a new spring

photo credit: Gazelle Valley Park, gvp.co.il

As an update to my previous post, at this past week's appointment I got to speak with the other MFM in more depth about the steroid shots. There are two MFMs who run the prevention of prematurity clinic, so I volley back in forth between them during my clinic visits. I think they are both really competent, and I appreciate having the two different perspectives.

In short, we've decided we will definitely do the shots at 28 weeks unless something changes in the mean time, in which case we would do them immediately. As Emily pointed out in her comment to my last post, Dr. W. said they work most effectively on more mature lung tissue, so from a lung maturation standpoint, they don't function optimally at 24-26 weeks. However, in this age group, they do decrease the likelihood of intraventricular hemorrhage (IVH), which in addition to the respiratory issues, is a major obstacle for micropreemies.

In the absence of any indication that I am going to deliver in the near future, she felt pretty strongly that it is best to optimize the lung maturation benefit we will get out of them and get good coverage during the 28-32 week window, which she sees as a more likely scenario than something catastrophic happening over the next few weeks. So I feel better having some resolution on that and I feel comfortable with our choice of waiting a few more weeks.

Baby girl is a bit of a chunker, which is great :) Last week her estimated weight was 1 lb. 9 oz., about a week ahead. Her other measurements put her in the 65% percentile for her gestational age. I am happy she is measuring a little big. I did my 1-hr GTT last week. I am a bit nervous about the results, because I didn't know I was doing the test and I had a couple of glasses of cranberry juice with breakfast before I drank the glucola.

I have a bad cold which is annoying, but it is nothing more than a nuisance. It felt really good passing V-day, but I will feel even better next week once we G-d willing pass 26 weeks and I am holding out for 28 weeks even more so. The outlook would still be quite bleak if our little girl was born this week, but still, reaching the point when there would at least be an attempt to intervene feels significant. I am hoping for this pregnancy to stay boring for quite a while longer!

I am also looking forward to March being over. February and March 2012 were two terrible months for us punctuated by complications, hospitalizations, and of course the loss of Aminadav and Naava. Since then, it has always felt to me like February and March were out to get us. Just one more week and we can kiss my dreaded season goodbye.

As the days get longer and warmer and we enter the spring holiday season, I remember the emptiness and hollowness of last spring. Most of all, I remember my empty empty arms after a winter spent gestating two vital little lives. This spring, I still carry that emptiness and hurt in my heart everywhere I go, but I feel thumps and spins and all sorts of acrobatics on the inside that I can't help but admit make feel hopeful and vital again. I guess you could say that finally I am expecting.

the steroid shot dilemma

At my last MFM appointment, my doctor let me know that this coming week (24 weeks), I am eligible to receive a course of steroid injections, which will help to mature the baby's lungs should she make an early arrival. Since respiratory issues are the most significant obstacle for many preemies, the ability to jump-start lung maturation is obviously a pretty big deal. There are 2 decisions we need to make 1) whether we want the steroid shots (or under what set of circumstances we would want them) and 2) when we want them.

I think it is the second issue - the timing of the injections, that I am having the greatest difficulty with. The potential side effects of the steroids to the baby are fairly minimal in my opinion - babies who have been subjected to repeated courses of steroid injections in utero tend to weigh less than their untreated counterparts. However, this is much less of an issue today.

Apparently, because there is a long-held belief that the steroids are no longer maximally effective after 7 days, it was common practice in the 1990s to give a course of steroid injections around viability to at-risk women and then to give repeat doses every 7-14 days if the woman hadn't delivered yet.

That is no longer done today - my understanding is that at most you might receive an initial course of steroid injections and then if you still haven't delivered, say 2 months later, but you are in imminent danger of delivering and the baby is still <34 weeks, then they might give a rescue course, so that is 2 courses of injections at the most.

