I'm actually 32 weeks pregnant and winning the battle slowly!

If you've been reading my blog, you'll notice I often start a post with "I can't believe we've come this far". That's because it's true. This has been such a harrowing journey that it's been very hard to visualize the end approaching. There were so many opportunities for things to go wrong. If I think about starting with an unexpected pregnancy that was discovered at 11 weeks. Then I lost that pregnancy 9 weeks later with a spontaneous dilation because of incompetent cervix. There's nothing as crappy as walking into a monthly appointment (Excited) and being told - you have to go to Labor and Delivery. Then 3 days later feeling your water break and knowing your baby won't make it.

Then spending another 5 years trying to actually get pregnant. That was a blur of excessive exercise, weight loss, diets, metformin aka glucophage, a 4 month stint of explosive diarrhea, a year's worth of fertility diagnostic work, a round of IVF (with a BFN), a mild case of OHSS, a frozen egg transfer, acupuncture, and finally a BFP. And as if that wasn't enough, a surgery to put in my cerclage ( stitches on my cervix to strengthen it), a cervix that decided to shorten 8 weeks later, 15 weeks of bedrest at home (which I'm 11 weeks into), and now gestational diabetes!

You'll find that I repeat it often but I believe to speak about personal challenges is to release yourself from the hold they have over you. I'm not ashamed of what I'm dealing with. My fertility battle is simply not something I'm ashamed of. As I manage to overcome these hurdles, I get more and more confident that we're going to make this happen.

So now onto the reason that I actually wanted to post today! My 32 week perinatologist appointment went great. Our baby is now 4 lb and 11 ounces. As she gets bigger and bigger I envision the risks of her being born early get smaller and smaller.  The doctor told me she's showing no signs of abnormal growth from the gestational diabetes - and that's comforting. I've been pretty diligent about testing my blood and sticking to the diet they gave us. She's head down and she's having fun pushing down as hard as she can. The only slightly concerning thing was that my cervix has started shortening again. In fact, it's the shortest that it's ever been - 1.7cm. The doc said it was expected - so I'm not going to get too worried about it. I also got my weekly 17 p shot at that appointment. It's hard to believe that it's been 11 weeks of going to the nurses, bending over, and getting a horse needle injection in my backside! The one interesting thing is that I'm only up about 10 lb in this pregnancy. Now anyone who knows PCOS is that weight gain is the bane of our existence - so this has been a pleasant surprise. I'm not going to struggle to get my body back after this pregnancy.

So I'm a happy camper. Our baby stretches a lot and is pushing the limits of my womb. It's a pleasant confirmation that she's doing just fine. Hopefully all will go well and I can get over the guilt I used to feel about not being able to provide a suitable womb to bring a child into this world.

Obsessive Positive Thinking May Be Setting Yourself Up For a Very Painful Failure

So I was part of a chat the other night for women on bedrest. There was a lady who came on and was all about positive thinking. She cited that the number one cause of pre-term labor is stress and bed rest causes stress. She talked about meditation, positive thinking and this concept visualizations. There was also a medical doctor who joined and he was actually not so keen on the idea of "positive thinking" saves pregnancies.

Now I think there's a balance here. On one side, it seems that the lady was suggesting that you pretty much keep saying - this baby's gonna make it - over and over and over - and it will happen. I see the other side, what happens if you get your hopes up and your baby doesn't make it. Having lost a baby at 20 weeks, and having allowed myself to slip into a 3 day period (at the end) of telling myself over and over - we're going to get through this... we're going to have this baby.... she's going to make it.... and then not making it. I don't know if I subscribe to that mentality. I lay there in hospital with wires and sensors wrapped to my body - and for 3 days willed my uterus to stop contracting. I willed my baby to stay inside. I willed by body to cam down just enough for the doctors to put an emergency cerclage in. What I got was my water breaking in the middle of one of these "positive visualization" moments. That was followed by an overwhelming sense of grief and failure.

Did I lie to myself and think I had more control over my situation? Did I not want my baby bad enough? Did I somehow fail my unborn child? Either way - I regret having that sense of false control because I could just be positive and get through this.

Going forward... I really just focus on still being positive, but being always aware of the risks and dangers with my situation. It might sound pessimistic, but I have to remember that there are 2 possible outcomes for this pregnancy - and both of them are equally possible. I don't really have control over how it's going to go, I can only control what I can do to tip the scales in my favor. I can't allow myself to think about this pregnancy going to term without remembering that it might not make it to term. It's been an interesting ride getting this far and I'm excited to meet my baby.... I just hope we make it to the finish line.

