Marmaduke*

I recently read this short story on the impact of infertility on relationships and enjoyed it so much I just wanted to share it (thanks Rachel).

I've been feeling so grateful lately for where our particular infertility experience has taken us and this story just reinforced those feelings. I have no idea what my marriage would look like today if we hadn't been so lucky with Piper. Now that she is here, I'm pretty sure we would have found our way through if it hadn't worked a second time, but I still can't believe our good fortune. I do still struggle with survivor's guilt but not as much as I did before Piper. It is important to me now to appreciate what we have and focus my attention there. I never want to feel like I've forgotten the struggle or left less fortunate friends behind, but letting go of some of the unfairness and "why me?" must be a part of my natural evolution in this process, of the sort I hope we all eventually find our way to one way or another. That may sound either very Pollyanna or shallowly asinine depending on your level of cynicism (or clomid dosage), but I'm damn glad to find out there does seem to be room for evolution for infertiles with a wide range of experiences and outcomes. I can't imagine living trapped forever in the prison of all the terrible feelings that dominated the first several years of our infertile experience. My heart aches for my friends who are still there.

*one of the names meaning "lucky" suggested by my sister after IVF #1, although i have not seen that given as the name meaning elsewhere so i suspect she was just trying to trick me into using it

And the confusion begins

Another nice scan at the MFM yesterday. No pictures though, the sonographer printed some but I think she forgot to give them to me. There was a nice profile shot too. Oh well. The upside to frequent checks with the high risk doc is plenty of pictures.

Everything was measuring on time (1lb 7 oz), and if this baby is going to drop off the growth curve like Piper did it isn't happening yet. Which makes sense since my BP is still normalish. The MFM noted the slight upward trend I mentioned at the last OB visit and asked why they don't have me on medication yet. So the confusion begins. I told him about the convo with the OB I saw last and he said I was absolutely right about starting medication BEFORE we see a problem. He strongly disagreed with her avoid-medicating-at-nearly-all-cost position but said let's give it four more weeks since all is well and then he will probably recommend to them to put me on medication. He also said to call if I ever feel like I'm not happy with what I'm being told at the OB practice.

So here I am again, feeling like it's up to me to make decisions I'm not qualified to make. But the OB I saw last time was also the one who screwed me all up with the previous pregnancy, and I only saw her because the doctor who we decided I should see exclusively (it's oh so intimate you know) was on vacation. When I'm back with my regular guy next week I'll talk to him about both visits and I feel very comfortable with his relationship with the MFM, and ultimately I have tremendous trust in the MFM and will defer to his advice. It makes a huge difference that he's gotten us safely through this once before so it does feel a bit easier this time. I can only hope the outcome is just as happy. So far so good.

blah, blah, blah, pregnancy induced hypertension, blah, blah, blah

A long post that will really only be compelling to those interested in pregnancy induced hypertension or the general category of scary pregnancy stories: abbreviated version - things are fine.

Had a good OB appointment on Friday. My BP was up ever so slightly (hopefully just because I was late and raced up the stairs to the office). But it gave me a chance to ask some questions--and I actually got some good answers!

I don't know if I ever accurately reflected how stressful the hypertension issue was last time. I originally made my blog public with friends and family who knew we were doing IVF as a way of letting them know what was going on without having to ask questions that might have been difficult (or me having to give difficult answers, particularly when I didn't feel like talking about bad news). I didn't want to scare anyone too much and those of you to whom the pregnancy-induced hypertension issue is important already knew enough to be scared for me. It's also just my nature to be weirdly level and pragmatic about things I can't control, so I tended to share key details but might not have really expressed the sense that we were always right on the edge of a dire situation.

I'd actually been dealing with hypertension for five or six weeks last time before I thought much of it myself. I was admitted to the hospital for monitoring several times, during which my BP would always eventually drop, usually after two hours or so of lying still connected to the monitors. It never rose much above the danger mark of 150/90 and I never had any other signs of preeclampsia, so it didn't set off major alarms with my OB.

But when I went to the MFM at 32 weeks it was another story. The IUGR was detected, and I started to learn about all the risks facing growth restricted babies (including stillbirth and motor and neurological disabilities). This was a big shock since all the time I'd been monitored for hypertension by the OB, I was repeatedly told the baby was very healthy. She looked great on the monitors but the fact was her growth had slowed and dropped from the normal curve. It is possible that small babies just run in my family (I was about five pounds) but IUGR was consistent with the drop off in development at a late stage after hypertension had set in, and finally with the terrible condition of the placenta at delivery - very small, fragmented, and calcified. The connection to hypertension is that the blood doesn't flow well to the placenta and so the baby doesn't have as much nourishment as it should.

