before I went on leave in the spring, and mentioned it to some other students when it came up at a department social event.  At 4.5 months I was showing while I lectured, but I never brought it up in class, and when our baby died just a few weeks into the semester, I was too freaked out and confused to have a calm and reasonable conversation with the students about it, so I just never talked about my loss with them (even though some of them were lovely and left cards and flowers outside my office).  I would probably do things differently now, but I’m also a different person now than I was then.  I still think that some of the students in the class had no idea what was going on, and I wanted to disrupt their educational experience as little as possible, so I don’t regret keeping it out of the classroom. This time around… I will wait to tell my research group until they’re back from summer vacation, and I won’t mention it to my big class of freshmen/sophomores at least until we’re past the halfway point in the pregnancy.  The only reason I think it’s something I should officially address in class at some point is to reassure them that my due date isn’t until February and that it’s very unlikely that my pregnancy will affect their experience in the class.  That’s all they need to know about it, as far as I’m concerned, but I do want to make sure that they don’t worry as they start to notice my belly expanding.  There are various other students who will need to know at some point, but the awesome thing is that I was scheduled to be on sabbatical in the spring anyway, so I can continue to use that as an excuse to turn down responsibilities for basically as long as I want!  (Sorry, you’ll have to find a backup advisor for the spring, since I’ll be on sabbatical!)

So that’s our plan.  There are still a few details to work out, and it feels like a big logistical puzzle, but I’m making progress and (mostly) looking forward to being able to let people know about our good news.  I’ve already had a couple of awkward conversations about this pregnancy, and I’ll be interested and amused to hear what comes out of people’s mouths when I tell them this time around (particularly the ones who said clueless things after our loss), but I’m really looking forward to being entertained by these stories rather than shattered by them.  I feel so much stronger now, after everything we’ve been through, that I feel ready to deal with whatever awkward conversations come my way — after all, if this experience has taught me anything, it’s that other people are *way* more freaked out about talking about pregnancy loss and infertility than anyone who’s been through it themselves.  If anything, I’m worried about making other people feel awkward because I’m *too* open about my pregnancy after loss feelings!  We just told our first local friend, a math professor at my university who has been great and supportive through our loss.  He was asking about whether I’ll get more monitoring this time around, and I was telling him about our pregnancy being high risk and what that meant, and then ended with, “But really, I’m just so happy that I’m pregnant again and that the baby isn’t dead yet.”  Which was true, and exactly what I was feeling, but I could tell that it shocked him a little — oops. 🙂 I’ve gotten so used to being able to say whatever’s actually on my mind when I talk to my husband and my mom (because they get it) that I’ve forgotten that it’s really not appropriate to be that straightforward with people who haven’t been through it all with me.  Guess I’ll have to up my brain-mouth filter for the next several months!

We have a fetus!

It’s a cute little blob, right?

We have officially entered the fetal period. Yay for developmental milestones!  Last week we had our last ultrasound with the RE, and saw our baby dancing around for the first time (my husband and I spent a while trying to dance like our baby — he claims that our baby appears to have inherited my dancing ability, which I do not think is a compliment!).  Yesterday we were at our local OB for a quick check-in and we heard the heartbeat on a Doppler for the first time at 10w1d.  It’s nice to know that now we can go for a quick Doppler check up whenever we’re freaked out (OK, whenever I’m freaked out, since I’m about ten times more likely to be freaked out about the baby dying at any given moment than my husband).

Rationally, I know that entering the fetal period is a big deal and a really good thing. There’s this study that says that for low-risk women, hearing a heartbeat at nine weeks means a 0.5% chance of loss for the rest of the pregnancy (I’m not low-risk, but it’s still reassuring that our odds of miscarriage due to chromosomal abnormalities are low at this point).  I also like to look at this page in early pregnancy, which combines data from two studies to interpolate a sort of day-by-day loss risk for women in their first pregnancy (again, not me), which levels out to a constant, low baseline around weeks 9-10.  All of these numbers seem to be reflecting the reality that successfully making the transition from the embryonic to the fetal stage is a major developmental milestone that sharply decreases your risk of miscarriage due to chromosomal abnormalities.  So, yay!

