Tag Archives: RPOC

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.

D&E vs. Medically Induced Labor

This is not a blog post about abortion.

Deep breath.  This is going to be a tough blog post to write.

I am not going to get political about abortion.  No way, no how — that’s not what this blog is about.  But since I happen to fall into the <1% of women who have experienced second trimester pregnancy loss (in my case not an abortion, but rather a fetal demise or a “missed” late miscarriage), I was deeply shocked and appalled to read this week that Kansas has become the first state in the US to ban the D&E procedure in the second trimester. I feel that I need to help make sure that medically correct information is out there about the risks of D&E compared to its alternative, medically induced labor, and speak about my experience with medically induced labor in the second trimester.

A depressingly large number of women have experience with miscarriage in the first trimester, but odds are that you don’t personally know anyone who has experienced a second trimester loss (and by “know anyone,” I mean, “know anyone well enough that you’ve discussed it with them”).  Maybe that’s not true of people reading my blog — we’re sort of a biased sample, alas.  But with that in mind, I’d like to share a bit about what a second trimester termination is like, from the mother’s point of view.

After the midwife couldn’t find my daughter’s heartbeat, and her death had been confirmed by ultrasound, the doctor discussed with me what would happen next.  I asked if I had options for how to deliver my daughter; she said I didn’t.  I now know that to be false: the two options that are typically available to women in the second trimester for ending a pregnancy (either voluntarily or after fetal demise) are D&E (which stands for “Dilation and Evacuation” — a souped-up cousin of the far more common D&C, or “Dilation and Curettage”) and induced labor.  The clinical evidence is clear: D&Es are safer and have lower rates of complication than medically induced labor.  I later found out that D&Es require a very well-trained and experienced practitioner, which can be hard to find largely because the procedure is so rare.  My doctor was not trained to carry out this procedure, nor was anyone at my local hospital, but it would have been available to me if I had chosen to travel to an abortion clinic in a city half an hour from where I live.  In hindsight, I wish I’d known the relative risks and had availed myself of the option of having a D&E performed rather than blindly following my doctor’s recommendation of going through with medically induced labor, because I did wind up being one of the 29% of women who have complications from medically induced labor — whereas my risk of complications with a D&E would have been 4%.

In a medically induced birth, labor induction is started 1-3 days before delivery with the use of oral and/or vaginal medications.  We found out that my daughter died at 4pm on a Thursday.  My doctor had me take oral doses of cytotec every four hours between Thursday afternoon and Friday morning.  Thursday night was the worst of my life, physically and emotionally (well, Friday night would be worse, but I didn’t know that yet).  I was still reeling from the news that my daughter had died, and it was impossible to sleep while my abdomen was racked with increasingly intense, clenching contractions.  I came back to the office Friday morning so my doctor could check on my progress; at that time she tried to insert laminaria to speed cervical dilation, but I was already too dilated and she wound up breaking my water instead.  Once your water has broken, it starts you on a clock, since you’re then susceptible to infection (especially since in a mid-trimester fetal demise, infection is one of the likely culprits in the first place), so you need to deliver in the next 24 hours or so.  She upped my dose of cytotec, sent me home again, and told me to come to the hospital when I needed pain medication.  She said that she wouldn’t hold back on the pain medication, since there was no need for me to suffer through labor unmedicated (because my baby was already dead, although she didn’t put it so bluntly).

After more than 24 hours of labor induction, when the painful contractions radiated through my midsection like strange hula hoops (at the time, bemusedly, I compared them to electron orbitals) and I could no longer keep walking or talking through a contraction, I finally decided to go to the hospital.  I apparently waited a little too long, though.  When we got to the hospital they knew I was coming and led me to a room at the end of the hallway, somewhat isolated from the sounds of living babies being born.  However, they had no standing orders for pain medication, so they couldn’t give it to me until my doctor or midwife arrived.  I got changed and managed to get myself arranged in the bed, all the while experiencing by far the most intense pain of my life.  The nurses kept assuring me that the midwife was on the way.  I don’t know how long it took — perhaps no more than half an hour, but when you’re in labor, half an hour is eternity.  Finally I felt something shift inside me.  I told the nurse.  She told me it was probably the baby.  The midwife walked in as my baby entered the birth canal.  There was no time for pain medication, and I delivered a very small, very beautiful, but very dead baby girl without any pain medication whatsoever.  She was small compared to a full-term baby, but larger than I’d imagined — about the length of my hand from the bottom of my palm to the top of my fingertips.  There was a lull after she was born, but little did I know that the worst was yet to come.

