Supplementing Pregnancy with Progesterone

It amazes me that OBs can still be resistant to testing for progesterone deficiency and treating it.  After two consecutive losses and a clean blood panel, I begged my OB to test my progesterone levels.  I was pregnant again.  Not only did she refuse to test, but she also said that even if I tested low for progesterone, she wouldn’t supplement.  Her “brilliant” idea to treat pregnancy loss was Clomid!  (You can read tons of stories about women taking Clomid and suffering miscarriages as well as being blessed and challenged with multiple gestation issues.)

I lost that baby at 10 weeks gestation.  It died a few weeks earlier.  I was devastated and so angry.  I’m still angry at that nutjob OB.  For numerous reasons I transfered to a more compassionate OB who had been through infertility with his wife and also seemed to enjoy thoughtful discussions with his patients.  Although he misdiagnosed my problem, he supported me in seeking a second opinion with a reproductive endocrinologist (RE).

The RE discovered low low low progesterone.  The RE also found adenomyosis in my uterus that was distorting the shape of my uterus.  He believes that my cesarean caused the adenomyosis.  He removed as much as he could.

I received the all clear to TTC and quickly became pregnant again.  (Becoming pregnant was never my issue.)  I began supplementing with progesterone via 17-hydroxyprogesterone shots.  An early ultrasound discovered that I was carrying twins.  (Recall the one OB’s suggestion to give me Clomid?!??!!!!!!!)

I continued the progesterone injections and weekly progesterone tests during the first trimester of that pregnancy.  My progesterone levels seemed ok on their own, but it was prudent to continue especially since specialists don’t know what a good level of progesterone is for multiple gestation.  After three consecutive losses, I carried my twins to term. :)

I accidentally became pregnant during my September 23, 2010 cycle.  I suspected it almost immediately after conception, so I began early testing.  By CD 28 I tested positive for pregnancy.  I contacted my OB’s office (my previous lovely OB died the day he cleared us to TTC in 2008) on a Friday, and was frustrated that it took until the end of the business day on Monday to get a script.  In the meantime, I contacted medical friends and even the RE’s nurse.  I was amazed that she got back to me and was still willing to advise me . . . 2 years later and from out of state.  What a blessing.

Your typical OB isn’t always well-equipped to deal with early pregnancy issues.  My OB recommended 100mg oral progesterone.  I double-checked this with the RE’s nurse, and she did NOT recommend this treatment.  My SIL also told me some sketchy stuff about oral progesterone supplementation.  The RE’s nurse said the best thing to do is either go back on the shots or do 200mg prometrium vaginally.  Since prometrium is so accessible and doesn’t require a stick in the bum, I went that route.  I also want readers to know that it took a while to straighten out the script, but by Tuesday I had what I needed thanks to a lovely independent pharmacist, the RE’s nurse, and the OB’s office following through with exactly what I requested.

I just want to offer this information up for those who are struggling to make sense of their losses.  Really, if you think you suffer from low progesterone and/or a short luteal phase, you need a medical script for progesterone supplementation.  It is unlikely that natural supplements will do the job . . . maybe for marginal progesterone?

Someone on one of my advocacy lists said that taking prometrium vaginally seemed “iffy” to her.  I must admit that irritated me, but she doesn’t know anything about me or how seriously I consider my health decisions.  Had I not been directed to this reproductive endocrinologist in 2008, I would probably not have my twins or be 16 weeks pregnant with my fourth and final baby.

Feeling Overwhelmed . . . hmm

I’m feeling overwhelmed this week.  Icky.

A couple of things have thrown me off my center, perhaps.  Like my good friend’s threatened labor now at 30w gestation.  Like my sister-in-law’s straight-forward CBAC yesterday – don’t get me wrong, I’m thankful, but it’s still affecting me.  Like having to go back to work in less than two weeks – survival mode.  Like all of the projects that I haven’t accomplished this winter break.  Like my birthday coming tomorrow – gross late-30s number!  Like CBA2C vs. VBA2C vs. CBA2C vs. VBA2C and on and on.

Ack.

What do you do when you’re feeling overwhelmed and ineffective?  Any suggestions?  It’s really causing me to stagnate and procrastinate.

It’s not like I’m doing absolutely NOTHING.  It’s just that I feel like I’m hiding in my birth research and stressing about a lot of different things and not actually accomplishing things in a timely fashion.  I just need to break the cycle.  I probably need a to do list – maybe a reward chart?!  Haha!

We already feel inadequate

I watched Orgasmic Birth last night on Amazon.  When I told my husband what I was watching, he gave me a look like “oh no, you’re going to be one of those women this time, huh?”  I told him that despite the title, the movie was supposed to be good, and for the most part it was.

