Back to planning

I must be feeling better, as my research instincts have kicked in again.  I decided to pull up the clinic success rate stats for women 35-37 (N's age).  Houston IVF is #11 nationally.  Here's the rest of the list: http://fertilitysuccessrates.com/report/United-States/women-35-37/data.html

CCRM is #1.  When we were cycling, I followed a message board thread about CCRM because I know Houston IVF is a sister clinic.  Today, I was surprised how much higher the CCRM success rates are, though-- 67% vs. 56.7% live birth rate, according to the SART data.  The CDC stats are slightly lower for each-- 65.1% vs. 54.3%.  I don't know enough about the methodology to know why the stats are different.  Anyway, I wonder if it would be worth consulting with them.  Don't know-- just grasping at straws.

Of interest, here's a list of supplements that CCRM recommends: https://www.evernote.com/shard/s166/sh/c4c8adf3-a496-4870-866b-9902a46679ae/1d602a25373c42a0512800489f1e6fda

Advanced Reproductive Care Center of Irving is slightly higher than Houston IVF (#9), but I don't know that it makes enough of a difference to matter.

I've never really thought much about this end of the decision-making process-- comparing clinics and protocols and whatnot.  A whole new world of research.

Edited to add: I'm reading the CCRM thread again and a lot of women seem to be doing PBB-- polar body testing-- which is genetic testing of the egg's chromosomes that is done very early after fertilization, without taking a cell from the embryo.  It does require a frozen transfer, but I wonder if it might be a good option?  Houston IVF offers it: http://www.houstonivf.net/Services/PreimplantationGeneticDiagnosis.aspx

Follow-up

Yesterday morning, I had my follow-up appointment with Mary.  Physically, everything already looks really good.  My cervix is "healthy, pink, and closed" and my uterus has returned to its regular size.  I am about 5 pounds up from my pre-pregnancy weight, which is about 10 pounds up from where I want to be ultimately (my weight now is at the high end of my normal range-- I'm aiming for the middle).  I should be able to lose all 15 by the first of the year or so without too much effort.

I got a copy of my lab results, and sure enough, everything was normal.  So now we just keep waiting for autopsy results.  Not that there are necessarily answers coming.  Mary does feel strongly that it was an issue with the baby or the placenta, not me.  Small comfort.

Mary said I should keep taking prenatal vitamins, since I intend to get pregnant again, relatively soon.  The range of answers I've seen for when it's safe to try again after a 20-week loss is immediately through six months, with the most popular answer being after 3 normal cycles.  I don't have any clue when my regular cycle will come back.  After I had Leo, it took months and I ultimately jumpstarted it with provera-- but that was after pumping for 12 weeks, which is obviously a different situation.  Mary thinks that given how well I've recovered already, I could get pregnant in as soon as a month or two, if I was emotionally ready.  I feel more comfortable with the three normal cycles wisdom.

So... as that suggests, I do hope to try again.  I don't think I have it in me to do cycle after cycle, but I can do at least one more.

Emotionally, every day is a little easier.  There are things I still have trouble with-- telling anybody who doesn't already know is an obvious one-- but for the most part, I'm getting through the day without losing it.

Footprints

Part 2, delivery

I updated a small group of friends on the day of the induction, so it's easiest just to copy those updates:

I took the first dose of misoprostol a little before 3 this morning. 4 pills, under the tongue. Held them there for 45 minutes before finally swallowing. Cramping started within that time. So did really bad shivering/cold flashes. At 4, I put on a hoodie and sweat pants and took a vicodin. I have 20 of them, so I can be pretty liberal with them. Finally got back to sleep. Woke up at 5:40ish with some rectal pressure- wondered if it was going to be this quick and I was already done. Sat on toilet and did nothing, but got nauseated and had to yell for Rick to bring me a bag to throw up in. And I started sweating like crazy and got really hot. Peeled off the sweatshirt and dry heaved in the bag- puked a tiny bit, but not bad. Now I'm up, listening to Mariela's alarm just go off. I need to eat something else and my throat is a little sore, but I don't feel like going to the kitchen. No idea at all if I'm progressing, but I assume so. Lucky me already experiencing the two most common side effects: shivering and nausea.

October 15 at 6:06am 

I fell asleep right after writing that. Woke up at 7 to take 2 more tabs of miso plus another Vicodin. Went right back to sleep and got up just now (8:15) to swallow what was left of the pills. No shivering this time. Lots of cramping, but no pain. I really do need to eat something, so I will wake up Rick in a minute. My mom bought two big grocery bags of fruit and snacks- momspeak for love. I'm going to have a muffin and a glass of milk. Maybe I'll stop being a princess and go get it myself.

