Thursday 28 May 2015

Out and Proud

A few nights ago, it was a rare occasion when Husband and I were at the gym at the same time. As we were waiting for the class to start, a guy who is probably in his early 40s came up to Husband and patted his shoulder. "So, I see your boys can swim!" he declared as he nodded in my direction.

I silently groaned. I hate that expression, but not as much as I detest the phrase 'shooting blanks'.

Without hesitating for a second, Husband set him straight.
"No." he corrected. "They were placed. Injected right into the egg."

Then, true to his nature, Husband had turn it into a joke.
"You see, they thought they were back in England and were driving on the left side of the road. Couldn't get to where they needed to go. In the end, they had to be air-lifted."

I was bursting with pride. His openness and honest disclosure made me love him a little more.

"Me too." the other guy admitted with some candour of his own. "'I'm in the same boat."

I wish they could have chatted some more, but it time to start the class. I hope they pick up the conversation again in the future. In a gym, a temple of masculinity and testosterone, two men were discussing their issues with male factor infertility. I often pause to reflect on my personal growth during our infertility journey, but I often don't give enough recognition to the progress Husband has made. It's hard to believe that someone who was once mortified at the thought that his efforts toward procreating would involve wanking into a plastic cup; is now out and proud.

Tuesday 19 May 2015

The Business of Being Born

I think my first exposure to the birth process was when I was 8 year old and saw the episode of Family Ties where Elyse Keaton gives birth at a radio station. If you're in my age group, you remember this episode too. It was during the WKS telethon, there was a major blizzard, pipes burst at their house causing flooding, you know, the usual chaos that accompanies TV births. Although the scene that made the most lasting impression was Alex dropping to his knees after hearing the words 'it's a boy!' I was curious enough to ask my mother just how the baby got out of her body. My mother indulged me with a detailed explanation, as she was probably hoping that I wouldn't ask the BIG question of how the baby started growing in her body in the first place. Her plan worked, I was overwhelmed with information and wouldn't ask the BIG question for a few more years, but I figured that this is how all babies were born. A few years later, while pushing the boundaries of my bedtime, I saw a Caesarean delivery on some medical drama (I think it was St Elsewhere) and I asked "why can't she push the baby out of her vagina?" Ah, back then I knew proper anatomic terms, I had to become a medical professional to learn words such as 'hoo-ha'. " So how was I born?" I asked, after my mother described the process of a Caesarean. She would confirm that I was a vaginal delivery, while she and her two sisters were delivered via Caesareans and my aunts also had Caesareans with my cousins. She was the only one in the immediate family to have a natural birth. I was only 10 or 11, but I could sense that she was proud of this distinction.

Many years later, I was a hospital volunteer in England and I was asked to accompany a nurse who had to go to the pysch ward to do a post partum assessment on a patient. The young patient became distraught after her Caesarean delivery which lead to a psychotic outburst. She was refusing to see the baby as she felt that she didn't deserve the baby. She had failed. As I overheard the pysch team discuss how she probably had an undiagnosed mental disorder and the birth was merely the trigger, I felt empathy for her. It was written on her chart "Indication for Caesarean: Failure to Progress." How could she not feel like a failure when that was her label? As I started my medical training, I became more aware of how the medical community viewed Caesarean births. I worked with a male paediatrician who routinely asked mothers, "Did you have a normal delivery or a C/section?" So, does that mean that a C/section is an abnormal delivery? That was my impression from his question and I think one mother interpreted it that way too, as she looked down at the ground and muttered that she did have a the big 'C'. I stayed behind after the doctor left the room and I told her, "I don't think he meant to imply that a C/section is abnormal, I just think he doesn't like saying the word 'vaginal'." A smile brightened her face and she giggled a bit.

