Category Archives: Midwives

Twice as nice?

I have spent a LOT of time mulling over the big issue with this IVF.

One embryo or two?

I realize that this may look like I’m getting ahead of myself. We haven’t even started stimming yet, let alone hit retrieval or transfer. We don’t know how many embryos we’ll have, or what quality they’ll be, or even if we’re going to make it to blastocysts.

Rationally I know that, and I understand that, in some ways, investing all this time and emotional energy in this issue  now is putting the cart before the horse.

But at the same time, it’s an important decision, and if I leave it until the moment where we HAVE to make the decision, I won’t be able to give it the thought it deserves.

E. is the product of a two embryo fresh transfer.

To me, that is the biggest reason for doing this again. This is what worked. We’ve had quite a few cycles now of things not working- eight other embryos in five other transfers have not worked, to be exact.

So there is the temptation to do the same thing again.

It’s also more than likely that a two embryo transfer would produce a singleton, just like with E. My sister did some research for me and discovered that, in my age group, a two embryo transfer that produced a successful (i.e., live birth) pregnancy resulted in a singleton 80% of the time.

And, of course, the odds of achieving any pregnancy are better with a two embryo transfer than with just one, although I’m getting the sense that just how much better is now quite heavily debated.

If we had insurance coverage for procedures, if cost was no issue, I would gladly do an elective single embryo transfer.

But we don’t, and it is, and we’re running out of options.

Plus, my body hasn’t exactly proved itself to be all that welcoming to those little balls of cells. E. is, let’s remember, my only pregnancy. We’ve transferred ten embryos (six Day 3s and four blastocysts) and only one of them stuck (that chemical pregnancy from the FET in October 2009 really doesn’t count given my initial beta was so low it was practically zero).

Every time I start to try to wrap my head around a twin pregnancy, however, I start to freak out.

In June a pair of articles on Babble garnered a lot of attention. They were written (anonymously) by a couple expecting twins. They used IVF to try to give their son a sibling. They hemmed and hawed and finally decided to transfer two embryos. They weren’t expecting, nor did they want twins, but that’s what they got.

Their articles were brutally honest. The reactions from the public were just plain brutal.

Admittedly, they didn’t always express themselves in a way that would encourage readers to empathize with their situation. But when I read the articles, especially the one written by the mum, I understood where they were coming from. I could see the anxiety, the fear, the sense of having lost control over the life that they thought they were going to have. I found another article written just this week, whose author also gave voice to some of the fears that I harbour, especially those concerning having to ignore the needs of one child to meet the needs of the other, something that I would face the moment I had two children, but something that would be even more heightened with the arrival of two babies simultaneously.

It’s easy for people to judge when they haven’t had to resort to IVF to get pregnant. Most people don’t even have to consider the issue of twins. Even mothers who end up with twins in a natural pregnancy haven’t had to weigh the decision whether to transfer one, or take the risk with two.

I know there are women out there who could go into a first ultrasound, see two heartbeats, take a moment to be overwhelmed, and then just be filled with gratitude for the two lives they were growing.

I’m not one of those women.

Everything about twins scares me. The high-risk pregnancy, when my pregnancy with E. and my experiences with my midwives had helped so much to heal the wounds of infertility. The fourth trimester, when I escaped PPD by the skin of my teeth when dealing only with one baby and with a husband who largely worked from home so he could be there for mental health checks much of the time. The whole first year, which, now that it is long behind us, has really driven home to me how much I prefer toddlers. Someone on my birth club the other day was commenting about how she longs for another baby, and I just found myself shaking my head. I want another child. Another baby? I’ll deal with that, because I’ll have to, but honestly, if I could outsource child rearing for the first fifteen/sixteen months or so, and get them back when they’re walking, sleeping through the night, down to one nap, and starting to really communicate, I’d be seriously tempted. I make no apologies for this either- the birth club has taught me that some people are just best suited to some phases of children’s lives. There are some mums on there who adore the teeny tiny baby phase and then there are a few of us who have really come into our own with toddlerhood.

