Posts tagged as:

pregnancy

Turn and face the strain

by Myg on November 4, 2008

Do you know what’s weird?

Waking up at 2am to pee, getting back in bed after you struggle to make room next to the dog, and staring wide eyed at the shadows on the ceiling in stark realization that your life is ending. I imagine if you knew the approximate date of your death it would feel somewhat like this. Only, granted, much worse.

This is me circa 2am, most nights.

And this is me in general: nary a good thing can happen without a moment of intense grief for what’s lost.

But to step back a bit, truth is I have been done with this part of my life for awhile now. Seriously, good bye. The last five years have been mostly too much work that was too hard combined with too much cancer and death in my family. Very little of the real work of my life got done because all I could do was trudge through another day of just making sure, in all seriousness, that nobody on my professional watch was going to kill themselves or get beaten, and if I wasn’t the world’s most miraculous therapist, so be it. Happily, everybody was left standing by the end of my clinical tenure this past March. Yeah I know. Go, me.

From January 2005 I’ve been trying to get pregnant, knowing full well that there was no way my body would bring forth a baby while I was under that kind of stress. It looks as though science is backing me on this one – there’s a study that says stress plays a role in up to 30% of infertility cases. To prove my point, about six months after my father-in-law died I got pregnant. I thought, yep, see, now that I’m not in acute grief I can conceive.

But just to keep me in the theme of depressing life shit, my pregnancy was ectopic. Stuck on the off-ramp, so to speak. And for a further dose of cruel poetic irony, I had to be treated with Methotraxate – a popular cancer drug – to end the pregnancy, otherwise it ran the risk of ending me.

With the ectopic pregnancy so went my chances for any kind of natural conception. And then it was onto the IVF ordeal, which began in July of 2007 and finally worked in June 2008. That was – holy crap in a handbasket – five months ago.

In any case, you know what I have say to the past five years of my life? SEE YOU IN HELL, BITCHES!

Sitting here thinking about all of this, on the eve of the most important election of my lifetime, I am realizing that if life-as-I-know-it changes as radically as I believe it will, I’m very much okay with that.

And so are Doot and Bing.

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Waiting for you. Week 22.

by Ms. Myg on October 31, 2008

It was pain week. Yes, that’s what I’ll call it.

I have a history of back/neck injuries sustained from two totally excellent places:

  1. Flipping over the handlebars of my Sears Freedom bike when I was 7 years old. It was real bad. So bad, I cracked my brand new adult front tooth in half, landed on my head in the middle of the street and was knocked unconscious. Hospital time!
  2. Rock and Roll. I played guitar and sang in an indie rock band from the time I was 19 until…well I last played a show in December of 2001. I was 32 then. (Ugh. That long ago?) Anyway, I had some terribly shitty posture and managed to herniate two discs in my neck, which became very problematic for me in 1999. With treatment (physical therapy, chiropractic adjustments, drugs) I fully recovered. Or, did I? Herniated discs are like that.

I haven’t had a lot of complaints about these issues in the last few years. I’ve been lucky. Every once in awhile if I was feeling achy I’d make a trip to the doctor and get an adjustment, then be fine. I maybe saw him a couple of times a year. Then came pregnancy. With twins.

The pain I now have in my back is different. It hovers somewhere in the middle, (“Really? Not your lower back?” most formerly pregnant women, aka mothers, ask me. Now, I may know absolutely fucking nothing about being pregnant, but I can tell you exactly where it hurts, damn it.) The pain was particularly vicious on the left side, right under my ribs, every night at around 8:30pm until I went to bed, when it would wrap itself around to my abdomen, making me ponder whether or not I was getting an ulcer. Then magically tonight it appeared on the right side, and behaved in much the same way. I was relieved for the change in scenery, as it were.

This pain started gradually. I first noticed that if I spent much time on my feet, I’d be screwed for days. I learned, hey, don’t spend so much time on your feet. Now it’s to the point where I can’t spend too much time sitting upright, either. I need to spend a significant part of the day laying down. Which sounds a lot nicer than it is – especially when you still sorta have a job, like I do.

Know what’s really killing me? I had to stop walking the dog. Couldn’t make it down my street to the corner without my mid back feeling like it was being ripped apart. I feel so, so bad about not being able to do things with my dog! Soon enough he’s going to be relegated around here to actual, you know, dog status. I was hoping for a little more time I could really dote on him. Poor guy – he’s just 19 months old – still a puppy for labs. [Insert gratuitous adorable dog pic here:]

Man, he still does that head cocked to the side thing when you talk to him too. He’s too much.

To alleviate the pain, I had a full on therapeutic massage last weekend. It was nice, but it didn’t fix shit. On Monday I begged my doctor to squeeze me in and got an adjustment. I think that helped – some. My pain is more localized now. But it still hurts. A lot. And for a lot of the day.

The OB/GYN told me to order the “prenatal cradle.” It’s a crazy borderline S&M looking contraption that will support my back in holding up my belly.

Wear it UNDER your clothes, dummy!

Wear it UNDER your clothes, dummy!

With that shoulder support, it should alleviate some of my mid back woes. If you need one, google it, but don’t order it from the maker, Prenatal Cradle, or you’ll pay about $20 extra for one with shipping. I ordered mine from Target for around $60, shipping was free. I’ll let you know when it gets here if it works. I really pray it does because if all goes well, I’m looking at another 15 weeks of this shit!

