Wednesday, December 13, 2017

My lovely lady hump

All is generally good here at 18w6d.  Baby continues to have a normal heartbeat, and is rumbling around so much I haven’t been scared that there won’t be a heartbeat at my weekly appointment.  I actually felt him kick (or punch??) from the outside the other day!  All of my labs have been coming back normal.  (Although we’re still waiting on the genetic carrier results from the fragile X and spinal muscular atrophy blood tests.) 

My massive online orders of maternity clothes were finally delivered this week, and with great trepidation I started cutting off tags of a few things so I have something to wear.  (I’m planning on leaving the tags on most of the things I want to keep until after my “20 week” (really 19 ½) appointment next Monday.)  My belly is getting harder and harder to hide, and I’m running out of energy to try.  I saw a good friend the other day and told her I was pregnant, only to have her say “I was wondering….”  This is the first time the tummy has given me away!!  I think it’s going to look less like too much cheese and more like too little baby in another couple of weeks.  For now, I just look like a person with skinny arms and legs and a beer gut.  Hawt!

I’m not super stressed out about the 20 week appointment next week—the high risk OB told us after our 15 ½ week appointment that everything look great and she would be really surprised if they caught something new on the 20 week.  That being said, I am still a little nervous.  It’s particularly unfortunate that hubby can’t make this one—he has an out of town meeting.  Boo.

What’s really keeping me up at night, though, is worrying about all of the things that could be wrong that they can’t or won’t find until baby is born.  Did you know that there are more than 4,000 different kinds of birth defects, and that around 3% of babies are born with some kind of birth defect, and that up to 70% of birth defects are undiagnosed??  AND, let’s not forget that the risk of birth defects rises with recurrent miscarriages (it doubles: https://www.ncbi.nlm.nih.gov/m/pubmed/8290380/), and it increases with a history of birth defects, and it increases with age of parents (although I read that while that is definitely true for chromosomal defects, it may not be true for all defects: https://www.webmd.com/baby/news/20140203/babies-born-to-moms-over-35-may-have-lower-risk-for-certain-birth-defects#1).  So I feel like our risks are pretty much sky high.  That’s not a great feeling.

Of course, we’re under a microscope and going to an awesome clinic, so we would expect a much higher detection rate than average.  And a lot of the super common and devastating ones (anencephaly, spina bifida, trisomy 13/18/21, structural brain defects, structural heart defects, structural kidney defects, limb defects, clubfoot, etc.) either have been ruled out or should for the most part be ruled out at the appointment next week.  AND some birth defects are relatively harmless.  (In fact, I was born with an abdominal hernia—a birth defect.  After a nail-biting [for my parents] surgery when I was a month old, I’ve had no issues.)  I mean, do I want my baby to have a hernia or cleft pallet or even tracheoesophageal fistula/esophageal atresia (what my niece was born with)?  No, of course not.  But those are generally fixable and have no super long-term issues.  I continue to worry that baby will be born with something profoundly wrong.  For now, all I can do is… oh, wait, I can’t do anything.

The other night I dreamed that someone told me that if I walked on broken glass it would help my baby.  So of course I chose to walk on broken glass.  (And it wasn’t like the thick broken glass of a dish.  It was super sharp like a broken light bulb or holiday ornament.)  When I woke up, I was at the part of my dream where I was pulling out bloody two-inch shards of glass from my feet.  And then I made the mistake of googling the meaning of walking on broken glass while pregnant.  Apparently it’s a bad sign.  Whatever.  I didn’t need to search out the meaning of my dream online to know what it means—I would do just about anything for this ~6in ~8oz little fella I’ve never even met yet.  (And it might be a throwback to all of the shit I was willing to do when we were trying to have kids with fertility treatments.)

My husband has started to get on my case about continuing to say “if” this works.  WHEN he says, WHEN.  When will I feel the same way?  I’m not sure, but not now.  And probably not for a while.

P.S I wasn’t super worried about it, but it doesn’t appear that either my new low-dose aspirin habit or my long-standing swimming habit poses any risk to the little man.  (http://pubmedcentralcanada.ca/pmcc/articles/PMC4805457/; https://www.ncbi.nlm.nih.gov/pubmed/23628264)

Monday, December 4, 2017

Doing it all wrong

I feel like my posts have been a little too optimistic lately, so time to bring things back down to earth….

