snapshots: parenting after loss

 
I know I haven't written here in many months. In fact, I haven't visited at all in many months. During my pregnancy with Naama, returning to this place became too much, this special and sacred place where over the past few years I opened up my heart and received so much from you in return. For anyone following along, I hope you will forgive me for my absence. I still can't quite explain why I couldn't write or come here for so long, other than being quiet was what I needed most during the spring and summer.

Naama was born on June 26, 2013 at 37 weeks gestation. Her name means pleasant and calm. She came into the world with a full head of black hair weighing 2700 grams (just shy of 6 pounds) and measuring 20 inches long. She has made my wildest dreams come true.

I don't go over all the details in my head constantly anymore. The details of what happened to me, to us, is too painful to take in all at once. But not infrequently, I catch a glimpse of something and I am transported back to that cruel, rainy winter and everything that transpired then and in the years that preceded it and during the months that followed.

Sometimes I am walking down the windowed staircase of the medical school research building to my research lab and I catch sight of the old inpatient building that is now defunct. I look across at the windows (shutters now drawn) and balconies of the third floor -- the women's ward -- where Aminadav and Naava were born and died in the final months of the building's use, before all the inpatient wards were relocated to the new tower. 

And I am back.

I remember my view from the hospital room, a nice view, really, with the Judean hills off in the distance. The grayness and bleakness of that drab winter, which was particularly cold and rainy. Early mornings being sent down with an orderly in my wheelchair for ultrasounds -- during the first hospitalization, hopeful -- just a bleeding spot in the placenta -- and then more bleak, the ones where I asked the technician to turn off the big screen and only Y could bear to look at the small monitor: two hearts beating, two beautiful, healthy babies, except one immobilized by no fluid left and the death sentence that awaited my two precious bubs.

I remember lots of the little details, and perhaps they are the ones that hurt most: the moment of shock and horror of my water breaking all over the bedroom floor while on bed rest after being discharged from my first hospitalization following my partial abruption. Knocking frantically on my next door neighbor's door, the one with the balloon animal-covered van who ran children's birthday parties, whose popcorn cart infringed slightly on our storage space in the basement. "It can still be, it can still be!" she exclaimed, mostly to herself.

Leaving the hospital through the mall once it was all over, walking past the baby store with my deflated belly and empty arms with the realization that Y and I were leaving the hospital as two and that was it, having gone from a family of two to four and back to two again. It would never be all four of us again.

Y telling me on the way to the car: Just so you know, we're not going back to my car, it's a rental because my car is in the shop because I swerved off the road and totaled it three weeks ago in the rain on my way home and I didn't tell you because I didn't want you to worry. 

I remember going home for three weeks and then going back to the hospital and my massive hemorrhage and the new worries about my platelets. It seemed like I couldn't keep myself out of the hospital.

My mother came from Massachusetts to Israel to stay with us and I wanted her in the apartment but not in the same room. I sat on the computer by myself and discovered a Glow in the Woods and searched every variation of "abruption" "PPROM" and "twins"  on PubMed again and again, searching desperately, pleadingly, for a way to save my dead babies. If only I could figure out the magic formula retrospectively, maybe I could bring them back. Maybe I would get a do-over and they would live.

Then, finally, is the second half of my story: redemption. When Naama was born, right after her Apgars, the nurse placed her immediately on my chest. I remember looking down at her in shock, stunned -- was this really my baby with her mop of thick black hair? Mine? Alive? Even when I was in labor, the sublime reality of it all seemed thousands of miles away in time and space.

But the photograph Y took in that moment captures something else -- a tiny hand reaching up, up, tightly clasping the round "N" and "A" discs on my necklace. Reaching out into the big world and embracing her big brother and big sister.

Does she know? I often wonder.

Usually I am not prone to those type questions, but I like to believe that my beautiful, vibrant, living daughter is connected to her older brother and sister in ways we don't necessarily understand. I do know that she would not exist had they survived. This is the complicated reality of parenting after loss. I could never had all my children alive, for Naama's existence is a direct consequence of Aminadav and Naava's death. To pretend anything else would be dishonest, though the reality is impossible reconcile.