So that was my week.

Oh, the kids? Here’s what Bing and Doot have been up to:

  • They’re growing. How do I know? Well, I don’t exactly, other than the fact that I have been growing. And they seem to be crowding my internals a bit more. Conventional Wisdom says they should be about a pound each and a foot long a piece. That makes me crave a Nathan’s. Or two.
  • They are now producing their own hormones. Great – just what we need around here. More hormones!
  • Moving around. I still worry about whether or not I feel them moving enough. But I do feel tap, tap, tap every now and then. First this side, then that. Every once in awhile in the middle of the night, somebody kicks me hard enough to cause pain in a vital organ. It’s reassuring.
  • Other than getting bigger, I’m not sure what’s left for these guys between now and showtime.

And as for me, the pain thing is really tantamount. If you’ve ever experienced chronic pain, you know of what I speak. It just flavors everything in your day. So since I devoted so much of this post with that, I’ll skip it in the bulleted recap of the state of me:

  • Getting clutzy and moving in the vertical plane is more complicated. Unplug something? Pick that sock up off the floor? Okay, I’ll do it, but it had better be REAL important to you.
  • Worrying. Like up at 3am thinking about every single thing that isn’t done. From the hall closet being a wreck to the nursery to work related things to my wedding photo album (yeah, I got married 6 years ago, but still.)
  • I HAVE NO FUCKING CLUE WHAT I’M DOING HERE! SHUT UP! GO AWAY! DON’T LEAVE ME!
  • Denial. Sometimes I just don’t believe they are really, truly in there. Just as I was typing this, I received a message in the form of a swift kick from Doot in the liver. Thanks, buddy.

I’ve got a lot more internal state of mind stuff to spew at you, but it’s late and I’m tired and oh, jeez, did I mention my back hurts? Makes even blogging a bitch.

You may be wondering, as I have, given my complaints above, do I still think pregnancy over 35 = AWESOME?  Well, yes. I do. But I will qualify this with the fact that awesome doesn’t mean easy. It doesn’t even always mean good. The big bang was awesome, wasn’t it?  Mother nature must have gotten a serious damned back ache from that, right?

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22 Week Belly Tour

by Ms. Myg on October 27, 2008


22 Week Belly Tour from Myg on Vimeo.

Soon I’ll write my “Waiting for you – Week 22″ post, but thought I’d give you voyeurs a glimpse of my ever expanding cargo space.

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Waiting for you. Week 21.

by Ms. Myg on October 24, 2008

I’ve picked up a bad habit – reading the blogs of other mothers, some of whom have some really, really awful stories to tell. But, oh! These blogs are good. The writing is good, the people are good, the stories are real. You can’t beat good blogging. It’s the new indie rock.

I found two of these new mom blogs because many women bloggers have, quite understandably, flipped the fuck out over John McCain’s assinine comments during the last debate about “health” of the mother being an “excuse” (I really wish I could render McCain’s sarcastic wrinkly finger wagging air-quote gesture in print somehow) that “pro-abortion” proponents use for protecting women’s reproductive rights.

The blogger backlash led me first to Uppercase Woman, by Philadelphia writer Cecily Kellogg. I’m now undoubtedly hooked, and the timing couldn’t be worse.  Why?  Well, Cecily was pregnant with twin boys four years ago, during the last presidential election. She had severe pre-eclampsia, diagnosed in week 22 (EXACTLY WHERE I AM RIGHT FUCKING NOW, btw) and lost both of them, four years ago this coming Sunday. But the story is even worse than that – worse than just “losing them.” She had to have a late term abortion after one of them died in utero and she was in danger of dying herself.

The other new mom blog I found is by a woman named Alexa at Flotsam. She shares another harrowing, god fucking awful tale about complications in her twin pregnancy. Her twin son had died from some mystery infection in utero and she ended up delivering her daughter at 25 weeks (she continues to blog about her daughter’s progress). Damn, damn, damn.

See why I shouldn’t be reading this shit right about now? But I have, so now I subject you as well.  Please, if you can stomach the kind of grief and heartache women face every day with this shit, read their stories. But for GOD’S SAKE, NOT IF YOU’RE PREGNANT! Especially NOT if you are pregnant with twins, like me! Wait until those little bugs are out here raising hell, at least.

But, if you are willing and able, here’s Cecily’s response to McCain and the recap of her story. (Scroll down to the bottom of the page to start from the beginning – there are a bunch of posts related to it.) Cecily, I know you’re dealing with some strong anniversary reactions right now and a lot of grief. Much love to you, fellow stranger.  Alexa Flotsam’s story is here, and it is equally powerful.

When you take 30 seconds to consider the reality for women who have to endure something as atrocious as the death of her unborn child or children at that stage of development, I hope you feel a very hard slap in the face. I hope it hurts. And by you I don’t just mean John McCain or Sarah Palin or any other so-called “pro-lifer” out there. I mean all of us. We all need to feel a little pain when considering how these kinds of issues become political footballs among the majority of us who will never have to face this specific brand of agony. But perhaps if we all hurt a little more for these brave, loving women, we might collectively come to our senses regarding the safeguarding of, yes, women’s HEALTH.

Glad I got that off my chest. It has been no small amount of emotional workout to keep my anxiety in check after reading those stories.