The second minor concern is that in animal studies some rats exposed to steroids in utero at doses many, many times higher than the dose given to human patients showed minor neurodevelopmental deficits. Again, this doesn't really concern me very much, especially knowing that steroids have been used in the context of speeding up lung maturation in utero since the 1970s, so pretty good follow-up data exists for humans. In short, I see little downside to getting the injections.

The second issue is timing - a long-held belief is that the maximal effect begins to dwindle 7 days after the 2nd (final) injection. However, newer studies have called into question the original data that led to this conclusion and it seems possible that you actually get pretty good coverage past 7 days - maybe even up to a month after the 2nd injection.

That being said, there is no doubt that after a certain period of time, the effect diminishes, so if you don't deliver within x weeks of the 2nd injection, it is probably not super helpful. I found it really hard to get a good sense from the literature exactly how quickly and at what time point the effect of the shots becomes worthless...I think it is still a contested issue.

I could get the shots this week at 24 weeks, which could be really nice from an emotional perspective -  knowing that if G-d forbid something happens during what is a disastrous gestation for birth, our chances would be better. On the other hand, there is no hard data that leads me to believe I am in imminent danger of giving birth, just a whole lot of fear based on my past.

So far, my cervix has stayed stable. I have been contracting fairly regularly, but my doctors assure me this is much more annoying than worrisome since my cervix hasn't changed. My placenta scan looked great and I haven't had any bleeding. Aside from my awful past, there is nothing concrete to suggest imminent danger (in spite of this, of course I worry like crazy - I don't ever want to be the sucker who assumes everything is going to be just dandy only to be rudely awakened).

Based on this information, it seems wise to hold off on the injections for a few more weeks -- maybe wait until between 26-28 weeks, when then at least I will hopefully get some coverage from them until at least 30 weeks. But then there is the emotional part of me who doesn't want to say "I told you so!" if something horrible happens in the next few weeks.

So what do you guys think? What would you do? Clearly there is no single right answer here - if there was, I am pretty sure my doctor wouldn't be leaving the decision in our hands.

dusting off the cobwebs

Its been a while. Quite a while. Since I last posted, we passed a lot of significant milestones. All of these milestones were pretty hard, and they actually made me feel less like writing. Instead, they made me want to crawl into my own little cocoon and burrow there for a while.

The Big Dates

The first big date was 19w2d, which was my PPROM milestone with the twins. It happened to coincide with the weekend before my SIL's wedding, so it was also a hectic family time. I spent a lot of time crying in the shower and crying in bed that weekend. Hitting my PPROM milestone was harder than I anticipated and made me sadder than I thought it would.

I was also incredibly fearful. I knew there were no ominous warning signs that my water was about to break, but it still felt like maybe there was something karmic or evil about that particular gestational age that would rob me of this little one, too.

My FIL made a toast at dinner in which he listed month by month all of the babies born in our extended family over the past year and he omitted Aminadav and Naava. Given my already fragile emotional state, this really made me feel like crap even though I know he meant no harm by it. I didn't think it was worth it to call him out on it, especially not on my SIL's wedding weekend when the attention should deservedly be focused on her, but it did really upset me and the timing was just very poor.

Y's grandmother noticed the omission and also commented that she always remembers them. We shared a little cry and that made me feel much better.

Later in the week, I reached the gestational age where I lost Aminadav and Naava. Getting to that point was surprisingly less emotionally charged and sad for me than my PPROM milestone. I felt a small weight lift from my shoulders as the day ended.

And just a few days after that was the Hebrew anniversary (yahrzeit) of Aminadav and Naava's death. I knew that being essentially on the same calendar with this pregnancy as I was with their pregnancy, all of these significant dates would come one after the other.

Their yahrzeit falls on the Jewish holiday of Purim, a particularly joyous holiday, ironically. Y and I decided not to celebrate. Instead, I lit their yahrzeit (memorial) candle and we went out snowshoeing in a nature reserve.  I wanted to do something solitary in nature, so this felt right to me. In the evening, we went out to dinner. I spent a lot of time crying on their yahrzeit and the crying was very therapeutic for me and actually made me feel better, as I find sitting in the depth of my pain on occasion often does.

