Last year, while I was preparing for my maintenance of certification exam, I came across this practise question in a review textbook:
1. The patient asks you about birth plans during her initial prenatal visit and inquirers as to your attitudes toward pregnant couples who wish to participate in decision making for the conduct of labour and delivery. How would you respond?
A. Birth plans are not a good idea; usually something goes wrong and the couple is disappointed
B. Birth plans are not a good idea; they frequently lead to unresolved guilt to the couple
C. Birth plans should be avoided; perinatal morbidity and mortality are usually increased
D. Birth plans are an excellent idea; everything always goes according to plan
E. Birth plans are a good idea; they involve the couple in the planning for the baby's delivery and can be an important part of the prenatal, postnatal and postpartum care
Here is a situation where I would argue that you have to read the questions carefully. If they are asking, 'what is the best answer?', then obviously they are leading you to select choice 'E'. However if the question were phrased 'what is the correct answer?', then I would go with choice 'A'. When I was working on Labour and Delivery, the majority of my patients were young girls for whom nothing about their pregnancies nor births were planned. However, there is something about the body at that age that is conducive to giving birth. Many of my patients had the all natural, unmedicated, intervention free vaginal births that the older patients on the floor desperately wanted. I always detected a sense of slight annoyance whenever one of the nurses was caring for a patient with a birth plan, but more so, the universal consensus from the nurses, to the midwives and obstetricians, to the anaesthesiologists and the OR techs, is that the more detailed the birth plan, the more likely the delivery would end up as a Cesarean. Even the Unit Clerk would ask about booking an OR if a patient handed her a 5 page birth plan upon her admission.
My thoughts on birth plans is that they can lead the couple to focus too much on the process and not the outcome and too often, disappointment is expressed when things didn't go according to plan. When Myrtle recounted her birth story, she described that she starting feeling cramping and uncomfortable around 11 PM. She went to bed and woke up around 5 the next morning and could tell she was contracting. She walked around her tiny condo for an hour and as the contractions picked up, they decided to go to the hospital. She was 5 cm upon her arrival and little Myrtle was born via a Vacuum Assisted Vaginal Delivery at 11:45 AM on her due date. Barely 12 hours of labour. Most of my patients and my infertile jealous self could only dream about having a delivery so perfect. Yet to Myrtle, there was one flaw. "I had to have an episiotomy, which I did not want." she complained. Oh, for fuck's sake Myrtle. It's not like you're at the deli and you're telling the guy behind the counter that you don't want pickles on your sandwich. I wanted to say these words to her, but as little Myrtle was in the Newborn ICU with breathing issues, I held my tongue.
Co-worker is the only patient I know who had a birth plan that went according to plan right to the letter. She drafted it right after learning she was having twins; 'I want a C/section'. Prior to learning of my placenta issues, my birth plan would have been 'let's just see how things go...' which has really become the approach for the since the discovery of the previa. As the placenta had moved past the os by 32 weeks, I no longer needed to be delivered between 36 and 37 weeks, but it still hadn't moved enough to allow for a vaginal delivery. So we had yet another follow up at 35 weeks and 5 days. The placenta was now 1.5 cm away from the os. It needs to be 2.0 cm to permit a vaginal attempt. The perinatologist that I usually see was on vacation, so of course, the one filling in offered a completely different opinion. He suggested re-scanning at 38 weeks to allow the placenta a little more time to move, and if it does, and as long as my blood pressure is controlled and the resistance index of the umbilical artery is normal, then I could go to 39 and a half weeks before he would induce. (The original perinate recommended delivery between 38 and 39 weeks due to my chronic hypertension).
So the latest birth strategery looks like this: If the follow up scan at 38 weeks indicates that the placenta has not moved enough, then we'll schedule my C/section the following week. If it has cleared 2 cm, then we'll induce at 39 weeks and 4 days, if I don't go into spontaneous labour before then. Hopefully not on July 4th. The petty aspect of my birth plan is that I desparetly want to avoid a 4th of July baby out of consideration for my English in-laws. It just feels like it would be very in-your-face to have their grandchild born on such an American holiday. Husband and I have discussing the pros and cons of each option. At times, the suggestion of a vaginal delivery makes me wishful for the conveniences of a scheduled C/section and most importantly, the opportunity to have my stomach muscles reapproximated. Other times, I feel that since we've come so far from a possible accreta and potential hysterectomy, then I sort of owe it to myself to try to avoid any major surgery by attempting a vaginal delivery. There are a few awkward logistical issues. My parents booked their flights when we thought I'd be delivery early and the baby would be 2 weeks at the time of their arrival. Now there is a chance they could arrive a week before the baby. Additionally, as we have been anticipating a Caesarean delivery, we've been factoring 8 weeks disability. My actual return date (not the one assigned to me by the DS) is predicated upon our trip back east at the end of October. If I have a vaginal delivery, it will be more costly as I'll only get 6 weeks leave and will have to take two weeks unpaid. Just as I was reflecting how shitty it is that women have take this into account with delivery decisions, Husband cheerfully piped in, "Best case scenario: you go to 39 weeks and 4 days, but ended up needing a C/section anyway!' Sometimes it's amazing how such simple concepts can rule the male mind...