After reading a bit about all that can go so desperately wrong at this stage, I freaked out and called the nurse practitioner coordinator person at my OB/GYN’s office. This is the first time during my pregnancy where I’ve had to wait more than two weeks to see a doctor in person. Given a few things, like a) Cecily’s story, wherein she had severe pre-eclampsia at 22 weeks and was virtually asymptomatic and b) women who’ve undergone IVF are twice as likely to have pre-eclampsia and c) I was still unsure if I was feeling the boys move enough, or in the right way and d) I didn’t have a glucose challenge test scheduled yet and e) after my last ultrasound, it was not recommended I come in after two weeks for a new cervical length check like they wanted me to at weeks 18 and 16, I had some questions.

“Wow, that was a thorough voicemail!” she laughed when she called me back. Damn straight it was. I’m a social worker. I work in the health care industry, though off to the side now. I know that doctors, nurses, all sorts of medical professionals fuck up. Not intentionally, but in a “we’re so, so, so overworked” kind of way. They follow protocols more than instincts, and treatment protocols are dictated by insurance companies who have the ultimate goal of saving bucks, not you. Often these are tailor made for the general population and don’t fit your specifics. So yeah, I had questions.

And you know what? I was okay with her answers, which were that a) they’ve been checking my urine and blood pressure for early signs of pre-eclampsia and everything looked great – they really were not worried at this stage. b) I’d get the referral for the glucose challenge test (to check for gestational diabetes) at my next visit. c) What I described over the phone as possibly the movement of the boys sounded like it was indeed movement, not bad gas, and if I was worried at all, to come in and they’d check on me. And to call if I had any worries or concerns at all. I was okay with that, and since that day I feel them moving a lot more. Though I still swear it feels like gas in the wrong part of my body.

Anyway, you want to know how the kids are? This is what they say about week 21:

  • They are plumping up like little turkeys in there, baking away and packing on the pounds. Like mother, like sons.
  • They are wrinkly like prunes or like your grandpa’s ass, perhaps. Depends on your grandpa.
  • They are sucking their thumbs! Man that’s so cute to think about I can hardly stand it.
  • They do seem to be wriggling around a lot in there now, as though to say, “Mom, look, you’ve got to get a grip on yourself!” after my agonizing and worrying about it.

As for me? I’m just great, just:

  • IN PAIN! My back hurts. Oh, it hurts. It hurts a lot. But the good part is that it’s a new kind of hurt, not that same old boring hurt I had from guitar injuries. And the other blessing, seriously, is that about 5 minutes of back rub in the right spot does give me relief for about an hour. How I suffer depends on what I do.
  • Worried. Ah, sigh. What can I do? I go back to the doctor on 11/5, unless I really just can’t deal with it. Then I’ll go back earlier to hear the heartbeats and reassure myself I’m not really that gassy.
  • Did someone say gassy? Hullo, constipation? Upping my rations of Rasin Bran this week.
  • Big. And getting bigger, it seems, by the day.
  • Limited in my activities. This is self-imposed, due to my back pain (see aforementioned bullet 1). If I stand long enough to get my hair dry, I’m in pain. Fucking ridiculous. I know, my belly is big and heavy and yes, teeming with life. My back muscles are not up to it, at all. I do have a massage scheduled for tomorrow. I know that’s going to help, and my appointment with my back doctor is on the calendar. So hopefully I can do things like unload the dishwasher and fold laundry again shortly. Yeah, I’m really hoping for that.

You know what else? I seriously can’t wait for this election to be over. I hope, oh how I hope, that Obama does it. I hope he gets in and whips the government back into shape. I think he can. I think we can. But god am I tired of the election. I’m just tired of it.

And you know what else, else?

I still love being pregnant.

Check back in another 15 weeks and see if I’m still saying that.

Blogged with the Flock Browser

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In or out? The Moms Only Club in the post-infertility world.

by Ms. Myg on October 22, 2008

This has been a hard post to write, let me say that up front. I think I need to eat some humble pie. We’ll see.

As a long time outsider to mom culture, I had no idea what kind of club I was going to find myself inducted into with this pregnancy. I sort of speculated when we adopted Mason, because dog-owners-who-love-their-dogs-too-much have a similar “us-ness” that you join when you do things like spend time at dog parks. But this experience is far beyond.

I admit, I’ve always found the “moms only” club irritating once I reached an age where most of my female friends and relatives were members. See, when you’re in your thirties and childless you eventually stop getting invited to your friends-with-kids’ parties and dinners, presumably because you’re thought of as someone who doesn’t want to be around kids.

But now that I’m pregnant, we’ve been welcomed back into this group of people – some of whom I’ve known forever.

It’s just, well, weird. It’s not bad. But it is the process of becoming a part of something you’ve resented for years. You definitely don’t want to opt out, but you don’t forget how you felt a few short months ago either. And that’s weird.

See, when you’re infertile you really don’t want to be around other people’s adorable children or around pregnant women. At least I didn’t. Whenever possible I avoided them. I was such an ass I didn’t even respond to several invites for baby showers, let alone RSVP with a polite “no” and send a gift. “Fuck it” said I. I couldn’t tolerate the idea of someone else having a baby that wasn’t me, not even long enough to step into Babies R Us to buy a stupid gift. I was really that bad. So bad that at one point I remember being at a party last fall where the host announced his wife was expecting, and I had to lock myself in their bathroom and sob. I left early.