October 15 at 8:21am

Ate my muffin. Admitting to myself that there will be pain, as I'm feeling some now, through the Vicodin. I thought I'd have some bleeding or discharge by now, but no. Time to watch my millionth Law and Order episode.

October 15 at 8:53am

Just puked up the muffin. Yay. That came on fast, as I was trying to figure out what to do about pain med dosing. Pain has gotten much worse. Prescription says 1-2 Vicodin every 6 hours. I've taken 1 every 3 hours. I'm afraid if I take 2 this next time, it won't last 6 hours. If I take 1, it may not touch the pain. Quandary.

October 15 at 9:56am 

I took 2. Rick said the ones I have are tiny.

October 15 at 10:02am

Threw up again. Pain is more labor like, despite meds. Another dose of miso due and I'm dreading it. Getting in shower. Eating pears so I have something in my stomach to throw up next time.

October 15 at 11:07am 

Peed and had a little bloody mucous. Progress. In the shower with my waterproof phone.

October 15 at 11:15am

Hopefully I don't make it another 4 hours to next dose.

October 15 at 11:16am 

Something is in the birth canal, so I am pushing now and then. Despite not feeling pushy. Let's get this done.

October 15 at 11:46am 

And the shower helps a lot.

October 15 at 11:46am 

Got too hard. Transferred to hospital.

October 15 at 3:30pm

 

 

So, to fill in some blanks...  We called Mary at about 11, when I said the pain was feeling more labor-like and she got there soon afterward.  I never expected a full labor-- with half a pregnancy and a tiny baby, I just expected it to be easier.  I was wrong.  That big gap of time between the last two updates covers an excruciating stretch of real, full, not diminished labor.  I was in the bathroom the whole time, in and out of the shower.  By 2, I think I had gotten back in the shower and was just determined to push and deliver and be done with it.  It hurt a lot.  There was no break between contractions.  I pushed and pushed, to no avail.  My body just wasn't ready yet.

 

My breaking point came because I had checked myself a couple of times and I was just staying at about 4 cm.  No progress that I could tell, despite intense and unrelenting pain.  The vicodin didn't touch it.  I told (cried to) Rick that I didn't want to do it anymore and that I wanted to go to the hospital so they could make it (labor/pain) stop.  Mary called ahead and we went at about 3 (12 hours after my first dose of Cytotec).

 

I live about 6 blocks from the hospital (St. David's), so it was an "easy" transfer.  Easy in quotes because I was in a lot of pain and absolutely miserable.  It seemed like it took forever to get checked in, even though it must have been pretty fast.  I signed a million consents, which I can't imagine have any legal significance, since I was out of my mind in pain.  Finally, the nurse went to go get my IV meds, which also felt like it took forever.  I threw up again (I think I missed chronicalling one of the puke events at home too), so I was dehydrated and she had some difficulty starting the IV.

 

But once it did get started, oh blessed and immediate relief.  They used Stadol, which completely knocked out both the pain and me.  I fell asleep and woke up about 30-45 minutes later (no real concept of time for any of this) to pee.  When I got up, the baby was already in the birth canal, ready to come out.  It was more a matter of holding it in until I got back to the bed rather than pushing.  On the bed, I laid on my side and he was born, in the sac, together with the placenta.  All at once.  At 4:15 on Monday, October 15.

 

I didn't see much then.  They took him to the baby station.  Mary and Rick looked at him, and couldn't see much since the sac was strong and intact.  They could move it and see his hand press up against the side.

 

In the meantime, they got some pads under me.  Dr. Polon came in-- I can't remember if that was the first time, or if he had been there earlier when I was in labor.  He did an ultrasound and found some lingering POC (products of conception) in my uterus-- not unusual when the baby had passed a couple of weeks before delivery.  He said I had about a 60% chance of having complications if I didn't have a D&C, but that the decision to get one was up to me.  He said I would have twilight sedation and, when I pressed him on it, said I could go home that night.  So, with Mary and Rick both weighing in in-favor, I decided to do it.

