Believing My Doctors When They Tell Me I’m Fine

… is easier said than done.

This week I managed to freak myself out about what turned out to be (probably) nothing.  And fortunately I have kind and understanding doctors who tried really hard not to make me feel like an idiot.

For a while now I’d noticed a sort of come-and-go pain in my lower right abdomen.  I know, I know… round ligament pain.  But see, I’ve had round ligament pain in both pregnancies, and this feels different.  My round ligament pain has always been really classic: sudden intense pain/cramping when I cough, sneeze, or get up after sitting down for a long time.  It also tends to be correlated with activity levels.  This is different: totally uncorrelated with activity, and in fact most noticeable after a long day of sitting at my desk.  Also, it’s extremely localized — if I push on one particular spot on my belly I can feel it radiating through my abdomen, in a completely different way than my round ligament pain radiates.

So naturally I went to Dr. Google (big mistake), and then I read that localized, one-sided abdominal pain can be a sign of appendicitis (which is no more common in pregnant women than in the general population, but is harder to diagnose in pregnant women and can cause miscarriage and stillbirth) or placental abruption (which I’ve already had one of, which means that I have an order of magnitude greater risk for a repeat than a woman who’s never had one before).  I’d been feeling it for long enough that I’d mentioned it at my last prenatal visit — my doctor told me it was probably just a different sort of round ligament pain and that I shouldn’t worry about it, but didn’t say any more than that.  I spent several days worrying myself to exhaustion about my placenta and my appendix, and then finally inquired with my MFM through their messaging system.  I got a message back saying that I should make an appointment, which I did, and then I hyperventilated until it happened.

The doctor checked out everything, told me she agreed it wasn’t round ligament pain but that she was quite sure it wasn’t anything dangerous for my pregnancy.  She said the location isn’t where my appendix would be, and she did a quick ultrasound and said the baby and placenta looked great.  Than she looked me in the eye and said very slowly, “Everything looks fine.  Don’t.  Worry.”  At which point I nearly burst into tears, because that’s so much easier said than done.

I will say one thing for my freak-out this week: there’s nothing that gets you to appreciate a pregnancy like the fear that you might lose it (again).  Thinking concretely about the possibility of losing this baby made me realize that I actually am far more bonded to him than I realized.  He’s a part of me, even if I don’t believe it much of the time.  He’s my son, even if he doesn’t make it out alive (although I hope he will).  I’m so grateful that he’s OK so far.

My freak-out also made me realize that I’m still having trouble dealing with the anxiety of this pregnancy.  I am not normally a hypochondriac, I swear.  I usually go to doctor’s appointments assuming I’m fine, and nod happily when the doctor tells me how healthy I am.  Not so in my apparently normal and healthy pregnancy during the last 15.5 weeks.  Pregnancy after loss still occasionally turns me into a quivering pile of jelly instead of my normally calm, centered self.  Somehow, I need to find a way back towards that equilibrium.

Part of the difficulty is that my poor experiences with healthcare providers during and after our daughter’s death caused me to lose trust in the medical establishment.  I saw the dark, uncertain side of medicine up close and personal for the first time in my life.  I’d seen it from a distance with my aunt’s cancer, but I’d never personally been in a situation where doctors just shrugged and told me I’d experienced a “lightning strike,” or did things that I afterward found out were poor judgment or just plain mistakes.  Even though I’ve since found new doctors whom I trust more, particularly the MFM team who are part of a department with an international reputation and always reassure me with their thoroughness and knowledge, part of that lack of trust still lingers — and it doesn’t help that I know that even my amazing MFM doctors couldn’t have predicted or prevented my daughter’s death.

How can I ever find my way back to trusting my body, trusting the medical establishment, trusting pregnancy?

