Friday, 31 July 2015

The Dreaded 'C' Word

Other than Cancer, Colitis, or Chlamydia, I don't think there is a more dreaded 'C' word diagnosis than Colic. I briefly recall the nurse at our baby class reviewed some of the typical profile features in parents who have colicky babies; scientists, computer programmers, people who deal with numbers and/or logistical reasoning. I'm not quite sure why, but for some reason, I just tuned her out when she mentioned the 'C' word. Husband listened carefully as he noted that we (although mostly him) seemed to fit that description perfectly.

The first two night at home with Jate were tough. She cried for about four hours before finally settling. For some reason, we didn't panic. She was getting used to being in her new home, we were still learning to care for her without the safety net of the nurses in the hospital. We searched the internet for ideas and things started to improve. She settled into a pattern of eating every 2-3 hours and we could get her changed, fed and back to bed in under an hour! Around day 7, she started to become a little fussier, which our internet research confirmed was likely due to a growth spurt. However, her fussy periods were isolated to the day time, which we felt we could manage. Two days before her two week mark, she exhibited her best day ever. She fed more frequently, closer to every two hours, but it was a day without any fussy episodes. We thought we had figured out her routine and that we had a 'good' baby. Then it all went pear shaped.

The night before her two week check up she returned to the inconsolable crying she had exhibited on her first nights. We noted that her abdomen seemed distended and chalked it up to gas. We had an appointment with the pediatrician then next day. He looked at the picture of her distended belly and commented that she was likely very uncomfortable, which would explain her crying, but he issued the c-o-l-i-c warning. I was in denial. My baby didn't have colic; it was just tummy troubles. We gave her Gripe Water and Simeticone, and performed various baby massage techniques, which seemed to settle her stomach.  Yet the crying didn't stop.

Once again, it seemed that we had managed to fall in the unfavourable side of the statistics. We hit the colicky baby lottery. "The good news about colic," offered the ever optimistic Co-worker, "is that it's only a few hours a day and it's temporary!" Only it wasn't isolated to a few hours a day. Her crying was non-stop. All day. And all night. Nothing would soothe this baby. I thought I was so prepared as I read The Happiest Baby on the Block cover to cover before her arrival. She's basically told the 5 S's that they can shove it. We have a Sleep Sheep and a White Noise machine. Not helping. Noises from the vacuum, washing machine and dishwasher? Nothing. Not the bouncy seat. Not even the Rock and Play. My parents (especially my dad) will sometimes be successful with rocking her, but she doesn't seem to respond if I try it. I think she just appreciates me to be her food source. Ours is more of a business relationship. The one thing that will work to get her to sleep is a walk in her pram. However, she'll scream her head off for the first few minutes as we walk down the block, which invites stares from the neighbours, as I can feel their judgement. What a terrible mother she must be!

I cry inconsolably too. Husband and my mum and dad have all tried to reassure me that this isn't my fault. I'm not doing anything wrong. It's the colic and colic sucks. Intellectually, I can accept this. It's much harder to grasp it emotionally. I feel so unprepared and inadequate. That I'm not meeting my baby's needs. I know how fortunate we are to have a healthy full term baby, given all the potential pregnancy complications, and I know we're so blessed to have a baby at all. I still feel as if it might be some type of pay back. A reminder that maybe there was a reason why we couldn't conceive on our own, and this is our punishment for side stepping the natural order.

Colic starts between 2-3 weeks, peaks at 6 weeks and disappears by 3-4 months. We've been searching everything we can find on The Google about colic, looking for one more trick to try, but that line keeps haunting me. This is my going to be my life; not for the next few days or weeks, but months. Colic is going to consume my maternity leave. I'll be begging to go back to work. According to my paperwork from the DS, I'm still scheduled to go back 6 weeks after my delivery date. Give me a schedule full of patients with chronic pelvic pain. Anything will be easier that this. I'm almost afraid to be around her. How will I be able to bond with her? So many people have told me, "enjoy this time! They'll never be this little again!" Yet, I can't wait to get past this point in time.

No one said it would be easy, but I never thought it would be this hard. At least a dozen times a day, we express our gratitude that she was a singleton. Amanda G, Jen S, Amber, Kimberly Q, Audrey, Unprolific, Suzanne and Co-worker; you all are my heroes for having twins. Husband has done the maths on how many days until we hit the three month mark. I know there is light at the end of this tunnel and that it will get better. It just seems so far away. I focus not just getting through the day, but managing hour to hour. My parents have been so helpful, watching her so I can take a shower or grab something to eat. I know I need to take advantage of their assistance while they are here, but it makes me feels as if I am unable to care for my baby and  it serves to remind me that I'll have to cope when they leave.

