Thursday, May 18, 2017

What causes PPROM? And what is a TAC?

I mentioned that I got a TAC a few weeks ago, so here is the post where I explain it.

There are a few theories as to why I lost Miriam, and we decided to do everything possible to prevent either one of these possible things from happening again.

1. Underlying infection
My MFM actually thinks this is the reason that I had PPROM (water breaking way too early) last time. There was never any infection found in my bloodwork, Miriam's placenta, or anything else, but this is what he thinks. This is not a crazy thought though as it's a common theory for undiagnosed PPROM. This is the scariest option to me since there's not much doctors can do to prevent this, since they never identified an infection last time, even after my water broke. The only thing I can really do is pay attention to any signs in my body. BUT, we also have a "natural guy" that does electro-dermal screening and detects infections WAY better than doctors can. It's a little on the "woo woo" side, but hey, we are up for trying anything to detect infections. I'm currently seeing him once a week to be on the lookout for any infection, and so far so good. Whew!

2. Pre-Term Labor
This is not highly suggested by most doctors because it's not usually considered 'pre-term labor' unless it happens after 24 weeks, and my water broke at 19w5d. BUT, we are still doing the only thing they know to do by giving me weekly progesterone injections. If I started having contractions or cramping, there are other medications I could be given to prevent labor. But, I seriously hope and pray that doesn't happen this time, at least not until at least 24 weeks! (Doctors are more likely to treat pre-term labor then, as opposed to earlier when baby wouldn't survive outside the womb anyway). 


3. Cervical Polyp Removal
At 18 weeks last time (which I'm very close to now... yikes) I started having spotting, which obviously scared me. After a healthy ultrasound, a cervical polyp was found by my midwife, and she said it was nothing to be concerned about, but that I would continue to have heavy spotting unless it was removed. So, she referred me to an OB who removed it several days later. 6 days after removal, my water broke. All the doctors say this was not related at all, but it's hard to not wonder. We also found a couple of studies online that showed that removing cervical polyps makes you more likely to lose a pregnancy, but apparently they are not widely accepted.

To help prevent any polyps in this pregnancy I had a hysteroscopy done by my RE in November. This is where they send a tiny camera up through the vagina, cervix and uterus to make sure everything looks good. When this was done they found a couple of budding polyps and removed them. So, hopefully none pop up in this pregnancy! But, of course if one does there is zero chance we will remove it. So, please pray I don't get any spotting or a polyp as this would freak me 100% the heck out. 


3. Incompetent Cervix
If you have undiagnosed incompetent cervix you will just keep losing babies. This is the most common reason for multiple PPROM losses. It's also believed by some doctors to be the primary reason for 2nd trimester losses. The usual treatment for this is a cerclage. Typical cerclage placement happens after first trimester (so they know you won't have a miscarriage due to genetic issues), and they stitch your cervix closed (or as close to it as they can) through the vagina. These cerclages have a 70% success rate for healthy babies coming home (although some are still born prematurely).

I heard about the abdominal cerclage through online support groups for women who experienced PPROM. It was also recommended to me by my RE and he suggested I not transfer any more embryos until I had the TAC (trans-abdominal cerclage). This cerclage is placed at the very top of the cervix, and provides a 95% success rate instead of 70%. However, because it's so high it has to be placed surgically. Instead of a stitch, it's a permanent band up there. Usually before recommending a TAC doctors want you to have TWO second trimester losses and/or a failed vaginal cerclage. However, there was zero chance we were going to just "see what happens" to see if I had another second trimester loss!  Pregnancies with vaginal cerclages also often involve bedrest, and we really wanted to avoid that. You can see in the picture below how much higher TACs are than other cerclages. 




So, in December, we drove to Indianapolis to get a TAC laparoscopically placed by one of the top 2 successful TAC surgeons in the country. It was my first ever surgery (besides my wisdom teeth taken out and that hardly counts). The surgery and recovery weren't too bad and I just have 4 tiny scars on my belly. Because there's a pretty permanent band at the top of my cervix I will have to have a c-section. Pretty ironic for the lady that chose to get her pre-natal care at a birthing center last pregnancy, right? However, after losing Miriam my "ideals" for birth went out the window and my priority now is just living child. One would think those are low expectations, but for me they seem rather high.

Anyway, so that's what a TAC is and why I got it. There's certainly a chance that I don't even have an incompetent cervix and didn't "need" it placed. But, which is worse? Having it and not needing it? OR needing it and not having it and losing another baby? I would certainly take the former!

As you can see we are being very proactive about preventing PPROM this time around, but of course, I'm still a nervous wreck knowing that any day anything can go wrong. Last pregnancy I truly believed pregnancy was durable, but this time my head couldn't be further from that truth. Please continue to pray for us and this little baby girl. We would love for her to be a full term baby!

Monday, May 15, 2017

17 weeks



Today is a good day. I will admit that my weekends are pretty anxiety filled since they are the last 2 days before my weekly doctor visits. And my appointments aren't until 3:15 Monday afternoons, so I'm READY when the ultrasound tech calls my name. 

