Tag Archives: anxiety

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!!!)

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.

Why I don’t want a baby shower

This week one of my closest friends (the father of the little girl who was born a few days after my daughter’s due date) called to chat, as he does every week or two.  At the end of our phone call, we had the following exchange:

Him: “Oh, hey, I wanted to talk to you about something.  I really need your help, or at least you need to go along with this.”

Me: “OK, what can I do to help?”

Him: “[Wife] and I love you guys a lot.”

Me: “We love you guys too!”

Him: “We want to throw you a baby shower at our apartment in January.”

Me: That… is so kind of you… and I… [Bursts into tears]

I surprised myself as well as my friend by bursting into tears that way.  I wish I could say they were happy tears, but they weren’t.  They were “but we can’t have a baby shower because I still don’t actually believe that our baby is going to be born alive” tears.  And they continued for about 10 minutes as we finished our call, and then started again when I tried to talk to my husband about it.

The way we left it was that I’d think about it and I’d talk to my husband, and then we’d talk again this weekend.  I really want to say yes to my friend — I found out afterwards that my mom was in cahoots, and thought that he should be the one to ask partly because she knew I’d have a harder time saying no to him (she was right)… but I think I have to say no.   It’s taken me a while to figure out why.

My poor friend was confused too.  “I just thought… you’ve started letting your mom buy some baby clothes, and you’ve started letting people give you hand-me-downs, so I thought you’d be OK with it.”  And he’s right… I am more or less OK with those things, at this point.  Partly it’s that we had some hand-me-down baby stuff when our daughter died, so I’ve already dealt with that.  Partly it’s that my anxiety over not having things ready when the baby arrives in January is getting stronger than my anxiety over having to pack up a bunch of baby stuff if our son dies, so the practical side of me is ready to start acquiring stuff.

But my feelings about a baby shower are really not about the stuff.  We’ll acquire stuff for the baby one way or another — that much is clear.  I’m not about to burst into tears at the thought of our friends giving us baby gifts.  We’ve already gotten a few, and I’ve been able to thank the givers profusely and write thank-you notes on the cute baby-ish stationary I bought for the purpose.  I also know that if this baby dies, we will use the baby stuff on our eventual future baby (since we will be parents one day, one way or another), just as we’re planning to use the stuff that people gave us for our daughter when our son is born.  So I really don’t think my discomfort about the idea of a baby shower is about the stuff.

When I think about a baby shower, the part that freaks me out is imagining sitting in a room full of friends and family with everyone excited and happy about a baby who might never be born.  I’ve gotten pretty good at pretending to be a normal, happy pregnant lady on a day-to-day basis, but I’m really not.  Every time I answer a well-meaning “Is this your first?” from an acquaintance with a “yes” (twice today!), I feel sad and anxious.  Every time I keep my mouth shut about my fears for our son and my memories of my daughter, it hurts, and imagining the concentrated pretending I’d have to do even in a room full of my nearest and dearest just makes me dread the idea.  Most days I manage a pretty good impression of a normal pregnant lady who’s getting ready for her baby to be born, but there’s still a surprisingly large part of me that doesn’t believe he ever will be.  Somehow the smaller doses of gift-accepting and even the little bit of looking at baby items that we’ve done have felt mostly manageable, but this larger celebration does not.

As my husband said, it’s not as though we really need to have a shower.  Babies don’t actually need that much stuff, and we are fortunate enough to be able to afford the stuff that we do need on our own.  I get that our friends and family want to honor this exciting transition in our lives, but I think there are other ways to do that (many of which they’re already doing, because we are lucky that way!).  I’m also pretty certain that the decision to skip a baby shower is not one that I’ll come to regret later.  I was also not into the idea of a bridal shower, for much less significant reasons than this time around, so I didn’t have one, and I’ve never regretted skipping that ritual either.