I thought dealing with infertility was hard. I know how to cope with the emotional aftermath of a failed transfer, but it didn't prepare me for this. Or did it? There were times we could have stopped pursuing treatments. I had proclaimed that I'd never do IVF. If we did decided to try IVF, we'd only do one cycle. Jate came into our lives because we were persistent. It's time to apply that persistence again. Start over with the 5 S's. Try the baby carrier again. Give the Rock and Play another go. What didn't work yesterday might work today. We just have to keep trying something. It will get better. It has to.

Sunday, 26 July 2015

Breastfeeding Women are Smug

DISCLAIMER: Not all breastfeeding women are smug, although I'm sure we all have encountered some who are. Those women who intend to breastfeed until their babies go off to college and believe that infant formula contains arsenic and cyanide. Tine Fey does a great job characterising these Teat Nazis (TNs) in her book, Bossypants, and she offers great advice if you happen to encounter a TN: lie about your own experience. Just proclaim that breastfeeding is the greatest thing in the world. I know there are a lot of women who make every effort to breastfeed, and for whatever reason, it just doesn't work out. Many women and their babies have additional challenges that present barriers for breastfeeding. I don't think it's appropriate for anyone to criticise or comment on another mother's feeding method, and it's wrong for women who do breastfeed to express a feeling of superiority. That being said, I do confess I feel a slight sense of personal smugness. As an infertile woman, I felt let down by my body at so many times. My ovaries are little bitches, my uterus was an asshole, but my breasts are rock stars. I know it's too early to celebrate, perhaps even premature, but so far, breastfeeding is going rather well.

The funny thing is that I never intended to breastfeed. I know it's surprising given my profession, but breastfeeding has presented many challenges during my career. As many of you probably have already learned, health care providers do not know very much about breastfeeding. We're taught all the reasons why 'breast is best' and that we should relentlessly encourage breastfeeding, but we're not equipped with any knowledge on how to make this happen. I've learned a bit over the years, but especially early in my career, I dreaded seeing a patient with any breastfeeding issues, other than a straight forward mastitis. I felt so inadequate and I felt guilty that patients wasted time at my visit, which amounted to receiving the advice, 'you need to see a lactation nurse...' While it is important to promote breastfeeding, sometimes I think we need to ask 'at what cost?' I recently read a case report from a Cardiologist. She was called to assess a postpartum woman who was experiencing shortness of breath. Fearing that she could have a pulmonary embolism, the cardiologist ordered a CT scan. She kept looking for the results, only to discover that the OB resident cancelled the test, as the contrast dye would be contraindicated in a breastfeeding woman. The cardiologist had to make the case that the patients's breastfeeding would be significantly compromised by her death in order to start facilitating the care that was needed. I read another story with very tragic results after a postpartum woman with schizophrenia had her psychiatric meds discontinued in the hospital, as they were contraindicated in breastfeeding. Fortunately, I've never dealt with such dire circumstances, but there have been occasions where I've felt I was sub optimaly treating a patient as I needed to find medications that would be compatible with breastfeeding. I have seen two breast cancer cases that involved a delayed diagnosis due to breastfeeding. In one case, a mass had been attributed to being a blocked duct. The patient presented to me two months after she stopped breastfeeding as the 'blocked duct' hadn't resolved. The other case involved a woman who refused to have a breast biopsy done as she was still nursing her 18 month old.

My professional experience offered one more aspect to discourage me from breastfeeding. I'm not proud to admit this, but it's vanity. A few years ago, I picked up one of the pregnancy magazines in our waiting room as it featured a story on "The 10 things no one tells you about breastfeeding". Ah-ha! This article would share my observations after spending many years examining naked women (not to sound pervy, but it is my job). Breastfeeding has the potential to overwork the elasticity of your skin and can leave your breasts looking like deflated balloons. However, the article did not shed any light on this potential outcome. The enlightening tidbits? It may hurt at first (not surprising) Milk may leak out of your boobs (duh) Your husband may like the enhanced size of your breasts... (DUH!) and You may find that you love it! There was no truth revealed in this article. It was all propaganda to promote the breastfeeding agenda.

