Leaves make me sad.  Things tend to go to hell in a handbasket (or more) in the Fall.  I’ve NEVER liked Fall.  Even when I like Fall, I’m wary of Fall.  And for good reason.

Do you see this picture?  I suppose I look happy.  I’m not.

By this time in 2007 I had suffered two consecutive miscarriages.  I was starting to panic.  I was starting to lose it.

This photo also reminds me of our last good day with Alfred, the first dog my hubby & I had together.  We were playing in the leaves that day and with our baby girl.  Life seemed complicated then, but things were good and we knew it.  Alfred died soon after.

Leaves surround me now and make me remember the wonderful things I’ve lost this time of year.  And I’m thinking of a student (and friend) with two young daughters who just lost her husband.  Another loss in the Fall.

These losses also remind me of the many blessings of my life.  I prayed and prayed for another baby . . . and lo and behold I have had 3 more!

Silver linings abound.  Blue skies lurk behind the grey menacing clouds.  If i were more of an optimist, I’d always be looking for those silver linings and blue skies.  However, the wicked past has taught me that the grey menacing clouds return, perhaps more frequently than I would like.  Does the blue and silver merely tease me?  Or does the grey remind me to be thankful for the brilliance of the others?

I continue to ponder this . . . this chiaroscuro that is life.


Re-Birthing Catherine

Background:  I spend a lot of time mulling over the amazing information on kmom’s Plus Size Pregnancy site.  Today I was drawn to the “Emotional Homework” suggestions found under Increasing the Odds for a Safe and Successful VBA2+C.  I started tearing up and getting a lump in my throat . . . not that it takes much to touch my poor lil feelings these days.

Try ‘rebirthing’ your cesarean births – Although it is often a very emotional exercise, many women find it particularly helpful to recall every detail of their cesarean births, and then later re-script the labor and birth so that it goes the way they would have wanted it to go.  Start by recalling (either verbally or by writing it down) every sensory detail of a prior birth. [ . . . ]  Then, when you feel ready, re-script and re-experience the labor and birth the way you would LIKE it to have gone.  Change whatever needs changing, as small or as big as needs be.  Concentrate particularly on healing things with your child, having the wonderful birth and nurturing time afterwards that so many of us grieve missing.  Write out the storyline of the changed birth so you will have it and review it as needed.

My 2004 birth story (the hind-sight is 20-20 version) is here.  I will say that re-reading my surgical report and going over it with my midwife recently was quite illuminating, and that makes this re-birth process a bit easier on my left brain though my right brain is in agony right now.

Deep breath.  [Contraction]  Ppphhhhhhhhh . . . here we go.

my last belly pic 12/2004!

I went to my 40 week pre-natal appointment with my CNM a day after my guess date passed.  I was a bit disappointed that nothing was going on – very little effacement or dilation, but also wasn’t terribly surprised since I had learned that many first time moms go into their 41st week before natural labor sets in.  All of our family had been in town for Christmas, but the brothers and sisters had to head back out to jobs and school and stuff.  It was just us, our dog, and both sets of parents left in town at this point.  Still we’d both had enough family time, so after a good lunch at one of our favorite burrito places, DH and I left for home ALONE to just chillax.  I think I spent most of the afternoon on the couch sleeping through movies.  DH was gaming on-line.

Later in the day I started getting really sick.  I guess it could have been as early as 6:30pm or as late as 8:30pm, but regardless, I was a sick puppy.  My blood pressure runs a bit low, so vomiting + being on the toilet = passing out for me.  It was a fun game to see if I could finish my business before falling to the floor.  So, I was in and out of bed and the bathroom.  There wasn’t much DH could do for me, and I was so sick that I wasn’t staying remotely hydrated.  And I was contracting (though I hardly even remember that detail).

DH insisted on calling our midwife, and of course she just advised that he do his best to get me hydrated and not to worry about the contractions, because of course, there’s no way that I’d be in labor!  That made sense to me.  I certainly didn’t feel like I was in labor.  I felt sick as a dog, and I was getting sicker and sicker.  After a few more hours of this, DH called the midwife back saying that even if I wasn’t in labor, he was worried about how dehydrated I had become.  (We’re both professional singers, so we’re very conscious about hydration.)

