Pregnancy

I went to the doctor today for my follow-up from the miscarriage.  It was all good news.  There was no indication of any problem with my body or the way I carried the pregnancy.  This is good because those problems might have meant higher risk for the future. 

The chromosomal analysis showed that the fetus had Trisomy 16.  This means that instead of a pair of chromosome 16, the fetus had 3 copies.  Trisomy 16 is the most common chromosomal cause of miscarriage.  This problem alone doesn’t indicate any higher risk of problems in future pregnancies.  If you’ve never heard the word “trisomy,” you might be interested to know that Down Syndrome is also known as Trisomy 21.  People with this condition have 3 copies of chromosome 21.  All trisomies are major problems but only trisomies 18 and 21 generally appear in living humans (although there are rare cases of live births withother trisomies).  The rest involve defects so severe that the babies die before birth.

Another good thing is that Trisomy 16 is in no way related to what happened with my first pregnancy.  The two problems that I have had are most likely totally unconnected.  This means that I’ve had some bad luck, and bad luck is much better than an underlying problem!

I still have to wait until Monday for blood test results to make sure that my hormone levels have gone down.  If they have not, that would indicate that some tissue remains and my body still thinks it is pregnant.  But once I clear that hurdle, we’ve been given the green light to try to get pregnant again during my next cycle, which means we have to wait just about a month.  I don’t think we’re going to try to avoid pregnancy this month, though; we’ll just see how it goes.

It’s been a week since my miscarriage and I’m feeling like I’m pretty much over it.  I did a lot less grieving than I thought I would.  The procedure on Friday went smoothly and I felt fine by Friday night.  I just moped around the house over the weekend and, although it was probably good to have some time to reflect, I was very happy to get back to my normal routine on Monday.

I guess I was right when I said that there wasn’t much of a context to disintegrate with this loss.  Usually, that disintegration is the work of grief.  (I got that from Leonard Peikoff, but the specific source eludes me.) When you love someone, you integrate him or her into your life.  You share values.  In my case, I hadn’t integrated a person into my life, but a pregnancy.  I had to do things like unsubscribe from a pregnancy newsletter, cancel ob-gyn appointments, cancel my prenatal yoga class, rethink next summer’s travel plans, set aside the plans for preparing the baby’s room, and even cancel a prenatal massage.  Those things were a disappointment.  I had valued all of it as part of the pregnancy experience.  But I had no connection with the life growing inside me yet.  I do indeed feel like this is just a setback.  We’re still going to have a second child and all the values that come from that – we’re just not going to have them as soon.

I don’t mean to diminish this experience.  It really is a horrible thing to go through.  I think when it happens in a first pregnancy it is much more difficult.  But it’s been a week and I’m over it.  Sure, there is a little residual sadness, but it is in the background.  There is a little bit of new doubt about whether we will be able to have a second child, but I’m fighting that by focusing on the fact that it is metaphysically given whether or not we will succeed.  We will take all the action we can to make it happen, but worrying about it will not change anything.

We did decide to get the chromosomal analysis of the fetus.  We should have the results in a few weeks.  If there is anything to learn from this that can help our future efforts, we’ll learn it.  Most likely, though, we won’t learn anything at all.  I’m ok with that too.

There are other things I’ve learned from this experience.  I’m working on a bad premise I have about accepting help and support from other people.  And I’ve been vindicated in my practice of being totally honest with my daughter about sensitive issues like this.  We told her everything from the day I took the pregnancy test to the miscarriage, and she’s handled it just fine.  I’ll write more about both of these subjects in the days to come.

So tomorrow I go to the hospital for a procedure called “dilation and curettage,” which is a type of abortion.  This is my second unwanted abortion, and I’m not happy about that.  Since it makes me feel better to write about all of this, I’ll tell you what I know about this process.  (And thank you all for your kind comments.)

In a case like this, where it is discovered that the fetus is not developing before there are any symptoms of miscarriage, there are two choices:  have the D&C, or let things happen naturally.  Eventually, my pregnancy hormones would adjust and my body would naturally expel the contents of my uterus.  The problem with that option is that you don’t know exactly when it will happen, it can be very painful, and it is very bloody.  The doctor emphasized, “a lot of blood.”  The risks of a D&C these days are minimal, the most common major problem being infection, which could lead to perforation of the uterus and infertility.  But I trust the doctor who advised me yesterday that this risk is very small.  I will be on prophylactic antibiotics anyway, and I’ve never been prone to infection.  Many times, even if you let things happen naturally, you need the D&C anyway to be sure all the tissue has been expelled.  The other benefit of the D&C is that a genetic analysis can be performed to possibly find out what went wrong.  I’m not sure if my insurance will cover this, so I’m not sure we’ll have it done, but it would be nice to know if possible, especially given my history.

