Thursday, October 27, 2011

The Best Laid Plans

My hubs cannot keep a secret, at least not from me. I find this one of his most endearing qualities, even if it has ruined a few surprises over the years. He can rarely wait until Christmas or my birthday to show me my gifts. He bought my engagement ring while out of town visiting friends, and was planning to do something big and romantic for a proposal, but instead as soon as he saw me, he bent down on one knee and proposed – the ring was burning a hole in his pocket. I love this quality of him, as it’s further evidence that I can trust him completely and he could never keep a secret from me, but it sometimes has a drawback – we often celebrate holidays with me giving him presents, but there’s nothing for me that I don’t know about already!

Last night, the hubs did it again. A package came in the mail, and he asked me if I wanted a gift. C’mon, what girl doesn’t want a gift? But then he explained that it was a “push present” and maybe I should wait until after I pushed to get it. First of all, I think push presents are silly, and I had told him this, but don’t mind getting a gift for any reason, especially if it’s to celebrate being a mom! Also, I was kind of bummed after my doctor’s appointment yesterday when I found out I wasn’t dilated at all and the doctor expects the induction to be difficult, and maybe result in a c-section. So I thought that opening a gift might cheer me up… And when someone is holding a gift excitedly and asks if I want to open it, of course the answer will be yes! So I said yes, and he told me the gift was from Blue Nile – could I guess what it is?

I got excited. For those of you that have been my bloggy friend for awhile, you might recall that I bought myself a charm bracelet last year for myself from Blue Nile. Here’s the post and picture. I bought two charms for the two babies I lost – hearts with the birth stones for the months that I lost my little ones. And I got some happy charms – a dog and one to commemorate our wedding. Upon request, hubs got me a cat one for Christmas. And I knew that someday, when I got my baby, I would get a charm to represent my baby. I really wanted the baby shoe here. I was planning on asking for it for Christmas.

So when I saw the Blue Nile box, I was very excited. I was getting my charm! But then I opened the box. And it was a heart with a November birth stone, with the letter A engraved for Alexandra. And I burst into tears. Hubs was so confused, he didn’t understand. “What’s wrong? I thought you liked the charms.” I sobbed, “I do, but it’s a heart.” “But I thought you like hearts – you have two on your bracelet!” “Yes, but they’re for the dead babies. I want Alex to be alive, to be different, and not be a dead baby.”

I feel so bad. Hubs really thought he was doing such a good job by getting me a charm to represent Alex, and he really did. I should have told him, been more clear when I picked out the charms, that for the live baby, I wanted something other than the hearts. I told hubs that I wanted something different, and he pointed out that this one had an A engraved for her name. Which caused me to sob even more – the dead babies didn’t get names! I felt so bad last night crying like that over a gift, but I couldn’t help it. For over a year, I’ve looked down at my charm bracelet, and touched those two little hearts, thinking of my dead babies, and looking forward to the time when I have something different to touch for my live baby. But last night I got very scared that somehow he jinxed us, that giving me a charm that was similar to my dead baby charms would cause Alex to be dead too. I know this isn’t rational, but I’m a nine-month pregnant woman about to be induced on Tuesday! I’m the first person to admit that I’m not at my most rational right now!

I finally calmed down, apologized for reacting so poorly, and suggested that maybe we should hold off on putting the charm on the bracelet until after Alex is born, and she’s healthy. Perhaps we should wait until after the pushing to use the push present…

So then in desperation to make me feel better, he ruined my Christmas surprise and showed me online the gift he plans on getting me: a beautiful Tiffany necklace with Alex’s birthstone!

Friday, October 21, 2011

Graduation

Two years ago, I decided that I had tried to get pregnant naturally for long enough and needed professional assistance, and so I hired an RE to help me. At the same time, I decided that I had tried to manage my mental health on my own for long enough and needed professional assistance, and so I hired a therapist to help me. After about 18 months with the RE, I graduated from his care, but it was easy to tell when it was time – I had a baby in my ute that appeared to be viable. But it’s harder to tell when to graduate from a therapist.

