Full term, and the end is in sight!

Hard to believe, but here I am at 39w1d — officially full term!  I just had what is looking like my last prenatal appointment this morning — one more NST and ultrasound, and then the midwife checked my cervix which is looking like it’s starting to do things (2cm, 60% effaced, medium, soft, and -1, for those who like the stats).

I’ve been talking about the possibility of induction with my providers for the past few weeks — my favorite doctor in the practice is on call next Friday, and L&D had openings, so we went ahead and scheduled an induction for next Friday.  I’m a little nervous about induction, but I’m more nervous about going too late and risking the complications that come with that.  I feel good about being induced at 40w2d — my dating is extremely precise (was tracking ovulation and had several ultrasounds around 6-8w that all agreed with ovulation) so there’s no chance of accidental prematurity, baby was measuring 76th %ile as of last week (bigger than my first son), and since my first son was born at 40w5d (after labor at 40w4d) and my cervix is already ripening I think the chances of my body not being ready for induction are pretty low.  I found some great statistics online, and with a Bishop score of 8 (or more by next week) and a previous vaginal delivery, it looks like my odds of needing a C-section with induction are about 6% or less.  Plus it’ll be good to have a date when I know I can stop taking the Lovenox — I just hope I don’t jump into spontaneous labor an hour after my dose sometime in the next week!  (I actually skipped it this morning, just in case the cervical exam got things moving — last pregnancy a doctor did a membrane sweep at 40w4d without warning me, and I had my first contractions within an hour after that appointment!)

It’s so hard to believe that by next week we’ll almost certainly be meeting our second son.  I mean actually hard to believe — it just doesn’t feel real yet, somehow.  We’re as ready as we can be, and now I’m just hoping for no surprises, no emergencies, and maybe even a similar textbook labor and delivery as we had with S.  It’s so helpful to have the memory of S’s birth to ground me — I feel much less fearful about going back to the labor and delivery ward of our local hospital than I did last time, when my only association with that place was the awful delivery of our daughter.  I now know that things can go well, and I even have an expectation that they might go well, rather than feeling like I’m constantly in emergency mode.  Part of me wonders if my more even-keeled emotional state in this pregnancy will affect the baby.  Maybe this baby will be more laid-back than his big brother?  We can hope!  (S was actually a pretty great newborn — he’s mostly just a bit more clingy and anxious than the average toddler, I think.  But if I got another like him, I’d be thrilled!)  Wish me luck!

 

Anniversaries

Today is the fourth anniversary of the day we found out my daughter had died.  It’s also four days after the first anniversary of my father’s death.  It’s been a somber week.

Both anniversaries feel a little bit lonely — nobody has remarked on either (though I did get a handwritten card from the funeral home about my dad).  I understand why.  I’ve had a couple of wonderful friends who remembered some of the important dates around my daughter’s death and have checked in with me on those days, which I so appreciate.  Four years later, while I still mark this day as a private day of grieving, I don’t feel as much need for the support, so it’s OK with me that my friends have stopped reaching out.  It feels natural and fine that they’ve played an important part in my healing process and the support has faded as I’ve needed it less — it’s not as though I’d expect them to remember and get in touch on this day for the rest of our lives.

As for my dad, well… I think that’s different because everyone close to me knows that I didn’t get along with him and was not close to him.  They know that his death raised complicated emotions for me.  So, probably they’ve either not thought about following up, or assumed it wasn’t important to me, or they have thought of it but have been too daunted by not knowing what to say.  And while it’s true to some extent that it’s not hugely important to me that anyone reach out, I admit that I would have welcomed some acknowledgment of the complicated feelings, or just someone to say that they were remembering him or thinking of me in some way.  I have been grieving, in my own way.  The death of a parent is always a little earth-shattering, even if you’re not close with your parent.  It’s not really something you can just emotionally skate over, even if I don’t have to deal with the deep feelings of loss and absence that I assume someone close to their parent would have to deal with.  I did a lot of my grieving for our relationship long before he died, but there’s still something so horrifyingly final about his absence from the planet.  No chance to revisit our relationship, no chance that he might be a better grandfather than he ever was a father.  And of course, a reminder of my own mortality, and the sadness that comes with seeing how easily his existence seems to have been forgotten.  He led a fairly sad and lonely life, and feeling like I’m the only one remembering the anniversary of his death just drives home the sadness of his empty life even more.

So, that’s where I am this week — not as melancholy as I sound, I promise!  But it’s a big week for memories and contemplation.

One hopeful project I started this week is that I’m knitting matching hats for my son, S, and his little brother.  When I was pregnant with S, I was too nervous to do any sort of nesting projects before he was born.  I thought several times about knitting something for him, but just couldn’t bring myself to do it, because it was too depressing to imagine having it lying around if S died too.  We reluctantly got some furniture in the room around this time in my pregnancy with S (or maybe even later?), and I remember sitting in the rocking chair in his room and crying every night for a long time (weeks?) before he was born, wondering if I’d ever be lucky enough to meet him.  This time around, I have been able to relax and hope a little bit more, which feels good.