Had my weekly appointment with the nurse today.  First things first, there’s still a heartbeat.  Just wanted to get that out of the way.  So that’s good.  BUT there are some things to be concerned about.  Nothing major… yet. 

(1) My platelet count is low.  Not dangerously low, but outside the bounds of normal measurements.  (It’s 140,000 now.  I’ve had my blood taken many times, and it’s always at the bottom range of normal.)  This is not entirely uncommon in pregnancy—approximately 1/10 women will have low platelet counts during pregnancy—usually closer to the end.  It’s called gestational thrombocytopenia.  And as long as my measurements are above around 80,000, they won’t do anything.  Once it goes below that, there could be some issues.  Among other things, if it gets too low, you can have bruising / uncontrolled bleeding.  And they won’t give you an epidural because of risk of complications.  Here’s some general info on it:


So bummer, but hopefully not something to be extremely concerned about.

(2) I’m at risk for preeclampsia.  There are many risk factors that I do not have, but the two big ones I do have are advanced maternal age and recurrent pregnancy loss.  Also, it’s been a while since my last pregnancy, which is also a risk factor.  (?)  For now the treatment is just to take a baby aspirin and hope I don’t get it.  Obviously I’m being monitored and I’m aware of the symptoms. 

Here are some articles about preeclampsia and risk factors:




(3) This is the one that gave me the most grief today.  I was not thinking the past couple of months and I’ve been eating sandwich meat.  (!!)  Once a friend reminded me that you’re not supposed to do that during pregnancy, I stopped.  Instead, at a meeting today, I had a veggie sandwich.  Only I realized after the meeting that I’m not supposed to eat sprouts, either, and that damn thing was full of them.  I spent 10 minutes googling and then completely freaked out and called my OB’s office and asked if I should make myself throw up.  They said no, and just don’t do it again. 

I swear to G, if I lose this miracle pregnancy due to food poisoning I’m never going to forgive myself.  And, in reading about the food risks, I realized I’ve been eating soft cheeses too, which are also no-nos.  ARGHHHHHHH.

(4) As if I didn’t have enough to fret about today, I realized that I need to get my fat ass into maternity pants.  I’ve been wearing dresses and tights, which have been quite forgiving.  But today I wore pants.  I tried to make due with normal pants and the old rubber band around the button.  (I don’t have any maternity pants, and was trying to put off buying them as long as possible.)  That worked first thing in the AM, but by mid-day I was not feeling it.  I was so uncomfortable that I spent a small fortune online shopping for pants.  (It was actually a pretty emotionally draining experience—this is the first time I’ve bought anything relating to baby/pregnancy since my son was born.)  I bought multiple sizes in multiple styles from Gap, Macy’s, Pea in a Pod, and H&M.  (I’ll return most of them.)  Hopefully something gets delivered this week and fits.  By the end of the day I was so stressed and ornery (and I’m pretty certain one of my male co-workers saw my unzipped fly and underwear when we were talking), I left work early and went to the mall and bought a pair of tights to wear tomorrow. 

Deep breath.  Tomorrow is another day.

Wednesday, November 29, 2017

Knock knock knockin’ on my uterine wall

Had an appointment with my OB this week.  It wasn’t just a heartbeat check (although it’s still there—whooh!).  She also checked me for other things, including some additional STDs.  (I’m not super worried about STDs!)  From my last pregnancy, I know I’m not a carrier for cystic fibrosis.  But now they can also test for fragile X and another degenerative muscle condition.  (Science—it’s amazing!)  So we’re going to do that non-invasive testing as well.

