Happy Birthday!

Last week I simultaneously reached 40 years of age and 40 weeks pregnant, but with not a single sign that labor was imminent.  Plans were made with my doctor for induction on my due date. When that day came, I delayed a couple of days more in hopes of labor starting naturally.

I spent my birthday awash in anxiety as the hours slowly crawled by without any encouraging signs of labor.  I've been induced twice before - when we lost Jeremiah and Miles.  I do not associate induction with happy endings.

To celebrate my birthday, Q and I went to the hospital at 8 p.m.  After some monitoring of the baby and checking me (zero dilation), I got a dose of the cervix ripening drug Cytotec, just as I had with my losses.

Since I was starting from zero, I expected it to be slow going.  Q went home at 10:00 to be with the kids overnight.  Things progressed slowly for me over the next six hours or so and I was able to doze off quite a lot.  Dilated to a one by about 2 a.m. after a second dose of Cytotec, then to a three by 6 a.m. This is when I reached the stage of labor where I shake violently and throw up - the part where it really starts to suck.

There was no need for further doses of Cytotec or any Pitocin as contractions were steadily two minutes apart by this point.  In fact, they were steady enough to warrant IV fluid to try to slow things down a bit, as well as oxygen and changing positions to try to keep the baby from getting too stressed.  

  

Q and my doctor both arrived at about 7 a.m. as planned.  By then I was dilated to five and struggling to cope with what seemed to be one brutal and unrelenting tetanic contraction. An epidural was sounding pretty good, but not surprisingly, baby was having some serious decelerations.  The focus was on changing my position to see if that would help - first on all fours and then in Trendelenburg position (essentially upside down) so I was working against gravity.  I was only able to assume these positions by force, as I was unable to move myself due to agonizing and constant pain.

Although I was capable of understanding what nurses were saying and formulating complete (yet amazingly expletive-free!) sentences in my mind, the pain rendered me incapable of speech or any other meaningful communication.  In fact, it was the most intense pain I have ever experienced. I could sense the heightened nervousness of the nurses as baby was clearly stressed. It felt like the situation was about to turn ugly.

I was shocked to hear myself yell, "I'm pushing!".  The nurse gave me the OK, but I wasn't waiting for anyone's permission.  I was already getting it done and she was born in a matter of seconds.  I'd gone from 5 cm to baby out in 20 minutes.  No wonder it hurt!

Everything looked good.  Baby was doing great with APGARS of 8/9 and a weight of 6 pounds 11 ounces.  There's nothing quite like the high of going from abject misery to elation instantaneously.  The cord looked fine.  Then as the doctor delivered the placenta, we found that there was a cord stricture.  Again!  You can see it clearly on the video.  Stricture is more common at the fetal end of the cord, as was the case with Miles.  I can't find any reliable statistics on how often stricture ends up being fatal, but whatever the odds we are thrilled to be on the good side of them this time around.

We never saw signs of a problem on ultrasound.  If scans had been more frequent and thorough as they should have been and were with my last pregnancy, would we have seen it?  The entire pregnancy was petrifying as it was.  Day to day functioning would have felt nearly impossible had I known. I would not have dared go to my family's reunion back in June, which was the last time I saw my brother alive. I was at the same gestation as when we lost our boys!  So scary!  Nor would I have dared go to my brother's funeral in September. Of course I'm thankful to have done these things, but how chilling it is now to contemplate what might have happened to my baby girl.

Sitting here holding her tonight, I feel like the luckiest person in the world.  How amazing it is that she was conceived at all! How incredible that she survived to be born alive and healthy! Her name is Nadia, which comes from the Russian "Nadezhda", meaning hope.  

"...Anything can happen, child. ANYTHING can be.”

-Shel Silverstein




THE END
Again.
This time for real.

Baby Got Back

Weeks 22 through 24:

We are back in Minnesota with baby still alive and kicking at 24 weeks.  I've had one appointment (NOT at the perinatal clinic!) and got pics of the cord finally!  See them here.  I'm supposed to go back again in three weeks.  It's a long time to wait.

I've gotten behind in posting and gone nearly incommunicado even with family & friends since getting back to Minnesota nearly three weeks ago.  The fact is I've been very depressed lately and have been trying to break out of it. This pregnancy is stressful, to say the least, and on top of it we've just rejected a job offer Q got from Texas.  Moving in the middle of this pregnancy seems just too risky and the job itself was not ideal.  Still, we've been trying to move and buy a house for SO long that it was sad to say no!

The Physician Menace

I am so fed up with doctors I could just cry.  I fact I have.