The placenta.  It’s common to have problems with delivery of the placenta during the second trimester.  In fact, retained products of conception are the single most common complication of medically induced labor in the second trimester, accounting for the large majority of the 29% of women who experience complications with this procedure.  It happened to me.  For four hours, the midwife tried to get the placenta to come out.  First by tugging on the severed end of the umbilical cord, then with an injection that induced monstrously painful contractions — even worse than the pain I’d experienced while delivering my daughter.  Periodically she’d also “massage” my uterus (scare quotes because no massage has ever felt more like sadistic torture).  The longer it takes to deliver the placenta, the higher your risk of hemorrhage, so after four hours of agony she called in the backup doctor on duty.  They could not bring me in for a D&C at that point, since I had snacked in the afternoon before coming to the hospital (my doctor had told me to eat and drink normally, so my husband and mom had tried to convince me to eat something).  The backup doctor, whom I’d never met before he walked into my hospital room that day, was the kindest and most compassionate person I encountered throughout all of this horrific experience.  At that point, I was all but begging for them to make me unconscious.  I found myself clawing up the side of the hospital bed to get away from the pain, before I realized how illogical that was.  He immediately increased my dose of pain medication by a factor of five (I’d been telling the midwife I wasn’t feeling any relief, but she didn’t listen to me), and finally I was able to handle the pain.  He then removed the placenta manually, using instruments to reach through my already-dilated cervix from the end of the bed.  Once the placenta came out I was immediately relieved of pain, and as soon as the nurses finished cleaning me up I slept like I have never slept before.  (I’d be back two weeks later for surgery for retained products, which would leave me with scarring of the uterus that now threatens my fertility, but I didn’t know that at the time.)

THAT is the alternative to D&E. If I’d had a D&E, I would have been under general anesthesia and would not have experienced any pain until after I woke up and started healing.  I would almost certainly not have experienced retained products of conception, nor the scarring of my uterus that followed.

Banning the D&E procedure does not mean banning abortion — Kansas can’t do that, because for now, at least, it’s unconstitutional.  So the only thing the Kansas law accomplishes is to unnecessarily subject women to the nightmare of a second-trimester induced labor, to increase their risk of complication and possible infertility.  And even though there are exceptions to the law (saving the life of the mother, for example), as my experience shows, it is already difficult to find an experienced practitioner to carry out a D&E, and if it is made illegal in all but the rarest of cases, good luck finding a practitioner who can carry it out for that one-in-a-million woman.  I know abortion is a hot-button topic in this country, but I hope we can all agree that while it would be far better for there to be no pregnancies ending in the second trimester, if pregnancies must end, they should be ended in the safest and most humane way possible.  What happened to me was both less safe and less humane than a D&E, and it scares me, truly scares me, to think that women in Kansas will now be forced to endure the same thing.

Emotional whiplash… in a good way this time!

happy-sad-1Have you ever felt like you had emotional whiplash?  You know… toggling between extreme highs and lows so quickly that it makes your head spin?

My last few weeks have been full of it.  Last week I finally saw a therapist for the first time, and the only time she could meet me was in the middle of the day.  I went from a Skype meeting with a collaborator about exciting science, directly to the therapist’s office where I relived the whole experience around my baby’s death while sobbing through her tissues, back to campus to meet with a wonderful colleague to strategize about helping one of my advisees (who is Native American and low-income and really wants to get involved in research this summer but is having trouble finding a spot in a lab), to a tense meeting with a senior member of my department who chewed me out for an email I sent last week, to a really nice gathering to celebrate the achievements of several members of our department, including one of my students who got into grad school… highs and lows, I tell you.

The lows have been pretty low lately (I’ve written about some of them here), but yesterday I experienced yet another bout of emotional whiplash, and suddenly I’m back up higher than I’ve been since our baby died in September.