The biggest cause of miscarriage is genetic defect.  If the problem is bad enough, the fetus can’t get beyond a certain state of growth.  When we are amazed at how well DNA builds such perfect human beings even with all the problems we see in living people, we shouldn’t forget that there are a lot of errors – these are the miscarriages.  I read last night that up to 75% of a 40 year old woman’s eggs may contain genetic defects.  Unfortunately, the book I have does not include footnotes and this figure sounds ridiculously high.  (The book is also one of those types where pregnant women are encouraged to take no risks whatsoever so I don’t completely trust it.  Another source put the percentage of defective eggs at 50, with the caveat that this figure was arrived at by studying only infertile women, so it is probably still high.)  But one hard fact is that the miscarriage rate for 40 year old women is about 1 in 3 and it goes up dramatically as you move towards 45. 

These figures can be depressing, and it is certainly possible that we’ll never have another child.  (Here is an interesting personal anecdote from a woman who tried to have a second child in her mid-forties – she eventually did fail.)  But I look at these figures as a way to understand and cope with this miscarriage.  As I said before, it can be seen as “normal” at my age of 39.  And I have to be prepared for it to happen again.  But for now, this is no deterrent.

Tomorrow is going to be a terrible day, and from what I gather, I’m going to be in pain through the weekend at a minimum.  But I want to get it over with.  I’ve spent the past 24 hours worried sick that things would start happening on their own.  I hope I make it through the next 24.

I had an ultrasound today.  There is no heartbeat.  The fetus stopped developing a couple of weeks ago.  I had a miscarriage.  On Friday I’ll have a D&C.  I’ll write more about that later.

It’s ok.  I mean, it’s horrible, but I’ll be ok.  This is nothing like losing a 24 week pregnancy.  When that happened, I really resented people who equated my experience with a miscarriage, but I wasn’t sure if my feelings were just, because I had never experienced a miscarriage.  Well, I was right.  This is hard, but I don’t feel like I’ve lost a baby.  We didn’t know the sex yet, we had never heard the heartbeat or seen the baby on ultrasound, and we hadn’t bought anything for the baby.  My belly hadn’t grown.  I hadn’t felt the baby move.  We hadn’t bonded with it.  We don’t have a huge context to disintegrate.  We just have to start over.

I do have one similar feeling:  the feeling that I have lost time.  When our first child was stillborn, I felt like I had lost a year of my life.  We had spent 4 months getting pregnant, 5+ months being pregnant, and then we had to wait 3 more months before we could try again.  I’m sure I’ll be told that we should wait 3 months again, but I might not heed that advice.  I started planning and thinking about it within 10 minutes of finding out, and Adam agrees: We’re getting right back on that horse!

I’m also thinking about the things that will be easier.  We have some travel plans that will be much easier now.  Next time, I’ll be better prepared with the right drugs for my psoriasis, which has gotten totally out of control since I had to suddenly stop my medication.  Well, that’s about all the positive stuff I can think of right now.  As for the negative, I think the thing that bothers me the most is that when we do have SS, there will be that much more of a gap between our children’s ages.  That, and the fact that, the older I get, the less likely we are to successfully have a child at all.  But, at least right now, I’m not feeling as stressed out about that as I was when we first decided to try for another child.  For some reason, I was really afraid that we wouldn’t be able to conceive at all.  A miscarriage is almost par for the course at my age, so I don’t feel like this doesn’t bode well for the future.  We might have another miscarriage, but we’re still fertile, and we’ve had one healthy child, so there is no reason to leap to worries about ultimate failure.

And that is one of the reasons I decided to announce my pregnancy to the whole world immediately.  I knew this could happen, and if it did, I wanted people to know.  I can’t tell you how shocked I was after our first, failed pregnancy, to find out how common miscarriages, infertility, stillbirths, and other problems really are.  Once you are a part of “the club,” the stories come out of the woodwork.  Miscarriage is common enough that I would call it normal.  If you don’t know how common it is and you have one, you will not have the right perspective, and you might become afraid.  It might seem like there is something wrong with you, or that you did something wrong like eating the wrong food or exercising too much.  Many women even feel ashamed, since it is just never, ever talked about (except in those internet chat rooms, and you should not go there–trust me).  I don’t want women to have to go through that.  I mean, I hate thinking about all the pity people will feel for me, and even the sympathy.  I hate to cause other people those negative feelings and I hate to be the object of them.  I could have spared all of us that by just keeping my mouth shut.  But now that this has happened, I can confirm what my gut told me in the first place:  We need to stop hiding early pregnancy and miscarriages.  It’s one thing to learn the miscarriage rate as an abstraction.  It’s another to know that 5 out of your 6 best friends have had miscarriages, fertility problems, or a stillbirth. 

