Starting 2016

I haven't been much of a blogger lately, but I have been slogging it out for awhile.  I'm entering my seventh year, though it has been much quieter around here since the kids were born.  It says something about my corporate job (and infertility too, I suppose), that the bulk of my nearly 600 posts came in those early years.  This outlet still holds a place for me that my other social media outlets don't and can't.  Facebook is not a blog (repeat after me) and neither is Pinterest or even Instagram.  And since I'm not selling anything over here (or anywhere), I have a little bit of a different take on each.

I'm finally getting around to reading "Quiet", which is amazing so far.  (Introverts unite!)  And looking forward to finishing it, so I can start on "When Breath Becomes Air" (you can read about it more on Cup of Jo and in the NYT) and then "We Should All Be Feminists" and "Between the World and Me".  One of my goals this year is to read more books...and actually finish them.  I've long been the queen of leaving books unfinished, and being on all the time for two busy preschoolers surely doesn't help.

The kids are doing great and we're all keeping busy.  We've done all sorts of classes over the years, but now we are trying to settle into a sport (dance for her since last fall, t-ball for him) and an instrument (piano for them both), though we'll mix it up come summer (tennis, soccer?).  We took a trip to the ENT to have Alistair's tonsils looked at and it turns out they are fine.  We are finally kicking whatever virus(es) have been plaguing us for the last few months.  Round and around it/they went...

If you aren't watching the last season of Downton Abbey, the last episode highlights that (spoiler alert!) having an incompetent cervix/infertility and cerclages are not new things.  And that others have had to move all the way to Boston to find themselves... I'm really going to miss that show (and yes I cheated and already watched the entire UK season online.).  Waiting for new Master of None and House of Cards (thank God for Netflix).

We just marked a decade in our house (and me in the burbs, the same amount of time I spent in Boston and Chicago combined), which means I've just now eclipsed even my childhood home for my longest tenured abode.  And we are finally almost done with the things we wanted to do here.  And in a few short months, it will be our tenth anniversary and my 40th birthday, which is all kind of crazy to think about.  So milestones and goals abound...

I still need to put together a post on our warm and wet holiday roadtrip to Nashville and NW Florida, so stay tuned!

Marking days (and knowing your risks for PTL)

The kids are 8 1/2 months old (nearly eight adjusted) and have surpassed their time inside, 36w4d, with their time outside, 37w2d, and today is the one year anniversary of the surgery that kept them cooking past 21w4d and saved their lives. 

After losing my mucus plug last 8/19 @ 19w (and then having an OB clear me w/a long and closed cervix as we were heading OOT on vaca) and then six days later discovering my funneling cervix at our anatomy scan (which put me on bed rest), I quickly found an MFM that ordered that I be monitored more closely (and put me back on P4).  After a week of twice weekly checks showed that my cervix was stable and then much improved/normal, the third showed that I was beginning to dilate.  By the time I got into surgery that afternoon, I was already two cm dilated (with four cm being the limit for being able to be sewn shut).  It was one of our very worst and (in the end) best days...

Every day now, I look at the babies and know how lucky we were that my appointment just happened to be on that day and that my body failed so slowly.  We've just passed what would have been the first birthday of our first baby who we lost.  I am a very emotionally resilient person, as is DH, but I'm just not sure that I would have been able to cope very well with birthing three lost babies.  There is a limit to how much you can even imagine bouncing back from...

In an attempt to hopefully save others from a similar situation, I wanted to share the risk factors that I had (and should have put me on a short list for closer monitoring) and all the many others, so you can advocate for yourself and your babies.

According to the March of Dimes, I had all three of the greatest risks of having a preterm birth:

A uterine septum (or other uterine/cervical irregularity) can cause problems, even after removed.  In our attempts to get pg, I'd also had several surgeries (three over the course of 16 months) to address my septum and a polyp, which involved dilating my cervix (any D&C-type procedure increases the risk of having cervical problems or adhesions).  I'd also had a cervical cone biopsy in my 20s after an irregular Pap, which thankfully was benign, but left me with a little piece of my cervix missing, which also weakens it.

Though I was carrying multiples, a major risk factor, just having done IVF and being pg with one baby is sadly also a risk factor for preterm labor.