When I started working in Labour and Delivery, all these prior perceptions were confirmed. A vaginal delivery was seen as a victory, while a C/section was an admission of defeat. Another statistic in the ever ballooning Caeserean rate. Is it any wonder that feelings of inadequacy are transferred to our patients? How can we stop treating Caesaran mothers as if they are second class citizens? My colleague recently described how she performed a C/section for a patient who ruptured her membranes before an external version of her breech baby could be attempted. "You are all ruining what is supposed to be the happiest day of my life." the patient told the OR staff. Despite the fact that a beautiful healthy baby came into her life that day, the experience was tainted because the baby wasn't expelled from her hoo-ha. We need to stop promoting one experience as being better than the other. To borrow a line from The 40 Year Old Virgin, we need to "stop putting the pussy on a pedestal."

The thing is... a vaginal birth is an impressive process. I am in awe of those who have that experience. I have been so privileged not only to witness, but to have had my hands welcome many babies into the world. It can be truly beautiful, but it can also be messy and complicated. I remember speaking with my mother after my first delivery, "How did it make you feel?" she inquired. Well, I really didn't have time to think about it. My mind was focused on, 'what can go wrong, and if X, Y or Z goes wrong, what do I need to do in those situations?'. That wasn't what she was really asking. "I meant, how did it make you feel as a woman?" Ah, my mother can be a big dork at times. I would eventually admit that it would often make me wonder what it would be like when I'm the one being commanded to 'p-u-s-h'. Although I've probably been wondering that ever since I saw Elyse Keaton's birth on Family Ties.

Infertility stopped my curiosity cold in its tracks. I knew I would be fortunate to have a baby any way I could, so the delivery mechanism was not important. After getting past the accreta scare and the potentially life threatening complications, the prospect of a routine C/section was actually appealing. I was digging the idea. Although I must admit I felt so validated as I had one of the ultimate indications for the big 'C'. I started looking a potential dates and began to plot my work leave. Yet, even when your birth plan is a C/section, situations change to challenge your plans.

It was time for my 4 week growth check and placenta follow up. There was a major accident and traffic was a nightmare. We took the back roads and made it to our appointment on time, but learned that the perinatologist wouldn't be available as he was stuck on the motorway. Fortunately, we had one of the most experienced sonographers. She confirmed that my placenta accomplished what the perinatologist thought was unlikely. It moved and is no longer covering the cervix. The placenta itself looks healthy. Baby Jate is growing well. However, he or she is in a spine down transverse position. I shared with my swim coach that he or she is already starting to do the back stroke. I was disappointed not to be able to talk with the perinatologist, but I also know that he would most likely say 'we'll have to see how things are at your next scan in four weeks'.

So back we'll go, for yet another ultrasound. As of now my placenta is still being considered a marginal previa as the edge is 1 cm away from the cervical opening. A C/section would still be indicated if it persists, but may not need to be as early as 36-37 weeks. If it moves further and is more than 2 cm from the os, then a vaginal delivery can be attempted, other conditions permitting. At almost 32 weeks, there still is plenty of time for Jate to move into a cephalic position, but I laugh thinking that after all the ordeal with my placenta, I still could need a C/section for a malpresentation. The other variable that can influence the timing of delivery is my blood pressure. My readings have been normal thus far, but I know all change change within a day. So... I'm still in limbo... yet again... I know this is such good news about my placenta. There is less concern about the risk for bleeding. Jate can be delivered at full term. Yet, I don't like being in limbo... although I do need to get used to it. Apparently, this is only foreshadowing life after the baby arrives. I sent an email to my contact in Sacramento who manages our disability to inquire what I should do about submitting my 30 day notice for my leave, but I never heard back from her. Quelle surprise. So for now, I'm working another week. Yay.

I have to admit I feel conflicted to possibly have delivery options. When it wasn't my choice, I became attached to the conveniences and benefits offered through a Caesarean. Additionally, there is a huge difference in the experiences of a planned C/section versus an emergent one. I feel that I don't want to attempt an induction on an unfavourable cervix. My friend in LA had a successful version of her breech baby, only to have a postdates induction at 41 weeks and 2 days. She was in labour for 38 hours before the baby showed signs of distress and they went under the knife. Thirty-eight hours. A Venezuelan runner with muscular dystrophy finished the Boston Marathon in only twenty hours. Looking back, she shared that the induction and labour were worse than the surgery. In hindsight, she wishes that either the version had failed or she had just opted for a Caesarean. She could have had the same outcome two and a half weeks earlier. Yet some times inductions work well and deliveries go smoothly. I am so reluctant to do this, but to quote one of Myrtle's favourite expressions, 'you just never know...'

