Bionic Mamas

you're not losing a vagina, you're gaining a son


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Items, Glorious Items

Were you in Oliver! ever? I was. Eight grade. I do not love that show. Sorry if this song is now in your head for the rest of the day, too. I don’t know what gets into me. We were instructed to wear our fathers’ old shirts for that scene, so while the rest of the orphans (whose fathers were bigger than mine, I gather) looked waif-ish, I looked like a blue, permanent-press sausage. At least I got to sing the pretty rose seller bit later, in a peasant blouse.

Sorry, as ever, for the silence. I’d say it has been difficult to find time, but the real issue is energy. I am just so beat these days. I feel fine in the morning, but by evening, forget it. Makes me rather nervous about what’s coming next.

Meanwhile! Pease porridge and items:

  • Thank you for your many thoughtful, um, thoughts, about the doula situation. I/we have not decided what to do, but your comments have been very helpful. After meeting with friend-doula, I feel about the same as I did before: I think she is a good personality match for me, but I am worried about the experience issue. On the other hand, it is very, very valuable to me to know her personality well enough to trust that she won’t be crazy at me during labor. The doctors I have met at my new OB place all seem very nice and swear they aren’t insane, yet I find I am having enormous difficulty believing that. Just having that concern out of the way about a doula might be valuable enough to make up for a lot. As for the “morning-after” problem, I never saw my last doula after delivery, and I think that on balance that hasn’t been so great for my mental health. I do plan to have some pretty clear guidelines for anyone in this role, namely: pay more attention to me than the baby; tell me what a great job I did more times than anyone could possibly need to hear. Especially if this isn’t the kind of birth people carry on about the beauty of.
  • Speaking of mental health, I did go see that therapist last week, and I have an appointment for next week. She seems good, I think. She said several good things, things many of you have said, but it is different to hear them from someone who doesn’t like me, you know? (Wait, maybe you don’t like me, either? Someone who I’m not trying to have a friend-style relationship with, anyway.) I chose her because she has training in CBT and EMDR; a cognitive approach to this situation feels much more to the point than still more mucking about in my feeeeelings. Of course, what did I do? I talked about my feelings for a fifty-minute hour, that’s what. But I am a narrative gal, and I did need to tell her the story.
  • I only cried once! Rather suddenly, at the point where I said the thing about how, when I imagine things going well this time, I imagine myself surrounded by warriors. That was surprising timing, to me. The therapist — she might need a bovine name, not because she herself seems at all cow-like, but because the waiting room of her otherwise very midtown office (converted apartment, doorman, and so on) is entirely decorated in strangely urbane cow art. Let’s call her Caroline, as long as we’re on a musical kick, for the new, blue, true, moo cow in Gypsy, the one who is willing to moooove to the city with Baby June. Anyway, Caroline stopped me and asked me to dwell on the feeling that brought up, and woman, I wanted to shout, all I DO is dwell! But anyway, I think that went about as well as expected.

how bovine is thy dwelling place
How…bovine is thy dwelling place

  • I paid another visit to the high-risk place with the fancy u/s machines, for part two of the anatomy scan. It was…a bit of an ordeal, frankly. (With the obvious caveat that I mean “ordeal” in the limited way the word can apply to a situation with a good outcome.) Sugar had an important work meeting, so it was just me; God bless my friend the Dane for taking the Bean in addition to her own kids for the afternoon.
  • First, there was the Great Cervix Search, the longest stretch (as it were) of dildo-camming I have as yet experienced. My cervices, you may recall, are of particular interest because having the two of ’em means I am at increased risk of cervical incompetence, number two on my list of most-despised obstetric terms. (Number one is “habitual aborter.”) On the MRI I had prior to ever being pregnant, the two of them are smack next to each other; before the Bean removed my septum with his head, they were fairly easy to find on physical exam, since each had its own little vagina. How cute. Post-Bean, one — the one he used — has been easy to find by hand, as it were, one much more difficult. When I was in labor, they only found one, so my hunch is that the other made itself scarce in late pregnancy, and many thanks I send it.
  • So, back in the stirrups: the tech spent a while poking around with the ultrasound wand, pursing her lips and printing pictures and, as they all do in these moments, interrogating me about how I knew there were two, anyway. (MRI, plus I used to bleed out of the un-tamponned side, plus the other tech found it a month ago.) This is a slightly annoying conversation to have while being dildo-graphed. After a while, she stopped but told me to stay put while she found a doctor to decide if her pictures were satisfactory. Enter doctor. “I’ve never done this before,” she says, and off to the races we go, complete with the same interrogation. Eventually, she gives up, too, and in comes the senior doc on duty, who is very luckily the southern one I like so much. “How does it feel to be a medical marvel?” He has a firmer hand with the whole business (GOD, I do not like being able to compare technique in this way, but there’s only so long I can stare at the ceiling and think of England.) After quite a hunt, at least punctuated with jovial asides and no dubious eyebrow twitches, he declares himself defeated by my marvelous anatomy, too, but willing to assume things are okay in the absence of symptoms, given the fine state of the less shy cervix and the full-term status of the Bean.
  • Now is the part where I insert a little prayer that Jackalope doesn’t get any funny ideas about using the untested one. Do you hear me, young…person?
  • Jackalope, who has been kicking up a storm through all this, has fallen asleep, and in a position not conducive to measuring anything relevant. Now we see what fun toys the fancy place has at its disposal, like the tilt-a-whirl electric bed I am soon sliding off of, head first. (Seriously, I braced myself only by putting a hand on the wall behind me.) I am basted with more and more gel and rotated like a rotisserie chicken. The paper under me tears into little, goopy pieces. Just…yuck. Eventually the creature shifts enough to show off everything except what the tech keeps calling “the gender.” I resist the urge to parrot a women’s studies lecture at her. Jackalope has her feet between his legs, or the other way around. As I am instructed to roll over again, I mention that they did, after all, get a look last time, but apparently they have to look again. Lord knows why — is it all that likely to have changed? I guess that would be noteworthy.
  • Eventually, the tech’s rolling and prodding and jiggling pay off. She releases me to attempt to squeegie some gel off of myself, though it is clear this is more a job for a pressure washer than a paper towel. Dr. Southern returns to say everything is fine, Jackalope is a good size, the cord, which they couldn’t see well last time, is inserted in the expected manner, and while the placenta is still marginally previa, it’s only by 2 mm, which even I can’t manage to fret over. And no cervix searches again until the third trimester, though I’m back for another growth scan in a month. Phew.
  • Because she is an angel, the Dane has not only kept the Bean all this time but has also made enough quiche that I can inhale half a pie-plate’s worth upon my return to Brooklyn.
  • I did at least get lots of pictures to show to Sugar and the Bean, who respectively described the Jackalope as “a barracuda” and “scawy.” So now you have to look at them.