She asked if I had any plans for travel, and I mentioned the family had plans to go to Costa Rica for spring break, but now I was not going.  She asked if hubby was still going, and I said that’s the plan!  Then she said if he does, we can’t have unprotected sex for 6 months.  Whaaa?  Apparently zika can be passed via seminal fluids (but not saliva).  So I was like, okay, I understand why no unprotected sex while I’m pregnant, but that would only be for 2 months after he gets back.  Then she said that even after baby is born, doctors are worried zika could be transmitted via breast milk!!  (Apparently zika has been detected in breast milk, although there are no confirmed cases of zika being passed via breastmilk.  https://wwwnc.cdc.gov/eid/article/23/5/16-1538_article  She said that the information on this is still evolving.  I checked the CDC’s website, and it just says use condoms during the pregnancy.)  Also, she said t of people with zika don’t have any symptoms, so it’s not like we would necessarily know if hubby had contracted it.  Then she said even if zika’s not passed via breastmilk, there’s a risk of other issues from infection, such as Guilain-Barre (temporary paralysis (!!)).  So she was like, you should definitely not go (I wasn’t planning on it!) and no unprotected sex because even if the chance is low, the risk is something really bad.  She did mention that there are potential options to work with the CDC to get tested.  So, in theory, hubby could try to see if he’s been infected.  (https://www.cdc.gov/zika/laboratories/index.html)

I was embarrassed, but I had to ask—does that mean no oral sex either?  She said she just had an awkward conversation with another patient on this same issue and the answer is no oral sex either.

So then I started getting worried—should my son/hubby not go?  Are they at risk for terrible things??  She said that other than the temporary paralysis (!!), there’s no risk to them.  (And I’ve been reading about it since then, the risk of infection/paralysis appears pretty low.  Only two people in all of Costa Rica have had Guilain-Barre potentially related to zika, and the infection rate in Costa Rica now is less than 100 a week.  http://www2.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=35222&Itemid=270&lang=en)

So I let hubby know, and we have to discuss further.  I think the risks are so low, he should still go.  The condom thing is annoying, but it’s not like we were going to be having tons of sex from 7 months pregnant to 4 months post-pregnancy, right??

I also got weighed at the doctor’s office.  I’m about 10 lbs up from when I got pregnant, but I’m STILL lighter than I was when I first got pregnant with my son… although not for much longer.  (I was marathon training when I got pregnant this time—skinny minny!)  I’m gaining weight at about the same rate as I did with my son (I’m an early weight gainer), and I gained 35 with him.  So I’m not worried… but I’m paying attention.

I have been exercising 5-6 times a week, though, doing swimming, running, and yoga.  Although I’ve been tired, I was able to exercise normally through the first trimester.  I’ve been slowing down recently, though.  I have a 5k fun run in a little over a week and a swim meet the day after.  That will be my last set of races for the season—the doctors I talked to suggested that competition is fine until about 20 weeks, and then you should take things a little easier.  (Although Olympian Dana Volmer swam a blazing 50m time in a meet at 27 weeks.  http://olympics.nbcsports.com/2017/04/14/dana-vollmer-swim-meet-pregnant-mesa/)

No big surprise, I’m starting to get a bump.  (That 10lbs had to go somewhere!)  Last week, a friend was teasing me that, after 3 kids, she looks more pregnant than I do at 15+ weeks.  And when I saw my family at Thanksgiving, they were like, look at your teeny tiny tummy!  By the end of the weekend, though, they were like where did that come from??  (Turkey and stuffing!)  And when I got back to work, my friend was like, you popped!  So I’m not sure how much longer I can get away with not being obviously pregnant.  I was hoping to make it to 20 weeks.  Tomorrow is 17, so can I make it 3 more weeks??

Another fun thing—I’ve started to feel flutters!  Right around 15 weeks I felt some teeny little scratches.  So I was not surprised we had a heartbeat at 15 ½ weeks.  But then I felt nothing for several days and started to get nervous.  And then right around 16 ½ weeks I felt some little bubbles again.  Since then, I’ve felt little flutters now and again.  I love it!!

The other fun thing—telling people!!  When we first told people, it was “we’re pregnant, it probably won’t work out.”  Their response was, of course, “oh, I’m so sorry.  I’m thinking of you.”  Then it was, “we’re pregnant, it might not work out.”  And then the response was, “oh, I hope it works.  I’m thinking of you.” “Now it’s just “WE’RE PREGNANT!!!!”  And the reactions are totally amazing.  One friend cried, one said she almost fell out of her chair, another was stunned into silence.  So that’s been really cool.  (Also, because of our history, and the fact that I am not really showing yet, it has been an absolute shock to everyone we’ve told.  Mark that as one more upside to a decade of infertility.)