Then about 10 days after that was the one year anniversary of their birth/death on the English calendar. That date was actually much easier and lighter for me than their yahrzeit. I focused on my appreciation for the blessing of their brief existence instead of on all of the hurt, pain, and what-ifs and should-haves.

The Babe and Me

Thank goodness this pregnancy continues relatively uneventfully. My only major complaint is that I have frequent contractions and cramping/pressure, which coupled with my anxiety makes me really nutty. I go in weekly for a tv u/s to measure cervical length and take a quick look at the babe. My cervix continues to hold stable, usually measuring between 3-3.7cm. This is obviously a big relief.

At 21 weeks, I had my anatomy scan. Everything looked good and we were told for the 4th time that baby is a girl :) The only notable finding was an echogenic focus on the heart, but we are told that with improving ultrasound technology, this finding is becoming increasingly common and is very unlikely to have any significance in light of our first trimester screening and quad screen results.

Baby girl was super active during the anatomy scan, which was pretty cool to see. I have an anterior placenta again this time around, so movement was a little muted at first, but during the past few weeks I have been feeling consistent movement including some really good jabs and kicks that are visible from the outside, which is pretty cool. I started progesterone on the same day as the anatomy scan.

I had a detailed placenta scan at 22 weeks, which showed my placenta looks great. This is also a big relief since it seems placental issues are what began the series of disasters that ultimately resulted in the loss of the twins.

I've made one trip to L&D, which was actually a positive experience, but hopefully we won't have reason to repeat it for many more weeks. I was having menstrual-like cramping and lower back pain for a few days that wasn't going away and I was scared of PTL. My MFM happened to be on call that night and she was very reassuring. We were in and out within an hour with the knowledge that even if I was contracting, my cervix was stable.

I met with the hematologist again a couple of weeks ago. The current plan is that I can get an epidural as long as I take clotting drugs prophylactically beforehand (the concern with an epidural with a bleeding disorder is a subdural hematoma). I will see her again in May.

I am really fearful and anxious these days. I am so scared my body will screw up. I know these next few weeks until 28 weeks are really critical. I relive my water breaking all of the time - it was such a strong sensory experience. 

I know that right now I am very "lucky." Lucky in that I had a relatively easy journey (relative to my previous history, anyway) conceiving this pregnancy after losing the twins and lucky in that so far, I have had a pretty good go of it this time around. (It feels a little ominous and foreboding to write that.) I have experienced enough to realize that this journey has everything to do with dumb luck and little to do with deserving.

I exist in this really weird place where I am constantly trying to mentally prepare myself for losing this dream little girl while in the same moment I can look at cute baby clothes and read carseat safety reviews. Stuck between preparing for the future I have dreamed about for so long and preparing for the death that I pray won't happen. 

                                                   23 weeks

on the pain olympics and why i don't think it's a dirty term

There have been quite a few posts in ALI World over the past few weeks about the infamous 'pain olympics' - a conversation that seems to rear its head almost annually around here. Mel provides a nice history of the pain olympics in the ALI blogosphere and also makes the interesting point that at different points in the history of ALI World, the attitude of the community regarding the pain olympics has shifted back and forth -- that is, it wasn't always a dirty term.

I have been thinking about the pain olympics a lot the past few days and I know perhaps I am in a minority, but I don't think the so-called pain olympics are entirely ugly. The term itself has an unpleasant connotation, but I think it describes a phenomenon that is a natural and fundamental part of this community.

To pretend that it comes from an entirely dirty and ugly place is to me, untrue. Similarly, the assumption that every compassionate, empathetic member of this community is "above" the pain olympics seems a little disingenuous and self-righteous.

Whether you call it the pain olympics or something much more benign, I believe that most of us are 'playing it' almost every day we engage in this community.

I would even go so far as to say that many of the (totally well-intentioned) musings I have come across decrying the evil pain olympics are exercises in hypocrisy because everyone has a story to tell about their brand of pain -- after all, isn't that why most of us participate in this community in the first place?

