The other shoe

While neglecting this blog the last couple weeks, what we haven't been writing about is how this pregnancy has now shifted from extremely healthy and extremely low-risk (although not necessarily easy, see the nose incident and that persistent morning sickness) to a moderately risky one necessitating pretty vigorous medical management. Great. We all know how much I love doctors.

The short story is that over about the last two weeks we've determined that I have developed a not-so-common (but not necessarily so uncommon) liver problem specific to pregnancy, with relatively conclusive labs coming back yesterday morning. I'm not going to name it, because expectant parents read here and you have enough to worry about; you don't a new tempting scary link. I promise, if you really need it, you can find out more than you ever wanted to know starting with the info here, but really, don't look it up unless you have good cause.

In addition to the most insane skin itching I've ever felt in my entire life, which was our tipoff that something was really wrong, this condition comes with substantial increases in scary stuff like pre-term labor, stillbirth, fetal distress and some other stuff. As near as we can tell, the real risk is to the baby, while the risk on my end is primarily completely losing my mind due to being up all night itching and itching and itching. The risks to the baby are minimized (to the point of being nearly eliminated) with medication, sufficient monitoring to make sure things are OK in there, and most effectively, early delivery at about 37 weeks.

Especially given that we've been earnestly planning our home birth, encouraged in our plans by that super-healthy pregnancy I was having, this is extremely unwelcome news. I'm at 34 weeks now. We will most likely have a baby in 3 weeks if not sooner. We had thought we were on more like the 6 to 8 weeks schedule, especially since for first pregnancies, the babies like to come a little late.

Obviously there are plenty of worse late-term complications out there. Even though moderately risky and unpleasant, this one doesn't seem to represent a huge hazard to the baby as long as we do what we need to do. I get that. I really do. But I'm still not happy about it.

We do at least now get some payoff for my putting up with those pesky back-up OB appointments. I was able to get labs through quickly without having to futz around to find a doctor willing to take me this late in the game, and even though I have a general distrust of doctors (oh, except my father, sorry Dad), for a host of reasons, some good and some not, I do at least like this OB, and count her among the "good ones." She was willing to be unofficial back-up for my midwife at a time when that is really not at all politically expedient in this area. She also seems to have a good grasp of what actually is and isn't evidence based in obstetrics. At my appointment this morning, she was extremely reassuring and is handling the transfer of care appropriately and respectfully. I feel like we're in good hands, even if it's not where we want to be.

We had been considering switching from this local back-up hospital to one a long drive south with a better c-section rate, but with our midwife's encouragement, we'll be staying with the local hospital, not only for continuity of care and to avoid the stress of traveling so far for monitoring, but also for the safety of having the hospital close in case of pre-term labor. Our midwife will also be continuing to work with us, but now in a labor support role. We trust her. She's been smart about all of this, encouraging testing at the right time and supporting appropriate transfer of care to a more medical approach. We'll be glad to have her there.

I suppose now we have to figure out what to do with those nice boxes of birth supplies out on our porch. Does anyone need a lot of chux, vinyl table cloths or drinking straws?

Acupuncture poster child, Part II

(See some of the backstory in Part I)

My first cycle with acupuncturist Li was excruciating. It was extremely long, and when I started bleeding at work on the first day of my period, the pain was so extreme I nearly passed out. My new boss (I had only been on the job about a month, fabulous first impression, no?) nearly called an ambulance but I managed to convince her not to, and instead she kindly gave me a ride home since a bike ride was clearly impossible. The period lasted longer than usual, and was heavier than usual. I was miserable. Li was thrilled.