I had other ideological objections. The feminist in me resisted the notion of being classified as a food source. The idea of needing to pump breast milk sounded inhumane, it would make me feel as if I were a cow. Breastfeeding in public? I fell on the side that if you need to nurse in public, you should use a modesty cover. I didn't understand why some women had the desire to be exhibitionists, just because they had a baby that needed to be fed.  My friend Alistair offered his observations on the issue; "Men like boobies. We really like boobies. It doesn't matter if there is a baby attached, Our eyes are drawn like a moth to a flame." That was the final consideration. I had always regarded that breasts were sexual. I feared that Husband wouldn't be as attracted to me after witnessing me feeding our baby.

Once again, infertilty changed my perspective. After discovering how hard it was to have a baby, I felt a greater obligation to provide the best that I could if I were fortunate enough to have one, including breastfeeding. I've been so fortunate to have enjoyed such good health as a child and even as an adult, that I would feel incredibly guilty if I didn't offer the same opportunity to my baby. I decided I would give it an honest attempt, but I wouldn't hold any expectations, nor would I set any goals to make it to X number of weeks or months. (Although Husband keeps reminding me how much we'll save by not needing to buy baby formula.) When we attended our baby basics and breastfeeding class, I diligently took notes as the nurse declared the commandments for successful breastfeeding.
Thou shall only offer breastmilk to the baby
Thou shall not give formula unless absolutely necessary
Thou shall not introduce a bottle prior to 3-4 weeks
Thou shall not use a pacifier in the first month (if at all...)
Thou shall not pump in the first month

We started feeding almost as soon as I was out of the OR and continued to feed every two hours throughout that day, and much to my surprise, it seemed to be going pretty well. However, in the early hours of the morning, it seemed that she wouldn't want to stop feeding, or at least engage in some non-nutritive sucking. I could see the writing on the wall. "I have the feeling we're going to need to supplement with formula and give her a pacifier." I told Husband. At this point, it didn't even phase me. Just some thing else not going according to my intentions. Sure enough, the next night we had to give her formula as her weight loss was getting close to the 10% threshold. I am so glad the hospital nurses recommended using the Supplemental Nursing System (SNS) as I've spoken to a few other friends who commented that they never had that option, the nurses went right to the bottle. The night before she went home, she was happily fed, but still wanting to suck, so another nurse suggested using a pacifier. No! We were determined to hold our ground on being anti-pacifier. "I'm going to put one in your take-home bag, just in case..." the nurse knowingly offered. It only took less than an hour of crying for us to reverse our stance on pacifiers and yield to the Soothie.

My milk still hasn't come in by the time we were discharged from the hospital. I kept asking, how I would know when the milk was in. "Oh, you'll know..." was the answer I received from several different nurses. As soon as we arrived home, I put the baby in her bassinet, pet the cats, and then cracked open a beer (as recommended by the nurse who taught the breastfeeding class). I'm not that big of a beer drinker, but after abstaining for almost 10 months, it was delicious. It could have been a Bud.Light.Lime and it would have tasted like Champagne. (More than one occasion, John Oliver!) After the next feeding, she spit up all over me. It was white and thick. Yes, they were right. I would just know when my milk came in.

She continued to feed rather well, although we still used a little Similac at night when she was fussy and needed a little extra encouragement to fall asleep and maybe stay asleep for just a little bit longer. We referred to is as "The Sixth 'S'" and I almost felt as if I were drugging my daughter to make her sleep, but I didn't feel guilty enough to stop doing it. (It did stop working for us after a few days). I did discover some other breastfeeding secrets that no one tells you. Nursing sleep bras are the best things in the world! Seriously, why hasn't the word gotten out on these. So much better than sports bras! It CAN be sexy! I was reluctant to make this purchase because of her name, but the Jess.ica Simp.son line available at Destin.ation Mat.ernity, offers some lacy and feminine nursing bras. Additionally, I don't know if it was the three beers talking, but Husband came into the nursery as I was feeding Jate and commented, "It really is a beautiful sight, when it's your wife and your  child." Pumping is not that bad... It's oddly satisfying. On a few occasions, I became so engorged that I had to pump for comfort. (BTW, it's not pumping, but having to hand express, that makes you feel like livestock). I was so encouraged by the production, that I actually danced around the house. I've already started freezing some milk.

