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.

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

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.

week 10 update

Today I am 10 weeks + 2. I am beginning to gain a little more confidence in this pregnancy, or at least feel a little more positive about our chances of making it through the 1st trimester, but I still worry constantly that everything could change in a second, maybe without me even knowing it.

I know I have written about it many times before, actually in a way that was eerily foreshadowing when I was pregnant with the twins, but I hate how when things go wrong you feel like such a sucker - like how could I have even thought that everything would turn out ok or how was I was oblivious to my fate.

Yet when things go well, you tend to feel just a little smug or you even berate yourself for having so much unfounded anxiety when everything is just dandy. And as I have also written before, of course the only thing separating Mrs. Sucker from Mrs. Smug is, well, the outcome of the pregnancy, but it's really something you have zero control over and sometimes while all available data points to yes, the outcome is still a no.

In the past week, we unearthed the doppler and I've been able to listen to the babe's heartbeat, so that has definitely been reassuring. Morning sickness has steadily gotten worse, which makes sense because it peaked pretty late with the twins, too. So far I have needed IV rehydration twice which is pretty unpleasant, but the intense vomiting (fun!), still hasn't been as frequent as with the twins. I am now taking diclectin a few times a day, which is a combo of vitamin B6 and antihistamine and that does seem to help, though it makes me really drowsy.

I also started packing up clothes that are clearly too tight and I've now taken out my maternity clothes. This feels like a leap of faith that I am just not totally comfortable with, but I am beginning to grow (mostly just bloat, I think) and it is pretty impractical to have all of these clearly too-tight clothes taking up space. I am more comfortable in mat jeans now than my regular jeans, but I don't plan on putting on any maternity shirts until the start of the new year, which will correspond to the beginning of 2nd tri, if I make it that far. I feel like maternity shirts make it really obvious, so in the mean time I prefer sticking to big sweaters.

I am weaning off of progesterone now, though the plan is to continue Prednisone until 12 weeks and then slowly taper between weeks 12-20. Even though I am on a low dose, I am definitely beginning to feel the side effects of 2 months of Prednisone but I can't complain.

I still have so much unresolved grief for Naava and Aminadav, which isn't at all surprising, but this new pregnancy definitely sometimes intensifies my grief. I just wish so so badly I had the chance to really get to know them and raise them. It is all so confusing - I know I wouldn't have THIS little one on the way if they had survived and I feel much more of an attachment to them than I do to this baby (I feel horrible just writing that) and I suppose all of that makes sense because I carried them for much longer and delivered two very real to me little people, whereas at 10 weeks this pregnancy is still obviously much more abstract.

Sometimes it definitely makes me feel guilty, like I am not 100% there for this little one. But I know that should this pregnancy G-d willing continue, my love for this baby will grow and grow, even if it might take me longer to become attached due to my past experiences and my ongoing grief. And little baby, I can't wait to get to know you and learn who YOU are.

 I think that is all the news fit to print in our corner...pretty boring, I think, but for now boring is good!

speechless

Please body, please G-d, please universe, please random chance: let this be good.

Hooray!

I ovulated :) That is really all there is to say. Now I know that barring any disasters, at least within 2 weeks our IVF cycle will start. Good job, body! In other news, if someone found my iPhone and saw how many of my text messages to Y are about my ovaries, they would be seriously disturbed.

Shaping up

Today I dug through the subterranean trenches of our bathroom cabinets to bring out into the light the Rainbow Light PNVs, high-dose folic acid, and vitamin D - also known as The things I might take if I was actually expecting to be pregnant soon stash. I am embarrassed to admit it, but I gave up on taking PNVs and extra vitamin D ages ago and I haven't taken any folic acid since my last injectables cycle. Among other embarrassing confessions, those PNVs used to make me a little bit giddy back in the day because they had the word 'prenatal' on them, and taking anything that pregnant women take made me feel so close to that stage I could almost taste it.

I am so used to thinking that I am not going to be pregnant in the most endless and infinite sort of way, it is quite a change in thinking to realize suddenly that I need to pony up and start taking better care of myself and act like someone who could soon be pregnant, much like my former naive new-to-TTC self. That girl was so hopeful for the future and so confident, healthy, and might I add sooo THIN, it is hard to get back in touch with her after all the sh!t that's gone down since then.

Ahhh, I hate this hope and all these high expectations for this upcoming cycle but at this point, it's all I have and so I love it too because it is what propels me forward and inspires me to carry on. Will I look back on the present a few months from now and think how naive and foolish I was to think I might get lucky on IVF #1 or is there a chance I could actually be That Girl for once?

Happy New Years! (and IUI #3)

Oh man, I can't believe how long it's been since I last posted! I fried the motherhood (sorry, motherboard, Freudian slip...but thought I'd keep it:) on my 3-year-old Macbook and am now waiting until my next trip to the states to replace it, so my computer time has been pretty much reduced to whenever I can sneak onto Y's computer or find a free few moments at work. Since it's been over a week, this post is probably going to be somewhat of a smorgasboard.

First, last Wednesday I went in for my CD14 monitoring ultrasound. Since in the past I haven't O'ed on Clomid CDs 5-9 until CD16 or 17, I wasn't particularly concerned that CD14 was too late. I was floored when the ultrasound technician mumbled "That's a little strange" (famous last words at most of monitoring appointments so that part in of itself was not particularly surprising) and then proceeded to tell me that I had two mature follicles at 25 mm and 26 mm already on CD14. The good news is that at least I didn't overrespond with a zillion measurable but not mature follicles this time, but it was still a little unsettling that they were that big at CD14 and also that I hadn't ovulated them naturally already at that size.

I was told to trigger immediately and return in the morning for our IUI. I worried that I would ovulate on my own before the IUI, and sure enough my temp was up almost a full degree the morning of the IUI. Strangely, I had a lot of discomfort and fullness on my right side above my hip bone a few hours after the IUI to the point that I couldn't stand or walk comfortably. Being Debbie Downer, I jumped to the conclusion that maybe one of those huge follicles was actually a functional cyst, but the pain disappeared by the next morning, so who really knows what was going on.

I don't know what the heck to expect this cycle, but as usual, I undulate about 30 times an hour between daydreaming about those two (very robust or very over-ripe?) follicles that are surely developing into healthy twins with a combined IQ of 500 as we speak and feeling sorry for my broken self who in all likelihood will face either another BFN or another miscarriage in the coming weeks. Thinking of all of you wonderful ladies, and hoping that in 2011 all of our wildest dreams will come true!