USWeek20001

I think all that dust is on the scanner and not in my uterus, but who knows?

USWeek20003

USWeek20004

Clearly, my mind is going, because I even thought the creepy 3-D ones were cute.
USWeek20005

…But maybe I also see where the “barracuda” idea comes from. Still not half as scary as the dragon-lizard the Bean appeared to be at a similar age.

 

  • Speaking of the Bean, he is charming, obsessed with street sweepers and the alphabet, awfully tall all of a sudden (36″), and still not much of a sleeper, very much to my consternation, though it is Sugar who gets the brunt of the night work, since he refuses to let me be the one to come in when he wakes. He mostly still naps (and is a holy terror if he doesn’t), but he rarely falls asleep before 10 pm. This would be annoying enough if he could be allowed to just stay up, but he really cannot function that way. So we start bedtime at 8 or 8:30, read books, brush teeth, all that, and then one of us sits in the dark for an hour or so. Every night. Thank God for iPads. (If he does not nap, he falls asleep much more quickly, but you will have to take my word for it that his mood and behavior for the last several hours of the day in that case are such that, NO. Artificially shortening his nap does not speed up bedtime.)
  • I did not answer the cat-torture question because I kept hoping I would find an answer or at least discover that his current delight in pestering the household felines was a short-lived phase. Ha. I don’t know what brought this on, but I know I want it to stop, pronto. Also a thing that could stop any time: “knocking” (read: hitting) his mothers.
  • He’s down to refusing all food except smoothies for dinner. (At lunch he will usually eat a peanut butter sandwich.) I don’t know anymore. He loves to cook and talk about food, just not so much to eat it.
  • He is very sweet about the baby, though, hugging and kissing my stomach and whispering, I love you, baby, in that not-very-whispery two-year-old way. This is very clever, as it is impossible to remain annoyed with whatever shenanigans he has been pulling when he does that.
  • Potty training is under way, in the most lazy way possible. His little butt is extremely cute in underpants. It is extremely hilarious when nude, as it often is, especially when he starts practicing being an acrobat.
  • This post is even more scattered than usual. Winning!
  • Sugar did come with me to today’s OB appointment, with the original doctor I know in the practice, the one who dealt with my Return To Stirrups last summer and also with Sugar’s menacing ovarian cysts, back in the day. She is very nice. She says no one at that practice is going to yell at me in labor. I have some trouble believing she can really know that about her colleagues, but I at least think she would not, so that’s a start. She did say, however, that she favors having women hold their breath while pushing, which I found ridiculous and panic-inducing. But we will work on that next visit, I guess. Time for another lit-review….
  • In the meantime, I am to acquire a blood sugar monitor in preparation for testing four times a day for two weeks, starting around week 26. This strikes me as overkill, but still better than having my brains scrambled the way they were by the glucola last time.
  • I asked whether it was really okay to be taking unisom every night, because if I don’t the first time I get up to pee is the end of sleep for me. “It’s not a great idea to take anything every night,” she started, but when I asked what I should do instead about being up for the day at 2am, it turns out she didn’t think half a tab was such a big deal, after all.

THE END.

  • (Don’t you always stick around, just to see if something comes after the credits?)
  • I’m going to DC for the weekend, for a baby shower. This is emphatically not the kind of thing I usually travel for, but the gravid friend in question organized my shower from DC, so it seems the least I can do. I will be there Saturday and Sunday, basking in the glory of the closed museums and terminally borked transit system, and while this was supposed to be sort of a treat, it isn’t feeling like much of one. So let me know if you are around or have great ideas for something nice to do that doesn’t involve alcohol or the federal government.
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24 Comments

Bloody Business

Before I begin, I want to just say, in a small voice, how crushed I feel by May’s latest news, by the utter un-rightness of it, by how badly the universe is flubbing its lines. This is not how the story is supposed to go, dammit. I know we talk a lot about how unfair all of this business is, but sometimes the unfairness is just so fucking unfair. It is not the only thing that has been Not Right lately; that doesn’t make it any less wrong.

I am wondering if any of you happens to know what counts as a normal postpartum drop in hemoglobin and what doesn’t. Imagine you have this patient who, after two days of fairly heavy vaginal bleeding, arrives at a hospital in labor. Her hemoglobin at that point is 13; her hematocrit is 37.8. Following a vaginal delivery, her numbers are 7.3 and 21.7, a drop in the neighborhood of 44%.

Question one: Is that normal? If not, how abnormal?

Question two: Are there causes of postpartum decreases in hemoglobin other than blood loss? Does the placenta itself (or the baby) in some way count towards the starting number?

Question three: Do you do anything about those numbers, beyond suggesting an iron supplement? Do you do anything if the patient calls three weeks later complaining of continued extreme fatigue, dizziness, breathlessness, etc.?