 

My decision was complicated when the anesthesiologist came in.  She said that since I was past 12 weeks gestation, I was considered "full stomach," which increased the aspiration risk and made twilight sedation not an option.  My choices were general anesthesia or a spinal.  I really didn't want to do either.  General freaks me out, as does having my spinal column punctured.  Bleh.  They even did a second ultrasound to see if the bleeding I had after delivery had addressed the concern.  It hadn't.  With assurances that I would still be able to check out that night, once my legs/pelvis were fully functional, I chose the spinal.

 

The procedure itself was easy.  They wheeled me to the OR and transferred me to the tiny operating table.  They gave me lidocain before giving me the spinal.  And soon after, they gave me IV sedation, so I slept through the whole thing.  Afterward, when they rolled me back to my room, I got the shakes, but I slept through most of it.  Dr. Polon said they removed quite a bit of material during the D&C, so it was good that I had it done. 

 

I can't remember when I looked at the baby, but it must have been before the D&C, because I walked over there.  He was small-- just 6.2 ounces.  He had passed some time before, and there was some evidence of that.  There was some kind of issue with his sacrum-- right between his bottom and his back.  It looked constricted, as if a piece of thread had wrapped around there.  Mary theorized that it may have been amniotic band syndrome.  Poor baby.  We consented to an autopsy.  Maybe we will get some answers.

 

After surgery, my legs woke up fairly quickly.  My pelvis took much longer.  In the meantime, Rick went out and picked up dinner from Jimmy John's, which was so good-- I was starving. To be discharged, we had to wait until my bladder fully voided, which took forever.  I think we finally got home at around 1:00am.  I immediately started a load of laundry and showered (hospitals are gross), and was in my own bed by 1:30.

 

I slept fine and felt good the next day.  No pain.  No physical issues at all.  And still no big emotional issues, either.  Which I really couldn't understand.  I lost a baby-- a baby I wanted to carry and protect-- a baby for a family I loved and cared about deeply-- but I wasn't crying.  I didn't feel sad.  I just felt numb.

 

Until that night.  Rick picked up a frame and I put together the baby's footprints with a quote and his birthdate.  I started crying while I was making it and just never stopped.  Big, heaving sobs for hours that night and then for hours the next day (Wednesday).  Wednesday morning, my eyes were practically swollen shut from having cried myself to sleep the night before.

 

Looking back now, I think it had to be that way.  There was no way I could have handled the emotional pain and the physical pain of delivery all at once.  No way.  So, without knowing I was doing it, I packaged all the emotional pain up and tabled it.  Stored it away.  And once the physical experience was completely over and done with, once the baby was gone and my body was healing, the floodgates opened and all of the emotions from the past 4-5 days came tumbling out all at once.

 

Tuesday night and Wednesday morning were the worst of it.  M called late Wednesday morning and we talked for 45 minutes, which was really helpful.  We all have different sides of this loss, so our experiences are different but still shared.  I am so appreciative for their support throughout all of this, when I know they are hurting as much or more.

 

So since then, I'm grieving as you would expect.  Some moments are better than others.  I did not look forward to coming back to work today-- and to tell the truth, it's as bad as I expected-- but I made it here for a little while anyway. 

 

I finally called the hospital this morning to ask about when we would have autopsy results, and they said it would be 30 days and the results would be released to my doctor (Dr. Polon, I guess?).  We are spending Thanksgiving with M and N (and bringing our parents), so maybe we will have some answers by then.  Though there's a large possibility that no answers are forthcoming and the loss will be unexplained.  Which would suck.

 

It's hard for me, The Planner, to leave it at that.  I want to know exactly what comes next.  If it were a novel, I would read feverishly to the end, so I could find out what form "happily ever after" took for all of us.  I do trust that the story works out in the end-- I have to believe this is just one sad chapter.  But for now, we stay in limbo.  We grieve.  We heal.  And we move on.

 

The whole story, part 1

I keep meaning to come post the full story of our loss, but it's overwhelming.  This morning, I'm back in my office for the first time, which is overwhelming in its own right.  So, heck, what better time to catch up.

I'm not sure where to rewind to.

I guess back to the anatomy scan.  Looking back, here are the things that should have concerned me.  And maybe they did, to some extent, but not in a way that would have ever led me to believe that the baby would die soon afterward.  First, I ate candy and drank a Dr. Pepper (neither typical for me) the morning of the ultrasound, to perk up the baby for a good show.  But the baby did not perk up.  He didn't move at all during the scan except for one slow arm wave.  Also, his weird, folded up position just seemed off to me.  And finally, looking at the ultrasound report after the fact, he was measuring 18w2d, when we were 19w.  Not a huge concern, except that he had never measured behind and none of the babies have ever measured behind-- they've all been 50%-ers.