Plus there are the associated financial costs of three kids rather than two. I don’t think the couple should have phrased it in terms of wanting to take their kids to Disneyland, but three university funds rather than two is not a small difference. We’d have to buy a car. It would be another ticket to see Q.’s family every couple of years. Maybe this sounds shallow, to worry about having to buy a car or about airline tickets, but it’s the sort of thing I think about. It’s the reality of how our life would change. I think it would be naive not to think about these sorts of implications.

Plus there would be the impact on my career. Twins would basically ensure that my career would be over before it started, as we would never be able to afford to have them in any sort of full-time care that would allow me to do anything in the academic world beyond very occasional contract teaching. (Daycare in my city, especially for the under 2s, costs significantly more than our mortgage payment.) You don’t recover from that sort of career path, and the first few years after your PhD is finished are your one chance to land a permanent position (assuming one even exists). I’m sure eventually, once they were in school, I’d be able to scrape together some contract teaching, but the reality is we’d be a single income family for a lot longer than expected.

Plus there is the added strain on a marriage. I’ve written before that Q. and I, while not struggling, have had to work harder at our marriage since having E. I know having a second child would add another whole layer of pressure, but I have to think that adding twins would be a giant atom bomb. I worry about how Q. would react to the financial pressure of being the sole provider, while at the same time becoming a father of three. I worry about how we would both cope with the sleep deprivation- that was one of our biggest sources of tension when E. was little and he could have been so much worse. I worry about how I would find the support that I would need, when we have almost no family in the city.

Plus there is the impact on E. He is such a sweet, gentle, sensitive soul. I worry endlessly about disrupting his ordered little existence with the arrival of one baby, let alone two.

Etc. etc. etc.

I don’t think thinking these things makes me a bad or a selfish person. I have the right to feel anxiety about the possibility of such an unexpected (and enormous) change in our lives. I’d be worried about some of the same things even if there was only one baby on the way.

I kept reaching a stalemate: the fact that E., the only transfer that worked, was a two embryo transfer, vs. my abject terror at the thought of a twin pregnancy.

And then my birth club had a post one morning from a mum who was ready to try for a second, but her partner wasn’t on board, and she was asking the other mums how they knew if they wanted another. At first the conversation just pissed me off, because I’m pretty sensitive to pregnancy/baby talk on there right now, given some days it feels like EVERYONE else is either pregnant, has already had a baby since our May 2011 littlies, or their May 2011 baby was their last one. But then a couple of posts really hit home. One mum, when describing how her husband felt, really highlighted how I felt about the prospect of twins- the chaos of infancy, the extra financial costs- but then described how she viewed it: more love, more cuddles, more of life to share. And then two mums said they visualized what they wanted their dining room table to look like in twenty years.

THAT got me.

In the short term- pregnancy and birth and the first year- I cannot face the idea of twins. Even in the medium term the idea freaks me out. I’ve basically decided that the first four years would largely be an exercise in survival and if we made it out the other side with our marriage still intact and all three children healthy with no one suffering pyschological damage, I’ll call it a win.

But when push comes to shove, when I picture us sitting at our table two decades hence, and it’s a choice between dear sweet E. sitting there by himself, or the happy chaos that comes with three, it’s a no brainer.

I don’t want E. to be solely responsible for us when we hit our dotage.

I don’t want E. to be by himself if we don’t make it to our dotage.

I don’t want E. to miss out on having nieces or nephews of his own.

He will spend the rest of his life only seeing half of his family every two years (if that). I have no idea if he will ever have cousins who live close enough for him to count them as real friends.

I still have to talk to Q., but I know now how I feel about the situation.

Fuck it.

If we’re lucky enough to be given the choice, I’m voting for two.

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Filed under 2.0 IVF, Anxiety Overload, Butter scraped over too much bread (a.k.a. modern motherhood), Down Under, E.- the third year, Emotions, Midwives, Second Thoughts, Siblings

Relief on two counts

We had a midwife appointment this morning. All was well. Bub is still head down, and said head was partially fixed in the pelvis, which my midwife felt probably explained why my fundal height hadn’t changed from two weeks ago (when bub was floating around). My blood pressure was good, and back down to where it normally sits. Bub’s heart rate was a busy 152 bpm.

