What Are the Chances?

En route to our 20-week ultrasound last week, I was nearly overwhelmed with nerves. I've mentioned before that I have tended to approach each appointment with a stoic attitude, prepared for the worst. My biggest concern this time would be that the ultrasound would show no kidneys, or some similar malformation that is not consistent with life outside the mother.

I tried to calm myself down, thinking "what are the chances of something like that happening, especially when I've already had such unlikely things happen to me?" But for anyone who's repeatedly been on the wrong side of the stats, this is less than compelling. I had two miscarriages in a row (there's a 1 in 20 chance of this happening) and then found out I had a rare uterine malformation (there's an estimated 1 in 6000 chance of this happening). I'm no stranger to the short end of the statistics.

Steve came with me to this appointment. We had to wait longer than usual in the waiting room, and I tried to remain calm while the clock ticked on. After what seemed like a long time, we were called back. The ultrasound tech started doing her thing. Once again, the little bugger was deemed "very active" and it took her a while to check all her details. Finally, she announced that everything looked normal, and I was finally able to relax.

I did confirm from the doctor that I am already having contractions. He said I have an "irritable uterus" and told me that's pretty normal for a woman with a unicornuate uterus. He told me to stay hydrated and lie down when the contractions come, and he gave me the signs to watch for that would indicate I should hightail it to the hospital. I've been chugging Gatorade ever since.

We also found the baby's sex. I'd had a strong feeling that it's a boy. Of course, I had a 50-50 chance of being right. I was shocked to find out for sure: it's a girl!

More Perspective

I had a checkup today to ensure my cervix was still behaving. (Thankfully, it was. All looks good for now.)

While I was waiting in the exam room at my high-risk OBs' office, I noticed an appointment schedule on the bulletin board. It listed women by name, and included a "notes" field. In the notes field were things like, "triplets -- wants reduction" and "blood clot in neck." Leaving aside the obvious privacy concerns, it kind of drove home for me how lucky we have been so far in this pregnancy.

Sure, we have some adversity. But things could be a lot worse.

Looking for Meaning Where There May Be None

One of the odd symptoms I had in early pregnancy was an apparent increase in the intensity with which songs would go through my head on endless repeat. Since I subscribed to XM a few years back, the variety of options for my internal jukebox has increased exponentially, but suddenly that seemed to make no difference.

I was about five weeks pregnant when I found myself struck with insomnia, while Reba McEntire's "Fancy" rolled through my head, over and over, through the wee hours of the night. In case you aren't familiar with the song, it's about a dying mother who realizes that her teenage daughter has only one way out of poverty, and it's via the proverbial Oldest Profession.

She handed me a heart shaped locket that said
To thine own self be true
And I shivered as I watched a roach crawl across
The toe of my high heel shoe
It sounded like somebody else that was talkin
Askin' "Mama what do I do?"
She said "Just be nice to the gentlemen Fancy
And they'll be nice to you"

She said "Here's your chance Fancy don't let me down
Here's your one chance Fancy don't let me down
Lord forgive me for what I do, but if you want out, well it's up to you
Don't let me down now, your mama's gonna move you uptown."

Well, that was the last time I saw my ma
The night I left that rickety shack
The welfare people came and took the baby
Mama died and I ain't been back
...
I charmed a king, congressman
And an occasional aristocrat
Then I got me a Georgia mansion
and an elegant New York townhouse flat
And I ain't done bad

A strange song to have stuck in my head, but maybe the message, if there is one, is that Fancy triumphs over adversity in the end.

A couple of weeks later, the Estelle/Kanye West song "American Boy" kicked off its rotation on my internal jukebox's endless repeat.

Take me on a trip, I'd like to go some day
Take me to New York, I'd love to see LA
I really want to come kick it with you
You'll be my American Boy.

This went on for several days. I wondered if my brain was trying to tell me something about the sex of the little bean growing inside of me. At this point, though, I remained completely unconvinced that this pregnancy had much of a chance of success. I tried to just tolerate my internal soundtrack and go about my business.