Brief recap… after our baby died and I experienced a painful and prolonged labor, I had retained products of conception and needed to have a D&C two weeks later.  We waited a month for my cycle to reestablish itself, then started trying for a baby again for a month, then shut that down after the MFM recommended waiting for a test at 3 months after the D&C.  Then the test (a sonohysterogram, for the connoisseurs) was abnormal.  My OBGYN recommended another D&C with hysteroscopy, which she would have done the following week.  But I was worried about the potential for adhesions (scar tissue), given my history, so I did my research and found a minimally invasive GYN surgery center (thankfully covered by my insurance) that would likely be able to fix, or at least diagnose, the problem with in-office hysteroscopy.

I had a lot of worries going into this appointment.  Going this route already involved waiting an extra month, which was really hard.  I was afraid that they wouldn’t be able to fix the problem at my initial visit, and that I’d need to wait even longer for surgery, plus some unspecified time for healing before we could even start trying again.  I was also worried because the hysteroscopy D&C option involved general anesthesia and a significant recovery time, while this alternative surgery involved no anesthesia whatsoever and the office kept telling me that whether or not the doctor could correct the problem would depend largely on my “tolerance.”  (Um, surgery without anesthesia, really?!)  The northeast also got slammed with another huge snowstorm yesterday, and the hospital is a 2-hour drive away.  First I was afraid we wouldn’t make it to my appointment, so we did the drive the night before and stayed with my cousin who just happens to live near the hospital.  Then, as we drove, they canceled approximately every school in New England and my facebook feed was full of people whose work had been canceled because of the snow, so I was afraid they were going to shut the office and I’d have to wait another month for the initial visit.  I hardly slept the night before.

Emotional whiplash!  The office was open and the appointment was awesome.  (Surgery without anesthesia = awesome?!)  The procedure took a grand total of three minutes, and was a total cakewalk.  Whatever the 1cm mass was that they saw on the sonohysterogram… was no longer there.  The doctor said maybe it was a blood clot that had passed late in my cycle.  He did find some scar tissue, which had blocked up about 10% of my cavity, but he snipped it away with tiny scissors while I watched on the screen that they had helpfully placed nearby, and I was so fascinated that I didn’t even notice the totally minimal discomfort.  And as soon as he was done, he was like “OK, you’re all better” (not in exactly those words, but that was the gist).  I was like… wait, don’t I need to wait to heal?  Are there restrictions on when we can start trying?  And he was like, nope, you can start trying tomorrow if you want.  Oh, and by the way, here’s a color photograph of your almost totally normal uterus in case you don’t believe me.

I was SO glad I went this route instead of having another D&C.  For one thing, it clearly would have been unnecessary, and more importantly, it might well have made the scarring (which they didn’t see on the sonohysterogram, perhaps because they were so intent on imaging the apparently nonexistent mass in my uterine cavity) worse instead of better.  Score one for my obsessive researching.  For another, this in-office hysteroscopy was so much easier on my body: no general anesthesia, minimal pain, no dilation, no recovery time whatsoever.  I feel like I should go evangelize for this minimally invasive surgery center — it’s hard for me to understand why this procedure isn’t more mainstream.  D&Cs are so common, but apparently they’re totally unnecessary much of the time, and like any surgery they carry risks (including the risk of scarring, which in fact happened to me, although thankfully not as badly as many other women who have late postpartum D&Cs like I did — for D&Cs 2-4 weeks after a late pregnancy loss, there’s about a 20-40% chance of developing significant scarring, which is a statistic that most OBGYNs seem to be blissfully unaware of).

So, in 3 minutes of a nearly painless procedure I ended several months of waiting and a full month of fretting about the unknown mass in my cavity that wasn’t there after all, plus the uncertainty about healing time (which my MFM had said might be 3-6 more months), and all of a sudden we’re cleared to try to conceive again.  Emotional whiplash indeed.  It really does feel like the first good news we’ve had since our daughter died in September.  Finally I have hope that we might (just might) finally be on the road to adding a second baby — perhaps even a living, breathing child — to our family.

Waiting after a miscarriage

infinity_o__clock_by_garycummins-d5k7p0tI’m not proud of it, but while my 4.5-months-pregnant belly was still covered in gel as the doctor was doing the ultrasound to confirm that our daughter had died, the words left my mouth: “When can we try again?”

I wanted nothing more in the world than to be pregnant again.  Well, that’s not precisely true: I wanted nothing more in the world than to hold a living, breathing child in my arms.  It’s still what I want more than anything.  But it’s the one thing I can’t have right now.