I’ve been seeing B (my therapist) regularly for two years – weekly up until about three months ago, and then every other week. She’s been asking at the end of our sessions if I still want to keep going on, and I’ve always said yes. But last night she kicked me out – she said I don’t need to come back anymore! She had been hinting around it for awhile, and two weeks ago she asked if I wanted to do one more session, so I knew it was coming, but it was still weird walking out of there without an appointment scheduled. She said that I can come back for tune-ups, and I can come back after Alex is born if I think I’m having problems with depression, but she thinks that I now have all the tools that I need to deal with my life. Weird…

I’m a little nervous, being out here in the world without B behind me, helping me figure things out, asking me how I could have handled things differently. She’s a bit of a security blanket for me, and being without her is somewhat scary. I wonder if I really am ready to be without therapy. Because not everything is easy, there are still a lot of hard things that I deal with, and the thoughts that go through my head are not good!

But then I remember a couple nights ago when I was up at 3:00 am, and I couldn’t sleep. Baby Alex wasn’t moving, and my thoughts immediately started racing – what if she’s dead? When was the last time I felt her move? What if I’ve gone through all this and I won’t bring home a baby? But within just a few minutes, I was able to stop myself, and remind myself that the likelihood is very slim that I won’t be bringing home a baby, and that I just felt her move a few hours before, and everything was ok. And sure enough, I got up, drank a glass of milk, and little Alex started moving around.

I also remember a few weeks ago when I found out that my mother was not coming to see me, even though she said she promised to buy a plane ticket to come see me before Alex was born. In the past, I would have been very upset, but this time when she told me she was coming, I told her that I was very excited to see her, but I told myself that it was likely not going to happen. And I shouldn’t expect too much. And when she said that she was too busy to come, I told her I was disappointed, but I didn’t get upset. I didn’t even cry or anything, I just told myself that it was her loss, and it was ok. Sure, I wish my mom was different, but I can’t make her into someone she is not, I can only manage my own expectations, and choose to treat myself well when others don’t.

Maybe all these things mean that I really am ready to be on my own without B. The bad things will continue to happen, my mother will probably drive me nuts until one of us is gone, and my husband will frustrate me to no end after Alex is born, I'm sure! But maybe I know how to deal with this stuff better than I used to. I will probably always have awful thoughts go through my head, but the difference between now and two years ago is I used to allow them to stay, and I couldn't move on. Now I acknowledge the thoughts, and turn it around, bring it back to reality, so much quicker than I ever have before.

I know that I can go back to see B if I feel like I need to, but I feel ready to take on this next chapter in my life, motherhood, with all the tools she has given me. I’m so much stronger than I was two years ago, and I’m very proud of myself for continuing to go to her and talk through things in my life. Sure it would be easy to keep seeing her, but we all must grow up and move on to the next place in our lives, without our security blanket. I guess it’s now my time.

Tuesday, October 18, 2011

The Final Two Week Wait

Throughout it all – the TTC naturally, the IUI’s, the IVFs, the miscarriages, it seemed like our lives were split into little two week periods. Waiting for ovulation, waiting for AF, waiting for that elusive BFP, waiting for an ultrasound, waiting to miscarry, waiting, waiting, waiting. And after it all, I am finally in the last two week wait for my baby.

I went to the doc this morning, and he scheduled me for an induction on November 1 – two weeks from today. At that point I’ll be 38 weeks, 3 days, and he doesn’t want me to go any longer for fear of going into labor naturally without being able to control the timing of Lovenox. I also had my first ultrasound since 20 weeks, which was cool. Little Alex was head down, and it looks like she’ll be a little small. She is weighing 5 lbs, 13 oz, and is in the 28th percentile. But everything looked good, and I can’t wait to meet her!

I can’t believe I’m giving birth two weeks from today (assuming of course my body doesn’t decide to do something differently). Of course my mind goes to my To Do list, trying to figure out what needs to happen before she comes. But there really is very little. Sure I’d love to organize some more at home, but after working all day, I’m completely exhausted, and I don’t get anything done in the evenings. I’ll be working until next Friday (woohoo! So excited to take time off!) so I really will only have one day off of work prior to induction date. This weekend we have infant CPR and infant care classes, so that should be fun. At least it will be very relevant, and the hubs won’t complain about not needing to know the information! Other than that, there’s really very little to do. The bag is packed with the exception of last minute items like cell phone chargers, the room is done, or at least as much as we’re going to do, and everything is ready.

