Tag Archives: pregnancy

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!

So, are you going to have another one?

The questions have started.  It really didn’t take long.  Mostly I just shrug them off with a blithe “We’ll see!”  But in the past few weeks I’ve had lunch with a couple of friends who really helped me through the dark time between our daughter’s death and our son’s birth, and both times it’s come up.  With them, it was harder to shrug it off.

The honest answer is “We want more kids, and I’m terrified.”

I guess it shouldn’t be a surprise that giving birth to a dead baby scars you for life in the baby department (literally as well as figuratively, in my case, alas).  But I still found myself tearing up as I talked with my friends and admitted that we absolutely want another baby, but that the thought of going through all of this again is terrifying.

I do think it’ll be easier to handle the uncertainty this time around, because I have a beautiful baby boy to distract me and I won’t have to deal with those awful feelings that I might never be a parent at all.  This time, I’ve got my son, and he’s a precious and amazing gift that I will never take for granted.  He also makes the time speed by — without him, as we waited for him, it was so easy for time to crawl.  So, there are a lot of things that will hopefully make this time around less daunting.

But it’s still daunting.  When my period does come back, I may still have to deal with irregular cycles.  The scarring of my uterus and fallopian tubes won’t have gotten any better, and might have gotten worse.  IVF might well turn out to be our best/only option.  If I manage to get pregnant, I’ll go back on daily injections of Lovenox.  I have to face the possibility that I might lose another baby, miscarriage statistics and my history being what they are.

It’s not something I’ll have to face immediately (for one thing, my period still hasn’t returned, hallelujah!).  But we also don’t want to wait too long.  It took us 2.5 years to have a living baby the first time around, and I’ll be 34 by the time we can start trying again.  Biology is ticking along: Advanced Maternal Age, here I come.

For now, I’m content to hang with my amazing son who is getting more amazing by the day (he just started pulling himself up to a standing position this week!).  His presence in our lives is so incredible that it feels extremely greedy to hope for more, and difficult to imagine that another baby could be as wonderful.  And I won’t lie — as things finally get easier, it’s also daunting to think about starting all over again with a newborn.  But my husband and I both want him to grow up with a sibling.  It still feels like there’s someone missing from our family.  There is no doubt in our minds that we’ll try again, however scary it feels to take that leap.

And as I snuggle my baby boy, and watch him grow bigger and stronger and start to become he independent person he’s supposed to be, one of the things that consoles me about the loss of his babyhood is that there might be another babyhood on the horizon.  As excited as I am to see him grow, I’m also not ready to give up being mom to an infant forever.  It’s such a special time.  I’m sure all ages are special in their own way, but as my baby stretches taller and moves faster and transforms into a toddler before my eyes, I can’t help but yearn to someday have another infant strapped into the carrier on my chest, snuggled into my lap, sleeping sweetly (if only occasionally).  What a beautiful time of life this is.  How tantalizing to begin to hope that I might get to experience it again.

Due Date

Today is my due date.  Still no sign of baby, but in honor of going the full forty I thought I’d post my series of bump photos.  We took one every four weeks, which I wanted to do partly because I regretted having almost no photos of my first pregnancy.  It’s kind of amazing to me how tiny my bump actually looked in the early photos, considering that I remember feeling huge when they were taken.  Today I am legitimately huge, and we have finally served baby boy his eviction notice.  Six days and counting, kiddo!  Without further ado…

16weeks

16 weeks

20weeks

20 weeks

24weeks

24 weeks

28weeks

28 weeks (also Thanksgiving Day)

32weeks

32 weeks (also Christmas Eve)

36weeks

36 weeks

40weeks

40 weeks!

A Plan

Today we had our last scheduled appointment with our local OBGYN group, two days before my due date.  We got the full workup (ultrasound, NST, exam) and discussed The Plan from here on out.

The results of the full workup are that baby is looking great, positioned in the same optimal birth position he’s been in for a few weeks now (lying with his head square on my cervix, facing my back), and my cervix is starting to change, but is not yet considered “ripe.”  (For those who like numbers: 1.5cm dilated, 40% effaced, -3 station.)  Of course, cervical info like this is nearly meaningless — it’s entirely possible that left to my own devices I’d stay at the same numbers for weeks, and it’s also entirely possible that I could go into spontaneous labor tomorrow.  But it was encouraging to hear that something is happening.

Then came the talk about The Plan.  I didn’t really know what to expect, but the doctor just came out and said, “OK, I know you have a preference for Dr. X in our practice.  She’s on call next Wednesday, when you’ll be 40w6d.  What if we start cervical ripening Tuesday night and plan to induce on Wednesday?”  I agreed, they scheduled it, and it’s on the calendar.