This weekend we went to a craft store to pick out some fabric for the window seat bench we are making for the new baby’s room (it’s an Ikea hack that we’ve been happy with in S’s room — we’re basically redoing everything we did in S’s room, furniture-wise, just with different colors and patterns), and while we were there I wandered over to the yarn section with S, who helped me pick out some yarn to make a hat: “One for S and one for S’s baby,” as S insisted.  S’s favorite colors are “light green,” orange, and purple right now.  There was no orange yarn in the baby section, so S picked out one skein of a lovely lavender and one of a lurid yellow-green.  I eventually convinced him that the skein he picked out was closer to yellow than green, and was able to suggest a softer leaf-green color instead, but there was really no negotiating beyond that!  So I started making this hat, with lavender and leaf-green cotton yarn.  It is a cute gender-neutral baby combination, and I love that S is so excited about me making matching hats for him and his baby brother that I don’t really care if the colors are a little weird (and will totally clash with S’s maroon winter coat). 🙂 It felt so nice (and a little bit ridiculous) last night after S was in bed to just sink into the stereotype of the nesting pregnant lady, resting my knitting needles on my 7-months-pregnant belly between rows.  This project is, for me, an act of hope, and an act of love and connection between me and S and the new baby.  I know that whatever happens, I’ll treasure the memories that these hats will bring.

Tenure/Pregnancy update: End-of-summer edition

30 weeks pregnant and all was well at our monthly ultrasound this week.  Little guy is bopping around in there, currently lying sideways across my belly.  My husband and I have settled on a default name (unless we come up with something we like better by the time he is born) and are setting up the nursery.  I don’t remember at what point we did all this with S, but I think it was later.  I do remember that this was the point in my pregnancy with S at which our dear friends offered to throw us a shower, and I broke down in tears and just couldn’t handle the idea of planning for a living baby (the upshot was that we agreed on a “sip-and-see” a few months after S was born, which was a lovely compromise).  Some days I still can’t handle the idea of planning for another living baby (how lucky can we possibly hope to be???), and some days that’s all I can think about.  I still feel plenty of pregnancy impostor syndrome — like, this pregnancy isn’t actually going to last, there’s not actually going to be a new baby, it could all come crashing down at any moment.  But I’m at least able to act more normal this time around, mostly not responding weirdly to people’s innocent inquiries about whether this is our first (standard answer: “No.  We have a 2.5-year-old at home”) or jibes about how we’ll have our hands full with two boys (standard answer: “I sure hope so!”).

On the tenure side, I submitted my materials to my department today!  Hooray!  Now comes a long, long wait.  If I’m lucky, I’ll have a final answer by May 2019, and if I’m not lucky, I’ll have a final answer by December 2019.  The big steps in the process are:

• This fall the department solicits letters from experts in my field around the country/world who can comment on my research portfolio.  This process typically takes a couple of months, as I understand — it happens in two stages, the first of which involves sending letters asking people if they will agree to write letters, and the second of which involves sending letters asking them to actually write the letters and then waiting for the responses.
• Hopefully by the end of fall, but possibly later if there are delays, my department will have collected all of the external letters and will meet to go over all of my materials and vote on my case.
• After my department has made its recommendation, presumably sometime in the spring, my case will go to a university-wide faculty committee for evaluation.  This committee currently includes members from the departments of English, Music, Gender and Sexuality Studies, Economics, Sociology, Chemistry, and Biology — there’s also one from Earth and Environmental Sciences, but she can’t vote on my case (unfortunately, since she’s the most qualified to evaluate it) because she’s officially my faculty mentor.  I go to the end of the line for the university-wide committee this year, since most faculty start at the university in the fall, but I started in the spring, so I’m on a one-semester-late review schedule.  This is the main reason for uncertainty in when I’ll get an answer about my tenure case — they will review my case in the spring if they have time, but if they are overwhelmed with fall cases they aren’t obligated to review it until next fall semester.
• After the university-wide committee votes on my case (if the vote is positive), it goes to the Board of Trustees, and then the university president.  If I’ve gotten positive reviews at each stage up until this point, it’s usually a rubber stamp at the upper levels, but there was a case in recent memory that was positive at the department and university level but was overturned by the president, so there’s always the possibility that something weird will happen.  Since the Board of Trustees meets only a few times per year, this is another potential source of delay, depending on when the university-wide committee reviews my case.

After all of this, I’ll get a yes or no answer: either yes, I can keep my job essentially forever (barring unlikely circumstances like a major failure to meet my duties or major reorganization of the academic structure like eliminating my department), or no, I’m fired and I have to go look for another job.

It’s a long time to be in limbo, and many faculty find the uncertainty torturous.  My goal is just to try to relax and let the process play itself out, and allow myself to be distracted by the hopeful new addition to our family in November.  It’s the sort of setup that could either be really great (because I’ll be so busy with a new baby that I won’t have time to fret about tenure) or really awful (because being home with a new baby is psychologically challenging and so is waiting for news about your tenure case).