So many of the comments in posts on the pain olympics begin with "OMG! I hate the pain olympics too!" and end with "From my own experience of [insert painful events here]…", it is comical to me. (Don't worry if you were one of these commenters I don't hold it against you -- there are way too many of you for me to keep track of who said what. :) )

A few scattered (and quite likely unpopular) thoughts & observations on the pain olympics through my eyes:

1. The sorting mill and asking "where do I fit in?" is a natural part of this community.

I think the vast majority of us are guilty of quantifying and sorting the pain and misfortunes of our comrades. I know I am. I would say most of us do it pretty constantly -- it often dictates whose blog we read and who we relate to most closely in this community. As many have pointed out, of course the problem in this is that there is no objective scale of suffering and if you think about what an objective scale of suffering might look like, +2 points for this, 3 demerits for that, it sounds totally ludicrous.

But I would argue that doesn't prevent most of us from making some sort of totally subconscious quick mental calculation anyway. As a reader, I am always interested in "how does this set of experiences relate to my own?" And I don't think it should be a dirty secret that feelings of empathy and kinship come much more strongly to me among writers who have endured experiences similar to my own.

ALI blogs draw me in for many different reasons -- sometimes the blogger is a really talented writer or sometimes she is really funny and creative or perhaps she always has interesting insights and a fresh perspective. Or perhaps sometimes it is just the thoroughness in her documentation of the journey or the feeling that she relates to her blog readership like a group of close friends. And sometimes it is just a shared history - maybe we started our blogs or began similar paths at the same time.

But the women who I feel the most empathy and compassion for? Well it's those who have walked a road similar to my own. And who are those women? Fellow baby loss moms, especially those who have also endured infertility and even share an extensive treatment history.

There are plenty of women who have fought other battles who I feel a lot of compassion towards and whom I so deeply admire, but I will shamelessly admit I tend to naturally gravitate most towards my own kind. I will even put it really bluntly and un-PC-ly -- those who have experienced my own brand of pain and suffering. 

And how do I determine who has experienced my brand of pain and suffering? Well clearly I am engaging in some level of pain olympics to come to that conclusion. To say I am not at least subconsciously sorting and categorizing different types of pain and misfortune would be dishonest.

2. Pain is pain and a loss is a loss (and you don't know my lyfe).

We see these truisms (pain is pain, a loss is a loss) a lot in our community. It might make me very unpopular, but I call bullshit on that. Those truisms actually make me batty.

Everyone comes to this journey with different expectations, coping capabilities, and support from their spouses and their larger support network. What tears one woman apart and makes it impossible for her to function can be a simple annoyance for someone else. Also, our coping abilities, expectations, and hopes constantly evolve and undulate throughout this journey. I was in a worse place emotionally  and more bitter after 6 months of trying to conceive naturally than I was many failed IUIs and IVF transfers later.

There are definitely unique challenging (and frankly sometimes soul-crushing) aspects of different stages of the journey that make that particular point painful and difficult. For me, the initial stage of realizing I had a problem and the process of adapting to new expectations was really hard, whereas at least by the point I had multiple IVFs under my belt, my infertility felt more like a chronic disease than an emergency situation. I am not saying being at that stage of the journey doesn't suck in its own right, but I like to believe that at that point my coping strategies and expectations had evolved to a point where that kind of disappointment was more manageable for me than it might have been earlier on.

So what I am trying to saying at far too great length is that "you don't know my lyfe"  does have a nugget of truth to it, in that just because your set of circumstances is objectively shittier than someone else's, doesn't mean they aren't struggling mightily too and just because you can look back and say "I remember when things were that good" doesn't negate the pain and struggles of that point in the journey and maybe you don't "remember when" because we can all experience similar things quite differently. But…

Speaking of "an objectively shittier set of circumstances" I really strongly believe such a thing exists. This idea that all infertility is the same or all loss is the same because we cannot precisely quantify it really irks me.  I think "pain is pain" or "a loss is a loss" diminishes and trivializes the suffering of those who have experienced the more extreme ends of infertility or loss. Actually, I think it can be downright hurtful.