Onward and upward!



Monday, November 20, 2017

Embracing ordinary

Since my last update, we had a heartbeat check (normal), a blood test (I do NOT have any STDs—whooh!—still waiting on the AFP test, but we expect it will be normal), and another ultrasound (normal).  Yes, you read that correctly—everything looked completely and totally NORMAL.  Brain?  Normal.  Kidneys?  Normal.  Stomach?  Normal.  Heart?  Normal.  Spine?  Normal.  Head?  Normal?  Growth?  Normal.  In other words, normal, normal, normal.  The high-risk OB we met (yet another new doctor) was absolutely giddy to deliver the news.  She said something along the lines of, “I am excited to inform you that everything looks normal!”  When I asked what our chances were of having a healthy baby, she cut right to the chase, “your chances are the same as everyone else’s.”

Do you hear that?  We’re ordinary! Yay!!!!!  Obviously we’re not out of the woods yet, but unless something terrible happens, we’re having a baby.

Tuesday, November 7, 2017

Guilt by association (with my fetus)

As I approach the end of my first trimester (one more day!) I’ve started to feel an emotion that I have not previously experienced—guilt for our (accidental) success.  I have always been aware of the fact that I am very lucky to have one biological child.  I think I’ve expressed that feeling many times in this blog.  I have a number friends who were never able to have biological children, or who lost pregnancies that were very, very far along.  I am absolutely sensitive to the good fortune I have, whatever else I have been through.
But I’ve never felt guilty that I was able to have that child.  Lucky, absolutely.  Fortunate, you bet.  But never guilty.
With this new pregnancy, though, I have been feeling very guilty.  Partly I think it’s because it feels like a gift that was not earned.  (Maybe other women who find themselves accidentally pregnant but very excited about it feel the same way?)  And part of it stems from the fact that, for better or worse, I have become something of a fertility oracle (guru? know-it-all?) to a number of friends and family over the years.  It was painful for me to tell a family member—who has struggled with infertility (and chose not to pursue invasive procedures) and now, past 40, is very unlikely to have a biological child (or adoptive, as they may have waited too long to start the process)—that we were pregnant.  (I told her earlier than I would have preferred to make sure she did not hear it from someone else.)  During lunch the other day with a friend, she confided that she was not one and done by choice, and she felt sadness that her child would not have a sibling.  I felt sick telling her we found ourselves miraculously pregnant with number two.  At breakfast the other day, another friend told me how hard it was for her to send her youngest of two off to kindergarten this year and how she would love a third but her husband said no way.  I felt sick thinking about telling her that we sent our little one off to kindergarten but were probably going to get to experience it again.  Last week another friend called me and confided that his wife has had a series of miscarriages and they just found out that she has very low AMH.  He was asking advice about fertility doctors and procedures.  While I know they will be happy for us if things work out, I dread telling them while they are going through the process of fertility treatments.  It just feels so unfair.
Anyway, I have been feeling VERY guilty.  One way that guilt manifests itself is that I am having a hard time feeling joy.  Originally my joy was dampened by the fact that it seemed very unlikely to work out.  But at this point, while nothing is certain, the odds appear to be in our favor.  But I still cannot feel that joy, or, more accurately, I start to feel it and then feel really sad for the many close friends who don’t have what I have. 
We had a heart beat appointment on Monday.  160bpm—good.  And I’m 14 weeks on Thursday.  I keep telling my husband, we can talk about it like it’s real after that 20 week appointment.  Until then, I don’t want to talk about names, or make plans for childcare, or start re-acquiring things for a nursery.  But, it’s hard to entirely ignore what’s going on.  My belly is getting rounder (I am becoming an expert on dressing for work to conceal a pregnancy) and I’m spending time daydreaming about what life will be like if everything does work out.  I suppose this feeling of guilt is good in a way, it is a form of recognition of further luck and fortune, with a little bit of you-didn’t-earn-this-but-you-can-still-enjoy-it mixed in.  I hope it works out and I have the fortune of feeling guilty.