The very next cycle, my temps started to move up a bit, I ovulated, and the next period wasn't nearly as bad. She moved me through several rounds of herbs meant to do various things I didn't comprehend (what does "tonify blood" mean?). In the year or so that I was with Li before the cycle that worked, I only missed ovulation on one cycle. As my cycles regularized (about 32-36 days), my mucus improved, and it became possible (though not necessarily easy) to identify ovulation with signs and a vast collection of OPKs, I started to have hope my body really could do this. Gail and I decided to still get basic labs with an RE (which we had not done for Gail), which I did in March 08. The RE gave me the all clear, despite being fairly dubious as to why my hormone levels were fine after I had described my history (and asking for Li's contact info for her other patients). I told Li we were ready to try. After all, we'd given her far more than the three cycles she had originally asked for, and she said, I kid you not, "You don't try this time. You will have a miscarriage." After much badgering I managed to get out of her that she wanted my post-ovulation temps higher, consistently above 98, and was concerned I did not have adequate progesterone yet. I put it off one more cycle but I had been waiting so long. You can only push a girl so far, and I don't know many women who would wait through nearly a year of acupuncture before trying at all. I decided my body might not be perfect, but I had semi-reliable fertility signs and did ovulate regularly now. We decided that if I could identify ovulation, we would try. Li reluctantly agreed, but wanted me to use progesterone cream on that first try.

At that point, Li and I had gotten into a bit of a battle of the wills. I felt so dependent on her. She had done for me something I thought was impossible and I was deeply indebted to her. But on the other hand, plenty of straight women had even worse cycles and got pregnant just fine. I knew that if I never tried, I really would never get pregnant. As I moved slowly through 3 cycles of trying, interrupted by break cycles due to travel and one anovulatory cycle, she gradually seemed to approve more and more of each try, and I felt a little less like I was fighting her tooth and nail. But on the cycle that worked, she still thought maybe we shouldn't try because I'd been sick and recently traveled, even though she said my hormones were great. But we did it anyway, because I finally actually got that OPK smiley face, and it was our last shot at the three year spacing I so coveted. Obviously, I'm so glad that we did. I can't believe that starting where I did a year and a half ago, I ended up getting pregnant without meds, on the 4th cycle trying. Now when I see Li, she's practically busting at the seams with pride, though at my visit to try to fix this constant nausea last week, her first words were "Why you carry that heavy bag!? Don't ride your bike! Walk slowly!!" I hadn't seen her in over a month, and it felt kind of like when you come home from college, and your mom starts to nag you right away. You know it's out of love and concern, but you're still annoyed.

So there you have it. I probably had no business getting pregnant without meds, with frozen sperm. If I were someone else, If I were older, had a different history or didn't have such deep concerns about the medical system and its inherent undisclosed risks, maybe it wouldn't have been worth the time, work and money (at least $3600 total for acupuncture alone). I certainly don't begrudge those who head to the RE right out of the gate, and if we'd gone on for several more unmedicated cycles unsuccessfully, we would have been there, too, and grateful for the help. But I am so glad that we gave my body this chance. Along the way, Li fixed longstanding problems with headaches and evened me out a bit emotionally, somehow helping me gain a reserve of calm I thought was only possible for folks with less fiery temperaments. Is acupuncture a cure all? Probably not. It has yet to fix my morning sickness, and I could really do without that. Is it potentially powerful if you can give it time to work? In my case at least, with a skilled practitioner, yes. But even I got impatient, and I was bound and determined to give it a full shot, so I'm sure that means it isn't for everyone. If you're in the thick of trying, it is excruciating to give up one cycle, let alone 3, or 6. I'm happy to provide a referral (if you still want one after I described all that nagging) to other Eastern MA folks. I swear by Li, even though she sometimes kind of drives me crazy.

Acupuncture poster child, Part I

I've gotten a several questions lately about my acupuncture treatment, so I thought I'd post them in case other folks are looking for information. I'm kind of an acupuncture poster child, and I don't mean to imply, in that way that anecdotal evidence does, that acupuncture will work for everyone else just as well. But what happened was absolutely true for me and my body, albeit in an n=1 sort of way.