In my opinion, the loss of my son and daughter due to extreme prematurity (born before viability) doesn't compare to someone who lost their infant in the NICU a few weeks after birth. And by the same token, if you compare your first trimester miscarriage to the loss of my twins, I find that hurtful. And if someone likens your 6 IVFs to their 2nd IUI -- again, offensive in my opinion (which will shortly bring me to my next point).

So I do think that there is a hierarchy to different types of pain and suffering in the ALI world -- player of the pain olympics, again, and I don't feel dirty saying it.

3. A lack of self-awareness can get you in a pickle (or where the pain olympics sometimes gets ugly).

On occasion there is an ALI blogger who could benefit from being a bit more self-aware. The most common offense in my mind is false commiseration -- the person who "knows what you're going through" or "me-toos" -- whether it's her first Clomid cycle vs. your 2nd failed IVF or her early miscarriage vs. your full-term stillbirth. False commiseration almost never ends well -- it usually ends up making the other person feel like her experience is being minimized  and while there is clearly a big gray area, in its most grievous form, I think it comes from a place of lacking self-awareness.

I think it is usually best not to engage the false commiserator. I don't see that anything constructive can come out of calling the person out. At best, you trivialize the experiences of the false-commiserator, which is actually exactly what they did to you. But it doesn't make the false commiseration behavior okay and it can definitely be downright infuriating.

4. The totally unacceptable side of the pain olympics.

I think the ugliest and most unacceptable side of the pain olympics is when a very angry and bitter person takes a post that has nothing to do with them and makes it about them. That is the pain olympics at its very worst  -- the person who wants to let you know that you are not entitled to your feelings of pain because "at least you're not me!"

Another phenomenon I find troubling (though less so than the cruel, cowardly trolling that usually re-ignites the whole pain olympics conversation in the first place) is when people minimize the experiences of others (often unprovoked) because they have not been through as much -- to the point of saying that someone who doesn't require IVF to conceive, for example, isn't truly infertile. I think that diminishes and invalidates the pain of others and to what end?

To say they are not infertile in many cases is just medically inaccurate. Perhaps they don't face the same extent of challenges that you do -- and in that sense they are not the same -- but the notion that you need to arrive to point "X" in treatment or treatment failures to be a 'real' infertile is ludicrous to me.

SO…I have gone on far too long, but in short, I don't think the act of comparing and quantifying one's ALI experiences (i.e. the pain olympics) is such a dirty thing. I think it is a natural, intrinsic part of this community and while the pain olympics certainly has a dark side, I don't think the dark side is the whole story.

a quick week 16 update

I was just updating the "our journey" tab of my blog and it made me so sad to think, when will I ever update the "Aminadav and Naava" tab? I can't believe we are quickly approaching a year since they were born and died. A little trite to say, but it certainly doesn't feel like a year since I lost them and yet my pregnancy with them and the happiness of that time feels like it was so long ago.

I have been thinking lately what I might want to do to acknowledge the one year anniversary of their birth and their death and I am still stumped. I just don't know. Unfortunately, early March is not such a nice time of the year for a special hike or outdoors activity. And of course the creeping thought has occurred to me: Will I still be pregnant with this baby on March 7? G-d I hope so.

I haven't even wrapped my head around what exactly this one year anniversary is - to be born and die on the same day - a birthday and a death day - what is that exactly? A celebration? A somber remembrance? I am not really sure. I guess it is up to us to make up the rules of this day.

In happier news, I had my weekly clinic appointment and the MFM was thrilled with the way my cervix looks. It is measuring around 3.4mm, so I actually gained a bit of length over the past two weeks' measurements, and she said it is curved (not stretched taut) and has a glandular pattern, which is also apparently a good prognostic marker. I am happy to be boring and hope to stay boring for a long time.