When Naama was three days old, I read her her first book, Goodnight Moon:

Goodnight room, goodnight moon, goodnight cow jumping over the moon.
Goodnight light and the red balloon. Goodnight bears, goodnight chairs,
goodnight kittens, and goodnight mittens. Goodnight clocks and goodnight socks. Goodnight little house and goodnight mouse. Goodnight comb
and goodnight brush. Goodnight nobody, goodnight mush and goodnight to the old lady whispering "hush."  

Goodnight stars, goodnight air, good night noises everywhere --
 

This part came out in a choked whisper. Hadn't I recited those same lines for Aminadav and Naava in my head when they left us? Many parts of this parenting gig have left me in tears of both gratitude and the knowledge of what was lost, especially in those first few days, when the details of another labor, another birth story, came flooding back. It all felt very familiar. And I suppose that in some parallel universe, I had done all of this before. It was all for the first time just as none of it was for the first time.

One of the most helpless things about losing children at birth is the inability to parent them. It is a biological cruelty that when you are left empty-handed, you are still flooded with the same maternal hormones that catapult the rest of us into the nurturing and caretaking of mommy land. And so all of these rituals of newborn care, the tedium of the feeding and rocking and diaper changing, took on new meaning for me, all of the things I couldn't do for my sweet twins. In her memoir "An Exact Figment of a Replica of My Imagination" Elizabeth McCracken writes about her son Gus, born after the stillbirth of her first son Pudding, and captures the notion of the parallel universe far more eloquently than I ever could:

Sometimes I look at Gus, and it all feels very familiar. Not him. He was a skinny just-born, with cheekbones and an incensed cry: he looked like an old man who’d been outfitted with hands and feet a size too big and he wanted to know to which knucklehead he should address his complaint. Now he is fat and looks like a retired advertising executive. He is gorgeous and inscrutable. I tell you, I’ve never seen his like. But taking care of him, changing him, nursing him, I felt as though I’d done it before, as though it were true: time did split in half, and in some back alley of the universe I took care of Pudding, when he was a tiny baby, and this reminds me of that. There’s a strange museum/ gift shop/ antique store/ tourist trap in Schuylerville, New York, the next town over. In front is a reconstruction of colonial Fort George done in wood cutouts — a soldier in stocks, Revolutionary soldiers in profile, all cut with a jigsaw and painted in bright colors. In front is a sign that says: An exact replica of a figment of my imagination, and that is what this life feels like some days. It’s a happy life, but someone is missing. It’s a happy life, and someone is missing. It’s a happy life —

I think she has it just right: "it's a happy life, but someone is missing. It's a happy life, and someone is missing. It's a happy life --"

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

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.

an eventful & stressful week

Sorry for the lack of updating. I still have a hard time writing about pregnancy. I apologize that this will likely get long since I am so far behind. It is always good to type things out, though - I hope that my experiences will be helpful to others and I also like having a written record for myself, too.

The past few days have been incredibly stressful. To rewind a bit, last Thursday I went in for my second scan. In typical fashion, I spent most of the day before day dreaming about a negative result…you know the positive visualizations they teach you to do in fertility mind/body meditations? I tend to take the skills learned there and adapt them for the bad. Anyone else do that?

Instead of visualizing my body doing something great (lots of follicles for IVF, many embryos fertilizing in their dishes, a strong embryo implanting), I visualize the worst in all of its sad, morbid detail and somehow I think this is some sort of amulet against it actually happening.

Or perhaps more accurately, I feel like if I visualize it first, I am easing myself into the possibility of bad news, adjusting my expectations so if something isn't right, I am not shocked, or so I don't feel like the 'fool' again.

There is some famous quote you often see on miscarriage forums about how if you worry about something bad or imagine it in your head and then it does happen, then you've had to live through it twice instead of once (and if it doesn't happen, you've unnecessarily subjected yourself to anxiety and fear). I guess I take the opposite approach -- I believe it is easier to experience the reality of bad news if you are already half-expecting it and have already walked around in it a bit.