It all happened so fast I didn’t really feel like I could think it through in the moment, but now I have some very mixed feelings, probably because I feel like this is a problem that just has no correct answer.

It’s a little earlier than I’d wanted, but only by about two days — I’d been ready to ask for cervical ripening to start at 41w0d, followed by induction, so this is two days earlier.  Two days isn’t a lot, but given where I am in pregnancy, it could very well be the difference between spontaneous and induced labor.  Or not — the problem is, there’s just no way to know.  Since two days is unlikely to make a substantive difference, maybe it’s worth it to have the doctor we prefer… but not if induction winds up leading to an otherwise avoidable C-section (not that there’s any evidence that this would be the case — the best recent studies indicate that induction at 41w does not increase the risk of C-section even with an unripe cervix).

In my ideal world, I’d rather go into labor spontaneously.  But there’s no guarantee that that will happen, or even that it’s what’s best for my baby and me.  After all, my mom waited, wound up going past 42 weeks, needed an emergency C-section, and I almost died.  So it’s not like waiting for spontaneous labor necessarily gives me a get-out-of-jail-free card for poor labor outcomes.  Waiting until 41 weeks seems like the best compromise according to the data — so one or two days earlier is probably negligibly different.

Another thing on my mind, of course, is the anxiety.  I’ve woken up in the middle of the night three times in the last week in tears with worry about my baby.  My nightmare (literally) is that I’ll wake up one day, won’t feel him move, and we’ll go in and he’ll be dead.  I know he’s alive and healthy now, and I want him out while he’s still OK.  I’m already in the regime where stillbirth risk is rising, and even though it’s still small overall, having had a baby die inside me with no warning once means that I just don’t want to take any unnecessary risk, even a tiny one, of having it happen again.

As I’ve been thinking about it today, I realized there may be a middle ground.  I know that the risks of induction leading to C-section are higher with an unripe cervix.  Given the slight dilation I have already and the excellent positioning of the baby, I’m hoping I’ll make progress by next week, but I just don’t know at this point.  So my slightly revised plan is to ask to go in for a cervical check Monday or Tuesday before they start the cervical ripening, to find out if my cervical status has changed.  If it has, I’ll feel much better about going forward with the induction.  If it hasn’t, maybe I’ll check on the call schedule and see if one of the other doctors I’ve felt reasonably comfortable with would be on call if I waited a couple of days.  There’s one doctor I definitely don’t want, and another that I probably don’t want, but either of the other two would be fine with me.  The only problem with this plan is that I think (although I haven’t confirmed) that they will not want to induce me on the weekend, which only gives me a couple of days of wiggle room unless I wanted to wait until Monday (which I’m not sure I do, and which my husband has already said makes him a little nervous). But getting to ask the questions would be reassuring.

At least for now, I’m happy to have a date on the calendar, and to know that there is a plan that everyone is OK with that would involve me holding a baby by late next week (fun fact: if all goes according to The Plan, it’s very likely that my son would share his birthday with his father!).  I’m also happy to feel like there’s some flexibility in the plan — the doctors I talked to today emphasized that I can call and ask questions anytime in the next week, and that changes in the plan were possible.  So for the moment I’m reasonably content to sit back and wait to see what happens.  Who knows… maybe I’ll go into labor in a few days and all of this will be moot anyway!  Point is, my son will be here soon, in a matter of days, not weeks.  And when I put it that way, it’s a pretty amazing place to be.

Birth Day

Don’t get too excited by the title — baby is still on the inside!

Tomorrow is my birthday.  It’s also the anniversary of my daughter’s due date.  It’s also the official “full term” 39-week mark in my pregnancy with my son.  Quite the triple-whammy of extremely mixed emotions.

Last time I wrote, I said I was mostly relaxed, content to wait for a while to meet my son.  Well, that equanimity has gone out the window this week, I can tell you!  Two of the last three nights, I’ve woken myself up crying in the middle of the night, the first time because I had a dream about delivering my daughter last year, and the second time because I was worrying about my son being stillborn.  The anxiety about wanting to KNOW that he’s arrived safely is starting to get to me, especially since I know that I’ve reached the upward slope of the U-shaped curve of stillbirth — even though the absolute odds of stillbirth are still low (about 0.5%), they’re increasing with every week that he stays inside, and will approximately double over the next two weeks.  I want to be patient and wait for spontaneous labor, but I also want to induce and get him out while I know he’s still OK.  A lot of my anxiety is coming from the fact that I never did settle with my doctors when we would induce if I don’t go into spontaneous labor (which I so far show no signs of doing, although obviously it’s still early). I find myself fearing that they’ll try to make me go to 42 weeks, and I just don’t want to do that.