So, I’m planning to say a very loving and appreciative “no” when I talk to my friend later this weekend.  I think I will probably suggest that we aim for a “meet the baby” gathering at their house (which is in a major city two hours from us, where many of our friends and family live) a month or two after our son is born instead.  That will give our friends and family a chance to honor the transition in our lives without freaking me out about having a party for a baby who might not be born alive.  And I’m sure there’s still plenty of baby stuff that will be useful at that point, if people want to give us gifts (like, clothing for older babies!).  And if they want to give us gifts before the baby is born, that’s fine too — just not in the context of a baby shower.

Baby shower drama aside, things are still going well.  I’m currently 29w2d, which means I’m firmly in the third trimester.  Our growth scan this week was right on target (55th percentile), and our little guy now weighs three pounds and is still very active.  I’m still feeling physically fine — my day today was extremely active (two 45-minute dog walks, three hours of volunteering at the therapeutic riding center, laundry, cooking, and a chorus rehearsal), and I’m just sitting here with a slightly sore back, but feeling good about everything otherwise.  My biggest medical concern at the moment is that our baby seems to favor a breech position and hasn’t flipped over yet, but they tell me I shouldn’t start worrying for another few weeks (easier said than done!).  All in all, things are looking good, the end of the semester is in sight, and February keeps getting closer.  It still can’t get here fast enough.

Return to the L&D ward

Tonight my husband and I went on a tour of the labor and delivery ward at the local hospital.  This was a big step for us: we haven’t set foot in that part of the building since I delivered our daughter at 18 weeks last September, and we knew it would be emotional.  It absolutely was!  But it was also bearable.  As my husband has been saying, we didn’t really need a “tour,” since I have in fact given birth there before, but the goal of tonight’s visit was to get us back in that space that holds so many sad memories, (hopefully) well in advance of when we have to go back so that I can deliver our son.  We figured it’d be less awful if we did it early, while labor is hopefully still far off, and I think that was ultimately a good decision.

Things started off with an info session about labor and delivery at this particular hospital.  One thing that I was excited to hear, which is a new development since we were there with our daughter last September, is that they now offer nitrous oxide (N2O) for pain management during labor.  (Those of you in civilized countries will probably be thinking “so what?” but availability of N2O has been extremely limited in the US until just the past year or two, and apparently they are one of only two hospitals in our state that currently offers it!)  That already made me feel more positive about this hospital, since I like that they’re keeping up with still fairly cutting-edge (in the US) medical trends, and since I had read about N2O and had wanted to try it but didn’t think I’d be able to.

After that positive start, the nurse led us into and through the labor and delivery ward.  It was hard to be there again, to remember the night that we walked ourselves in and got settled in a room only to experience some of the saddest and most traumatic hours of our lives.  We both remembered exactly which room we had been in, and I’d been nervous about going near the room, but for better or for worse, we weren’t allowed to go in that part of the ward anyway since there was a woman actively giving birth in that wing. So we saw it from a distance, but didn’t actually walk past.  We went into another birth room, and saw the same furniture and equipment, and that was quite enough, thanks.

I had somewhat anticipated the difficulty of dealing with naive, bubbly first-time pregnant women, but it was still hard.  One woman’s only question or concern was to ask the nurse how to make sure she could tell everyone that she didn’t want to hold the baby until after it had been washed off.  Oh, if only that were my biggest worry!  Another woman in the room kept asking questions that made it clear that her biggest concern was totally minimizing any medical care for her or her baby — she wanted to know if the hospital would let her deliver in water, wanted to see where the tub could go, and she practically jumped on everything the nurse said with “is that required or can we opt out?”.  I’m not sure why this bothered me so much — I believe that women should be supported in giving birth in the way that they want, and I won’t judge any other woman’s birth plan.  I know that unmedicated birth can be beautiful and powerful for many women, and I thoroughly respect (and to some extent share) the desire to minimize unnecessary medical intervention.