Anyhow, enough about neuroses for now! The scan actually went really well. I was measuring 8w0d -- still a day ahead -- and we got a nice strong heartbeat of 167 bpm. Also, we are at the gummy bear stage -- little limb buds beginning to form and I saw the spine, too.

So I left last Thursday's appointment feeling pretty good about things. On Saturday afternoon I got a headache, which over the course of a few hours turned into a bad headache with very severe vomiting. Over the course of about 6 hours, I vomited 15-16 times. I could just not get a grip on the vomiting and I was really miserable. Y brought home IV fluids and Zofran and managed to rehydrate me at home.

Sunday I was still feeling under the weather but had some things planned and yesterday I was really dragging my feet at work -- just didn't feel like myself. Around 3pm I started to get very intense contraction-like pains. After two waves hit (with about 10 minutes in between) I realized it wasn't going away and I left work as quickly as possible, highly suspicious that the contraction-like pain was the early stages of miscarriage. Bleeding all over the place at work is basically one of my worst nightmares, so I high-tailed it out of there.

Managed to make it home and to the couch. The pain was intensifying. In between waves, I was merely uncomfortable, but the contraction-like pains themselves felt EXACTLY like how I felt when I received Cytotec to complete my 1st miscarriage. Y came home and squeezed my hand and we were both so upset. After a couple hours of this with no blood in sight, Y suggested that we head to the ER to see if we could get some idea of what was going on.

We went to the hospital in the city that specializes most in pregnancy issues and has 24/7 ultrasound facilities. The ER was a horrible experience. We waited just over 5 hours to be seen. In the mean time, the contraction-like pain slowed to 15 minute intervals and then 20 and then eventually stopped, thank G-d.

They wouldn't allow me to drink a cup of water over those 5 hours which in retrospect makes me livid (they weren't giving me IV fluids, either). I assume the reasoning is that they don't allow patients complaining of abdominal pain food or water in case they have a surgical abdomen, but after waiting over 5 hours to see a doc, you can be pretty damn sure no one REALLY thought I had a surgical abdomen.

Anyhow, we finally see the doc who doesn't examine me but brings in a portable ultrasound. He says he sees a flicker and suggests I come back in the morning for a full ultrasound and sends me on my way. He also says my labs look fine.

Today I saw the lab results from last night and my ketones were +3, so I don't think there was any doubt that I was at leastly mildly dehydrated. I now suspect that I never fully recovered from my dehydration on Saturday and that I was walking around trying to do too much while dehydrated -- hence setting of the contractions. What is maddening is the three other women being seen for early pregnancy issues who were sitting in the same waiting area all had IV drips and they wouldn't let me have a sip of water or give me fluids! So basically I went to the ER to become more dehydrated than I already was against my will.

I also don't think it would take Dr. House to look over my lab results and my complaints and think "Oh severe dehydration 48 hours ago + current severe cramping + currently throwing ketones - must be dehydrated!" But since I didn't have access to my lab results while we were in the ER, I never got the opportunity to put 2 and 2 together.

This morning's ultrasound was good, thank G-d. I am still really shaken, though - that level of pain was really unnerving and definitely not normal. They sent me to a nurse to get the results. She had a prepared speech that the risk of miscarriage at this point is 50/50. Even I the eternal pessimist call bullshit on that.

Maybe the risk of miscarriage is 50/50 around the time of implantation, but after seeing a good heartbeat and good progression over the course of 3 ultrasounds (now 8.5 wks), I am quite sure the risk of miscarriage is well below 50%.

I asked her whether the chance of a miscarriage might be lower based on seeing a good heartbeat on multiple occasions in hopes that she would revise the 50/50 statement and she said "Yes -- definitely -- once you see a heartbeat at the NT scan and then at the anatomy scan at 18-20 weeks, the chance of miscarriage is much less."