I’ve only known that I miscarried for about 8 hours now, and I’ve had to tell 5 people.  Telling people is difficult and painful (although writing this blog post is cathartic).  I understand the desire not to have to go through that.  But I think that telling people is an important part of facing up to what happened.  I can’t imagine having been pregnant this whole time, losing the baby, and having the whole thing be invisible to all of my friends and family.  I think it would prolong the pain.  I don’t mean that I want to ”share” the pain, like spreading it out would lessen it or something.  I just don’t like keeping secrets from people who are close to me.  (And once you tell those people, the cat is out of the bag and you might as well tell everyone.)  It’s important to note that I absolutely do not think that it is dishonest to keep an early pregnancy a secret–it is nobody’s business but the parents’ and there are plenty of situations where it is rational to keep it hidden.  What I’m saying is that this default practice of waiting 3 months to announce a pregnancy does not do anybody any good.  Ignorance is not bliss.

I’ll write more about this in the days to come, but now I have to go have a good cry.

I finally got started taking photos of my pregnant self.  Here I am at 7 weeks pregnant.  (For the uninitiated, being “7 weeks pregnant” means that you conceived 5 weeks ago.  A pregnancy is dated based on the first day of your last period.  Your due date is 40 weeks from that date.)

That belly you see is just my usual fat self, but I have gained 5 pounds and my clothes are too tight.  I’m determined not to buy any maternity clothes until I absolutely have to.  This is not because I don’t like maternity clothes.  As a matter of fact, I love maternity clothes!  The only time I get to wear a lot of new things is when I’m pregnant because I’m the kind of person who normally spends about $100 a year on clothes.  Maybe $200 if you include shoes.  $250 if you include jewelry.  Seriously, my budget is $20/month.

So anyway, the reason I don’t want to buy anything much in advance is that last time around, I grew out of clothes before I had a chance to wear them.  I was due in September, so in March I went out and bought a lot of summer things.   That year in Michigan the warm weather didn’t come until June, and by that time I was too big for some of the stuff I bought.  You’re supposed to just buy size ”small,” “medium,” “large,” etc. based on your pre-pregnancy size and, just to be safe, I bought a size up from that.  Still, I had to keep buying new things cotinuously.  By August I had grown out of every single thing I owned and had to buy a whole new wardrobe (ok, that just means a few pairs of pants, really) for one month of wear.  I had to shop in the fat womens’ maternity section, and I’ll tell you, it was really hard to find anything at all that fit me.  I went from an original size of 6 to bigger than 14.  That’s not about the belly – that’s just the hips and thighs and the rest.

Even with all of that, I really loved the big belly.  I never felt “fat.”  Well, there was that one photo that clearly showed all the cellulite on my thighs (shudder).  But really, I loved the whole thing, including the maternity clothes.  Yesterday, I went into my closet and looked at all those jeans that feel so tight, and I thought, “I’m going shopping!”  The thought of buying stretch pants was a thrill.  (I know, I’m sick in the head.)  But I came to my senses.  In the meantime, I’m going to go shopping in those boxes of maternity clothes that have been in storage for 3 years.  Yipee!

I just completed a nightmarish 4 day saga of deciding which prenatal diagnostic tests to have.  I got no real help from my doctors or the support nurses in the Future Moms program I am participating in.  I finally decided to stick with the Nuchal Translucency screening, which was what I did in both of my previous pregnancies.  It involves an ultrasound and a blood test and it looks for markers that indicate a higher likelihood of genetic problems such as Down Syndrome.  It does not test directly for these conditions, but just gives you an indication that you might want to take a definitive test such as an amniocentesis.  There is a pretty high rate of “false positives” – results that indicate higher risk when there is no actual abnormality present.  So you have to be prepared to get a scary result, take another test, and then wait about 10 days for definitive results.  I can live with that.  The NT screening also tests for neural tube defects and congenital heart defects, which CVS and amniocentesis do not, unless they are part of an identified genetic condition.  (I can’t find anything that tells me exactly what is tested for, just these broad outlines.) 

Because the problems with my first baby were detected through ultrasound, I like the idea of this direct “looking” at the fetus.  The 20 week ultrasound will be the most important one, but the NT screen will give me a measure of comfort if the results come back negative.  I also like that the test is more comprehensive, even if less definitive.  My situation does not lend itself to looking for any specific problem since the cause of my first baby’s problems is a total mystery.  I want the most comprehensive testing possible.

