It's Clearly Not About Me

 ​​​​​In previous pregnancies, we’ve always shared fetal sex as soon as we knew it. We’re not doing that this time. “Why,” you ask? Two words: my mother.

After we lost Alexis and Zoe, at some point during a conversation with my mom, she shared that “everything would turn out all right, because I had a dream of you holding a baby boy, so I know you’ll have a living baby.”

Let’s unpack that for a second. One, when you’ve lost two children, nothing ever in the world will make it “all right.” Nothing. Remove those words from your vocabulary when talking to a loss parent. Seriously. Dick move #1. Two, I had wanted girls. Badly. My mom knew this. My mom has always shared that when SHE was pregnant, she wanted a girl. This would suggest she might have some empathy about sadness over losing girls and having boys. Nope. Dick move #2. 

I sat with that for a while, and then told her that while I appreciated that her words came from a place of love, the reality was that in order for her dream to “come true”, we had to lose our girls. We never wanted three kids (ha!), and if we’d had two girls, we never would have had a boy. In this context, I asked her not to bring it up again.

Then I got pregnant with Quinn. Until the NIPT, I was convinced I was carrying a boy. I foolishly mentioned this to my mom. She burst out with her dream again. I reminded her of how hurtful that was and asked her not to bring it up again. Alas, we all know how Quinn’s pregnancy ended.

I don’t remember her mentioning it during A and T’s pregnancy, but after they were born, there was an “I told you so” type moment where she raised it as I was cuddling A. Gloating that your daughter lost enough babies for your prophetic dream to come true? Ultimate dick move. 

During our IVF rounds, she told me she’d had a new dream of me holding a baby boy, so she thought it would work out.  Thus, we are not sharing sex. I want neither gloating that she’s right if it’s a boy, or being reminded of her dream repeatedly as her way of “warning” me, if it’s a girl. I will deal with any comments after the fact if/when baby is here safely.

All this pisses me off. I want to be able to talk about baby with appropriate pronouns. I want to share this information. I don’t want to worry about accidentally spilling the beans. I get so little joy in pregnancy that it really makes me angry to have this taken away. I’ve advocated, bluntly, for myself to no avail. I love my mom, I’m grateful for the million other ways she’s amazing. More importantly, my kids love her, so I have no intention of cutting her out until birth. It’s just a lousy, no-win situation. It’s not about her, but she’s determined to have the last say, so suddenly it is about her. 

Abdominal Cerclage, Round 2

 My first abdominal cerclage was an awful experience. The hospital wasn't great, I was in the 8s and 9s on the pain scale, my digestive system broke down on me, and I wasn't ready to return to work four weeks out, although I did.

I was scared stiff about how this one would go, given that I already felt like hot trash from the HG. It was a breeze. I would do it again, no hesitation, if only because whatever the anesthesiologist gave me afforded me three, gloriously nausea-free days! So, here's the recap. This was with Dr. Sumners, and Ascenion St. Vincent Hospital in Indianapolis.

Tuesday: Flew to Indy.

Wednesday: Pre-op appointment. I had a detailed scan, looking at baby and cervix. After that I met with Dr. Sumners, several of his nurses, and another doctor who was shadowing him. He told me at this point that he was planning to place both a single TAC band, and a TVC. He never said anything, but I could see when watching the ultrasound that the lower portion of my cervix was already dilating. We discussed my pain from last time, my allergies, and timing for disability leave. He was thoughtful about my concerns and had sound responses. He told me he wanted me on anti-contraction meds for 48 hours post surgery.

After he left, his nurse walked through things with me like the pharmacy I'd use to fill my prescriptions (pain meds and anti-contraction meds). I had sent Dr. Haney a 3 page summary of past surgeries and pregnancies. The nurse expressed her appreciation that I had that together and she didn't have to pull it from my hundreds of pages of charts! She was also really sensitive and didn't make me rehash all past pregnancies, but said she'd fill those in from the summary I gave her. That was a thread with nearly everyone I worked with: real sensitivity to my past losses. I appreciated that a lot, as I find I rarely experience that compassion. 

Thursday: Surgery day. I had to check in at 6:45 am for an 8:45 surgery time. The hospital was relatively empty, with just my mom and I and two pregnant ladies who were clearly checking in for c-sections. I was taken back alone for pre-op. Changed out of all of my clothes (but held onto the piece of Quinn's blanket that I had brought with me until the last moment). Was told I have great veins and had an IV placed. The nurse spent nearly an hour going through my full medical history. She was extremely thorough, which was nice. Everyone agreed to put 'Zofran' as an allergy on my chart, to ensure that I'd be given something else instead. We discussed the best tapes to use for that allergy. There was a TV in the pre-op room, so when she left I turned on something mindless.

Dr. Sumners and the Dr who had accompanied him the previous day came in. He assured me that he'd been practicing on the patient before me! I was asked to confirm what surgery I was there for. 