My second trimester pregnancy loss (at 20 weeks) Part 3 - The Recovery Process

There's no doubt that miscarriage is hard. Second and third trimester miscarriages are considered even harder because of how close you came to having a baby. It's also because you have to deliver. You may or may not hear your baby cry. It's sort of unfair to get so close to seeing that new life - only to see it extinguished. I'll pick up my story from the previous post - where I pretty much got over my 2 week crying fit over my loss.

Note : Part 2 of this story is here : http://pcosflowerchica.blogspot.com/2011/03/my-second-trimester-pregnancy-loss-at_25.html

Part 1 is Here : http://pcosflowerchica.blogspot.com/2011/03/my-second-trimester-pregnancy-loss-at.html

Now I'm a very determined person. I can pretty much handle setbacks well - but I was ill-prepared for the emotional turmoil that would come with losing our baby. I pretty much let myself weep for 2 weeks and then I decided enough is enough. The first thing I did was make sure that my life would have a manageable stress load. I was working and in college at the same time.

My immediate actions to get my mind right: 

I should say - before I started figuring out what I had to do to normalize my life... I took a non traditional approach to the miscarriage when it happened. I refused any hospital counseling and really didn't want to go down that road.

First - at the hospital - I refused to hold my baby that had passed away. The nurses put the baby in the incubator for me - and I walked over once and looked at her for 2 seconds and that was enough. I know they keep them in an incubator so they can still feel alive - but that just seemed wrong to me.

Secondly - I refused to name her. I did not want to humanize my baby and create a relationship in my head that never really existed. I didn't want to let my thoughts flow towards the times we would have had together. I wanted to accept that she was the baby that would never have been.

Third - I didn't name her.

Fourth - I didn't have a funeral or attend any services for her. I said my goodbye in the hospital and that was that.

Fifth - I don't celebrate the date that she passed and I refuse to make an anniversary of it. I don't believe in intentionally dragging up a painful memory over and over. I'll never forget her and what we went through but I don't need the anxiety leading up to the anniversary and then the emotional ride afterwards.

Sixth - I packed away everything related to her - ultrasounds etc. There would be no reason for me to keep having reminders of the painful memories.

That's pretty much what I did to make sure I had a proper solid goodbye in my mind. It hurt - but I knew it would be for the better.

The next thing would be to make sure my life functioned in some normal way: 


Step 1 - I decided to withdraw from all of my classes that semester. I would pick up where I left off in the next semester. I didn't want to go through the rest of the semester battling my emotions while trying to struggle through my courses.

Step 2 - My job was on campus so it wasn't hard. So I decided to keep that. That would give me a routine and force me to get up and be productive on a daily basis.

Step 3 - I also decided to get back into my workout routine. Funny enough, my obsessive exercise regiment was the reason that I managed to get pregnant in the first place. I guess I had so much exercise that my ovaries were jolted into giving me a few good eggs! So I re-engaged my running partner - and we went back to hitting the trails! The running was awesome. There's a sort of escape from your emotions when you run. Especially with us running out in the woods, I could simply get lost in the good feelings of my legs pumping away, my heart beating strongly, breathing deeply and slowly and just smelling the earth. The second plus is that the endorphins are an awesome legal high that you don't have to feel guilty about. So I ran maybe 3 days a week. I also got back into the gym.

Step 4 - Re-entering my social circle. Now it's very easy to want to withdraw from social settings when you have a loss like this. Of course everyone I met wanted to say something nice to acknowledge what I was going through. Some would dismiss the loss to say - it will work next time. Some wanted to ask what it was like. Some just wanted to acknowledge the pink elephant in the room without being tactless. It was difficult for all of us - so I decided not to make it a taboo topic. It wasn't off-limits topic with me and I did indulge anyone who wanted to know what happened. Honestly - talking about it sort of made it more bearable. It because this thing I went through but not some deep dark secret that I bore alone. It also allowed me to talk about it and to embrace it as just a part of my life. Several months of that and I began to realize that it wasn't having as much of a hold over me.


Step 5 - I went home . I traveled back to stay with my parents and family for a period of time to get a bit of an escape from everything that reminded me about the miscarriage. That helped a lot to give me a "break" from everything.