That doesn’t mean I haven’t found things to worry about, of course. 🙂 At our appointment with the RE (8w6d), our baby’s heart rate measured 185bpm.  When I asked the RE if that was good, she said, a bit distractedly, “We like to see it under 190.”  This, of course, freaked me out because I’d never heard that a heart rate could be too high before, so naturally instead of thinking to ask the expert in the moment my anxiety built until I went on a great Google spree that evening.  Turns out there are generally two reasons why you might be concerned if your baby’s heart rate is too high: (1) it could indicate that the baby is experiencing distress of some sort (usually later in pregnancy), and (2) abnormally high fetal heart rates in the first trimester are correlated (though obviously not perfectly) with chromosomal abnormalities like Down syndrome.  I found a bunch of charts showing the typical fetal heart rate ranges and how they change over time (the fetal heart rate generally declines from about week 8-9 until the end of the trimester), but they all started at 10 weeks (or a crown-rump length longer than our 8w6d measurement) so I had to extrapolate backwards from some pretty noisy data.  It did indeed look as though 185 was on the high side of normal — somewhere close to the 95th percentile (using my extrapolated estimate).  So I spent a week freaked out about chromosomal abnormalities, despite the fact that I was using fetal heart rate charts to evaluate the heart rate of an embryo.

Yesterday at 10w1d the doctor measured the heart rate at around 170 — when I went to put that measurement on the chart (no extrapolating this time!), it was right around the 50th percentile.  Phew!  (Yes, I realize I’m obsessing unnecessarily.)  This doesn’t mean that I’m totally over my fear of chromosomal abnormalities, but I sent off my NIPT kit yesterday and should get the results back sometime around the date of our nuchal translucency screening a week from Thursday, so hopefully I’ll get some reassuring news in the next two weeks.  It also helps that my mom mentioned when she dropped off the kit that they haven’t yet had any patients from her office come back with a positive NIPT result yet.  Of course, I can’t help but think that it’s only a matter of time so maybe I’ll be the first!  (<– That is some useless, illogical thinking right there.)

Whatever the results, we’ll also know the sex of our baby when the NIPT results come back.  I’ve read enough about pregnancy after loss to know that many loss moms have complicated feelings about finding out the sex of a new baby after a loss — some are really, really hoping for the opposite sex, so that they can get a clean start and feel less like they’re “replacing” the baby that died, while others are really, really hoping for the same sex, so that they can fulfill the dreams of mothering a little boy or girl that they had with their previous baby.  Of course, my husband and I just want a healthy baby, and we will be thrilled with whatever the coin toss turns out to be.  But if I’m being honest (and we’ve talked about it, so I know my husband feels the same way)… we both wanted a girl, and were so excited when we found out our first baby was a girl.  Maybe it’s because I was the only daughter of a single mom, but I really want that special mother-daughter bond, and I also seem to find girls easier to relate to than boys in general.  I’m sure that would change if I had a son, and I know I’d love him to bits with all of my being.  As I told my husband, there are some pretty great guys in the world, after all, and if our son is anything like my husband, I’m sure he’ll be one of them. 🙂 I do feel bad even admitting that I have a preference, but I have to be honest — having that dream of a daughter to raise snatched away so abruptly in our first pregnancy was really hard, and it’s making me nervous about finding out the sex this time.  Mostly because I’m afraid of my own reaction.

To end on a (somewhat) lighter note, one curiosity I had going into this pregnancy was whether I’d start “showing” at the same time or earlier than in my first pregnancy.  There’s lots of information out there about when you start showing in a first pregnancy compared to a second, and everyone says it’s several weeks to a month earlier in your second pregnancy… but what if your first pregnancy was only half-baked?  I’d just about made it to the halfway point when our daughter died, so my uterus only got stretched out partway.  It’s hard to say for sure, since this pregnancy has been different than the last (I’ve been on progesterone, for one thing, which increases bloat), but I do think I’m starting to show sooner than I did last time.  At some point this week, I decided that I’m about two weeks ahead of how big I was in my first pregnancy, based on how I look in the bathroom mirror before I take a shower and how my clothes are fitting.  I’ve hardly gained any weight this time around — 1-2 pounds at most, compared to probably 3 or 4 by this point in my first pregnancy — but still I can definitively see my belly starting to poke out as things get crowded in there (the internet tells me that my baby is the size of a kumquat this week, and my uterus is the size of a grapefruit — why is it that everything about pregnancy must be compared to edibles?!).