But either way, both of these big projects are looking like they’re in good shape at the moment, so I have to focus on that.  And now that I’ve turned in my materials, they have something else in common too: there’s essentially nothing I can do to change the outcome of either at this point.  The work I’m submitting for tenure has been done and documented, and this baby is baking away and the only thing I can do is to take care of myself and wait to see what happens.  I should avoid doing stupid things, like starting a feud in my department or suddenly becoming a binge drinker, but otherwise I have to accept that I have little to no control over the outcomes of either my pregnancy or my tenure case at this point.  And that’s hard for someone who likes to plan and act!  But if nothing else, my experience with pregnancy loss and infertility have given me plenty of practice at waiting, accepting lack of control, and dealing with difficult outcomes.  So, I’m pretty sure that whatever happens, we’ll make it through.

Second place is a good place to be

Two big pieces of news this week: (1) We had a normal anatomy scan, and (2) as of today, this pregnancy officially moves into second place of my five pregnancies in terms of how long it has lasted.

The anatomy scan on Tuesday morning was blessedly uneventful.  It was my husband’s first time seeing the baby on ultrasound, which was pretty special for him (he came to every single prenatal appointment for my first two pregnancies, but when you have a toddler somehow all our time disappears and “divide and conquer” becomes a survival strategy).  This baby moves around a lot (which was also commented on at the 13-week NT scan), but apparently is more cooperative than S, because they didn’t have to tilt me upside-down or make me walk around and they still got all the views they needed — unlike with S, who was so stubborn that we had to wait four more weeks to get a decent view of his aortic arch.  The ultrasonographer was quick and efficient, not chatty, but that was fine — she just kept snapping pictures, saying “looks perfect,” and moving on.

The doctor who came in afterwards was fine, but could really work on his bedside manner.  Basically his job was to tell us that the scan was normal, but that of course a normal anatomy scan doesn’t guarantee a problem-free pregnancy or birth.  Instead, he delivered the message in such a way that it sounded basically like he was saying, “There are SO MANY ways a pregnancy can go wrong!  I mean, you’ve already had a normal NIPT, but that’s only really good at detecting Down Syndrome, and of course the anatomy scan is normal, but it doesn’t pick up everything and you could still do an amniocentesis if you’re really worried about catching every uncommon chromosomal abnormality, but even that doesn’t rule out a whole host of other birth defects!”  Luckily, my husband and I weren’t too fazed by it, since we do already understand the limitations of the tests and the probabilities that go along with them, but this doctor must freak out a whole lot of families — and he’s in an MFM practice, so you’d think he’d know better!

Otherwise, 18w is feeling OK so far.  It is hugely reassuring to have the normal anatomy scan under our belts (a milestone I never had in my pregnancy with my daughter).  S’s sleep has been a little rocky lately which means I feel the pregnancy fatigue a little more acutely, but my anxiety level is MUCH lower in this pregnancy than it was with S.  I mean, I’m still far more anxious than I was in my first pregnancy, and I assume more anxious than someone who has never experienced loss and maybe particularly late loss, but I do not have the acute panic with every minor twinge that I had during my pregnancy with S, which is a huge relief.  I think the big difference is that when I was pregnant with S, I had no experience with what a normal pregnancy was like, since our daughter had died, so even stuff that I had experienced in my first pregnancy (because it was totally normal) freaked me out in my second pregnancy because I didn’t know if that was a sign that whatever happened to my daughter might be happening again.  Now I have one normal, full-term pregnancy under my belt, which gives me a much better sense of what’s normal vs. what I actually need to freak out about.

And this week is another big milestone in the sense that this pregnancy is now officially my second-longest-lasting of my five pregnancies so far.  I think second place is a great place to be, and in my ideal scenario (healthy live birth within days of my due date) it would stay there until the end, since I don’t really want to go a week past my due date again!  The milestone of a normal anatomy scan has also opened us up more to starting to think about logistics: names (boy names are hard!), rearranging our house (relocating my husband’s home office as we turn the current room into the new nursery), figuring out what furniture we need (e.g., are we going to try to do the transition to a big-kid bed, or buy another crib?  Do we need a second glider?), and all of the other things we’ve been studiously ignoring up until now.  There’s a lot to think about, but it’s fun to plan, and it feels good to be able to believe in this pregnancy enough to start actually making plans.

Another piece of ultimately good news is that our little campus daycare seems as though it should have a spot for our baby in March, which is when we really need it.  They’ve been horrible at communication (first they told us yes, then they told us no, then today the director emailed that we’re in again), but ultimately it looks like they’ve worked out a solution that should be reasonable.  The problem is that our daycare is so small that it only has four infant slots, but they rigidly age-group the kids by fiscal year so having an infant starting in March means that if they reserve an infant slot for our baby next year they are essentially only able to have three infants the first eight months of the fiscal year, which is a loss of about $10k in tuition for them.  The director was going to save us the spot anyway (which is why she originally told us yes), but then the “executive board” (two parents who are now on my blacklist) decided that the cost was going to be too high so they were just going to ignore the fact that we had top priority on the wait list and not offer us a spot until the new fiscal year in July 2019.  I mean, there are all kinds of dumb things going on there, including the fact that $10k is a miniscule fraction of what our family will be paying the daycare to send two kids all the way through from infant to preschool, and also compared to what they’d lose if we pulled our our older kid before he switched to preschool, since they have a lot of pressure on infant slots but usually have trouble filling all the preschool slots — and if we had to find another daycare for our second baby, the probability that we’d pull S out is actually quite high, since he’d be transitioning to preschool anyway and it’s better to make that transition a bigger one for him than to totally disrupt an infant’s routine four months into daycare to get them in the same place.