The doctor’s answer at the time was 2-3 months.  I have since asked this question to various medical professionals (the midwife, the perinatologist, the reproductive endocrinologist, the new OBGYN I switched to after I was unhappy with my care during our loss), and I have gotten every answer from “3-6 months” to “go for it!”.  It’s a bit complicated — there’s a pretty solid-looking study that says there’s no reason to wait after a first-trimester miscarriage (and in fact that women who get pregnant in the first six months after the miscarriage have higher live birth rates than women who wait longer), and there’s evidence that you actually should wait 6-12 months after a full-term stillbirth, but our loss was in the hazy middle, the second trimester, where the statistics are particularly sparse.  We’re neither here nor there.

So… I waited for my period to come, so I’d be able to date a pregnancy if it happened.  Then we gave it a try for a month (no luck).  Then came the consult with the perinatologist, who told us that it would be a good idea to have a sonohysterogram at 3 months post-D&C to make sure everything had healed properly, so we stopped trying for the next month.  Then the sonohysterogram was abnormal, and the OBGYN told us it would be a bad idea to try again before the problem was corrected.  They wanted to schedule the surgery for the following month, so that it would be between days 5-12 of my cycle.  So I’m waiting for surgery, a week and a half from now, 4.5 months after our loss (in fact, it’ll be about a week before my original due date), and the wait is driving me absolutely bonkers.

I look back with a sort of wistfulness on those first few months of trying, before my cycles went crazy, where time ticked by in weeks, with predictable highs and lows as we tried… and then I got my period… and then we tried… and then I got my period.  Since our loss, time creeps by in months.  The days feel longer.  I watch women who were pregnant at the same time as me become moms.  I watch our friends’ kids grow, start a new school year, move up to the toddler room, gain new skills, get older every day… and we’re right where we started.  In a way we’re parents, but nobody else recognizes that, and we’ve been robbed of the experience of watching our daughter grow.  Instead, we’re waiting.

Depending on what they find in the hysteroscopy, they may or may not be able to correct it at my appointment a week and a half from now.  If I need another surgery, it might take time to get on the schedule.  Then, depending on what this abnormality is and how hard it is to correct, I’ll need to wait (perhaps months) to heal.  Then we can start trying (which wasn’t easy for us the first time).  And THEN, assuming we can get pregnant, I have to go through pregnancy again.  I already did 4.5 months of that — the first trimester was hard, and was LONG.  And as my husband bemusedly pointed out to me a couple of weeks ago, even though our September loss feels like a long time ago now, I’d probably still be pregnant if our baby had survived.  Pregnancy is LONG.  So, it sounds like we’re looking at a minimum of a year until we get to hold our living baby, and likely substantially more than that.  And we started trying a year and a half ago.  This waiting and waiting and waiting to start the next chapter of our lives is maddening.  Truly maddening.  (I’m working on getting help for that… but that’s a subject for another post.)

So that’s where we are right now.  I know some women feel like they need to wait after a miscarriage or stillbirth, to give themselves a chance to heal emotionally and physically.  I wish that were me.  I’m trying to distract myself; the semester has started again at my university, which means I’m a lot busier now than I was over the holidays, and that helps some.  I’ve made a resolution to do one fun thing per weekend with my husband this semester, since it feels like so much we do these days is so emotionally heavyweight — hopefully that will help.  Has anyone else out there been forced to wait after a miscarriage?  How did you handle your impatience, your despair, and the restless energy you wanted so desperately to put toward being a mom?

Teaching through a Miscarriage

Let's think

Wow, she even remembered the constant of integration!

And now for my first academia-focused post…

Google rarely lets me down, but there is just not a lot out there about going through a miscarriage while teaching at the college level.  Tons of hits on how to help your students through their miscarriages, and a few stories from K-12 teachers who got substitutes, but what do you do when you’re teaching an advanced 13-week class for college students on your own particular specialty that nobody in the department can reasonably cover for, and your life suddenly falls to pieces?  (Obviously not just a miscarriage issue…)

Here’s a little bit of an inside look at experiencing a miscarriage while being a college professor:

I canceled only one class.  I’ve mentioned before how dumb this was in retrospect, but at the time I was freaking out about lots of things, most of which were out of my control, and getting extremely far behind in my teaching responsibilities was one fear that I could actually do something about.  Also, after a few days of sitting at home slowly realizing that my baby was actually gone and sobbing inconsolably and zoning out in front of about a dozen episodes of Buffy, I wanted nothing more than to escape from my own head for a while.  Seriously, I felt trapped, and it was scary.  I have never felt that way about my brain before.  I was hardly able to focus, but when I did finally manage to force my way through grading a few problem sets, the hour or two of relief I got from the obsessive misery I was experiencing felt therapeutic.  Your mileage may vary, of course, but for me, grading was an escape.