Things have been very tense around here lately and the pregnancy is just part of it.  I'm at eighteen weeks now and have been feeling the baby move for a couple of weeks now.  Hopefully this is a sign that all is well with baby and that it will continue this way.

I had an ultrasound last Tuesday at 17 weeks 1 day.  I had to beg and plead with the perinatalogy clinic to get this appointment because they were quite insistent that I wait until 20 weeks for another appointment.  I was quite insistent that this would not do AT ALL.  I was able to talk with Dr. Collins and he thought it was absurd that my clinic was being difficult about this.  This is the same clinic I saw when pregnant with Anastasia.  At that time they did weekly doppler scans of the cord starting at 16 weeks. They were only too pleased to take my money then and I just can't understand why they are taking this radically different approach now.   

So I went to the appointment and had the ultrasound, which showed baby's growth is on track.  They also did dopplers of the cord, but refused to do any other scanning of the cord, such as trying to look at it in 3D or trying to measure the coiling.  Q and I talked to the doctor and she said the dopplers looked OK to her.  She seemed generally dismissive of our concern about the cord despite our explanations about this being a recurrent problem for us.  We also explained that we want Dr. Collins to look at the pictures since he is an expert in this issue.  She then gave us a disk with our pictures on it and we went on our merry way.

When I put the disk in my computer at home, however, I found that we had only 4 pictures - one of baby's profile and 3 of her legs.  This does me no good at all.  I called the clinic when they opened the next day (Wednesday) and was told there's nothing anyone could do until at least Friday when the particular satellite clinic that saw me Tuesday would be open again and could try to get the cord pictures off the ultrasound machine they used.  So I waited until Friday and after several phone calls, was told I could come pick up a disk of the cord photos at the clinic after 2:00.

And did our little story finally end happily?  Of course not.  At 1:00 the clinic called again to say don't bother coming in because actually they can't give me the pictures after all.  Suddenly it's against their policy to let patients have any images except a few "just for fun".  I assume then that if recurrent leg problems were an issue with my children, I would not have been given the three "fun" leg pictures I now have and may instead have gotten some "fun" cord pictures.  I made clear that this was entirely unacceptable.  When I made the appointment I stated that the purpose was to get pictures of the cord to send to Dr. Collins.  I also discussed this with the actual doctor when the ultrasound was done.  She didn't say one word to indicate this was a problem, but now she is the one who "made the call" not to let us have the images.

Next, I got to speak with the actual doctor.  I do not not take kindly to know-it-all, condescending, patronizing doctors and was very direct while still remaining civil.  Where we stand now is that I'm supposed to be able to get the images from the clinic on Tuesday (tomorrow) when they are open again.  Doing it that day was apparently just too much for the overworked staff.  You know how hard it is to transfer .jpg files onto a disk.  

If that doesn't happen, I am making an appointment at my regular OB office to get pics of the cord.  They don't have the expertise to interpret such pictures, but they've said they do have the capability of at least giving them to me.  I am supposed to go to Tennessee for a family reunion in two weeks.  I will be twenty weeks - the same time frame when both Jeremiah and Miles died.  My stress level is 

at Severe already and I want to know what Dr. Collins thinks about these images before I hit the road.

And on top of all this, Q has a job offer in Texas to consider.  This is a VERY dramatic decision, especially given the timing.  

Also, I will run out of Lovenox tomorrow despite my best efforts over the past two weeks to acquire a new supply from a mail-order pharmacy as required by my insurance.  Just found out I will not be getting it in time from them and now have to fight with my insurance to let me get it at a retail pharmacy locally, if  I can find one that actually has it in stock.  

After that, I will spend the rest of the day taking kids to the mall and the beach because it's summer break now.  We're going to have fun, dammit!  One of the most exhausting things about the current situation is trying to act as if everything is perfectly normal.  

A New Hope

So it appears that improbable things DO happen to me after all.  A full eight years after Q and I were last able to make a baby just with tools we have around the house, I found out that I am pregnant again.  How did this happen, you may wonder?  I'll tell you when you're older.

Where I am now is 14 weeks along.  What we know so far is that the baby is a girl, she has normal chromosomes, is measuring on track, and the due date is November 9, which is the week of my fortieth birthday.  What we don't have any idea about yet is the state of the umbilical cord.  If you know of my history, you know this is a critical matter.  Until more is known about the condition of the cord, I hardly dare imagine what the future holds.

When I was pregnant with Anastasia, my older two kids were in school, so I had a little discretionary time each day.  I tried to compartmentalize all things pregnancy-related into that time - appointments, finding baby's heartbeat with the doppler, writing this blog, and worrying.  Of course, I was unsuccessful at compartmentalizing the anxiety, but it was nice to have free time for the other things.