So anyway, the upshot is that the infant/toddler teachers were apparently just like, “Um, why can’t we just move S to preschool a few months before his age-mates to free up a spot for one of the older infants to officially become a toddler and then we’ll be able to open a new infant spot in March?”  So, it looks like S will move upstairs to the preschool about a month after his third birthday (which I think will be mostly a good thing — being the oldest in his age group means he’s occasionally seemed bored and frustrated at the end of the year when he’s ready for big-kid things and gets barred from them because of the arbitrary age grouping).  His age-group buddies will join him in July, but since he’s currently in the same classroom as the group who will be moving up to preschool this year and therefore he already knows them, I’m not too worried about the social aspect of moving rooms a few months before his age-mates.

So anyway, the point is that things are good, and we’re thinking about the future and starting to plan for a new family member, which is a nice place to be.  There’s always that part of me that fears making plans or telling people (like my students) about my pregnancy, because what if…?  But I’m mostly able to accept that those fears will always be there, that the possibility of another loss will always be there, but that it’s OK to be optimistic and hope and plan in the meantime.  In a way, having faced the worst in the past makes the worst seem at least hypothetically more manageable this time around.  I hope beyond hope that it won’t happen again, but I know that if it does, we’ll get through it, because we’ve done it before.

Chromosomally Normal Boy

At 10w5d, the results of our NIPT screen came back, showing that I am pregnant with a chromosomally normal boy.

Hooray for chromosomally normal!  I have honestly been freaking out a little bit about what I would do if there were chromosomal abnormalities.  I mean, I freak out about everything in pregnancy, so it’s not anything special, but I am hugely relieved to find that our risk of chromosomal abnormalities is so low (<1 in 10,000 for all of the common ones they tested for), and now I can stop worrying about that particular aspect of pregnancy.

The boy thing is more complicated.  I’ve written before about my complicated feelings about the sex of our babies.  The short version is that we were wildly excited in my first pregnancy to find out we’d be having a girl — my husband and I both want healthy babies above all, but bonus points for a girl.  Well, I had my girl… it just turned out that she died, so I didn’t get to do much mothering of my daughter.  With all of my subsequent pregnancies, I’ve been hopeful that I might get another chance at being the mother of a daughter, and both times I’ve made it far enough to find out the sex, I’ve found out that we were having a boy.

The news is honestly easier to deal with this time.  My son is the most wonderful thing that has ever happened to me in my life.  Not only do I have no regrets about being his mother, but every day I feel grateful and awed that I have the privilege of being his mother.  I love him more than I can express, more than I have ever loved any other human on the planet (please don’t tell my husband or my mom!), more than I knew was possible.  So, it’s not that I think I won’t love this little boy.  Obviously I will.  More than I can currently imagine, I’m sure.

It’s more that I can’t help but wonder about what being the mom of only boys will mean I’ll miss out on.  My male friends are mostly less emotionally less close to their mothers than my female friends are, so I might miss out on that often-special mother-daughter relationship.  If I have grandkids, I’ll always be the mother-in-law — I won’t have that special closeness during pregnancy when my daughter wants to know what it was like when I was pregnant with her, and I probably won’t have the experience that my mom had of being in the delivery room when her grandson was born.  Those are the big ones, but there are little ones too.  Helping a daughter through puberty would be a heck of a lot easier than helping a son through puberty for me, I think.  I loved Girl Scouts when I was a kid, and I would just love to pack my daughter off to Girl Scout camp rather than having to consider the local Boy Scout camp whose website brags about the different number of projectiles that boys will learn to fire.  And ugh, the superhero/macho/violent culture that stereotypically goes along with little boys is so repulsive to me — I donate any hand-me-downs we get with those hypermasculinized slogans and characters on them (seriously, it starts when they are babies and toddlers!), and I try whenever possible to stock my son’s wardrobe with bright colors and gender-neutral themes, but I’ll have less and less control over his interests and preferences as he gets older.  I mean, obviously none of these things are guarantees.  Some men are really close to their mothers, and some women aren’t.  There’s no guarantee that even if I had a daughter she’d ever get married or have kids.  There are plenty of great co-ed camps and activities to choose from.  My interests are more stereotypically boyish than girlish.  I fully realize that sex and gender are far less deterministic than we tend to assume.  And yet… we live in a gendered society.  I love the company of other women.  I don’t get much of it in my everyday life, where I live with my husband and son and work in a building and in a field dominated by men.  I hoped that there would be one other set of XX chromosomes joining our house to keep me company, and it’s a lonely feeling to think that my life will be even more male-dominated than it already is.