The anesthesiologist came in next. We discussed my issues with Zofran and preference for Reglan. I brought up some of the pain control options, and the fact that morphine makes me puke when I take it orally/IV post op. He listened to me, but kept trying to steer me back to what he wanted, which was standard spinal and post op PCA. In the end we agreed on a nerve blocking medication, decadron for nausea, a standard spinal with morphine, and Norco for post op pain medication. That was an awesome combination. The worst my pain ever got was a 5, and most of the time if I laid still, I didn't feel any pain at all. Best of all, the nausea went away. I can not convey how awesome that was. I could lay still and feel good and human again, even right after surgery. Such a difference from last time!

I was moved to antepartum a few hours post op, and they did a doppler check so I could hear baby's heartbeat All sounded good. They insisted on clear liquids only, to give my digestive system time to recover. I made sure to get a full dose of Miralax in, along with as much apple juice as they'd give me! 

During the day, I drowsed in and out, thanks to the meds. I didn't get much overnight sleep, because I was having my blood pressure measured every 10 minutes. It kept being very low (80s over 50s), so the alarm would go until I pressed the call button for the nurse to come in and silence it. A few ties the alarm went off because my heart rate was high - basically any time I rolled over I'd get THAT alarm, too. Frustrating. 

Friday: Around 5 am Friday morning, after not sleeping due to alarms, I realized I was having contractions. I also realized that I hadn't been given the anti-contraction medication since right before they wheeled me back for surgery, almost 24 hours ago. It's supposed to be taken every 6 hours. I asked the nurse and she said there weren't orders. I told her there should be and asked her to contact the Dr since I was contracting. She asked me to wait for rounds around 9 am and I told her I wasn't comfortable with that. It took about 2 hours, but she asked the resident, found out I was supposed to be taking it, and gave it to me.

Around 9 on Friday morning the nurse removed the catheter and I got up to pee. Side note: last time I had a TAC, peeing burned like the worst charley horse you could imagine. This time, almost no pain at all, despite the fact that they'd removed a lot of scar tissue from my bladder. So, so grateful.

When getting up, I made it to the toilet just fine, sat down just fine, even peed a bit, but realized I was going to pass out. I needed help to get back to bed. I tried to get up and walk an hour later and it was the same story - almost passed out. Since my blood pressure was still 80/55 this wasn't surprising. I asked them to let me have solid food, since being NPO, then clear liquids only for 36 hours was a lot. After I ate something around lunch time, I tried walking again and was able to toodle around my hospital room without issue. That, plus the fact that I'd passed gas and urinated, meant I had met discharge criteria. 

Normally, Dr. Sumners has you come to his office for an ultrasound post-discharge. Unfortunately the u/s room was in use, so after a few hours, a technician came and wheeled me to the ultrasound in antepartum. We checked that baby was still alive- yes, and that my cervix looked good. She said she was getting some swelling in the way, but it looked good. Overall the most pain I've felt the entire time was when I had to lay down on the ultrasound table, which didn't have any rails, and then get my legs into stirrups. The tech tried to help, but I wasn't clear what I needed and so it hurt. After that I confirmed meds quickly and my mom drove me back to our extended stay hotel. The hotel hadn't gotten the promised wheel chair, but I was able to walk in, up the elevator, and up to our room by myself. 

Saturday: I kept up with Norco and nausea medication every 6 hours. As mentioned, as long as I was still, I felt really good with minimal pain. Slept well, too, thanks to the meds. Got a shower and it was so much less traumatic than either my first TAC or my c-section. I was able to put my own socks on! I had to sit down on the toilet to do it, but I did! Even dried my hair a bit. Did laps up and down the hotel hallway every few hours. 

Sunday:  Got up, got a shower, had cereal for breakfast, then headed to the airport. My mom had arranged to have a wheel chair waiting for us at the rental car return, and I was grateful. I could have walked a decent amount, but not all the way to our gate. They got us there, with only a small snafu when my mom went in the pre-check line while I got the regular peon line despite still having her luggage. The screener pulled her bag, because it had cashews in it! Go figure. She had gotten us bulkhead seats, so I didn't have to shimmy into a tight window seat, which made the flight home easy. I have never been so appreciative of grab bars in airplane bathrooms!

There was a waiting wheelchair when we landed, and that took us to the curb where my husband was waiting. I took one last norco when we got home, and that was the last narcotic I needed. 

Monday - Thursday: I slept in our guest bed and kept up with tylenol and my nausea meds every 6 hours. Getting into and out of bed, and rolling over in bed were hard, but kept getting easier. By two weeks out, I have mostly normal use of my body, although my uterus still hurts. 

So, in TLDR terms; What went wrong: Already dilated, needed TAC and TVC, lots of scar tissue, nicked a vein, didn't get my anti-contraction meds, had super low blood pressure, was missing a wheel chair. 