A week or so after that, as the nausea descended heavily upon me, came another unique selection. The Smiths' "The Boy With a Thorn in his Side" began playing in my head on endless loop.

If they don't believe us now,
will they ever believe us?
And when you want to live, how do you start?
Where do you go? Who do you need to know?

In addition to the clear connection to a fragile life, I noted with interest the gender-specific title, and the fact that my UU condition causes all my pains and twinges to be localized to one side of my abdomen.

A thorn in my side, indeed.

Later, as the 12-week nuchal screen for chromosomal disorders rolled around, my anxiety again neared a peak. The concern nagged at me that we'd find no heartbeat, and if it was still alive, we'd get results that indicated a high chance of abnormalities.

Around the same time, though, "One Step at a Time" by Jordin Sparks (yes, the American Idol winner -- don't judge) started up on the old internal jukebox. Desperate for some sort of philosophy to cling to, I locked onto this one.

Hurry up and wait
So close, but so far away
Everything that you've always dreamed of
Close enough for you to taste
But you just can't touch
...
Now you're feeling more and more frustrated
And you're getting all kind of impatient
Waiting
We live and we learn to take

One step at a time
There's no need to rush
It's like learning to fly
Or falling in love
It's gonna happen when it's
Supposed to happen that we
Find the reasons why
One step at a time

At the test, we saw the little bean jumping and flipping around. Steve was fascinated by the ultrasound images. We got great results from the screen. And as of yesterday we're at 16 weeks and counting.

One step at a time, right?

Thanks to metrolyrics.com for most of the lyrics, with a tweak by me here and there. ;)

Step Right Up. Take a Chance. Everyone's a Winner

Only a few posts ago, but a long time ago in blog years, I mentioned that Steve and I were headed to Emerald Isle, NC.

It was a great vacation on a beautiful island.

We hung out on the deck in our little beachfront cottage, cooked out on the old grill, ate lots of seafood, drank a few beers, and relaxed as never before.

We explored the island and visited Fort Macon. Below, Steve peruses the fort.


It was very windy all week long. I had some crazy beach hair.



Perhaps most momentous, however, was one of the last pictures we took:


I met this news with trepidation above all else. Steve was hopeful, but subdued. There was no way to know if the third time (our third pregnancy) would be the one that stuck. On the last morning of our vacation, before we headed back home, I spent some time sitting on the steps to the beach, looking at the ocean, trying to remind myself of my very small place in the world. The ocean always helps give me perspective, and I needed it, badly, after getting this news.

I was beside myself for the first few weeks, certain that each day would be the last one for this pregnancy. Even seeing the heartbeat at 6.5 weeks didn't make me feel any better -- we saw a heartbeat last time, too. I kept assuming it would be the same as before -- that is, until about 7 weeks, when the nausea hit harder than ever. That was the first real sign that this pregnancy might be different. (Because of the nausea, I had to cancel a much-anticipated business trip to Las Vegas.)

But still, for each doctor's appointment, I went in feeling stoic, bracing myself for bad news.

I'm at 15+ weeks now, and so far the news has only been good. This morning, for the first time, I entered the doctor's office without the certainty that I'd be leaving with a D&C appointment. Things are looking up, but we aren't out of the woods.

I'm considered high risk due to my unicornuate uterus, and I go to a perinatologist every two weeks now for a checkup to ensure everything is still closed up tight -- no signs yet of premature labor. I can't express what a relief it was at my first peri appointment, when I asked the doctor if she'd ever seen a UU before (typically the answer with past doctors had been "no" or "rarely"), and she said they see UUs regularly, because it's a very busy high-risk practice. I feel confident that we're doing everything we can do to stay on track.

We haven't told many people yet. I felt a deep aversion to sharing my news and having it go "viral" thoughout our friends and family. I didn't want to have to round up everyone who knew to tell them if things didn't work out. Even now, there are people in my family who don't know. I'm not sure when I'll feel comfortable telling them.

I don't believe that "God will watch over our baby." If that were true, there would be a lot more babies in this world -- in fact, there would be more in my house. If that were true, people would never miscarry or have stillborn babies or have preemies that can't survive. It actually upsets me deeply when people say things like, "this baby is God's plan" or "I know God is keeping my baby safe." It implies that people who experience devastating losses were abandoned by God.