Now I still had moments of melancholy. There were still the sporadic bouts of tears when I was alone or with my husband. But I got to a point where I could go to baby showers without feeling bitter. I could watch TV shows about babies without lamenting. And I got over that hollow feeling in my womb. I don't believe that I was mentally ready to go back to work, re-enter my social circle, and start living my life again - but I decided to do it anyway. My attitude is that sometimes the body must go on while the mind takes its time to catch up. What I didn't want was to come out of my mini-depression and find that I've lost my job, I've gained a ton of weight, I've flunked my classes oh and yea ... still don't have a baby! I didn't want to allow the emotional component to become a destructive factor in our marriage. It wasn't easy - but it was for the better because this way - the stressors from the pregnancy loss didn't spill over into the rest of my life and I was able to return to some resemblance of a normal life - even though we were dealing with this tragedy.

It took probably a year before I "came right". And even now - there are still the memories and fears from that miscarriage that ride with me through this pregnancy. It's the reason I'll never really fully relax until I hold this baby in my arms for the first time. I'm ok with that - and have accepted that - but I refuse to be crippled by the memories of our first lost baby. I refuse to let it destroy the joyful opportunities in future pregnancies.

My second trimester pregnancy loss (at 20 weeks) Part 2 the D&C

So as I'm sitting here at 24 weeks and 1 day, trying to discern if the mild ache I just felt was normal or something more significant, I figure it's probably time for me to write the second part of my miscarriage story. If your'e looking for part 1 - it's here : http://pcosflowerchica.blogspot.com/2011/03/my-second-trimester-pregnancy-loss-at.html

So to catch you up, I've already miscarried, delivered in the hospital, and now I've been released. My delivery went ok. I even delivered what seemed to be the entire placenta with no problems. I was given that awesome ice-pack filled panty in the delivery room. I know it's a strange thing but with all the discomfort that you go through with a delivery - it simply felt amazing! Anyway, I was released and I went home. I was given a list of symptoms to watch out for.

The very next day, I noticed that I was passing chunks of tissue. It was sort of like a heavy period.  I thought this was strange because I was supposed to be experiencing spotting, maybe some light bleeding. I let the day progress, and the chunks were still coming! So I figured something was wrong. I called the doctor, and they said I should come in. The obgyn on staff did an examination and I kid you not, pulled out some friggin foreceps. She then proceeded to attempt to pull the chunks of tissue out of me!! Right there in the examination room. Now I have a fairly high tolerance for pain - but this was absolutely unbearable! I was damn near in tears. I finally had to tell her that this was not going to work. I was squirming and wincing in pain. She finally stopped and stepped out of the room. When she returned, she said... ummm.... we've scheduled a surgery for you - a D&C - you need to have your uterine lining scraped. We can't do it here.

Oh really? No kidding? What the hell gave you that idea? The fact that you were trying to pull chunks of tissue out of me with foreceps and no anesthesia? And you had to go to med school to know that was a bad idea??? OK I didn't say all of that - but I'm pretty sure the expression on my face said that!

So I hobbled out of that office made my arrangements to have my D&C and I think the next day I was scheduled for a D&C to be performed by my primary obgyn. Now surgeries are always strange things. The meds are weird, you feel loopy, etc.

I got to the pre-op, met the anesthesiologist and my obgyn came to talk to me. He talked about the percentages for success, risks of poking my uterus , etc. Great - just want I want to be thinking about before I go under! They started to bring me down with sedatives and everything went fine. They rolled me into the operating room and transferred me to the operating table. I would be having full anesthesia for this procedure. I remember distinctly that my obgyn / surgeon wouldn't look me in the eye while I was on the table. I didn't know if that was part of his ritual - but I thought it was really creepy LOL. The anesthesiologist told me that she was going to put something in my IV to put me to sleep. She said it would be quick. I sort of looked up to my left and saw her drawing some Fentanyl into a needle. She put it in my IV and instantly I had an itching burning sensation that ran through my body. I tried to tell her that "it itches" but by the time I finished that sentence, I woke up in the recovery room. Now I expected to drift off to sleep - but I literally just shut off.

That was definitely strange. I remember my obgyn coming by and the anesthesiologist telling me everything went ok. I remember my dear husband by my bed telling me - welcome back ! I spent a few more hours in recovery and when I was able to walk - we did the bathroom test. For those of you who have never had an outpatient surgery - the general rule is that if you can piss - you can go home. So I was walked over to the bathroom and I sat on the toilet and spent about 15 minutes taking a pathetic pee. I managed to do so - so they helped me get dressed and I was released. I don't know if I subscribe to that rule - because you're so friggin out of it - that although you can pee - they still wheel you out of there in a wheelchair!