This time I don't have any regular free time for myself and when school gets out in three weeks I'll have to cut back further, and that's really going to hurt.  In the past, I was able to write and read other blogs frequently and thus became part of a community of bloggers.  This time around, I'm simply writing for myself and to update friends and family, as well as for the benefit of anyone who suffers recurrent cord-related losses like mine.

My kids, who are now 12, 10, and nearly 4, know nothing of the pregnancy so far.  One of the most difficult things about our situation is the need to hide the pregnancy until it is far enough along that we feel there is some hope that the baby will live.  We have a high-level ultrasound scheduled at 19 weeks which we hope will yield good enough news that we could tell the kids.  I look back at how fun it was a few years ago to tell them I was pregnant with Anastasia.  But then I also remember when I was pregnant with Miles, who died just days before we were going to tell the kids I was pregnant.  This could go either way.  Not having much free time to think about this is not such a bad thing after all!

? at 11 weeks because the 14 weeks pics are even fuzzier!

Mother Mother

Good news again!  Cord and blood flow still looking great for Mei-mei at 26 weeks!  Our whole family is just SO excited about Mei-mei!  Each Thursday when I pick my kids up from school they ask how Mei-mei's appointment went.  And they always remember to pray that she will grow safe and strong.

Quite some time ago, I had talked to Dr. Collins in Louisiana about his home monitoring program for moms who have lost babies to cord problems.  He'd said the earliest I could do that is 26 weeks.  I have looked into it, but I think I will pass.  "WHY?!" you may ask. Well, Dr. Collins and the doctors at the perinatology clinic all agree that things look perfectly fine.  Also doing this would require a solo trip to Louisiana and quite a bit of money.  I feel that the care I'm getting now is adequate for the situation.  Thankfully, this pregnancy is high risk only because of my past history and not because of any current concerns.

With each passing week, I get a little less anxious and the idea of bringing home a live baby seems a little more real.  In fact, I think we may go shopping for a nice recliner or rocker.  Our old uncomfortable rocking chair just will not do for what I'm hoping will be many happy hours spent holding Mei-mei.

Also this week, like it or not, is Mother's Day.  It can be rough for a lot of people - people who are infertile, people who have lost children, people who have lost their mothers, mothers who feel like they can't live up to all the idealism, etc. For me, this Mother's Day is both happy (for obvious reasons!) and sad since I'm still not on speaking terms with my mother.  I have a feeling there is going to be some ugly drama once Mei-mei shows up and creates a reason for a family gathering.  On the upside, I'm learning more about what NOT to do as a mother.  Hopefully I won't screw things up so badly that my kids won't speak to me when they're older!

  

Even though I don't feel like it and also don't much care for the sickening sweetness and commercialism of Mother's Day, I shall try to fulfill my societal obligations and send a little something to my mom:

Mother mother how's the family?

I'm just calling to say hello.
How's the weather? how's my father?
Am I lonely? heavens no.
Mother mother are ya listening? just a phone call to ease your mind.
Life is perfect, never better, distance making the heart grow fond.

(Tracy Bonham)

A Little Sigh of Relief

Thankfully today's scan left me more reassured than last week's.  Mei-mei's measurements are right on, which is a relief.  It had been four weeks since the last measurement scan and I do worry about that.  I worry about everything!  I thought maybe I'd calm down a little bit once I got past the points where I lost the boys.  Nope.  Maybe this next week will be better since today's doctor (another new one) told us emphatically that everything is looking great with the cord.

A sidenote in response to some comments on last week's post regarding the doctor's "upper end of normal cord coiling" comment:  A cord that doesn't have coiling is very dangerous for a baby and so is a cord that has too many coils (hypercoiling).   This site has interesting ultrasound pictures and information about both extremes - look about halfway down the page.  What you want is to be in the middle on coiling.

Last week's Wisconsin getaway was fun and we had a great time with my sister and little niece.  Last year when my sister was pregnant, I gave her all my maternity clothes and baby girl clothes.  Now I am borrowing them back.  My stash was lacking in summer maternity clothes and the seasonality of my first daughter's baby clothes is off for Mei-mei.  BUT since my sister's due date last year was August 10 and mine this year is August 11, she has filled in those gaps and I don't have to buy a single thing!  How perfect is that?!

At this time last year things were looking pretty grim and they got much worse before they finally got better, but against all odds here I am 23 weeks pregnant and things are looking good!  Who'd have thunk it?  Not me, that's for sure.  Since this week is my second blogoversary and it also happens to be near Easter, I am doing a giveaway of a pysanky (Ukrainian Easter egg).  Just leave a comment and a winner will be chosen at random.  If you win, I will design and make a pysanky especially for you!  Winner will be announced on Monday, the 18th.

