A Note to My Friend

This morning I received an encouraging e-mail from a friend.  She has been through infertility and recurrent losses, but it looks like she finally has a keeper!  Luckily she has found medical providers who were able to come up with a good treatment protocol for her situation.  She has weaned off of the progesterone shots (daily shots of progesterone in oil – owie!) but is still on heparin, I believe, for the duration of her pregnancy.  She is finally in the second trimester!

She mentioned that her fear of childbirth is abating.  Some of that is because she has experienced natural miscarriage, and she has been told that it is like mini labor.  I wanted to share (most) of my response to her.  Of course I could have said much much more, but I really don’t want to be “that crazy friend” who can’t shut up about natural childbirth.

Just remember that the OB is just a person, not a god.  And what YOU want DOES matter.  Ask about birth plans and how the hospital honors them.  I would hire a doula, someone who will be able to advocate for your needs and your desires.  Seriously, that’s the biggest mistake I made – I thought that having a CNM would “save” me from unnecessary intervention, but it didn’t.  The rest is history.


I thought the childbirth education classes at [name removed] were just fabulous.  My only criticism is that I somehow didn’t understand how life altering the cesarean was going to be.  I’m not trying to scare you – the cesarean was a piece of cake for me, and it didn’t mess with breast feeding at all (in my case).  It’s just that I was so shocked when I went in for my 6-week post-partum appointment with the OB who did my surgery and was told about uterine rupture.^  And then last July-August when I was preparing for baby #2 I learned so much about the failings of our maternal health care system, and that’s when I really “cracked.”  I was just so pissed and became somewhat disappointed in [name removed] for not having been more forceful.*

Regarding labor – I didn’t even know I was in labor.  Granted I had a violent stomach flu . . . but I was surprised that I showed up at the hospital 9cm dilated!  Probably one of the most painful things I have gone through was my second miscarriage.  Supposedly subchorionic hematoma miscarriages are pretty bad, and this one was no exception.  And during my last miscarriage I kept nearly fainting from the blood loss.  Labor?  Piece of cake.  You’ll be brilliant!  Remember that the pain is good – it’s there for a reason.  It helps get your baby out and into your arms.

I am just so excited for you.  I am so glad that you’re out of the first trimester!!  And hopefully you’ll really start feeling great, and pretty soon you’ll start feeling your “lemon” move.  That will bring you much comfort and joy.

^ For the record, every laboring women has a small risk of uterine rupture.  Most uterine ruptures in VBACs were historically caused by labor augmentation and induction tactics.  A “window” or a dehiscence (separate terms in my mind) is not the same as a true uterine rupture.

* One thing I forgot to mention to her is that my husband seems to remember our childbirth educators talking about uterine rupture.  Maybe they mentioned it, but again, it didn’t leave the impression that it should have.  I only pushed for 2 hours and then gave in to the cesarean.  I thought it made sense.  Had I known – really known – what a cloud the cesarean would cast over the rest of my childbearing years, I’d have resisted that cesarean.  My baby would have tolerated it – when she was delivered, her APGAR scores were 9 & 9.  Nearly perfect.  Not a baby in distress as I had been told.

Perhaps what childbirth educators could add into their series is a session on how doctors perceive cesarean scars.  Why the medico-legal culture dominates obstetric practices.  Why certain risks (cesarean surgery, amniocentesis, etc.) are acceptable and others (natural birth, especially after a cesarean) seem foolish.

PTSD After Pregnancy Loss

I have taken the bones (and admittedly, most of the meat) from the post, PTSD after childbirth, to construct this post. I know personally and from talking to others that women can experience Post-traumatic Stress Disorder (PTSD) and Post-partum Depression (PPD) following birth losses. We enter our pregnancies with the fear of loss in the background – some worry more than others – but ultimately expect to be holding our beautiful babies in a mere 8 months after getting that BFP (big “fat” positive) on the home pregnancy test. I myself have been pregnant 4 times and have one living child. I have a lot to be thankful for. But 3 consecutive losses were almost too much for me.http://www.flickr.com/photos/parapet/

Yes, women can and do experience PTSD and PPD after miscarriage, pre-term birth loss, and still birth. The Florida Psychotherapy blog applies the DSM-IV-TR to childbirth related trauma. Let me apply the criteria outlined in that post to PTSD after loss(es).

According to the DSM-IV-TR, the following criteria must be met to be diagnosed with Post Traumatic Stress Disorder (PTSD):

A. The person has experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others AND the person’s response involved fear, helplessness or horror.