The best part of the appointment was when my midwife was able to put my mind at ease on two counts. The first was inductions. For some reason I had it in my head that my other midwife had told me very early in the pregnancy that if I reached 41w3d, I had to get farmed out to an ob/gyn. Turns out this isn’t the case at all. At 41w3d they can offer an induction, but I can decline it. At 42w they consult with an ob/gyn, who, let’s face it, will recommend inducing, but again I can decline it, as long as the now-increased monitoring isn’t showing any problems. They don’t have to induce me until 43 weeks. And even if I do end up with an induction, the midwives take over my care again as soon as I’m in active labour. Given the baby is still head down, and my blood pressure is fine, and I don’t have any problems, it’s now very unlikely I’ll have to have my care transferred from my midwives. This all makes me SO happy. Given we’re absolutely positive about the due date, I can’t see myself hitting 43 weeks anyway, but it’s great to know I’m not going to staring down the barrel of an induction as soon as we get over 41 weeks.

The other big bit of relief related to Group B strep. I have a friend who tested positive, and she had midwives, and they told her this meant that she could no longer labour at home in the early stages, but that she had to go straight away to the hospital. Turns out that isn’t my midwives’ protocol at all. If I do test positive, they give me a prescription to fill, and then they’ll come to my house when I’m in active labour and hook me up to the IV. It only takes ten minutes to get the antibiotics, and then they’ll unhook the IV and just leave the lock in case I need a new dose. So I can still use the shower/tub, etc., and I still don’t need to head to the hospital until 6-7 cm. Again, HUGE relief. I now can’t decide if I can even be bothered to do the whole garlic routine to try and test negative since I won’t have to go to the hospital early, and I won’t have to be hooked up constantly to an IV.

One of my infertility friends had her baby this week. She was due on the 9th, went into labour on the afternoon of the 18th, and had the baby via c-section at 4 am on the 21st. Apparently she stalled at 9 cm for TWELVE hours. Clearly something was going on, so I’ll be interested to hear from her when she’s recovered enough to want to tell the whole story. Baby is doing well, but mum is obviously exhausted from the four-day labour. She had done hypnobirthing classes, and had a doula. It really goes to show that there’s no point in making too many plans for labour and birth, because you really have absolutely NO idea what’s going to happen.

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Filed under Midwives, Pregnancy

The results are in…

And I do NOT have gestational diabetes! Hurrah! My midwife said my sugar levels were “very very normal” and then looked at my diet record (they got me to track what I ate for three days) and said my sugar levels are reflected by my diet- I’m eating so well there’s no issue at all. My iron and blood pressure were also fantastic. Fundal height was 28.5 cm. I’m a superstar preggo!

Bub was also in great shape.  Heart rate was 160 bpm. Most excitingly, bub is now clearly head down, with his/her bum up on my right side. I had thought s/he might be tranverse, but I guess I’ve been getting kicks and punches at the same time. SO glad to see that switch from the breech bub of four weeks ago. It’s still early, but I’m really hoping s/he gets comfy and settles in now for the long haul.

We had a chat about kick counts (she only wants me to do them if I hit the end of the day and realize I can’t remember feeling the baby move), and a couple of minor things. Our next appointment is in two weeks- the countdown has really started now!

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Filed under Midwives, Pregnancy

The 24 week midwife appointment

We had our 24 week midwife appointment today. This was the first one with our primary midwife since 12 weeks, as she was on holidays at the end of December. I like them both, but my primary midwife is just so much more experienced, and it really shows in how she talks to us and handles things. I went in there wondering if I should be pushing for another u/s to check to see that the cyst has resolved, and by the end I wasn’t remotely worried anymore. She did a great job of explaining what it means (nothing), and called my genetic screening (IPS) results a “negative”, which shows just how little risk she thinks there is. She also said, which I have heard before, but it was good to hear it again, that the ultrasound technology is now almost too good- they see all sorts of things that are meaningless, but they are legally obligated to report them. So I think I will stop worrying, at least hopefully for a little while.