Here are this year's additions (others are here and here).  I find that making these is

quite calming and that's a very good thing right now!

Walk the Line

I'm still very much in the Danger Zone with this pregnancy as I've noticed my losses and other women's similar losses tend to cluster right around the 19-20 week mark.  Today's ultrasound was very thorough.  Mei-mei's measurements are right on and the cord is looking good.  We confirmed that she is indeed a girl, which is good because I already gave all my boy clothes to my new twin nephews!  :)   Also we learned that Mei-mei has none of the markers that would indicate Down Syndrome or other chromosomal defects.

With each ultrasound that looks OK, it gets harder and harder to maintain the necessary balance between optimism and pessimism.  It's difficult to walk that line and not fall off painfully on either side of it when I'd love nothing more than to be over-the-moon happy about my baby girl.  But I just don't dare and probably won't dare until the day when (hopefully) she's in my arms alive.

Have you ever played that game "Baby If You Love Me, Smile"?  One person says that to another person and tries to get them to smile.  If they do smile or laugh then they are out.  That pretty much sums up how I feel about this pregnancy - like the moment I dare to just be outright joyful about it she will be snatched away from me.  So I'm doing my best to stick with a straight line for now.  Besides, people will get suspicious if I go around with a big grin on my face after being depressed for years.

It's been a good week overall and I'm glad to be past the 18w5d mark where Miles was born still.  Next big milestone: Jeremiah's 21 week mark.  My daughter's birthday party last weekend went very well.  On Sunday I even made her the big birthday dinner that she wanted - cream cheese wontons, lemon chicken, ham-fried rice, stir-fried veggies, AND chocolate cake made from scratch.  I really am amazingly functional sometimes!

Concealed Carry

Another week, another ultrasound.  This time it was quick. We got lots of cord pics and even remembered to get one of the baby this time!  According to the ultrasound tech, the perinatologist, and Dr. Collins, the cord is looking okay thus far.  This does not make my anxiety level go down (I have to make it through March for that to happen!) but it does prevent it from going further up, which is really the best I can hope for right now.

So far I've been quite happy with the clinic I go to.  The nurses are really nice, the sonographer has actually gone to Dr. Collin's website to learn more about cord issues, and the doctors take my concerns seriously, so I haven't had to visit Doctor Dammit.

Now at 17 weeks it's getting harder to hide my bump.  And I hate hiding it after fighting so hard to get it, but it seems necessary for the kids' sake.  I'm just hoping and praying to make it to April and beyond.  I looked at a few websites for ideas on how to pull off a concealed carry.  Several suggest showing a little leg or some cleavage to draw attention away from the thick waistline.  Conceal being knocked up by drawing attention to the knockers?  I don't think so.  Sure they're real and they're spectacular, but that's not my style.  Here are a few of my strategies:

Coats, jackets, and bulky sweaters - good thing I live in a cold place and it's winter!

Button-up shirts, preferably with vertical patterns:

Props - For example, at church I use a songbook or bag to cover my belly from view:

For reference, here's what I'm hiding:

A few months back I put a "Labels" section in my sidebar, but hadn't looked at it in awhile.  Now "pregnancy" has moved from the bottom of the list up to the second row!  Keep growing "pregnancy" - come out on top of infertility and IVF!!  I regret that "amusing pictures" and "attempts at humor" haven't been appearing much lately.  All this stress has made me completely lose my sense of humor. A painful loss.  Hopefully it'll come back soon.  Until then, thanks for sticking with me through a very tough time!

It's a . . .

. . . normal-looking cord according to the ultrasound tech and my doctor today.  At least for now, all signs seem to indicate that placenta and cord are doing their jobs.  This is by no means a guarantee that things will continue to look good, but it looks good today and we're thankful for that.  We are still VERY anxious going into this next month.  March is the fifth month of this pregnancy and we'll hopefully be passing the 18 week and 21 week marks when we lost Miles and Jeremiah.  I'm keeping my commitments in March to a bare minimum - there's just no way around the fact that it's going to be a tough month.

Today we also found out that baby is a GIRL!  At 16w0d she is measuring 16w2d.  All body parts are looking good and she was moving around a lot.  In fact, this past week I've been able to feel her move for the first time :)   Q and I are a long way off from daring to talk names, but since we now know it's a girl I figured she needs a better name here than just "the baby".   So for now I'll call her Mei-mei, which means "little sister" in Chinese and is pronounced like the month May.  We are still hoping to keep the news from the kids until we (hopefully!) make it safely through March, but that may prove tricky as I'm starting to look pretty "fat".

