2nd Time Unlucky

So it's happened again.. another 'mis'.  We found out we were pregnant several weeks ago.  I'd done a test 29 days after my last period on the 4th December and it had come up negative.  I'd then done tests on the 8th, 9th and 12th of December and they all returned very faint positive results.  I was booked in to have my first appointment and ultrasound with Dr Holden on Monday 22nd December, but I was also concerned that there was no increase in the boldness of the lines over the course of those days, so I had bloodwork done twice the following week.  My levels were increasing as expected by that stage and I was hopeful going to meet with Dr Holden on the 22nd. Going by a 'normal' cycle, which I know mine are not anyway, I should have been around 7 weeks. I knew that I wasn't going to be 7 weeks because of the results of the initial tests.  I knew that I must have ovulated very late in my cycle.  Dr Holden said that I was very early, about 4 weeks, and to have another ultrasound two weeks later.

It was a long two week wait, which crossed over Xmas and NYE.  A few days before Christmas I'd felt like my symptoms had weakened, and that I didn't feel as pregnant because I wasn't as nauseous or hungry.  We arrived at the 51st location of Columbia Medical for the sonogram on Monday 5th January.  I told the sonographer that I had previously had a miscarriage and to tell me if things didn't look right, as the last time the sonographer had kept telling me to speak with my Dr rather than giving me a conclusive answer.  As soon as the screen came up I knew it didn't look right.  We were expecting a foetus and heartbeat by this point, and there was only a small blurry mass of tissue, with nothing inside.  I knew it was another blighted ovum.  I think I had been expecting it, not only because of my lack of symptoms but because we know so many people who have had miscarriages in a row.  It's very sad and upsetting, but as Mark keeps reminding me, we must think ourselves lucky and move on quickly.  It was very early days, and we have a beautiful little boy who reminds us how lucky we are every day, and that is something very special.

I had the MVA (Manual Vacuum Aspiration) procedure on the Friday of that week.  It was much more painful than I was expecting.  The five injections in my cervix were extremely intense, especially the last two, after which I thought I was about to faint!  I felt fine and normal once it was over, and took the rest of the day off from work.  I barely had any bleeding following the procedure until the following week, when I started getting spotting and then heavy bleeding on the Thursday.  We went away to Mexico that Saturday, and unfortunately I was bleeding heavily and expelling large clots for the first half of the holiday, which wasn't conducive to a bikini break!  Thankfully, it subsided towards the end of the week.  Two and a half weeks after the procedure, the bleeding is only just tailing off, which is frustrating, but I know it's the process my body has to go through to ensure that it's ready to go through a cycle in 4-5 weeks and for us to be able to try again after that.

N.B. I found this paper on MVA, which goes into the detail of the injections etc. that I had during the MVA http://www.ipas.org/~/media/Files/Ipas%20Publications/MVAPAIN2E09.ashx

A Bump in the Road

Having not had a period whilst I had been breastfeeding, I wondered how long it would take my body to have a cycle. I'm not sure if I had been ovulating while I was breastfeeding, as I hadn't fallen pregnant in that time. I had gradually dropped feeds from our return to NYC, coming down to two feeds in the two weeks that I had in NYC prior to returning to work. Hunter was on formula for the two day feeds and still being breastfed morning and evening. In April, I dropped the evening feed to a formula feed and then finally in May I dropped the morning feed to formula. Two weeks later on 23rd May, I got my period. We were going on holiday to Turks and Caicos the next day, so I was a bit annoyed that I was going to have to deal with it on holiday as I'd heard from friends that the first period you have after pregnancy and breastfeeding is long and heavy. I needn't have worried, as it was a very light period and only lasted a couple of days. Looking back now, I wonder if that wasn't enough of a 'clean out' for my body to be prepared to carry another baby.