For now, I’m reassured by having my concerns addressed directly: by seeing on ultrasound that there’s no bleeding around my placenta, by hearing that the pain is not coming from anywhere near my appendix, that it’s probably just one of those strange musculoskeletal things that just… happens sometimes in pregnancy.  In my first pregnancy, that would have been easy to accept.  This time, it’s harder.  But I’m working on it.

Does Getting Past the Point of a Previous Loss Matter?

I’ve been ruminating on this question lately, now that I’m 15 weeks and rapidly approaching the 18-week mark at which our daughter died last year.

At our prenatal appointment this week our doctor (whom I generally love!) said something she’s said before: “Oh, it’ll be great once we get you past 18 weeks!”  I appreciate the sentiment, but honestly it feels like a lot of pressure — as though I should suddenly be OK once we get past the point at which our daughter died.  I know she was just trying to be encouraging, but I couldn’t help but hear some of that pressure in her comment.

18 weeks is not magical.  Getting past that point doesn’t guarantee me a healthy pregnancy with a complication-free full-term birth.  My pregnancy will still be high risk.  I will still be at risk of placenta-related complications, even the same complication (placental abruption) that I experienced in my first pregnancy, which is actually more common in the third trimester than the second.  I also think that I will be particularly nervous for at least a month or two after I hit the 18-week mark because of how I experienced the sensation of movement in my first pregnancy: I had just started to feel my daughter move, then didn’t feel anything for a few days, and chalked it up to the inconsistency of those first flutters in the second trimester.  I’m told that it’s a totally normal experience — it just so happened that in my case, it happened to actually coincide with the death of my daughter.  As a result, I suspect that the weeks in this pregnancy when the sensation of motion is weak and inconsistent will be particularly nerve-wracking for me.

But on the other hand, I find myself really looking forward to passing 18 weeks.  I’m excited about being more pregnant than I’ve ever been before.  I also feel like it will help me bond with my son a little more, since I’ll have started to know him longer, and with more detail in his movements and activity levels, than I did with his sister (there’s also some guilt associated with that idea as well, but whatever — I will only ever have had one first baby, even though she died before we got to meet her).  I’m looking forward to getting to know our son through feel rather than just through ultrasound.  And I’ve been putting off some planning tasks until we get past that point — I haven’t yet signed us up for prenatal classes, or started on the baby to-do list that has been sitting idle since last September.  We’ve got things to do!  Making wills and deciding on guardians and making decisions about car seats and cribs and and and… I haven’t been able to make myself do any of it yet.  I’ve been thinking about it more often recently, with a certain amount of excitement, and I think that once we get past 18 weeks I might finally be emotionally ready to face it all.

So for me, at least, getting past the point of our previous loss both does and doesn’t matter.  I know it’s not going to be a magical moment at which everything is suddenly better and I get my first-pregnancy optimism back (ha).  But at the same time, it will be a very personal milestone, and I think it will mean something important in my relationship with my son.

Has anyone else made it past a previous pregnancy milestone?  How did it feel to you?

More than 1/3 of the way there

I know I already mentioned the end of the first trimester in a previous post, but it occurred to me yesterday that I am now definitely more than 1/3 of the way through this pregnancy.  Today I am 14w1d, and I know that my OBGYN won’t let me get to 42 weeks.  Hence, >1/3 of the way there, even if I wind up being overdue!

I haven’t been updating much lately — part of that is travel (my last two weeks included a week at a conference six time zones away, followed by a week of vacation with my husband, including a few days in a cabin in New Hampshire with no internet, which was glorious), and part of that is just not feeling like I have a lot to say.  But for those of you who have kindly expressed hope that everything is well: fear not!  Everything is going fine.  Our little guy is healthy, and has a strong heartbeat of around 160 bpm, as of Wednesday (13w6d).  We spent part of our vacation visiting my mom, who is a women’s health nurse practitioner, and she brought home a Doppler so that we could listen to the heartbeat as often as we wanted while I was visiting.  Not only did we hear a steady heartbeat every time we listened (and my mom always found the heartbeat quickly, unlike one of the docs at our local OB practice who nearly gave me a heart attack last week!), but we could also hear him moving around — little “zip!”s in between the whooshing of the heartbeats.  Very reassuring.