So, I'm not at that point of You may find that you love it!, but I'm rather satisfied. I acknowledge it doesn't take any special skills, but mere luck. I'm fortunate that my baby has a good latch and I've been able to produce enough milk plus a little extra for the future. For the record, Myrtle wasn't able to breastfeed. Little Myrtle never latched well, and she didn't produce much with pumping, but this is the last category I ever expected to hold any bragging rights. Yet at times, I do feel like giving myself a little pat on the back. I'm pleased that at last, some part of my body is cooperating. Plus, I broke some of the rules and still made it work. So yeah, I'm a little smug about that.

Friday, 17 July 2015

Welcome To This World...

During the last few weeks of my pregnancy, Myrtle and a few others asked if I had become so uncomfortable that I reached that point of being nearly desperate to get the baby out. I was still enjoying the pregnancy so much, even at the end, that I never felt such an urgency. Until the very last day. My carpel tunnel syndrome was in full rage. Performing the simplest task induced agony and on a few occasions brought me to tears. I felt so pathetic. Other women would be experiencing labour pains on the day before their baby's arrival. I was crippled by pains in my hands. How lame.

I was amazed at how much we got done and were able to cross off our 'to do list'. Although I pushed to get most tasks accomplished on Friday and Saturday, so that we could enjoy a leisurely Sunday and last day baby free, it didn't exactly happen as we were still working right up until we went to bed, which was probably a good thing. My case ended up getting moved to 9:30, which was also to our benefit as someone correctly predicted, we didn't get much sleep. Tyler stayed by my side for the entire night. It was so hard to believe this day had finally arrived. My transfer was just before Halloween and I delivered after the 4th of July. I was pregnant through Thanksgiving, Christmas, New Year's Day, Easter, and Memorial Day. My pregnancy extended through the Australian Open, French Open, Wimbledon and the Women's World Cup. That's a long duration.

I had come to terms mentally with a C/section, but it's not really possible to prepare physically, even when you know what to expect. The anesthetist was awesome and she got my spinal in on the first try. The warm and heavy sensation in my legs was weird, but not unpleasant. For some reason, when she placed the wedge under my right shoulder, a sense of panic took hold. I'm not sure if claustrophobia is the correct term, but it reminded me of the anxiety during my MRI. I was very aware that I couldn't move and people would be doing things to me. I wanted to bail. I changed my mind, I would rather take my chance with an induction and potential blood bath of a delivery, just so I could have some control. Yet, I knew I would end up back in this OR, only it would be an emergency case and instead of everyone enjoying pleasant banter as they prepped me, there would be a frantic sense of urgency. I thought about asking for some Ati.van, but realised it's probably not recommended as some would go to the baby. I was considering going under general, but then Husband was brought into the room and he sat beside me. I wanted to remain awake so I could share this experience with him.

The occlusion drape was stretched very high. "It's like you're playing tents as a kid..." the anesthesiologist joked. I couldn't see anything that was going on. I held Husband's hand and closed my eyes as I went through the procedure in my mind as soon as I heard my OB announce to the anesthesiologist that she was making her incision. Skin incision done. Knife back to the OR tech, Bovie to slice through the subcutaneous layer. Stop to cauterise any bleeding vessels... Identify and open the fascia. Place the retractors to protect the bladder. Knife for the uterine incision, work through the lower segment. Bandage scissors to extend the uterine incision. Break the amniotic sac...

Then I sensed the pressure on my abdomen as they worked to delivery my baby. I was in a state of sensory deprivation except for my hearing. I heard a crying sound. It was a loud penetrating wail. A sound that I'll never forget. "That's our baby!" I said to Husband, "That's our baby crying!" My own eyes were weepy. As his hand was still in mine, I felt all the stress and tension that he had been carrying for nine months leave his body. The empty shampoo bottle that he refused to throw away because he used the last amount on the day of our beta test. The pregnancy related webpages on his phone that he refused to delete as he didn't want to tempt fate. It all went away. I know it would only be a matter of time before he would find new sources of stress, but for that moment; it was gone.