This was after midnight.  He’s scurrying around the house trying to figure out what to put in our hospital bag, and I’m thinking that he’s nuts for trying to take me out of the house in this condition.  I remember not wanting to leave the house.  No, no, no – this is just NOT right.  And how the hell am I supposed to get to the car without passing out, pooping myself, or vomiting everywhere?  Hmmm??  And once I’m in the car, how the hell am I supposed to ride in the car without pooping or vomiting everywhere?  Hmmmmmmm???  Oddly enough (thought I get it now), I stopped getting sick.  I became more aware of the contractions, I guess, but I was more curious about why I had suddenly stopped getting sick!

We arrived at the hospital a few minutes later.  The intake gal wasn’t the slightest bit concerned about me . . . taking her sweet ass time while I’m contracting away and wondering when the next wave of sickness would take over my body.  I didn’t think I could get to L&D on my own, so once DH got back from parking the car, I think he wheeled me away to L&D.  I was kind of excited in a way!

Get to L&D.  Everyone is in slow motion.  They knew that I was on my way, but yeah yeah . . . 1st time mom thinks she’s in labor, yeah right.  They didn’t have a proper L&D room ready for me, so they put me somewhere else for my initial assessment.  It didn’t bother me any.  I was just trying to manage contractions.  So blah blah whatever questions that I couldn’t focus on but DH was mostly able to answer.  Taking their sweet ass time.  They check my cervix and holy moly SHE’S 9 CM DILATED!!!  GET HER MIDWIFE HERE STAT!!!  All hell breaks loose.  It was comical.  They readied a L&D room and transferred me.

So here we go!!!  We get set up in our room and our midwife arrives looking a bit sheepish since she insisted TWICE to my DH that I was NOT in labor.  After confirming that I was 9cm dilated, she offered to break my water to help move things along faster.  I knew that she was just trying to help since I was so sick, but DH reminded her that we were not interested in any unnecessary interventions.  He asked again about my dehydration, and they said the quickest way to remedy this was IV fluids.  It sounded like a good choice even though I was bummed to be connected to tubing that could restrict my movement.

At some point the labor nurse noticed fluid coming out of me.  I think she thought that was amniotic fluid, but no . . . ick, it was from uhhhhmmmmm, somewhere else in the vicinity.  I was a bit embarrassed that I was having diarrhea everywhere, but I knew that in order to bring this baby down, I needed to move and change positions.  For some reason, it seemed logical that I would turn my butt to the room and sort of drape myself over the back of the elevated head of the bed.  That was just a great position for me, even though I was making such a mess.  Thank God for chux pads, people!!!  Anyway, from this position, I was able to sway my hips and bounce like a maniac and still ‘rest’ my head.  Upright positions definitely felt the best and seemed the most productive.

I didn’t ever really ‘hit the wall’ like I had expected because obviously I transitioned either at home or in the car when I was still so sick.  Once I got to the hospital, I was still having diarrhea, but I stopped vomiting thankfully!!  I started feeling pushy, so my midwife examined me again and encouraged me to push.  However, she had me on my side for pushing and was having me push for counts of 10.  This was horrible.  They had to give me oxygen, and the position was excruciatingly painful.  My contractions were one on top of the other even though the stupid monitor was telling them that my contractions were ending.  I hated that damned machine.  I wasn’t making progress.  I was getting tired.  I was frustrated.  I was sick.  I was contracting and grunting and moaning and getting nowhere fast.  My midwife estimated that the baby was stuck at 0 position and not tolerating pushing particularly well.

DH & I thought back on our childbirth education series.  We knew something had to change.  So, I got back into that other strange position of draping myself over the top/back part of the bed and pushed in that position.  The counting to 10 was driving me crazy, and I yelled for everyone to stop.  I just decided to push whenever for however long and see what that did.  I felt my baby girl making her way down.  Eventually, that is.  My midwife wanted me to lie down so she could check the baby’s position, but I didn’t see how I could possibly do that, so she contorted herself and checked me and found that I was +1 or +2 . . . can’t remember.  Aha, progress!  That was all I needed to invigorate me.

Some rights reserved by Travis S.