Of course, that’s me. In case it’s not obvious yet, I am nothing if not overwrought with intensity at all the inopportune moments in life. My struggle with infertility shook me to my foundations – challenged the very meaning of my own life. IT SUCKED BALLS.

Despite my best efforts to contain myself (and I’m a licensed therapist, so you can honestly consider me a pro at that), perhaps my personal hell was noticeable to my friends with kids after all. I’d like to think that’s the reason we were excluded from their social lives for awhile, but truthfully I think they had more reasons to bond with other parents who could share child watching, toy sharing or other concerns. I don’t blame them at all for that. During the same period, mostly due to my frequent sour moods, we became far less social and offered invitations to our home only for rare special occasions. I can’t say the loosening of ties wasn’t a mutual process.

But I will say I was surprised to see how proactively our company has been sought now that I’m pregnant.

Would I suck if I said it makes me nervous?

I want to join the club and you know what? I really need to for my own sanity. I want to be able to ask people stupid questions like, “How do you go to the bathroom in a public restroom with twins in a stroller? Should I even bother to go out in public with them for the first six months? Where should the babies sleep? For how long?”My problem is, I hate, hate HATE to ask anyone for help. With anything.

Lucky for me, I didn’t have to ask. Help is coming, whether I’m able to ask or not. That’s one of the small miracles of motherhood I’ve discovered. Mothers can’t seem to help themselves when it comes to helping others.

So, I’ve found myself the recipient of this incredibly sweet outpouring of attention and support the likes of which I’d never imagined. I am humbled by the generosity especially of other women who have kids – many I’ve known and paid little attention to for years (some in my own family) and even several I’ve never met other than from their interest in this blog.

Other than being pregnant, I can’t understand what I’ve done to deserve such commeraderie. So I try to understand it like this.

Being pregnant is the dichotomy of a truly unique experience and a truly common one. It’s special beyond special. More special than Christmas morning waffles and more special than shooting stars. It’s the specialist thing I’ll ever do. I know that, even despite the ever present spasms in my shoulders and twenty pairs of shoes that don’t fit. And so do all these women who are reaching out to me now.

I think it’s partly to welcome and honor me for partaking in this continuity of the life force. And I think it’s partly their way of honoring and remembering the experience itself.

So whatever happens now, consider me in.

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Gross armpit lump story. Mmmm…did that get your attention?

by Ms. Myg on October 6, 2008

Week 18 – which I haven’t posted yet (I’m working on it!) had one full day of “Oh My God I’m Gonna Die” agony.  It had to do with that gross extra breast tissue under my arm (which I go on about in Week 17.) I actually went to my doctor’s office and saw the nurse practitioner (NP) for it. This was the second time I had this armpit evaluated. The first was back in April before I was pregnant, because it was swollen and it hurt. My previous OB/GYN announced it was nothing to worry about, and then he proceeded to not worry about it. No follow up. Fucker. Another reason I’m glad I changed docs.

This lump under my right arm sometimes swells up and really, really hurts. It used to happen during my period, and there was a smaller, harder more painful lump inside. Since getting pregnant, it has been fairly consistently swollen, and now there are two smaller, harder lumps in there which last week after examination, the NP stated were palpable nodes. Lymph nodes. I was referred that day for an ultrasound on my armpit to take a look. (As an aside, I must note that when I used the medical term for armpit (axillary) with the scheduling person at the Radiology department she asked, “What’s that?” How confidence inspiring, really.)

“If there’s an issue with the lymph nodes we’ll follow it. If they get worse, they may have to come out, though I’m not expecting that.”

Right.

Like a lot of people, I have a whole ton of cancer in my family so talk of swollen lymph nodes without any obvious infection symptoms made me go pale. Tell me not to worry all you want. It just. doesn’t. matter.

I had the ultrasound and the tech said, “Okay, place your finger exactly on the spot where you think there’s a lymph node.” I found the spot – it’s the most painful place on my body, so not terribly hard to miss. She put the machine over it. “I see nothing – no nodes.” We looked all over that engorged lump of fatty tissue and still, no lymph nodes.

“What is it then?” I asked.

“I have no idea” she said. Comforting, right?

Apparently there was no difference between the larger lump of fleshy tissue and the harder smaller lumps inside of it, according to the ultrasound. It was all the same gross stuff.  The tech left the room and showed it to the doctor, and he said “I dunno either.” She said it doesn’t look like breast tissue either – just some other fatty tissue.

“It doesn’t look bad,” she said. “You look upset! Don’t be upset! There’s nothing scary we’re seeing here. Just tissue.”

Okay, great. That’s easy for someone to say who has one iota of medical or biological know-how. I do not. Strange fatty tissue masses appearing randomly in my body do not make me happy.

I’m glad nobody is worried, sure. But I have to ask – why don’t the doctors want to find out what it is? Our medical system is mind boggling with its inexplicably bad communication with patients. If you had random fatty lumps growing in your body, even if they were not cancerous nor in any way dangerous, would you not have the curiosity to find out how the hell they got there?

I had a massage a few weeks ago and the massage therapist felt those two little hard lumps and said, “you have a couple of serious knots in here that are causing you this shoulder pain.” I let her work on them (and it hurt so fucking bad I can’t even describe it), and my nagging persistent shoulder pain did indeed decrease. But not the armpit pain.

So when the Nurse Practitioner announced they were nodes, I wasn’t happy. All kinds of things went through my mind.