We chatted about a few things. I’m going to go straight to the 3 hour gestational diabetes diagnostic test. I’ve heard so many negative things about the 1 hour screen and how inaccurate it is, and given my PCOS predisposes me to these sorts of problems we agreed that it made sense to just do the definitive test. I will be shocked if I have a problem, as all the tests I’ve had done over the last few years have consistently shown that I have no signs of insulin resistance and my ability to cope with blood sugar is better than normal. And my pee sticks at the midwife clinic have always been perfect. But it will be good to know for sure. I’m going to make sure I don’t have a sugar overload the day before!

Everything looked great. Uterus was right where it was supposed to be. Fundal height was exactly 24 cm. Bub’s heartbeat was easily found and was around 150. Bub was breech, so the head was able to be felt. I think bub does spend a lot of time head down though, as that’s the only way I can explain the times I get a super heavy feeling in my lower belly/pelvis, and have to dash to the loo. Blood pressure was my usual rock bottom 82/54. We’re going to check my hemoglobin when I do the diabetes test, but she isn’t expecting a problem because mine was so high at the start of the pregnancy (I guess taking prenatals solidly for three years pays off!).  It was another one of those lovely, boring appointments.

We’ve now got a registration form for the hospital, a sheet to record my diet for three days, and an optional birth plan to fill out. Things are really starting to get real!

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Also, a huge thank you to everyone who weighed in with their likes/dislikes/must-haves on my last post. It is so interesting to get different perspectives on what will be most useful, and you highlighted a few things that I hadn’t thought of. Keep all the suggestions coming!

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Filed under Midwives, Pregnancy

An anxious start to a new year

First up, I am SO behind in reading blogs. I didn’t read at all while I was away, and then I took a couple of days at home just to hang out with Q. So I am behind on everyone’s news, and will try to catch up soon!

This was not how I would have wanted to start 2011.

I was so excited for the new year- the year in which our baby would be born. We spent New Year’s Eve with friends and, because we are all exhausted these days and have never been big on wild parties to ring in the new year, Q. and I still got home in time to watch the clocks turn over in our kitchen.

All was well, until I woke up at 3.30 am and was violently, violently sick. After a repeat performance at 7 (caused when I tried to take my thyroid pill), I realized that I was not at all well. The rest of the day- the first day of this brand new year- was miserable. I wasn’t running a temperature, which was the only thing that kept us from paging the midwife, but I could barely keep anything down, had skeletal and muscular aches, and was so tired all I could do was lie in bed. I kept sitting up every couple of hours to try and read, only to put the book down 10 minutes later. I wasn’t sleeping- just lying on my side, totally out of it. I slept for 12 hours that night and woke up the next day feeling totally fine.

We figure I must have eaten something that had a minor bug in it and my system went into preggo-protection overdrive. Our best bet for the culprit was the marinated vegetables we picked up from one of those grocery store olive bars to bring to our friends’ house. Turns out both Q. and I wondered if we should buy them, and never said anything to the other. And yes, I know I probably shouldn’t have eaten them, but it was New Year’s Eve, and there were artichoke hearts and little button mushrooms and…well, I’ve learned my lesson. I’ll be extra careful with the food from this point on. That’s the sickest I’ve been in years.

The other niggling worry came from our appointment last week with our midwife. Generally all was well- my uterus was right where it should be, and the heartbeat was nice and steady at 152 bpm. My blood pressure was super low- 80/50, which is low even by my standards, but I haven’t been dizzy so she wasn’t worried about it.

The only negative came from our ultrasound report. Everything was normal, except that there was one isolated choroid plexus cyst on one hemisphere of our baby’s brain. This is a “soft” marker for Trisomy 18 and (less of a correlation) Down Syndrome. The midwife said that as an isolated factor it was basically meaningless. The radiologist didn’t recommend any followup (I think the exact words of the report were something like “All findings normal. One choroid plexus cyst detected. No followup recommended.”) It apparently increases the risk of Down Syndrome by 1.9, but that still makes our odds 1 in 3300, which are excellent by any standard.