Of course, all of this assumes that (1) this pregnancy will continue, and (2) we’ll be done having kids after this next one.  Obviously I would be delighted if (1) were true, but it’s not a guarantee. (2) is probably true.  Before we got married, we thought we wanted 2-3 kids, but after our son was born, my husband said he’d be OK with stopping at one, although he was also OK with two — he sounded pretty skeptical that he’d be up for three.  I’m also pretty skeptical that I’d be up for three.  Considering everything we’ve been through to get to this point, if this pregnancy keeps going well, it’s hard for me to imagine doing it all again: trying to conceive, possibly having even more miscarriages, being pregnant, dealing with a newborn… and we’ll be older, and who knows if I’d even be able to get pregnant and carry to term again at the age of 37+, and obviously there’s no guarantee that we’d get a girl even if it all worked out!  So I’m pretty sure we’ll be done after two, and since (thankfully!) everything is looking good at this point, odds are high (though definitely not guaranteed) that I’ll be a mom of two boys and that’s that.  I’m OK with it, and in some ways delighted about it… just wistful.

When I went to the OBGYN’s office today for a heartbeat check and I heard that little whooshing thump, I smiled and fell in love all over again.  How amazing it is to have a little one on the way again.  How lucky we are that it looks like it might work out for us not once but twice — I never forget how awful it was the many times I doubted that I would ever be able to have kids, and I always know how lucky I am that I wound up being able to after all.  I still hope against hope that this will be a healthy, uneventful pregnancy like my pregnancy with my son, and a healthy mom and healthy baby are all that really matter to me in the end.  This is just one of many ways in which pregnancy after loss is emotionally complicated — I don’t think my feelings would be this strong if I didn’t have to deal with the feeling of having my daughter stolen from me three and a half years ago.  I never forget her, and I always wonder who she would be if she were a little three-year-old running around now.  My sense of loss is mostly about her, and I’m doing my best to focus on the world of things that I will gain by hopefully adding this new little life to our family come fall.

Still Looking Good

Since my last post, I’ve had two ultrasounds: my last with the RE, and my first as a new OB patient with the local OB.  Everything is still looking good — growing right on track, nice strong heartbeat, and I even got to see those first little twitchy movements on the ultrasound today.  My official due date is Nov 7, though I’m currently measuring two days ahead, which puts me somewhere around 9w right now (I was measuring 9w0d today, though according to LMP/EDD I’m 8w5d).

The weird thing is, I felt totally calm until after the ultrasound today, and then I got all shaky and weepy and was barely able to hold back tears while I was talking with the new midwife in the practice during my appointment.  She must think I’m nuts — everything looks perfect, and I was an emotional wreck anyway.  I should have been thrilled.  I’m honestly not sure I can explain why I was so weepy today.  Yeah, yeah, pregnancy hormones and all that… but I think it’s also just because with everything I’ve been through, pregnancy is so darn stressful, even when things look good.  In fact, especially when things look good, because I’m an expert at handling losses at this point, but I also know that the later I go, the harder it will be if this pregnancy ends.  There’s the fear of getting attached, the fear of getting hurt as much as I was hurt when my daughter died.  And, let me tell you, when that little nubbin was kicking its little arm and leg stumps on the ultrasound this afternoon, I was amazed and a little in love in spite of myself.  Just dreaming that this might work and we might get to add another baby to our family… it’s so big, and so incredible, and I’m just afraid to even start to believe that it might happen.  Hence the tears and shakiness.  This is wonderful, guys, but it’s also really intense.

I mean, the plus side of almost losing it in front of the midwife is that when I asked if I could come back in two weeks instead of five for a heartbeat check, she didn’t even hesitate — and she also offered to let me come back as often as I need to for reassurance.  I really don’t think I would have been able to stay sane waiting 5 weeks to know that everything was OK.  They might consider me a normal (if geriatric) OB patient, but I am pretty far from emotionally normal, clearly.

She did try to reassure me with the old line about how “a normal heartbeat at this gestational age means that you have a less than 5% chance of miscarriage,” but I put the kibosh on that.  I told her (gently, I think) that those numbers don’t really mean anything to me since losing a pregnancy at 18 weeks (and I didn’t even add that they almost certainly don’t apply to me, since 2nd and 3rd trimester losses are highly correlated and MFM told me I have a significant risk of placental issues in all my pregnancies).  I have long since stopped expecting doctors to have any idea about what it is like to lose pregnancy after pregnancy in the first and second trimesters.  I do appreciate it when they try, but I sort of feel like whenever I’m feeling up to it, it’s a service to the others who will come after me if I try to give them some insight into what it feels like and what is and is not reassuring, so I’m glad I spoke up a bit today.

Anyway, next week is my intake appointment with MFM, along with the bloodwork for NIPT and the other standard first-trimester testing, and then the following week I go back for a quick check-in with my OB, and then it’ll be time for the 12w ultrasound.  So, at least I have weekly opportunities for reassurance over the next few weeks to help me stay sane.