Oh, there’s plenty I could say, mostly about how this pregnancy is different from my first pregnancy.  I sort of hate making these comparisons, but they’re always in my head.  I think the major difference can be summed up in the following statement, which I expressed to my cousin when I was home this week:

In my first pregnancy, once the first trimester was over I didn’t really believe the baby wouldn’t be born alive.  In this pregnancy, I don’t really believe the baby will be born alive.

Maybe things will be different when I start to feel him moving consistently, or when I start to experience things that I never experienced in my first pregnancy, but so far everything feels unreal, and I feel detached.  I feel terribly guilty about it — on one level I’m extremely grateful to be pregnant again, but on another level, most of the time I don’t believe that I’m actually pregnant, or that this pregnancy will actually result in a living baby, so I just can’t get excited about it.  I also feel like I’m cheating my son out of all the happy, magical emotions that I fed to my daughter during my pregnancy with her.  With my daughter, every time I saw something beautiful or good, I’d sort of mentally telegraph it to her, and think about sharing these experiences with her after she was born.  After she died, that mental reflex became incredibly painful — seeing a beautiful sunset or having a touching interaction was all the more painful, because when I reflexively thought about sharing it with her, I was reminded that she was dead.  Tonight I was walking with my dog through the fields near our house, in a glorious late-summer evening after a rain storm, with a huge arc of rainbow overhead — it was gorgeous, and I wanted so badly to feel it and to share it.  I tried to feel the way I felt with our daughter, and send that feeling to my son… but I just couldn’t.  And that just made me so sad.

Maybe it’s also that we’re creeping up on the point of our first loss.  I know that September is going to be an emotional land mine for me.  September 11 is the anniversary of the prenatal appointment at which we found out our daughter had no heartbeat.  I delivered her the next day, on September 12.  Our son will reach the gestational age at which we found out she had died on September 17, and the gestational age at which she was born on the 18th.  One thing that will help me get through the next month is that my maternal-fetal medicine specialist scheduled an early anatomy scan on September 10, when I’ll hit 17w in this pregnancy.  She wasn’t intentional about the date, but hopefully (assuming all goes well, which of course I can no longer assume) the timing of the anatomy scan means that we’ll be getting some reassurance before the deluge of significant dates hits.

I also have a really cool distraction from the September 17-18 significant dates — I was awarded a prize for my science research, given by my PhD-granting department to one of its graduates under the age of 35, and it turns out that my visit back to my alma mater to give a talk and go through the prize ceremony will be September 17-18.  It’s a very happy occasion, and hopefully I’ll be too busy and happy to brood too much on the significance of the dates.

I want to end on some positive notes, because I don’t want you to think that this pregnancy is all doom and gloom.  It’s been very hard for me to go through pregnancy after the loss of our daughter, but there are bright points too, and I want to make sure to share some of them:

• When I was home visiting my mom, she bought us our first item of baby clothing.  It’s a very cute onesie, mostly light blue and yellow with monkeys.  We never bought anything new for our daughter (we had started a stash of hand-me-downs from friends and relatives, which we are still planning to use for our son), so this is something new for me in this pregnancy.  I wasn’t at a place yet where I felt like I could buy it for us, but she wanted to do it, and I let her, and it really did make me happy.
• I’ve decided to start taking bump pictures, since one of my regrets from the first pregnancy was that I didn’t have any pictures of my growing bump.  I’m looking forward to seeing how my belly grows over the next few months.
• This is gallows humor, but I found it hilarious (sorry if you don’t!).  My cousin (age 48) just went through an ovarian cancer scare — she’s fine, and doesn’t need further treatment, but she wound up having both ovaries and her uterus removed.  We visited her in the hospital this week, and she was doing great.  She was asking how my pregnancy was going, and I mentioned the fatigue and constant naps, and then we were talking about how apparently she’s now going to go through a sort of accelerated menopause, and my mom said she’ll probably be experiencing a lot of fatigue as well.  So we started joking about how we’ll be doing synchronized napping for the next few months. 🙂 Naps are the best!
• Speaking of naps, when I woke up from a nap yesterday and was lying there quietly, I felt what I think might be the first flutters of movement from my baby.  It’s not crazy to feel it this early, especially since I remember the sensation of movement from my daughter — this was the popcorn-popping kind.  It’s too early for me to be sure, but it’s something to look forward to over the next few weeks!