I thought I was ok with it all, but over the last couple of days I have felt the anxiety rise and rise and rise until last night I was losing sleep over the prospect that our baby, our much loved, much wanted baby, might not be ok. I was FINALLY starting to settle and enjoy the pregnancy- you could see the change in my face in the holiday pictures. And this report just made me feel like I’ve been thrust back into uncertainty.

So I emailed my sister, who happens to be a microbiologist (she is very useful in that way), and she went and read the peer-reviewed scientific journals for me. And what she found was that an isolated cyst basically had NO correlation with any of the trisomies and that it was only meaningful if other factors were seen on the ultrasound. Apparently there is a big debate in the ob/gyn community right now as to whether or not the cysts are a useful marker at all, and whether they should be used to recommend an amnio or further investigation.

So that has helped quell the anxiety again. But I would love to know if any of you know of women whose babies had these cysts at the ultrasound and then they turned out to be perfectly healthy. Because I’m worried that this nagging doubt isn’t going to go away, and my anxiety is probably more dangerous to the baby’s development.

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Filed under Emotions, Midwives, Pregnancy, Ultrasounds

Relief

My midwife just called with our IPS results.

For my age, my risk of Down’s is 1 in 769. The point where they start to get worried is 1 in 200.

My result came back at 1 in 6620, which is the equivalent risk for someone who is less than fifteen years old.

And my risk for spina bifida came back at 1 in 54,600.

Even though the great nuchal fold measurement gave me a lot of reassurance, this was just wonderful, wonderful news to receive.

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Filed under Medical issues, Midwives, Pregnancy

A perfectly normal appointment…

And it is SO nice to be having those!

I would not have said it was possible, but I like my backup midwife at least as much as my primary midwife, and possibly even a bit more. These ladies are AMAZING. I feel so lucky to have such great care.

Uterus was right where it should be, and right where I thought it was (just below my belly button). Bub was quite happy to yield up his/her heart rate to the doppler (155 bpm). Blood pressure was high for me, but still fine (100/62). Basically everything looks great!

My midwife couldn’t care less about what I weigh, so I’ve decided I’m going to keep the scale hidden wherever Q. put it. I will get weighed at about 25 weeks at my endocrinologist appointment, and that will be a good point to just check in and see where I am going. I honestly don’t think I could make many changes to my diet without either being constantly hungry, or constantly miserable that I was depriving myself of anything that constituted a treat (and by this I include the emergency bagel with cream cheese I seem to need every Monday). And that’s just not worth it. So no scale for me!

We had a chat about a few things, like prenatal classes and the ultrasound we’re having at 19 weeks. I go back again at the very end of December. My primary midwife is on holidays, so I’ll see my backup again, which is great, as it will give Q. a chance to meet her.

One thing I did notice yesterday after I posted that I don’t think there is a huge change in my belly, is that there is a change in my belly button. I have  a scar from the laparoscopy my f/d did before we did the IUI/IVF conversion cycle. Normally you can’t see it at all, unless I am poking at my belly button. But now it’s much more visible. So something is flattening out!

The other thing I find funny is I now forget to take my prenatal vitamin. Because who can remember ONE pill?!

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Filed under Midwives, Pregnancy

Coming out of the infertility closet?

So after the ultrasound on Thursday, Q. and I decided that we could stop keeping this baby a secret among our wider circle of friends, as we were both tired of lying about our plans for next year, why I wasn’t ever drinking, etc. And luckily we had a work gathering that same night, so we were able to tell almost everyone at the uni who matters at the same time and avoid the rumour mill. Everyone was thrilled, obviously.

And then the funny thing happened. May 2011, if you didn’t know our history, is a perfect time for us to have a baby. I am through everything in my PhD except for my dissertation. Q. is about to go on sabbatical. I have a whopping big scholarship that means my uni has to pay me, whether or not I choose to teach. All our ducks are in a row.

So our dear friends all assumed that we’d planned it that way. That Q. and I just woke up one morning, decided that May 2011 was an appropriate time to have a baby, and chucked out the birth control pills.