I think about half of my students knew I was pregnant.  After the 14-week ultrasound was normal, I had made the announcement to my research group, since I wanted them to hear it from me (rather than worrying as they saw my belly start to expand, or hearing the news from a colleague) and I wanted them to know I had a plan for how to handle my leave during a semester when two of them would be writing theses and graduating.  So my research students knew, and some of the other seniors and masters students knew since it had come up at a department happy hour.  And maybe some of the others guessed or gossiped, I don’t know — I felt like it had to be obvious by the time I was 4.5 months along, especially since it was late summer and I was wearing form-fitting short-sleeve tops, but I know that (thankfully) not everybody is as attuned to my body as I am!  Anyway, I told my research group right away by email what had happened (in very few words), and I’m sure word got around to the other students.  The students who did acknowledge it were generally lovely.  Two of them left flowers and cards outside my office.  I never said anything in class either about my pregnancy or the miscarriage.  When I canceled the Monday class, I told them by email that I had had a serious health issue and had been in the hospital over the weekend, but that I expected to be back by Wednesday, and I was, and that was that.

Going back to teaching was… surreal.  There’s no other word for it. My first experience back in the department on Tuesday was to go to a seminar that one of my colleagues was leading.  I still remember sitting there, hearing nothing that he said (or at least not processing any of it), and seeing visions of my dead daughter interspersed with plots and bullet points.  It amazed me that everyone could act like nothing had happened, or that anyone cared about what we were talking about (I sure didn’t).  When I taught the next day, I just walked in there like nothing had happened and got started.  I was still dizzy, so I made sure there was a chair, and I sat in it for some of the class.  There was one point when I was writing on the board and I got a wave of dizziness.  I felt like I swayed a little — I’m not sure — and I know I stopped talking for a moment… but I was so determined to get through the class that I just plowed on.  To me, the class felt like a mess, but at the time I didn’t care.  At least the preparation, just like the grading, forced me to focus on something outside my head, something other than the disaster that had just hit our family.  I’m not sure that it was entirely healthy to try to avoid my morass of feelings that way, but there was no one right thing to do, and I just muddled through as best I could.  I spent plenty of time processing my emotions over the subsequent weeks and months (clearly I’m still doing it!)… teaching just allowed me to spread it out a little to keep it from becoming overwhelming.  It occurred to me to wonder at some point how stay-at-home moms manage, when family is so much more central to their daily lives and they have no secret identity to escape to.

The most absurd teaching day by far went like this: I rescheduled my canceled Monday class for the Friday 1.5 weeks later.  The day before the make-up class was scheduled, which was also two weeks after they had started inducing labor, I went back to my midwife to investigate the intermittent heavy bleeding and pain I’d still been having.  The midwife suggested an ultrasound, and said that the hospital would call me to schedule it later that day, and that it would take place on Friday.  She wanted to get it resolved as soon as possible in case it was something like a retained placenta that could make me hemorrhage.  So, Friday morning I started calling the hospital and my doctor’s office about scheduling, in between preparing for the make-up class and meeting with my students.  I met with my research group members in the morning, but during one meeting I had to excuse myself three times to take calls from the hospital and my doctor’s office as they sorted out the missing order and got me on the schedule for an ultrasound that afternoon.  I worked through lunch to prepare my class (just as I was putting my first spoonful of lunch to my mouth the office called to tell me not to eat just in case I had to have surgery that day), went to the hospital at 2, had an incredibly painful transvaginal ultrasound (twice, since they had a student do it the first time — normally these things aren’t at all painful, but everything was still quite tender), and then went back to finish prepping my class while I waited for the doctor to call with results.  At 3:30, my doctor called to say that the ultrasound didn’t look normal and she was recommending a D&C for retained products of conception, and that we would do it that night if I was ready.  I said yes, since I just wanted to get this all over with.  So, she gave me the pre-op instructions, and I called my husband to make sure he could drive me to the hospital after work.  Then I picked up my notes and went to teach my class, lightheaded from fasting all day, still leaking blood and ultrasound goo, freaked out about having surgery in a couple of hours, but slightly manic about it all.  I have no memory of that class whatsoever.