And with that, I think I’ll sign off.  I never forget through this pregnancy how fortunate I am to be here, even when it’s hard and I feel sad.  I’m trying very hard not to let my fears about the future (at the moment: abnormal anatomy scan, another abruption, stillbirth, etc.) cloud my appreciation for every moment that I’m pregnant with our little boy.  It’s a strange state of multiplicity, this simultaneous grief, fear, wonder, and hope — but I guess it just reflects the double-sided coin of life and death that is so salient in any pregnancy experience.

Adios, First Trimester!

Well, here I am, 12w2d pregnant and staring the end of the first trimester in the face.  There’s a lot to love about the end of the first trimester — I’m already feeling much less nausea, for one thing!

On Thursday we had our NT scan, and everything was looking great.  The NT measurement was 1.3mm, which is nice and low, exactly as they want.  Our little guy was making life difficult for the sonographer, and she had to jiggle my belly a bunch of times to get him to flip over several times so she could make all the right measurements.  He was wriggling up a storm, which was really cute, and we got some great shots of his profile, his face, and his foot (the only body part that the sonographer decided to label on the printouts, for some reason!).

Oh, and you might have noticed the pronouns.  We got our NIPT results back on Monday, and found out that our baby is at low risk of all the common chromosomal abnormalities… and it’s a boy!

I mentioned before that I had some anxiety about finding out the sex of our baby, especially given how excited we were to be having a girl the first time and how I let myself run away with dreams of mothering a daughter.  Well, I’ll admit it (although never to my son!) — when I found out it was a boy, at first I felt numb, and then a bit later I cried.  I wasn’t really crying about having a boy — as I sobbed, all I could think was “I want my little girl back” and “Why did she have to die?”  It wasn’t really about him as much as it was about losing the dream of a daughter all over again.  I felt incredibly guilty about it too — still do, in fact.  All along I’ve said that I just want a healthy baby, and I’ve meant it.  I’m now pregnant with an apparently healthy baby, and I do not at all underestimate how lucky I am to be here.  I’m going to love this kid with every fiber of my being, no matter what his chromosomes or how often he pees on me when I change him — I know that, of course.  All my feelings about this pregnancy are just so complicated, and wrapped up in the loss of our daughter. I’ve tried to give myself permission to be honest and feel what I feel about everything we’ve been through, and this is part of that process.  (My husband felt the same way, if you’re wondering.  After we found out he asked “Are you disappointed?” and I said “Not really.  Well, maybe a little,” and he said, “It’s OK — I am.”  And then we talked about it.)