All of that was the easy part of the analysis.  The hard part was trying to compare the costs of each procedure.  Health insurance co-pays are supposed to signal costs to the consumer – something that has been lost in our insane collectivized health system. (Of course, the current proposed “reforms” of health care would make this problem worse, but I’m not going to get into that issue on my blog.)  My insurance company, however, makes it impossible to figure out what something will cost me ahead of time.  I spent 4 days making phone calls trying to figure out my portion of the costs of these tests, and ended up knowing nothing at all.  Finally, I gave up.  I’m going to rely on the fact that there is a yearly maximum out-of-pocket expense that I can pay.  I’m going to budget that full amount and be prepared to spend it.  I still have to be careful, though, because if I neglect to get a pre-authorization for a procedure that requires one, I’ll have to pay all the costs and my maximum won’t apply.  How do I know what requires pre-authorization?  I have to guess, and then call the insurance company for every single thing that I suspect might require it.  What clues do I have to go on?  Nothing.  Wish me luck!

The next thing that I decided to do was to get a flu shot.  That took over a week of work.  First, I had to figure out where I could get one under my insurance.  That took a few phone calls and hours in front of their web site.  Once I figured that out, I found that all of the places giving the shots would get a small supply, use it up, and then have nothing for weeks.  I had to keep calling different clinics and pharmacies every day to see if they had any shots and how long the wait was.  One time, I raced out to a CVS in the next town over, only to find that there was a wait of over 2 hours!  I got lucky last night and got my shot at my local supermarket pharmacy.  By just showing up and asking, I think I cut in front of dozens of people on the waiting list (they were waiting for a phone call from the pharmacy), but I could care less.  I’m supposed to have some kind of priority because I’m pregnant anyway, but I don’t know how I was supposed to exercise that priority.  

I’m still debating about whether I’ll get the H1N1 vaccine when it comes out in a month.  It is recommended for pregnant women, but I’m nervous that it is a new vaccine and that it was “rushed.”  I’ll think about that next month.

The bureaucracy of health care is one of the biggest stressors in my life.  Every single time I consider going to a doctor, I become confused, angry, and sometimes I just shut down.  I don’t trust the doctors, who are more concerned with liability and getting ripped off by regulations than in my health, my insurance company is my enemy, and I can’t stand the arbitrary rules, paperwork, and processes.  None of this bothered me at all with my pregnancy with Sammy.  The birth center I used was not part of the medical establishment and I didn’t use insurance, but just paid for it out-of-pocket.  I need to find some way to deal with the medical world this time, or else it’s going to suck all the joy out of this pregnancy.  Honestly, I don’t know how I’m going to do that.

I had my first prenatal doctor’s appointment last week.  I was pretty excited about it, and had hoped that it would kick-start the feeling that this pregnancy is for real, and that there actually is a baby coming.  I guess I still have mental scars from my first pregnancy, because I’m having a hard time getting excited.  Unfortunately, the appointment was nothing at all like my prenatal visits at the birth center where I gave birth to Sammy.  It was just another doctor’s visit.  They took my blood to confirm the pregnancy, which is totally unnecessary.  They didn’t even do a urine test (because, I suppose, they don’t really believe that I’m pregnant yet.)  The doctor was completely unhelpful in discussing the first trimester diagnostic tests that I should have.  Since I have an unusual history, I was hoping for some advice on whether to do the standard NT/blood test screening, or go straight to CVS or amniocentesis.  The doctor didn’t even give me any statistics on accuracy or risk, and basically said, “It’s up to you.”  Gee, thanks.  She didn’t even calculate my due date.  Sure, I’ve already done this myself, but isn’t that one of the fun parts? (Officially, my due date is May 16, but I’m holding out hope that this baby will come just a bit early like Sammy did, so I’m saying early May.)

I’ve met 2 of the 3 doctors in this practice now, and I didn’t particularly like either of them.  They have 2 midwives in the practice, though, which is why I chose this place.  I’m holding out hope that I’ll like one of them better.  I can pick my preferred doctor/midwife for the birth of my baby, but there are no guarantees – the person could not be on-call or could be on vacation and another would have to cover for her.  Apparently, it’s standard practice to induce labor just so you can get the doctor you want.  This is absolute insanity, in my opinion.  Inducing labor increases the risk of needing a C-section.  Once you have that pitocin, it kicks off the chain reaction of medical interventions that cause so many problems.  The two best ways to avoid a C-section are to let labor come when it comes, and to stay out of the hospital for as long as possible.  I think I’ll take my chances with whatever doctor is available and let nature take its course, thank you very much.