I do remember wondering when pushing would end.  I thought I recalled reading that 1.5 hours was fairly standard, but I had been pushing for twice as long at least.  However, I was surviving (I think thanks to that bag of fluids), and the baby was now doing better with the pushing.  Hooray!  What seemed like an eternity later . . . eventually resulted in me feeling like my vagina was on fire and going to explode.  Baby was crowning!!  My midwife applied counter pressure to the perineum so I wouldn’t tear and encouraged me to ‘go easy’ with the pushing if possible.  Eventually I couldn’t resist any longer, plus I was tired of the out and in game that the baby was playing.  I pushed really hard – I think I was on all 4s at this point – and her head came out.  Relief.  It feels so much better once the head is out, I can’t even tell you.  A couple more pushes and the shoulders and body were out, and my sticky gooey baby was in my arms.

Many women feel like birthing their babies was a transformative experience.  I am one of those women.  I felt like, if I can do that, I can do anything.


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:

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.

Getting Weary from the Drawing Board

I’m supposed to have some more blood testing done later this cycle.  On CD3 I had FSH and estradiol levels checked.  Fortunately they came back just dandy – lo and behold my 35-1/2 year old advanced maternal age eggs are doing just fine.  Of course this does bust my hypothesis that my fibroid is caused by imbalanced estrogen levels.  Actually, one of the nurses said that the estrogen-fibroid connection is only relevant in post-menopausal women.  I haven’t done follow-up research to decide if I agree.

Anyway, the RE told me to buy an ovulation prediction kit (OPK) to determine when I would ovulate this cycle.  He didn’t trust me when I said that I *know* when I ovulate.  So, I spent the $24.00 on the cheapest OPKs I could find.  (By the way, Dollar Tree does not uniformly carry OPKs any more.  Drat!)  Let me just say that OPKs are the most stupidly designed hormone tests EVER.  When you test you will likely get 2 lines, but that doesn’t mean that the appropriate hormone (LH, I believe) has been detected.  Oh no.  You need 2 lines of equal strength or your line should be stronger than the test/constant line.  So, is it an equal line?  What if both lines are equally weak?  What if I *think* I’m seeing a strong and equal line but it’s not really accurate.  At the end of the day, I just ended up taking the stupid test so I could say I did it and then rely on my body’s very reliable signs to tell me that yes indeedy I did ovulate when I thought I did.

How am I so sure that I ovulated?  Well, without divulging too many gory details, here are some good ways to know: cervical os open, lots of egg-white-like cervical fluid, ovarian pain, elevated basal body temperature to name a few.  In my case, ovulation is starting to get a bit uncomfortable.  Am I really feeling new pain on the left or am I feeling pain there because I think I should be feeling pain there because I now know that there’s a fibroid there that the doctor has told me needs to be surgically removed?  I feel this discomfort every month.  Isn’t that a bit strange considering that we supposedly ovulate on alternating sides?

Anyway, I called to let the office know that I ovulated.  One of the doctor’s nurses called me back and gave me the good news about my FSH and estradiol levels.  She was far more informative than the other nurse I talked to last week about my test results.  However, she also wanted to talk to me about my x-ray.  Huh?

Evidently my doctor has been carrying around my chart with him.  My new medi friend says that it’s not unusual for a doctor to carry around patient files.  Ok.  Back to the story.  So, he has just recently looked at my HSG picture.  (He wasn’t the doctor that ordered or performed the HSG.  However, why was he looking at the film?  He supposedly had already looked at it and decided that I didn’t have a Mullerian Anomaly.)  What?  And she said that he’s going to want to do a sonohysterogram on CD6 next month.  What?  After the ultrasound he did at my appointment, he very confidently told me that the fibroid is definitely causing me problems; a sono was NOT necessary; get on the books for a myomectomy.

Why has his story changed?  Did he forget that he had already looked at the HSG?  Did he forget that he said a sono was no longer necessary?  Did he forget that he wanted to schedule me for surgery?  Or did he receive some input from one of his partners or the radiologist with regard to the HSG or recent ultrasound?  Is he confusing me with another patient?

Can I just say that I’m very frustrated and that my trust in this medical professional is waning?  Three different doctors; three different diagnoses; at least three different protocols.  It’d be nice for there to be some agreement with regard to a plan of action, particularly between my new OB and this RE.  Or do I need to go back to the drawing board?