So now that we've established a p-l-a-n, it's going to invite the Universe to fuck with it. The first potential variable is my blood pressure. It has been so good, I've almost been back in denial on whether or not I really have chronic hypertension. I tested myself by taking my Labetalol a few hours late and obtaining a reading. It was creeping up to 132/88. Sorry Jane, it's the real deal. I also know my well controlled blood pressure doesn't provide too much reassurance as I've seen patients go from zero to full blown severe pre-eclampsia in a day, if not, within hours. The other variable is Jate himself or herself, who won't stay head down. I suppose the former gymnast in me should be proud that he/she is essentially doing cartwheels in my uterus. At my twice weekly NST appoinments we've seen the head on the left side, the right upper side, cephalic presentation for the perinatologist, and most recently spine down transverse with the head on the right lower side. It's been like Mark Twain's description of the weather in New England; just wait a few minutes and it will change. I feel a little more encouraged as baby can spontaneously vert into a cephalic position and I've been doing the Forward Leaning Inversion and Breech Tilt, which is supposed to help with a transverse baby. I've been trying to determine the position, but it's hard to do Leopold's maneuvers on yourself as your hands are at the wrong angle. When a transverse presentation is confirmed, it feels as if I have something sitting across my lap, and I have much more pressure on my bladder when baby is cephalic. Transverse presentation is a little more frustrating to manage than a breech. If an external version is to be attempted, then an induction should follow immediately if successful as transverse babies are more likely to vert back than a breech. It's also recommended to deliver between 38 and 39 weeks as there's a higher risk for cord prolapse if spontaneous rupture of membranes occurs.
Alas, we wait and see. I still have no idea when, how or why I'll be delivered...
Thursday, 18 June 2015
Friday, 12 June 2015
If you leave, don't leave now...
Sadly, I'm old enough to remember when Bill Clinton signed the Federal Medical Leave Act (FMLA) into law, and it was considered a legislative victory and represented progress for women's rights. Twenty plus years later, it's widely recognised that FMLA protection is rather inadequate as it only secures one's job while he or she takes twelve weeks of unpaid leave after the birth or a baby, adoption or need to care for an ill family member. Additionally, FMLA is rather restrictive as one must be a full time salaried employee for at least one year at a company with more than 50 employees in order to even qualify. It is projected that 40% of employees are not even eligible for FMLA protection. Last Week Tonight with John Oliver recently broadcast a brilliant piece on the shitty state of maternity leave in the United States, and he featured some clips from the opposition to FMLA, which sound so familiar. There were claims that it would "cost jobs" and it was a "suffocating regulation being shoved down the throats of businesses and families" (from a female Congresswoman). Tom Delay, who many will remember was indicted on charges of conspiracy to violate election laws among other dodgy allegations, claimed the bill was "unfair, invasive, anti-business, anti-growth and deathly expensive". Yet less than 10% of business expressed any negative effects about complying with FMLA mandates. California broke ground in 2002 with the introduction of a Paid Family Leave, which provides partial pay for six weeks and is financed through payroll taxes. Over 90% of California businesses report a 'positive' or 'neutral' impact of the paid leave. As John Oliver describes, "It's like having an ice hockey game on at a bar. It's not bothering anyone and some people are actually really into it."
When I first spoke with the Disability Specialist (DS), I took note that she seemed reluctant to offer any information and only replied to specific questions. It would seem that she were just lazy or incompetent, but now I appreciate that she is a very diligent employee who has probably been trained to be evasive. She wouldn't tell me how much leave I could take, only that it would depend on my eligibility, which couldn't be determined until I submitted my request. I was instructed to apply for my leave 30 days before the intended date. As my latest ultrasound had revealed that my placenta is moving and my delivery date could be pushed out, I emailed the Disability Specialist to ask if it would be better to file 30 days before the earliest possible date of my leave and then change the date as needed. She never wrote back to me and as my office manager kept asking if she should open my schedule for another week, I decided to say 'fuck it' and planned to file a week later with the hope that I would need to change the date and would create extra work for the DS. At last when it was 30 days before my intended last day, I clicked on the weblink that the DS had sent me so that I could sumbit my request online. I couldn't get passed the first page before the site crashed. Repeatedly. I tried calling the 800 number that was listed, but after waiting on hold for twenty minutes, I had to leave a message. I called again and waited for another 20 minutes to no avail. When I didn't hear back from anyone at the end of the day, I called the DS and received her voicemail. I left a pissy message indicating that I did not want to have to work past my intended stop date and did not want to have to take unpaid leave just because her department didn't have their act together.