Anyway, the surgery was a success. I had mild spotting for a few days and my bleeding disappeared. They also put me on Percocets. Percocets are my happy pill. I prefer them to other pain killers. They don't give me any of the nausea, light headedness or discomfort like I get from Vicodin. I also understand why there are never refills on them. They literally make all your pain go away and you simply feel happy. Just 6 hours after my surgery I was at home, smiling away, with no signs that I'd lost my baby. No wonder people get hooked on prescription pain killers. All that good feeling and no side effects!

When the pain killers wore off and I decided to stop taking them - I was hit with a wave of grief. I hadn't cried much through my miscarriage. In fact, I think at that point I only cried once when my water broke and I realized our baby wasn't going to make it. And it was just on a phone call to my husband who was getting food at the cafeteria. I simply said - I need you ... she isn't going to make it. I didn't cry during delivering the baby. I didn't cry when she died. I didn't cry when she was laying in that incubator. I sort of went into a state of shock and I got fixated on making sure that I was coherent enough to deal with the medical things that were going on.

So now I was home, not pregnant any more, no baby in sight, and I'll never forget - I went upstairs to my bedroom and simply collapsed in the floor in grief. I cried in a way I've never cried before. I cried for my loss, I cried for my baby and thinking how I'd failed her, and I cried for the pain I had just endured. My husband just held me and let me cry my little heart out. I was sporadically weepish for about 2 weeks and then I woke up and said enough was enough.

I put together a plan to make sure that this tragedy didn't spill over into the rest of my life and completely derail me. So I guess that's another post for another day :) I'll follow up with what I did to recover and make sure that this miscarriage wasn't going to be the thing that ruined my life.

Why is OBGYN/prenatal care so crappy?

I should start with a disclaimer - this piece is a bit of a rant.  Because of my "complex" medical history regarding child rearing, I've had the pleasure of being under the care of an obgyn, endocrinologist, general practitioner, reproductive endocrinologist and perinatologist. And yes at any given point, I've been under the care of more than one of them. So here's what inspired today's post:

Yesterday I went to see my peri to get my cervix measured and make sure I'm not going into pre-term labor. Due to some mixup, the nurse at the front desk gave me my medical file. Since I had to wait almost an hour to see the doctor, and I've read every brochure in that doctor's office thrice already, I decided to browse my file. The most interesting thing I found was a note from my perinatologist to my reproductive endocrinologist and obgyn. It was regarding my cerclage. Apparently there was extensive debate over my case. One doctor didn't want to give me a cerclage - and my peri went to defend the right to give me a cerclage. And get the reason why the one doctor didn't want to give me one : He preferred that I get 3 second-trimester losses BEFORE I qualify for a cerclage. Now how on earth does that make sense? Will I even have the mental wherewithal to still try to get pregnant after losing 3 babies in the second trimester? I'm PCOS, I had to have IVF to have my baby, should I pay for 3 IVF cycles to earn the right to try and save my pregnancy? Who makes up these rules???

Anyway - I digress :) So here's what happened in my first pregnancy - and why I'm very anti OBGYNs. When I got pregnant the first time - I was set up on a monthly appointment schedule. The average appointment consisted of a urine sample, bloodwork, and a quick abdominal ultrasound. That's not so bad. Except, one day at 20 weeks, I walked into my monthly obgyn appointment and was 4 cm dilated. Hmm... someone missed something. I know incompetent cervix is often asymptomatic - so at this point - I gave them a pass. A year later when I was ready to conceive, I had no periods. I didn't get a PCOS diagnosis from my obgyn. What I got was 3 failed unmonitored clomid cycles and then advice to go speak to a specialist.

Fast forward a few years, after finally becoming an IVF graduate, I get released to my OB. Wow.... after spending 2 years with a specialist, you realize how low-grade OB facilities are! My first appointment didn't include an ultrasound or a doppler - because my RE had done one the week before. Of course, every pregnant woman in the first trimester wants an ultrasound or at least doppler to confirm her baby is still there. Needless to say I went on amazon and bought a doppler immediately afterwards! Every monthly appointment afterwards pretty much consisted of a 10 second doppler, bloodwork, and urine samples. And that's it. Now how could you possibly catch anything wrong if that's all you look at ? They have yet to give me an ultrasound. One of my coworkers didn't get her first ultrasound until 20 weeks!! I'm probably just very biased, but with the number of premature babies born in the USA, and the whole range of pregnancy complications, I wonder if a more aggressive screening approach could help a lot of us. Also, why is it people want to see recurrent pregnancy loss to believe you might really have a problem. At my OB office, one doctor tried to categorize my 20 week miscarriage as fetal demise - instead of incompetent cervix. That one statement could have disqualified me for the pregnancy saving cerclage I have right now.