First Family Photo

They invited him to look at the baby to announce the gender. Although it was concealed by his mask, I could tell he had a big smile on his face. "Kate is here." He informed me. Wait... "Does that mean what I think it does?" I asked. "Yes, Jane. A girl." (I would later learn that he also double checked with the pediatrician before he was sure she was a girl) Truth be told, I may have had a heads up. I didn't share this with anyone, but at my very last scan, the tech may have slipped. As I was sharing how baby had been flipping in and out of the transverse position, the tech noted, "Well, hopefully she or he!" she quickly added "will stay head down...." The look on her face was more telling than her words. Yet, I still wasn't completely convinced, so it truly was a surprise.

Yes, It's a Girl!

Husband accompanied Kate to the nursery and I closed my eyes until the surgery was complete. My OB described that the placenta was very low and the only way I could have had a vaginal delivery would have been if her head were fully engaged and would have applied pressure to tamponade the placenta. She was relieved that the blood loss was much less than expected, but commented that my placenta was very "sticky". So perhaps even without the marginal previa, I could have ended up in the OR needing a  D+C and transfusion after the delivery. I'm so glad not to have that drama, as I was able to meet Kate in the recovery room right away. The nurse placed her on me and she lifted her head as if to look around before latching on straight away. The nurse was quite impressed. I felt rather proud. That's our girl.

I knew that I loved her from that first moment, but it would take some time before I appreciated just what that love felt like. She was still a stranger. I couldn't believe that she was mine. Each day the bond grows stronger, but what really makes my heart melt is seeing how much Husband loves her. Fatherhood suits him perfectly.

The recovery from the C/section was much easier than I anticipated. I was able to just use Motrin for pain relief and I no longer needed any meds by post-op day #4. Getting in and out of the hospital bed was tough, but not nearly as excruciating as getting in and out of the car. Upon bringing her home, I let out the first string of expletives in front of my daughter.

Could.Not.Resist.this onesie 

Here's my 'I've experienced this once, so now I'm an expert' words of advice for anyone with an upcoming delivery: do not accept any visitors in the hospital. Some people actually wanted to come to visit on the day of my surgery. It was easy to say "No" as I was groggy and puking every 20 minutes. However the next day, once I had my IV removed and could tolerate PO liquids and foods, I felt back to my old self and I expected to act that way.  I almost didn't feel that I should be in a hospital. My parents arrived around 2 in the afternoon, and after they each had a chance to hold her, I continued her feeding schedule under a modesty cover. Since Kate latched so effectively, I didn't pay as much attention to her latch, and I wasn't hand expressing some colostrum to encourage her, as the nurses had suggested. As a result, I had a baby who spent the day exerting much effort, only to get very little colostrum in return, which made for a very fussy baby and a baby who lost 9% of her weight and we needed to start formula with a Supplemental Nursing System (SNS). I hadn't pushed fluids as aggressively as I should have been. I felt guilty, so the next day, I was determined not to let anything affect the baby's feeding efforts. However, I thought I saw a window of opportunity to feed her before my parents arrived in the afternoon, so I decided to wake her to feed. Huge mistake. She was so pissed off that she didn't want anything to do with feeding and refused to latch. We were regressing. Now I had a baby who was on the bubble of losing too much weight, who wouldn't feed and I realised that she hadn't had a wet diaper since the night shift.  Meanwhile, my mother was trying to talk to me about her friend's son's drug problem. The nurses had suggested that I try to pump some colostrum for the SNS. One of husband's (male) hockey friends was going to try to stop by that day. It was time to put up the Do Not Disturb sign. I told Husband to cancel any visitors and he came up with a clever rouse to take my parents on a walk to Starbucks, so I could have the room to myself to pump. I know everyone will be anxious to see the baby, but your recovery time needs to be for you and your baby. Entertaining my parents was distracting my focus from Kate and taking care of myself. As there isn't an established routine, it's hard to anticipate when would be a good time for visitors and since modesty and privacy are important to me, I didn't want any guests walking in while I was nursing or pumping.

I can't say enough about how amazing the postpartum nurses were. Our LA friends, who delivered via Caesarean a few months ago, encouraged us to take advantage of the extended hospital stay by asking lots of questions. The nurses shared many tricks and tips, and tried to install confidence that we would manage as we embarked upon this adventure called parenting.

Home. We are going... 

