Tag Archives: breastfeeding

Slow-Motion Miscarriage

I really wanted medical management of my miscarriage, i.e., to take medication to speed it along.  I wound up not having that option, since my indicators last week were not great, but also not totally inconsistent with a healthy pregnancy.  Since my doctors weren’t sure, they didn’t want to intervene with medication or surgery (a decision I certainly understand and agree with), which meant that I wound up undergoing a slow-motion miscarriage as, over the course of the week, I slowly went from spotting to bleeding to passing tissue and knew that it was over.  An ultrasound this morning confirmed that my body passed the tissue on its own (even though I am still bleeding), so I have officially miscarried.  Gravida 3, para 1.

The strange thing about going through a slow-motion miscarriage is that you can’t just curl up at home with a pint of Ben & Jerry’s and wait for it to pass.  I mean, I guess you could (perks of the flexibility of an academic job?), but mine has gone on for at least a week, and that would require more pints of Ben & Jerry’s than I am really comfortable consuming.  So, as a result, I wound up doing a lot of things that I never imagined I might do while having a miscarriage:

  • Having a miscarriage during research meetings with my students and postdoc
  • Having a miscarriage while talking with my department chair
  • Having a miscarriage while writing an invited major review article on recent advances in my field
  • Having a miscarriage while sitting on the grass and listening to a student folk music concert with my toddler
  • Having a miscarriage at my department’s end-of-year party
  • Having a miscarriage while baking cookies and playing board games with my old college roommate, visiting from New York City
  • Having a miscarriage during an ice cream fundraiser for my son’s daycare

I mean, on the one hand, if you have to have a slow-motion miscarriage, many of these things are quite pleasant ways to pass an otherwise depressing time.  On the other hand, I’ve felt weirdly disconnected from my life this week, and it’s bizarre to be engaged in some other activity and then have the intrusive thought “wow, isn’t it weird that I’m doing this while having a miscarriage?”  It also feels strange, and somehow dishonest, to interact with other people when they have no idea that you’re having a miscarriage during the interaction — but not quite enough that I really felt like telling them about it (I did tell the two close friends who happened to call this week, and my visiting college roommate).

It’s also frustrating because my son seems to be old enough now that people feel comfortable asking me if we’re planning to have another baby.  Twice this week alone, I got the question, and not from people that I’m particularly close to.  I wanted to yell at them that I was having a miscarriage, and they really shouldn’t ask questions about people’s reproductive plans (or at least point them to this amusing flow chart).  Instead, I just gave my stock answer of “we’ll see!”

One thing I found both disturbing and reassuring this week was a recent study on 2nd and 3rd trimester loss that was published in 2016.  I wasn’t aware of it until this week, since it wasn’t published yet when I was scouring the literature after we lost our daughter in September 2014.  I thought it was such a great study that I emailed the author to thank her for doing the work, particularly since there seems to be so little research on 2nd trimester loss.  You can read the full article here, but these are the two main takeaways for me:

  • Second and third trimester pregnancy losses are strongly correlated, indicating similar etiologies.  Once you have had a 2nd or 3rd trimester loss (including before 20 weeks), you are about an order of magnitude more likely than a typical woman to have another one.  The overall probability is about 4%, with recurrence more likely if the cause of your first loss was placental or maternal, and less likely if the cause was fetal or unexplained.  (This was the disturbing part — my first loss was placental/maternal, which puts me in the higher risk category of ~8% recurrence.  I sort of knew that already, but this was the first time I’d seen the probabilities broken down in that way.)
  • First trimester miscarriage is not correlated with 2nd or 3rd trimester loss, including recurrent 2nd or 3rd trimester loss.  Roughly a quarter of previous pregnancies ended in first-trimester loss for all the women in the study, regardless of the number of previous 2nd or 3rd trimester losses, which is not significantly higher than the general population.  (This was the reassuring part — it makes it more likely that my current miscarriage was just run-of-the-mill bad luck.)

So, anyway, here I am, just waiting again.  Waiting for the bleeding to taper off, waiting for my cycles to reestablish themselves, waiting to see if we can get pregnant on our own again.  The OBGYN had me make a follow-up appointment for August, mostly as a chance to check in and come up with a plan if necessary.  She half-suggested that I could go for an infertility evaluation at the local big state hospital system if I wanted, but since I’m already being followed by an RE at the other major hospital system in the state I figured it wasn’t necessary, at least not yet.  As I discussed with her, while it’s great that we spontaneously conceived (and so quickly!), it does make it hard to know how long to wait before going back to the RE again.  I did put in a note through the electronic messaging system to my RE to update her about this pregnancy and ask if she had any suggestions moving forward, and her one suggestion was: stop breastfeeding.  I’m not quite ready to do that yet, and it seems pointless to go back to her before I am.  So I guess the plan is to wait a few months, see what my cycles are up to, and then reevaluate.  I think I’m OK with that plan for now.

