Heparin is Out

Just a quick note to say that everything is fine, but it’s been a slightly more exciting several days than I might have hoped!

Last Thursday when I hit 36 weeks, the plan was to switch from the once-a-day Lovenox injections I’ve been giving myself throughout this pregnancy to twice-a-day Heparin injections.  This is pretty standard — Lovenox is great because it has a long half-life and the side effects are less common and more predictable than with Heparin, but as you get closer to labor the shorter half-life of Heparin becomes more attractive because if you go into labor it leaves your system faster.  This is a good thing for two reasons: (1) you shouldn’t have an epidural when there’s still a bunch of blood thinner in your system, because it can cause rare but severe complications that mess with your spine (scary!), and (2) if you give birth (or need a c-section) when you have too much anticoagulant in your blood you’re at risk for hemorrhage.  To give you an idea of the timing involved, you have to wait 12-24 hours after your last Lovenox dose for an epidural (depending on who you ask), but only 6-8 hours after your last Heparin dose for an epidural.

I’ve had no side effects at all from the Lovenox in this pregnancy, so I wasn’t even a little bit worried about the switch to Heparin.  After all, they’re very similar drugs (Lovenox is actually a type of heparin — what they call a “low molecular weight heparin”).  At first, things seemed fine.  I thought it was kind of cool to learn how to draw up the medication into the syringe and everything — new life skill!  (The Lovenox syringes are pre-filled.)

Then I started to notice red patches around the injection sites.  And they were getting bigger.  By the end of my second day on Heparin, I had a two large red streaks, each about six inches across, that spread across the two injection sites on each side of my belly.  Of course, it was Friday night by the time I got freaked out enough to realize that I should do something about it.  After all, I’ve had little bits of bruising and weirdness at injection sites before — but those always faded with time instead of getting worse. If anything, the area around the first day’s injection was larger and more red than the second day’s.

I didn’t feel like my throat was closing up or anything, so I waited until Saturday morning to call the doctor.  She told me to stop taking the Heparin, switch back to the Lovenox for the weekend, and come in on Monday to talk about what to do.

Today the doctor explained that there were two possibilities they were concerned with: one was that I was having an allergic reaction to something in the Heparin (it may or may not be the medication itself; apparently there are various preservatives and byproducts of exactly how the particular brand of medication is manufactured that can cause reactions).  This was actually the less scary possibility.  The scarier possibility is that I could have caught the earlier stages of something called Heparin-Induced Thrombocytopenia (HIT).  Luckily, there’s an easy test for this, so they drew some blood to check my platelets, which came back normal.  Allergy it is!  The doctor assured me that having an allergic reaction to the medication wouldn’t hurt the baby, so that’s a relief.

So, now they’re recommending that I stay on Lovenox for the remainder of the pregnancy.  I’ll just have to be very vigilant about early labor signs — I’m supposed to call when I feel any sort of regular contractions, so they can help me decide whether or not to stop taking the Lovenox.  In theory, this should all be fine, since most women have very long labors with a first baby — even though I gave birth once before in the second trimester, I only dilated 3-4 cm, so they don’t think this will make my current labor any easier/faster (rats!).  I’m a little bit nervous about it, especially on the off chance that I wind up needing an emergency c-section because of some complication.  I’d really like to not bleed to death, thanks!  And if I need a c-section, I’d rather be awake for it, which I can’t be if I can’t get an epidural (I’d really rather not miss my child’s birth because I’m under general anesthesia if I can avoid it).  I’ve read that there’s a way to reverse the effects of Heparin if necessary, but not Lovenox.  I think I will try to ask more about this when I call tomorrow to ask them to refill my Lovenox prescription (I also have a non-stress test and visit with my regular OB tomorrow, but they might not know the answers).  The doctor also gave me the option to try taking one more Heparin injection tomorrow to see if the red streakiness persists, assuring me that it wouldn’t hurt the baby and was very unlikely to have serious side effects for me.  I may do that, although she didn’t sound very hopeful that the reaction would miraculously have stopped, and she sounded pretty sure that I should just stay on the Lovenox for the rest of the pregnancy.