I have good news about the Lovenox & aspirin while breastfeeding thing. I talked with my OB about it, and he thinks I should just stop taking both drugs at birth. Yes, I have a clotting issue, but I’ve never actually had clots that have been diagnosed, only a gene mutation. So he tells his patients with this situation to just stop the drugs at birth, no weaning required, and he’s never seen an issue. So that makes the decision very easy!

It’s so strange to admit, but I’m having a little anxiety about being a mom. The time is finally almost here, and I hate to admit that I’m nervous about being able to handle it. I hear from others about how hard the first few weeks and months can be, and I’m getting nervous about it. I honestly think it will be fine, but I also wonder how na├»ve I am being – what if it’s not fine? I don’t spend much time with these thoughts, but sometimes at 3:00 in the morning when I can’t sleep the fear races through my mind…

I must get back to work as I have a huge list of things that I need to get done prior to leaving work. But as I complete these tasks, the words “Two more weeks, two more weeks!” keep going through my mind. Two more weeks – can you believe it???

Wednesday, October 12, 2011

Medical Confusion

First I want to state for the record that I apologize to my bloggy friends – I am WAY behind on reading blogs! I’ve been working so hard lately, as there are so many projects that need to get done before I go on maternity leave, that I haven’t had any time at work to blog. And let’s face it, work is my primary place for blogging… Usually when I go home, the last thing I want to do is get on the computer. But I promise to get better and get caught up!

I have had a whirlwind of doctor appointments over the last two days: my regular weekly OB appointment, my asthma doctor to update my scripts so I could have fresh meds for labor, and a pediatrician. My OB appointment was fine, except there was a bit of a scare – the nurse took my blood pressure and it was 148/102, which is very high for me, at the beginning of my appointment. Then I did the NST for about 30 minutes, and the doc came in. He took my BP again, using what I call the fat person cuff, and it was 122/82, which is more typical for me. So I worried a bunch while getting my NST for nothing… The nurse had told me that there wasn’t protein in my urine, but still! Pretty concerning to have high BP and just sit there and think about it for 30 minutes! At my asthma appointment today (which went fine), my BP was 120/78. So I think it was a fluke and a result of using a too-small cuff, like my doc said.

The doctor visit that threw me for a loop is the pediatrician. I went to a doc that was recommended by some ladies at work, and I expected to like her, and I did. But it was very interesting, and is causing me to do a lot of googling, so I figured I’d come to the best source – my infertile sisters!

As a brief medical history, I’ve been treated or at least consulted with 3 docs: Dr. Sher in Vegas, Local RE, and OB. Local RE ran a bunch of tests at my request after my miscarriage last summer, and I was diagnosed with compound heterozygous MTHFR – two mutations. He recommended taking Folgard 2.2 twice per day, and low-dose aspirin. My understanding is that these are meds for the rest of my life, now that we know I have the MTHFR mutation. Then I had a consult and testing with Dr. Sher, when he diagnosed me with elevated NK cells, and recommended intralipids for that, and in addition to the Folgard for MTHFR, recommended Lovenox during pregnancy and for 6 weeks after birth. I ended up going with Local RE for IVF and a subsequent FET, which resulted in a baby in my belly, but only because Local RE agreed to follow Sher’s intralipid and Lovenox protocols. But even though Sher didn’t think aspirin was necessary, Local RE recommended it, and so therefore I’ve been taking Folgard, low-dose aspirin and Lovenox, every day, throughout my pregnancy.

Meanwhile, after getting pregnant, I went to see my OB, who is fine with me taking baby aspirin and Lovenox, and is now the prescribing doc for Lovenox. He is not a fan of switching people to heparin prior to birth, and instead prefers to induce labor prior to me going into labor on my own, so we can control the timing of labor with the shots of Lovenox. So I will get an ultrasound next week at 36 weeks (can you believe it?!?!?!) and based on that, we’ll schedule an induction somewhere around 38 weeks (so excited – she’s almost here!!!). Nobody has really mentioned what will happen after birth, except I always knew that Sher’s protocol said Lovenox until 6 weeks post-birth.