If you go to the OG website, you’ll see that they define the word orgasmic differently than you would expect: “Intense or unrestrained excitement or a similar point of intensity or emotional excitement.”  I’d agree that all of the normal physiologic births shown on the video demonstrated intensity.  It’s important to read the definition above with the word “or” in mind.  A woman does not have to achieve orgasm during labor/birth to have an orgasmic birth.

I found it interesting that one of the interviewed NCB experts suggested that we don’t share our birth stories because we don’t want to make other women feel inadequate.  Perhaps a woman who consents to an epidural in a hospital setting will feel inadequate, I don’t know.  But, a woman who has undergone a cesarean after trying to labor will almost always feel inadequate in some way.  (I know there are always women out there who will say different.)  Let me explain.

A woman is told that babies come out of vaginas, and that most of the time that is possible.  Women may enter into the last stages of pregnancy knowing that they want an epidural or to be induced, but they still expect that in most cases, the baby is going to come out normally.  However, most hospital birthers are not given the right kind of support to achieve a natural physiologic birth or normal birth.  Inductions are fairly normal.  Augmentations are fairly normal.  Epidurals are extremely common.  As one expert pointed out on the movie, when most (like 90%) laboring women receive an epidural, and you don’t, you take the staff out of its comfort zone.

So after these interventions and more (constant monitoring, restricted movement in labor, etc.), women are still expected somehow to birth vaginally.  And a third of us are sectioned – or more, depending on the location.  Our bodies failed us, we are lead to believe.  “Thank God I was in the hospital or my baby and I would have been in big trouble.”  Our inadequacies are magnified by the overwhelming successes of the medical machine.

Women who have had cesareans are defensive.  “My cesarean was necessary” is a common belief.  But to suggest that women don’t share their birth stories because they don’t want to make a cesarean mother feel inadequate is not understanding the situation.  We already feel inadequate.

I am 1 of 3 women sectioned in childbirth.

I am one of numerous women told that her body wasn’t capable of birthing her baby.

I am 3 of 4 women sectioned in Montana for twins.

I am nearly 100% of women in my community told they cannot have a VBAC in the hospital after multiple scars.

I am nearly 100% of women told to be thankful that they have a healthy baby after a cesarean section.

Share your birth stories in a supportive, instructive, and hopeful manner.  Give cesarean mamas hope that next time can be different, if she chooses.  And she has to choose; you can’t choose for her.  I myself am preparing for a transformational experience this summer.  I can’t get there unless I embrace stories of uninhibited natural physiologic birth.

Flashbacks

2007 – 2008 were really tough years.  I suffered three consecutive pregnancy losses.  I nearly lost myself.  I look back on those years and shudder.

I was driving down the road the other day and couldn’t get these losses out of my mind.  I gave birth to twin girls in August 2009, but this doesn’t mean that I don’t still grieve for those lost souls.  Ugh, I don’t like thinking about it.

Perhaps these losses are on my mind because I had that evil Mirena IUD taken out last month.  My cycle has returned.  I had my first real menses since 2008.  The blood reminds me of all I have lost and all I have gained.

I’ve just ovulated.  The lovely CM and pains of mittelschmerz remind me of all I could lose and all I could gain.

My heart craves another child.  My body begs to be useful . . . and to be complete . . . and to bring my childbearing years full circle in the comfort of my own home with my husband and perhaps a midwife or doula.

A few 2007 birth statistics

I’m not bored, but I did wake up at 4am which led me to the CDC.  Under “What’s New” at the NCHS page I read, “Twin Births Remain Stable, New Report Shows”.  Ok, so I was a bit disappointed that it wasn’t an entire report about multiple birth, but since I still hadn’t actually read the 2007 birth report, I suppose it was good that I took a peak.  If you’re interested to see what I posted about multiple gestation and birth as well as a collection of other data points that I found interesting, have a look here.

I browsed the site further and found some interesting statistics.  I was particularly looking for information on multiple gestation, of course, and was disappointed not to find method of delivery stats readily available for multiple gestation sets.  I did create a little spreadsheet though for 2007 births by gestational age and method of delivery.

I only looked at 34+ weeks gestation.  Information from 20-33 weeks gestation is available, but since I know less about those groups, I didn’t include it.  It is possible that premature babies are more at risk of dying during vaginal delivery than cesarean, I don’t know for certain, and I’m sure that parents need to consider their options carefully, if options are given.