Sunday, 12 July 2015

Pregnancy Reflections

Sometimes I'll catch a glimpse of myself in the mirror, and I'll think 'who is that pregnant woman?' I'm still in a state of disbelief that after so many years of not wanting to become pregnant, and then not being able to get pregnant when I wanted to, that the reflection is actually me. More so, I'm amazed at how much I've enjoyed being pregnant and how much I've cherished this opportunity. Once we were seemingly out of the woods with the accreta scare, and the potential for life threatening complications were no longer making us question if we shouldn't have pushed things and should have accepted that we weren't meant to have any babies grown in my uterus, we could finally embrace the pregnancy and almost appreciate that we may have a little baby in our arms at the end of this all. By week 27-28, Jate became very active and I felt myself wanting to savor every kick and every hiccup. I could already appreciate a sense of nostalgia. I am going to miss being pregnant.

Although I won't say never, the probability is very high that this will be our one and only pregnancy. If we're fortunate enough to have a healthy mother and healthy baby from this experience, we don't want to tempt fate again. I hate the thought of going through the uncertainty of another transfer, an agnosiging beta wait, and all the lurking potenial obsetrical complications we could face after making it through the first trimester. Not to mention, we're not getting any younger. We won't officially make any decisions regarding our embryos for another year or two, but I already decided my post partum contraception will be Nex.planon. I was an IUD user for 10 years, but if my ute makes it to the end, I'm going to give her a well deserved rest. Plus, Nex.planon inhibits ovulation. After spending three years determining when or if I was ovulating, I don't want to ovulate at all for the next three years.

I managed to make it to the third trimester before wearing any formal maternity clothes, although I had picked up a few larger sized items and some stretchy material skirts by the time I hit twenty-four weeks. I had always vowed that I would never wear maternity jeans with the large stretch panel, so I managed to make do with a Bella band, even though it is essentially the same look. I shopped conseignment stores for a few maternity dresses and tops, but I did go to a proper maternity boutique to get one new dress. I felt a bit smug at the check out, as the woman at the till next to me had filled three shopping bags and she was barely at the half way point. So far, I've managed to escape any stretch marks, thanks to the genetics from my mother and a European cream not available in the United States. I had purchased some when we first started trying to conceive, because I had to be prepared, and my prediction came true that it expired by the time I was actually pregnant. It would cost over $160 to purchase through, but Husband procured a few bottles for less than £20 while he was in England. Apart from my pre-Thanksgiving irrestible desire for Tater Tots, I haven't had any food cravings and my appetite has been pretty normal. As of 34 weeks, my weight gain was around 23ish pounds, although it could vary by 2-3 pounds depending on my swelling, but it stayed in that range until the end. I've been trying not to obsess (too much). I had wanted to keep the total gain closer to 20 pounds than 25 pounds, and it became frustrating as my weight kept increasing depsite maintaining approximately the same caloric intake. My OB appointments felt like a reverse Weight Watchers weigh-in. Myrtle had gained 15 pounds by the time she was 18 weeks and was up 35 pounds by 32 weeks, so I imagine she must have been between 40-45 total gain by the time she delivered. I know it's not a competetion, but I'm winning in at least one category.

Since the early weeks of my pregnancy, I've had some nights with interrupted sleep. It's the middle of the night and I'm wide awake. Recently, I've been getting up and trying to do something productive, so I can somewhat adjust to being functional at night. I'm still fairly comfortable while sleeping, and I find that I'm actually able to sleep on my back. It makes me silently chuckle when women present for their first visit and are concerned about sleeping on their backs. Overall, my energy level is rather high and I don't feel too fatigued. I feel very fortunate that I don't have any aches or pains. From my own experience,  I have become more convinved about the benefits of exercise during pregnancy. It seems to follow the 'body at rest, stays at rest and a body in motion stays in motion' philosophy. I feel that if I were less active, I would be much more stiff and seized up.

I do miss running and I hate that I have to delete the many emails I receive for local races and events. I had wanted to continue running and had planned to run a half marathon at 16 weeks, but I developed plantar fascitis. My running shoes were long overdue to be replaced, but I had many races in November and December, and I didn't want to run with new shoes. I had also changed my pronation due to the pregnancy and the combination of those factors wrecked my feet. Since the main treatment for plantar fascitis is rest, I figured this would be the best time. I also really miss my ankles. I don't know why, but I was naive enough to think that I was going to be immune to the swelling effects and I was devidtated on the day that I looked down and saw that I had cankles. I had to banish my favourite pair of Mary Janes to the back of my closet as I discovered that it was not a good idea to wear any shoes with a strap. I purchased a pair of basic Easy Spirit black flats which are made of a very comfortable stretchy material. Still, my lower extremities look like baggettes stuffed into shoes. Husband has commented that my ankles look very similiar to Tyler's paws. I was offended, but his observation is pretty accurate.