Just as I had resigned myself to the fact that I will probably always be jealous of Myrtle and her fucking textbook perfect vaginal delivery, my friend Amy provided some inspiration. We recently met up for lunch as she wanted to pick my brain about a repeat C/section versus an attempted Vaginal Birth After Caesarean (VBAC). A colleague of hers had a successful VBAC over twenty years ago and she shared how it felt so validating to her, especially as she viewed her first C/section as being unnecessary. "She seemed to presume that I had unresolved issues or resentment toward my Caesarean birth, but actually, I don't" Privately, I had to admit that I had similar thoughts about Amy. She really tried to have a natural non-medicated birth. She laboured at home for as long as she could and was admitted at 7 cm. They hired not one, but two doulas. She was on Kai.ser's midwife service, but interestingly it was the attending midwife who wanted to artificially rupture her membranes and start pitocin on her admission orders. A few months after the birth, she had requested a copy of her records, which she wanted me to review to see if her C/section was justified. Now, she was announcing that she was really leaning toward a repeat C/section. There was the practical convenience of having a scheduled date, so her mother could plan her trip from So Cal to stay with her daughter. She feared having another emergency delivery and felt that if she were to have another 'C', she wanted to be on her terms. Most sobering, she commented, "if I were to have a VBAC and the baby sustained an injury, I don't know how I'd live with that guilt" So, if a Berkeley hippie can get over not having a vaginal birth, I know I can too.

*I admit I haven't watched the Ricki Lake documentary. I just borrowed her title.

Friday 15 May 2015

2015 Challenge Update #2

When we last left our heroes, construction on the garage was paused while Husband was away for a few weeks. A few days after his return, we had our anatomy ultrasound, where we first learned about the potential placenta issues and need for an early delivery. That prompted Husband to bust out the rest of the floor in the storage space and install installation.

We went away for a long weekend in February and fretted about missing a weekend of productivity, but we soon learned that was only the start of our delays. A trip to the permit office uncovered that we needed to increase the roof venting if we were closing in the ceiling. Adding the extra vents required approval from our HOA, which only meets every other month. Husband had to stalk track down the HOA President to receive emergency authorisation. Finding a roofing contractor was difficult as a late storm had swept through our area. Coordinating with the inspectors was another challenge.

[insert cricket sounds]

Recycling Fees $50
Permit Fees $650
Roofing Work $1,450

Meanwhile, the contents of our garage as well as the storage units, are scattered around our house, which hindered preparations for the nursery. 

Finally, the dry wall work was done.

The morning after the dry wall was finished, I tried to turn on the heat, but it failed to convert. We called a repairman to evaluate our furnace. He speculated that there may be a broken piece, which would cost $300-400 to investigate and repair, but as our furnace is almost 27 years old, it will probably need replacing soon. Although not a good time financially, we decided to bite the bullet, as we wouldn't want the furnace to konk out after the baby's arrival. The next morning, I made the unpleasant discovery that we didn't have any hot water. It appeared that our hot water heater (which was replaced last year) was also out of commission. We paid extra for an after hours service call from our plumber, who couldn't figure out what was wrong. It was another day and another cold shower, and a visit from the water tank repairman, who also couldn't find the problem, but suggested contacting our energy company. Husband placed a call to PG&E, and after listening to Husband go into detail on how every appliance was breaking down, the representative had one suggestion, "have you checked your earthquake shut-off valve?" Five minutes later, our gas line was back on after Husband realised it had been shut off. We're not sure if it was triggered during the dry wall work or by a local 3.6 earthquake. Nonetheless, we decided to proceed with replacing the furnace. At this point, what's one more unexpected expense?

Dry Wall Work $2,800
Plumber After Hours Call $110
Hot Water Repairman Service Call $65
New Furnace $3,150 

Total to Date: $10,425

Thursday 7 May 2015

Not a Distant Memory

Dear Dr Somebody that I Used to Know,

I hope all is well with you.