Question four: Supposing a patient with this history is pregnant again. One likely source of postpartum bleeding (vaginal septum) is gone, though possibly the vaginal wall where it attached has scar tissue. Is postpartum hemorrhage in such a case likely to recur? Do you do anything in particular to lessen the chances of her feeling terrible for months again? Is there anything you can say to her to help her feel less frightened?

Question five: Is this patient a good home birth candidate? Just kidding.

My hospital records — the short version only — from the Bean’s birth arrived this week. I’d put off ordering them for a couple of years, which I guess is good, considering that I find myself a little taken aback anyway. This is just the abstract — test results and some nonsense from the lactation consultant, an extremely silly person. There are errors: I am listed as having a didelphic uterus (nope, not that normal), and hemoglobin and hematocrit are reversed in one place. (I flatter myself that a hematocrit of seven might have been more worthy of note.)

Also this week, I finally tracked down a picture I didn’t know existed until recently, of Sugar cutting the Bean’s umbilical cord. That is to say, it’s a picture of my crotch, post delivery but prior to the arrival of the placenta. I thought it might feel sort of empowering to see that, since I was scared to look at that part of my body for weeks after birth, not wanting to see all the stitches. Maybe it would have been, but I found it hard to pay much attention to my flesh, finding the pool of blood I was apparently lying in rather visually distracting. When I say pool, understand, I mean pool. I don’t mean the bed was a mess. I mean liquid. I mean depth. I mean volume.

I thought I was done finding new things to feel angry and scared about, regarding the Bean’s birth, but I guess I was wrong.

I haven’t written in much detail about how sick I was after the Bean was born, partly because at the time, I was filled with confusing hormones, alternately elated and distraught, and, well, sick. I’d been pretty thoroughly conditioned to believe that only people with (unplanned) c-sections were allowed to feel sick or sad after birth, anyway; the websites said I should be exulting in my all-powerful womynhood and resuming my exercise routine while teaching the baby French. All that matters, as you know, is that the baby is healthy. The vessel has done its job.

So, here: I was pretty sick after the Bean was born. For the first week or so, I had an annoying tendency to black out every time I tried to nurse him. The nurse I asked about it told me that was “oxytocin, filling your body with feelings of well being.” Later I realized that was the only time I wasn’t lying flat. I couldn’t hold him during the lactation class and was grateful that lesbian privilege meant I alone among the women there had someone to help. (Men weren’t allowed.) We left early because I couldn’t sit up anymore.

For the endless rounds of pediatrician visits for weight checks in the first few weeks, I took cabs. One day Sugar had a work meeting, and I couldn’t carry the Bean in his carseat. I could barely carry the car seat. We tried to take the subway once. Sugar carried the baby while I shuffled behind her, hips still entirely disconnected, like a troll aunt of some kind. (Sugar got lots of congratulations for her new baby in those days. She deserved them, but my own invisibility beside this gorgeous, healthy, thin woman and her perfect baby was sometimes hard to take. “Don’t worry, honey,” one woman said, “you’re next!”) Sugar went to the store for a different kind of iron supplement for me while I took the dwindling Bean to a lactation group. I remember feeling such utter hatred for the other woman there, so pink and healthy with her fat, pink baby, who was younger than the Bean. While Sugar was gone, I started shaking convulsively. I was losing my vision, trying to figure out how I was going to get myself onto the floor without dropping the baby, who was so, so heavy. Sugar arrived just in time, and held him while I lay my head on the desk and shook. No one asked if I was okay. I took a cab home.

It’s hard to write this without feeling I am exaggerating things, but this happened. Other things happened, too, many of them good. I stayed conscious for the ride home from the hospital, even if I did have to go immediately to bed and so missed the cats greeting the Bean. Friends came over, and I sat and talked with them. But it was months before I could walk around the neighborhood normally. Going up the gentle incline of the train station left me breathless, my vision blotchy. I feel existentially queasy looking at pictures of me with the Bean in the early weeks, because I am so very grey.

I got better. The human body really does have amazing powers of restoration. But does the patient’s recovery mean the treatment regime was wisely chosen? The heroic medicine doctors, the bleeders and purgers and givers of mercury, thought their treatments worked because their patients often survived, when the truth is those patients recovered in spite of the medicine. Regardless of whether I should have had different treatment in objective terms — and I gather from google that sources differ on the guidelines for iron infusions and blood transfusions and so on — I feel sure the other aspects of treatment could have been better. Only one nurse, when I was already in the process of being discharged, mentioned my hematocrit drop and asked if I really felt okay. (Desperate to leave, I said yes.) The nurse practitioner at my OB office told me I should expect to feel tired when I described my trouble breathing while walking. At the infamous postpartum appointment, Dr. Russian didn’t know my hematocrit levels and dismissed my questions on the topic. None of that was helpful, even if it was the case that the best course of action was waiting for my body to rebuild itself. It’s a kind of gaslighting, I think, not to tell a patient that how she feels is not in her head or her weak moral constitution.

Besides angry, I feel a bit scared by these new documents, in particular the picture. My septum is gone and presumably won’t break and bleed again. I expect it caused some of the trouble, in addition to other tears. The midwife at my new clinic says that didelphic cervices can bleed a lot, and suggested they might try rectal cytotec in addition to pitocin if it seems necessary. (I haven’t talked numbers with her, just my experience of being anemic.) If the pre-labor bleeding was a placental abruption — and we’ll never know, since the head of the OB practice didn’t see fit to take it seriously — there’s a chance that won’t happen again, and a 100% chance I won’t let it be ignored this time. I have the reassurance that I did survive, however sick I got. But there is still that nauseating feeling of almost having been run down by a bus, not realizing it was even there until it passed.