My Blog Title is Apt Again

Well, whaddya know.  I’m pregnant.

It has never taken us less than 8 months to conceive before.  This time, first try.  We are thrilled and a little stunned.  I’ve always been a little skeptical of the stories you read of how people who have experienced infertility/loss often get pregnant quickly after a full-term, healthy pregnancy — I mean, maybe it happens to some people, but I was sure it wouldn’t happen to me.  Well, here I am!

For now, of course.  I know as well as anyone that first trimester miscarriage is a distinct possibility, as are losses at later stages of pregnancy, as are all manner of other health problems (I’m still at elevated risk for ectopic pregnancy and placental abruption, for example).  But for now I’m pregnant, and that’s a very, very good thing.

We’re a little shocked at the timing — I mean, we were trying to get pregnant, obviously, but we just didn’t expect it to happen this quickly.  Of course our minds started jumping to the possible reality of having a new baby join our family in January.  Two under two — yikes!  It would also throw a monkey wrench into my tenure plans (I’d been on track to submit my materials a year and a half from now), but… we’ll deal with that.  Our family is more important than my tenure case, and if I wind up using both my clock extensions and spending nine years on the tenure clock, so be it.

I was also just starting to cut back on pumping at work this week, but for the moment I’m still breastfeeding/pumping four times a day, which is going to start feeling like a lot as I get more pregnant.  But… what if I wean, and then miscarry?  I’ll be mourning the loss of a baby simultaneously to mourning the loss of a wonderful breastfeeding relationship.  I suppose I’ll just keep doing what I’m doing (i.e., weaning from the pump during the day, since I would never mourn the loss of a relationship with my pump!) and see how things go over the next few weeks.  I’ve got a viability scan scheduled for a week from Monday, after which we’ll know a little more (and, if all goes well, I’ll start back on Lovenox).

What a weird and wonderful week it’s been.  Pregnant again.  Holy cow.  Here’s hoping this little bean sticks around!

Dragging My Feet on Trying Again

I’m curious whether any of you have ever felt this way.  Before we were pregnant with our daughter, and then again after her death, I was laser-focused on getting pregnant as quickly as possible.  I was temping, I was charting, I was using OPKs, I was doing everything I could to time things properly and maximize chances of conception.  This time around feels… different.

I want another living baby, very much.  Therefore, I want to be pregnant again.  And rationally, I realize it makes sense to start trying now.  It has never been easy for us to get pregnant, and it probably won’t be this time either.  I’m 34, so Advanced Maternal Age is staring me in the face.  If we want another kid, there’s no time like the present, clearly.

But… our son is still so little.  Our breastfeeding relationship is still going strong.  He’s only just started reliably sleeping through the night.  I’m enjoying the mommy-daddy-baby triad and am not eager to upset it with another little one, even though it’s absolutely what we want for all three of us in the longer run.  Starting over with a newborn sounds exhausting.  Being pregnant again sounds exhausting.  Heck, even getting pregnant again sounds exhausting — getting pregnant with my son was an exhausting and heartbreaking almost-2-year-long haul, counting everything we went through with my daughter.   That’s part of what makes me eager to get started sooner rather than later, but it’s also a big part of what’s making me reluctant.  I just can’t imagine going through it all again.

So, I’ve been dragging my feet a bit.  Just last night my husband asked… isn’t this the week?  And I was surprised to realize that it was, and I just hadn’t really been on top of keeping track.  But he’s keeping track, apparently!

Are we really ready to get back on this roller coaster?  I know that another living baby in our family will be more than worth it in the long run.  But it’s been a LONG run to get to where we are now with our son, and it’s daunting to think about going through it all again.  There’s also my tenure clock lurking in the back of my mind.  If all goes as planned, I’ll submit my materials about a year and a half from now.  Another baby between now and then would practically require me to push back that clock.  But since it’s probably going to take us a while, it still makes sense to start now so that ideally our pregnancy will be timed (ha!) so that my due date would be shortly after I submit my materials.  So there’s the gamble about trying to time it so that it’s soon… but not too soon.  But I also fully subscribe to the mantra that there is no good time for a baby, and that the potential pitfalls of waiting too long are far more dire than the pitfalls of moving back my tenure clock a bit… or even than not getting tenure at all.