The worst part was in the final weeks before I was induced - I hadn't expected so much of that decision to fall on me. I thought there would be some sort of medical standard for assessing the risk/benefit trade-off, but because the MFM and the OB have different ideas about how much risk to tolerate, it all culminated in a conversation with me stretched on a gurney in the hospital, my OB explaining the risks of underdeveloped lungs, and asking me if I wanted to go through with the induction. I decided to trust the MFM, who I adore, and who had said to me "I just really think this baby is going to thrive when we get her out of there." And of course she did.

Anyway, all of that is a long way of explaining why I'm a bit hung up in trying to understand this whole hypertension thing this time around. Of course my main focus has been on whether there's anything that I or the medical team can do to prevent a repeat performance. My primary OB said to me at the first appointment: "Basically the only way to be sure this won't happen again is to not get pregnant. That's not to say you shouldn't get pregnant, but the fact is this is your body's response to pregnancy, and its not your fault and not something you can necessarily control." But the interesting fact I learned on Friday is that pregnancy-induced hypertension only repeats in a second pregnancy about 15% of the time. Now of course I have found myself on the short side of the odds before, but that's still nice to know.

My normal BP is in the one-teens. I think it was 112/75 at my first OB appointment this time. It was at 126/something at the second and 130-something/80 at this latest appointment. All of these are very much in the normal healthy range, but the fact is they are higher than normal for me and they seem to be creeping up. So I asked about medication. This was another tricky thing last time, some docs thought I should medicate, others disagreed, saying we didn't want to "shock" the baby by suddenly dropping my BP, afterall, the baby appeared to be thriving in the high BP conditions until we saw the IUGR in the final weeks. So I had wondered if it would be wise to start medication earlier this time, at the first sign that BP was increasing, to maybe somehow head it off before it was so high. I've asked this question before and keep getting answers like "We just have to keep a close eye on it and see," but this time I got a clear answer: no. We don't want to medicate unless we absolutely HAVE to because there are some risks with medication. We need to keep monitoring it, but the hope is that I will be in the 85% who don't have to go two rounds. I am to stay well hydrated, watch my salt, and not get overly worked up about it. Which all sounds good to me.

Halfway

Hard to believe it's 20 weeks already, where has the time gone? I'm feeling fine and everything seems to be on track so far. Next scan to check for IUGR is about four weeks away. Piper's "sprained ankle" has continued to bother her and two weeks later she still has a limp so we saw an orthopedic specialist and it turns out she has a tiny fracture in her shin. My poor baby has been hobbling around on a broken bone. It's apparently not a big deal, very common and healing fine on it's own. They expect it to be sore for a while, thus the limp. We go back in four weeks just to be sure its healing properly.

She's a trooper and otherwise doing well. Seems like such a big girl to me lately. When J comes home she says: Hi Daddy! When I give her a much-requested pretzel she says: Thank you Mommy! Yesterday when she was playing in the tupperware cabinet and I said it was time to get in the car she first put it all back and closed the cabinet before meeting me at the garage door. (Don't get the mistaken impression that we are the center of calm and order. This was a fluke, related to the fact that kids her age do enjoy take-it-out, put-it-back games. If they happen to quit the game after a put-it-back rather than a take-it-out stage you're just lucky.) Despite our fair share of tantrums and time-outs, she's been a happy girl lately. She learned the word on Sesame Street and when I picked her up from her nap yesterday she started beboppin and dancin around saying "happy happy happy."

The passage of time has been on my mind lately. These 20 weeks have flown by and I see Piper's babyhood quickly escaping my grasp. Last weekend I bawled through my niece's two hour dance recital. This was her third year and since I don't see her dance in between, comparing it to her first recital at age 5 and even last year's was unavoidable. How did she ever get to be seven?? There have been some unsettling family events lately that have me appreciating how nice my life is right now, while nervously awaiting the fallout and how it will affect us. As when Piper was first born, I find myself wishing I could just freeze time and keep everything just as it is. I keep thinking of a line that stuck in my head when I read The World According to Garp as a teenager - I can't shake the ominous feeling that the "undertoad" is lurking.

Four doctors in two days

I should start by saying everything is fine. I had an OB appointment yesterday and the Peri today - all completely routine. The excitement began yesterday when Piper had a little tumble and then was limping around for the rest of the day. We went first to her pediatrician and then to radiology for an x-ray. Holding down a screaming 18 month old for an x-ray is HORRIBLE. Thankfully Daddy was there to do the dirty work. Turns out to be just a sprain, but I guess they have to be extra cautious with little growing bones. She still limps and has some pain but she'll be fine.

The perinatologist appointment was for the anatomy scan. Funny how imaging and measuring every important bone in a growing fetus is tremendously easier than taking one little ankle bone picture in a toddler, but I guess the size of the challenge is proportionate to the size of the girl: Piper is roughly 42 times the size of her little sister in ounces. They don't say anything very definitively this early but it looks like sugar and spice in there. Most importantly, everything measured just fine and right on track. Because of the IUGR history, we go back in 6 weeks just to keep an eye on things, but my blood pressure is still completely normal so all's well around here tonight.