I know the answer is supposedly "we never know what God has planned for us," and that, like Job, we are supposed to learn from the "gift" of devastating losses. But the fact that pregnancy is directly caused by unprotected sex, versus some sort of lightning strike from Heaven (Jesus/Mary notwithstanding), implies otherwise. And the fact that crackheads and murderers can have children if they have unprotected sex at the right time also seems to indicate something less than the hand of God in the mix.

I believe what science shows, which is that the human reproductive system is not perfect. For some of us, like myself, it is even farther from perfect. It's a crapshoot, and all we can do is make the best of it.

Here's hoping we've rolled our lucky 7 this time.

Some Things Are Just Out of Your Control

Today at work I saw a presentation by Al Haynes, captain of United Flight 232, which crashed in 1989 in Sioux City, Iowa. Captain Haynes detailed 45 minutes in the air during which he and his co-pilots desperately tried to maneuver their crippled plane toward an airport after a design flaw caused engine #2, on the tail, to break off and spray shrapnel across the rear of the plane, slicing through key hydraulic mechanisms. The pilots flew the plane using nothing but the throttles on the two remaining engines. In the end, the plane crash-landed in a corn field at the Sioux City Airport. Miraculously, 185 of the 296 people aboard the plane survived.

Later, investigators tried to recreate the crew's flight and landing under the same conditions, and were unable to do so. Captain Haynes detailed conversations he had with DC-10 experts who said that the breakdown that occurred was impossible, as was flying the plane if that breakdown *did* occur. The captain said it was because of a few factors -- luck, communications, preparation, execution, and cooperation -- that so many of the passengers survived. And luck was #1.

Then, Captain Haynes moved beyond the standard disaster story into the personal. He said he gives these talks because it helps him heal, even 19 years later. He told us that his family has had its share of losses, with the sudden loss of his wife, the death of his son in a motorcycle accident, and a close call with his daughter, who needed a bone marrow transplant. He said the biggest lesson he learned is that some things are just out of your control. And in the end, you have to just keep going and live your life.

***

Monday was my one-year blog anniversary. For some reason, my thoughts turned to my Mother's Day post last year, when I wondered if I'd have reason to celebrate this year. Then I found out 10 days later that that pregnancy, my second, had ended. So there will be no celebration for me this time. I'll still call my mom like I do every year. I'm sure Steve will call his. And who knows what next year will bring.

One of the areas my job touches on is risk management, and perception is a major issue. No matter what the statistics are for the likelihood of a given event, humans tend to believe that if something has never happened, it never will (until 2005, few really believed a hurricane could devastate New Orleans), and we also tend to believe that the most recent disaster is extremely likely (prepping like crazy for hurricanes after Katrina). I guess that's what I'm doing here, too -- thinking that I'll never be able to get the job done, and that the same pregnancy disaster will happen again and again.

I know it's only been a few months on the fertility drugs, but it seems like a long time. I hate taking the hormones. I hate that one of the hormones mimics the symptoms of pregnancy. I hate that I'm bloated and my chest is too big. I hate having to insert suppositories twice a day starting on Day 9. I hate having bright green discharge and having to wear a pantyliner 2/3 of the month. I hate that some friends cut me out of their lives when they got pregnant, or when they hit the second trimester. I hate that I can't make firm plans to go out of town until I know when my Day 1 is.

I want to just say screw this whole thing. It's completely out of my control.

But in the end, I have to just keep going and live my life.

It's All Over but the Bleeding

Well, that sucked.

Today Dr. Mango couldn't find a heartbeat at all. It should have been 8 weeks, and it was measuring only 7. It wasn't moving on screen and it looked like a crumpled piece of paper. This apparently is what is clinically known as a "missed abortion." The doctor said to go for another ultrasound, and he gave me a referral, but I don't know if I'm going to bother. I know it's over and I don't need to lie there being violated by a plastic wand and see it on the screen again.

Now I have to wait to bleed, and if it doesn't happen then I have to go through the D&C routine next week.

