rivka

You know what's not a good idea, when you're damn near 37 weeks pregnant?

Falling hard on the ice on the way into the midwife's office, that's what. I seem to be okay, but I think it's going to be a tense 24 hours until we're absolutely 100% positive that it's not going to send me into labor or anything. We are under orders to call immediately if I notice anything whatsoever that seems funny.

Also, I landed on my right hip, which is the difficult one.

Also, thank goodness Michael and Alex came along to the appointment, or I have no idea how I would've gotten up again.

Fall and resultant shakiness notwithstanding, I managed to come up with a good blood pressure reading of 110/72. No sugar or protein problems. I've gained four pounds (!) since last week, which may partly be a factor of last week's visit being before lunch and this one being immediately after dinner. My uterus is measuring 40cm when I'm contracting and 39cm when I'm not contracting. (Why yes, I am contracting a lot.) I'm Group B Strep negative, yay. (That saves me from having to get antibiotics in labor.) My symptoms are as normal as an extremely normal thing. The baby's heartbeat sounds strong and beautiful.

Then I sent Michael and Alex out of the room and told Kathy about the feelings I had after the hospital tour. She is not the touchy-feeliest of midwives, but she was great. She gently told me that it was entirely appropriate and reasonable and expected to still be grieving and to have negative feelings triggered by my upcoming birth. She thinks that laboring women focus intensely on labor, and that I am unlikely to have significant problems with D&C memories in labor, but she is ready to remind me that I am there to birth a baby. Also, she is fairly certain that if I call when I first notice labor signs they will be able to snag me the room where Alex was born, which not only has positive memories associated with it but is huge and couldn't be more different from the rooms I was in when I miscarried. She's going to tell the other midwives how I'm feeling, which is good.

She also told me, firmly, that the universe intends for me to have this baby, that this is the baby who is meant to be. I'm not sure how I feel about that as a theological position, so I will choose to focus on the part where we are positive that I am going to have this baby.

Yesterday was my due date for my lost pregnancy. Tomorrow, my current pregnancy will reach thirteen weeks - the point at which I lost the other one.

This is a weird place to be.

I am so, so grateful to be pregnant on the day that, by all rights, I should've given birth been complaining bitterly about when was the damn baby going to come already. I've been watching for this day for the last six months, and praying that I'd be pregnant when it came. I know it would be far harder if I were still feeling broken and barren.

And yet it's also hard to be where I am. The end of the first trimester is supposed to be a tremendous relief - the point at which you know that, probably, everything is going to be Just Fine. The point at which you tell everybody. The point at which vanishing symptoms are cause for relief, not anxiety. Last time, at this point, I had even broken out my least-obvious pair of maternity pants. This should be the point where I can relax, having made it through the dangerous part of pregnancy, and look forward to the genuine pleasure that is the second trimester.

Instead, this is the point where I feel like I'm at risk of being utterly blindsided by tragedy.

I've joined a really good mailing list called SPALS: Subsequent Pregnancy After Loss Support. The SPALS list has helped me keep my sanity through some scary early signs of trouble with this pregnancy, and I admire these women for the supportive community they've created. But the reverse of that support is that participating in SPALS makes me all too aware that you can actually lose a pregnancy at any time. Lots of women on the list have had stillbirths.

My midwives told me to take my progesterone supplements until 13 weeks, which I am interpreting as "the end of the 13th week" rather than as "the first day of the 13th week." After that, they say, my placenta should have totally taken over progesterone production, making supplementation unnecessary. But honestly, as much as I hate those damned things, stopping using them feels like stepping out over a cliff and trusting that something I can't see will break my fall. Who knows whether my placenta knows what the hell it's doing? If I wasn't making enough progesterone, who says it will make enough progesterone?

My first-trimester symptoms, bless them, are hanging on until the bitter end. I've had a bad cold this week, and postnasal drip + human chorionic gonadotropin = ZOMG incredible nausea. I expect that as my cold goes away, so will the nausea. In the meantime: my jeans still fit. I have the Incredible Pregnancy Rack of Doom (now size 36H!!), but that's the only place I've put on any weight. There are still eight days until the midwife appointment at which we may (may) be able to hear the fetal heartbeat with a Doppler. I'm still a few weeks away from the earliest possibility of feeling fetal movement. At the moment, to borrow a phrase from fairoriana, this is Schroedinger's Pregnancy.

It seems like such a cruel trick of fate that all of these dates converge: the lost due date, the gestational age at which my miscarriage happened, the point at which pregnancy symptoms are scheduled to go away, the point at which I'm supposed to remove the supports and trust my body to do the right thing hormonally.