Maybe it’ll be easier this time.  Maybe we’ll surprise ourselves and get pregnant quickly without intervention (unlikely, but possible).  Maybe I won’t lose another pregnancy.  Maybe the Lovenox will just inject itself every day.  Maybe we’ll get a magical easy newborn (ha).  Right now, it just looks like a lot to handle, and I’m tired (but not newborn tired, thankfully!), and I want to enjoy my son, whom I love to the very depths of my soul and with whom I never feel like I get to spend enough time.  I’m sure this ambivalence is normal.  But I’d love to hear any thoughts about how to get past it.

In other news, S continues to delight.  He’s walking and climbing all over the place these days, and starting to communicate.  No clear words yet, but definitely several expressive gestures that he uses in different contexts (I won’t call them “signs” because they’re not the official ones that I’ve been using with him, but he has clearly developed his own signs — instead of “all done,” for example, he’ll grab the front of his high chair tray with two hands, and just this morning he also did it when he wanted to get out of his jumparoo.  It was very clearly the same communicative gesture in a different context, and it was so cool to see that he is actually putting together the pieces for communicating with other humans!).  He’s big into blocks and wheels and gets delighted whenever he manages to balance a thing on top of another thing.  He’s very snuggly and pretty social and loves to hang out with our friends and family members, or walk outside and just look at the world and touch the bushes and trees.  I simply can’t get enough of him these days!  Having another little one to watch grow up has to be just as great… right?

Breastfeeding and Trying Again

OK, here’s the thing… we are three weeks away from my son’s first birthday.  There are many amazing things to reflect on at the end of this first year.  I am acutely feeling the parenting cliches: on the one hand, it feels like only yesterday that I was holding my wide-eyed newborn son in my arms, and on the other hand, it feels like he’s been with us forever, and I can hardly remember my life without him.  There are many more things I hope to write about as his first birthday approaches and passes, but another thing I’ve started thinking about as his first birthday approaches is our strategy for conceiving the  living sibling we hope that he will one day have.

Surprisingly for me, my thoughts on trying to conceive our third child are all tangled up with my feelings about breastfeeding my son.

Conception and pregnancy have never been easy for us.  It took 2.5 years from the time we started trying to conceive to the birth of our son.  There were two pregnancies along the way, including the loss of our daughter in the middle of the second trimester.  Both pregnancies involved consultation and testing with a reproductive endocrinologist, and the second time around the RE had recommended moving onto IVF due to tubal factor infertility, which we were in the process of preparing to do when I became spontaneously pregnant with my son.  I am not expecting conception or pregnancy to be easy the next time around either.  Tubal factor infertility (in my case, due to the infection and scarring that occurred after the loss of our daughter) does not tend to get better with time, and it might have gotten worse since the birth of our son.  It is likely, though not definite (we might get lucky again!), that IVF is in our future.

What does all of this have to do with breastfeeding?  For one thing, breastfeeding influences menstrual cycles.  My period returned when my son was 10 months old, but it’s been irregular.  While I’m breastfeeding, it may remain irregular, but I won’t know whether the irregularities are due to breastfeeding or some other hormonal imbalance.  Muddying the waters, I had wildly irregular periods for 11 months before conceiving our daughter, and then clockwork regular periods for 8 months before conceiving our son.  We’d like to try for a while on our own before going back to the RE, but it’s trickier while my periods are irregular.  There are also some data indicating that breastfeeding might impede implantation and reduce the likelihood of pregnancy.  Finally, most REs make a blanket recommendation that you should cease breastfeeding before starting fertility treatments, although it’s not clear how evidence-based that recommendation is.

Many women think of it as a tension between their living child and their hoped-for child: do I prioritize the breastfeeding relationship with the child I have and love, or do I wean in order to maximize the probability of conceiving the child I hope to have?  I suspect there’s a middle-of-the-road option I might be comfortable with, but I’m not yet sure what that looks like.  My breastfeeding relationship with my son is still going strong as his first birthday approaches, but he doesn’t seem to be as attached to breastfeeding as some of my friends’ children.  He doesn’t really ask to breastfeed very often, and he’ll often refuse when I offer because he’s much more interested in seeing what’s going on in the world around him and doesn’t want to take any time out to nurse.  So a bit of mama-led weaning might be well received.  At the same time, I love our breastfeeding relationship and am not sure I’m ready to encourage its end, plus I know that my son derives comfort from it, especially when he is sick or tired.