She then went on to describe if the baby is healthy and no anatomical problems are found at the anatomy scan, you are almost home free. If she is an OB/gyn nurse, I would hope that she knows that most late pregnancy loss is due to maternal factors. I thought it was super ironic that she was telling me that a good anatomy scan means you are almost home free less than a minute after I told her I had a partial abruption followed by PPROM at 19 weeks, while she was reviewing my history. The whole experience just made me upset.

Right now I am feeling incredibly grateful to still be pregnant but really down-trodden over the events of the past few days. This is the hospital that deals most with high-risk pregnancy and the place where I will be receiving my care and frankly, so far I have found the level of care appalling compared to Israel and I have very little confidence in them, which is a really sucky feeling.

our little squiggly & welcome iclw

Today we went in for our first ultrasound - a day earlier than planned due to some pretty bad cramping I've been having. I have been really terrified the past few days, so I was really happy to get it over with. Thankfully, the news is good.

We have one beautiful squiggly measuring a day ahead (6w6d) with a heart rate of 139bpm. I am happy. I am feeling more hopeful than I have in a very long time. I was terrified that we would see an empty sac, but I was also really scared we'd see more than one baby. Twins are so special and wonderful, but after losing Aminadav and Naava, a twin pregnancy is too risky for us. With a singleton, I hope I will have a good shot of carrying close to term. Of course we have a LONG way to go before we are back to the prematurity/PTL concerns.

I will do another ultrasound next Thursday and then we will take it from there. This was my first pregnancy-related ultrasound in Canada and it was weird to me that they didn't allow Y into the room, didn't let me see the screen, and would only give me results via my doctor. It felt really paternalistic to be honest. However, they did give me a nice picture of Squiggly. It feels so strange to say that I am feeling happy and peaceful, but it's true!

For those just joining us through ICLW, welcome! For a brief recap, we recently learned that we are rather unexpectedly though wonderfully pregnant after a long-shot Clomid/Prednisone cycle while waiting to start a new IVF. We started fertility treatments in August 2010 and since then we've done 6 IUIs and 5 IVF transfers (3 fresh, 2 frozen).

We've had many failed treatment cycles and several losses - two early miscarriages and the loss of our beautiful twins, Aminadav and Naava, who were born catastrophically early last March due to PPROM/PTL.

This blog has been an infertility blog turned pregnancy after infertility blog turned infertility blog many times over. Through the past few years, I've written quite a bit about unexplained infertility, the IVF process, miscarriage, high-risk pregnancy, and baby loss. The posts that are most meaningful to me are those about Aminadav and Naava, my lost hopes and dreams for them, and my grief.

Whatever brings you to our community, I am so sorry for your struggles. This is a sucky club to be a part of, but thankfully for us it is populated by many courageous, funny, resilient, and bright women.

quiet

I know I have slipped back into my cocoon the last week or so. There is not so much to say about my pregnancy. It is basically a black box until our first ultrasound on Thursday (7 weeks).

The days are passing very slowly and I constantly worry that my symptoms are too mild. But I suppose it boils down to something pretty simple -- either there will be a heartbeat(s) on Thursday or there won't be.

It is a little haunting how this pregnancy came almost exactly a year after my pregnancy with the twins. The two due dates are just 15 days apart. I can't help but be transformed back to last November -- every little detail of where we were, of how my pregnancy with the twins began to unfold.  But it is strangely comforting, too. I feel Naava and Aminadav's presence more strongly now. It is a sweet, bright presence that brings me nostalgia and warmth.


Israel has obviously been weighing heavily on my mind. Seeing on the news what it going on back home and not being there -- it is all very strange. Also, now living outside of Israel and seeing the way (some) of the outside world views the conflict is truly distressing and frightening to me. Those who question the right of Israel to exist and defend herself disturb me greatly.