In retrospect, I didn't have very strong pregnancy symptoms with my miscarried pregnancy. At the time I certainly felt tired and nauseated, but there's just no comparison to the way the first trimester is beating me down this time around.

It's not totally intolerable, and in fact I actually find the symptoms reassuring. I need all the evidence of pregnancy that I can get. But... it's the difference between having to be careful about what I eat and sometimes being unable to eat; between often feeling tired and often needing a nap to get through the day; between outgrowing my regular bras and outgrowing my maternity bras. (ZOMG I have outgrown my maternity bras and I'm only just entering the ninth week.)

I produced pregnancy hormones last time - enough to make a placenta, even though it had nothing to support. My pregnancy symptoms were real. But they were a shadow of what I'm experiencing now that I'm churning out enough hormones to support an inch-long fetus.

I just walked out of church in the middle of the service because there was a child dedication for an infant and I suddenly found that I couldn't handle it at all.

This is all part of the process. I know that. But you know what? The process SUCKS.

I do, at least, have awesome friends at church. One of whom followed me out of the service and one of whom just happened to be walking bythe portico at the right moment. Thank heavens for awesome friends, because right now I don't have a whole lot else to hold on to.

This really, really bites.

A month after I miscarried, I felt mostly okay. I'd read things that would refer to months and years of post-miscarriage grief and think "wow, I'm glad that my reaction has been milder." I was aware of potential future roadblocks - the due date from that pregnancy, the anniversary of the miscarriage - but for the most part I thought I was adjusting and moving on.

As we cleaned the old house, all last week, I became increasingly anxious about the prospect of doing a final walk-through with our landlords. I realized that, of all the people I know, they were the only ones who still thought I was pregnant. I made Michael promise to do the walk-through by himself so that I wouldn't have to see them. Or, more specifically, so I wouldn't have to see them see my regular-sized belly and my pronounced lack of glow.

I don't think there's anything unusual about that, but the amount of time I spent thinking about it and being anxious about it was kind of excessive.

The dolphin show on Saturday was about play - how dolphins play, why animals play, how play is used in dolphin training. There was a video montage of mammals playing. It included a few brief images of human infants. Boom: tears. I cried at a dolphin show. From, like, three seconds' worth of baby exposure.

Sunday, at church, out of nowhere: uncontrollable, but mercifully silent, crying. Not related to the service content.

The only thing I can think of that might behind the suddenly increased grief is that we are gearing up to try to conceive again. (I need to buy an ovulation predictor kit on my way home from work.) That has always been a fraught and anxious process for me, and it seems about ten thousand times more so now. What if we can't? What if it takes a long time? What if it's hard to even bring ourselves to try, and the whole... process... is overshadowed with grimness?

I shouldn't have to do this. I should be about halfway through my pregnancy. I should be wearing maternity clothes. I should have had my high-level ultrasound, and watched blood pumping through the tiny channels of a tiny fetal heart. I should know the sex. I should be making plans for who will take care of Alex during childbirth, and checking out new-baby preparation books from the library for her. I should be pushing to get my grant up and running before my maternity leave. I should be pregnant.

This really sucks.

The music committee at church has asked people to write short essays about their favorite hymn. I don't know yet if I want to write up something formal to send in (you know, in my copious free time), but telerib wrote up something about the trials of adjusting to the Unitarian-Universalist hymnal, and it got me thinking. ( Read more... )

Seventeen days after my D&C, the pathology report is still not back. That's the bad news.

Fortunately, though, that's the only bad news. Based on the way my HCG (human chorionic gonadotropin, a.k.a. "pregnancy hormone") levels have been dropping like a stone, taken in context with the immediate experience of the D&C, my midwife is certain that what I had was a "blighted ovum" - a fertilized egg so messed-up that it made a placenta but wasn't able to grow or sustain an embryo.

My HCG level as of Friday was a stunning 33, down from 190 the Friday before. (I don't know what it was the night of the D&C.) We have high hopes that it will hit zero sometime this week. Then my body can go about the business of returning to its normal rhythms.

An exam showed that everything is getting back to normal: uterus and ovaries feel normal, cervix is closed, and there's physical evidence that the hormones are normalizing.

We can start trying to conceive again as soon as I've had a couple of normal cycles. If I get pregnant again, we'll monitor the pregnancy more intensely: HCG levels beginning at the positive test, progesterone levels, an ultrasound at 7 or 8 weeks. But there's no reason to believe that this would happen again. It was one of those random chances.

Needless to say, I'm still very very sad. (Wow was it hard to be back in my midwives' office.) But it's a big relief to know that there isn't anything horrible hanging over my head. There's no physical aftermath to a blighted ovum pregnancy. No long and frightening period of monitoring. We can just focus on the long, long job of picking up the pieces, emotionally.