I really wish I’d had the wherewithall to ask a ton of questions but I was so anxious my mind was blank. “What could this mean? What are the possible causes of this? How likely are they? What are some common reasons this could happen?” Etc, etc, etc. I didn’t ask any of those, and I take responsibility for that. But the nurse said virtually nothing other than, “Go get it looked at.”

So in the hours before I could get the ultrasound I combed the internet. Mistake! Why? Cancer, cancer, cancer. That’s why. Try googling “swollen lymph node” and “axillary” or “armpit” and see what you get. Lymphoma, breast cancer, Leukemia. These are not the things you should be reading about at 18 weeks pregnant if you don’t absolutely need to. Especially if you are like me, and in your immdediate family there’s one person who’s had breast cancer before age 40 and another who had Leukemia before age 30.

When I’m anxious I NEED information. Need it. But without doubt it would have been better to get real information from a real medical professional, instead of from the internet. Probably better to call the doctor back and ask the questions. Maybe next time I’ll be smart and do that.

Today I’m not worried. The lump has ceased to be painful for now, and what testing I’ve had doesn’t indicate any reason to worry. I know that elevated levels of stress are not good for the little guys inside and I’ve nothing to hang my worry on anyway.

A mammogram would totally rule out any scary cancer related stuff here, but obviously I can’t get that now. I had a baseline done when I was 37 because as I said, I have a lot of cancer in my family. It was perfectly normal. My breast exam last week was perfectly normal too.

When it’s all said and done I’ll get another mammogram anyway, given that some studies have shown an increased risk of breast cancer among women undergoing IVF treatment. But I’m not going to worry about it. No, really.

I’ve got maybe 19 weeks to go now before the little ones are here, and it seems if I’d like to worry, there are a great many other worries to choose from.

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Pregnancy in the time of corporate bailouts.

by Ms. Myg on October 2, 2008

You know what’s funny? Being pregnant during the great economic disaster of our time. No wait, did I say funny? I meant it’s suckass.

Things have been bad for awhile, I realize, and always getting worse. Home values falling, foreclosures, gas and food prices rising.  Even so, I consciously decided I would do whatever I possibly could to get pregnant. I’ve been trying for years and seeing the potential for tough times ahead wasn’t going to stop me. Let’s face it - besides the economic disaster there are two wars afoot, tensions around the world are rising and then there’s the incredibly scary reality of global warming. Things don’t look rosy on the global scale, for sure.

On a personal level, hard economic times have resulted in me having my hours slashed at work and as a result my healthcare is about to be cut off. I’m the primary breadwinner, so we are fairly strapped for cash as my husband is trying to finish up graduate school.  Talk about a clusterfuck of life timing.

As strange as it sounds, I feel better when I consider that my in-laws were born during the Great Depression. My mother-in-law can tell stories about growing up on a farm in Nebraska, a busy happy life but one so devoid of excess, she and her four siblings sometimes had to even share one towel or one tub of bath water. 

My father-in-law always used to say, “I never knew I was poor, because everybody else was too.”  He didn’t have a sucky childhood because of the Great Depression. I guess that’s because kids don’t need money or things. Or at least they don’t understand that they need those things. They just know that they need parents.

And whatever else happens, I  know I can give my kids that.

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Waiting for you. Week 16.

by Ms. Myg on September 16, 2008

Suddeny I’m struck by the fact that the little suckers growing in my belly aren’t going to be in there forever. They’re going to be out here, and sooner than I think.

Doing this weekly “Waiting for you” post, where I track week to week what it feels like to pregnant with twin boys has been a strange external clock for me. I actually write the post at the end of the week (tomorrow will be the start of week 17), though it feels like I am writing these posts closer and closer together. Like the universe is expanding, time itself is speeding up, and by the time I’m done writing this, those kids are going to be here nagging me for money to go to the movies.

Still, I can’t wait.

I had my 16 week ultrasound last Friday and my kids now have SPINES! I could see their SPINES! Like little dinosaurs in there – ribs and spines showing up all nice and bright against the blur of the ultrasound. They are each now about 5 ounces, “Three sips shy of a small coffee” as the tech said.

Other extremely cool developments

  • They can now hear! The synapses in their little brains aren’t fully connected yet, but the external structures are there. So I’ve been singing “99 bottles of beer on the wall” just so they can start to get used to what life with mom will be like.
  • They are starting to be “proportioned” like real babies, and much less like the big headed, flipper touting aliens we saw on ultrasound at week 12.
  • They’re getting finger nails and toe nails now. Like they really need those in there?
  • Their little hearts are pumping roughly 25 quarts of blood each day. 25 quarts! That sounds like a lot, doesn’t it? What impressive kids they are, already.

And as for me, this week brought

  • More trouble sleeping, and being less comfortable sleeping on my back. I sleep on my left side and keep a pillow wedged behind me to help me stay that way. But I am tossing and turning more. I know, I know. It’ll only get worse.
  • A heightened awareness that there are two tiny little people growing inside of my body. Inside of my body! How weird is that? Being pregnant is totally surreal to me. And I am beginning to grow restless that I don’t know what to call them yet. So the quest for names has been renewed in earnest.
  • They say I might be able to feel the babies this week. I don’t know if i have or not. A couple of times I wondered, “maybe that’s it!” only to realize it was, indeed, gas. And I did seem to have a lot of gas this week. Maybe it was all the Mexican food.