Before the ultrasound I had (finally) started to fel some big movements/kicks.  I had eagerly awaited those kicks-- my favorite part of pregnancy-- and celebrated them.  I might have felt a few more in the weekend after the ultrasound.  I honestly don't remember.  But I know for sure by the Thursday after that (so, 19w6d), I was telling Rick that I hadn't felt movement and I was worried.  I tried laying on my stomach and would feel tiny little somethings, which I tried to tell myself was the baby.  But no more kicks.  I tried laying upside down (supported headstands), in case he was in a strange position.  I drank Sonic iced tea, which had sparked a big dance party in the week before the ultrasound.  But I still didn't get any big kicks. 

I spent another week listening to Rick and other people's reassurances that everything was ok.  "Your placenta must be anterior."  (It wasn't-- I'd asked specifically at an early ultrasound, and knew it was posterior.)  "The baby must be in a funny position."  (Possible.  But I'd tried so hard to move it.)  "This happens every time."  (Said by Rick, but not true.)

On Thursday morning (20w6d), I finally resolved to go get checked out and either end the paranoia or confirm that something was wrong.  I drove the midwives' office after the kids went to school and sat in the driveway, waiting for someone to show up.  The "someone" was Debra, and as she got out of her car, I told her "I'm sorry I don't have an appointment, but I need a heartbeat check."  She asked why and I explained I hadn't felt the baby move for about a week.  She took me inside and to an exam room right away.

She got the doppler and started checking for a heartbeat.  Nothing.  She went slowly, over every inch of my lower abdomen.  Still nothing.  She had someone go out to her car to get a different doppler.  Still nothing.  She said it was possible that the baby was in a funny position, but that it didn't look good.  She asked if I wanted an ultrasound with Dr. Berry and I said yes and asked her to call for me.  Dr. Berry did not have an appointment until 2.  She asked if I would call her when I found out anything and I said I would, which was also the first time I started crying.  I walked out and to my car, where I lost it and bawled on the way home.

I called N to tell her something was wrong with the baby.  I was crying so hard that she didn't understand everything I said, but I think she and Rick talked too.  She didn't tell M at first, since there wasn't anything to do but wait for more answers.  By about noon, they had told him and he called me, supportive and positive as always.  Rick was at work, but I called my mom to come over and she spent the day with me.  I texted my good friend, Eve, who agreed to meet me at Dr. Berry's office.  Having to wait until 2 did seem cruel, when the doppler had been at 8 in the morning.

At 2, I got to Dr. Berry's office and Eve came in just a couple of minutes later.  We talked about non-baby stuff, at my request.  Eventually, we were called back.  A sonographer (not the one we'd seen before) did the scan and confirmed that the baby had died-- there was no heartbeat.  I think she also told us that it looked like it had been a while (it's a bit of a blur here).  She left us with tissues.  I cried just a little bit.  I felt numb.  I giggled about her assuming Eve was my partner.  What's the right way to react?  How do you hold it together in the face of that kind of news?

Dr. Berry had been in surgery, so we had to wait for him to get back to the office to discuss next steps.  It took a long time.  30 minutes maybe?  an hour?  Gosh, I have no idea.  When he got there, he did another scan and said yes, it did look like the baby had been dead quite a while.  He seemed disbelieving that we had been there just 13 days before.  The baby was measuring smaller than he had at 19 weeks (17w6d, I think without looking), which is a natural part of decomposition, but made it clear that he had not grown at all since the ultrasound-- he must have died within no more than a few days of the "everything looks great" ultrasound.

Dr. Berry said our options for delivery were waiting for my body to go into labor naturally, which would likely take 2-3 weeks, or inducing.  Most people induce, since the wait is intolerable (and there are some risks to waiting).  I was glad he didn't suggest a D&E, which I knew was an option, but not one I wanted to take.  We agreed I would talk to Mary to figure out exactly what our plan was.

He also ordered a slate of lab tests (bloodwork), to rule-out some of the more common causes of late miscarriages-- clotting issues, infection, etc.  When I left his office, I went straight to the lab for the tests (all of which came out normal- to skip ahead).  Then I talked to Mary, who told me I had the option of inducing at home with Cytotec (misoprostol).  I was glad that was an option, since I didn't want to be admitted to the hospital and spend the night there.  That's what I decided to do.  Mary wanted to do more research, so she said she would get back to me with specifics.