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Happy Hour Items

Greetings, internets, from a local trendy bar that turns out to be more than capable of turning out something “fun and non-alcoholic,” if requested. I thought this order might reassure the woman giving me side-eye as I, well, bellied up to the bar, but it turns out that is just how she holds her face.

Nevertheless, I am looking rather fecund at present, even in the tent-dresses that are all I can tolerate wearing at present. I haven’t had much of the stretching and cramping and so on I had in early Bean-pregnancy since the first couple of weeks, but lately anything putting even nominal pressure on my uterus makes me sore and dizzy and nauseated. An ultrasound probe, for instance. I tried a belt for twenty seconds this week and was off all afternoon, and even my maternity jeans, which felt fine at first, caused trouble after an hour. Sure hope this sorts itself out before the weather turns.

The nuchal scan went well, I’m into the lowest risk zone for miscarriage, and my body is rapidly outing itself, but Sugar is interviewing for a new position at work, so we are in the odd position of telling people in real life but not on Facebook, where Sugar’s colleagues will see it, lest the idea of her taking time off in, say, February, make another candidate look more appealing. (Her job does not give “paternity” leave — or indeed maternity leave beyond six weeks of disability (stay classy, academia) — but she took unpaid FMLA leave when the Bean was born. Besides giving them invaluable bonding time, the leave was frankly necessary for my health, as I was in no condition to be left alone with an infant, being among other things rather deficient in the hemoglobin department.)

The not-telling has me a little blue, it turns out. I don’t mind waiting a little longer, but I sure hope they hire somebody before February. That concern would not seem silly if you knew how long it’s taken them to schedule interviews. Meanwhile, why does a group email seem so much more intrusive than a social media announcement? Thank heavens for you all.

(Speaking of, have I mentioned how over the moon I am to be pregnant at the same time as our beloved May? I am in danger of leaving orbit.)

Meanwhile, the nuchal. It went well! Despite my anxiety-fueled delusions of intuition, risks of trisomy 13, 18, and 21 are as low as the statisticians are willing to concede. (I gather that in some circles it is poor form to admit happiness at this news, but I am not in those circles. I would not bear a grudge against anyone happy to find she didn’t have the diseases I have, for one thing. For another, my father’s line of work leaves me without certain protective illusions.) Because I was too deep in denial to schedule childcare and because the timing of the appointment interfered with prime toddler napping hours, the Bean joined us. He was not exactly an advertisement for bringing a toddler to such an event, but with Sugar there to wrangle his truck beads, he did okay. We have not, to answer gwinne’s long-ago question, told him the score, but he clearly suspects something, though I don’t know what. There have been several pointed questions lately along the lines of, “What’s in YOUR belly?” (I equivocate. “Lots of amazing things, just like in your belly.” “My belly!!!” Fin.)

We had the same super-nice doctor go over the results as last time. His southernness relaxes me. I find myself stifling the thought that if only I did have a high-risk pregnancy, I could see him. We talked for a while about my peculiar mix of normal and anomalous reproductive anatomy, and get this, he actually apologized at one point for asking too many personal questions! I told him that particular bar had been set rather low by the doctor who invited his receptionist in to see my vaginal septum, and he appreciated my stories about the look on the same doctor’s face when, after he told a fully-clothed me he was sure I didn’t have a septum, I replied, “I can put two fingers inside and they don’t touch.” (This diagnosis is not rocket science. Necessary equipment is two fingers and a functioning brain.)

ANYWAY, this doctor, who is not a condescending nitwit, delivered the happy news that not only were the ultrasound findings good, but this time, in contrast to last time, my blood count numbers were also all good. I find it cheering that my body or the placenta or whatever is in charge of whatever PAPP-A even is, is doing so much better this time (to the tune of about 85 percentiles higher than last time). Low PAPP-A is associated with a host of unpleasantries I was watched closely for last time, including pre-eclampsia and also IUGR, pre-term labor, and placental insufficiency, all of which also go along with mullerian anomalies.

I asked whether I should still be considered at increased risk for the MA complications, or whether my delivery of a normal-weight, full-term baby (albeit one at the low end of normal on both counts) meant my future risk was lower than MA baseline. I was pleased by the caution of his answer, which amounts to that it would mean that, if I had a more typical MA combination, but that my rara avis status means that there are no relevant statistics. (I found one case report of someone like me in the journals I searched, and the dominant theory of fetal development says I am impossible.). He is therefore recommending to my OB practice that I still have cervix-length checks and regular growth scans. I know some people find that sort of thing intrusive, but I find it very reassuring. Meanwhile, in a surprisingly decent move on my psyche’s part, I simultaneously feel much more confident than last time that things will work out, because they did once.

Yeah, I don’t know who I am anymore, either.

I am supposed to be using my time away from the house to work on another writing project, so I will have to tell you about the midwife at the OB office another time. Meanwhile, a picture, because pictures!

12 weeks 1 day

ETA: I just realized these aren’t even items. You must feel so cheated!


11 Comments

Embryo Aweigh

Hi, internets. Sorry for the wait. Valium remains my favorite drug, which is why I didn’t write yesterday.

So. The transfer was fine. After striking out with our usual sitters, thanks to the holiday weekend, I found a former student to stay with the Bean. I was beginning to think I would have to go to the clinic alone, which was a sad thought. Of course all my monitoring appointments have been just me, but a transfer feels more momentous (or at least potentially momentous), and a person likes to feel she isn’t acting unilaterally, you know? It was unexpectedly cold, so Sugar and I had a chilly walk to the clinic from the subway. It rained a little.

At the Baby Factory, we were directed upstairs, to the floor with the ORs. Dr. BFs office, the exam rooms, and the blood draw room are on the lower floor. The last time I was upstairs was the day of the Bean’s transfer, but I always think of the first time I climbed these stairs, when we paid our $450 gay tax in the form of that stupid “counseling” session. Luckily, Starrhillgirl distracted me with a picture of the blue mountain view where she was waiting, and I reciprocated with a picture of the lot beside the Baby Factory, which, despite what I can only imagine must be an astronomical value, has been vacant for at least four years. To give you an idea of the kind of money we’re talking, that tall building in the background is the UN.