Since my first pregnancy ended in a spontaneous loss, this also put me at higher risk for another preterm loss (since the root causes, including low P4, were likely the same).  First trimester losses sadly garner little serious attention, so it was not considered a risk at the time.  Though if it had been several weeks later, it would have raised more red flags and I would have been a candidate for a preventative cerclage, rather than needing a rescue cerclage.  How sad is it that you not only have to lose babies to be treated proactively, they must be farther along...

Though I was nearly 35 when all this occurred and age (high or low) is a risk factor, I was very healthy and didn't have any of the other health related risk factors (preeclampsia, high blood pressure, diabetes, under/overweight, clotting disorders, other disease/infections/birth defects, etc.)

All the other/lifestyle risk factors actually ran counter to my situation.  These include race, socioeconomic status, marital status, working status, access to prenatal care, unintended pregnancy, smoking, alcohol/drug use, lack of social support, stress, domestic violence, and exposure to environmental pollutants.

If you are TTC or newly pg, please check out the list of risk factors (there are so many, but some intersect w/those causing IF, like PCOS) and see if any of them apply to you and discuss with your physicians.

And so it is finally September, when we also mark two years since we lost my FIL and my sister was dx w/cancer.  Those were some dark days...  Thankfully, my MIL is bolstered now by having my BIL back in India, a new DIL, and of course new grandbabies (which she'll be back to see in the new year).  And my sister is so far cancer free since her surgery and chemo last year.  Thanks to those who sent her cards and/or added her to your prayers.  We also get to mark another year of marriage (6!) and life (36!), opportunities that we cherish.  We know just how lucky we are and are very thankful, every single day.

If you are going through hell, keep going... -Eleanor Roosevelt

A month on... (& nearly 26 wks)

A month ago today, we had the emergency surgery that saved our babies.  It is still difficult for me to wrap my head around all that has happened.  To say that we feel lucky is a huge understatement, but as my step-mother told me frankly it was actually me that is responsible for them still being around.  By going to the hospital and seeking out an MFM promptly after we learned of the funneling, we made it known that we were not going to follow their passive stance and wait for the inevitable terrible things to happen, we were going to fight my failing body with everything that we had.  If I had waited the two weeks that the not my regular OB had told me to be seen again, it likely would have been too late.  As even on bed rest, 12 days later I quickly began to dilate.  While that should just make me feel good, it was a huge burden that was really overwhelming for me to carry for the several weeks as we waited to get to viability.  It is terrible to feel like you are the only ones who care about what is it stake.  They were not just 20 week not yet viable babies to us, they were/are our babies that we had already fought like hell for and were not just going to sit by and see if maybe we were lucky, they might make it.

We are coming up on 26 weeks, which is again not a major milestone, but is ever closer to the end point.  If the babies were to be born in the coming week, their chance of survival would be at least 85%.  The cerclage, which still appears to be holding, is now ten weeks from coming out.

I actually put real (non-yoga) clothes on today for my big trip to the OB, but don't get too excited I still don't do hair and make-up.  This dress makes me look bigger than anything else I've worn.

Emergent cerclage for incompetent cervix

The title pretty much says it all, but this is what we've been up to for the last few days. 

I had my regular cervical check yesterday and the u/s showed that we had regressed to where we had been a week before (short: ~2.5cm and funnelled to ~1cm), but upon the manual check by the OB, she found that she could get her finger up into my cervix.  She sent me to L&D immediately.  By the time we got to Prentice and got checked again (a few hrs later), I'd dilated to 1cm.  They finally gave us the option to get a cerclage.  We said, yes please.  By the time I got in the OR a few hours after that, I was dilated to 2cm.  They stitched me up tight after giving me a spinal, which was not terribly pleasant and hurts like hell now.

I spent the night in the hospital for the first time ever, with DH and my mom (who just happened to be passing back through town again), and it was a rough one, I'm still exhausted.  My room, ironically, looked out over the MCA, where DH and I had our first date almost seven years ago.  My OB, Dr. Levin, came by this morning to discharge me (she had been on vaca during my recent adventures) and we decided to do not only full bed rest and weekly checks, but also weekly IM progesterone shots, which will be administered in the office.  The compounder is sending it off to them, so I will go in either tomorrow or Friday for the first one.

Still having lots of aches and pains and hoping that time and rest will help me feel a little more normal.  Almost 22 weeks! :)