How a prospective mother views early pregnancy can contribute to PTSD. One of my sister-in-laws had an early loss but wasn’t terribly affected by it. I was shattered after my first loss. How did the prospective mother react to her loss? Did she panic? Did she cry a lot? Does she remember the entire experience? Has she withdrawn from her life? These and other reactions can be stress responses to her loss.

B. The traumatic event is persistently re-experienced in at least one of the following ways:

  • Recurrent and intrusive distressing recollections of the event.
  • Recurrent distressing dreams of the event.
  • Acting or feeling as though the event were recurring (including flashbacks when waking or intoxicated).
  • Intense psychological stress at exposure to events that symbolize or resemble an aspect of the event.

Women who have experienced pregnancy losses can have nightmares about her losses. Strong images and flashbacks may occur at random moments, or she may have trouble NOT thinking about her experiences with pregnancy loss. Women who do participate in support groups and especially on-line forums need to be careful here. By continuing to relive and replay the experience, you may slow down your recovery.

C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the event) as indicated by at least three of the following:

  • Effort to avoid thoughts or feelings associated with the event.
  • Efforts to avoid activities or situations which arouse recollections of the event.
  • Inability to recall an important aspect of the event (psychogenic amnesia.)
  • Markedly diminished interest in significant activities, such as hobby or leisure time activity.
  • Feeling of detachment or estrangement from others.
  • Restricted range of affect; eg, inability to experience emotions such as feelings of love.
  • Sense of a foreshortened future such as not expecting to have a career, more children or a long life.

Here are some examples of how this many manifest. She may avoid places where she is most likely to encounter other pregnant women – play groups, gynecologist, church, heck . . . even the grocery store. She may have trouble relating to other friends with children and friends who are currently pregnant. She may be unable to watch shows that feature pregnancy and birth, look at milk cartons, hear about abused or murdered children, etc. She may no longer find pleasure in activities she once enjoyed. She may avoid sex and/or intimacy with her partner. She may not remember that she was bleeding all over the bathroom and that her young daughter saw the blood . . .

D. Persistent symptoms of increased arousal (not present before the event) as indicated by at least two of the following:

  • Difficulty in falling or staying asleep.
  • Irritability or outbursts of anger.
  • Difficulty concentrating.
  • Hyper-vigilance.
  • Exaggerated startle response.
  • Physiological reactivity on exposure to events that resemble an aspect of the event, eg breaking into a sweat or palpitations.

Moms may have an anxiety reaction when driving past their birth centers or hospitals. They may get anxious when discussing the birth or when birth stories come up in conversation. They may also feel detached from their baby, partner, family, or friends.

E. B, C, and D must be present for at least one month after the traumatic event.

I certainly experienced many of the above symptoms. I had an outright panic attack shortly after my first loss. After my second and third losses I was taking medicine to keep that from happening. I’ve had an incredibly difficult time concentrating since my losses began. I’m doing better now, but last Spring was agonizing.

F. The traumatic event caused clinically significant distress or dysfunction in the individual’s social, occupational, and family functioning or in other important areas of functioning.

Like postpartum depression, PTSD is highly treatable, meaning the woman can get better, sometimes very quickly. Treatment options include

  • talk therapies such as cognitive-behavioral therapy
  • medications and herbs
  • acupuncture
  • body therapies such as Eye Movement Desensitization and Reprocessing (EMDR), biofeedback, and hypnosis

I wasn’t able to recover quickly or easily and was prone to relapses. My last relapse was in August 2008. I went to a therapist and got tired of being told that “this is normal.” There is nothing normal about considering suicide. That is NOT an acceptable response, in my opinion, to any situation – merely “stressful” or absolutely traumatic. There is nothing normal about excessive drinking. There is nothing normal about not wanting to be around your partner or child (children). There is nothing normal about being nearly incapacitated for months and months. There is nothing normal about going out drinking and accidentally getting so drunk that you throw up in public, have to be driven home, black out, and want to kill yourself all over again. Of course, this last paragraph is MY situation, and I’m sure it may seem a normal response to recurrent pregnancy loss, but that doesn’t make it ok. I share these deep dark secrets with you so that you know if you experience these same or similar things, that you’re not alone. It may be normal, but it’s not ok. Please get help!

Additional resources:

And PCOS too

Well . . .my uterus looks just fine.  Looks like I’m healed up from the surgery – the “stripe” looked just lovely.  I still have a posterior fibroid, but I don’t think that was the one the RE messed with this summer since the adenomyoma was just above the cesarean scar.