Waiting room view

Soon enough, a very solicitous nurse with an English accent led me back to the changing room, buckled me into my hospital bracelet, and gave me that Valium I’d been pestering everyone about. I changed into a Baby Factory gown, but unexpectedly I got to keep my own socks and sweater. I might have chosen more special socks, had I realized, but I was very pleased that I’d worn my softest, most comforting sweater. And the socks were red and striped, so it could have been worse.

I sat in a backwater of the recovery room for a while, waiting to be reunited with Sugar and meet the doctor. A man in Hassidic dress — long, black, silk coat, white stockings, round, flat, black hat — hurried back to meet his wife behind a curtain. A tall, Russian nurse strode in and out in scrubs. I am almost certain her shoes, with blue, gauzy surgical covers wrapped and tucked around them, were either flip-flops or the cheap, mule-ish houseshoes people here wear in the summers. She had lovely ankles, but all that bare flesh still seems odd in an environment with so many sharps containers. Then again, I was walking around in socks.

Bunny slippers

Because of the shoe covers, I can’t say for certain that these are the ones she was wearing, but neither can I guarantee they aren’t.

By the time someone took me to the antechamber by the OR, the Valium was kicking in a little. A nurse took some blood from my left arm; I’m still letting the right recuperate following its refusal to yield anything last week. Sugar met me there, and Dr. Friday, an unknown quantity, arrived to talk about our embryo. It turns out I like Dr. Friday, though I admit that her almost cartoonish voice — it’s possible my mental fog exaggerated the pitch and speed — baffled me for a moment. Pre-transfer googling (what?) leads me to believe she, unlike most (all?) of the other Baby Factory doctors, also still does some OB/gyn work, and she certainly seemed more gyn-ish than the others, in that she seemed interested in hearing about how my septum had behaved in delivery (and, following some clipped statements from me to the effect that I had not been pleased with my medical care, who my OB had been). I know what you’re thinking, but her practice is in Connecticut.

She gave us some papers to sign and said some complimentary things about the embryo in question. The embryology lab, we are told, is put in a very good mood by embryos like this. Later, when I was looking at the creature itself on a screen in the OR, she said “it doesn’t even look like it’s been frozen!”

I’m glad she said all those things, because in truth, it doesn’t look to me quite as textbook-perfect as the Bean’s. I expect it isn’t, but I’m hoping that doesn’t matter, and I certainly know that less than perfect looking embryos have turned into actual people. (Who knows? Perhaps even my own embryonic beginnings were not so glorious.) It’s a 4BB, from what I saw on the chart — only maybe one of those Bs was lowercase — and something about it was “95%”. I don’t have much of a sense of what that means in the scheme of things. Regardless, it’s the one that’s inside me now, so alea iacta est, you know?

Off Dr. Friday and I went to the OR. Nurse Flip-Flop helped me into the most spread-eagled stirrups ever. The embryologists put the embryo up on the TV screen. It was fascinating to watch it change radically as they shifted the focus of the microscope; I wouldn’t have guessed it had enough height to make depth of field an issue, but it did. (Must be the donor; I am quite short.)

Dr. Friday cranked the speculum open to 11, and I must say, it was excruciating. The pain burned from two lines, top and bottom, running the length of my vagina; I suspect this is where my septum was. I have had occasion on my own to notice that what I assume are those areas do not stretch as well as the surrounding tissue. Indeed, Dr. Friday said she could see the septum’s remains, which was almost interesting enough to make up for the pain.

The transfer itself was perfectly smooth, like the way other people often describe IUIs. No wonder people don’t think this is a big deal! (I’ll still ask for Valium if there is a next time, though, if only for the sake of my nerves.) Unlike Dr. Paternalistic, who always hogs the ultrasound screen, she left it tilted enough that I could see it. She and the nurses pointed out the image of the catheter entering my uterus and then, after it retreated, the glowing, white ball of fluid enveloping the embryo it left behind.

Blast 2


15 Comments

Post-Ovulatory Items

Sshhh, internets, the Bean is sleeping. Finally. I should be in the other room, using this time to finish my semester grading, but the Bean is also sick, and if I move, nap over. So how’s about some items, since I’m here for the foreseeable?

Item: for those following along at home, I was finally deemed worthy of triggering on Saturday. Transfer day is Friday. Cross your fingers, if you don’t mind, for an easy transfer and a conclusive beta to follow. Of course, I’d prefer a conclusively high beta, but what I’m most focused on at the moment is numbers that mean I get to go on our planned summer trip of friends and family and beautiful, quiet places in the north woods of Michigan. When I ran this idea past Dr. BF, he said it was all fine as long as they were satisfied nothing ectopic was happening. No one wants to risk a rupture that far from a hospital, not even me.

Item: There will be Valium at the transfer, and don’t think I haven’t made mention of that to every warm body I can find at the Baby Factory. (I know some clinics always use Valium — and I find their logic of reducing uterine contractions convincing — but mine doesn’t.) Look, I know things have changed in the down-there department, post-Bean, and it’s wholly reasonable to suspect at least one of those pesky cervices is a little easier to navigate now that six pounds of baby has gone through it, but I don’t care to test that theory for no good reason. A tiny part of me is holding out hope that Valium plus baby plus lack of septum (and therefore more space for the hand that rocks the speculum) might mean no tenaculum, even. A girl can dream.