Since then, I’ve been doing a lot of thinking about what it will mean to raise a boy, and I’m starting to come around to the idea.  For one thing, there is so much variation in what it means to be a “girl” or a “boy” that it’s almost laughably meaningless — I know I’ll feel differently when there’s an actual little person in front of me than a single-attribute mental construct.  I’m far from a “girly” person anyway, and my dreams of being mother to a daughter never included mani-pedis and tea parties (I’m pretty sure I disappointed my own mom when I not only scorned the whole white wedding dress thing but also refused to wear so much as a speck of makeup at my own wedding). 🙂 I have plenty of things in common with someone with stereotypically “male” interests, after all.  It also helps me to think about our baby as a little version of my husband — my husband is one of my favorite people on the planet, and having a mini-him around the house would be pretty great.  I also think that a lot of my nervousness about raising a boy comes from just not having a lot of experience with boys.  I was raised almost exclusively by women, and the two cousins that I was close to growing up are both women.  So I’m starting to think about raising a boy as an opportunity for learning and growth.  xykademiqz left a very sweet comment on my last blog post about being a mom of three boys, and I loved her thought about how being a mom to boys has let her understand and really love men and boys in general in a new way.  That sounds to me like an awfully good thing, and I’m looking forward to that opportunity for growth as a human being.  Of course, I’m sure that being a mom to a living child will make me grow in new and exciting ways no matter what. 🙂

Other things that have happened in the last ~week or so since I wrote:

• I met the little girl who was born to my close friends a few days after my daughter’s due date.  She’s unsurprisingly adorable and sweet, and she took to me right away.  I was nervous about meeting her, worried about how she would remind me of what we were missing out on and what might have been if our daughter hadn’t died.  Well, she did, but when faced with an actual little girl I was able to see her primarily as herself rather than as the concept of our daughter who might have been.  It wasn’t nearly as traumatic as I’d feared.
• We’ve started telling people about this pregnancy — I told my coworkers after our NT scan, because I’m really starting to show and I don’t want to make them pretend they don’t see it.  It’s been strange, and sometimes sad to have these conversations.  Some people have been great, really hopeful for us while also sensitive to our loss.  Some people have made clueless remarks, as expected.  I had one conversation with my department administrator that got awkward and more detailed than I’d intended.  I mentioned that this pregnancy was considered high risk, and she was really confused about why.  She said, “Why, just because you lost one?” (Ouch.)  I told her it was more about when and why our daughter died, and she asked what I meant.  So I wound up telling her about the placental abruption, and she was still kind of confused.  She said, “Is it your hormone levels? My niece had to go on hormones until she felt the baby move.”  I told her that that wasn’t it — for one thing, I’d already felt the baby move when our daughter died.  So she asked, “Wait, when did you lose the first one?” and I told her 4.5 months.  She said “Oh, I thought you lost it closer to this point, like three months!” and I said no… this was all sort of weird, because I’d told everyone in the email I sent about our first loss that it was at 18 weeks, but I think people just don’t do the math and realize that 18 weeks is actually almost halfway through a pregnancy and well into the fifth month.  It’s a little odd that she’s only realizing now a little bit of what we’ve been through.  It always bothers me when I wind up in a situation where I have to explain to someone that what happened to us was not a typical first-trimester miscarriage — I never want to minimize the emotional impact of first-trimester miscarriage, which is often deep and profound, but at the same time I want people to understand that losing a baby in the second trimester often has long-term implications for future pregnancies that a single first-trimester loss does not.  It’s a fine line to walk.

Anyway, the headline news is that things are going really well so far, we’ve had nothing but good news from our first trimester screening, and I’m excited about entering the second trimester (whether you want to call it 12 or 13 or 14 weeks, we’re at least right on the cusp).  As we’ve started to talk to more people about this pregnancy we’ve had to start dealing with a wider range of reactions, but so far that hasn’t been too traumatic — unlike after the loss of our daughter, I’m generally in a good place emotionally, and excited about the pregnancy, and that makes it easier to deal with insensitive remarks.

Now I’m at a conference for a week, then my husband and I are going on vacation for a week, and then it’s back to prepare for the impending semester.  We’ve got a quick check-in planned with the local OB when I get back from vacation, and then the next big milestone is our early anatomy scan at 17 weeks (the MFM said she usually does an early anatomy scan for couples with a history like ours, and I admit that a good anatomy scan a week before the point of our first loss would be a huge reassurance).  That’s all the news that’s fit to print!  Here’s hoping that all y’all are enjoying the last dregs of summer too. 🙂