I did a pregnancy test twenty-nine days after the 23rd May, but it came back negative. I was a little disappointed, but thought that it would have been miraculous if we'd fallen pregnant first time around after one period again. A week and a half went by and on the Tuesday, I started to feel a little bloated and crampy. I also noticed that I wasn't able to run for as long at the gym, which was a similar symptom that I'd had with Hunter. I did a test that night and the test came back with a very confused blue screen; you couldn't make out any lines at all. I told Mark that night that I thought I was pregnant and he was very excited. I did another the next morning, and it came back very pale but positive. Mark was so excited that he started telling people we were pregnant. I thought it was too early to start telling people, but didn't see the harm in it given that we had had such a smooth ride with Hunter.

I rang Dr Holden's office and booked in to have an appointment with him on the 14th of July, which would be my 7 week mark and first ultrasound. That weekend was July 4th and we had been invited to go to Long Island to stay with friends. I still couldn't believe that I was pregnant, so I did another on the Saturday and it came back much bolder this time around. It was a long week's wait for the ultrasound appointment and when it finally came I was quite nervous. Up on the screen, Dr Holden pointed out the gestational sac but said that it looked like it may be too early to see a foetus. We had a quick chat about next steps, which he said would be to take blood that day and then again a few days later to see that my hCG levels were increasing appropriately. After that, I would have a viability scan the following week to make sure that everything was progressing as expected. I asked him if there was a chance that it could be a miscarriage and he said yes, but that we would see.

I had the blood results come back on the Friday. Dr Holden said that the hCG levels were increasing nicely and that the next step would be to book in for a viability scan. I was quite confident going in for the viability scan. I thought that everything must have been progressing as expected if the hCG levels were also. I knew straight away that something wasn't right when I saw a big blob on the screen with nothing inside. The sonographer was being very aloof when I asked her if it was a miscarriage, saying that I would need to speak to Dr Holden. It felt like she was treating me like idiot. I had more blood done and I remember crying to the nurse, Patti. She was trying to reassure me, saying that nothing was certain yet and that Dr Holden would be able to give me more information. I knew that it couldn't be good. I had been expecting to see a foetus and a heartbeat, but there was only an empty sac. I called Mark as soon as I was out and he didn't quite understand it at first. He just thought that I meant it was too early to see anything. I told him that it didn't look good and he started to realise the same. I hopped in a cab and went home, but ended up going back into work because I needed to take my mind off it until I spoke with Dr Holden. He called me in the afternoon and told me that it was "a mis". I felt numb. He was speaking in such a soothing tone that I thought he must have dealt with this many times before. I couldn't help but cry. We spoke again that evening and he explained in detail what my options were. He told me that I had three options; I could wait until the tissue expelled itself, which could take weeks, or I could take some meds to expel the tissue, which should happen 24-48 hours after taking them, or I could have a D&C, a surgical procedure that has some risks (though extremely rare), such as puncturing of the uterus. I decided to go with the meds. They didn't work the first time around, so I had to take them again a week later; apparently I was part of the 3% who they don't work for the first time. A week later, I only expelled for a day. I had a sonogram a couple of days later, which showed tissue still there, so Dr Holden gave me a prescription for different meds to expel the remainder. Nothing happened. We went away on holiday to Barbados to get our visas processed (I was changing jobs in the middle of all of this) and luckily nothing happened while we were on holiday. The day after we arrived back, it started again and I expelled blood and gross-looking tissue for two weeks straight, beginning my new job right in the middle. A couple of weeks past and I started bleeding again. I thought it was my period, but I've since learnt that there has to be around a four week gap (at least) for a proper hormonal cycle to occur. It went on for a week, and then almost a week later I started bleeding again. I got in touch with Dr Holden and he told me to book in for a sonogram to see what was going on. The sonographer told me that there was still a lot of tissue remaining and said that I would need to see my Dr as soon as possible, as the tissue may have been there so long that it could be difficult to remove. Dr Holden was busy the next day, so I was booked to see Dr Perera, another Dr in his team, at the hospital to have an MVA (manual vacuum aspiration). Dr Perera said that she wanted to have another look inside my uterus before she began anything to make sure that it was the correct procedure. She pointed to the remaining tissue on the screen, showing that it was taking up most of my uterus. She then said that she was going to bring in another Dr to get a second opinion about the procedure. The second Dr came in and they both agreed that it was best to do a D&C in the operating theatre and put me under a general anesthetic in case of excessive bleeding and also to make it more comfortable for me, in case the remaining tissue was difficult to extract. I was booked in to have the D&C the following week with Dr Holden.