So I go see the pediatrician yesterday for a “new mom” visit, and I don’t really know what I’m doing. Sure I’ve downloaded some questions to ask from the internet, but really I just want to see if I think I’ll get along with her, and like her style. She asks me at the beginning if there have been any complications with my pregnancy, and I give her the brief run-down: “No not really after getting pregnant. Trouble conceiving, miscarriages, IVF. Diagnosed with clotting disorder so taking Lovenox, so OB wants to induce around 38 weeks so he can control the timing.” Ped doc said that sounds like a good plan, and moves on. At some point, I ask her about her feelings of breastmilk vs. formula feeding.

Now as a side note, I feel very prepared to breastfeed, or at least as prepared as I can. I’ve read a couple books, including Jack Newman’s book, The Ultimate Breastfeeding Book of Answers, which I highly recommend. I’ve done a bunch of research online. I even dragged the hubs to a breastfeeding class. Bought a pump, nipple cream, breast pads and bras. In short, I really want to breastfeed, and I will do anything to make that possible.

I’ve read in the books about how to tell if a doctor/hospital is breastfeeding-friendly. And this new pediatrician, or at least her nurse, broke the number one rule. As soon as I checked in and was brought back to an office, the nurse happily exclaimed that she had all kinds of new mom gifts for me! Lots and lots of formula samples… But giving the office and the doc the benefit of the doubt, maybe they just want to get rid of the stuff that I’m sure the formula companies give them…

Anyway, I asked the ped doc about breastmilk vs. formula feeding, and she said that breast is best. She firmly believes in breastfeeding. But she’s supportive of situations that require formula. “Like for you, if you need to take Lovenox after birth.” I’m sorry, what? She said that Lovenox is a bad drug to take if you’re breastfeeding, so if I’m taking that, I’ll need to feed my baby formula. I responded that I read that Lovenox has a high molecular weight, and will therefore not pass into breast milk. So she got out her meds for breastfeeding book, and we went to Enoxaparin (generic name for Lovenox) and like she said, it’s listed as a Level 3 drug. Level 1 – great. Level 2 – just fine. Level 3 – no studies have been done to prove anything either way. Level 4 & 5 – bad. (At least that’s how I interpret the levels – some of you science types could refute me…) And she explained, which I wasn’t really aware of, although it makes sense, that the levels for breastfeeding are different than the classifications for pregnancy. I knew Lovenox was Class B for pregnancy, so I figured it would be fine for breastfeeding. But she said it was Level 3 – no studies have been done, so she doesn’t like me taking it and breastfeeding. Yes, the book mentioned the high molecular weight and that it’s unlikely that it could pass through to breast milk, but she wasn’t buying it – it was a Level 3, and that’s it. But it’s a judgment call and it’s up to me. Also, aspirin is classified as Level 3, and it has been linked to Reyes syndrome, but not in low doses. So that is up to me as well!

I’ve read a bunch of stuff online, and most things that I read say that both Lovenox and low-dose aspirin are just fine, but it is concerning to have a pediatrician disagree with you… I consulted Jack Newman’s book, and he mentioned low molecular weight heparins (like Lovenox, but not specifically addressing Lovenox) and that it has too high of a weight to get into breast milk. He doesn’t address aspirin at all.

Yes, I’ll talk to my OB about it, but I doubt he’ll have any kind of opinion as he’s just following the recommendations of other docs. Part of me just wants to stop both Lovenox and aspirin when I give birth. Yes, I know there’s a risk of me developing clots, but I’ve never had any kind of issues in my life until trying to get pregnant. I would have never even known about this if I hadn’t miscarried! And using Lovenox and baby aspirin is somewhat controversial for compound heterozygous MTHFR folks, so maybe I don’t even need it… I hate that once again, there is no clear-cut answer when it comes to infertility and the things we do to combat it.

All I know is I want to breastfeed my little Alex, and just be a normal mom. Is that too much to ask???