As pregnancy issues and complications go, I’ve been really lucky in this pregnancy, so I can’t complain that something is finally not going quite right.  After all, you win some lotteries and lose some lotteries, and I’ve been winning all the important ones in this pregnancy, so having this one minor hiccup should not be a big deal.  That said, I think all pregnant women get anxious about how labor and delivery might go, and this is just one more thing that might make it more complicated for me.  I’m not too freaked out about the prospect of not being able to get an epidural when I want one — I’ve been on the fence about epidurals anyway, and even if it’s hard, women have been surviving labor without epidurals for most of human history.  What I’m more freaked out about is the possibility of hemorrhage if things move too quickly or if an emergency c-section becomes necessary and I need general anesthesia.  I think these are all relatively low risks, but I’d like to know more about exactly how likely these various scenarios are.  Mostly, it’s just one more set of unknowns to worry about as labor approaches.  Well, we’ll see how things go, and I’ll ask some more questions at my appointment tomorrow.  Here’s hoping I have a nice, long, not-too-painful, uncomplicated labor and don’t wind up needing to worry about any of this!  (Ha!!!)

Time Warp

I’ve had two experiences over the past week or so that have made me feel like I’m in a time warp back to last year.

This past weekend, I was one of the organizers of a big regional event for undergraduate women in physics.  Last year I attended the same meeting, held at a different university, four months after the death of our daughter.  That was one of the notable times that I lost it in public.  During the meeting, a string of female science professors got up to introduce themselves and talk about their work and personal life.  One, who works in my field and whom I know casually from conferences, was just slightly less pregnant than I would have been if our daughter hadn’t died.  Seeing her up there and hearing all those women talking about how important their kids were to them was incredibly painful — somehow amplified since it was a bunch of female scientists living the work-life situation that I so desperately wanted.  I quietly sobbed in the crowded auditorium, and found myself physically shaking afterward.

This year, I was the hugely pregnant woman at the front of the auditorium, and it felt odd.  On the one hand, it was wonderful to have such a clear reminder of how far I’ve traveled in a year.  On the other hand, it was also a clear reminder of what my emotional state was like last January, and I was acutely aware that seeing my large belly might be painful for some of the women at the meeting and I might not ever know.

Similarly, the last time I went to a prenatal appointment, I saw a woman sitting with her partner in the waiting room with THAT LOOK on her face.  Fighting back tears, looking down, clearly avoiding eye contact with anyone else in the room, but not looking at anything in particular.  Her partner was holding her hand and hovering protectively.  I don’t know her story, of course, but I strongly suspect she’d just had a miscarriage.  And there I was, in all my 8-months-pregnant glory, remembering exactly how painful it had been to sit in the waiting room last year watching heavily pregnant women and newborn babies come and go around me.  To remember how even when they moved me to a private waiting area, a woman about as pregnant as I now am waddled up to the water fountain in front of me and all I could feel was the bleakest despair.  I wanted so desperately to say something to the woman in the office last week.  To tell her I was sorry for her loss.  To tell her that I’d been there.  To tell her she’d make it through, even though it didn’t feel possible right now.  To let her know I wasn’t the carefree pregnant lady she probably assumed I was.  But how can you start that conversation?  I couldn’t.  I smiled hesitantly at her partner.  And then my name was called and I walked away.

The pain of pregnancy loss has so many associations for me now.  Seeing sad women in the waiting room of an OBGYN practice is an obvious one, but who would have thought that an event for female physics students would do it too?

These two situations brought me back strongly to last year, but I’m also happy to report that my husband and I are moving forward and planning to welcome our son home in just a few short weeks.  We finally took the plunge and started organizing our baby stuff.  I washed and sorted all the hand-me-down clothes, and we started buying stuff to fill in our needs around the edges. The Amazon boxes have been arriving in a steady trickle.  We even took a trip to Ikea for some furniture, and now the room in our house that has stood empty since we moved in a year and a half ago is starting to look terrifyingly like an adorable nursery.  I still feel the dizzying duality of fear and joy when I think about it.  I imagine holding our son, rocking in the old rocking chair that my in-laws brought us at Christmas.  When that gets too scary, I remind myself that even if we don’t bring home our son this year, we will eventually be parents, and that the nursery will eventually be used by a living child, even if it’s not this one.  Thinking about it as our family’s nursery, rather than our son’s nursery, is my coping technique du jour.  I wish I could fully commit to making it HIS nursery, but I’m just not quite there yet.  And still, we act like he’s coming home soon.  The carseat is installed in the car, just in case.  We’re planning on taking a trip to Target this weekend for exciting necessities like diapers and wipes.  We’re preparing, ready or not.  While it’s not likely yet, he could theoretically arrive any day (now that I’ve reached the 36-week mark).  I mostly feel calm, until I think about things too hard.  But I suspect that’s a normal feature of late pregnancy.