I think I was more rattled by the juxtaposition: while my husband and I were actively fighting our anxiety about dead babies and placental abruption, which was brought back more strongly than ever by being in the place where our daughter was born, this woman was clearly primarily worried about having her birth go the “right” way — which is just really far from where we are right now (which is more along the lines of “we want a live baby and a live me at the end of all of this and anything else that goes well along the way is a bonus”).  I liked the nurse’s eventual response to the incessant natural birth badgering, which was that she was happy to help us come up with a “wish list” and do her best to make the birth happen exactly as each of us wanted, but that we should realize that birth is unpredictable and might not live up to our expectations, and that to avoid being disappointed in our birth experience we should think of the birth plan more like a Christmas list of things that we would really like to have, even if we know we might not get all of them.  That seemed reasonable to me, and quieted the hyped-up natural birth lady as a bonus.

I managed to hold it together pretty much until the end of our tour.  At the end, the nurse gave us each her card and asked each couple personally whether we had any questions.  My husband and I had talked about our main requests from the hospital, namely that we not be put in the same room or have the same nurse as when our daughter was born, but I didn’t really want to ask those things in front of everyone.  So we stayed and listened to everyone else’s questions, and then when they had left or were talking amongst themselves we went and talked to the nurse quietly.  She was very nice about it and said that they should easily be able to accommodate those requests, which really helped put me at ease.  But still, having that conversation, and having to put into words why we were making the request, sent me over the edge into weepiness, and as we walked out of the hospital I started sniffling and then totally lost it in the car on the way home.  I’m not even sure I can articulate why — it was just such an emotional evening, and brought back so many memories of the night we spent at the hospital and the birth of our daughter.  I still miss her so much.  I want her back, and I want to know what our lives would be like today if she hadn’t died.  I know that these wants are nonsensical, and I’m very grateful that we are fortunate enough to have another baby on the way, and therefore thankful for the situation that is making us revisit these difficult emotions in the first place.  But the tears were just an uncontrollable emotional response to being back there and revisiting everything that’s happened to us over the past 13 months.

So, anyway, that was our evening.  I’m also grateful to have a loving and supportive husband with whom I can both cry and snark about people who are afraid of slimy babies.  As I write this, I’m about to hit the 23-week mark with our son, who has been kicking away in my belly for what now feels like ages.  Earlier this week, he kicked me so hard in such a weird and constant way in my side that I got extremely ticklish and started writhing in bed.  My husband thought I was nuts!  Our little guy also kept running away from the doctor’s doppler at our appointment on Tuesday.  I would have been more worried, except that instead of his heartbeat we heard the “zip”s of his movements as he scooted away from the doppler every time she tried to get a measurement of his heart rate — and on top of that, I could feel him moving away from the wand, so I was never really worried that there was a problem.  It was more funny than scary, for once.

I hope all is well with all of you out in blog land.  Thanks as always for your incessant support and kind words!

Thinking Ahead: Labor & Delivery After a Loss

First, a quick update: all is well!  We had our first growth scan Thursday, and in addition to showing a nicely growing little guy who weighs about a pound now (at 21 weeks), we got the last view of the heart that they couldn’t get at the anatomy scan and it was fine.  As the doctor said, “There are never any guarantees of a healthy baby… but everything looks fabulous.”  Our little guy is kicking up a storm, and I’m getting bigger too.

It’s still a long way off, but something that’s been bouncing around in my brain a lot lately is the question of how to approach labor and delivery with this baby.  My first L&D experience was traumatic for various reasons, but mostly (aside from the obvious fact that I was giving birth to our dead daughter) because I felt out of control and in extreme amounts of pain, and as I found out afterward, the inexperienced midwife made some really poor medical decisions.  So as I start to think about what L&D will feel like for me in this pregnancy, I worry that I’ll be panicked and fearful, and that I won’t feel that I can trust our new providers, and I don’t want it to be that way.

Penny Simkin, author of “Pregnancy, Childbirth, and the Newborn” and famous childbirth educator, distinguishes between pain and suffering in labor.  She believes that it is possible to experience labor pain without suffering, and that suffering comes from feeling out of control or believing yourself or your baby in danger.  I certainly experienced both pain and suffering with the birth of my daughter, and it has made me feel panic and fear when I think about giving birth to my son.  But I don’t want it to be that way — I want to feel prepared and powerful when my son is born, no matter what the circumstances.  And whether or not I feel pain (my plan is to start off without pain meds and decide as I go — I’m not going to berate myself if I opt for an epidural), I do not want to suffer with this birth the same way I did in my first.