So, the short version is that things are going really well so far, and we’re very excited to have made it to the fetal stage.  We’re really just waiting for the flurry of activity at 12 weeks, when we’ll find out our chances of chromosomal abnormalities, and in the meantime trying to enjoy our little dancing bean!

The Little Things

Last night, my husband touched my belly for the first time in this pregnancy.

Well, I’m sure he’s done it before by accident, but this was the first time he reached down and rubbed it, with clear intention and thought about our baby.  Before it happened, I hadn’t noticed that he wasn’t doing it.  But as soon as he did, all the memories of our first pregnancy came flooding back — last year, he started touching my belly early on, almost from the point of our first positive pregnancy test, thinking about our baby.  This time, it took until 9w4d for him to get to that point.

He touched my belly again as I was leaving for work this morning.  It made me so happy, and simultaneously so sad that I almost burst into tears.

We’re both having trouble believing in this pregnancy — and our parents are on eggshells as well, especially his.  Since everything is happening within a week of when it happened last year, it’s particularly poignant.  Some things are the same, and some are different, and the differences are highlighted by the samenesses.

In our first pregnancy, starting within a week or so of our first pregnancy test, we incorporated our baby into our bedtime ritual.  We have a silly thing we do as we’re falling asleep: my husband will say “good night” to our dog, and I’ll answer back in her “voice” (we talk for our dog pretty often actually — probably our friends think we’re weird, but our dog is hilarious, let me tell you!).  With our first pregnancy, long before we knew that our daughter was a girl, he’d also say good night to our baby, and I’d answer back “good night, daddy!” for her.  In this pregnancy… we just didn’t.  Maybe a week ago, we started doing it again.  Every time we do it, it makes me happy, and I also hope that this baby survives so we don’t have to go back to that empty silence before we fall asleep.

My husband’s parents made the several-day drive to visit us for a week, as they do every summer, and just left for home yesterday.  Last year they visited in August, so I was just beginning the second trimester.  His mom had brought a bunch of old baby stuff she’d been saving, plus a new blanket she crocheted for our baby.  She cooed over ultrasound pictures, and we talked about our ideas for names.  This year they hardly talked about the baby, and when they did, it was very cautiously.  I got dizzy while kneading some bread on a hot morning (occasional lightheadedness/weakness has been normal for me in both pregnancies), and his mom was solicitous then, but there was none of the hopeful and cheerful banter of the summer before.  When we came back from a prenatal visit Wednesday morning with new ultrasound pictures they hardly looked at them.  I understand that they’re hurting too, and that they want to protect our feelings and especially their son’s… but I wish we could all celebrate this pregnancy for as long as it lasts.  I miss our daughter so much, and I’m so afraid for this pregnancy… but I also know that withholding love and excitement isn’t going to make it any easier if it ends without a living baby again.

I love that my husband is starting to incorporate this baby into our lives.  It also highlights the anxiety I already have, because I don’t want him (and us) to have to go through another painful loss.  I’m counting down the hours until our next appointment with our local OB on Friday — just a check-in to make sure there’s still a heartbeat.

I will also say that as I look forward I do feel like maybe I can see a light at the end of the tunnel.  Don’t get me wrong — there’s plenty that I’m anxious about, and I could certainly enumerate my anxieties right up through the end of this pregnancy!  (I started to do it, and then realized that I really don’t need to drag myself or you through that again!)  But within the next six weeks or so we’ll hit some major milestones: the end of the first trimester, and along with it our first trimester screening results for chromosomal abnormalities, plus our first routine anatomy scan at 16 weeks (they’re doing it early because of my history, so I’ll probably need a repeat for the heart study at 18 or 20 weeks).  Those are some of the biggest anxiety-producers for me right now, but the good news is that they’re all coming up, so I won’t have to wait too much longer to get through them.