I can't remember talking to M that night.  Maybe I did.  I had texted them from the appointment, to confirm the bad news, and I know Rick and M talked a couple of times.  I asked Rick to cancel our plans to go to Houston that weekend-- we'd long-planned to go to the Rice Centennial and stay with M and N.  M pushed us to reconsider and, with the girls and Rick pushing me to, I eventually did.

This whole time, I was still feeling very numb.  Sad, but not as sad as I would have expected.  I was doing things like being careful not to put my ipad on my belly (I never do if I'm pregnant, in case there's a risk to that) and waiting for movements, even though I knew it was over and I had a gin & tonic on my nightstand.  There was definitely a disconnect between the intellectual reality of what had happened and my emotional reaction to it.

By Friday, Mary finished her research and had Dr. Berry call in my prescriptions (misoprostol and vicodin).  Since we were going to Houston, we decided we would induce when we got back-- Sunday night or Monday morning.  Rick picked up the prescriptions, and I spent most of my day watching Law & Order SVU-- which is what I would end up doing for most of the day for the next week.  Rick picked up Mariela from school, we packed in a whirlwind, and then left to go pick up Andie and drive to Houston.  In lots of traffic.

The weekend was ok.  We spent some time at the Rice festivities, though I did not feel festive.  I laid around a lot.  I still felt mostly numb-- moreso than sad.  M and N were gracious hosts as always, despite their loss.  The kids all had fun together, which was a good distraction.  That and our Saturday night drama.  My girls took a shower and when Andie went to open the shower door, it shattered, filling the bathroom with tiny crumbles of glass and prompting blood-curdling screams.  Andie jumped out in her panic, cutting up her feet and causing a crime scene (blood everywhere).  But eventually, everything got cleaned up and everyone put to bed.  On Sunday, after a huge breakfast, we headed back to Austin.

I guess that's as good a place to end this chapter as any.  Up next: induction, delivery, emotions catch up.

The beginning of the end

Sometime tonight I'll take the first dose of Misoprostol/Cytotec. 400 mcg sublingually, followed by 200 mcg every four hours until "expulsion."

I still feel pretty numb about it all. Will write more eventually.

Bye baby

Today we found out the baby died. Very sad. More later.

Blog as medical record

I got a flu shot today.  Pretty exciting!

I spent the last three days in Rockwall at a conference.  I didn't sleep well while I was there (don't know why-- usually I can sleep anywhere!), so last night, I was asleep in my own bed by 9 and slept all the way through until 6:30.  Ah, much better.

Still not getting any big movements like I was getting before, so I think the baby has found a position that he likes that isn't great for me getting to feel him.  I do feel "something" every so often-- I'd just prefer to be back to the big rolls/kicks/punches.

We'll be in Houston this weekend, for the Rice Centennial Celebration/ Homecoming.  Looking forward to it!

20 weeks

Halfway there!

 

Creative framing/head chopping courtesy of Andie.

 

I'm still carrying pretty small, though I can feel my uterus up over my belly button, so I know I'm still growing correctly.  At the ultrasound last week, the baby was breech (butt down) and folded in half-- his knees up over his face.  He had one arm up over his head and the other between his legs (boys!).  Anyway, I think his little squashed up position down low is keeping me from showing much more and also keeping me from feeling very much movement.  I do feel some, but the only guarantee to feel it is laying on my belly (which I can still do comfortably at this point).

 

I would like him to stretch out and explore the real estate a little more.  According to my weekly pregnancy update, most babies do stay folded up until about 20 weeks.  I'm thinking they mean curled up rather than acting like contortionists like this kid is doing, but in either case, maybe this week he'll check out the neighborhood a little more.

 

After the ultrasound last week, we went to a Brazilian steakhouse and ate too much.  At around 5:30, once my kids were home from school and had performed several dance routines, we went out for dessert, which turned into appetizers and 8 desserts shared by 7 people (including 3 kids!).  And then we went out for shaved ice, since apparently we needed more sugar.  My kids have now taken to saying WWMMD (What would Mr. M do?) when planning their ideal meals.  LOL.  He'd already won their affection, but limitless dessert did not threaten his #1 position.

 

Really not much else to report for me or on behalf of baby.  With all of his systems in place, he's just going to spend the next 20 weeks growing and getting cute and chubby.  Which I guess is true of me too, though I'm not sure how cute it will be!