Physically, I’m fine.  Most of the time I feel pretty placid about the wait.  Other women have told me they were miserable by 36 weeks; I’m not.  Sure, there’s some discomfort, but it’s all minor aches and pains.  I can still walk my dog two miles in the morning (just slowly).  I can mostly sleep at night (with a few interruptions).  I can mostly focus on work and sit at my desk comfortably (as long as I waddle to the bathroom every so often).  Life feels more or less normal.  The strangest thing about this week is the buildup to the start of classes.  It’s the first time in three years as a professor that I haven’t been caught up in the buzz of the start of the semester.  I’m working hard, trying to finish two papers before the baby comes (I finished a draft of paper #1 and sent it off to collaborators today!), but I’m not putting together a syllabus or writing lecture notes or fielding frantic student emails about whether there’s space in my class.  Students mostly aren’t bugging me about stuff, because within my little department they all know that I could disappear at any moment.  I’m watching my colleagues buzz around instead.  I’m guiltlessly saying no to any requests that do make it to my inbox.  It’s unsettling to start to disengage from work so thoroughly, but also kind of exhilarating to imagine how different our first few weeks of parenthood will be from the academic life that has been my “normal” for… well, forever.

So that’s where I am at the moment: in a strange time warp, in limbo between my painful past and what I dearly, dearly hope is our impending future with our son.

What I have to look forward to

This week has been a vacation week for local schools, the university, and university-affiliated daycare.  As a result, faculty parents are bringing their kids to campus with them — the kids are playing with each other, the parents are looking frazzled, but everyone is generally running around and having a good time between semesters while the grown-ups try to get a little work done.

Several times this week, as I’ve wandered the halls 7.5 months pregnant, I’ve gotten comments from frazzled parents along the lines of, “See, this is what you have to look forward to” — usually while their kids are screaming, hitting each other, or otherwise misbehaving.  Another variation includes, “Just be grateful yours is still on the inside — they’re so much harder once they’re out.”

I have to admit that in my hyper-emotional highly pregnant state, some of these comments have brought me to the brink of tears.  Pregnancy, especially late pregnancy, isn’t easy for anyone, but it’s particularly emotionally fraught when it’s a pregnancy after infertility/loss.  Here’s what goes through my head when I hear these comments:

• What if I’m making a mistake, and nearly three years of dealing with infertility and pregnancy loss on our way to a living baby is only going to make me miserable?
• How am I going to deal with highly physical boys like these?  Why did my daughter have to die?
• God, I hope I have this to look forward to and that my baby doesn’t die again.  Don’t you know how lucky you are to have two or three living children to annoy you? 

In my saner moments when I’m able to sit down and think things through rationally, I realize that this is all silly.  I know that none of these parents would, for a moment, give their kids back.  I know that they love their kids with their whole heart, that even when it’s tough they value the time they get to spend with their kids.  So why are they making these hurtful comments, the ones that make their kids sound like monsters, in my very pregnant direction?

Of course, there are all sorts of moments that they might have chosen to highlight instead, where those very same words would give me strength and hope instead of insecurity.

When they’re snuggling together — “See, this is what you have to look forward to.”

When those sticky little hands give them a hug, a little mouth gives them a kiss, and a little voice says I love you, Mommy — “See, this is what you have to look forward to.”

When their heart bursts with pride to see their child being kind and generous to someone else — “See, this is what you have to look forward to.”

I recognize that it’s part of an entire genre of things that people love to say to freak out pregnant women: “Sleep now, because you’ll never get any sleep again after he’s born!”  “Boys are such a handful — say goodbye to your clean house!”  “You’ll never know what hit you.”  And then add 1,000 horror stories about labor and delivery.  These things are normal.  They’re mostly just good-natured teasing.  I know that I’m extra-sensitive, especially right now.  But wouldn’t it be nice if people could make the positive versions of these comments instead?

I know it’ll be hard to have a baby.  I know that I don’t know how hard it’ll be.  But I also know that most of my parent-friends feel that despite the difficulties, parenthood is one of the best decisions they’ve made.  It’s something my husband and I very deeply want to experience.  We are so looking forward to welcoming this new little life into the world, and to all the good and bad experiences that come with being parents.  As January begins and my February due date looms ever closer, I’m trying to look past the negative comments, and focus on what I truly have to look forward to.  To think about looking into my son’s eyes for the first time, to think about holding his little body safe and snuggled into mine.  To think about watching him grow and change and learn and discover all the beautiful and amazing things the world has to offer.  That, along with a million other little things, is what I have to look forward to.