Thursday, October 26, 2017

Normal

I’m happy to report the 12 week appointment went well.  Baby’s heartbeat is 144bmp.  Normal.  Baby is measuring at 11w6d (a day behind as always!).  Normal.  The nuchal fold was 1mm.  Normal.  Baby’s head looks round, so no anencephaly.  The baby’s bones appear to be ossifying.  There are no signs of an omphalocele (or gastrocentesis).  The baby’s brain and spine looks normal (regular, no bulge) so there are no early indications of spina bifida.  There was nothing suspicious at all in the appointment.  Normal, normal, normal.

Of course, it’s too early to diagnose all structural issues.  We’re going to have another appointment at 15.5 weeks to look at the kidneys, the head in more detail, the face in more detail (looking for a cleft), the diaphragm, further signs of spina bifida, normal growth, etc.  But, as the doctor said, we’ll be doing it mostly to give me reassurance.  This was my first time meeting her—she’s at the high risk OB office, and this is my first time seeing a doctor there this time—and she was absolutely lovely.  Like the doctors at my OB’s office, she was like we’ll do anything you want to make you happy/comfortable.  All you have to do to get the four-star treatment from your OB is lose a whole bunch of pregnancies, including two in the second trimester due to catastrophic development issues.  (Not worth it.)

She also said that the 20 week appointment is the BIG one.  There, we can really take a look at the organs, including the heart.  She said if we survive the 20 week appointment without any lethal issues, we should be in the same boat as everyone else—terrible things can happen to anyone, but we would have a very good chance of success. 

Because of my age, she also said I would have weekly monitoring starting at 32 weeks.  (Again, assuming we make it that far.)

She said considering this good appointment, and taking into account on our history and age, she thinks we an 85% chance of having a healthy baby.  (I love a doctor that will actually give odds!)  Let’s see how that matches with my updated odds:

·        5% chance we have spina bifida (diagnosed via 15 week AFP test/ 15.5 week appt.).
·        10% chance we make it all the way to 20 weeks but have catastrophic issues diagnosed then.
·        2% chance something else terrible happens

83% chance I end up with a healthy-ish baby.  Okay, pretty much SPOT ON.  That’s pretty good, right? 

Here’s to hoping my little man continues to be normal!

Wednesday, October 25, 2017

Nerves of sugar

My big appointment is tomorrow.  How do I feel?  NERVOUS.  How am I handling it?  Oh, just eating my feelings.  I had 2 rice krispies treats and a dilly bar yesterday, and THREE dilly bars today.  What can I say, when I’m nervous I eat!  (Nom nom nom!)

What am I nervous about?  Well, obviously I’m nervous that we’re going to find some catastrophic structural issue, just like we did at our last 12 week appointment (omphalocele, poor spinal ossification, etc.) or just like we would have if we’d had a 12 week appointment for my pregnancy before that one that went that far (anencephaly, which would have been seen at 12 weeks, was not diagnosed until 15 weeks).  I’m also nervous that there will be something catastrophically wrong, but we WON’T see it at the 12 week appointment, and instead will see it at our 15/16 week appointment, or our 20 week appointment, or (worst of all) not until after baby is born.

I did some searching on a variety of topics.  One was just the general risk of miscarriage, particularly when age is factored in.  (I’m 39 now y’all!  Hubby’s turning 41!) http://onlinelibrary.wiley.com/doi/10.1046/j.1469-0705.1996.07030170.x/pdf  This article says what we all know—miscarriage risk increases with age, decreases the longer baby sticks around, and increases if you have bleeding (which fortunately I do not have this time).  However, it did not find an association with previous pregnancy loss and miscarriage rate.  (I don’t believe it, but I’ll take it!) The article also says that for losses between 8-15 weeks (the zone we’re in now), 45-70% of the cases are likely due to chromosomal abnormalities.  We do not appear to have those—at least any of the common ones.