Here's to a quieter, calmer week for everyone.

beta #4 and RPL appointment

Yesterday beta #4 (20dpo) was 2341, up from 955 two days before (I think I originally wrote that it was 956...I was off by the last digit!). I was pretty relieved and quite pleased with that. My progesterone took a nosedive though, which is weird. I think my dose probably needs to be upped a bit. Of course it makes me nervous...just like everything else.

I have another beta draw tomorrow (#5). Hopefully this will be my last. I find the betas really nerve-wracking, so I would be very happy to be done with them, but the RPL doc wants two to compare that were drawn at his clinic since there can be inconsistencies between clinics.

Speaking of which, we had our appointment yesterday afternoon with the RPL specialist. It was originally set up as an IVF consult, so I am quite grateful that he was still willing to see us in the context of this rather surprising pregnancy. I did all the first tri bloodwork as well as screening for a bunch of antiphospholipid antibodies.

Truthfully, I didn't look too carefully at the requisition sheets so I am not exactly sure of everything we did (very unlike me) but it amounted to 15 vials of blood. Apparently, false negatives for antiphospholipid antibodies are common during pregnancy, but a positive result could change our current management, which is why we still did the tests.

In the mean time, I am continuing on with the progesterone and Prednisone (until 12 weeks) and starting low-dose aspirin. I know I spoke to several doctors in Israel who don't believe that baby aspirin does anything, but this doctor felt pretty strongly about it, and I don't think it can hurt...hopefully it will help. He will continue to follow the pregnancy and then if I am lucky enough to make it past first tri, I will be referred to the high-risk clinic.

Overall, I feel like we have our bases covered and I am so relieved my beta didn't drop but we have a long way to go, baby - just 5 weeks today.

beta anxiety (second edition)

Last night Y got a script from his dad for a beta, if I wanted to repeat it today instead of waiting. I toyed with idea - I figured if this pregnancy is truly on its way out right now (a possibility), it would be reflected in a beta that is the same as yesterday or falling. But an equally likely possibility, perhaps even more likely, is that the number would be up, maybe another slow rise, and repeating it within 24 hours instead of the traditional 48 would just make it unequivocal and hard to interpret. The final possibility, that my hcg is playing nice again, is also definitely possible, but just having the 24h result, I'd still be nervous.

So...I decided I would POAS this morning and if the FRER was clearly getting lighter, I would go in for another draw this morning to confirm a fall, if it looked the same or even darker, I would wait 48h for the next draw....very scientific, I know :)

I had a really weird dream that I was getting some work done in an empty classroom, which apparently involved spreading my possessions about, including a massive collection of saved FRERs from this pregnancy. In the dream, I proceeded to pack up most of my stuff, forgetting the FRERs, and realizing only too late that a class had begun and a bunch of kids were now in the room...WEIRD.

In my second dream, this morning's FRER shattered before I could really interpret the result. And for what it's worth, in reality, today's FRER looked the same as the one from 2 days ago, but since the pregnancy line is so much darker than the control line, it is hard to interpret beyond safely saying that my beta is not likely plummeting.

So now I get back on the waiting train. I know I was a bit dramatic last night....but I was really so sad and disappointed. I know I have a tendency to jump right to the post-mortem before disaster has been confirmed (or sometimes even, denied).

What doesn't help this tendency to jump to the worst conclusion whenever anything is less than perfect is my history. It seems that anytime anything is slightly less than stellar for me pregnancy-wise, it inevitably leads to a succession of events that culminates in something bad.

The truth is, I am barely coping with my fear and anxiety when everything is going perfectly, so when stuff goes less than perfectly, it really throws me a curve ball. For now, I am just trying to get through the day.

I know that betas that stop doubling nicely can be ominous and unfortunately, the first sign of a pregnancy that isn't doing well can be jittery betas, even if it's only weeks later that the pregnancy actually fails.

Two rather innocuous possibilities for the slower rise:
1) There were two embryos and now there's one....a vanishing twin. My betas have been higher than average, even for a twin pregnancy, according to betabase, though I know there is no hard science to predicting multiples based on betas...high betas can also of course correspond to a singleton who implanted on the earlier side. If there was in fact a vanishing twin, my betas should recover with the next draw.