We also found out that baby appears to be a GIRL! I am equally thrilled with either prospect, but I was pretty convinced that this babe is a boy, so it was a bit of a surprise :) I had my quad screen drawn this week as well as a bunch of platelet function tests.

My only complaint is that I continue to have weird cramping and what I think are probably sporadic Braxton-Hicks contractions, but painful ones. The various pains definitely put me on edge. I just have no idea what's normal and since I had some pretty significant cramping both before my partial abruption and before my water broke, I never know whether any given 2am cramps are just insignificant, normal pregnancy pains, or whether they are the harbinger of a new disaster.

Does anyone have some ideas of what we might do to acknowledge the one year anniversary of Aminadav and Naava's birth and death? Unfortunately, since we are currently in Canada and they are buried in Israel, visiting the cemetery isn't an option.

these two lands

I hold a kernel of hope deep in my heart that this pregnancy is going to end in a baby that we get to take home. It seems a bit bold and gutsy to confess to that, but it's true. I am not confident in my ability to carry to term, but I think the odds of me getting to something like 28 weeks are much better with a singleton and I think that each new week that passes by with no bleeding bodes well.

Still, it is hard not to be consumed by my fear. This is a different pregnancy, a new pregnancy, and yet it all feels so familiar. I have done this before, walked many miles in these shoes exactly a year before, and we all know how that turned out. Sometimes I even slip up, forget it's not Aminadav and Naava in my belly, and sometimes friends and family slip up, too, asking a question about 'the babies.' If only we really got a do-over, but Aminadav and Naava are still buried in the ground in Israel and in my belly I carry a brand new little one in Canada - the little sister or brother we haven't met yet.

I suppose it makes perfect sense that this winter feels like an extension of last winter and that my pregnancy with this baby feels like an extension of my pregnancy with the twins. After all, this winter and last winter, those babies and this baby are part of the same story and the same journey.

The memories of the terrifying moments are so visceral, so engrained in who I am, it is hard to not constantly relive the sheer terror of my water breaking (exploding really) way too soon and all of the sensory details of the experience.

I was really nervous during the first trimester about an early miscarriage and then I had a brief respite from anxiety, but now I feel my fear slowly creeping back up as I approach the gestation where I began having complications with Aminadav and Naava. 

Every morning I wonder is this the day I will go to work, end up in the hospital, and not come home? Is today the day I'll start bleeding or the day my water will break? Is today the beginning of the end, or just the beginning of the beginning, like it should be? 

I exist straddling a weird in-between of hope, excitement, and fear. Just like last time, I want to read reviews of fancy stroller models and daydream about baby-wearing and making my own baby food, but in my sleep, I give birth in tens of bizarre and disturbing ways to a baby that is not yet viable. Sometimes in these nightmares the baby is somewhere on the floor but so small I wonder if I will find him at all. 

There are limitless demons that can haunt you once one truly awful thing happens - one of those sort of things that isn't supposed to happen. It opens so many new possibilities and avenues of horror. All of the sudden every freak complication seems equally possible because you are one of those people.

The belief that there are those people and then there's you is what keeps your imagination from plunging too deeply into the menagerie of horrors that could befall you. But once you become one of those people that wall comes down and you skate on thin ice because every manner of disaster could happen to you. Suddenly, the improbable odds and freak statistics feel very personal.

So I carry this kernel of hope deep in my heart; this belief that this time will be different but I have another foot grounded in a land of fear and disaster. Praying that in the right time I will land, two feet on the ground, with a screaming, cooing bundle in the 'normal' world - the land of the lucky.

**In mundane medical news, I had a MFM appointment on Thursday. Cervix is funneling a tiny bit at the top, but with fundal pressure, the cervix doesn't go below 2.8-2.9cm and my baseline measurement at 13 weeks was 3.0cm, so there is very little if any change there. The NT results combined with the first trimester screen gives us a 1:29000 odds of trisomy 21 and the appropriate PAPP-A levels combined with u/s suggest that my placenta is functioning well at this point. I think we will do the quad screen at my appointment this week.