I wonder if I knew on some primal level that it wasn't going to make it, or if I was just randomly pessimistic and happened to be right. I guess I'll never know.

I haven't been able to talk to Steve yet. He's been away from his desk. It is going to be so hard to disappoint him like this again.

I feel like I have this trusted position of bearing us a child and I can't get it done. I know it's irrational, but there it is.

Heading to OB Appointment. Nervous

So my HCG tests from last week were inconclusive or something, and I need to repeat the test. This means my levels were not doubling every 48 hours, as is optimal. It's not the end of the world if they aren't doubling -- a pregnancy can still survive -- but it's much better if they are increasing at a normal rate.

Today I have an appointment with Dr. Mango, and he's going to do another ultrasound. I'm nervous about the visit, because what if he can't find a heartbeat this time? I know it does no good to worry, and I have been ok this week so far, but now that the appointment is in a half hour, my stomach is in knots. Uuugh.

How to Get Immediate Medical Care Part 2

This is part 2 of my recent medical drama, the story for which begins in the post below.

The irony with the whole situation is that if I had had some medical care earlier on, maybe I would not have worked myself into such a frenzy, and I would have saved my insurance company a bunch of cash on ultrasounds and emergency appointments. Hopefully I won't have to pay too much out of pocket. For the record, the symptoms of ectopic pregnancy and an anxiety attack have a lot in common:

What symptoms can a woman experience with ectopic pregnancy?
(source: OBGYN.net)

* Abdominal pain (90-100% of women)
* Absence of menses ("not getting your period") (75-90%)
* Unexpected bleeding through the vagina (50-80%)
* A vague soreness or spastic (colic) pain in the abdomen
* Abdominal pain can be generally everywhere, or it can be in a specific spot (localized) in one side or both sides
* Pain in the shoulder because of diaphragmatic (broad muscle under the lungs and heart that separates the chest from the abdomen and helps move the lungs during normal breathing) irritation from blood in the abdomen (25%)
* Dizziness and fainting (33%)
* Pregnancy symptoms (20%)
* Urge to have bowel movement (defecate) (10%)

Common symptoms of anxiety attacks
(source: The Linden Center)

* Rapid heart beat, pounding heart or palpitations
* Sweating
* Shaking visibly or inside
* Choking sensations or lump in throat
* Smothering or shortness of breath sensations
* Chest pain or discomfort
* Nausea, bloating, indigestion or abdominal discomfort
* Dizziness or unsteadiness
* Feeling light-headed
* Derealisation (feeling unreal or dreamy)
* Depersonalisation (feeling outside yourself or like you don't exist)
* Fear of losing control or going crazy
* Paresthesias (numbness or tingling sensations) in face, extremities or body
* Chills or hot flushes
* Skin losing colour
* Blushing or skin blotches
* Urgently needing to urinate or defecate

So I'm not totally crazy. But I do admit that the anxiety attack symptoms were a 95% match with my symptoms, whereas the ectopic symptoms were only about 70% similar.

Regardless, I feel better now just knowing I have medical care available. If my blood tests look good this week, I might actually buy some transitional maternity clothes. I'm not really the "rubber band around the button" type. I like my clothes to fit and be comfortable.

When I got home from the appointment with Dr. Mango, I called Steve. I told him about my day and reported that I had seen the heartbeat. He immediately started giggling. "Did you?" he laughed, adding, "it's really little."

I think he's imagining it as a teeny tiny cute little baby, rather than a tiny mollusk with a giant head and a vestigial tail.

How to Get Immediate Medical Care

On Monday, I showed up to work feeling just fine, but around 10 a.m. I went to the bathroom and all hell broke loose. I suddenly became dizzy and faint and got chills and cold sweats and pain in my lower abdomen. It felt like food poisoning but I wasn't actually having any stomach issues.

I basically stumbled back to my office, closed the door (thank god my officemate was in a meeting), and lay down on the floor for a few minutes until I stopped feeling dizzy. I googled my symptoms and freaked out when I saw that they appeared to be identical to those of an ectopic pregnancy, which often presents itself between 6-7 weeks, which is where I am.