Item: I mentioned this to the nurse who took my blood on Tuesday (progesterone check), and she asked if my inseminations had always been difficult. They were, I said, but less bad with the Valium. I think the first one, with no Valium, was traumatic for everyone, not just me, and for me it was downright ghastly. (To say nothing of the pressure I felt to think warm, welcoming thoughts for a baby, while I was getting stabbed and prodded to the point of tears.) Yes, she said, I think I was there.

And you know what, I feel downright comforted to know that she remembers. The Baby Factory is a big place, with a lot of patients, and this was some time ago. I just looked back at the post I wrote at the time, which in no way captures the horror — no doubt I was imagining some future baby reading about his beginnings and didn’t want to scare the mite (guess who hasn’t filled in the birth story page of her son’s baby book?). We don’t need to go back over such old wounds as that, but suffice it to say that directed coughing in no way distracts from the pain of having yet another cervix stabbed with pointed tongs yet another time, and that seeing the doctor break a sweat isn’t very calming. No one said anything much about it at the time — and what could they have said that would have done anything but worry me? — but I am relieved to know that my impression of the day wasn’t crazy.

Item: That the transfer is on Friday means a doctor I haven’t met before (I think. Unless she was at the aforementioned IUI of nightmares.) will be on duty. And thank heavens for that. Had it been Thursday, we could have had the same guy who did the Bean’s ET, which has a cute aspect to it and all, but also has the less winning quality of requiring me to spend more time pants-less with a paternalistic asshole.

Seriously, I don’t know what this guy’s deal is, but it certainly could use a slightly more robust idea of his patients’ bodily autonomy. I found myself in stirrups with him again last week. He looked at my chart and said, in a disbelieving tone, “natural FET cycle? Why would you do that?”

You know that thing when some guy asks you some supposedly neutral question, like what your name is or why you look a certain way (usually: not thrilled just to be near him), and you just know that no matter what you say, you’re about to get hit on/told you are misbehaving/both? (And okay, I’m sure there are instances of women doing this, but stick with me here.) And you seem, in that moment, to have a choice about how to respond — to take the question at face value or to address its obvious subtext by ignoring him/ rolling your eyes/ telling him off — but really, there is no choice, because either you are going to walk right into the condescension (by being nice), in which case you aren’t allowed to complain about it, or you are going to socially overreact, which means you get called a bitch? Anyway, Dr. Paternalistic (who shares a name with a city in California, if you are local and curious) is like that. There’s no right answer. Except instead of his being a stranger on the street, he is the only one in the room wearing pants, and he’s holding an ultrasonic baton.

Gamely, I said, “why not?” And really, why not? My actual doctor thinks my odds of success are the same this way as in a more medicated cycle. But he didn’t like that answer, because this kind of cycle means I have to come into the office a lot, which, by the way, I haven’t indicated any impatience with, because I don’t actually mind. So I said that I liked that this cycle meant I could avoid the progesterone shots (since my body will make its own, meaning the suppositories are sufficient insurance). This isn’t an insignificant reason, to my mind — a few extra office visits versus stabbing myself in the increasingly lumpy ass for three months? No contest — but he looked unconvinced. “Also,” I said, bracing myself, “I liked the idea of letting my body do its own thing, since there’s no indication of any problem with my hormones.”

“I GUESS,” he replied, with all the self-effacing deference I’d expect from a fourteen year old. And then he stuck a dildocam in my vagina. Because that’s how this game goes. At least there’s no septum for him to make me feel bad about anymore.

Item: I cried on the bus ride to school after that. I’m sure it’s frustrating, as a doctor, when patients don’t make the same decisions you would — hell, I’m frustrated by other people’s decisions all the time — but maybe make a distinction between decisions that actually have anything to do with health outcomes and those that don’t. And then maybe try not to be a jackass, also.

Item: On the other hand, the nurse who gave me my trigger shots (two, because they are subcutaneous now and therefore weaker) on Saturday is in my good books. She, too, noticed and commented on the NATURAL scrawled on my chart. They don’t do many cycles this way, and that note has a lot of highlighter on it. “Good for you! Making your own follicle!” And then she stabbed me in the stomach (because that’s how this game works) and we talked about people eating their placentas. Not our thing, we agreed, but no reason others can’t do it. Imagine that.

Item: For the medical record, the progesterone is different this time. Last time, it was little waxy bullets from a compounding pharmacy, but this time I was given a choice between Crinone twice a day or prometrium thrice. My decisions was entirely based on math: 2<3. So far, the crinone is fine, except for making me crampy and leaving an absolutely revolting substance behind for removal during shower-time spelunking. Still, I will take gross over painful any day of the week.

Item: For the further medical record, following an awful morning of intense nausea, I decided to be pushy and ask if I really needed the doxycycline I'm on, given that I've had no invasive egg retrieval this time, no one thought I needed prophylactic antibiotics for an IUI (which is not essentially different from an embryo transfer), and my stomach is still all ducks and drakes from this sinus adventure. Message relayed via nurse is that I can indeed stop it, and I think I shall. I shall carry on with the methylprednisolone (how much extra do you think my insurance paid for the pre-metabolized version of a cheap, old drug?), as I can see the medical point of that one.

Message goes on to say that I must also stop taking Prilosec and Pepcid post-transfer, which is less good news. (Sinus doctor wants me to stay on both for another month while things heal; they a not presently back to normal.). I remember from last go-round that Dr. BF didn't even want me taking lysine for cold sores while under his wing, so this is hardly surprising. Lysine is an amino acid, for crying out loud; it's in FOOD. Similarly, I was directed to take both Pepcid and Prilosec while pregnant with the Bean, though admittedly later in the process. I guess every drug is suspect except the fertility drugs, which we all know wouldn't hurt a fly. I am at heart a Good Girl, though, so I will try for a bit and cry to my new OB if things get hairy.

Item: I can't believe the Bean is still asleep, but I woke him up prematurely yesterday (following his passing out on the floor in the late afternoon, following heroic meltdown, following utter refusal to nap earlier) and he still didn't go to sleep in a timely manner last night.