If I am lucky enough to make it through the first trimester, I have to start worrying about the fact that my pregnancy is pretty much at the worst possible timing for an academic, but that’s a subject for another post.  There’s nothing I can do about it now, other than trying (and failing) not to think about it, because it would really make me feel a lot better to have a plan but I can’t make one until I’m ready to tell my department chair that I’m pregnant.  I mean, after four perfectly-timed academic pregnancies in a row, it figures that the awfully timed one would be the one that sticks, amirite?  I’m also trying not to freak out about the fact that this baby and my tenure packet are due exactly the same week.  But hey, cross that bridge when I come to it, right?  These are really very good problems to have, in the grand scheme of things.

And that’s the update!  Hopefully, my updates will be similarly boring and normal from here on out.  Wish me luck!

Miscarrying and Hypothesizing

Well, I opted for medical management of this miscarriage, and it’s proceeding slowly.  I took the first round of medication Friday night, and not much happened, so I took another round Sunday morning, and finally things are moving.  I don’t think I’ve passed the main pregnancy tissue yet, but hopefully soon (I was so afraid it was going to happen in the middle of my lecture yesterday!).  I’ve got another week before they’ll start pushing a D&C on me, which I’d like to avoid if possible since I have adhesions from my first pregnancy.

In the meantime, I’ve started to do some research on causes of recurrent pregnancy loss.  I’ve already been tested for clotting factors and some of the immunological stuff, and other than being heterozygous for Factor V Leiden it all came back normal.  But it’s hard for me to believe that FVL is the only culprit, since it’s not associated with an increased risk of 1st trimester loss.  The main thing I haven’t really been evaluated for is heritable chromosomal issues, like a balanced translocation in my husband and me — but I find it hard to believe that that could be the source of our woes, since we know that two of our four pregnancies at least have been chromosomally normal, including the daughter we lost in the 2nd trimester.  It’s also not particularly associated with 2nd trimester loss.

There are actually very few issues that are associated with increased risk of both 1st and 2nd trimester loss.  But one thing that I read about immediately clicked for me, and now I am anxious to talk about it with my doctor on Tuesday.  You’d think that with everyone looking at my uterus in every which way over the past four years someone would have brought it up before now, but I’m about 95% certain that on one of my recent ultrasounds the tech noted a slight septum that she didn’t think was clinically relevant.  But anatomical abnormalities like a uterine septum are one of the most common — and most treatable — causes of recurrent pregnancy loss.  They are also one of the few etiologies that causes both 1st and 2nd trimester loss.  The ASRM guidelines on recurrent pregnancy loss note that the likely mediating factor causing 2nd trimester loss is abnormal placentation, which was the leading hypothesis for our daughter’s death.  It just all makes so much sense!  If I have a slight septum that isn’t bad enough to cause total infertility, but is enough to cause poor blood flow to the embryo/fetus, it would explain why I keep getting pregnant but keep losing the pregnancy, sometimes early and sometimes late, even in the absence of chromosomal issues.  It at least seems worth asking about, since the prognosis for treatment is really, really good — there are some studies where the live birth rate jumps up to like 85% (normal!!!) after surgery to correct a septum.  I would love to have an 85% chance of a live birth, instead of the 75% chance of miscarriage that I seem to have had in my pregnancies so far.  Maybe my doctor will tell me I’m nuts and that this slight septum can’t possibly be causing my problems… but I feel like I have to at least bring it up.  And if my regular OB doesn’t listen, I have an appointment with the RE on the 28th and will bring it up again then. And again and again until someone listens and has a real conversation with me about it.

I’m just ready for someone to take this problem seriously and stop telling me it’s just bad luck — it seems so clear that whatever is going on, it’s more than just bad luck.  One 2nd trimester loss… maybe?  But that’s already really bad luck, since it happens in only ~1% of pregnancies.  Two losses?  OK, fine, a single first-trimester loss out of three pregnancies does seem within the realm of normal.  But three losses out of four pregnancies, including a loss in the middle of the 2nd trimester?  How can people keep attributing this stuff to bad luck?  I mean, I know it’s not always possible to find a cause, but it would be so much more helpful if someone would say, “Look, your history is crappy and indicates a problem.  We don’t always know what the problem is or how to solve it, but here are the things we can check for and here’s why I do or don’t think that each of them might be a problem for you specifically.”  That’s what I want.  Why is it so hard for doctors to talk to patients that way?

Anyway, that’s where I am now.  Waiting to finish miscarrying this pregnancy, walking around, acting like everything’s normal in the meantime, diving back into the literature on pregnancy loss to try to find some answers about what’s happening to me.  This semester has just been so hard, with my dad dying the first week of the semester and my third miscarriage happening in the middle of the semester.  I’m kind of amazed that I’m still functioning, but at the same time I really don’t think I can take any more, and I’m having to bite back yelling at people or bursting into tears all the time.  I have very little patience for anything even a little bit trivial right now, which is really not the frame of mind I should be in during advising week for our freshmen, who are freaking out about their schedules for next semester.  I also can’t handle any kid-related stress, and when my toddler was clinging to me at daycare dropoff yesterday I actually started crying right in the middle of the toddler room.  I don’t think the teachers noticed, and I got myself out and to the car before I really let loose, but I wanted to cling to my son as much as he wanted to cling to me!  You’d think I’d be used to pregnancy loss by now, but I don’t think you really ever get used to it.  Having a living child makes it easier, for sure, but it’s still awfully hard.