So, I’ve been trying to think about ways to prepare myself for L&D well in advance of going into labor with my son.  I’m starting to compile a list, partly based on things that I came up with on my own, and partly thanks to suggestions from an online group for women who are pregnant after 2nd trimester loss that has been very helpful to me in this pregnancy (I won’t advertise it here because it’s non-anonymous, but if you are interested and can give me a way to contact you privately I’d be happy to share the information!).

  • Birth classes – This falls into the “obvious” category, but I think it’s going to be very important for me as I prepare to give birth to my son.  The first time around, I had signed up for childbirth classes, but they hadn’t taken place yet, so I only knew the bare bones of what to expect (and I wasn’t exactly in a frame of mind to be educated and deal with things calmly, either!).  As I think about going through L&D again, I want to be informed and prepared for the process of normal labor, as well as common complications and interventions.  For me, as always, knowledge is power.  We are signed up to start childbirth classes at our hospital in November.  One woman from the 2nd trimester loss group suggested seeking out a couple of different classes through different organizations, since the information and format is often very different.  This sounds like a great idea, and I’ve seen free birth classes offered by a local community center that I might look into.
  • Hospital tour – I don’t really need the tour to find my way to the L&D ward of our local hospital — after all, I’ve been there before, for some of the saddest and most painful hours of my life.  When I think of going back there, I shudder.  But I’d rather go back when I’m feeling well and in control than show up when I’m already panicky and in labor.  So I’ve signed us up for an early tour next week, and I might drag my husband back there another time or two before we have to do it for real, just to build some memories and experience there that is different from the birth of our daughter.
  • Making staff aware of our loss – Many people have suggested this in one way or another.  Some are planning to call the L&D ward before they go into labor, others are writing it prominently on their birth plan or making a sign for their door.  Obviously our local OB group knows about our previous loss, but since we won’t know until we get there which doctor will be on call or which nurse we’ll get, we’ll have to think of a way to be prepared to communicate our history and our need for extra understanding and reassurance.
  • Hiring a doula – This is something that we’re considering, but haven’t firmly decided on yet.  There’s some evidence that continuous labor support from a doula can reduce rates of interventions and c-sections… but like most of the literature surrounding pregnancy and birth, the strength of the evidence is a bit shaky.  Still, it seems like it might fall into one of those “can’t hurt, might help” categories, which makes it at least worth looking into.  One of the women in the 2nd trimester loss group has been working with her doula to help prepare herself for birth after loss, which I think sounds great if you can find a doula who is sensitive to the needs of someone who’s pregnant after a loss.
  • Reading positive birth stories – This is something that hadn’t even occurred to me, but it’s true that most of the birth stories you read on the internet are negative.  Since my own first experience with birth was also quite negative, it might help to read about what happens when things go right, to prepare myself with some different visions of what my reality might be, or what I might hope for in a birth.  I think I’ll have to be careful not to get my expectations too high, but since I have plenty of negative birth images and experiences to color my thoughts, I might as well add some positive ones to my arsenal too!
  • Hypnobirthing fear release – This method may be a little too crunchy for me, but since it’s helped other women in the 2nd trimester loss group, I thought I’d mention it.  Apparently if you just purchase the fear release track it only costs $4 — link is here if you’re curious.

So, that’s where I am at the moment.  If you have other ideas for dealing with fear left over from a previous traumatic pregnancy experience, I’m all ears!  I know it probably seems early to be thinking about all of this, but as I found out last time, you just never know when you’re going to wind up in the hospital — so the sooner I deal with my issues the better.