So: sad, but thankful.

Grief is kicking my ass today.

We went grocery shopping for the first time in two weeks. At the milk cooler, Alex was hopping around being helpful.

"Mom, do you need your yellow milk?" (Milk in the yellow carton is low-fat. She drinks whole milk, in the red carton.)

"No, I'm not going to buy any." I hate milk. I only consume it when I'm pregnant and need the extra calcium.

"But you don't have any yellow milk at home."

"I know. I'm not going to have any milk for a while."

We turn away from the case. She's still not done. "Mom, you drink special milk, right?"

Yes. When I was pregnant, I drank "special" low-fat milk that was just for me, not for underweight toddlers. I'm not pregnant now. I won't be buying any more low-fat milk unless I get pregnant again. Okay? We're not buying milk in the yellow carton BECAUSE THE BABY DIED.

I didn't say any of that. I just sent her off to the deli with Michael. And had the two of them play Letter Searchers in the check-out line so she wouldn't notice me crying.

OMG grief is just kicking my ass today.

Just talked to my midwife's assistant. I was a little confused about my discharge instructions from the hospital, which said to follow up with my midwife in two weeks. Originally she had told me that I'd be following up with a perinatologist (an OB who specializes in high-risk pregnancies) to monitor my hormones, because if this is trophoblastic disease it will be vitally important to know whether my pregnancy-hormone level goes all the way down to zero and stays there. (If it doesn't, it means that tumor cells implanted somewhere else and are continuing to grow.)

At the hospital, apparently, someone told Michael that my hormone levels were lower than they'd expect to see with trophoblastic disease, and that they were leaning more towards thinking it was a "blighted ovum" - a fertilized egg so chromosomally damaged that it was able to produce a placenta (and therefore pregnancy hormones and symptoms) but not an actual embryo. But that's not something they can actually diagnose until the path report comes back - which won't be for two full weeks, because (among other things, apparently) they have to do a chromosomal analysis.

So it turns out that we're going to be following a middle path. I don't need to go straight to a perinatologist, but I also can't just coast until my two-week follow-up at the midwife's. Instead my midwife will be ordering weekly hormone-level tests until we figure out what the hell this was all about. That seems reasonable to me. It's somewhat of a relief that they're not just slapping me onto the full trophoblastic protocol, and yet I also really really want to know what my hormone levels are doing.

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I am in a lot more pain today, although it's nothing 800mg of ibuprofen can't handle. I now admit that yesterday I was being a macho, irrational, self-denying idiot. So today I didn't just stay home in the morning - I stayed home, resisted the urge to do "just a little" packing or cleaning, and laid on the couch for two and a half hours watching West Wing reruns. And I asked Michael to arrange his schedule so that he could drive me to and from work.

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Emotionally I am coming along. I am sad but not completely prostrate with grief. However, I notice that I am banking a lot on being able to get pregnant again almost immediately, and I suspect that if that doesn't, or can't, happen then I will probably fall apart in a big way. And that might well be a problem.

If this is trophoblastic, standard medical advice is that we not even try to get pregnant for a year. Which would realistically mean that we'd wind up with kids who are five years apart or more, which... feels like a family with a big hole in the middle of it, where another kid should've been. Honestly, even a four-year gap seems like too much to me, except that that ship has clearly already sailed.

It's also the case that I'm almost 35. Even if we can start trying again right away - if it's a blighted ovum, for example - there's no guarantee that it wouldn't take a year or more for me to get pregnant. And I'm pretty sure that I wouldn't handle that well.

I think I will be able to cope with a baby deferred. I don't think I'll be able to cope with maybe-not-another-baby. Or a family with a big aching hole in the middle, instead of kids close enough to play together.

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I also notice that I am channeling a lot more emotionally energy than I normally would to planning and organizing things for Alex. This seems reasonably healthy as long as I keep things under control practically and financially. But boy, have I ever been doing a lot of shopping for the perfect big-girl bed with the perfect accessories. And the best presents for her birthday, two months away. It's nice to be able to divert my energy towards the kid I actually have. It's nice to have a kid to divert my energy to.

The short version: My bleeding got worse, and my midwife had me come to the hospital whether or not they had room for me. I had to wait a very long time. In the interim, the bleeding got downright dramatic. I had the D&C, and by a couple of hours later I felt surprisingly okay: tired, crampy, and weak, but okay. I waited even longer for the hospital to finish things up and then came home. Michael, Emily, and wcg are heroes.

( The long version: warning: includes a description of what makes bleeding qualify as 'downright dramatic,' plus some other graphic content )