Item: Acid reflux and moral purity be damned, Sugar and I are going out for what I hope is a last-gasp cocktail tonight. Which means the Bean will have a babysitter, and sleep, well, that's her problem.


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Uterine News And Weird Reports

You might be a trifle done in, if your foremost thought at the prospect of upcoming surgery is relief at the idea of spending a few hours knocked out.

Returned to the Baby Factory this last week, for another look at my storied uterus. During the last dildo-camming, all appeared normal, but the spotting I’ve been having for up to a week before my period for the past several months made Dr. Baby Factory suspect a polyp, one he might not have been able to see at that point in my cycle, when my lining is pretty plush. Sure enough, at the low-nap of CD 8, there it was, big as life and smack in the middle of everything. Even I could have diagnosed something from that ultrasound, though I might have gone with “spontaneous mini-kidney.”

It’s not huge, as these things go, 7 by 8 millimeters or so. Dr. BF says lots of people get pregnant with polyps. But lots of people have miscarriages with polyps, too, and after watching a youtube video of one getting excised, I think understand why: the sucker didn’t bleed. If there’s one thing I know for sure about uterine tissue, it’s that it ought to be robustly vasculated, embryos not being entirely unlike vampires in their basic desires.

So. Out it comes, via hysteroscopy. That’s hyster- for “uterus” and -scopy for “you’d rather not be awake for this.” Dr. BF only operates on Thursdays, my busiest teaching day this semester. Luckily, he is willing to do this surgery any time I’m not bleeding (some people only do them early in the cycle), which means I ought to just squeak in during spring break, a few days before I expect my period. That gives the ol’ ute April to recover herself for a May FET cycle. Here’s hoping.

If you’ve read, um, anything I’ve ever written here, you know what comes next is the part about how freaked out and anxious I am about all this. And believe me, I’d be telling you aaaalllll about it, except that, well, I’m not. Isn’t that weird? I don’t know who I am anymore, either.

Partly, this is because it will be Dr. BF wielding the scalpel cervix telescope/floodlight/scissors thing. I’ve been peeved at him once or twice (twice) during our time together, but he’s never given me the slightest reason not to trust him. Granted, I am not deaf to flattery, and he did call my ovaries beautiful and remark that he loves my (medically rarer-than-rare) uterus. But it’s more that the initial impression I got when first reading his blog (what? You don’t choose your doctors via blog? Wish Dr. Russian had had one), that here was someone with a careful mind who also really cared about his patients, seems to have been accurate. I was a little surprised, during our Triumphal Return appointment, that he didn’t ask much after the Bean. It occurred to me later, however, that there is something really refreshing about talking to someone who seems mostly interested in me, not just the fruit of my wacky womb.

My mother has a story along these lines, which I’m going to put in here because it is funny and my paragraphing is all to hell anyway. Ahem. Mama went to medical school with a woman who had an identical twin living in the same area. Her twin gave birth, attended by a doctor the med students knew. When she saw him next, the med student thanked him for delivering the baby. He looked blank. Incredulous, she asked, “don’t you ever look at their faces?”

I trust Dr. BF because of the post that led me to him, in which he discussed common mistakes in diagnosing mullerian anomalies, because knowing how to do something wrong is an important part of truly understanding how to do it right. I trust him because I know he cares about his patients, not just because he has been considerate of our feelings (mostly — still holding a grudge over that psych consult), but because his blog was the first (only) place I’ve heard a doctor express disdain for the term “chemical” pregnancy, on the grounds that it diminishes the experience of loss. (That I read this right after Dr. “I’m sure you don’t have a septum even though I’ve never examined you” seemed cozily baffled by my observation that “incompetent cervix” is an obnoxious term makes the memory stand out.) And I trust him because I watched his video of a hysteroscopic resection of a uterine septum, which I heartily recommend if that kind of thing doesn’t squick you out.

I admit that I am pretty sad that this means no travel during break. I had visions of a jaunt up to friends in Boston or down to Starr Hill, but Sugar can’t travel the first weekend, and even though I know recovery from this sort of thing is supposed to be no big deal, the thought of counting on feeling up to schlepping somewhere the following day with a toddler in tow makes me queasy. It’s just, I’m lonely. I hadn’t counted on how isolating this “having a toddler means someone is always sick” business would be, and lately, someone is always sick. (And holy smokes, this latest one is a doozy. It’s taken a week to write this, and it hasn’t been a fun week.) I miss seeing friends, you know, in the ol’ Real World. Guess I should have thought of that before I went and got myself knocked up. Meanwhile, I don’t know what I’d do without y’all, I really don’t.

Speaking of, did you know you’d almost gotten me to not care about the specter of those PIO shots? Only almost, but almost is a big deal in this context. You are a pretty amazing bunch. Drinks, all around.

Which brings me to the appointment’s good news. I admit it, after the PIO surprise, I played the field, support-wise. I will always love y’all best, you know that. But I also asked about it on a forum, and one of the women there asked why I wasn’t doing a “natural”* FET. Was there any reason to believe my previous difficulties were related to my hormone levels?

*someday you will get my rant on how much I hate that word. It’s long.

Well, now that you mention it, no, there isn’t. We’ll never know for sure, but I favor Dr. BF’s hunch that I wasn’t getting pregnant via IUI because of structural issues: the endometriomas were preventing eggs from leaving my ovaries, various adhesions were keeping the Fallopian tubes from picking them up, scarring in the tubes was generally fouling things up, or some combination. Given how very many eggs I made on a moderate FSH dose (32), how much those eggs seemed to like the sperm in question (24 fertilized), and how happily the resulting embryos grew (12 frozen, one currently staring in adoration at the engines of Sodor), these explanations seem quite plausible.