Week 16 is a wrap then. With luck we’ve got about 21 more to go (they say 37 weeks is full term for twins, don’t they?) And no doubt they’ll show up faster than I can manage to document them.

I am very glad now that I had the CVS (Chorionic Villus Sampling) test done at 12 weeks – though the way that all came about was not such a happy tale (the long version of which is here). I know a lot of women agonize around this time about all of those screening tests, and I have to say I was a complete wreck. If you’re over 35, those tests are a HUGE ass deal because depending on who your doctor is, you will be convinced, absolutely convinced, that something is wrong with your kid and that you must have this terrifying big needle shoved into your belly so you can find out exactly what.

My first OB/GYN (not the IVF folks, the regular guy) was a real dick about all of that. I fired him and got someone who was much, much more helpful in sorting out those issues. I can’t recommend highly enough, if you have a doctor who makes you feel at all upset during what should be one of the most amazingest times of your life, tell him (or perhaps her) to fuck off. Sooner rather than later. I know I felt immediately better when I changed doctors.

And if you’re agonizing about the screening tests, know that we all agonize about them, I think. But for the vast majority of us – even those of us over 35 and over 40 – we learn that everything is just fine. The odds are that’s what you’ll learn too.

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Too pregnant: the quiet agony of high order multiples. Part III

by Ms. Myg on September 12, 2008

This is the third and final installment of my saga about being pregnant with high order multiples and facing multifetal pregnancy reduction (MFPR), wherein I’ll tell you all about me me me and what happened to me me me and the little nuggets inside of me. You can read the first part here, and the second part here if you haven’t and would like to take it from the top.

Back to me and what happened

By week seven, another ultrasound had revealed that only three sacs remained viable, but that one of the three remaining viable sacs actually had monozygotic (identical) twins. So I was down a sac, but up a kid. That means I’d actually started out with five. FIVE. But I was down to four now, so in a way there was little net change. The doctor told me to just wait another week to see what would happen, but I’m not the waiting type. No, really I’m not. If there’s a pending crisis, I need a plan.

Living in NJ, I am blessed to be only an hour away from Dr. Mark Evans, the doctor written about by Liza Mundy (whose brilliant work on multifetal pregnancy reduction I talked about in yesterday’s post.)  I called Evans’ office and spoke to one of his staff. I was both impressed and surprised that he called me back personally within the hour to talk. The conversation I had with him was refreshingly bullshit free. Just information. Like statistics – data – I could think over to make my decision. What kind of data? Data like this:

  • I had at minimum a 25% chance of miscarrying my pregnancy if I did nothing.
  • Because the monozygotic twins made the pregnancy act more like quintuplets in terms of risk, the risk of miscarriage could be as high as 50%.
  • The average delivery for quads is at 28 weeks – extremely premature.
  • There was a 10% mortality rate for each baby within the first year if they survived the pregnancy
  • There was a 6-10% rate of long term disability per baby, if they survived the pregnancy and survived their first year of life.

Some women are very brave and decide to carry these pregnancies to term, and I have to hand it to them. Some are blessed enough to have healthy kids. But so far I hadn’t been very lucky in the pregnancy department and after looking at the real numbers my resolve to reduce was as strong as ever. I cannot tell you how helpful it was to have actual data from, you know, a doctor who deals with this exact issue every day of his career, to help me make a decision.

Did I hate myself on some level for wanting the reduction? Of course. I am 100% pro-choice. I think the law needs to bend over backwards to protect a woman’s reproductive rights on every front. But did I want to retch every time I found myself praying that two out of the four heartbeats I’d heard would cease to beat? You bet I did.

Bottom line

I figured this was my first real test as a parent. And sometimes as a parent you have to put your own agony aside and think about what’s best for your children. As Dr. Evans said to me on the phone,

“You have to ask yourself, What is the most important thing here? If the absolute most important thing to you is having a healthy baby, then it seems clear what to do. But that’s the question you have to answer.”

Frog appropriately lodged in throat, I made the appointment to come in at the end of week 12 for the procedure. The procedure can be done anywhere from week 10 on, so why wait? Well, most miscarriages happen before week 12, and there’s little sense doing it when there’s still a chance of a natural miscarriage, unless for religious reasons you need it done earlier.

You have to schedule two days for this event. Day one would be the CVS test to determine if any of the babies had chromosomal problems that would lead to miscarriage or disability. Day two would be the reduction, based on the CVS test, the location of the fetus and if all else was equal and we wanted to know, the sex. We didn’t want to know and didn’t care about the sex, but it was an option if we wanted it. (Did I mention we didn’t?)

Family drama fear

You want to know one of my biggest fears about this? Dealing with my pro-life mother. My mom is an Italian-American Catholic with some fixed ideas about abortion.  You may think I had the option to just not tell her about the quad pregnancy, and I certainly did have that option. But the reality is that I am a terrible liar and I’m also very close with my mother. It was just going to be easier to tell the truth and deal with the drama than to cover it up. (That’s just how Italian families work, for those of you wondering. At least, it’s how my Italian family works…)

Mom was shockingly supportive. “You’re not doing this out of convenience! You’re doing it to save the lives of the others. You have to think of it this way.” And I did – I was just really relieved to see that she did too. Now, I didn’t mention that I doubted the Pope felt that way. But it does go to show how one’s beliefs can flex, luckily, to suit the actual reality that they live.