I want to induce no later than 41w0d, which I think is backed up by good science.  I would probably chill out even more if the induction date were set a few days earlier, but at least right now I feel that I will completely panic if they try to make me go later.  Not only am I worried about stillbirth, but I’m also worried because my mom went more than two weeks overdue when I was born, and I went into fetal distress and almost died after her emergency C-section (it’s not clear why, but might have had to do with an aging placenta).  And when I say I almost died, it’s not an exaggeration — my mom was a labor and delivery nurse at the time (now she’s an OB/GYN nurse practitioner), so she knew that what was happening was truly scary.  It involved Apgar scores of 1, 2, and 2 (as my mom likes to say, it was the only standardized test I ever flunked).  Apparently I was the giantess of the NICU for a few days (since the NICU is mostly full of preemies, and I was the one huge post-term baby).  The very fact that my mom went late with me means that I’m more at risk for going late with my baby, and the fact that I have a history of placental abruption means that I’m at higher risk for placenta-related problems in this pregnancy.  Taken together, these things mean that I want this baby OUT before something really bad has a chance to happen.  Not to mention that I feel that giving birth to one dead baby is more than enough for one lifetime, thank you very much, and I’m happy to accept the risks of induction (which at this stage do not include an increased risk of C-section, it turns out) in exchange for a lower risk of stillbirth.

Phew.  OK, now that I’ve got that off my chest…

I’m trying to relax and enjoy these last few weeks of pregnancy, but it’s really, really hard as my anxiety ratchets up.  It’s also poignant to experience the anniversary of my daughter’s due date and my birthday in my hugely pregnant state.  It makes me think about where I am in life: tomorrow, I turn 33.  I would also be celebrating my daughter’s first birthday this month (probably this week) if she hadn’t died.  But of course, she did, so I’m not — even though I consider myself her mother, I’m still “childless” in the eyes of the rest of the world.  I’m finally on the brink of giving birth to a living baby, but he’s not actually here and safely in my arms.  Yet because birthdays make me think about life in a broader sense, I can’t help thinking ahead to my next pregnancy (if there is a next one) — my husband and I have always hoped to have at least two children, and IF our son is born healthy, we plan to start trying for #2 around his first birthday, since it took us 2.5 years to get to this point with him and I have known tubal scarring that will make conceiving again tricky.  That means that in all likelihood, I’ll be at least 35 by the time our second baby is born (if, indeed, we are lucky enough to get there at all).  When we first started talking about kids, back before I turned 30, we said we wanted two or three, and we were going to start having them right away.  We planned, and God laughed.  Now, as I turn 33, my biggest hope and dream is that our baby boy will finally join our family sometime in the next two weeks… it seems like too much to hope that he might have a little sibling in the next couple of years, but I can’t help but dream about it and hope that things don’t get too much more complicated as I get older.

So, in the meantime, I wait.  I will say that my birthday tomorrow is looking very exciting!  First, I am planning to submit the paper I’ve been working on to the journal — it will feel so good to get that done before the baby arrives!  My coauthors have been really great about doing their share of the last-minute work to make sure it’s ready for submission, and it feels like a nice, solid piece of work.  I’m really quite happy with it. Tomorrow is also a big day in science because of the expected announcement of the first-ever detection of gravitational waves!  This is huge news, guys — extremely likely to be awarded the Nobel Prize in physics over the next few years.  I’m planning to watch the press conference live at 10:30am EST, and I invited the rest of my department to come watch it projected on the big screen in our library along with me.  Assuming the rumors are true, it’s going to be a pretty spectacular scientific birthday present!  Then, of course, I officially hit “full term” in my pregnancy tomorrow, which is exciting in its own way.  In the afternoon, my husband and I get to go talk to lawyers to do the super-fun job of drawing up a will (we’re being responsible future parents!).  And then my husband is cooking me my traditional birthday cake, the same one I’ve requested for three years running.

In the meantime, I’m trying to take a deep breath and coast through these last days (please, let it only be days!) of pregnancy.  I’m still feeling fine physically, still capable of tying my shoes and walking my dog two miles a day, and more or less able to sleep at night.  I mention this not to gloat, but rather because I only seem to read about how physically miserable all women are at the end of pregnancy — I’m not, and I want to make sure my own positive story is out there in case it makes anyone feel less apprehensive!  My main discomfort is just that I’m slightly obsessed with poking my baby all the time to make sure he’s still kicking.  Poor kid.  Hopefully I’ll be able to update you soon with pictures of him on the outside!

The End is in Sight

Our baby has reached term.  He’ll be 38 weeks on Thursday, which means that he could be here any day now.  Sometime in the next three weeks I’ll be in labor.  We will most likely be parents to a living baby this month.  All of this is unbelievable to me, but somehow it’s real.