The following Monday, I finally reached the DS. There was no mention of my prior messages or email. She took my information started the process of my leave application. Two days later, I received a formal letter from her. According to my paperwork, I was approved to take six weeks off from my delivery date. She had already slated my return to work date, which was exactly six weeks to the day from my original due date. As that date falls on a Thursday, I would be expected to return on a Friday. As in 'don't be cheek enough to think you can take one more day and restart on a Monday...' The icing on the cake? She mentioned that I could use my PTO time, but according to her records, I had zero hours of stored PTO to apply. Cue freak-out from an emotional, hormonal pregnant woman.
I just couldn't escape the feeling that I would get screwed over by the process. I am a hard working, tax paying citizen who has never had to use the system, let alone have any idea how to work or manipulate it. One of our affiliate offices hired a new doctor who was about 4 or 5 months pregnant when she started working. She only took 6 weeks off, as she wasn't eligible for California benefits since she hadn't been an employed state resident long enough. I've been a full time employed resident of California for the past 8 years and I have all the receipts to prove that I've paid my taxes. I realise that she has to put something down for my return date, and it was probably arbitrary, but it's hard to believe that when you're looking at an official looking document that also states how you can be penalised if you don't return to work on your anticipated date. Still it felt insulting. As if this was all the time I was allowed to take, six measly weeks, which I know is a reality for many new mothers. She was proposing that I take the shortest possible time as I needed to get my ass back to work right away. What was so aggravating, is that thanks to my cousin, I am aware of the paid leave options provided by the state of California. Why was she seemingly so reluctant to let me know my leave options? FMLA allows me to take up to 12 weeks. I wondered how many employees wouldn't challenge this letter and would only take 6 weeks off. She doesn't actually work for our company, so there is no benefit if I take less leave, which is financed by payroll taxes and does not accrue costs our company. Actually they probably save money as they're not paying my salary while I'm out, although they lose the income generated from my productivity. Maybe she was offered some incentive to screw me over.
I sent her another email and I revealed that I had a family member who is a Human Resources director and had discussed my leave options, including California's Paid Family Leave. Her simple response: "that's a different leave. You'll apply for that when your disability leave finishes". I wanted to write back to ask when or if she even planned to discuss this leave with me and why any mention of it was omitted from the forms in my 'Leave Packet'. I sat on my hands to prevent myself from writing such a message. Firstly I figured that she would just reference the extremely vague and confusing handbook that can be downloaded from the company's intranet. Secondly, until everything is complete, it's probably best not to completely piss her off. I emailed the Bean Counter to inform her of my intended leave, which included my Pregnancy Disability Leave, Paid Family Leave and my 4 weeks of PTO, which I knew were available to me. Much to my surprise, the Bean Counter actually asked the DS to remove the arbitrary return date as she did not want my schedule to be opened, which could lead to booking erroneous appointments for patients.
The California disability leave also allows pregnant women to start their leave four weeks prior to the due date. I've always held a certain admiration for women who work up until their due date. One of my colleagues in Connecticut started contracting as she finished seeing patients in the afternoon session. We hooked her up to the office monitor and she finished her charting while banging out contractions every 3-4 minutes. Once she was done, she walked over to Labour and Delivery to be admitted and her baby was born later that night. Over the past few weeks, I've developed an apprehension as I leave the office each night. If I had to be taken out of work, how many tasks would I be leaving for others to finish? Thus, it's become a push not to leave anything for the next day. All my billing, results reconciliation and other correspondence must be complete each night. I realised that it would actually be less disruptive and less of an imposition to my colleagues to have a set end date, even if it does mean starting my leave earlier. Additionally, there really is no benefit to working longer, except that it's more time get paid on your full salary than partial disability pay. I've heard some patients say "I'd rather work up to the due date to be able to take more time off after the baby is born", but the four weeks prior to the due take is a 'take it of leave' it proposition. You can't apply it to the leave after the baby is born. My new mantra; don't be a hero. It's better to leave on your terms.