I did learn something new about pregnancy, although it wasn’t from the doctor, it was from this “Future Moms” program I’m eligible for through my health insurance.  The idea is that the insurance company can help keep costs lower if they provide education and incentives to pregnant women to take care of themselves.  So if I participate, I don’t have to pay the hospital co-pay when I deliver.  That saves me a few hundred bucks!  Plus, I can talk to a nurse on the phone 24 hours a day, during the pregnancy and for postpartum support.  I suspect the nurses will be more helpful than the doctors, so this is a nice perk.  (I’m going to call them regarding the diagnostic tests this week.)  What do I have to do in exchange?  I had to enroll and give a health history (so they could assess my risk), and I have to have a dental cleaning before 24 weeks.  A dental cleaning?  Yes, you see, preterm deliveries are the biggest maternal health cost to insurers.  (Think of the amazing things they are doing for preemies in the NICU.)  And many preterm deliveries are caused by infections.  And many of these infections are apparently caused by, of all things, poor dental health.  Interesting!

Everything seems to be going fine with the pregnancy.  I’ve had no nausea, and just a little bit of fatigue and emotionalism so far, all of which is normal for me.  I enjoy pregnancy.  It’s the post-partum problems that get me.  Don’t worry, I’m sure I’ll share all the disgusting and horrifying details with you when the time comes.

Things I will do differently during this pregnancy:

• I won’t wait for 3 months to announce that I’m pregnant (check that off the list).
• I won’t gain as much weight.
• I won’t buy maternity clothes ahead of time, but wait until I absolutely need something to buy it.
• I won’t keep a pregnancy journal.  I loved keeping a journal last time, but I re-read it and there were only a few things that I found interesting, all of which I can capture this time on the blog.
• I’ll give birth in a hospital instead of at a birth center.  I wish I could do it the exact same way as last time, but there are no birth centers with tubs in Northern Virginia.  Now that I’m more experienced, I think, barring complications, I can achieve what I want in a hospital – a calm, natural birth – without having to shell out a few grand since health insurers are too stupid to realize that hospitals waste money like crazy on childbirth. (Actually, I know why they don’t cover birth centers – it’s not stupidity, it’s that all coverage is decided by pressure group warfare and birth center users are not a big enough group to have an impact.)
• I’ll slow down towards the end and try to take it easy so the baby doesn’t come too early – Sammy came 2 weeks early, which was great, but I don’t want it to be any sooner than that, so why push it?  With Sam, I started a business 6 weeks before my due date which had me squatting and lifting boxes up until the day before she arrived.  I must have gone a little loco there at the end.
• I’ll eat sushi occasionally (in fact, I already have).

 Things I will do the same during this pregnancy:

• I’ll drink a cup of coffee every morning.
• I’ll drink a glass of wine on occasion (after the first trimester).  It’s especially fun to do at restaurants.
• I’ll enjoy eating for two.
• I’ll have every diagnostic test as early as possible.
• I’ll do my Kegels.
• I’ll do some form of exercise.  Last time it was a bit of yoga, a great pregnancy workout tape, and a lot of dog walking.  That worked very well for me so I’ll probably stick with it.
• I’ll get prenatal massages (in fact, I’ve already signed a contract with Massage Envy for one massage per month!).
• I’ll get pedicures as soon as I can’t easily reach my feet.  This is an indulgence I normally scoff at as wasteful, but, ohmygod, it is so worth it during pregnancy.  Not only does one part of your body look dainty and pretty, but it’s so good for those aching, swollen feet.
• I’ll play the pregnancy card with Adam for as many foot rubs as possible.  Because you can’t get a pedicure every day.
• I’ll have a natural birth if possible.
• I’ll (we’ll) find out the sex.
• I’ll (we’ll) wait to decide on a name until I (we) see the baby.  We had 3 choices lined up when Sammy was born and it was nice to look at her face and try to decide what suited her best.  (The other 2 were Maia and Zoe.)
• I’ll take pictures of myself every month.  If I get as huge as last time, you’ll be very entertained.
• I won’t take this amazing experience for granted. 

This has been the conversation in our house for the past 5 months:

• “I’m tired.”  “Maybe you’re pregnant.”  “I don’t think so.”
• “I’m hungry.”  “You must be pregnant.”  “No, probably not.”
• “I really want a hamburger.”  “Now I know you’re pregnant.”  “Yeah, right.”
• “I think I have a pinched nerve.”  “Do you feel pregnant?”  “No.”
• “That commercial made me cry.”  “Maybe you’re pregnant.”  “No, it’s probably PMS.”
• “I’m cranky.”  “Maybe you’re pregnant.”  “Shut up!”

It’s good to finally be wrong!