I have 4-5 more weekly checks before I move bi-weekly checks. My MFM wants me to come weekly at least through my loss date (21w1d) mostly for my own anxiety. At these appointments after the tech calls me back she always does a general belly ultrasound to be sure baby overall looks good, measures the heartbeat, and checks the fluid level. Today was the first day I was actually worried about the amniotic fluid levels and thank goodness they were good! She also confirmed for sure that baby is a girl, so the blood test 6 weeks ago was correct! 

Then I get a transvaginal ultrasound to measure my cervical length (the main purpose of the appointment) and today it looked good at 4.7 cm long. Then, the high risk doctor (MFM) comes in and answers my questions. He is so awesome and gracious with his time with me. He always answers all of my questions thoroughly and kindly. I have probably said this before, but I hate it when doctors talk down to their patients and/or treat me like I'm stupid for having lots of questions. But he never does and he also appreciates my nervous/stupid/self deprecating jokes, so I really like him. 

I then venture 2 floors down where my OB's office is and a nurse gives me my Makena/progesterone injections. Today was my second so here's hoping it goes well again like last week. I also love that these doctors offices are so close together and only 5-10 minutes from my house. Each one of these recent appointments I leave feeling so grateful. I continue to hope and pray that all continues to go well and I will keep having good appointments for 20 more weeks. That sounds do-able, right?

This weekend I realized that I was exactly 4 weeks from the gestation I was last time when we lost Miriam. So I know the next month is going to be especially hard. To be honest most days I can't yet see past that point and things still going well and this baby still growing healthy and strong, but I hope and pray every day that that becomes true. It's hard to not fixate on my anxiety and think about the trauma of what happened in August. I want there to be a new ending so very badly. 

In my head there is endless counting. Today I am 2 weeks and 2 days away from the gestation when my water broke. That's scary to think about. I can't even imagine how my emotions and mental health will play out that week. I know there will be fear in the coming weeks, especially when I hit that 19 week mark. Deep breaths necessary. 

In good news, I ordered some maternity pajamas and they are glorious. The shorts are the most comfortable shorts of my life, and the nightgowns are even more amazing. My sister also loaned me her fancy pregnancy pillow (the snoogle) and it is also awesome. So between the cozy pillow and pjs I really, really look forward to bedtime now. ❤️

Thank you all again for all the prayers and thoughts. I believe they are carrying us through this anxity filled time. The countdown continues. 

Thursday, May 11, 2017

16 weeks


Here's a question... when I post weekly updates should they cover the week before? Or should I post them at the end of the week in which I'm pictured? So if I post a "16 week update" should it include what happened before I hit the 16 week mark? Or what happened during week 16?  I've never done this before and this is a legitimate and not a rhetorical question. Haha

Since I'll be 17 weeks tomorrow I guess I'm choosing the latter for now. Adjustments can be made so please advise. 

The hardest part of this pregnancy by far is the anxiety. I know there are uncomfortable and difficult parts to pregnancy, but I don't care much about those. It's the mental and emotional hurdles that are tough. I look forward to every doctor, counseling, and acupuncture appointment as if I'm clinging to them for dear life. I breathe a sigh of relief each time there is good news or I get support. But at home and in between every appointment I wonder when things will go wrong. It's nearly impossible for me to imagine there being a healthy baby at the end of this. I wonder if today is the day we get bad news or that my water will break. I have moments of panic where I wonder if my water is about to break any second and what I would do if I'm in a public place. That may sound silly, but last time my water breaking totally came out of nowhere and was completely unexpected. And without a definite reason for what went wrong last time I'm terrified it can happen again, even if I'm told it's not statistically likely. 

But I will say that my apt Monday was good. We heard the heartbeat again, which is always reassuring. I also got my first progesterone shot. Often times after a loss like ours progesterone shots (usually called p17 or the name brand of Makena) are recommended in subsequent pregnancies to prevent pre-term labor, if in fact that was part of the problem. These needles are huge and go right into your behind. 😳 

Your nurse can give you these injections and that's what we opted to do. I had a small amount of anxiety about this due to my horrible reaction to a different kind of progesterone shot used for fertility treatment (progesterone in oil). Dave gave me these shots, which were also right in the booty, starting right before our embryo transfer back in February, and my body reacted terribly. My butt muscles got so tight that I had to sleep on a heating pad on the couch, and I still could barely sleep at night, and I also could barely walk. So I was very nervous this was going to happen again! Thankfully it did not, so I will be able to keep taking the Makena injections once a week through the rest of the pregnancy. I hope they help! My OB's nurse is so kind to be willing to give these to me once a week. 😀

In possibly exciting news I may have started to feel baby move. I have an anterior placenta, so I'm told I likely won't feel her until 20 weeks or so, but over the weekend I felt what may be early flutters. It was a very new sensation to me and felt like a "flip flop" on one side of my uterus. My OB said it could be baby, but she doesn't want me to get disappointed if I don't feel her again much, if at all for several weeks. So, who knows? 