I do feel like I’ve entered a point of relative calm in this pregnancy.  I still feel good physically, I’m enjoying the “new” pregnancy experiences as I get bigger and the baby gets stronger, and I’m starting to plan ahead, just a little bit.  Our nursery is still an empty room… but now it has curtains!  My husband had ordered some curtains for the main upstairs bathroom, which will be the “kid” bathroom eventually, and while they were totally adorable, they clashed with the shower curtain.  So I found us some solid-color curtains for the bathroom to go with the patterned shower curtain, and tentatively suggested that maybe these curtains would look nice in the nursery?  My husband agreed, and installed them immediately.  I think they look great.  Maybe I’ll post a picture once we start to accumulate actual furniture!  After many months of feeling like time was slipping away from us while everyone else’s family was growing and changing, it’s nice to feel like things are moving forward again, to start to make plans, and to keep hoping as hard as we can that things will work out this time, and that our son will fill our house with baby cries and gurgles soon.

Some days are different

Getting pregnant almost exactly a year behind the timeline of our first pregnancy (during which our daughter died at 18 weeks) has been surreal.  Hitting milestones within days of when we hit them last year means that every milestone in this pregnancy is a vivid reminder of the same milestone we hit with our daughter last year, only to lose her just shy of the halfway point in our first pregnancy.  But finally, this week, things have started to feel different.

Mid-September was rough for us, as we passed the anniversary of our daughter’s death and then, a week later, the same gestational point in this new pregnancy with our son.  Now, here I am, 19 weeks and 3 days pregnant, and I can finally say definitively that some days are different.

The anatomy scan was a huge one, of course — the day before the anniversary of our daughter’s death, we went in for an early anatomy scan with our son, and instead of our daughter’s lifeless body on the screen, we had the incredible experience of watching our son wriggle and kick and listening to the sonographer check off normal anatomy point after normal anatomy point.  We’d never had that experience before.  It was new, different, and extremely emotional.

But now I’m hitting reminders of my first pregnancy that are less momentous on the surface, but often more poignant in a lot of ways.

I’m the faculty advisor to my university’s women in science group. Last year during our big start-of-year open meeting, just over a week after delivering my daughter’s lifeless body, I stood in front of a crowd of bright-eyed young female scientists and tried to greet them enthusiastically, all the while still deeply mourning the loss of my daughter who would never get to decide on a college major — and more alarmingly, while feeling in the middle of the meeting one of the large gushes of blood that I did not yet know heralded the retained products of conception that would require surgery later that week (I also didn’t know I had a raging pelvic infection that was in the process of scarring my fallopian tubes, which along with the blood loss probably accounted for some of the weakness and dizziness I felt).  After the meeting I rushed back to my office to call one of the nurses at the OBGYN office and tell her I’d just bled through my second pad in two hours, and she told me to sit down and put my feet up and call them back if the bleeding didn’t stop in an hour.  Well, that was sort of useless advice as I had to teach a class in an hour, and had a special guest coming in to do a neat demo with my class, and I had to greet him and make sure he had what he needed to set up his equipment.  I walked into my department chair’s office shaky and weepy and needing advice, and he told me it was fine if I wanted to cancel the class, but I decided that I’d just sit through the demo and try to stand as little as possible during lecture.  I survived and made it home, only to wind up in surgery later that week.

This week, I led that same women-in-science meeting almost exactly a year later.  This time, I was visibly pregnant, and felt my son kicking while I scarfed two slices of pizza during the meeting.  As I faced a room full of bright-eyed young female scientists, thoughts that my daughter would never be one of them were no longer foremost in my mind (although they were certainly still there) — instead, I wondered more about who our son might be at this age.  Various other female science faculty who had come to the meeting greeted and congratulated me.  I walked back to my office on a bright September day, not in panic, but peacefully.  I taught my class without fearing that I’d pass out.  After class, when I sat down in my office to relax and catch up on email, my son threw a dance party in my belly.  It was such a contrast from the same day last year.  It made me think about my daughter and remember what we lost, but it also drove home that this pregnancy is different from our first.  Last year’s horrors aren’t (yet) repeating themselves (thank goodness).  This pregnancy isn’t picture-perfect by any stretch of the imagination, and I’m still a mess of anxiety, but these new experiences and the reassuring movements that I now feel every day are reminding me that things are different this time.  Now that we’re past the point at which our daughter died, the differences between this pregnancy and our first are more obvious than the similarities, and that’s been an important change.