I have Polycystic Ovarian Sydrome (PCOS).  My OB just discovered it today via ultrasound – the “string of pearls” were clear as day.  I don’t know how much of an affect that has on RPL.  GETTING pregnant hasn’t been my issue, and it seems to me that most women who have PCOS and suffer from infertility are having trouble conceiving.  Maybe that’s inaccurate.

My appointment was very interesting.  My OB doesn’t believe in the luteal phase defect.  That’s not to say that he’s antagonistic – he’s more than willing to treat with HCG and progesterone injections.  What I learned today is that some reproductive endocrinologists don’t believe that the luteal phase has anything to do with conception issues.  It’s the 1st half of the cycle that governs cycle length.  Evidently, if you ovulate then you will have a sufficient luteal phase.  REs that ascribe to this philosophy are more likely to treat with ovulation triggers like clomid, especially with PCOS.

That’s about all I have to say right now.  Just wanted to give the faithful an update and those of you who struggle with faith a bit of information, hope, and comfort.  YOU ARE NOT ALONE!

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Think of Me: Post-Op Ultrasound

I’m a bit of a wreck today.  I seem to get pretty antsy and stressed out before OB visits anymore.  Hmm, wonder why.  Anyway, I have an ultrasound scheduled tomorrow to check on my healing from the hysteroscopic myomectomy that was performed in August.  The myomectomy was supposed to remove a fibroid from the uterus and uterine muscle.  However, the surgeon found NOT a fibroid but an adenomyoma, endometrium growing in the muscle layer.  He’s not sure how much he was able to remove.

I must admit that I’m not feeling terribly confident.  I think I’m feeling less discomfort during ovulation from before, but that’s the only noticeable positive change.  I had one ok period followed by a horrific one in September where I was bleeding and clotting so heavily, and of course, I was busy at a conference at that time.  This last cycle only lasted 22-24 days.  I started spotting on the 22nd day and started heavy flow on the 24th day.  Bummer.  My progesterone must really suck.

I suppose the two possible outcomes for tomorrow are: (1) things look healed, so go for it, or (2) things don’t look so great.  I wonder how distorted my uterus still is?  I wonder if the myoma really had anything to do with my losses?  If things don’t look great, will that mean another surgery?  Or will it just mean more agonizing waiting?

And then what?  I can’t hardly remember any more.  I think I’m supposed to start on antibiotics and low-dose aspirin the cycle before conception.  Then I’ll have HCG shots during my luteal phase and progesterone shots once I get a ++.  My husband and I are both itching for another baby.  It’s crazy, really.  However, we don’t feel like our family is “done.”

What would I do if I lost another baby . . . God forbid.

Please keep me in your thoughts over the next 24 hours.  Thank you!

A Hole in My Venus

I’ve been looking through stock and Creative Commons Licensed photos tonight that deal with pregnancy.  I figured that while I’m in the mood I’d look for some photos that we could possibly use for the upcoming ICAN Conference in April in Atlanta.

I find this a particularly interesting portrayal of Venus, the goddess of fertility among others.  Notice that in this piece of artwork, she is missing her lower abdomen.  There is a hole there.  This is how I feel – like a goddess (albeit worldly, a woman who is quite fertile) whose corrupted uterus has been excised from her body.  It is so hard not to point at the cesarean as the root of my current woes.

I am so sorry that so many of you know how I feel.  No one deserves it.

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Loss Never Ending

I can’t hardly breathe tonight.

My phone rang today.  Our good friends are in need.  She’s about to have their third baby, and since baby Y-H is about a week early, my friends parents haven’t arrived yet.  Other good friends are out of town, and I feel honored that they turn to us for support during this most important time.

But now as I clean up around the house . . . and am faced with new baby coupons and childbirth books and gmail friends’ status messages updating us on pregnancies and new babies . . . I am overwhelmed by my losses.

June 4 was a lifetime ago.  Geez, no, early April, my first loss due date was a lifetime ago.  That’s right, my June baby was my “perfect timing baby.”  And the unimagineable still happened.  I lost another baby.  My baby was due around September 15.  I (should) have a 4-week-old baby, and my best friend is about to have her baby.  She found out about her baby a few days before I lost mine.  No wonder she was such a wreck when she first saw me after my loss.  She was pregnant and pukey and in agony since her dream was coming true and my dream was dashed yet again.

She’s about to have her baby.  Her third baby.  I have coupons.