I have loved not knowing the baby's gender. So many people have said to me "Oh, I don't know how you can do that! I'm way too impatient!" Honestly, I'm still not anxious at all to find out. I supposed I'm applying a bit of the Monster at the End of the Book tactic, which is the longer I hold out on knowing, the longer I can hope for a girl. I honestly have no inclination either way. Sometimes I've had a certain feeling or vibe from some of my patients that has lead to an accurate guess, but I have no speculation on my own baby. There seems to be an almost 50/50 split between the conjectures of my patients, staff and friends. I've been running scenarios through my mind where I hear my OB declare "it's a girl!" or "it's a boy" just to try to prepare myself. Oddly, I've had two dreams where they baby was born, and we still didn't know the gender.

So far, there have been no significant labour signs or symptoms. Although, I'm a bit embarassed to say that I'm not entirely sure. It's been ages since I used to sit an palpate a labouring patient's contractions. Some times I'll feel a vague sensation of tightness or hardening, but I can't tell if it's just Jate moving about. I've decided it's akin to determining if a woman had an orgasm: if you have to ask, the answer is probably 'no'. My cervix has not been able to be checked due to the low lying placenta, but I've felt some odd twinges toward my vagina, so it may be effacing a bit.

Best moments of the pregnancy? There have been so many, which is why I'm going to miss being pregnant so much. The highlights definately include seeing the smile on Husband's face when Misery announced that my beta was 175. Watching the vivid and dark test line appear on the First Response Early Pregnancy Test. Making my mother cry when she first looked at the ultrasound photo. Receiving an email from my Dad celebrating each week, often with a silly poem that he wrote. Feeling the clumsy thud that announced Jate's presence for the first time. Noticing that Jate seem to kick more often while I would be listening to the fetal heartbeat for one of my patents. While the 25 minutes inside the MRI machine, was not a highlight, receive the news that I looked to be clear on an acreta certainly was. Planning and decorating the nursery was quite a bit of fun. I ordered so much online, it felt like Christmas as so many parcels arrived on our doorstep. My aunt and cousin hosted a baby celebration event, which is not to be confused with a baby shower. While I was so thankful for their efforts, I was quite nervous as my aunt is one of the most disorganised and infocused people I know. I arrived earlier than instructed as I figured we'd have to help with food prep and other arrangements. When I walked through the door, my aunt announced that everything was under control, thanks to a special helper. My mother flew out for a surprise visit. I was so thrilled to see her and was so relieved as I knew the party would go off without a hitch. (My mother did state that she had to crack the whip to make sure all tasks were being done). The event was a perfect celebration with friends who have supported us through the disappointment of every failed cycle to the triumph of a pregnancy that might finally produce a baby.

Most of all, I've loved sharing all this with Husband. I'll especially miss lying in bed at night with his hand on the bump to appreciate Jate moving about. I love the way he talks to the baby as I love seeing how excited he is about becoming a father. He caught me bump smuggling one day and commented, "It's such a beautiful sight. It's something I thought I'd never see." Neither did I. It's been such a privledge to experience this pregnancy. Perhaps, I've enjoyed a deeper appreciation after infertility and pregnancy loss.

Friday, 3 July 2015

The Final Verdict

I remember watching the episode of The Office when Pam returns after having her first baby. "How was maternity leave?" she repeats the question asked by the never seen nor heard interviewer. "Oh, it rocked. It rocked my ass off." It has only been one week, but so far, my leave has been rocking my ass off.

I felt oddly emotional as I headed into my last day. I wondered what it would feel like to wake up on Monday morning and not have to go into work. I didn't get to have that experience until Tuesday as I had a 9:00 fetal monitoring with Co-worker on Monday morning. It was as if it were just a regular day. Except I got to wear open toed shoes and I had my swim suit on under my clothes as I planned to attend the noon swim class. During my last week, I scanned myself on a daily basis to confirm Jate's position. He/she was head down on Monday and Tuesday, flipped transverse on Wednesday, and was back to cephalic on Friday (I checked twice that day). I suspected baby was transverse again on Sunday night, which Co-Worker confirmed on Monday morning. Interestingly, in the complete oppositie direction from Wednesday. I felt so defeated. I was now 37 and a half weeks. 97% of babies are head down by 37 weeks. Once again, I was in rare minority. I hated having one more issue. One more potentially complicating factor. Okay, I get it. I suck at pregnancy. I really, really suck at pregnancy. Husband had started to become alarmed after doing a Google search on transverse position. He also tried to bribe baby to turn head down by promising him or her a kitten. I left my appointment to go swimming, which was my first time in the pool in almost two months. While we were doing our kicking drills, I felt a flipping sensation inside. Jate went head down again and has stayed in that position. I've been palpating myself somewhat obsessively to confirm. At least once an hour.