Finally, the 8th of October arrived. I went through to the operating theatre after pre-op and was put under general shortly after. I woke up as if nothing had happened. I rested in the post-op room until Mark arrived, and was told to take it easy for the rest of the day. I didn't have any pain or cramping as I was told I might, so didn't need to take any painkillers at all. I couldn't believe how good I felt after the D&C and really wished I'd done it right at the beginning to save a lot of time and emotional energy. It was a huge relief to know that it was finally all over. I still feel the loss, but I am grateful that it did not progress to a foetus, as I think it would have been much more devastating to see the beginnings of a little baby itself. It was a bump in the road that went on for months and months, but hopefully we will have another little one with us soon enough.

D Day - Delivery Day

This post has been sitting in draft for some time, and unfortunately I can tell that my blog might get somewhat neglected now that Hunter has arrived!  Spare time is precious these days, and it's usually spent making sure I have a shower and getting Hunter and myself out of the apartment each day for a good wander with the stroller, either down to Tribeca to see Mark or to Wholefoods, Buy Buy Baby, a pharmacy or to have a 'what's happening in the world' catch up with someone... but I'll go back to D Day before I carry on with the most recent weeks.

On the day of Hunter's birth, we arrived at the hospital just before 6am.  There was barely any traffic on the West Side Highway so it was a very quick ride up to Columbia Medical University / NY Presbyterian Hospital in Washington Heights, past Harlem.  Mark and I had a nervous wait in the maternity reception before we were asked to go to the pre-op rooms, which was followed by another anxious wait.  Of course, naturally you're still thinking about what could go wrong at this point; will the c-section go smoothly, will he be healthy, what will he look like, will he have a birth mark all over his poor little face etc.!  I changed into a hospital gown and had a cannula inserted.  The baby's heart rate was being monitored, as well as my contractions, which had apparently already started although they were too mild for me to notice anything physically.

We were originally due to go in at 8am, but that came and went.  We were told by our nurse that there had been two emergency caesareans that had taken priority in the operating theatres, so we had to wait until we were told anything further.  Finally close to 10am, after what seemed like an eternity, we were told that we would be going in shortly.  Dr Holden arrived at the reception desk and we waved a quick hello.  I'd had to go to the toilet several times due to nerves, as well as the drip running through me.  Unfortunately, I hadn't been able to eat anything after midnight, so I felt quite clogged up when normally my breakfast would get me moving!

Dr Holden came to collect me and Mark was to wait until they had done all of the pre-op stuff, such as my epidural etc..  He had been given his own hospital gown to put over his clothes and would be picked up when they were ready.  I walked in with Dr Holden, the anesthetist and the rest of Dr Holden's team.  Dr Holden asked me to sit on the hospital bed facing him and to slouch.  He helped by putting his hands on my shoulders, and the anesthetist inserted the needle with the anesthetic that was to numb the area where the epidural would be inserted.  I felt a tiny prick, which wasn't painful at all.  Dr Holden then told me to be very still for the epidural, which was going in next.  I was quite nervous, but it was over in no time and they quickly spun me around to lie on the bed.

A big blue sheet was drawn up in front of my chest so I couldn't see past it.  The anesthetist was on the right side of me, monitoring the anesthesia by what I was able to feel.  It was taking longer than expected to take effect, so they tilted my body so that my head was lower, allowing gravity to move the anesthesia more efficiently.  Mark came into the room shortly afterwards and stood on my left side.  He started peeking over the sheet and despite being asked to sit down because "many dads have been known to pass out", he actually tried to convince them that he would be fine because of all the fish he has gutted!