Dealing with the decision

My IVF doc had said, “Some couples like to leave these things up to nature. It’s easier for them. Some don’t feel that way.” And I had to think about that. How could you go through IVF – the most amazing technological feat of our time, really, and entirely unnatural – and at the point where you must face the possibility of losing all your potential children due to a high order multiple pregnancy, decide to “let nature take its course?” Nature by no means had gotten me into this situation. With the help of my doctor, technology and years of meticulous research, I’d gotten myself into it. I had no reason to assume nor hope that nature would just bail me out of it.

I needed a lot of processing, mentally and emotionally, to prepare for what was to come, and you probably would to in this situation. I prayed a lot. I am by no means a religious person. I absolutely can’t deal with church. But I have had the peculiar habit of praying ever since I was a kid. Maybe that’s more of the Italian in me, I don’t know. But I did pray and pray and pray that I would not have to go through this procedure. I needed to talk about it, but the trouble was I didn’t want anyone to know about it. Aside from my mom and husband, I did have one friend that just listened extremely well, which helped quite a bit. And I did a lot of writing. All these things helped me bear the agony of my decision. And I knew I would go forward and reduce in order to protect whichever fetuses I could from such high risks of death and disability.

The unexpected

At week 8 I went back for my last appointment and final transvaginal ultrasound at the IVF clinic. Same drill, naked from the waist down, lying on a table while getting poked in dark places with high cost machinery. I wasn’t expecting much change and I’d just about had it with the IVF clinic at this point. The one thing I should have learned by this point was to expect the wholly unexpected.

“Okay, there’s one…” the doctor said. “And here’s two…….hmmmmm….” and he was quiet for a few seconds, jamming that wand around up in there. “There’s no heartbeat in the third sac.”

“Really?!” now I’m sorry, but it just sounds and feels fucked up to be happy when your identical twin embryos die, which is what they did.

“Yes, there’s no heartbeat here. See?”

“Thank god…” I said it, and I meant it. As weird as it was, I did feel like my prayers had been answered. He printed out pictures of my now fraternal twin fetuses and handed them to my husband for inspection.

“Yes, it’s much safer for the pregnancy to continue now.” The doctor smiled, said good luck and left. The technician stuck her head back in the room as she was closing the door behind her and said, “Good luck and please send us pictures! Don’t forget about us!”

Like, really, could I forget?

I was lucky. Very, very lucky. But of course I worried and I still worry. What if I kept reducing? What if I reduced all the way down to nothing?

It’s been two months since then and so far so good. I actually did go in to see Dr. Evans for the CVS test, and I’ll post about that another time. I decided to do that test with him even though he accepts no insurance and I’d have to pay a lot more out of pocket, simply because I trusted him so much. That’s because he wasn’t afraid to tell me the truth.

You’re not alone!

If you’re in the situation where you’re considering what to do about higher order multiples, I hope you’ll find a doctor who will deal straight up with you on this topic. It makes all the difference in making your decision, whichever way you decide. Dr. Evans accepts patients from all over the world if you have the means to get to New York City and can pay out of pocket (insurance may reimburse you, but not likely for the total cost, which isn’t cheap. It was going to be $3900 to do CVS on quads, and $3900 for MFPR, for a total of $7800).

If not, and if you need a MFPR, please be sure to find a doctor who has done this procedure a lot. The most important factor in the success and the safety of the procedure is the experience and skill level of the doctor. My guess is a call to Dr. Evan’s office might point you to resources to find the right doctor for you.

If you’re in this situation and the most important thing in the world to you is having a healthy baby, and if you decide MFPR is what you need to make that happen, then know you’re making a good and brave decision that’s going to increase the likelihood of that reality.

And know I’m behind you, and I get it.

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Too pregnant: the quiet agony of high order multiples. Part II

by Ms. Myg on September 11, 2008

This is Part II of my saga of going from a quintuplet to a twin pregnancy, wherein I’ll cry foul and give you some additional stuff to read on the topic of multifetal pregnancy reduction. You can read Part I here. The conclusion of the story is here.

What they say about the third time

Two nail biting weeks after my third trial of IVF, I got a call from my nurse telling me I was pregnant. Not only that – my HCG levels looked really, really, really strong! Wow! In fact, she said, it could be more than one! Yippee! Maybe it was the twins I’d been dreaming of all along. It wouldn’t be more than that, of course, the risk was so low, right? “Nah…” I thought. But worried anyway.

I told my mom I was pregnant, to her extreme joy. And I told her that I might be carrying more than one baby. Her reaction – which is typical – was to joke around about having triplets or quads. “Manny, Moe and Jack!”  Somehow I didn’t find it funny. “Triplets or higher order multiples are a medical disaster, Mom.” I’d said. “Pray it’s not that.” She said, “When I was a kid, there was a family down the road that had triplets and they were fine!” Like many, she didn’t know much about all those families that haven’t had such great luck with higher order multiples.

See, if you pay attention to any kind of media on this stuff, the stories about multiples higher than twins are all these “miracle babies” triumph pieces. And to be sure, those babies who actually survive the pregnancy and go on to lead healthy lives are worthy of celebration – because they are indeed miracles of modern medicine. The operative word here is miracle.

You don’t see many news stories on the women who bravely decide to carry their higher order multiples to term and aren’t so lucky. Where are the stories about all the women with triplets and quads who miscarry? Or those who give birth and have still borns? Or those who have their babies at 28 weeks and those kids go on to suffer with all manner of physical and developmental problems? I’d venture to say you could actually find more real women with stories like that if you tried. But I suppose here’s one case where good news is more interesting to the media than bad news. “Woman pregnant with quads miscarries at 20 weeks” wouldn’t be much of a headline, would it? Too mundane, really.