And with all of this going on, with the little things that remind me of my first pregnancy, with the things that are different this time, I try to keep reminding myself that for now I am pregnant, and that’s a very good thing.  For now, we have no specific cause for alarm.  For now, I am trying to trust my body to keep our baby healthy, and I’m trying to enjoy and start to bond with this new little life.  For now, I’m going to enjoy it every time my husband rubs my belly, and every time we dare to dream about this little life growing inside me.

Overcoming Self-Injection Anxiety (and other Pregnancy After Loss anxieties too)

I wanted to write with an update on my continuing issues with self-injection anxiety.  I can report that after a round dozen self-injections, it does in fact seem to be getting somewhat easier, but there was really a hump I had to get over, and some specific actions that helped me get over it.  In case there’s anyone just starting the self-injection saga and dealing with similar anxiety, I figured it might help if I write down the stages I’ve been through, and how I’ve worked to move past them (and if you don’t care about self-injection anxiety, skip to the last two paragraphs where I briefly recap my other ongoing pregnancy-related anxieties!):

  • Stage 1: Hey, needles have never bothered me, and this is something new and interesting!  I swear, I got through the first couple of injections on pure adrenaline.  I was shaky and weak both during and after, but kind of on a high, and proud of myself for getting the job done.  And it was a novelty.  The fact that I’d have to overcome that mental barrier every day for the next 9-10 months didn’t quite hit me until…
  • Stage 2: Wait, I have to do this to myself every day?  Cue mental freak-out.  I worked myself into a cold sweat every morning trying to do the injection.  I blamed myself for being a wimp.  I blamed my husband (how come he doesn’t have to deal with this?!  He could at least help give me the injections!).  I cried tears of anger and frustration.  I tried to bully myself into doing it.  I spent 10-20 minutes per day sitting in my bathroom staring at the needle poised above my belly, freaking out about all the time I was wasting being stupid. I convinced myself that there was just no way I could do this for the rest of my pregnancy.
  • Stage 3: This is a legit problem that I’m going to have to deal with.  I read lots of stuff on the internet.  I read this Cognitive-Behavioral manual for dealing with self-injection anxiety from cover to cover and laughed as I recognized my own irrational and self-defeating thoughts sprinkled throughout.  I started trying to work some of their suggestions into my morning routine (more on that below).
  • Stage 4: This is easy!  Ha, just kidding.  I haven’t gotten there yet, and might not ever.  But it’s definitely getting easier, and having piled up a bunch of successful self-injections is making me more confident that I can keep doing this for the foreseeable future.  Having strategies for dealing with my anxiety makes me feel more in control of the situation and less trapped.  It’s still hard, but I think I’m past the worst of the freak-out.

Here is a list of things I’ve done that have helped me get through my morning injections, mostly adapted from the manual I mentioned above:

  • Reframing negative (and untrue!) self-talk.  Instead of “I’ll never be able to do this for nine months!” I started telling myself “I’ve already done this 11 times, therefore I’m very confident that I can do this 12 times.”  (Tomorrow will be a baker’s dozen!)  Instead of “Why can’t I make myself do this?  I’m wasting so much time!” I started telling myself, “I will stay calm and give myself as much time as I need to do this because it’s important to keep me and my baby healthy.” (Perhaps unsurprisingly, this has actually made the whole process go faster!  I was down to only about 5 minutes of needle-staring today!)
  • I now consciously relax my thigh muscles and take deep breaths from my diaphragm to fight the automatic panic responses that were setting in every time I got out the needle. This has definitely reduced my tendency to sweat.  My hand still shakes a little, but hey, one thing at a time.  We’re moving in the right direction, at least.
  • I decided that I would continue to give myself the injections and not ask my husband to do it (even thought he offered), for a few reasons: (1) The manual discusses how short lapses can lead to longer-term relapses, where someone who could previously self-inject misses a few days or gets someone else to do it for a while and then finds it harder to re-start.  (2) I want the independence of being able to do my own injections, and not being dependent on my husband’s schedule or having to re-start with the whole anxiety process when I travel for work.  (3) Lovenox burns going in, and afterwards too — it’s like a bee sting, maybe worse.  It helps if I go really, really slowly on the plunger, even stopping sometimes, and I’m sure I couldn’t instruct my husband on the right speed.  That lack of control is just setting the situation up for failure.  Having made the decision to continue to do all the injections myself feels good, and puts the kibosh on my negative mental talk about my husband (thank goodness!).
  • I started doing the intermediate step of touching the needle to my (alcohol-cleansed) skin before plunging it in.  I can’t really articulate why this helps, but it was on the list of steps to work towards in self-injection in the CBT manual, and for some reason it helps me.  The slight poke reminds me what a needle prick feels like — unpleasant, but nothing I can’t handle.  I think my brain usually blows the sensation of a needle prick way out of proportion right before I plunge in the needle, and this helps me get past that irrational panic.  I also read about how it actually doesn’t matter whether you put the needle in fast or slow, and I’m finding that on some days it’s actually a little easier for me to do it slowly. I used to freak out that I was being unhygenic if I touched my skin or put the needle in partway before I put it in all the way, but now I don’t worry about it as much since I read that it’s OK.  Knowledge is power, man.

I think those are the biggies!  As I mentioned above, I’m definitely not to the point where this is a ho-hum part of my morning routine.  This morning, even though I managed to get through the injection in record time, I had my first episode of what is probably a vasovagal response that made me worried I might faint for a moment (I felt dizzy and weak and had ringing in my ears and my vision started to fade a little).  I’m a little worried that that might continue. Unfortunately it seems to be a side effect of my new-found ability to push the needle in slowly instead of quickly, and the fact that I’ve found that keeping the needle in for 10 seconds after I finish injecting seems to help minimize bruising (another tip from the internet — thanks, internet!).  So we’ll see — I suspect there may be some tradeoffs involved here (e.g., deciding that bruising is better than fainting), and I’m not out of the woods yet, but I do feel that things are getting better.

Oh, and in case you’re wondering, this is far from my only source of anxiety in this pregnancy — it just happens to be the one I have found the most control over. 🙂 After seeing our baby’s heartbeat for the second time last Monday, I’ve been anxious the last couple of days that it’s stopped since then.  I was worried because I’d managed to convince myself that my pregnancy symptoms had decreased.  It’s frustrating, because I also remember from my first pregnancy that they do tend to come and go, so rationally I know that the odds are that everything’s fine, but I just can’t convince myself to calm down.  Yesterday I was sure my breasts had stopped being sore, although when I put my laptop on my lap as I started writing this post, I noticed pain when the pillow brushed over them.  Guess they’re still sore!  I also felt less nauseated yesterday and today, although when I think about it I realize that being home over the weekend means that it’s easier for me to graze on little snacks whenever I start to feel queasy, and usually I feel my most nauseated right before a meal after not eating for a while, which mostly happens at work (like on Friday, when I thought I was going to vomit walking to our weekly pizza lunch for the summer students).  Anyway, you get the idea — these are the sorts of thoughts that are constantly going through my head.  Oh, and want another piece of evidence of my constant anxiety about this pregnancy?  On Thursday I had calf pain when I got up to walk my dog in the morning.  I had noticed pain in the same place for the previous ~week or so, but it was worse on Thursday.  Since I had inadvertently been giving myself slightly less than the full prophylactic dose of Lovenox, I was worried that I might have a blood clot.  So I called my doctor, who sent me in for a deep vein ultrasound just to be cautious, and everything was fine, other than the fact that I was embarrassed.

Guys, I’m only 8.5 weeks pregnant.  I’m not sure I can stand this level of anxiety for a whole pregnancy!  But hey, 9 months of anxiety is certainly better than the alternative… I’ll take it!  So, I’m doing my best to calm the heck down while we wait for our last appointment with the RE on Wednesday.  I’m sure I’ll feel better when I see that flickering heartbeat again… for all of five minutes. 🙂

Persistent Needle Anxiety?