Still Trying… With Some Perspective

After four cycles of trying, still no luck.  I know that especially since my tubes are crap this is still well within the range of normal, but I’m starting to contemplate when to go back to the RE.  The decision is complicated by the fact that my ovulation pain reached new heights of awful this month and sent me back to my OBGYN basically asking “This is not normal, right? Is there anything I can do about it?”

To give you an idea, this month for five days leading up to ovulation I experienced pressure and abdominal pain.  For the ~2 days around ovulation, everything hurt.  It hurt to sit down, it hurt to walk, it hurt to have sex (which is just adding insult to injury), and the pain was so bad that it woke me up in the middle of the night.  I mean, I know some level of ovulation pain is normal, but this just seems beyond normal.  I had brought up ovulation pain at my last annual visit and my doctor brushed it off, but it was so bad this month that I decided to go back.  So I made an appointment, which wound up being with their midwife who I haven’t met before (I thought someone told me she had retired, but apparently she’s back).

I ran through my symptoms and she basically said that she’d be happy to order an ultrasound but didn’t think she’d see anything — I agreed that she was probably right, particularly since I just had two ultrasounds in May/June during my miscarriage, which also didn’t show anything weird about my ovaries.  She said it’s probably either endometriosis or adhesions — I know I have some scarring from the first pregnancy when we lost our daughter at 18 weeks and I developed an infection that I later found out had scarred my fallopian tubes (worse on the left than the right, which is probably why my two subsequent pregnancies have both been on the right).  She said that there’s basically nothing they can do about those things: “Well, I mean, there’s surgery, but…” she said with a little laugh.  I was sitting there thinking: why are you laughing about surgery?  It was as though she thought it was ridiculous that I might consider surgery for pain bad enough that it affects me for a whole week of every month and wakes me up in the middle of the night.  I mean, that’s bad, right?  So the upshot of the appointment was that I declined another ultrasound, and she told me that my best option was going back to the RE — she thought maybe another HSG would help break up some of the adhesions and relieve the pain a little (which sounds sketchy to me, but what do I know?).  I left totally down in the dumps, wondering when I can finally put this phase of life behind me, because it’s just so unrelentingly awful (except for my son, who is the best thing in the Universe, which is the only reason I am willing to keep putting myself through this crap to try to have another one).

Fast forward two weeks to today, and my period arrives.  I’m feeling like crap, thinking I’ll never get pregnant again, or if I do, the baby will probably die again.  Then I had a meeting with our colloquium speaker.

This colloquium speaker and I have known each other on and off through meetings, talks, and conferences for a number of years.  I think we have sort of a little mutual admiration society going on. I remember meeting her for the first time when she was a grad student and I was visiting her university as a postdoc to give the colloquium.  She had just had a baby a few weeks before, but came to campus specifically to meet with me.  I was equally as interested in her science as in what it was like to have a newborn — we had a ton to talk about.  She just seemed so put together, was doing such awesome science, was interested in science education, was thoughtful, and appeared to be super-mom on top of it.  My career was a little farther ahead than hers, but she was a little older because she’s a non-traditional student who started her PhD a little later in life.  So, we kept tabs on each other a bit, as we both bounced around and wound up in our dream jobs as physical scientists at liberal arts colleges only an hour’s drive apart in New England. I started my job four years before she did, which means that she just started her job in January of this year.  I had a kid about three years after she had her first.  She invited me up to give a colloquium her first semester on campus, and this semester I invited her down to give a colloquium at our campus.  Today she’s visiting, and we started off our meeting with the usual excited back-and-forth about what we’re both up to — how her first year of teaching is going, how my approach to tenure material submission is going, etc.  Then, she changed the subject.  She mentioned that she was 22 weeks pregnant.  I congratulated her, quite genuinely, but couldn’t help feeling a small pang of self-pity that she was pregnant and I had just gotten my period for the fourth time after miscarrying, seven months into the journey to conceive our second living child.

But then, she kept going.  She remembered a conversation we’d had a while ago — she had shared that she had two miscarriages in a row, and I had shared about the loss of our daughter in the second trimester.  Well, it turns out that two weeks ago, at their 20 week anatomy scan, she got some bad news that their baby is much smaller than expected.  She is in that heartbreaking waiting phase where they’re trying to figure out how bad it is and whether they will be able to make it to viability, but there is much talk of early delivery and long NICU stays and potential long-term health issues.  Apparently they can’t yet tell whether it’s a placental issue or a chromosomal issue, but neither outlook is good.  She won’t know more until her next ultrasound in two weeks, but she’s been thinking a lot about how to handle it.  She wanted to know if I had any advice based on what I’d been through before (with weirdly similar timing relative to my tenure clock — we are truly living parallel lives in some ways).