Reality bites

In any case, after the news of my positive pregnancy test I was eager – and anxious – for my first ultrasound. With IVF treatment, you have a transvaginal ultrasound about a week after your pregnancy test, which is around week four. They can take a look and see how many sacs you have and if there’s a viable embryo growing. My doctor dimmed the lights and started poking around up there. My husband was at my side. “There’s one…” the doc said. “There’s two…hmmmm.” He was quiet for a few seconds. “Okay, there’s a third here. And, it looks like you’ve got a fourth one here too.”

“Four? I’ve got four?”

“Looks that way. But it’s still early. They may not all continue growing.”

The triumphant joy I’d felt at finally – finally – being pregnant vanished into an agonized frustration.

My mind raced to a cousin of mine who’d had IVF and had gotten pregnant with triplets. She miscarried the entire pregnancy. She’d been offered what’s known as multifetal pregnancy reduction (MFPR or selective reduction) but she didn’t go that route. Whether she miscarried as a result of that choice or for some other issue, she’ll never know. But I knew already, if that had been me, I’d reduce.

Now that’s what I was thinking about.

Still half naked on the exam table, I burst into tears. The doctor scrambled to find tissues. My husband squeezed my hand. I began asking about my options, where I could go, who I could talk to.

“It’s early and things can change,” the doctor said. “Let’s see how you do here over the next few weeks.”

“Is it likely that I’d naturally reduce all the way from quads to twins – without having a reduction performed?” I asked.

“Well, it’s not typical that it happens like that, but it could. And these days with triplets we can manage them pretty well. Either way, the odds of a decent outcome is roughly 50/50 whether you reduce or not, so it’s really your choice what you want to do.”

Bullshit

You know what folks? That’s simply not true. The odds of a decent outcome are definitely NOT the same whether you do MFPR or not. If you have MFPR and reduce to twins, your rate of losing the entire pregnancy is 6% – and that’s the same rate of potential loss if you have twins to start with. If you try to carry a triplet pregnancy, your rate of losing the entire thing is 25%, with another 19% of kids born as triplets dying before they turn one. Then there’s a greater risk of dangerous pregnancy complications for the woman. So don’t fucking tell me there’s no difference, okay? There’s a big difference.

My doctor was a coward. I don’t know if he was secretly religious or if fertility doctors are so bullied by lawsuits and the right wing that they’re terrified to tell you the truth about the actual data about multiples.  “It’s up to you.” he’d said. Well thanks for handing the responsibility to me – I KNOW it’s up to me. But, am I a fucking doctor? How am I supposed to make these decisions without the correct data presented to me?

Where to turn

It’s another situation where the patient is left to her own devices. My device? The Google. Now if you’re going to turn to Google to research something as gut wrenching as MFPR, be warned that you’re going to wade through a lot of garbage and for God’s sake STAY AWAY FROM FORUMS where a bunch of nuts lurk and tell horror stories.

Instead, I’d say start with this extremely helpful piece, believe it or not, from Yahoo Health. It’s called “Should I consider a multifetal pregnancy reduction?” and comes complete with a decision guide. It’s one of the more clearly written articles online on MFPR. One misleading piece of information in the article is that MFPR can be done during the first trimester. That’s true, but it can be done in the second trimester too, if your doctor is willing and capable.

Then, if you find yourself in the camp of considering MFPR seriously, please read “Too much to carry?” It’s an article written by Liza Mundy for the Washington Post in 2007. There’s also an excellent follow-up feature of Mundy taking questions from readers that’s also well worth reading.

The article itself features Mundy shadowing Dr. Mark Evans of New York City performing MFPR for two patients. It gives an account of the CVS (Chorionic Villus Sampling) procedure – a test for chromosomal problems that is given prior to reduction – and the reduction itself. I will not say it’s an easy read, but I will say it’s a must-read if you are in this situation and considering this procedure. It couldn’t have illuminated better for me what was in store.

Liza Mundy’s article was a reprint from her book, “Everything Conceivable: How Assisted Reproduction is Changing Men, Women and the World.” This Q&A segment where Mundy is asked about her experience writing the book is ripped from the book’s website:

Q: What most alarmed you?
A: The explosion in multiple births. No question about it. So many parents conceiving through ART end up with twins, triplets or even more. Many of us—and many ART patients, starting out—have the idea that a lot of very tiny babies, born as a set, are something cute or desirable—an entire family, delivered overnight! In truth, these babies are far more likely to be born premature, and to suffer from lasting and severe medical problems, and they place a great deal of stress on their parents. The industry needs to do much more to eliminate multiple births, and it can do more. I interviewed patients who had suffered so much tragedy and grief as a result of conceiving multiples, and inevitably they had not been adequately warned of the dangers involved.

I was rather upset to agree. I didn’t think I was adequately warned. Another point she makes is that fertility clinics are not required to report the number of resulting multiple pregnancies from their procedures, so it’s difficult to track exactly what percentage of women go through this special kind of hell. And although this is anecdotal only, from other women I’ve talked to or have heard about undergoing IVF in their 30s, it’s not at all uncommon to be pregnant with triplets or higher after the procedure.

Jump to part III.

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