Somehow, I made it through the rest of the semester.  Academics tend to be fanatics about their jobs, and most of the time I think I have the best job in the world.  But for a few weeks after my baby died, I just didn’t care about anything, least of all my job, and the extreme apathy that settled over me was scary (in retrospect; at the time it was a mere curiosity, since I didn’t really care about the apathy either — that was weird).  I prepared for class only minimally; I’d copy out some notes from the last time I taught the class once and call it good (this is NOT my normal method!).  On some level I felt bad that the students weren’t getting the best professorial version of myself, but on another level… apathy.

Oddly, one useful thing that the semester taught me was that I can get away with a LOT less preparation than I normally do.  Even with everything that happened, I got really high student evaluations.  There were a few comments about how I’d botched some derivations (those classes were disasters, seriously — the embarrassment was almost enough to penetrate my haze of apathy), but a full 3/4 of the students nevertheless rated the class and my teaching “outstanding.”  It’s possible they were being nice because they knew what had happened, but I don’t think so.  My canceled class was only in mid-September, and I know that none of the students had any idea about all the complications that dragged on for weeks.  My “fake-it-til-you-make-it” approach (which has gotten me through much of the transition to professorhood, by the way) seems to have worked, and plowing through those classes was evidently good enough.

So, that’s my story.  I have very little advice for anyone going through the same thing.  I can only express my extreme condolences, and hope that your recovery is as smooth as possible.  I’d like to say that you should take as much or as little time off as feels right to you, and trust yourself to be the judge, but I remember at the time feeling like that advice was unrealistic in the extreme.  I didn’t feel that anyone else could cover for my classes (although I got a couple of offers), and I felt a strong responsibility not to let my personal tragedy screw up the educational experience of all my bright young students. And ultimately, I think that sense of responsibility, and the pressure to focus on something objective and numeric, was actually therapeutic in a way.  There is no good way through this — you just have to get through it however you can, making sure to take care of yourself and your family first, and know that from the outside nobody sees what a complete and utter wreck you are.  Your prior teaching experience will carry you through if you need to keep teaching, and it won’t look as bad to your students as it feels to you while you’re going through it.  I survived, and you can too.

First post, second try

Hello, world.

I started this blog about a year ago, when I was first trying to get pregnant, and having issues (in the form of wildly irregular cycles).  A lot has happened since then: infertility evaluation, pregnancy, second trimester miscarriage, complications on top of complications.  Synthesizing information that any mildly dedicated googler could figure out for herself in a matter of minutes wasn’t enough to keep me writing, so I’m starting over and trying something new this time.  Plus, I find that when I look at other people’s pregnancy blogs these days, I’m mostly not looking for medical advice (I get plenty of that from the army of doctors I’ve been seeing), but rather for stories to relate to.  So, I’m going to try telling my own story here.  I’ve been a journal-writer on and off throughout my life; this is my first time making it public (if pseudonymously).  But sh*t’s gotten weird enough that I feel compelled to put the story out there for other women going through the same weird sh*t — with so few of us, the pseudonymous internet is really the only way to form a community.  I can use all the support I can get, and if my story helps even one person out there, it’s more than worth it.

That said, here’s a brief recap of my story:

July 2013: Got married to my amazingly wonderful husband.  I was 30; he was 32.  Our ceremony involved tons of participation from friends and family, was outdoors, was exactly the way we wanted it (although about 20F hotter than we might have preferred), and we were off to a great start.

September 2013: We started trying to conceive.  I had been off birth control since the beginning of June, because I knew my cycle could take a few months to normalize, but actually I’d had three lovely, regular cycles.  We were ready to be parents — bring it on, world!

Winter 2013-14: My cycles got wacky.  By spring, I’d had as short as 27 days, as long as 66, and everything in between.  I kept thinking I was pregnant, but then I wasn’t.  I freaked out, went to my local OBGYN first, but she wasn’t helpful, so we went to an RE (reproductive endocrinologist).

Spring 2014: Basic fertility workup.  Hysterosalpingogram showed that tubes were open.  Hormonal levels were all normal.  My basal body temperature showed that I was ovulating.  Husband’s sperm were hunky-dory.  I started using ovulation prediction kits (OPKs).  RE prescribed Femara, and we were waiting for my period to start the prescription.