I’m getting a little jittery just looking at it…

Here I come, asking our savvy blog community for advice again…

I know a lot of you have a lot of experience giving yourself injections.  How long did it take you to get used to sticking yourself with needles?

I’ve been giving myself Lovenox injections for 8 days now, and… I’m not sure it’s getting easier.  I’ll still sit there with my skin pinched for 10 or even 15 minutes, staring at the needle and trying to will myself to plunge it into my skin.  Eventually I do it, but it’s hard!  It’s like I need to sit there and get angry and frustrated with myself enough that I finally just overcome the barrier through sheer rage — and that’s not a fun emotional journey.  (This morning, I worked myself into tears before I was able to do it.)

I’m also wondering if I’ve been having more trouble the last couple of days because when I spoke with the nurse at my MFM visit on Monday, she said I needed to switch from injecting myself at night to injecting myself in the morning.  I take it this is not for any medical reason other than that they need to monitor my platelets for the first few weeks and the blood test needs to take place four hours after I do the injection, which means I need to do it in the morning.  But mornings are when I feel the worst — I wake up feeling queasy and weak and weepy, and then I tend to gradually feel better as the day goes on.  So add to general morning pregnancy malaise the need to exercise a fairly extreme amount of self-control and sheer force of will… and it’s not a good mix.  I tend to feel better in the evenings, and I think I was more able to cope with doing the injection before bed partly because I was feeling better in general.

So, what say you, O wise ones?  How long did it take you to adjust to giving yourself injections?  Is it normal to still be freaking out about each one at the end of 8 days?  Were there any tips or tricks that you found helpful when learning to inject yourself?  It does get easier eventually… right?

An Update and an Academic Quandary

More good news!  Yesterday we went for our first visit with Maternal-Fetal Medicine.  We saw that heartbeat flickering away, and our baby is still measuring perfectly on track.  We really liked the MFM doctor we saw — she was clear and straightforward when she talked to us, answered our questions and addressed our concerns thoroughly, and was friendly and reassuring.  I hope we’ll see her again during this pregnancy.  One thing that was cool about going to MFM was that they have these really great ultrasound machines that produce amazing images — I was totally confused when she said she was going to do an ultrasound, because nobody had asked me to undress and from my experience with my first pregnancy I know that it’s normal to get transvaginal ultrasounds up through week 10 or more.  But at 7w4d she just slapped some gel on my belly and zoomed right in on the flickering heartbeat.  It was so cool!

It was also good to have a chance to ask some questions about my Lovenox — apparently (this is for Empty Arms, Full Hearts in particular) I should in fact be depressing the plunger enough to activate the needle guard while it is still in my belly!  But the nurse did mention that it’s different for every manufacturer, so it’s important to follow whatever instructions you get from your manufacturer.  If you’re using needles from a different manufacturer, it’s in fact likely that you’re not supposed to activate the needle guard while it’s in your belly!  So confusing!

And here’s the academic quandary: a couple of months ago, I was asked by the big national facility I use for my science to give a talk on their behalf at next February’s meeting of the American Association for the Advancement of Science (AAAS).  These sessions are pretty high-profile advertisements for the science that I do, and they tend to attract lots of press.  It’s a real honor to be asked.  Well, today I got the email that our session proposal had been accepted, and that I need to email them within the next two weeks to re-confirm my availability and make arrangements for the meeting.  Cue hyperventilation!!!  The meeting takes place mere days before my due date.  Odds are I won’t be able to go, and I don’t want to lie to them — I want to make sure they have plenty of time to find a replacement if necessary.  But especially with a high-risk pregnancy in the first trimester, I really, really don’t want to disclose my pregnancy right now.  I’d been planning to wait to tell work colleagues until after we passed the 18-week point at which our first pregnancy ended — but that’s not until September.

So, I’m not sure what I should do.  I could tell them, but that didn’t work out so well last time around.  It happens that my PhD thesis advisor was also asked to speak on the panel, and I believe has done this before, so I could ask him for his advice.  He doesn’t have biological kids (he adopted his daughter as a teenager when he married her mother) and is clueless about pregnancy, but I generally trust his advice and wouldn’t be too uncomfortable disclosing early to him.  Any advice?