So here we are, entering the “different” days of this pregnancy.  As I expected, it’s been scary being in the early days of fetal movement, since anytime I don’t feel him move for a few hours I get nervous (after all, I felt our daughter move for a few days, and then didn’t feel her move for a few days, and then we found out she was dead).  Fortunately I’ve got our hand-me-down Doppler to get through the worst of those times.  It also feels like the farther we get into pregnancy, the higher the stakes, since if something happened now or even closer to term, it would be all the more painful — and having barely survived the pain of an 18 week loss, I shy from even considering a later loss.

That said, the differences are also reassuring.  I’ve never needed reminders that this pregnancy is different from my first pregnancy — it’s felt different from day 1.  But I am relieved to have hit the end of the period of eerie similarity — of telling the same people I’m pregnant at the end of summer, of switching to maternity clothes as the semester starts, of going to the same start-of-year activities with the same burgeoning bump (just a different baby inside this time).  Now the experiences feel more new, and I’m finally starting to experience parts of pregnancy that I never experienced in my first pregnancy.  It leaves me wistful for what we missed out on in our first pregnancy, but mostly grateful that this pregnancy is happening and hopeful that our son’s outcome might be different.  As I hit the halfway point this week, I’m thinking about February, and finally starting to imagine what life might be like with a living baby in the house.

More Pregnant Than I’ve Ever Been Before

As I write this, I’m 18w3d pregnant, which officially makes me More Pregnant Than I’ve Ever Been Before.

The last 1.5 weeks have not been easy.  I felt OK emotionally leading up to the anniversary of the day we found out our daughter had died (September 11), but then was thrown for a loop by a repeat of some symptoms that had occurred at exactly the same gestational stage in our first pregnancy, just a few days before our daughter died.  I won’t go into details, but think GI bug.  They had told us the first time around that it was unlikely to be related, and I was tested for a bunch of different food-borne pathogens that can cause pregnancy loss and everything came back negative… but it was still just incredibly disconcerting to spend the anniversary of our daughter’s death having the same symptoms at the same gestational stage that I’d had the year before, and which preceded her death by less than a week.  And by “disconcerting” I mean that it completely freaked out my husband and me.

I put in a teary phone call to MFM that day and wound up talking to a nurse who spoke to me like I was four years old: “You know, even though they’re in the same part of your body, your digestive system and your reproductive system aren’t actually connected…” and “You may not be aware of this, but one in five pregnancies doesn’t make it to term, and sometimes lightning strikes.  That’s probably just what happened to you in your first pregnancy: bad luck!”  Neither of which was helpful to me to hear at the time (also, I wish people would stop quoting the one-in-five statistic at women who’ve experienced second trimester losses — for us, the odds are about 1%, and half the time the problem is a non-chromosomal issue that makes future pregnancies more risky!).  I thought I was getting better over the weekend, but when Monday brought a renewal of my GI symptoms I put in another panicked call to my local OB’s office and had a teary visit with the one doctor in the practice I’d never met before who checked me over (including making sure my cervix was closed) and then proceeded to bemusedly tell me I was probably fine and that I should really be trying to enjoy this pregnancy because you don’t get that many pregnancies in your life and it’s a wonderful and beautiful and miraculous thing.  Which also was not something that was helpful to hear at that moment, even if I appreciate the sentiment (did she think it just hadn’t occurred to me before that I should try to enjoy this pregnancy?).

Anyway, fortunately I had just received a package in the mail the week before, containing a home handheld Doppler from a friend who had gone through infertility not too long ago.  I had thought I wouldn’t use it, but being able to regularly check that our baby was still alive for the few days after my freak-out in which I was constantly convinced that he was dead really saved my sanity last week.  Now I’m finally feeling like I’m past whatever disrupted my GI system, the baby has survived, and I’ve made it past the emotionally difficult anniversaries.  Things are finally looking a little brighter.

