One-Eighties

When I was pregnant with my daughter, despite having had a miscarriage just prior to her conception, H and I were pretty laid back during the first half of the pregnancy. Once we saw her heartbeat, we really relaxed (ha! just relax!) about the whole thing, and we made a lot of plans and remarks that assumed a good final outcome. Looking back, I can't believe how naive we were, but in our defense, I suppose most people are that way unless they've been through hell during their efforts to build a family.

Anyway, we looked forward to the 20-week ultrasound as a chance to discover her gender, rather than dreading it as a chance to discover what horrible thing was going to happen to us next. And for the most part the ultrasound turned out that way. They told us they were pretty certain she was a girl, we got some nice profile pictures, they measured my cervix as long (greater than 3 cm) and closed, and that was that. The only problem was that she went to sleep partway through the ultrasound and wouldn't move, so the technician wasn't able to get a good shot of all four chambers of her heart. Everything else looked perfect, though, so the technician sent us home.

Dr. Favorite duly reviewed the footage and called to tell us it all looked good, but for completeness' sake she wanted us to return in a week or two for a follow-up to get that last image of the four heart chambers. So we returned. The technician got the shot of the heart, and then she said that since we were there, she'd take another look at my cervix. Once she did, her demeanor changed markedly and she said she'd just hop out of the room for a second to ask the radiologist something.

Well, still being quite naive, H and I weren't too concerned. Eventually she returned and said the radiologist saw a lot of funneling in my cervix (note: this is very, very bad) and wanted me to go home immediately and lay down, and he'd have one of the physicians from my OB group call and tell us what to do next. The technician said she thought they'd have me get a cerclage, or a stitch placed into the cervix, to hold it closed and keep the baby in. For some reason we thought this sounded reasonable and manageable and we didn't freak out. After all, the demonic pregnancy book that we owned included a brief discussion of cerclages, so they couldn't be that big a deal, right? (Note: at 24 weeks I was past the latest point at which they like to place cerclages.)

So, we went home and I called into work (I was teaching two courses that semester) and explained the situation. My lab associate drive down from campus to pick up the exams I was due to give each of my classes that evening, and said they'd found people to cover them, no problem. I assured her that I'd be back in a few days at the most.

A comedy of errors ensued with the OB on call that day, and he didn't get a hold of me until nearly 5 PM. He wasn't overly concerned with the radiologist's opinion that there was severe funneling since it was a radiologist speaking and not an OB, and since I already had a checkup scheduled for the next morning, he told me to take it easy overnight, and then they'd look at my cervix the next morning.

The next day I saw Dr. Favorite, who measured my (now incredibly shortened) cervix, told me to get dressed and sit right there in that chair, and was across the hall in her office on the phone with a perinatologist in about fifteen seconds. To summarize a lot of panic in a few sentences, within minutes I was admitted to the hospital, gowned, IV-ed, and being treated with the most drastic tocolytic (anti-labor) drug they have, which is IV magnesium sulfate. They gave me two injections of the steroid beta methasone over the next 24 hours to hasten the baby's lung development in preparation for a possible premature delivery. This last fact was what really brought it home to us that after 24 weeks and 4 days of pregnancy, I was in active labor, and there was a good chance our daughter was about to be delivered as a micropreemie.

That week was the worst that it got. One of the NICU neonatologists came to my room and had a frank conversation with me about the baby's chances, were she to be born. There was a 50% chance she would die immediately. If she survived, there were horrifyingly high chances that she would have lifelong disabilities as a result of her prematurity, including blindness, paralysis, and cerebral palsy. He gently questioned me about whether we would want the neonatal team to take extreme measures to preserve life at all costs, or if there was a point at which my husband and I would prefer to let her go.

(I should note that the IV magnesium sulfate (aka "mag") I was on at that point works by relaxing the uterus that is, after all, simply a large muscle. It has the rather fortunate side effect of relaxing every other muscle in your body as well, and also made me pretty loopy. If you're going to deal with something like this, doing it while on mag is the way to go. My poor husband had to deal with all of this stone cold sober. Poor lad.)

Anyway, I responded well to the mag. Things stabilized. The perinatologist Dr. Lunatic (another favorite of mine- I like a wild sense of humor) did an ultrasound where he identified a small area of bleeding between the placenta and the inside of the amniotic sac, called a subchorionic haematoma. This, he believed, is what kicked my irritable uterus into active labor. A normal uterus would not have reacted in such an extreme fashion. We waited ten days and eventually weaned me off the mag and onto some oral medications with similar uterus-relaxing properties. I was discharged and sent home, there to remain on strict bed rest, and with instructions to call day or night if I had more than 6 contractions in an hour. After we had to return to the hospital for contraction monitoring three times in a week, and despite additional medications at increased dosages, my cervix shortened even more and I was readmitted to the hospital, put back on the mag, and there I remained for all but the last three days of my pregnancy.