All of a sudden, it feels like we’re as ready as we’ll ever be.  We have a safe place for our baby to sleep, a few clothes and diapers and some books and toys, and even some pictures on the walls of the nursery. Tonight we did two big things:

  • We facetimed with my husband’s cousin and her husband and asked if they would serve as guardians for our baby if anything should ever happen to us.  They agreed wholeheartedly, and even asked us if we would do the same for them (apparently even though their kids are 4.5 and 2.5 years old, they’ve never asked anyone, and they guessed that this was what we wanted to talk to them about, discussed it, and agreed that they would ask us too!).
  • We packed our hospital bags.  I hardly packed anything for myself; just some clean clothes, toiletries, breast pads, extra socks, a charger for my phone, and flip-flops.  Most of what went into my bag is for our son: two one-piece outfits for bringing our baby home, one in newborn and one in 0-3 month size (in case he’s big), a fuzzy hooded bunting with bear ears to keep him warm for the car ride home, the hat knitted for him by one of my friends on the faculty (who has also experienced baby loss).  I also packed some sentimental things, foremost among which is the coming-home outfit that my mom knitted for me when I was a baby — it’s woolen and potentially itchy, so I didn’t want it to be the only clothing we brought, but I do want to put it on him for some photos at least.  There’s a photo of me wearing it as a newborn, and I am so looking forward to taking that same photo of my son.  Then, I brought the tiny micropreemie hat that is the only item of clothing our daughter ever wore.  It won’t fit our son, but I want to have it with us, and maybe include it in a photo of him.  And there’s the receiving blanket that my mother-in-law made for our first baby, which is lovely and soft and will also help keep this baby snug in his car seat for the February car ride home from the hospital.  I feel so fortunate to have so many lovely, meaningful, handmade things to help welcome our baby home.  Yes, there were waterworks as I dug into my daughter’s memory box tonight to fish out her hat — I couldn’t help going through all the cards people sent us after she died, which got me thinking again about the might-have-beens, including how she’d be turning one any day now if she had lived.  Thinking of her while our son squirmed in my belly was bittersweet, and her presence will very much be with us as we head back to the hospital, hoping for a happier outcome this time.

Otherwise, things are going fine.  We had our last growth scan at MFM yesterday, and he is measuring right on target: 54th percentile, with an estimated weight of 6lb6oz.  Today was our weekly NST and OB appointment.  He was so active this morning that they kept me on the monitor for an hour trying to get a “baseline” reading of his resting heart rate, but he kept squirming and showing accelerations (which is what they are mostly looking for anyway).  Everything seems set for me to stay on the Lovenox, and I got reassurance from my doctor that being on the medication is very unlikely to increase my (already low) risk of hemorrhaging if I need a C-section — apparently they often give doses of anticoagulant before surgery to people with high clotting risks anyway (who knew?).  I had a chat with our doula today about breastfeeding, pumping, and sleep with a newborn, which was helpful.  And I’ve been organizing the hand-me-down bottles we’ve been given, washing parts and ordering new nipples and a microwave sterilizer which should arrive later this week.

Overall, I feel mostly a sense of calm anticipation.  I’m having trouble thinking about anything other than pregnancy/baby stuff (although I am still hoping to get at least one paper submitted to the journal before I go into labor — I am so close, just waiting on some last-minute input from colleagues!).  So many women have told me they were miserable by this point in their pregnancy, and I am happy to report that I am still not miserable.  In fact, I feel pretty good.  A little tired, a little large (OK, very large), but still generally not too uncomfortable and I am content to be pregnant for a couple weeks longer if that’s what happens.

I am nervous about labor, of course, but at this point I mostly accept it as an inevitability.  I know that I’m as prepared as I can be, and that now I will just have to deal with whatever happens as it comes.  It reminds me of the feeling I used to get before exams in college: I knew that I’d done as much preparation as I could, that I was as ready as I’d ever be to deal with whatever they threw at me, and that I just wanted to get it over with, already!  I know that things could still go wrong, that our son could still die.  At the same time, I’ve finally reached the place where I was at the beginning of the second trimester in our first pregnancy: I don’t really believe that our son will die, even though I know (oh, boy, do I know) that it’s a real possibility (although unlikely).  While that might sound like a good thing, it scares me, because I know how unimaginably horrible it was to have that belief and then lose our first baby.  I also know that it would be even worse this time around since I’ve now carried our son twice as long as our daughter.  So while my daily emotions are calm, I have a storm of anxiety brewing in the background.  I just hope that I’m able to maintain my equilibrium as long as possible, and that I don’t panic during labor.  But at the same time, I also recognize that the outcome is largely out of my hands at this point.  I’ve done everything I can to stack the deck in our favor, and now we just need to see how the cards play out.

38 weeks on Thursday.  Baby arriving any day.  Life is truly a wonder right now.