It's funny how over a year ago, I was longing to be able to take a maternity leave as I was starting to feel burnt out. As my work load has been much more reasonable, I no longer feel such a need to escape. Since I entered the work force, I've never taken longer than two weeks off at any given time. I fear I'll lose a little of my identity during my leave. I'll miss my patients. I wonder how many office policies and procedures will change while I'm gone. I wonder how rusty and out of sorts I'm going to feel after four months off. Mostly, I wonder how lonely it's going to feel going back to work without Jate. I've grown accustom to his or her company.
When I first spoke with the Disability Specialist (DS), I took note that she seemed reluctant to offer any information and only replied to specific questions. It would seem that she were just lazy or incompetent, but now I appreciate that she is a very diligent employee who has probably been trained to be evasive. She wouldn't tell me how much leave I could take, only that it would depend on my eligibility, which couldn't be determined until I submitted my request. I was instructed to apply for my leave 30 days before the intended date. As my latest ultrasound had revealed that my placenta is moving and my delivery date could be pushed out, I emailed the Disability Specialist to ask if it would be better to file 30 days before the earliest possible date of my leave and then change the date as needed. She never wrote back to me and as my office manager kept asking if she should open my schedule for another week, I decided to say 'fuck it' and planned to file a week later with the hope that I would need to change the date and would create extra work for the DS. At last when it was 30 days before my intended last day, I clicked on the weblink that the DS had sent me so that I could sumbit my request online. I couldn't get passed the first page before the site crashed. Repeatedly. I tried calling the 800 number that was listed, but after waiting on hold for twenty minutes, I had to leave a message. I called again and waited for another 20 minutes to no avail. When I didn't hear back from anyone at the end of the day, I called the DS and received her voicemail. I left a pissy message indicating that I did not want to have to work past my intended stop date and did not want to have to take unpaid leave just because her department didn't have their act together.
The following Monday, I finally reached the DS. There was no mention of my prior messages or email. She took my information started the process of my leave application. Two days later, I received a formal letter from her. According to my paperwork, I was approved to take six weeks off from my delivery date. She had already slated my return to work date, which was exactly six weeks to the day from my original due date. As that date falls on a Thursday, I would be expected to return on a Friday. As in 'don't be cheek enough to think you can take one more day and restart on a Monday...' The icing on the cake? She mentioned that I could use my PTO time, but according to her records, I had zero hours of stored PTO to apply. Cue freak-out from an emotional, hormonal pregnant woman.
I just couldn't escape the feeling that I would get screwed over by the process. I am a hard working, tax paying citizen who has never had to use the system, let alone have any idea how to work or manipulate it. One of our affiliate offices hired a new doctor who was about 4 or 5 months pregnant when she started working. She only took 6 weeks off, as she wasn't eligible for California benefits since she hadn't been an employed state resident long enough. I've been a full time employed resident of California for the past 8 years and I have all the receipts to prove that I've paid my taxes. I realise that she has to put something down for my return date, and it was probably arbitrary, but it's hard to believe that when you're looking at an official looking document that also states how you can be penalised if you don't return to work on your anticipated date. Still it felt insulting. As if this was all the time I was allowed to take, six measly weeks, which I know is a reality for many new mothers. She was proposing that I take the shortest possible time as I needed to get my ass back to work right away. What was so aggravating, is that thanks to my cousin, I am aware of the paid leave options provided by the state of California. Why was she seemingly so reluctant to let me know my leave options? FMLA allows me to take up to 12 weeks. I wondered how many employees wouldn't challenge this letter and would only take 6 weeks off. She doesn't actually work for our company, so there is no benefit if I take less leave, which is financed by payroll taxes and does not accrue costs our company. Actually they probably save money as they're not paying my salary while I'm out, although they lose the income generated from my productivity. Maybe she was offered some incentive to screw me over.
I sent her another email and I revealed that I had a family member who is a Human Resources director and had discussed my leave options, including California's Paid Family Leave. Her simple response: "that's a different leave. You'll apply for that when your disability leave finishes". I wanted to write back to ask when or if she even planned to discuss this leave with me and why any mention of it was omitted from the forms in my 'Leave Packet'. I sat on my hands to prevent myself from writing such a message. Firstly I figured that she would just reference the extremely vague and confusing handbook that can be downloaded from the company's intranet. Secondly, until everything is complete, it's probably best not to completely piss her off. I emailed the Bean Counter to inform her of my intended leave, which included my Pregnancy Disability Leave, Paid Family Leave and my 4 weeks of PTO, which I knew were available to me. Much to my surprise, the Bean Counter actually asked the DS to remove the arbitrary return date as she did not want my schedule to be opened, which could lead to booking erroneous appointments for patients.