It just seems to me that there's an expectation that if a pregnancy fails.... oh well stuff happens. But no one wants to take it seriously unless it happens over and over. That's fine (I guess?) for women who can get pregnant at will. However, for those of us who have to literally fight and spend insane amounts of money to get our ONE chance at having a baby - that kind of attitude is just appalling. Anyway rant over... that's just my 5 am thought for the day.

So begins day 8 of bed rest!!!!

My second trimester pregnancy loss (at 20 weeks)

I got pregnant by surprise. In fact - it was nothing short of a miracle - except I didn't realize it at the time. I found out when I was 11 weeks pregnant. The story of how I found out was actually kind of interesting. I was driving into town one day, and I suddenly felt really really tired. Not tired - like I should go and take a nap tired, but tired like my eyes are closing right now. I was cruising in the speeding lane, and I noticed a loud fast thumping sound. That was me waking up as my car started skidding into the barriers in the speeding lane! It hit me - I had just fallen asleep!


Completely freaked out, I drove straight to the doctor's office. I simply told them what happened and said I'm not leaving here until you tell me what's wrong with me. They ran tests on me for hours. I went from one office to another. They thought I had a virus, thought I had a UTI, thought I had some kind of infection, and then hours into it - one doctor came in and said... ummm... you might want to sit down for this. I sit down - and he's like you're pregnant! We do an ultrasound and confirm I'm 11 weeks pregnant. How could I have gone almost 3 months without knowing I was pregnant? In retrospect - it was actually pretty easy - I was PCOS and having a period was a rare event for me anyway!


Moving forward, at about 19 weeks and 6 days, that evening, I wasn't feeling so hot. It wasn't anything major but I felt a little bit uncomfortable. I didn't think so much of it because I was scheduled for a doctor's appointment the next day. I distinctly remember going to the bathroom before sleeping, and I saw a little extra yellow discharge in the toilet. It wasn't a huge amount, I wasn't in pain, and it really didn't seem that significant. I went to bed, and then in the morning drove myself to the doctor's office. When I got examined, the doctor's eyes got real wide. He stepped out for a bit, came back in a few minutes and said - you have to go to the hospital immediately - the labor and delivery entrance. You're 4 cm dilated!!! Are you sure you're not in any pain? 

I was in complete shock. I was in no pain, and had no discomfort. I called my husband and told him to meet me there. I got to the hospital and was admitted and put in a critical care ward in  Labor and Delivery. There I got the news, I was in danger of losing my baby. They put me in the Trendelenburg position. It's sort of a way to raise your legs over your hips to help the baby "slide" back in and reduce pressure on the cervix. The picture to the left is an example of it.


That experience was a blur of nurses and doctors. People would randomly come in, lift the sheet and poke around there and move on. I distinctly remember telling the nurse that I am this child's mother, and she's not coming until I say so. Hollow words in a dire situation. The doctor's wanted to put in an emergency cerclage but I started to get contractions. My contractions wouldn't stop. On day 3 of this wait-and-see game, I felt some moisture between my legs. I called a nurse who did a test for amniotic fluid and gave me the bad news. My water had broken - and my baby wasn't going to make it. I then prepared myself to deliver my baby knowing she had no chance of making it at 20 weeks. 


Another thing I didn't realize... at 20 weeks - you go through a full delivery - except you come out empty handed. I had an epidural put in and the doctor warned me that the baby might cry but I shouldn't take that as a sign she will make it - it wasn't possible. Fortunately our baby died in childbirth and I didn't have to hear her die. The delivery was fine. The nurses wrapped the baby in a blanket and left her in an incubator for me. I took one look, but I refused to get too fixated on it. I never named her either. I sort of needed to accept what happened and to move on. The rest was pretty standard, I recovered, was released from hospital and was sent home. I was an emotional wreck but I got through it. 


I'm a bit tired now - so I'll pick up later with the next piece of this story .... what happened when we realized that the placenta was not fully delivered and I was still passing chunks of tissue days later!


Part 2 of this post is here : http://pcosflowerchica.blogspot.com/2011/03/my-second-trimester-pregnancy-loss-at_25.html