Dr Holden had already told me that I would feel poking and prodding but no pain.  Soon he said to me from the other side of the blue sheet that I was about to feel a lot of pressure.  It was a crazy feeling, like I was being pushed down into the floor a few times, and then all of a sudden I felt this huge WHOOSH and knew that the baby had come out.  Mark and I had been looking at each other the whole time and had both started crying.  It was such a colossal wave of emotion, like nothing I've ever felt before.  They asked if Mark wanted to go over to see the baby under the heater, where they were cleaning him up and performing all of the required tests, while I was stitched up.  It was very strange hearing his first cry from behind the blue sheet and not being able to see him.  Mark came back around and told me he looked like my Dad, which wouldn't be such a bad thing later in life but I wasn't sure how cute a baby that would make him!  Though, once the swelling from the fluid retention had gone down, he looked quite different and very cute.

Once the anesthesia began to wear off, I started to feel the pain of the incision.  I actually couldn't move out of the bed for two days from the pain, even though I was taking some fairly hardcore painkillers.  They managed to help me out of bed on the third day, so that I could shower and get cleaned up.  I had Hunter in the room with me during the entire hospital stay, as opposed to my room mate who's baby was in the nursery for most of the time apart from feeds.  Mark had been coming up to the hospital to spend each day with us, some days running up along the Hudson. It was a nice feeling being in the hospital with doctors and nurses to help you with everything and give advice.  By Friday my milk came in, which was extremely painful and looked quite ridiculous!  I still felt totally battered and not in any state to go home, so I requested to stay in an extra night.  On Saturday, we packed everything up, left with numerous supplies of things from the hospital (diapers, wipes, baby blankets, giant hospital pants for me!), and made our way home as a family.  It was such an overwhelmingly scary prospect that I was totally overcome with emotion when we came home and cried (happy tears!) for some time!

The Lead Up

So I'm now writing this post following Hunter's birth, and in this sleep-deprived state that I am permanently in at the moment, it is very weird thinking back to pre-Hunter days! 

The few weeks prior to the birth of the baby really seemed to fly by.  It was great having the time off work to prepare, as I made countless visits to various stores, in particular Buy Buy Baby, the huge baby department store on 7th Avenue in Chelsea, which has everything you could ever imagine baby-related.  It was also nice being able to rest up in between.  My hip was still quite painful during the night, so it was good to be able to relax when I wanted to for as long as I needed to.  The weather was scorching and hotter than anything I had experienced in years.  I made sure I drank loads of water each day, and some days were spent inside in front of the air con and fan.  A few days before the baby was born, I didn't leave the apartment until 7pm that evening because of the sweltering heat outside, and even at that time the humidity made it still feel like it was more than 40'c.

The date of the delivery was initially scheduled in for Friday 19th July.  We found this out early in the week prior.  I had always wanted the birth to be as close to my due date (25th July) as possible, so asked Dr Holden if we could move it closer to the 25th.  The dates that Dr Holden was working around the 25th were already booked up, but if someone went in to labour earlier, then I would be able to take their slot.  Closer in on July 17th, a slot on the 24th came up, but Dr Holden had said that the 23rd was better for him, so if a slot was to come up for that day, it would be ours.

On July 22nd, the news of Princess Kate going in to labour was on every channel and people were eagerly awaiting the news of the future King's birth.  I was in the Chelsea Markets with my girlfriend, Lucy, who was over from Australia when I received a call from Dr Holden's secretary to tell me that a slot had come up for the 23rd, the next day, and could we be at the hospital around an hour and a half before our 8am delivery.  It suddenly felt so surreal that our baby was to be delivered the next day, in a matter of hours.  I called Mark and told him, 'We are having a baby tomorrow!'.  He was really excited.  It was so weird to think that we had just one more night of 'the two of us' before we became a family.

Later that afternoon, there was news that Princess Kate had given birth to a baby boy named George. It would have been cute to have our baby born on the same day as the future King, but our little guy gets his own day the day after!

The Final Sonogram

Mark and I were both excited and nervous for the final sonogram on the 25th of June.  Mark hadn't been able to attend previous sonograms, so he was excited to see the baby in the live scenario and we were both looking forward to seeing how different he looked compared to earlier pictures.  I was also anxious to see if the placenta had moved and whether the decision about the birth was taken out of my hands.

The baby was facing down and towards my spine, which unfortunately made it difficult for the sonographer to get a good angle for us to see him properly.  It was amazing to see the intricate bone structure of the baby, his spine etc..  The sonographer performed several checks, including making sure the kidneys looked healthy, which she advised is an additional Down's check.  She said that everything was great, and that also the placenta had moved away from the cervix.