I went home and changed out of my suit, and then I went immediately to the urgent care doctor near my house.

The urgent care center was a strange place. I definitely got the feeling that urgent care was a side business. They had signs all over the place for weight loss and hair removal programs. (Maybe the sign outside saying "WEIGHT LOSS -- URGENT CARE" should have tipped me off.) But I felt better just being there, knowing that if my fallopian tube burst, someone would get me to a hospital.

The urgent care doctor drew blood and made an appointment for me to get an emergency sonogram that afternoon. In the meantime, that doctor's office tried to call my OB-GYN, who I'll call Dr. Degree From Grenada. Dr. Degree From Grenada will not see a pregnant patient until 8-10 weeks, under any circumstances. Dr. Degree From Grenada also does not seem to work a full week, but I went to her practice because it was convenient to my job (when I worked in Falls Church) and because there are numerous doctors there that I could see at her practice. I have never gotten through to a real person when attempting to call Dr. Degree From Grenada, which is why I went to urgent care instead of my OB-GYN's office.

Typically you have to leave a message and Dr. Degree From Grenada's office gets back to you at their leisure. The urgent care staff managed to get a real person on the phone twice to discuss my issues (ectopic pregnancy can cause DEATH, people), and they were disconnected both times during the call. The third time they called, like 10 seconds later, the "we're closed for lunch" message was on. The urgent care suggested a new OB-GYN and got me an appointment for the next morning.

I was at the sonogram place forever. They did a pelvic sonogram and an abdominal sonogram, and then they did an internal one (they stick the ultrasound wand up your va-jay-jay). They found the "sac," and it wasn't ectopic (whew), but the technicians told me that the embryo was measuring really small for what it should be. They wouldn't tell me anything else, even about the big white dot on the image of my kidney (was that a kidney stone? they wouldn't say), so I got the feeling they were pretty certain of the measurements.

I spent Monday night depressed, wondering when the miscarriage was going to happen. I told Steve and he hugged me and said at least each time things move farther along, so if this didn't work, maybe next time would be the ticket.

Tuesday morning, my new OB-GYN, who I'll call Dr. Mango, talked to me about what was going on. I recapped the symptoms of my illness from the prior day, and he comes up with, "you had an anxiety attack." I objected: "But I wasn't even stressed out about anything!"

Then I thought about it. Every time I go to the bathroom I look at my underwear expecting to see blood. The episode happened in the bathroom at work. Perhaps constantly steeling myself for theoretical blood is not healthy behavior.

Dr. Mango asked me all sorts of specific questions about what happened and whether we had anxiety disorder or obsessive compulsives in my family. (We do.) So he basically said I need to chill out and stop worrying about everything. He asked me why I was worried, and I said because of the prior miscarriage, and because it took my mom four years to get pregnant. Dr. Mango said for a 33 year old I actually have gotten pregnant pretty quickly, even if this is the first pregnancy.

(He thinks the one in February was not a real pregnancy at all -- I don't buy that, but I'll buy the idea of a chemical pregnancy. I'm going to bring him my chart from that cycle to show him all the signs.)

Dr. Mango said it's totally normal for it to take a year for a 33 year old to get pregnant and it's nothing to worry about. He said the sonogram technicians were working at the limits of the technology's resolution, so the estimate of the age of the embryo could have been off pretty easily. Then Dr. Mango did a vaginal sonogram, and what do you know -- I saw the little heart beating. For a second I caught my breath -- I was so surprised. It looked like a little bean flashing on and off.

Dr. Mango said the pregnancy seems viable but we'll know more based on blood tests. He's going to do a blood test every two days for a while and the hormone level should be doubling each time. He said that is the best indicator for whether it is viable or not. I have a blood test scheduled for Thursday and another sonogram for next week.

It's night and day compared to Dr. Degree From Grenada, who I wouldn't have even seen for another 3 weeks, and who would not run early blood tests. Basically, with Dr. Degree From Grenada, it's up to you to get your pregnancy to 8-10 weeks. THEN you get to have some prenatal care. They don't even mail you a leaflet on what not to eat or anything -- what if someone's going around eating sushi and deli meat and seared tuna and soft cheeses because they don't know to avoid them? (I admit it, I envy that person in theory.) You are on your own.