"One of these things is not like the others..."

My final ultrasound to assess my placenta was scheduled for Thursday morning. I wanted to be prepared in case the perinatologist advised me to be delivered the next day. I completed my necessary errands. I prepared some meals to put in our chest freezer. I gathered items to bring to the hospital, although I haven't yet packed them into a suitcase. (For a great list of what to pack, check out this post from Climbing the Pomegranate Tree) It wasn't all work, as Husband suggested that I should spend at least part of the day with my feet up. Wimbledon! The Women's World Cup! Don't mind if I do! I couldn't have planned the timing of this leave any better! It has dramatically reduced the swelling in my ankles. My feet are still a bit puffy, but I lost two pounds, which I'm pretty sure was all water weight. At times, I felt a bit guilty. If I'm able to swim, cook and run important errands such as getting my bits waxed and squeezing in a pedicure, then I should be able to work. Although the swelling has improved in my feet, it's become worse in my hands and I have carpal tunnel syndrome. I feel that I would struggle performing certain procedures. At least, that's what I keep telling myself.

Tyler has been keeping me company during my feet up time.

I had been counting down the days until this scan, as it would finally once and for all, answer the questions that had been on everyone's mind for the past twenty weeks. What would be the mode of delivery and when? I was less concerned about the mode of delivery and more curious about the when. I know how selfish this sounds, but I was really hoping for an extension that would grant me some more days of this wonderful leave. I think I have to also acknowledge that I'm freaking out a bit as we may have an actual baby really soon. Despite the pregnancy and preparing the nursery, it hit me when Husband installed the car seat and we took it to the Police Station to be insepcted. I'm driving around with a car seat in my car! Are we really ready for this? We know that this baby is going to change our lives as we know it, but how are we going to react to this change?

The technician must have obtained at least twenty measurements of my placenta and the furthest distance she could measure from the os to the placental edge was 1.8 cm. It would need to be more than 2.0 cm to permit a vaginal delivery. Jate's head was pretty high while she was taking the transabdominal measurements, but the head was more engaged during the transvaginal scan. As the head moved lower in the pelvis, it brought the placenta closer to the cervix. Half a centimeter to be precise. That seemed to seal the deal. A vaginal delivery was just not in the cards for me. I'm okay with this. Quite at peace with it, in fact. Even if the placenta had moved enough, I had decided that I would request a C/section rather than an induction if I didn't go into spontaneous labour.

The Perinatologist was detained at the hosptial and wouldn't be back until the afternoon. I was waiting for his phone call while everyone who knew we would be receiving news was texting and emailing me for an update. He called after 5:30. As he still hadn't left the hospital, he didn't have a chance to look at my images. I reported the findings as well as the recent issues with Jate's presentation and a summary of my blood pressure readings. As long as my blood pressure is within range and baby stays head down, I can schedule my C/section at 39 weeks and 4 days. My maternal side is so happy that Jate will be delivered after 39 weeks. Selfishly, I'm happy about having another week to myself. The doctor offered that we could do one more scan on the day of my Caesarean and if the placenta has moved enough, then we could convert to an induction. NO THANK YOU!

Although, it brought such a sense of relief to have this decision made and to finally have it scheduled, I had to admit to myself that I would proabably always be jealous of Myrtle and the fact that she was able to experience the wonder and beauty and all the glory of a natural vaginal birth. As I filled her in on the details, I asked if her husband slept at the hospital. (I told Husband that he can sleep at home, so at least one of us gets a good night sleep) "I think he did." she replied "We were both so tired as I was up the entire night while I was in labour..." I realised this was my opening for a C/section Women are Smug moment: "Yeah, I was offered if we wanted our case to be at 7:30 or 12:00, and I chose the noon time slot, so we'll have one last morning to sleep in..."