And here’s the thing- this really started to bug me. It’s not as though I wanted to preface the whole announcement with, “Well, we never said anything to you, but it’s actually taken us three YEARS to get pregnant and more than one round of IVF”, but at the same time, this assumption that we’d just fallen pregnant right when we wanted? It made me feel a bit dirty. Like I was contributing to the cone of silence surrounding those who struggle.

I think part of me had always figured that if we did get pregnant, we’d end up with twins, and that makes people more willing to ask “mind your own business” questions like if twins run in your family. So I figured I’d be able to drop a couple subtle hints that this wasn’t super easy for us and leave it at that.

But now everyone thinks we’re just fertile superstars. When I told my grannie, she asked me “How did that happen?” I laughed and said, “Well, it’s a long story.”  “No it isn’t!” she replied, and then the conversation took a different turn.

I have to respect Q.’s wishes- he doesn’t like to talk about it. That’s the main reason no one at work has known. But at the same time, I’m frustrated that there doesn’t seem to be a way to acknowledge our struggle.

I’m thinking I might post a couple of the early ultrasounds on f/b- ultrasounds from a time when, if you know anything about pregnancy in Canada, you would know that people do not normally get ultrasounds. And then see if anyone wants to inquire.

That was the other big step- on Sunday I outed myself as pregnant on f/b. And then almost instantly freaked out. All these people! Commenting and liking my status. Holy crap. Did I have too many friends? And why were they ALL on f/b on a Sunday evening?! Frankly, it was a little overwhelming- I don’t normally get all that many comments on my f/b stuff, and I don’t spend a lot of time on there. But it seemed like everyone came out of the woodwork to pass on their congratulations. I dropped a hint in my status update that this had been a long process- it’s there to pick up on if you are reading sensitively. So we’ll see.

I had my first “real” appointment with my midwife this morning. She felt for the top of my uterus- it was obviously present, so she decided it would be worth having a listen with the doppler. She cautioned me not to freak out if we couldn’t find the heartbeat, and I said I wasn’t worried because we just saw bub on Thursday.

And get this- I meant it. I wasn’t worried. I wasn’t concerned that the baby had somehow died over the weekend. I was utterly positive that bub was right where s/he should be. And when she turned on the doppler, there it was instantly- a perfect perfect heartbeat.

Maybe, just maybe, I will get to be a normal pregnant woman now.

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Filed under Emotions, Family, Friends, Midwives, PhD, Pregnancy

Meeting the midwife

Today we had our (rescheduled) first appointment with our midwife. She is FANTASTIC. I could not be happier. She is incredibly experienced (probably one of the most experienced in our province), very down to earth and straight talking, and, most importantly, not pressing an agenda that we will feel forced to follow. She emphasized the importance of their policy of “informed choice”. And we talked about how I would like to avoid as many medical interventions as possible, but that our ultimate (and only) goal from labour is to end up with a healthy bub and mum. So if she decides that I really do have to be induced, I won’t fight her. I think she is a good fit.

Q. was also really happy with her. I think he’s been a bit skeptical about the whole midwife issue- secretly I think he thought they would all be hippy-dippy, into chanting and crystals and demanding home births for all. So I’m very pleased that he’s now totally on board.

I see her again in three weeks, when we’ll have the official first appointment with the taking of our medical history, etc. But I was happy to sign her form naming her as my primary care provider today. She suits us. We will have a second midwife as well, and we’ll alternate seeing them with each appointment, so by the time of the birth we should know them both quite well. Obviously it is possible that neither of them will be able to attend, but our chances of having someone we know deliver our baby are, we figure, much higher with this system than with any obstetrician. They have hospital privileges at one of the two hospitals in my city at which I would be very comfortable giving birth, so that’s all sorted as well. She said the facilities are excellent.

It somehow made the whole thing seem more real. I know that probably sounds ridiculous, given the number of ultrasounds we’ve had, but I think I’m so used to being treated with kid gloves at the clinic that it was unexpected to be treated as a “normal” pregnant lady. And having our midwife chat to us happily about what will happen in May and what to expect just seemed so surreal.

I think for the first time I actually believed that we might be having a baby, and that this wasn’t some giant cosmic joke that was about to come crashing down on us at any moment.

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Filed under Emotions, Midwives, Pregnancy