Monday, June 11, 2007

Ugh

I thought I'd dodged this bullet. Constant waves of mild yet thoroughly debilitating nausea. At least it means there's still something going on in the ol' uterus. It's nice to have the reassurance that I am still pregnant.

Why do they call it morning sickness if it lasts all day? And isn't 8 weeks a little late for it to join the party?

Bleh.

Thursday, June 07, 2007

Starting to Believe

It all went perfectly. Gestational sac, embryo, and yolk sac are all appropriately sized, with a good heart rate. We saw the skull. It's empty (as it should be at this point). Apparently my task for the next 7 days is to grow some brains in there for the embryo. It measures 7 weeks 6 days, plus or minus 3 days. If you go by my last period, I'm 8 weeks tomorrow, if you go by suspected ovulation, then I'm 8 weeks on Sunday. Both within the margin of error.

I'm starting to think this might be okay. At least the first trimester miscarriage thing. I'm not even thinking about second trimester preterm labor stuff. It's just... well, the only other pregnancy I've had that made it this far resulted in my daughter. I guess that was a bigger mental milestone than I thought. My husband, on the other hand, is getting more freaked out the further we get. I think for him, the more real it starts to seem, the more we have to lose. He told me he was really nervous as I sat, pantsless, on the exam table waiting for the PA. The last couple of weeks we have only discussed this pregnancy while at the fertility clinic. The rest of the time it's just not mentioned. This is odd for us; we usually talk about stuff quite a bit. I guess there's just not much to say. It's either going to continue or it's not and there's absolutely nothing we can do either way.

But, for now, all is well.

Wednesday, June 06, 2007

Unwelcome Surprises

Nobody tells you how much bleeding is normal after you give birth. The nurses on the postpartum floor supply you with pads that seem appropriately sized for, oh, a hippopotamus, which gives you a teeny clue. But, every woman is different, blah blah blah. They do warn you that nursing causes your uterus to contract and that you'll probably bleed more while actively breastfeeding.

I spent the majority of my time the first 5 weeks after D was born trying to breastfeed. It did not go well. I had a low supply, my nipples were absolutely trashed, and D didn't use her tongue properly to draw the milk out. Instead she used more of a chewing motion. Fun for everyone. I did discover that nursing her certainly increased the rate of my postpartum bleeding. This was an item of rather minor interest until one afternoon when I was attempting to feed her and felt... well, let's just call it a large clot. I stood up to discover I had bled through my pad, underwear, pants, and done significant damage to the cushion of the armchair I had been sitting in. I set D in her bouncy seat, dashed upstairs (we had been living in our brand new house for about 2 weeks at this time) trying desperately not to drip blood on the new carpet, did a quick cleanup, and put on my oldest, ugliest maternity underpants, and a pair of workout shorts. I went back to get D, checked the new pad, and decided a trip to the emergency room was in order. I called my husband (at least an hour away at work) and a couple of friends, one of whom left work instantly, came to my place, and assumed care of me and D. She dropped me off at the ER and took D to her house to look after her.

H met me in the ER, where I was given an ultrasound and diagnosed with "retained products of conception." The bleeding had stopped, so after talking to my OB, the ER doc on call discharged me and said my OB's office was expecting me first thing the next morning for a D&C. On the drive home, the bleeding resumed. I was attempting to get my OB on the phone, when I apparently passed out from loss of blood and scared about 15 years off my husband's life. He called 911 and the paramedics arrived.

So there I was. 5 weeks postpartum after nearly three months in bed, eating mostly See's Chocolates and Wheat Thins. (Let's just say I was not at my slimmest.) I hadn't showered that day. I was clad in nothing but a breast milk-stained tank top, the aforementioned maternity underpants, and my workout shorts. There was also a fair amount of blood involved. I was untidy.

Well, they scooped me up and brought me back to the hospital, where I was admitted by the same doctor who had sent me home not an hour earlier. Deemed too unstable to be ambulanced down to the hospital where my OB-Gyn group had privileges, I had the D&C done there at about midnight that night by a doctor who heard my history and promptly tried to get me to leave my current group and come to his local practice. I think his pupils actually turned into dollar signs as he looked at me.

D was, at this time, very hungry. She didn't react well to the abrupt transition from bring breastfed (albeit very poorly) to being bottle fed formula, which her stomach kept violently rejecting. It was a long night for everyone. Eventually, though, I was deemed likely to live, discharged, and sent home, where D was very happy to be reunited with my breasts.

Did I mention this all happened on my husband's birthday? Every day I am amazed that he ever recovered enough from all of this to agree to try for another child. Later I learned that he followed the ambulance to the hospital in his car, hoping all the way that the lights and siren would just stay off. As long as they were off he was managing to keep it together. Poor guy.

Anyway, we're braced for tomorrow's ultrasound. 9:30. Let's hope there aren't going to be any unwelcome surprises.

Wednesday, May 30, 2007

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.

-------------------

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?

Tuesday, May 29, 2007

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.

Thursday, November 02, 2006

A Red Letter Day

Wow, I just got my first comment. Thanks Kiernan! I feel so validated!

Haven't been posting much due to:

1. Obsessive reading of blogs by Jo Leery Polyp (in progress-- just got to the birth story!), Julie A Little Pregnant (finally finished... wow, what a story. Plus, I'm finding her thinking regarding child #2 very relevant) and Erin PCOS Baby (ditto on the relevance).

2. Unexpected loss of hours of my life at a stretch (see #1 above).

3. Week long snotfest involving D's nose (icky).

4. Husband at weeklong conference on East Coast.

5. 1+4 = no sleep = bad combination

6. Cranking up Metformin dosage = yuck.

7. Trying to write exam for my lecture course on a computer connected to internet... leads back to item #1 above.

Does anyone know where I might purchase some self-control? Shouldn't finishing the coursework I am paid to do be a higher priority to me than reading blogs? Sigh. Must go grade homework assignments. I'm at least 90% of the way done writing the exam.

Am also wondering how long I should wait for periods to resume while taking the Pill and Metformin. I'm on my fifth pack of pills and nothing happening yet. Only on the fourth week of Metformin though.