I will continue to have detailed ultrasounds weekly to monitor Mei-mei's growth and to look closely at the cord for any sign of trouble.  We were able to get pictures of the cord, but unfortunately they are black and white.  At the clinic the blood flow was shown in color with the vein blue and arteries red.  Here the vein shows as the darker color:

Coiling in a 2.5 cm section of the cord

All the cord pics are being sent to Dr. Collins and we'll see what he thinks about them.  For those who are as obsessive as I am about umbilical cords, more pictures from today can be seen here.  This is quite possibly the only blog out there where you'll be seeing tons of pictures of the cord and not the baby!

The Reign of Terror

Fourteen weeks along today and baby is still alive.  Today's ultrasound was another quick one done with the little bedside machine, which produces VERY poor quality images.  Basically all we could see for sure was that baby has a head, a body, a beating heart, and some limbs.  The baby did move it's head during the ultrasound, but certainly was not kicking around like it was the last few times.  It's hard not to worry about this, even though I tell myself that we only get to look for maybe a minute each week and such variations in activity level are perfectly normal and to be expected. 

Two more weeks until the very detailed ultrasound.  Will we make it that far?  It's been nice to at least get a little peek at baby each week and know that the heart is still beating, but on these ultrasounds there's no way to see any details of smaller structures, such as THE CORD, which as you may imagine I am absolutely obsessed about.  We could barely make out the cord for a couple of seconds today (see below) and although the picture is very bad, I did not like what I saw of the cord located between baby's face and leg because to me it looked like this: / / / / / /   Six parallel sections bunched up next to each other.  Is this normal?  Is there hypercoiling again?  Am I just trying too desperately to see some clue about my baby's fate?

Told you the image was bad.  Of course it's much worse here than it was on the screen at the clinic.  These are both the same picture, one left as is so you can get a clearer picture (ha!) and one with parts labeled by me.

We still haven't told anyone but family that I'm even pregnant.  Mostly, this is because we don't want the kids to know yet and there's no way to keep it from them if other people around them know.  My daughter did tell me that I look chubby.  My son told me he can't train me to be a Jedi because I'm too fat.  I don't know how much longer we can keep it secret.  I just don't want them getting all excited about that prospect of a baby (and they WILL be excited!!) only to have the same thing happen again.

The other reason for not announcing the pregnancy is that I don't want to hear any gushing from people who have no idea what hell we've been through - "How wonderful that you're "expecting"!" and "Nothing bad could possibly happen now that the first trimester is past!".  It's hard enough to keep my own "expectations" in check.  I'm not ready to deal with the expectations of others.  For me so far the odds have been 50/50.  Two kids lived.  Two died because of malformed umbilical cords.  I had really hoped the odds would be more in our favor this time around with the Lovenox and high-risk care, but I am now convinced it is still 50/50 no matter what we do.  Actually the odds at this point are much nearer either 0 or 100 percent as the baby's fate is probably already decided and there's nothing anyone can do about it.  The cord is formed - will it give life or take it away?  Perhaps it was all decided on November 18 when this child was conceived.  We just have to wait to find out whether there is any hope for our baby, and the waiting is pure torture.

I've recently been in contact with two women, Cindy and Wendy, who have lost babies at the same time and in the same manner as I have.  Perhaps they will share their experiences in more detail later, but for now here are the basic facts:  The odds for all of us have been 50/50, and that's not counting early miscarriages.  Cindy had four babies live and four die of cord problems.  Just like me, she was told to use heparin for each pregnancy after the second loss, but the odds remained the same - 50/50.  Wendy had two babies live and two die of cord problems, with the second loss happening just weeks ago and only eight months after the first loss.  All three of us first had two successful pregnancies followed by multiple losses.  Together we have eight living children and eight dead children, four girls and four boys who all died in the fifth month of pregnancy.  

All I can think after comparing our stories is that it must be genetic after all.  As I'd postulated in an earlier post, perhaps most cases are caused by a random genetic mutation and therefore very unlikely to recur.  But suppose a baby survives despite having a usually deadly genetic mutation that causes malformed cords?  That baby would grow up and have kids - then his random mutation gets passed on to his offspring as an inherited mutation.  This is what happens in genetic disorders with an autosomal dominant inheritance pattern.  50/50 odds.  

And so the reign of terror continues . . . two more weeks until we may get a clue which way it will go this time.  Will we finally get to dust off the cradle?  Of will it be another grave?  And how could I possibly go on if it is the latter?