Houston, we have a heartbeat!

Today was our 6-week scan, and it was perfect!  Last week’s squint-worthy fetal pole has metamorphosed into a recognizably humanoid little blob, with a big head and tiny limb buds… and most importantly, a heartbeat (130bpm, which our doctor told us was great!).  It’s measuring exactly one week bigger than the scan one week ago, now at 6w5d, which puts our EDD on February 18, 2016.  That’s a LONG way from now, but I’m having trouble keeping myself from imagining everything that would come along with a new little one joining our family around then — alive this time, please!

I really appreciated the way my doctor handled the scan today.  I had arrived early (I drove 1.5 hours from the conference I’ve been at all week, and I wanted to make sure to leave enough time in case I hit traffic).  They brought me into the exam room 15 minutes before my scheduled appointment time, and the doctor was there within five minutes. She said, “We really should see a heartbeat today, so let’s look first and talk after.”  There was no waiting — we just got straight to business.  She zoomed right in on the heartbeat, and said, “There it is!” and only afterwards did she go back and do all the measurements of the size of the embryo and its the heart rate.  I love that she was sensitive to my natural anxiety about finding out as quickly as possible whether there was a heartbeat — one of the awful things about the loss of our first pregnancy was that we’d done all this prenatal visit chatter about scheduling the routine anatomy scan and getting a flu shot and yadda, yadda… so it was enormous emotional whiplash to then have to go through the deafening silence of the Doppler and the ultrasound.  I’m going to ask my regular OB if she can do the same for all my prenatal visits: confirm the heartbeat before we talk.  It really made things easier today.

The thing my doctor fumbled on was starting me on Lovenox injections.  Last week she’d told us that assuming everything looked good this week, she’d immediately start me on Lovenox and that they’d teach me how to do the injections.  Well, she certainly prescribed the Lovenox and instructed me to start immediately… but then she seemed sort of flustered about the whole “teaching” business.  She asked the nurse, “Do you remember whether it comes in a pen or a syringe?” and the nurse was like, “No…” and then the doctor said to me, “Oh, well, it’s easy.  It’s subcutaneous, just like insulin!”  When I gave her a blank look (I’m not a diabetic), she said, “Oh, it’s just like [fertility medication brand name], have you done that before?”  Another blank look.  When she eventually asked if I’d ever given myself an injection before and I said no, she said, “Oh, well, I’ll go look up the information about how they package it, and then we’ll teach you.”  A few minutes later the nurse came back in, handed me a printed paper packet of instructions, and said, “So, you just grab your side, like this, and then you inject into the skin fold.”  She searched around the room for something to demonstrate with, grabbed a pen from her pocket, and proceeded to fake-jab herself with a pen.  At this point it was clear that this was all the instruction I was going to get, so I thanked her and filed the information away so I could start googling when I got home!  My mom (the women’s health nurse practitioner) called to ask how my appointment had gone, and laughed about the “instruction” I’d gotten for injecting Lovenox.  She gave me a few other pointers that the nurse had forgotten (rotate injection sites, don’t rub the site, etc.), and then said, “Oh, you’ll figure it out — it’s not rocket science!”  Ha, ha, Mom — she loves to say stuff like that to me. 🙂

I’m still being closely monitored for the next few weeks.  Next week is my first appointment with maternal-fetal medicine.  They’ll be doing monthly ultrasounds to catch any sign of fetal growth restriction or problems with the placenta, since my first pregnancy ended with a placental abruption which gives me a ~30% risk of placenta-related complications this time around (thankfully only a 7% chance of a repeat abruption).  The week after that it’s back for my last appointment with the reproductive endocrinologist, and then I get handed off to my local OB.  It only takes two to make a baby (in our case)… but sometimes it takes a village of doctors to get through pregnancy, apparently!

So, here I am, with two beating hearts inside me (one very small and very fast!), about to try injecting myself for the first time in a college dorm room at a science conference.  Life is weird sometimes.  Wish me luck!

(Edited to add: I did it!  I injected myself!  I was shaking like a leaf, and could barely get the plunger down, but I managed it.  It must get easier with practice, right?)