Following the sonogram we met with Dr Holden and during our appointment he ran through all of the risks associated with a caesarean birth (http://www.babycentre.co.uk/a1029062/caesarean-birth-what-are-the-risks-and-benefits).  Many of these are very scary, however as I have mentally prepared myself for a caesarean throughout my pregnancy, I have decided to continue to plan for the caesarean birth.  Dr Holden said that I could change my mind at any time, but I know that my decision is unlikely to change at this stage.

We discussed the date that the baby would potentially be born, and Dr Holden is going to check the days he is in the hospital during my 40th week (19th-25th July), so that we can schedule in the caesarean.

I finished work and began my leave on June 30th.  I'm now on 'short-term disability' leave in advance of the birth of the baby, and my twelve weeks maternity leave begins from the date of birth.  In recent weeks, my hip has become extremely painful during the night and I'm not getting much sleep at all, so it's a huge help having the time prior to the birth to prepare both mentally and physically for the arrival of the baby, as well as to have the time to make sure that everything is in order before it all gets crazy!

To C or Not to C

For as long as I can remember, I had always thought that I would prefer to have a planned caesarean section over a natural birth.  This had stemmed mainly from the traumatic stories I'd heard from many friends of mine who had had nightmare natural births, most with epidurals.  My sister-in-law had a prolapsed uterus following her labours, which meant that she could literally feel her uterus inside her cervix, and had to undergo a hysterectomy to have it treated.  Some other girlfriends of mine who had also had natural births had told me some horrific stories, where they had haemorrhaged or other dramas had occurred with the baby during the birth, such as the umbilical cord being wrapped around the baby's neck causing the baby to lose air and it had all gone pear-shaped, or forceps or the suction tube being used to get the baby out, which is quite a distressing way to helplessly see your little baby be brought in to the world.  Other girlfriends had told me that it's never the same again 'down there', which also concerned me!  Also, for one reason or another, several other girlfriends had ended up having emergency caesareans, so all in all, I was more of a proponent for a planned caesarean than a natural labour.

Once I fell pregnant, however, I became more open to the idea of going with the flow and letting nature take its course.  At one of the appointments with my OB/GYN he had said that the normal process was to go down the natural route, unless there was something that precluded this from happening.  So at that point, I was becoming more willing to accept that I would probably experience a natural birth in all of its glory.

When the time came for the anatomy sonogram, it hadn't occurred to me that one of the checks the sonographer would perform, in addition to confirming whether the baby itself was anatomically correct, would be to check what position the placenta was sitting in.  Towards the end of the sonogram, she said that she had noticed that the placenta was sitting low, and would conduct an internal sonogram to get a better view of its exact position.  I was unable to recognise much on the screen, but she pointed to a large blob that she said was the placenta and that it was sitting quite close to the cervix.  She had one of the OB/GYNs come in and explain to me what it all meant.  She said that it was too early to be concerned about, as most placentas that are sitting low move up as the uterus expands throughout the pregnancy, but that they needed to make me aware just in case it came to the point later in the pregnancy where it had remained there so it wasn't a surprise.  I had my appointment with my OB/GYN shortly after and we talked briefly about it.  I asked him whether it was common and he said that it was not really common, but not uncommon.  I've done some reading since, and if the placenta remains in a position that is close to, partially or fully covering the cervix, a diagnosis of 'placenta previa' is given, and this only occurs in around 1 in 200 pregnancies.  My OB/GYN added that it would be checked again at around 36 weeks and it would be then that the call would be made as to whether or not a C-section is the recommended method of delivery.

Finding out that the placenta was sitting low made me wonder whether I would be truly happy if I had to have a planned c-section with the decision taken out of hands.  One of my girlfriends has had two planned caesareans in the last few years and said that she has no regrets whatsoever.  There was no stress or drama for either her or the babies, and her recovery was relatively quick.  She was up and walking same day, and started exercising again after 6 weeks, with only a 9cm scar to show for it, and this will usually fade well.  The added bonus is, of course, that there is no wear and tear 'down there';'The Fanny Saver', as many girlfriends of mine refer to it as!  Other women I've spoken to, which include those who have actually had both, have said that if they had to do it again, they would have the caesarean any day.  An additional plus would be, I imagine, that it's also a much less stressful situation for the father-to-be to be in, having heard how traumatised some of my girlfriends husbands were following their respective labours and deliveries!