My eyes immediately filled with tears for her.  And I silently kicked myself for allowing that earlier pang of self-pity.  It was an important reminder that we never, ever know what other pregnant women are going through, even when it looks from the outside like everything is perfect.  Advice.  What advice do I have?  None, really.  I don’t think I handled my 2nd trimester loss particularly well, but I also don’t think there is a good way to handle it.  I told her a few things:

• Please accept offers of help.  I didn’t and I made things unnecessarily difficult for myself.  This is a huge life event, and it’s a small fraction of your time on the tenure clock and your life overall, so be kind to yourself while it’s happening.
• If doing work feels therapeutic to you, go with it.  I couldn’t function for my own sake while I was going through our loss, but I could force myself to function for my students’ sake.  So if it feels right to work, work.  If it doesn’t, don’t.  You need to do whatever you can to get through this.
• She wanted to know if I had thoughts about when she should tell her department — should she tell them soon so they could plan for the possibility that she might need to take medical leave?  I don’t know if this is the right answer, but I said no.  She doesn’t know what will happen.  Possibly nothing will happen, and she’ll be able to get through the rest of the semester without any issues.  Nobody can plan for this right now, so she has no responsibility to tell other people if she doesn’t want to.  They will figure it out.  They will not blame her for not telling them the news sooner.  There is really nothing to tell right now other than that her baby is sick and she doesn’t know what’s going to happen.  I advised her to wait until she knows what she needs so that she can ask for what she needs.  Unless she wants them to know for emotional support purposes, but my experience was that people really don’t understand pregnancy loss, especially in the second trimester, and having everyone know is often just a higher emotional load to deal with.

That was pretty much all I could think of.  I also told her that I am so, so sorry, and that I am here to help or if she just wants to talk — I told her that when our daughter died, I was just desperate to talk to people who had had second trimester losses, especially those who had gone on to have healthy pregnancies afterward, so if she has the same desire I am absolutely here for her.  I just wish she didn’t have to go through it, especially not this tortuous period of not knowing what’s going to happen.  She sounds pretty pessimistic about having a healthy baby at the end, but I will be hoping upon hope that it’s another case of unreliable ultrasound and that everything will be fine.

These childbearing years are the hardest thing I’ve ever been through, and it breaks my heart the more I learn how awful they are for so many women.  I wish there were a better way.  I wish it were easier.  I wish people talked about it more and were better at supporting each other through it.  I wish we could just wish children into our lives.  When they do come, they’re amazing, but it doesn’t seem like we should have to endure so much suffering to get there.  I will be holding this friend in my thoughts, and checking in with her in two weeks to see if she needs anything after their next ultrasound.

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.

Half a Year

Working in academia means that the year has a distinct rhythm.  Last week the students moved into their dorms again, a fresh batch of misty-eyed parents unloaded minivans full of stuff and left their precious children to their own devices, and this week I got up in front of a classroom for the first time since last December, before my son was born.  As the start-of-school milestone passes yet again, it makes me think back on our journey, and how our quest for a living child has ticked against the start of classes during my time on the tenure track.

Three years ago we were just starting to realize that getting pregnant might not be easy for us.

Two years ago I was four and a half months pregnant and deliriously happy; I had no idea that on September 11 we’d find out that our daughter had died.

Last year I was four months pregnant and completely freaked out but hopeful.  The other faculty knew, but I waited to tell the students until it was obvious.  I was juggling an academic schedule with frequent prenatal visits and trying not to lose my mind as the anniversary of our daughter’s death approached.

This year I have a six-month-old bundle of snuggles and love.  He has ten fingers, ten toes, blue eyes and blond hair like his daddy, two teeth(!), and an intense desire to crawl.  He’s now been in full-time daycare for one week, and I miss my little sidekick, but he’s doing great.  He just started drinking from a sippy cup (after adamantly refusing a bottle his entire life), which means I have a little more freedom and my baby is a little more grown up.  We’ve survived his first two illnesses (the first a week-long epic fever followed by ear infection followed by full-body rash from antibiotics, the second a plague that swept our household and left me delirious with my first fever in a decade and left our poor little guy a drippy-nosed, coughing mess for a couple of weeks).  Completely disordered sleep suddenly seems to have resolved this week into once-a-night wakeups (knock on wood!).  He sits, he laughs, he explores his world.  Our baby is growing up.

And still, I teach.  I love being back in the classroom, talking about physics, prompting discussion, fielding my students’ intense questions about our place in the cosmos and how it all fits together.  My first class of freshman majors are graduating this year, and the amount of growing they’ve done since I first welcomed them into a college classroom is staggering.  In a seminar I’m teaching this fall (packed to capacity), during introductions the first day several students mentioned that they’re taking the class because I brought them into the field with my introductory course, and even though they ultimately chose majors in other subjects they wanted to keep taking classes in my subject because they loved my class so much.

Brown-nosers, the lot of them. 🙂

I’m in a very happy place now, but the start of the school year reminds me that it’s been a long time in the making.  Seeing the students arrive on campus also reminds me that my hopes for my son involve him leaving me to join a similar tree-lined, ivy-covered campus about 18 years from now.  As he started full-day daycare last week I sobbed to my husband, “Today it’s daycare, tomorrow it’s kindergarten, the next day it’ll be college and we’ll never see him again!”  Possibly an exaggeration, but the feeling of time passing is inescapable.  I love his emerging personality and his increasing independence, just as much as I love having my tiny baby to snuggle and hold and nurse while he lets me.