Tuesday, May 30, 2017

19 weeks 😳



Today I am 19w4d. That means tomorrow I will be at the gestation I was when my water broke with Miriam. Thank goodness I have a counseling session booked for tomorrow already! There will be plenty to talk about.

To be honest I've been pretty proud of myself for how well I've been doing emotionally the past few weeks as we got closer to this date. Last week at the anatomy scan I was surprised how many times it felt like I would burst into tears. Not necessarily happy or even sad tears, just really overwhelmed tears. I can remember so vividly all the ultrasounds that were so terrible last time with Miriam, and since the anatomy scan is the longest ultrasound I had so far all of those memories came flooding back and it was hard to focus on the happiness of a good and healthy ultrasound.

Yesterday was a very anxiety filled day. Every twinge or pinch I felt and trip to the bathroom were PTSD reminiscent of last time with Miriam and convinced me it was the beginning of the end again. It took me a bit by surprise, but I've found that when anxiety really hits me I can live and breathe through it, but I don't get a big sigh of relief until a good doctor visit. So, I struggled through yesterday (you know I'm not doing well when I don't even care if the house is a total mess) and thank goodness had an appointment this morning.

I specifically asked about my amniotic fluid level and that looked great. Whew. Baby girl also looked good and had her little feet up by her head this time. And my cervix was also long and closed and measured at 4.8cm! The longest yet! Yay! So, we took some deep breaths and were grateful for such a good appointment.

However, there is still a lot of anxiety. We've talked in counseling that it's ok for me to feel anxious and that it would be unusual if I didn't feel this way. That's what a previous traumatic event does to you.  You may think I'm exaggerating, but if I shared with you the details of how everything happened you would agree there was trauma involved. Dave and I both have flashbacks to August and the upsetting and heartbreaking things that happened. These memories pop into our heads at inconvenient times and are hard to get out of your head. Thank goodness for good counseling because I have strategies in place to help put those out of my mind as much as possible while in this already anxiety producing stage. But, it still happens and still contributes to mental and emotional unrest. 


So, if you think of us in the coming weeks, please say a prayer for us. Please pray that baby girl continues to grow healthily and that my body will continue to be a healthy place. My biggest fear is my body failing this baby too. And please pray for emotional and mental health in the coming days and weeks. There are going to be days where I feel somewhat incapacitated by fear, which is to be expected. But, I'm hoping and praying (and begging) we get to viability the last day of June and that this baby girl will still be going strong! It seems like I may never get there, but I'm trying so hard to take it one day at a time.  

To be honest, when I saw this profile today all I could think was how similar it looks to Miriam's face profile.
A open mouthed grin and a foot by her head. A promising future in dance or gymnastics, right?






Thursday, May 25, 2017

18 weeks

Tomorrow I will be 19 weeks, so I'm a little late to this weekly update, but so be it.




I'm seriously in the countdown now. Today I'm exactly 6 days from the gestation when my water broke last time so anxiety is high. I know that will continue as I (hopefully without incident please God!) live out the days between my PPROM and Miriam's birth/death gestation at 21w1.

Until then I'm attempting to be busy and counting down all the days to every appointment. I feel like when I've seen "pregnancy update" blogs before they do cutesy things like what the mom is craving or how her clothes fit, etc., but I just can't make myself go there yet. Hopefully once I get to 24 weeks I'll feel more "cutesy" about this pregnancy. And hopefully I GET to 24 weeks! It's just 5 weeks from tomorrow but seems like an eternity!

Good news from this week! We did the anatomy scan on Monday at 18w3d and baby girl looks great! All the measurements looked good, and so did my amniotic fluid level and cervix. Every time we leave our weekly appointments Dave and I just talk about how grateful we are for our doctors and how close they are to us (10 minutes in traffic). And I'm TOUGH on my doctors. :)

Here are the photos of our little girl from the anatomy scan! Isn't she just so cute? ;-) And if you're curious about names, many have been discussed and nothing has been decided. With all 3 other kids we were in a total time crunch and we're happy with all the names we chose, so I have a feeling we won't settle on anything until we absolutely have to. Please God let that be at least 4 months from now! 

Cute, little profile

Open mouthed smile!

Left foot











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!