When I had my first miscarriage, you offered many comforting words, and you predicted, "when you're thirty weeks pregnant, this will all be a distant memory."

Nearly thirty months later, I am thirty weeks pregnant. A feat that itself had seemed like an improbable quest. I am thirty weeks pregnant and I still remember the elation that I felt when the elusive second line appeared on my pregnancy test. I was gobsmacked with disbelief. I was so certain that it was yet another mistimed cycle and we had conceded that assisted reproduction would actually be easier. We had become one of those couples. The urban legends who spontaneously conceive just before starting infertility treatments. We shared the news with some friends who concluded that it must have been the threat of such treatments that coerced our gametes into cooperating. I was so overjoyed that I couldn't be bothered to correct their inaccuracy. Rather, it made me question if I had just been over-reacting. Maybe we really weren't that subfertile.

I vividly remember the morning that followed two weeks later. I woke up to go to swim practice and I turned on my fertility monitor just so I could have the smug sense of satisfaction to see it read CD42. I was six weeks pregnant. It was a sprinting day, and I was so focused on my times, that I had almost forgot that I was pregnant, until I took notice of an errant drop of water that had landed on the ground in a perfectly formed circle. I'm not sure why, but I couldn't stop staring at it and I suddenly had the urge to check for spotting. Sure enough, I saw a very small light pink dot. I probably would have told one of my own patients that it wasn't any cause for concern, but I immediately knew it represented impending doom for my pregnancy. I didn't hold out for any hope and the inevitable took place in the next thirty hours.

Although I know I am so fortunate to be thirty weeks pregnant, I will always feel that an opportunity was taken away from us. We could be experienced parents of a twenty month old, rather than nervous newbies just starting out. We could have contemplated having a second child before my cut-off age of forty. As I hear the excitement in my parents' voices as they talk about the upcoming arrival of their first and only grandchild, I can't help to reflect that they were denied two years of their experience as grandparents. I really try not to think about all the struggles in the past two years that could have been avoided if my spontaneous pregnancy went to fruition.

Even while appreciating my baby's movement, I still felt pangs of jealousy as a swim teammate recently announced her pregnancy. "We weren't even trying!" she added for extra emphasis on just how easy it was for them. I already knew how unfair this process can be, so I found the reminder to be a bit annoying. While feeling genuinely happy for her and her partner, I hold a greater sense of relief for them. She was aware of it too, as she added "We're so glad we didn't have to go through those extremes like some infertile couples. I could never do that!" You mean someone like me... Her words sting, but what really hurts is that I have to acknowledge that I probably would have said the same thing if we were blissfully fertile. Actually, we probably did say something similar after our spontaneous conception.

Infertility became a core component to my identity and even at thirty weeks pregnant, I still cannot separate myself from my past experiences. I walked around a baby supply store quietly and inconspicuously. Even with my prominent bump, I still felt that I didn't belong there. Fellow infertiles have shared with me that these feelings persist even after the baby is born. Infertility affected so many aspects of my life. It caused disruptions within long standing friendships, but also helped me reconnect with some old friends and develop bonds within the infertility community, for which I offer infertility my reluctant gratitude. The label that I dreaded and the group that I never wanted to join became my comfort zone. Infertility is a bit like the Hotel California. You can check out any time you'd like, but you can never leave.

Even at thirty weeks pregnant, I am not cured and I never will be. Our experiences with infertility and pregnancy loss will always be with us and will always affect how we feel. At times, I carry feelings of survivor's guilt. Why were we fortunate enough to have a successful treatment while there are so many others enduring failures? I know science holds the answers, but science also explains why we were infertile in the first place. We feel it is very important to be open about our experience with infertility and pregnancy loss. Acting as if we conceived naturally is disrespectful to everything that we experienced and is a disservice to others infertiles. Words seem so inadequate to express our appreciation for your services, yet I struggle to find such words as I don't think we yet comprehend the magnitude of our gratitude.

We may become survivors, but we're forever scarred. It's a scar on a wound that time can't heal. Maybe in thirty years, but not thirty months later, and not at thirty weeks gestation. It's not a distant memory.