Another topic was, what are the chances of miscarriage of a chromosomally normal baby after a normal 12 week scan?  Well, the internet has an answer!  It’s about 0.5%, which means 1/200.  That number sounds pretty low, or pretty high, depending on how you look at it.  http://onlinelibrary.wiley.com/doi/10.1002/uog.5138/pdf  “In singleton pregnancies with estimated risk of Down syndrome < 1:250 according to NT screening at 12-14 weeks, the spontaneous fetal loss rate before 25 weeks is likely to be around 0.5%. NT thickness up to 3 mm does not seem to affect the risk of miscarriage in such pregnancies. Instead, the risk seems to increase with number of previous miscarriages and deliveries, and possibly the risk is highest in the youngest and oldest women.”  Ugh again on the old mom shaming.

Okay, the topic that’s really got me stressing—how much does stress impact fertility/birth defects?  It turns out, probably some.  https://www.nature.com/articles/s41598-017-01792-3  This article looked at a variety of prior studies and suggests that stress does increase miscarriage risk: “Whilst chromosomal abnormalities underlie many cases of early pregnancy loss, the present results show that these psychological factors can increase the risk by approximately 42%.”  The article appears to accept that stress does not cause chromosomal abnormalities, but suggests that stress can increase miscarriage risk “from activation of the hypothalamic-pituitary-adrenal axis by recruitment of hypothalamic neurones which secrete corticotrophin-releasing hormone, increasing pituitary secretion of adrenocorticotrophic hormone secretion and hence of adrenal cortisol. This hormone has direct effects on decidual and placental metabolism but also interacts with progesterone signalling. Stress-related early pregnancy failure could also result from suppression of the hypothalamic-pituitary-gonadal axis…. These mechanisms are relevant because progesterone activity is crucial for the maintenance of pregnancy; low levels in early of gestation predicting miscarriage. Among its multiple effects, this hormone contributes to the suppression of maternal immune response to the conceptus.”  They also cite a study that “reported a live birth rate of 86% in women with recurrent (≥3) miscarriages who were enrolled into a program of emotional support, compared to 33% in similar women who had no formal supportive care.”  Maybe that’s why my OBs are pushing therapy on me!  I’m not sure what they would think of my rice krispies bar and dilly bar therapy plan….  (The article also cited an article I’ve seen before that says working out more than 7 hours a week increases miscarriage risk up to 18 weeks gestation.  http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01496.x/abstract;jsessionid=549CA759D4EC7D5FF1256DE51DE4C1B5.f03t04)

Here's the one that really bums me out—the potential link between stress and birth defects. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094125/  Here, the researchers looked at the 2 months before conception through 2 months after conception and evaluated the mother’s stressful life events to see if there was a correlation with birth defects.  The mothers answered an 18-item inventory of stressful life events, such as:
whether she or her husband (or partner) had started a new job or lost a job;
whether she or anyone close to her had had a serious illness or injury, serious legal or financial problems, problems with drinking or drugs, or had problems with immigration;
whether she or anyone close to her had been a victim of violence or crime;
whether anyone close to her had died; whether she was separated or divorced or had had serious difficulties with her husband or partner;
whether she had moved;
whether she had had serious problems or disagreements with relatives, neighbors, or in-laws.

Most of the mothers of in the study were Hispanic, many had less than a high school education, and a majority took a folic acid-containing supplement during the periconceptional period.  The researchers found that birth defects tended to increase with the more stressful events the women had experienced.  The specific birth defects they say increased from stress were oral clefts, neural tube defects (ugh), and conotruncal heart defects.  They theorize that stress causes increased production of corticosteroids, which are teratogenic (ie bad).  They concluded, “more stressful life events experienced by the mother around the time of conception were associated with increased risks of orofacial clefts, NTDs, and conotruncal heart defects among offspring.”

Of course, if I were a participant in this study, I would have answered no to every single question they asked.  But going through fertility treatments—especially after a history of loss—is VERY stressful.  Plus, I have a demanding job that can be stressful at times.  How do I know if my life stresses—admittedly nothing to those faced by many other women—contributed to our birth defects?  I don’t.  And apparently stressing out about it is not going to make it any better.  So I’ll just have to wait and see what happens tomorrow....And maybe find something to eat.