I was sprung from my perinatal prison ten days after an amnio done at 34 weeks showed that the baby's lungs were starting to make some surfactant. So one Saturday morning, we had the ceremonial turning off of the mag. They thought I'd deliver within 24 hours. The next day I was still contracting away, but it didn't seem to be going anywhere. So, at last I was sent home, with strict instructions to return with all possible haste if anything changed, so as to avoid giving birth in the car. Thursday at about 4 AM I woke up in the middle of a painful contraction, and we were off. By the time we got to the hospital, got checked in and onto the labor and delivery floor, I was 7 cm dilated. A couple of hours (and just two pushes) later, we were handed our scrawny little troublemaker. After 11 weeks of bedrest, I had my girl just three days shy of 37 weeks and being considered a full term infant.

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Today: after a week of thinking I was experiencing miscarriage #3, we saw it. Instead of an empty gestational sac, we have a perfectly round, 4 mm by 4 mm yolk sac, and a little blob of a fetal pole with a flickering heartbeat. I can't believe how quickly everything can change.

Tension, Anyone?

Last night I had a nightmare in which my Dad kept sticking a rattlesnake into my face in spite of my repeated refusals. I eventually punched him. (In my dream.) In real life, I apparently punched my peacefully sleeping husband as he lay alongside me in our bed.

Who knew you could punch people while you sleep? Do you think perhaps I'm a little tense?

Attempting to Blog, Take 2

I'm going to give this blogging thing another go. I've been spending a lot of time in the last year reading about various infertiles and I think the time has come to get some of the nastiness going on in my life out of me, so maybe typing it out will help. I took a quick look at my previous posts and I see I had just started thinking about trying for child #2 and seen Dr. Favorite to start Metformin. Since then we have:

(1) had a consultation with our perinatologist to see what he thought our risk of preterm labor would be if we tried again (30% or so)

(2) had a consultaion with our RE regarding possible problems related to my not having resumed having periods in the 14 months since having D

(3) discovered the RE was much more concerned over the possibility of scarring to my uterus from the emergency D&C I had after nearly bleeding to death from retained products of conception 5 weeks postpartum (a story for another day)

(4) had saline injected through a catheter into my uterus to look for said scarring (none there- hooray!)

(5) started having periods again after about 9 months of not nursing, 9 months on the Pill, and 6 months on Metformin

(6) stopped taking the Pill

(7) immediately got pregnant

(8) 3 days later became un-pregnant (miscarriage #2 for those keeping track, if we call chemical pregnancies miscarrages, which I think we should)

(9) got pregnant again the next cycle (I realize for someone with PCOS to get pregnant this many times is pretty disgusting)

(10) immediately called the RE for a beta, E2, and progesterone checks. Progesterone was low, started suppositories. Beta was 26. They were not optimistic.

(11) Second beta 2 days later. Doubling time 23 hours. Optimism seeded.

(12) Third beta 4 days later. Doubling time 49 hours. Optimism flourished.

(13) First ultrsaound last Thursday. (6 weeks 0 days since last mentral period) Gestational sac in uterus: check. Yolk sac: absent. Fetal pole: absent. Odds quoted by RE of this pregnancy continuing: 50%.

Since then: pregnancy symptoms are dwindling. Period remains absent. Belief that this will continue is pretty much gone. Memorial Day Weekend desire to drink heavily in order to grieve doomed pregnancy was hindered by the tiny possibility that pregnancy is not really doomed. Who do I think I'm kidding?

Mostly I worry that my chance to conceive without serious intervention by my RE is ticking away. I don't believe I ovulate on my own unless I have recently come off an extended period on birth control pills. So far in my life I have conceived four times, all within 4 months of coming off birth control pills. I'm terribly afraid my body's ability to ovulate without fertility drugs is wearing off while we wait around for another miscarriage.

A note here: I have no problem with fertility treatments. If I need to use them to have another child I will. But, I was in the hospital for nearly three months during my pregnancy with D. I nearly gave birth to her at 24 weeks 4 days. I have been told in the strongest language that I need to avoid conceivng multiples. My RE thinks my best chance of conceiving a singleton (using fertility treatments) is with IVF with a single embryo transferred. My insurance does not cover IVF. So here we are.

The next ultrasound is at 9:30 AM Thursday. Never has time passed so slowly.