Otherwise, my body feels healthy and I don't feel sick like I did in the first trimester. I've officially gained 10 lbs so no worries there either. I bet I could slow down a bit. Haha 

Thank you all so much for the thoughts and prayers. I know we will need them especially in the next month as we come up to the gestational age I was when my water broke and we lost Miriam. I'm trying to take it one day at a time, but I know the coming month will he emotionally difficult and I just pray we make it to the other side without anything horrible happening. ❤️

Thursday, May 4, 2017

15 weeks


Please pardon my tired smile here. Posed photos do not come naturally to me. 

No big updates this week, except I had my first cervical length check. I have a TAC that was placed laparoscopically in December (more about that to come since you probably have no idea what that is), and it is helping to keep my cervix nice and long, over 4cm as of Monday. 

My MFM is great and I will be seeing him regularly for my cervical checks, and maybe some other stuff if I make it to the third trimester. He knows I'm a total worrier, but never belittles me or my questions and explains everything as thoroughly as possible to help put my mind at ease. This is not that common in doctors so it's much appreciated by me! 


For the past couple of weeks I have had a lot of twitches, pinching, pulling, and unknown uterus and uterus-adjacent feelings which have had me on edge. He assured me that it sounded within the realm of normal and that with a TAC I would likely feel more of this than in a pregnancy without it, so that made sense and helped me feel less worried for about 24 hours. 😀

Dave and I have been going to weekly counseling and it has been invaluable. Now that I'm well into the second trimester and just 4 weeks from when my water broke with Miriam, we are doing everything possible to support this pregnancy and my mental health. Yesterday in counseling we talked about the fact that managing anxiety is healthy, but that I'm having to come to the place of accepting that I'm going to be anxious. It would maybe even be unhealthy if I wasn't concerned in a subsequent pregnancy after loss. So I'm "ok" with being anxious. But I also know that there's a dangerous level of anxiety and I have to use various coping measures to keep in manageable. I'm sure I'll have plenty to share about anxiety in the weeks to come. 

Please continue to keep us in your thoughts and prayers. Each day that I pass seems like a huge accomplishment and I'm grateful for each day. But each day also feels like an opportunity for something to go disastrously wrong. It's so so hard to imagine things going well when all we know from experience is things turning tragic. Experience is a strong teacher. 

Tomorrow will be 16 weeks! I celebrate each daily and weekly milestone! Please baby keep cooking! 
 

Sunday, April 30, 2017

Ultrasound and Belly Pics


So, I kind of hate belly bump and ultrasound photos. Or at least they were super hard to see for over 5 years for me. These kind of photos popped up at least on a weekly basis on social media for quite some time and it was always hard to see others' pregnancy announcements. So, I won't be showing any of these photos on Facebook due to their sensitive nature. But, I figure if someone takes the time to actually visit this blog they won't mind (and probably would appreciate) seeing these photos. So, here are the belly bump and ultrasound pictures so far. Due to me taking most of these photos in the evening, and also to the fertility drug hormone bloat, my belly was fairly puffy and much the same size in most of these photos so you can't really see a difference. But, I still plan to print these pictures and put them in a baby book. Hopefully there will be a child born alive that will appreciate seeing these one day!  

First of all I'll start with the day we transferred the embryo. This is me that very day at the fertility clinic hoping for the best! 


One pretty cool thing about IVF is that you get to see a picture of your embryo 5 days after conception. So this little blob is how an embryo looks 5 days after fertilization. Cool, right?! The app text is totally wrong though. It's definitely not the size of a grain of rice. Our doctor (RE) said it would fit on the end of a pen. So, it's teeny tiny. 



This is my refusal to smile big at week 6 since we were nervous as heck. We took it just a few days after hearing that I was going to have a miscarriage (but after we saw the heartbeat), so I was still quite an emotional wreck.


The first time we saw and heard the heartbeat at 6w3d. The baby is the little white worm looking object at the top of the sac. It's hard to believe there's "fetal cardiac activity" from such a tiny thing! 


I look way more pregnant than 9 weeks in this photo. I will blame a giant Mexican meal.


Ultrasound photo from my first OB (vs RE) appointment. Look at that little shape! This is when she started measuring one day ahead. So technically I was 8w5d, but she measured just shy of 9 weeks here.


At 10.5 weeks I had my first MFM (maternal fetal medicine specialist, or otherwise high risk OB) appointment. At this appointment he said I had a 90% chance of bringing home a healthy baby. That was encouraging! 



She was SO wiggly at this appointment! Like super wiggly. They say when you are this early they have plenty of room to move around. 


By 12 weeks we had just gotten the blood work back that baby was genetically "normal" (not a super thorough blood test, but detects common trisomies) and that she was a girl! So, we were feeling pretty good this week.




This was at 12w3d and look at that cute profile! That was also when they did the nuchal fold test, which measures the back of the neck, which can detect abnormalities, but the measurement looked great. She was pretty wiggly then too. :)


There you have it so far! I was hesitant about getting too many ultrasounds when I was pregnant with Miriam, but this time my thoughts are, "Give me all the ultrasounds to reassure me that everything is currently ok!"