What went right: TAC in place. TVC in place. Baby and mama both have heartbeats still. Much easier recovery than last time, despite being pregnant. 

I would absolutely recommend anyone with cervical issues/cervical insufficiency/incompetent cervix reach out to Dr. Sumners.

Gift Horses and Role Models

 ​​​​​At Christmas, the husband and I had the start of an interesting conversation that I feel the need to unpack and think through. It’s also one that I’d love to hear others’ perspectives on.

As background, if “love languages” exist, mine is NOT gifts. Husband’s is NOT either. When we were younger, I’d put a lot of thought and money into gifts for him, and in our earlier dating years, he often didn’t reciprocate. In marriage, I found myself constantly being the one to have to come up with gifts for all the parents, or watch him scramble and spend double or triple on X-mas eve to get something for his mom and brother. X-mas eve, when I usually needed his help getting the house ready for guests, and since he was out, I didn't get that help. I decided enough was enough and suggested to all family that we stop exchanging gifts. Everyone except for his mom (whose love language might be gifts) was really happy about this.

Now we have kids. I look forward to giving them presents because of the obvious enjoyment. This Christmas the husband suggested that we needed to start giving each other gifts again to ‘role model’ appropriate gift giving to the kids. I had an almost visceral reaction against it, and I needed to process why in writing.

First, I think it’s more important to role model that consumer spending is not necessary, beneficial, or necessarily good. Giving X-mas gifts just to give gifts is probably the biggest example of conspicuous consumption or consumer behavior I can think of us engaging in. It doesn’t add value, it doesn’t bring joy, there is really no benefit at all that I perceive in giving a gift just to give a gift. Or in receiving a gift just to receive one. I don’t want my kids to learn consumer behavior, I want them to learn to identify when spending brings them or their loved ones value, and focus on that spending. 

Second, I wonder what lesson I'd be teaching. The lesson of waiting to the last minute and spending far more than necessary for an item that could have been purchased elsewhere or earlier for less? The lesson of bailing out on helping with joint responsibilities because you put off your own too long? The most charitable interpretation I can give for this last minute approach is that DH is aligning his values (of the convenience and lowered stress of not having to think of anything until the last minute) with his spending. I don't think procrastination is usually a beneficial life skill, so I'm not enthusiastic about modeling that. I am equally unenthusiastic about modeling a situation where one partner, the female one, takes on all the mental and practical load of gift giving. 

I think I'm also bothered by this idea of modeling love as shown through gifts. I have quite a few friends whose families showed love via gifts and not much else. I don't want that. I'm not really worried about that, as I'm pretty confident these kids will know they're loved and that their parents love each other, but it's a trap that I've witnessed too often to feel great about repeating.

There's something else that bugs me about this, and I can't even put my finger on what. Maybe someone else has an idea. Having said that, the great news about being married to a die-hard procrastinator is that I can be confident that unless I decide to do what he's asked and start giving him gifts, he won't actually do it himself, so this is all a moot point! 

As I've let this draft sit, I think I've figured out what the 'something else' is. I think the last, perhaps biggest, thing that bugs me is that we'd be doing this because it's a societal norm. I *really* don't like doing things just because they're norms. I want my kids to learn to evaluate their options and decide based on their own values and preferences what they'll do or not do. I don't want them feeling as if they have to conform just to conform. Not to say that non-conformity is the path to happiness, but I think my life has been vastly easier ever since the point that I stopped giving a damn what other people think about my actions/appearance/beliefs, and focused on what was intrinsically important to me. I desperately hope I can give them the self confidence to find the beat of their own drum and take joy from following it.

An Update on 13

 I've been silent for a while. That's compliments of yet another HG pregnancy. I had forgotten just how bad HG is until around 7 weeks, when I had that moment of stark, animal terror as I was throwing up continuously and realized I needed to take a breath but my throat was still full of vomit and there was a real possibility I'd suffocate if I tried to breathe. I had forgotten that terror from last time(s). HG is really, truly horrendous.

Despite the HG, things have gone relatively well. We did a CVS at 10w4d, with the hope of getting full results back before my scheduled abdominal cerclage at 12w4d. It was difficult that early, especially because apparently I do have a lot of bowel that was in the way (further proof that I really am full of shit!), making it very hard to find a safe spot to draw the CVS sample. Both FISH and microarray were normal, so off to Indy I went for a TAC.

The TAC wound up being more complex than expected. At pre-op, I was already dilating in the lower cervical segment. As a result, the surgeon placed both a TAC and TVC. Double whammy. They also found my bladder was adhered to both my uterus and abdominal wall with scar tissue, which had to be cleared. During the clearing, the nicked a vein. Despite all that, and despite being pregnant and puking and having to fly home, my recovery has been light years easier than my last TAC. Go figure. Maybe I really did get gluten contact before that one as I've long suspected. I'll try to do a full write up later, in case it ever helps someone else.