I also had the experience this week of going back to visit the institution where I had earned my PhD to give a prize colloquium.  It was the first time it was clear from other people’s reactions that I was visibly and obviously pregnant — perhaps because people there knew me well enough to know that I don’t normally have a giant belly, so they were more comfortable than total strangers about commenting on the fact that I was pregnant.  Many people commented immediately, as soon as they saw me.  With others, when it came up in conversation that I was pregnant (I’d mention that I was going to be on leave next semester), their surprise made it clear that they hadn’t noticed at all.  It was funny — I’d have thought that the younger faculty with young kids at home would be the most attuned, and the older men the least attuned, but it absolutely didn’t work out that way.  The old male scientists were often the first to notice and immediately comment!  Maybe the ones with young kids are just too sleep-deprived to notice who’s pregnant and who’s not?

One experience that showed me that I’ve gained some equilibrium talking about our experiences with pregnancy loss was an awkward moment at the dinner after my colloquium.  One of the nearly-retired male faculty asked me, “Wait, is this your first?  For some reason I thought you had another…” and I was able to easily answer, “Well, that’s actually a complicated question.  Last year I was pregnant, but the baby died at almost exactly this stage in the pregnancy.”  I didn’t tear up at all — I was able to just be matter of fact about it.  I didn’t feel that I could have answered any other way, especially since three of the eight people at the table (my PhD advisor and two of my closest collaborators) knew what had happened, so I just figured I’d put it all out there.  I was sitting next to a senior woman who’d been a fantastic mentor to me during grad school, and she proceeded to tell me that in the process of having her three boys (the eldest of whom just went off to college this year), she had three miscarriages along the way.  So we talked about it on our own for a while, and then the conversation moved on, and that was that.  Not long ago, I wouldn’t have been able to have that conversation, but even on the day that I hit the same gestational stage that our daughter had died, I was OK with it.

And now… I’m just trying to look forward to experiencing new parts of pregnancy.  From here on out it’s uncharted waters for me, and while that’s a bit scary, I’m primarily thankful that I’ve made it this far and I’m looking forward to the parts of pregnancy that I never got to experience the first time (my friends who have had normal, full-term uncomplicated pregnancies think I’m nuts and tell me it’ll be miserable, but I don’t care!).  I already feel my son moving inside me more strongly than I felt my daughter, and I’m looking forward to feeling more distinct kicks and hiccups as he grows.  I’m starting to love my growing belly again, and am actually looking forward to seeing it get bigger and bigger over the next few months.

I’m even feeling that maybe I’ll be able to start thinking about decorating the nursery and accumulating a few basic baby items sometime soon.  I’m not putting any pressure on myself to do that — I know that if it doesn’t get done before the baby arrives that’s OK (infants don’t need much, after all) — but if I can bring myself to do it I think it’d be nice to have that normal nesting part of pregnancy, and might help me start to feel closer to my son.  The room we’ve left empty in our house since we moved in last June has been a source of complicated feelings for me over the past year and a half, and part of me really wants to start to fill it and make it look like the home for our baby that we’ve always imagined it would be.  After everything we’ve been through, I hold tightly to the thought that no matter what happens in this pregnancy we WILL be parents one way or another (probably through adoption if our son doesn’t make it), and creating that space would for me be an act of hope for our developing role as parents as much as it would be an act of love for this particular baby-to-be.  I think maybe I can be OK with that.

Anatomy

This morning we had our early anatomy scan, at 17 weeks.  Spoiler alert: it’s all good news!  But man oh man, have I been a mess until now.  Tomorrow is the anniversary of the day we found out our daughter died, and next week our son hits the same gestational stage.  I’ve been… a little bit of a wreck the last few days.  This morning I woke up at 2:30am with my mind buzzing full of worries about anatomy — I couldn’t get back to sleep, so I picked up a book, “read” it for a while, and finally fell back asleep around 3:30.  Then I got up with the dog at 6:30, went downstairs, turned on my laptop, and read the horrifyingly sad post by Sweeping Up the Broken Pieces about her second bout with neural tube defects (which is probably going to lead to her third TFMR), which was just discovered on ultrasound this week.  I sobbed for her.  I’m not linking to her blog here, because I don’t want any pingbacks to what has turned out to be happy news for us to hit her at a vulnerable time, but seriously, if you don’t already follow her blog, head over there and give her some support (just google “Sweeping Up the Broken Pieces blog”).  The universe is a crappy place sometimes, and it’s being particularly crappy to her right now.