So, what does our plan going forward look like?  When he was first born I thought “We’ll start trying when he’s a year old, and go back to the RE at six months.”  Now, with no end to breastfeeding in sight (and, honestly, with sex still kinda uncomfortable thanks to the breastfeeding hormones), I’ve started to think “Maybe we’ll start trying when he’s 18 months and go back to the RE when he’s 2.”  I don’t want to wait too long, because I’m not expecting the road to be easy, and I’m not getting any younger.  I’m turning 34 next week, and staring Advanced Maternal Age squarely in the face.  I know that timing can make a huge amount of difference in IVF cycles, and that waiting to even go back to the RE until I’m already 35 (when my son turns 2) might be risky, especially since we’d love to keep the option of a third living child open if we are lucky enough.   I feel sad contemplating the end of our breastfeeding relationship.  But the experience of having our son in our lives has only made our desire for another living child stronger, and my husband and I don’t want to wait too long.

Nursing on the Tenure Track

Hello, everyone!  It’s been a while, but I’m still here, mostly reading and commenting on all y’all’s blogs, but also thinking about writing once in a while.

First, a quick update: Little S is 10.5 months old.  He has 7 teeth (with tooth #8 about to pop through any day, poor guy), and is right on the brink of walking and talking (he walks with a push toy, and can stand for a couple of seconds before plopping down on his bottom.  I think he’s been trying to say the word “cow” for one of his favorite toys and “dog” when we see dogs out on our walks).  The best parts of the last week have been (1) he learned how to splash in the bathtub (wet, but fun!), and (2) we took him sledding for the first time after Saturday’s snowstorm — he was skeptical, but didn’t cry, so it’s a win, I think!

Our nursing relationship is still going strong.  I didn’t really think much about nursing long-term before he was born — in fact, when our weirdly aggressive breastfeeding instructor demanded to know my nursing goals while I was still pregnant, I stammered out “um, try it and see how it goes?”  Then, my kid was a born sucker (there’s one born every minute, after all), and I was surprised to discover that I really loved our nursing relationship.  It’s not all roses, of course — I seem to be prone to plugged ducts (not mastitis, thankfully), and it quickly became apparent that the downside of nursing is that a small human is still physically dependent on your body months/years after you’ve finally evicted them from the inside, so your freedom is a bit limited.  But on the whole I feel so fortunate that it’s worked for us, and I love the closeness and the special relationship that it’s helped to develop between my son and me.  Nothing beats that snuggle time.

Another thing that I didn’t think much about before my son was born was how moms combine nursing with work, particularly academia.  I mean, I vaguely knew that women pumped while they were at work, and that lactation rooms were supposed to be a good thing.  But man, it’s a whole lot more logistically complicated than I ever imagined.  We had a few challenges that were somewhat particular to my baby: for one, he never took a bottle, which made it complicated for anyone other than me to feed him.  When I went back to work part-time four months after he was born, his dad finally figured out a labor-intensive cup-feeder solution, which the daycare ladies gamely continued until he was 6 months old and learned how to use a sippy cup.  But he would refuse to eat from anyone other than dad or the daycare ladies, and actually these days he generally refuses to take a sippy cup from dad.  When I organized a conference at my university that took place on a Saturday when he was 7 months old, the little guy went on a hunger strike and my husband brought him to me to nurse over the lunch break so that he wouldn’t have to go 12 hours without eating.  Even if he had been one of those normal babies who takes a bottle without a fuss, it’s never easy to leave home as a nursing mom, because for every feeding you miss you have to pump to keep yourself comfortable and keep up your milk supply.

Which brings me to pumping circumstances.  I’m very fortunate to have my own office with a door that closes and locks.  However, all the faculty/staff offices in my building share a single key, and occasionally people will let themselves into my office if they think I’m not there, to leave something on my desk or change a lightbulb or whatever.  So, yeah, after one awkward incident, I made a great big sign for my door as well as a smaller sign that hangs from the doorknob and covers the keyhole when I’m in there.  Also, my window shades are almost as old as my 100-year-old building, and don’t close all the way, and my window is right at eye level on a staircase that students sometimes use to leave the building.  Oh, and the electrical system in our 100-year-old building is flaky, so there have been days when the lights in my office flicker in time with my breast pump, which is a little disconcerting.

I thought that lactation rooms sounded like a great idea, until I had to use one when I went to a conference at a large research center in November.  Don’t get me wrong — I think they’re infinitely better than what most women have, which is nothing more than a bathroom or a broom closet.  But once you’ve been pumping for a while, you realize how critical the timing is.  I found that with my tendency towards plugged ducts, I couldn’t safely go more than about 3 hours between pumping sessions (maybe 3.5 if I stretched it), at least when I was at peak milk production when my son was around 6-8 months old.  If I fed my kid at 8 before we left for the day, then my ideal pumping times were ~10:30, 1, and 3:30, and then I’d nurse him when I got home around 5:30.  The problem with a lactation room is that most of the other women are on the same schedule, so everyone wants to pump at ~10:30, 1, and 3:30, and nobody wants to pump at 9:30 or 4 — so the lactation room is empty most of the day, but crowded when you need it. Surely there must be a better solution!