Milestones

I almost broke down in Red Robin. Walking out of the restaurant behind Piper, seeing her silhouette in her jacket with her little hood up, she looked so much her own little person. Just as I was thinking she is getting so big, she paused and turned to wave goodbye to the giant Red Robin statue. "Bye bye" she said in her sweet little voice and then blew him a kiss. I held her hand and walked her out trying to hold back tears until we got outside then picked her up and hugged her tight all the way to the car. Then I realized it was her 18 month birthday.

And so long first trimester! A far less bittersweet milestone. I won't miss it one bit. A list of reasons why, if for nothing else than my own record: the constant nausea from week 6 to 11, the four straight nights of inexplicable, excruciatingly itchy hives that kept me awake for nearly 96 straight hours, the trip I took solo with Piper when we didn't sleep for three nights and concluded with me wretching bile in every planter, trash can and dark corner of the airport while carrying our luggage, carseat, stroller and Piper by myself through rental car return and security, and finally the two week long sinus infection complete with fever chills and shakes which wrapped up right on time at 13 weeks. Whew.

This pregnancy is so different. I believe in babies now. I have seen one go from day three follicle check to 18 month old and I can see a possibility of it happening again. What I find impossible to imagine is Piper not being the only one. She is the center of my universe, the love of my life, and I can't imagine sharing it with another one. I know when there are two your heart makes room and I'm not afraid it won't work, I just can't possibly imagine it.

So in honor of her 18 month milestone, here's a little snapshot of Piper these days:
-She's gone from social butterfly to discovering shyness (partly due to daycare I think). She used to wave and say Hi to everyone everywhere we went, now she clams up when strangers talk to her, although she does always say thank you to the checkout people in stores. More like a sing-songy little "juke ooo." She is a big time talker at home. She had over 100 words at 15 months and communicates pretty much all her needs verbally, although as she adds more I'm having a harder time keeping up and understanding them all.

-She's VERY busy. She can't stand to be restrained in a high chair, car seat, stroller, etc. She HATES to lay still for a diaper change. We take the stroller to the zoo and she just wants to push it the whole time. She will sit in a high chair or booster seat long enough to eat two bites of food before she works herself into a tantrum and will nearly fling herself over backwards. She likes pretty much anything we give her but is generally uninterested in sitting still to eat. California rolls and broccoli are current favorites, there are just a million other things she'd rather pay attention to.

-She loves to be outside exploring. She wants to walk, run, pick up rocks, follow bugs, play in her water play table and LOVES the playground. The Itsy Bitsy Spider song makes her laugh her head off. She has a funny little sense of humor, a great little giggle and an adorable dimple to go with it. Other than the dimple she looks just like I did at her age, still with hardly any hair.

-She's in a major mommy-centric mode. When she's not racing around outside she wants to be held constantly, and only by me. When I don't pick her up she throws herself into the limp noodle position and falls over backward crying her heart out. I simply can't hold her as much as she likes but when its practical we both love it. She's my little buddy and loves to ride around on my hip, checking things out and asking what everything is. She also loves to sit in our laps and read books.

back in March, looking all grown up...

big girl riding a dinosaur at the park a few weeks ago...

and my sweet girl just this past weekend at the Air & Space Museum, posing under a Piper Super Cruiser that circled the globe back in 1947...

Don't get me wrong, there are days that feel like they will never end, but it all just goes way too fast.

Really Good News

The first trimester screening went great yesterday. The NT measurement looked fine and we saw all the major parts that were supposed to be there - arms, legs, hands, feet, stomach, eyes, nose, mouth, regions of the brain. The nasal bone was present, also a good sign. Baby floated around and waggled it's tiny limbs but did none of the crazy cartwheels Piper was doing at that scan, so I'm hoping this is our calm child? I'll have my risk number in a week when the bloodwork comes back, but so far, so good.

But the best news: my blood pressure was completely normal. Doesn't mean I won't develop gestational hypertension again; I probably will, it would be really unusual for it to set in this early anyway. But it just means there's no reason to think there's anything wrong now, and gives us time to monitor and take action whenever, if ever, it becomes appropriate.

I'm just back from a couple of weeks of hectic travel. Here's how much time I've spent in airports lately: washing my hands yesterday I held them under the faucet at home waiting for the water to come on automatic sensor-style. If ever my BP should be elevated it's now. Although watching the scan on the big overhead monitor (nice touch!) was very relaxing. J was there holding Piper who at one point climbed up on my lap. What an incredible feeling sitting with her on the same table where we'd first seen her at 12 weeks gestation, all big now and grown up.