Indeed, I had always imagined we would do an unmedicated FET, but when that’s not what Dr. BF described at our recent consult, I just assumed there was some reason. Insert the usual business of not wanting to look foolish by asking. Yes, it’s a great defense mechanism, why?

Emboldened by my forum friend, this time I did ask Dr. BF what he thought…and it turns out he thinks it’s fine! He might still want me to do some progesterone supplementation, but the good old coochie bullets are fine for that. I asked him about odds, expecting they would be lower than in a medicated cycle, but he said that assuming they don’t miss my ovulation (which would mean game over that cycle — this is why they don’t do many cycles this way), he thinks the odds are about the same.

I feel great about this idea, and not only because it limits the ass-stabbery to one trigger shot. I feel excited at the idea of giving my body a chance to just do its thing — at least, as much as such a thing is possible after embryologists have entered the picture. It makes me a bit warm and fuzzy, it turns out, to imagine trusting my body.

I know. I don’t know who I am anymore, either.


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Back In The Saddle

…or the stirrups, anyway.

No, no, not in the TTC sort of way, not yet anyway. I won’t spring that on you without some high-octane angst first, promise.

But I did go to the OB/Gyn, for the first time since my postpartum appointment, which some of you may recall ended with me wandering the avenues of Midtown, weeping so hard people were forced to break the NYC taboo on talking to crying people and the one on stopping strangers in the street. (In case you’re wondering, it does take some doing, especially in the blocks around Grand Central.) I was, erm, a little nervous. Related: what is it about filling out those medical history forms that makes me afraid I’ve forgotten my own name, let alone whether I have kidney disease?

You will not be surprised to hear that I did not return to Dr. Russian, as punching her in the face would open me up to more court and jail time than fits my schedule. I stacked the deck a bit by going to Sugar’s doctor, whom I have met before. (In fact, I tried to go to her practice when I got knocked up, but they weren’t taking new OB patients.) Nevertheless, I was feeling pretty shaky as I sat there on the table waiting, gripping my notebook of questions. I fetched my journal out of my purse, for the sense of enhanced safety only another book can provide.

And…she was wonderful. She listened to my slightly quavery explanation of why I was switching practices and said it all sounded pretty traumatic. She said that lots of women push for four hours with a first baby and that it doesn’t mean they aren’t trying, and that they give nifedipine if they even suspect Reynaud’s in the nipples of a breastfeeding mother, because Reynaud’s is so awful and nifedipine is so safe. (See here and here for contrast.)

I haven’t written about this, but one part of labor that I have felt increasingly upset about in recent months is the part where I was bleeding heavily for days at home and Dr. Skinny said it was nothing and then was such a bitch about my calling back when it hadn’t stopped, twelve hours or more after my first call. I’ve talked to many, many women since then about their experiences of labor, and I have yet to hear anything that reassures me it was normal. I suppose it’s possible that it really was just a particularly determined (and large — this was a lot of blood) broken vessel in my cervix, but it’s also possible it was a placental abruption, and there is no way Dr. Skinny could have known it wasn’t via phone. I didn’t think it seemed normal at the time, and I shouldn’t have let her intimidate me out of that. Things turned out okay for me and the Bean, of course, but it’s not a comfortable feeling, thinking that I could have let my baby die — oh, and potentially died myself — because I was too chicken to argue with a doctor. I told the new doctor that, and she looked very serious. That does not sound normal, she said, and no one at this practice would have let you stay at home if you called bleeding that much. That will not happen to you here.

Ultimately, she said that while she couldn’t ethically say things about Dr. Russian to a patient, she was — I think the word was “horrified” — by what I had told her. Then she said so again.

So. Maybe it wasn’t just me.

If this doctor has a fault I am aware of, it is that I find her a little happy to cut, as surgeons tend to be. On the other hand, as much as I don’t want to have surgery for the endometriosis I’ve thus far fail to cure with denial or pregnancy, I’m not sure she’s wrong that I should have it. Things are getting worse, and most months I now spend three out of ever four or five weeks in some amount of pain. In particular, pain in the week before my period is getting out of hand, such that I’ve been dipping into my hoarded Percocet stash to sleep. Nothing else does a thing. The question in my mind is whether surgery is worth the pain of recovery, given that it doesn’t always help with endo. Somehow I didn’t get that question in, but I am being sent back to Dr. Demure, the man who did a transvaginal ultrasound without so much as seeing my legs, to see how my garden of ovarian cysts grows. Well, I imagine, from the way my back feels half the month. I’m also to see a rehab specialist about the way my hip joints fall to pieces and leave me so weak once a month, though she seems unconvinced that isn’t somehow also endo.

If I am going to try to get pregnant again in the spring or summer, I’m not keen to have surgery first. I’m hard-pressed to come up with a rational excuse for that — besides that I have no idea what I would do with the Bean for two weeks if my recovery were anything like Sugar’s — but she said it did not sound crazy. Should have asked her why not. In the meantime, I have a legitimate prescription for Percocet now, though she said several times that we couldn’t just carry on like this until menopause. Other than pain medication and surgery that might not help, there is no treatment. Birth control pills help some people, but are a bad idea for people like me, who get migraine with aura and don’t like the idea of having a stroke.

The pelvic exam itself was not much fun, though I think she was as gentle as possible while hunting around for cervix number two. Righty seems to have done the job at delivery, for those who were wondering. The worst part, though, was the groping around for uterus and ovaries and such like. I was doubled-over after and am still in a fair bit of pain, though some sangria left over from our party on Sunday did take the edge off last night. She may have a point about this situation not being tenable.

So! On balance, a win yesterday, I think. Let us hope for another one tomorrow, when I have a job interview at a college in Staten Island. I am hoping that my scanty publication record’s including a book about a forgotten corner of our most ignored borough will give me an edge.