Speaking of schedule issues, when I was teaching last semester, my class met from 10:20-11:40am, which meant that I had to pump around 9:45am to get to my class in time to set up, hand back papers, and have everything ready to go.  Then after class I’d be swamped with students until at least 11:50, which meant that if I had a lunch meeting or seminar I had <10 minutes to pump, which wasn’t quite enough time, so I either had to arrive late at my lunch meeting or pump after the lunch meeting, which meant stretching the time between pumping sessions to >3hours — and then if I got held up at the lunch meeting, it could easily go to 3.5 hours or beyond.  Two plugged ducts later I decided it wasn’t worth the risk, so for the rest of the semester I was late to all my lunch meetings and seminars on teaching days.  (I was totally ready to play the “breast pump” card, but nobody ever asked — I hope they don’t think I’m flaky now.)

The other thing is, I have no idea how nursing moms manage all the travel in academia.  I have a number of advantages, including a husband who works from home and has a very flexible work schedule, plus my son has three supportive grandparents, two of whom are retired.  For the conference in November, my husband came along.  The conference was three days long, but we compromised so that I went for 1.5 days and then we came home so that my husband only missed two days of work but I still got to go to half the conference and give my invited talk.  In February we are going to a two-week-long workshop in California (I was actually invited to attend for all three months of the workshop, but that was totally unrealistic, so I settled on two weeks instead).  One of the grandparents is tagging along to babysit for the first week, and my husband is coming out for the second week.  I am already dreading this, partly because upending my son’s schedule is going to make him a cranky, whiny, sad little baby, and partly because I suspect he’s going to go on a sippy-cup strike which will stress my mom out while she’s trying to babysit and will mean she’ll probably wind up bringing him to me at the conference at least a couple times a day to nurse.  He’s doing pretty well on solids these days, so the nursing intervals are starting to stretch out, but he still nurses quite a lot.

When people talk about how to support young parents, especially young mothers, in academia, they talk a lot about conference daycare and lactation rooms.  What I could really use to help me continue traveling is money, with the flexibility to use it however I need.  In addition to my normal conference costs, this two-week trip is going to also require us to pay for two extra plane tickets (my mom’s and my husband’s), two weeks of a rental car (which I wouldn’t normally splurge on, but with a baby it seems necessary), all the extra food for my mom and husband, and then there are the hidden costs of my mom and my husband taking vacation time from work.  We are fortunate enough to be able to afford it, but if we weren’t so lucky, it would be a real barrier to my attendance at the conference.  If I were going for only a day or two, it would also be immensely helpful to have funding to pay for a service like Milk Stork — I know people in business careers whose companies have agreed to pay the cost of Milk Stork while they are on work travel, but it’s not exactly the kind of thing I can charge to a research grant (as far as I know).

As a pumping scientist mom, I have had some fairly wacky pumping experiences, including pumping in an old Nike radar station and a transmission electron microscopy lab.  It actually felt weirdly empowering to pump in such super-sciencey places — I am science mom, hear me lactate!  🙂  And as tricky as it’s been to combine pumping with academia, I’m still more than a little bit sad to think that our nursing relationship is already starting to wind down as my baby grows up.  Honestly, part of me loves that nursing gives me a reason to bring my son along to conferences, instead of leaving him for days at a time.  In his whole life, I’ve never been away from him for more than the length of a daycare day, and I’m dreading the first night that I spend away from him (y’know, except for the uninterrupted sleep part).  I’d also really like to continue nursing for as long as he’s interested, but I’m just not sure how realistic that is with all the travel that my job requires.  I’m a little bit worried that I’ll inadvertently wean him (or totally distress him) the first time I have to leave him for several days.  It’s also having an impact on my career: for example I’m probably going to turn down an invitation I received to a conference in Germany in April because I just can’t imagine that a week-long separation is going to work at this point.  That said, if having a baby has taught me anything, it’s that with babies, change is the only constant.  He’s already getting very fidgety at our nursing sessions and nursing for shorter times and less frequently than he used to, so maybe he’ll surprise me one day and just decide he’s done, and I’ll shed a tear and pack up my pump and move on with life.  We’ll see.  I feel fortunate to have made it this far, and I know that I am luckier than many women who don’t have the flexibility to make an extended breastfeeding relationship practical.  And knowing that our breastfeeding relationship is finite makes those snuggles all the more precious while they last.