With all that buzzing in my mind, we loaded up the car this morning (my mom had driven from two hours away to come to the anatomy scan with us) and headed down to MFM.  They were running way behind, and our ultrasound took place almost an hour after it had been originally scheduled, so I got to spend plenty of time biting my nails and discussing choroid plexus cysts with my mom (who is a women’s health nurse practitioner) in the waiting room.  Our sonographer was soft-spoken and reassuring (I asked her to tell us as much as she could during the scan), and as she snapped measurement after measurement and I slowly started to realize that maybe everything would be OK this time, the tears started rolling down my cheeks.  I managed to hold it together enough that I don’t think anyone else realized I was crying (if the sonographer did, she didn’t say anything).  But it was just so emotional after the horrific ultrasound 364 days ago in which the OB made the same measurements on our lifeless daughter that it just totally undid me to finally see a healthy wriggling fetus at last.

The scan went on so long that my husband started yawning (after all, he had been inadvertently woken up by a freaked-out pregnant lady at 3am), and I almost fell asleep.  Apparently our little guy was being super-stubborn about getting into a position that would work for one particular view of the heart that they wanted to get.  The sonographer called in the doctor, who tried unsuccessfully for a while, and then after a break the sonographer tried again.  They tried everything — lots of tummy jiggling, running the ultrasound transducer up past my belly button to get a sideways view, tilting the table until I felt like I was going to slide off head-first (by that point the doctor had come in, and he was much more taciturn — he just said, “hold onto the sides, please,” and I really think I would have fallen off if I hadn’t!), and finally having me get up and walk around to try to get our little fellow to turn.  But nothing worked, and eventually they gave up and said they could either have me come back for a short ultrasound next week just for this one snapshot of the heart, or they could just do it when I come in for my regularly-scheduled growth scan in four weeks.  Since everything else looked normal (including every other view of the heart — four chambers, arteries, whatever else), we decided we could wait four weeks to tick the last box on the anatomy scan, and for now at least I’m feeling completely OK with that plan.

Everything else looked great — amazing, really.  Tiny kidneys, brain, spinal cord, some cute shots of his nose and lips, fingers, feet (and, yup, a penis!) — all parts present and accounted for.  There were a bunch of really neat color Doppler images of blood flow through the heart, umbilical cord, and arteries — you could even see the tidy spiral of the blood vessels around the umbilical cord.  Our boy was more active at the beginning of the scan, wriggling and moving his arms and legs, and then I think he fell asleep at some point (my mom said they generally have ~half-hour sleep/wake cycles at this point, and indeed, it was about half an hour into the scan that he seemed to want to take a break and rest, in that unfortunately inconvenient position).  Then we had a quick check-in with one of the MFM attendings to talk about adjusting my Lovenox prescription, and finally headed home just in time for lunch.

It’ll be another week and a half until I’m more pregnant than I’ve ever been before, but it’s really exciting to (mostly) pass a milestone — a normal anatomy scan — that I never reached in my first pregnancy.  I still know that anything could happen with the placenta, and that abruption risk has nothing to do with fetal anatomy, but it still feels like something new, different, and GOOD, which is a really nice feeling to have.  Hopefully this good news will carry me through the emotional minefield of the next week and a half.

So that’s our story!  I continue to have freak-outs, and we continue to have nothing but good news at every turn. I’m showing enough now that I’ve gotten my first “Are you sure there’s only one in there?!” (from a retired old bachelor scientist), and people are starting to notice before I tell them.  I still haven’t had the nerve to bring it up with any students (even my research group, which is starting to be problematic as they make their plans for the year), but that will inevitably happen soon.  Every week feels a little bit more real, and today was a huge step towards believing that maybe, just maybe, we’ll be able to bring home a living child this February.

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.

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!