One of my other very close girlfriends who recently gave birth in London had an epic labour of 50 hours, which encompassed water birth, hypnosis, induction and finally a c-section.  She said that at the end of it all, the epidural and c-section were amazing.  I think she is amazing for continuing that long without demanding a c-section!  After managing through a hellish 50 hours of pain and agony from a natural birth, I think I'd be quite disappointed if I ended up having a caesarean in any case!  She said that she didn't get the level of advice or care that she would have hoped for, and was actually discharged from the hospital the day after her delivery!  Here in the US, the hospital stay is 2-3 nights following a natural delivery or 4-5 nights following a caesarean.

I'm almost more inclined now to once again prefer a safe, planned c-section.  I've done a lot of reading about the operation as well as the recovery, so am not naive or ignorant to it.  I know that the pain around the incision and other abdominal discomfort will be immense, but I think I am prepared to put up with whatever I need to post-birth if the trade off is not going through the stresses and risks associated with a natural birth.  It's no right of passage for me to experience child birth, and if the placenta remains in a low-lying position it is out of my hands anyway, but I'm now completely fine with that.  With the extra time in hospital, I will also get a good chunk of post-delivery care from the doctors and lactation consultants, which will be great.

At one of my last appointments with my OB/GYN, I asked him what the options were if I was actually quite partial to a caesarean.  He said that if the placenta has moved when it's checked again at 36 weeks, it will also be then that we could have a chat about whether I then want to elect for a caesarean.  More recently, we've been talking as if I am having a c-section whether or not the placenta has moved, as I've become so used to the idea of having it.  I did have some concerns about having a caesarean after reading articles that said that babies born by planned caesarean before 39 weeks are more likely to have breathing problems than those delivered vaginally or by emergency caesarean.  My Dr reassured me, though, that they do them after 39 weeks in any of the 7 days leading up to the due date, so at this stage our little boy will be born between the 19th and 25th of July.  The actual date will be determined in early July when my Dr knows his schedule for the hospital and we will then book it in, which seems quite bizarre!

Pregnancy Bump & Weight

One of the quite funny (or mostly irritating!) things I've found during the pregnancy is strangers giving their opinion as to what sex they think the baby is, based on either the shape of the bump or the weight that I'm carrying.  I'm sure every pregnant woman goes through the same thing!  Early on in the pregnancy, I had a few people who I didn't know well at all tell me that they could tell that because of the areas I'd already put weight on (thanks!), I was having a girl.  They said that 'apparently' just a bump with not much weight gained elsewhere means you're having a boy.  Now that we know we're having a boy, it's funny that some people are now saying to me that it's a boy bump, though I think that's because my bump is so huge rather than anything else!  I think in the early stages when there is not much bump to see, that it's impossible to make a judgement as to what sex the baby is.  Plus, other girlfriends of mine who have recently had girls barely put on any weight at all.

Now that I'm in the later stages of my pregnancy, I can certainly tell that as the bump is growing, my lower half is responding in much the same way!  I'm still trying to get to the gym regularly during the week, but I've not done any running at all since I discovered I was pregnant, as it just isn't comfortable.  Even brisk walking now is a stretch (literally!), so I'm relying on the elliptical (cross-trainer) as my main form of exercise, which I've found to be the most comfortable with the ever-increasing bump and weird weight distribution.  It feels lower impact than even a fast walk, and I can try to target my legs and not twist at all while holding on!  It's also an added bonus being able to watch E!News when I go up to the gym at work during my lunch break.. ha!

I am almost gagging to be able to run again.  It's not that fun being limited to less effective exercise when you're used to a regular and more effective exercise routine that balances out a healthy appetite!  At this stage, it won't be until early September that I'll be running, following the recommended six week wait after birth.. gah!