I had a hematologist appointment on Friday. They asked me to enroll in a study following pregnancy and medical outcomes of women with bleeding disorders. There is so much known about the role of thrombophilias (clotting) disorders in pregnancy but much less known about the implications of bleeding disorders in pregnancy. The suggestion that my bleeding disorder may have played a role in my abysmal obstetric history is actually pretty unsettling to me.

14.5 weeks - long overdue update!

I am so far behind, I am not really sure where to begin. I often wish I had been much better at documenting my pregnancy with Aminadav and Naava since in the end, my pregnancy was the only time I had with them. I have mused about how I did a good job recording all the mundane details of our fertility treatments and yet I did such a crappy job of documenting the next stage. And here I am again, doing the exact same thing. Actually, I have been even worse about documenting this pregnancy than my pregnancy with the twins.

I suppose it gets back to the age-old question that has boggled many an infertility blogger - how do you blog about the next stage? Who is your audience? And based on your answers to those questions, how comfortable do you feel writing about pregnancy and maybe even parenting? 

I still feel pretty uncomfortable writing about pregnancy. I realize this is pretty stupid given that despite several pregnancies, including one that came very close to living take-home children, I know firsthand that pregnancy doesn't necessarily translate into a baby or babies in your arms and that pregnancy isn't always the holy grail to The Other Side. It is just another stage in the journey to The Other Side. Yet regardless of these experiences, it seems like I will never make the easy transition from infertility/baby loss blogging to pregnant after infertility/loss blogging. 

But I do still feel a tugging to document this pregnancy for myself, for this babe, and for anyone else out there who is experiencing something similar or will in the future. I am so incredibly grateful for this pregnancy. I still can't believe that it is my current reality. At the same time this pregnancy is also of course really complicated for me emotionally. I am very fearful that it could all be taken away from me at any moment and with each day further I get, I feel the stakes increasing. 

I also still desperately miss and long for Aminadav and Naava. I feel like I knew them. I still don't understand why they aren't here with me and I know if they were here, this baby wouldn't exist in the first place. That's complicated. I feel like I knew them. But not this little one. Not yet anyway. I ask all the time: Who are you? Who are you in there? 

And while I have not been busy imagining up a personality for this little one, I think of this baby as a he. I am nearly convinced of it. I will honestly be so happy with either a girl or a boy, but I will be a little surprised if this baby is a girl :) 

On the practical front, I had my first MFM appointment at 13 weeks. I stopped progesterone supps at 11 weeks and I am now tapering off Prednisone while continuing baby aspirin. We did the NT scan and the first tri screening blood work, but I won't have the results until my next appointment. I was just really satisfied to see that baby was still alive! I am so far very impressed with the MFM - he seems very compassionate and knowledgeable. 

At this stage, I will be going to the MFM every other week and they will check cervical length by u/s. I will also continue to be followed by the RPL specialist. At 20 weeks (assuming I get that far), we plan to start progesterone to prevent PTL. Since it is not so clear-cut whether there may have been an element of incompetent cervix in my PPROM and since the 2 D&Cs for retained placenta could have caused cervical damage, cervical change is something they will be closely monitoring. The other thing they will be monitoring closely is my placenta since I had a partial abruption with the twins preceding PPROM. The good news is no bleeding so far in this pregnancy. My next appointment is this Thursday at 15 weeks.

To wrap things up on a light note, here is a recent bump pic. I still treasure my bump pics from my pregnancy with the twins, so I know even if things don't turn out well this time, I'd still like the little momentos. Lastly, in silly news, the most exciting thing that happened this past week was that I got a Snoogle. I can't believe I was deprived of a pregnancy body pillow when I was pregnant with the twins and spent so much time in the hospital and on bed rest - I guess what I didn't know I was missing then couldn't hurt me.