2) Y suggested that perhaps I was a bit dehydrated for beta #2, artificially raising the result. If you consider only the first and third beta values, the overall doubling time is still within 48 hours.

I am so anxious about the future, but like with everything else, unfortunately only time will tell.

beta blues

I wish those magical two pink lines didn't make my heart sing with glee every time I see them. I wish those magical two pink lines didn't tempt me to fantasize about my dream life, the life I took for granted that would be mine for so many years every time I see them.

Every time so far that I've seen those magical two pink lines, I've been duped, and yet, every time I seem them again, I am filled with renewed hope and anxiety and fear and forboding, yes, but also so much joy too.

Why? Why can't I view those magical two pink lines of a pregnancy test with the same detachment I view the two very unassuming lines on an ovulation predictor stick? Why can't I just learn my lesson? In my world, those magical two pink lines -- they pretty much mean...nothing. But I seem to be very late to the game in accepting this on an emotional level.

The doubling time between betas 1 and 2 was 33 hours -- from 146 at 13dpo to 391 at 15dpo. Those were some pretty strong betas. However, beta 3 at 18dpo was 956, a slowing to a 56 hour doubling time. Coupled with the awful headache and lower back cramps I've had today, I can't help but worry that this pregnancy has begun to fail.

Also, this is ridiculously subjective, I know, but I POAS yesterday morning and the pregnancy line was soooo much darker than the control (it stole most of the dye from the control line), I really think that it would have corresponded to a beta of at least 1000 and that things just took a downturn in the past 24 hours.

I know a beta can take 72 hours to double and it can still be okay. I know the 48 hour doubling time rule is a little arbitrary and that there is a whole spectrum, but I have never had betas not double in 48 hours and had it been okay. Also, these cramps are for real. So, I think I might be pretty close to bidding pregnancy #4 goodbye. I only hope that if it's not meant to be, it won't be a protracted ordeal with unequivocal betas and ultrasounds and that it will end quickly.

I am sad tonight. I really believe in my heart every time that this is the time that will be different, but sometimes to continue trying just feels like punishment. I also believe in my heart that this is a problem with my body and not our embryos.

the (great) unexpected

So…this is very strange for me. This was something I wasn't anticipating at all. I actually feel pretty uncomfortable writing about it. In my last post, I mentioned that before getting back into the IVF grind I was doing a long-shot Clomid/Prednisone cycle, just to help pass the time.

I also mentioned it was a bit of an experiment - I thought it was a little uncanny that both of the 2/5 IVF transfers when we used Prednisone I conceived. With IVF, there are so many variables, it was obviously impossible to speculate too much about the role of the Prednisone. I did wonder, though, if our problem was really of the implantation/autoimmune variety, whether I might be able to get pregnant with minimal intervention if I was on Prednisone.

It still obviously seemed like a total long-shot with my history -- after 6 IUIs and 5 IVF transfers you don't realistically expect to get KU with $60 worth of pills. But it happened. Y and I are both shocked that this far-fetched experiment to pass the time before our upcoming IVF consults following the epic Canadian wait has worked…at least so far.

Even if this cycle doesn't result in a successful pregnancy, I think it has taught us a lot. We really need to re-address some of our most basic assumptions about the nature of my infertility and its treatment -- specifically, considering the autoimmune angle.

I got a positive hpt at 11dpo, the day after I wrote my last post. Today my first beta at 13dpo was 146. Obviously, we are feeling very cautious and guarded. We've experienced so many different ways of pregnancy not working out, it feels like a bit of a mine field and it is really hard to have any expectations at all, especially this early.

Also, I have been spotting the last 2 days which makes me pretty nervous, though the first beta helped to allay my fears a little bit. I go back on Friday for beta 2. Please keep us in your thoughts that this turns out well.

I am feeling really guarded in sharing the news this time around even on the blog -- still trying to process this really surprising but obviously extremely welcome news myself.

Here we go again. Let's do this.