May/June 2014: My period never came.  Second cycle using OPKs did the trick, and I was pregnant!  We got a lot of monitoring early on since we’d been seeing the RE, so we saw a heartbeat at 6 weeks and 8 weeks.  At 10 weeks we started seeing the local OBGYN.  Another ultrasound showed a somersaulting baby and confirmed that I was due on my birthday.  My husband’s birthday is two weeks after mine, so our baby will most likely be born in between — we’ll be a February family!  We do non-invasive prenatal testing at 10 weeks.  It’s a girl.  (A girl!)

August 2014: End of the first trimester.  After the 14-week ultrasound was normal I told my family, friends, and people at work; I requested parental leave for the spring semester and got on the waiting list for campus daycare.  I turned down three invited talks that would have fallen during my maternity leave.  People started giving us their old baby stuff.  By September (4 months along) I was in maternity clothes, and starting to show.

September 11, 2014: We went for a routine prenatal appointment at 18 weeks + 1 day and they couldn’t find the heartbeat.  Our daughter had died.  They induced labor and I delivered just over a day later.  After five excruciating hours the placenta wouldn’t come out, so they extracted it with instruments.  My milk came in.  I cried a ton, had no appetite, couldn’t sleep, didn’t care about anything in the world, and felt like I’d never recover.

Late September: After two weeks of pain and intermittent ridiculously heavy bleeding, they brought me back in for an ultrasound and found retained products of conception.  They scheduled me for a D&C (dilation & curettage) that night.  Finally, I started to heal (or so I thought).

Fall 2014: Results of tests and autopsies trickled in over the next month or two.  We found out that our baby was chromosomally normal, that there was no evidence of infection, that the only significant autopsy finding was a blood clot on the placenta, and that I was heterozygous for Factor V Leiden (a genetic mutation that predisposes me to blood clots).  We were referred to a maternal-fetal medicine specialist, who reviewed all my records and told us that she believed our baby had died of a placental abruption, possibly related to my clotting mutation.  She told us our next pregnancy would be high risk, and offered prophylactic blood thinners, with the clear understanding that there wasn’t a lot of evidence that they would help.  She also recommended that I have a sonohysterogram (saline-infusion ultrasound) 3 months after the D&C to make sure my uterine cavity had healed normally, and that we refrain from trying to get pregnant until then (this almost killed me, since I have wanted nothing more than to be pregnant again since the moment we found out our baby had died — it may sound callous, but it’s true).

January 2015: Sonohysterogram is abnormal.  My OBGYN suggested a hysteroscopy D&C, but I’ve read enough about intrauterine adhesions at this point to be freaked out about another D&C, even one that is performed under hysteroscopic guidance.  I found a doctor who runs a minimally invasive gynecology ward in the Boston area (about a 2-hour drive from us) who can treat adhesions and small polyps in the office hysteroscopically, without the need for general anesthesia.

… and that’s my story so far.  I’ve got an appointment with his office on February 2nd, and now I’m just waiting.  Again.  The worst part of all of this has been my baby dying, but the second-worst part has been all the waiting and the setbacks.  If you had told me immediately after the delivery that I wouldn’t be pregnant by my original due date, I would have crumpled into a puddle of misery.  Now that I know that there’s no chance of that happening, I haven’t quite crumpled, but I’ve got plenty of misery to go around.  I know that I’m taking the proactive and responsible path, but all I want in life right now is a living, breathing baby.

This has been quite a saga, and I suspect that even my nearest and dearest are getting misery fatigue from me talking about it (although my nearest and dearest have generally been amazing and wonderful and I am quite possibly the luckiest person in the whole world in my friends and family).  But I need an outlet, and I want to connect with other people who have been through similar things, and this seems like a way to at least start down that path.  So, please, leave a comment, tell me your story, or just listen.  I’ll try to update semi-regularly from now on.

(Oh, and why “The Pregnant Physicist?”  I’m a tenure-track physical science professor at a northeastern liberal arts college.  My experience with trying to start a family is inextricably tied to my identity as a scientist, so intersections between academia and pregnancy will — I guarantee it — pop up now and then.  Juggling family planning with a busy travel schedule, doctors appointments with classes, teaching class while dealing with pregnancy loss… it’s a challenge.  But that’s my life for now.)