I'm 14 weeks now. Sore but not in agony. Scared but not terrified. Finally also nauseous, but not constantly vomiting. So, progress. I continue to hold my breath and beg the universe to keep this little one safe until a planned delivery in late August. I am still concerned about an accreta diagnosis, especially after hearing of the amount of scar tissue found during the cerclage, but that will not come until my anatomy scan in another month, so I try not to borrow worry. 

Here was the day of our CVS, working on thumb sucking. 

Up to 13

Our first ultrasound was moved up to today. I started spotting brown again this morning, but I'm also throwing up. As far as prognostic indicators go, that seemed to cover all possible bases. 

I haven't believed in intuition since I totally miss-guessed Quinn's gender. At the same time, my last two twin pregnancies, intuition said it was twins. This time, same thing. Intuition said twins, even though it was an unmedicated pregnancy and they're so unlikely in that situation.

Intuition wasn't completely off. One gestational sac with a FHR of 120 and a CRL equivalent to 6w1d. One completely empty sac. A vanished twin.

I really, really, really didn't want twins again. I didn't want the extra sickness. I didn't want the hospitalizations and prematurity. I didn't want an in-pregnancy cerclage on a uterus pregnant with twins. I didn't want the financial implications of another set of twins.

I didn't want twins. Why, then, do I feel so devastated about this? 

The doctor said everything was perfect. I'm more than a bit concerned about the CRL, but I know that's subject to measurement error. I also know that a heart rate of 120 bodes well. I'll remain nervous until the next ultrasound in two weeks. Hell, I'll remain nervous until delivery. I'll also remain sad about our little Baby A, the one who didn't make it. These were babies 12 and 13, if I'm counting. That's just too many babies to lose and not be sad, no matter what you think of twins. For now, I'm hoping that come August I'll be able to tell myself '13 babies, 3 healthy, living children.'

Reflections and Cynicism

 The events in my home country have really shaken and saddened me. In my cynicism, I've often said that other humans never fail to disappoint me, but this goes far beyond that. 

The questions I keep turning over in my mind is: how could a reasonable person believe that the election results were fraudulent? How could a reasonable person attempt to subvert democracy while simultaneously claiming to do so because others have subverted democracy? I certainly understand how a reasonable person could be upset and angry with an election outcome that countered their preference. I understand how they might want to look for a way to achieve a result they liked better. I don't understand how masses of people could wholesale believe in such a massive hoax and turn to insurrection to 'resolve' the matter. There's the true fraud perpetrated this election: the fraud of the incumbent claiming a victory that was definitely not earned.

I wonder if the culture of avoiding things that upset us is somewhat responsible. I'm part of an IF group. That group maintains a separate place for members to discuss 'success.' However even in that separate place, some people were getting upset over the details of others' success. What options did they have? They could have avoided the success discussion all together. They could have acknowledged that other people get the things they want, and that's not a reason for anger. Instead the group decided that those reporting on success could no longer provide any details. Rather than saying "Hey, I want to have a success like that, and it kills me that I don't, but I'm happy for you." they said "Find someplace else to celebrate so I don't have to feel pain because of you."

Now we have part of our country who can't stand being faced with the pain of not having their candidates win. They can't stand it to an extent that they're rioting and attempting to violate the very democratic foundations of our country. Maybe the time has come for each of us to say "Hey, there are some things in life that I don't like. But rather than deny or avoid or get angry at those who have what I want, I'll focus on doing what I can to improve myself and my environment through reasonable and legally appropriate means." Alas, I'm too cynical to think that most people are willing to take on that level of emotional work. 

Repeat Beta

I had my second beta draw exactly 48 hours after the first. With the first result being 655, I figured I needed 1310 or thereabouts.

Beta #2 was 1608. 37 hour doubling time.

This was an unmedicated cycle of a 41 year old. It can't be twins, right? 

The ever amazing betabase shows the following for twins:

15 dpo: 376
16 dpo: 565
17 dpo: 835
18 dpo: 1200

For singletons:

15 dpo: 197
16 dpo: 294
17 dpo: 425
18 dpo: 616

My results:

15/16* dpo: 655

*This is possibly 16 dpo if I ovulated within 12 hours of peak LH test and tempted too early the next morning to catch the progesterone rise. I usually temp just after midnight, so that's possible. I was testing twice a day with LH strips, so I'm very certain of the surge timing. That means I can't be any later than 16 dpo.

17/18 dpo: 1608

We had two reasons for going through IVF. One, so I could do a pre-preg TAC. That's not happening. Two, so we wouldn't risk twins again. I know that given my age I should be much more worried about seeing ANY euploid baby with a heartbeat, but these numbers have me scared.