To be continued.

Mother's Day

I never really thought too much about Mother's Day before this year, except to make sure I sent my mom some flowers or something and called on the actual day. But this year, I'm not sure what to make of it.

If my first pregnancy had lasted, I'd be about halfway through, and I might be able to feel confident thinking of today as something I theoretically could celebrate. But now, it's too early to count on anything with this one. It's strange. I wonder if I'll be celebrating Mother's Day as a mom next year.

At the moment, my size 8 jeans are feeling a bit tight around my lower abdomen. Very sad. I still haven't called my OB/GYN about the pregnancy. I have my annual exam scheduled for May 25, and it takes months to get on her schedule for an annual. Initially I figured I might as well hold off on canceling that, just in case. Now I'm thinking maybe they can just change that appointment to an 8 week exam. I still don't want to call them, because I'm worried they might make me come in later. I just want to get in there and find out if there's a heartbeat. It's my understanding that if you make it to 8 weeks with a fetal heartbeat, chances of a miscarriage drop to less than 10%.

It might make me feel better about the whole thing.

Going for No. 1 Baby

If this pregnancy sticks around -- and I'm still not remotely convinced that it will -- the due date is January 3, 2008. Two random things strike me about this date:

1. We might narrowly miss a nice 2007 dependent tax deduction. (Shoot.)
2. We have a shot at first baby of the year! woohoo!

I'm by no means impressed by the idea of getting on TV, especially in a post-childbirth state, but I do seem to recall some fabulous prizes are awarded, such as diapers (for the kid) and jewelry (for mom). I wouldn't mind some free gifts. It would also be a great story to tell the family.

But I do feel bad for the potential kid -- January is a terrible month for a birthday. Everyone's done with parties after the holiday season and people just want to hunker down inside. One year, as a kid, I celebrated my January birthday in June so I could have a pool party and we could go horseback riding. As an adult, I've had several birthday celebrations canceled due to terrible weather or plague.

Regardless, I'm definitely getting ahead of myself. The kid thing all remains very theoretical to me.

Meanwhile, I'm trying to stick to the rules and avoid eating uncooked sushi or hot dogs or Italian subs or basically any of the things I always ate as a treat. Yesterday I nearly had a sub anyway, but then I looked up Listeria online and saw that it causes miscarriages. If I have another miscarriage, I want to know for sure that it WASN'T due to consumption of deli meat.

So, no sushi, no cold cuts. No soft cheeses (although I still do have pasteurized feta in my Greek salad -- I gotta draw the line somewhere). No decongestants, which sucks today because my sinuses are killing me. No wine, which is a major drag, especially because my hormones are causing a lot of anxiety and a glass of wine would take the edge off.

It's hard to take these prohibitions seriously, because I still have the mindset that it would be foolish to expect to end up with a baby in January. Right now, if all is developing normally, it looks like a tiny pink worm. It doesn't start resembling a baby until about 10 weeks. But I had a friend who miscarried at 10 weeks, and another friend who miscarried at 13 weeks -- right after she made it out of the high-risk time period.

I wonder when I'll start believing this might actually happen.

Annoying Questions From Well-Meaning People

Yesterday I talked to my friend Christy for the first time in a while. She mentioned that she's talked to her longtime boyfriend about getting married. I admitted that I had been wondering about their plans -- they've been dating for about 5 years -- but I didn't want to ask, because it might be a sore subject. Turns out, it may have been. She has been bringing it up for a while with her boyfriend, and he's just on his own schedule for the whole thing. Stay tuned.

The inappropriate-question issue has hit home recently for me when people ask when Steve and I are going to have kids. I just say, "it's on the agenda," and think "you idiot." There are so many questions that people ask regularly just to make conversation without realizing how upsetting/annoying they might be.

"Are you going to get married?"
"Are you going to have kids?"
"When are you going to have kids?"
"Are you going to have another kid?"

None. Of. Your. Business.