ATTENTION!  Notice that the nation 2007 cesarean rate was 31.8% in 2007, another all-time high.  The World Health Organization suggests that a cesarean rate of 10-15% is indicative of a birth reality that is consistent with science and good practice as measured by healthy birth outcomes for mom and child(ren).  Get above that 15% range, and THE RISKS BEGIN TO OUTWEIGH THE BENEFITS.  I repeat . . the risks outweigh the benefits outside of the cesarean rate range of 10-15%.

So let’s extrapolate a bit . . .
You’re the MOST likely to birth vaginally if you make it to 40 weeks.  Problem is that most OBs do not encourage women to gestate to 40 weeks and a high number of elective cesareans take place in the 39th week.  If your baby comes before 37 weeks, look out . . . 41% of all live US births between 34 and 36 weeks gestation happened via cesarean surgery.  We need to be asking . . . WHY.  And why are nearly 1/3 of all babies being born via major surgery.  Why are so many women having their babies surgically extracted from their bodies, especially when subsequent pregnancies will even more likely end with a repeat cesarean?  WHY WHY WHY!!!!!

ASK SOMEONE WHY!

WHY 32% . . .

Cesarean Recovery, v.1

I am annoyed by my cesarean recovery.  I am more than 5 months post partum and still have pain and tenderness on the left side of my abdomen.  I’m sure I must have a number of adhesions that need to be broken down.  I did attend ICAN’s webinar about scar care and have been doing some massage.  I use a few drops of Young Living’s lavender oil – I recommend a therapeutic/medicinal grade essential oil – and massage it into my skin.  I have to massage all along the left side of the top layer of abdominal muscles (rectus abdominus), and it’s tender from pelvis to ribs.  Not good.

I am also annoyed that so many people are resigned to putting themselves, their babies, and their patients through this major abdominal surgery without a really really good reason.  Fetal distress, small pelvis, cephalo-pelvic disproportion, maternal demand, and previous cesarean are the usual suspects and are not necessarily indication for a cesarean.  <sigh>  I recovered easily enough from my first cesarean, but this time around it’s a different story.

I’ll end v.1 here.  To recap, I am not pleased with my recovery because I still have significant tenderness and pain more than 5 months after my surgery.  Does that sound like fun to you?

Positive Thoughts On the Cesarean Section

One of my ICAN friends posted this on Facebook today:

BirthCut Calling all C/S mothers! I am looking for positive cesarean birth stories! I am also looking for any tips about the actual surgery and/or recovery you may have for cesarean mothers. And, well, anything else you may have — art, videos, etc etc. Thanks!

Interesting thought.  Do I have anything positive to say about my cesareans?  Actually, I think I do:

DECEMBER 2004

I was exhausted from the flu – vomiting and pooping everywhere.  The illness forced my body into labor before we were ready.  Although I arrived at the hospital at 9cm dilated, my baby quickly got stuck.  I don’t know if I could have pushed her out.  I was so utterly exhausted.  I pushed with everything I had and it still wasn’t enough.  By the time I had the cesarean I was incredibly thankful for the “convenience” of modern medicine.

I did recover quickly physically.  I don’t recall feeling poorly for long.  And I still felt like superwoman . . . for a while, anyway.

AUGUST 2009

Pregnant with twins which meant that I was “risked out” of homebirth and birth center birth.  By 37 weeks both twins were breech.  When my Baby A broke her water in the middle of the night, I knew she did it with her feet.  I was so disappointed because the LAST THING I WANTED was to go through major abdominal surgery again.  I had learned so much about my body . . . I learned that my miscarriages were likely influenced by the presence of adenomyosis (caused by the first cesarean in 2004) . . . I knew that if I were to get pregnant again that a VBAC after 2 cesareans would be nearly impossible unless I wanted to try it alone . . . I know that these abdominal surgeries are risky in my line of work (I’m an opera singer).

I had considered bucking the system since breech is a variation of normal, depending on who you ask.  I thank God for guiding me elsewhere, because my precious Baby A would not have likely survived a vaginal birth.  She was entangled in her cord, and the cord was wrapped around her legs.  Both girls presented double footling breech.

Although I am still in pain 5 months later, and have yet another scar, and have yet another saggy somewhat sensation-less flap of skin above my scar, and have found my singing to be anything but stellar due to my weakened core, I am thankful that a cesarean was available to me.

I don’t recommend a cesarean unless it is really REALLY necessary . . . sad that probably half of the cesareans that are performed in the United States are likely not necessary.  A cesarean is considered a morbidity because of its seriousness – it’s a MAJOR abdominal surgery.  However, there are situations where a cesarean may be prudent or necessary.  When the technology is used appropriately, it is indeed a blessing.  To learn more about c-sections, visit Childbirth Connection and ICAN.