The California disability leave also allows pregnant women to start their leave four weeks prior to the due date. I've always held a certain admiration for women who work up until their due date. One of my colleagues in Connecticut started contracting as she finished seeing patients in the afternoon session. We hooked her up to the office monitor and she finished her charting while banging out contractions every 3-4 minutes. Once she was done, she walked over to Labour and Delivery to be admitted and her baby was born later that night. Over the past few weeks, I've developed an apprehension as I leave the office each night. If I had to be taken out of work, how many tasks would I be leaving for others to finish? Thus, it's become a push not to leave anything for the next day. All my billing, results reconciliation and other correspondence must be complete each night. I realised that it would actually be less disruptive and less of an imposition to my colleagues to have a set end date, even if it does mean starting my leave earlier. Additionally, there really is no benefit to working longer, except that it's more time get paid on your full salary than partial disability pay. I've heard some patients say "I'd rather work up to the due date to be able to take more time off after the baby is born", but the four weeks prior to the due take is a 'take it of leave' it proposition. You can't apply it to the leave after the baby is born. My new mantra; don't be a hero. It's better to leave on your terms.
It's funny how over a year ago, I was longing to be able to take a maternity leave as I was starting to feel burnt out. As my work load has been much more reasonable, I no longer feel such a need to escape. Since I entered the work force, I've never taken longer than two weeks off at any given time. I fear I'll lose a little of my identity during my leave. I'll miss my patients. I wonder how many office policies and procedures will change while I'm gone. I wonder how rusty and out of sorts I'm going to feel after four months off. Mostly, I wonder how lonely it's going to feel going back to work without Jate. I've grown accustom to his or her company.
Thursday, 4 June 2015
Welcome to the Jungle...
This is the photo that inspired the jungle theme. Many years ago, I spotted it at the Embarcadero craft market, and even though I didn't think I would want to have a child at that time, I decided that I would want this photo in the nursery. I bought some other prints from the artist, so I was able to track down her email address and made arrangements to order this photo.
The crib was provided by my cousins, although we purchased a new mattress. It was used by both of their boys and had been stored in their garage for the past few months. We cleaned it with some Chl.orox wipes and a Mr Clean Magic Eraser, which really does have magical powers. I don't think the crib has been this clean since they first took it out of the box. It took Tyler all of two seconds to find his way into the crib...
What do you mean this is not my room?
The glider will go into this corner. The baby supply store has signs indicating that they offer a plethora of fabric and colour choices, but they don't state that a custom order takes at least twelve weeks to receive. Twelve weeks! That's almost an entire trimester! We'll move the bassinet (also offered from my cousins) into our room once the baby arrives. I thought the bassinet seemed a little flimsy, but it has been used by four other infants, so that's a good indicator of quality control. Someone else has offered to test out the bassinet for us.
When we thought we might be facing a pre-term delivery and NICU stay, Husband wanted to wait until baby was born before purchasing any furniture for the nursery. I convinced him to take a leap of faith, which was a good idea, as I tried to order this changing table from Ama.zon, only to discover that it was backordered for weeks. Fortunately, I found it at Way.fair for almost half the price! Score!
We're going to try cloth diapering through a local service. I was cloth diapered and I felt proud that my parents were so environmentally conscious, until my mother explained that it was really because they were poor. We found that the cost of using a diaper service is about the same as using disposables, but the other advantage of using a service is that their washing process uses less energy and less water than cleaning the nappies yourself. Husband has been busy practicing his technique.
I tried to find a simple mirror as I was going to stencil some animal designs on it, but in my search, I came across this mirror from P.ier1 and I decided that I had to have it. Unfortunately, it was also backordered, but I had a saleswoman at a local store track one down for me and secure the sale price! Not only does it compliment the colours in the room and is an interesting decorative piece, I love how it captures the reflection of the tree design and other pictures in the room. It took us nearly three hours just to hang the mirror and the pictures. Really glad we didn't put this off until after the baby's arrival...
The final detail was a small little basket for toys. I made the lining myself. I wanted to place the stuffed animals on a small shelf, but it would impede opening the closet door, so on the floor they sit...
It was a lot of fun to put the nursery together and we hope Jate likes his or her room. The jungle theme not only works well from a gender neutral standpoint, but 'welcome to the jungle' seems to be a good metaphor for parenthood...
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.
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.
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 tostalk 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.
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?
Total to Date: $10,425
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
[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.
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.
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.
Sincerely,
Jane
Jane
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