I started tracking my menstrual cycles in Jan 07 in anticipation of starting to try as early as August 07. It quickly became apparent my cycles were not as they should be. This shouldn't have come as a surprise. I already knew that I bled inconsistently and, when I was younger, sometimes so heavily that I had to stay home from work or school. I had excruciatingly painful periods, the kind of pain that ibuprofen couldn't touch and that sometimes made work impossible. In the past I had been on prescription drugs known to cause PCOS and hormonal/menstrual problems (not that I was told of these risks when they were prescribed, and not that my doctors ever inquired about how these drugs were impacting my cycles). But the drugs had been out of my system for a while, and I was much healthier than in the past, so I still felt surprised my cycles weren't behaving. I had been in some measure of denial about what a long road it might be to get this particular body pregnant, and seeing my crappy cycles, laid out in black and white, on Gail's homemade spreadsheet, was crushing.

My temps were so low we had to make a new custom chart, often in the mid-96's, and only rarely out of the low 97's, even when I got that coveted biphasic ovulation chart. My cycles ran between about 19 and 40 days, and luteal phases, when they happened, could be as short as 8 days. I could identify biphasic patterns suggestive of ovulation in about a third of my cycles, if that, and even on those cycles, OPKs did not seem to predict ovulation. I had no meaningful quantity of cervical mucus, and my uterus was positioned such that feeling my cervix, either for mucus or position/softness was impossible. Absolutely nothing was lining up and I started to ask around about REs, bitter that I was probably going to have to start the process at the doctors office with lots of drugs, instead of on our own, as we had conceived Leigh.

But I decided that since we weren't yet actively ready to try, and since I felt so seriously about only seeing an RE if I really needed the help, I would first give acupuncture a solid go. Acupuncture had helped to regulate my cycles in the past, had fixed Gail's short luteal phase in only 2-3 cycles, and started Gail's labor when she went 10 days overdue. I started in Spring of 07 with the practitioner who had fixed Gail's cycle, and though I think her work helped to regulate me a bit, she didn't seem to understand my problems. She kept giving me herbs to take pre- and post-ovulation when it wasn't at all clear or predictable when I ovulated, and never seemed to take meaningful diagnostic information (either asking questions, or doing those usual chinese medicine things like taking my pulse or looking at my tongue). I felt like I couldn't get any information out of her. After a few cycles with her, I switched to the practitioner, named Li, who had started Gail's labor and I had heard from a friend would tell me exactly what she thought, for good or ill.

When I walked into my first appointment with Li, she exclaimed over how horribly red my face was (I had just biked to the appointment...sheesh!). She asked me if I was quick to anger (umm....kind of) and seemed concerned with the color of my hair ("too red!"). She had lots of concerns over how much water seemed to be retained in my (relatively slim) abdomen and kept putting my finger on my belly after she had placed the needles, saying, "See? Feel that? It is so wet." I couldn't feel a thing. She looked at my charts, and muttered things about needing to "clean me out" and made me swear that I wouldn't try for at least three cycles. She peppered the conversation with barely intelligible tales of women with horrible problems she had fixed. All of this was made even more surreal by the fact that the appointment took place in her office that had recently suffered a fire started in the restaurant next door, and thus had no electricity, no plumbing and no heat. But I heard she was a miracle worker. And I needed a miracle...

To be continued in Part II

One of the reasons why

If I had written before this worked, about my personal reasons for wanting so badly to be pregnant (other than the obvious reason that Gail and I wanted another child), my reasons would have had a lot to do with pregnancy being a way to reconnect with my body, and as a way to have evidence that my body worked, after years of neglect and mistreatment. I've implied before, that I've not been treated kindly at the hands of western medical care. In particular, by agreeing to care that I did, for nearly a decade, for a condition it turned out I didn't even have, I exposed my body to extremely dangerous drugs that damaged my overall health and may have also damaged my reproductive health. I worked extremely hard for many years to extract myself from that system of "care" in a way that protected my body from further harm. Once I was free, I was so angry at myself for having been sucked in, for being so naive and accepting, for just believing what I was told without understanding the deep risks to which I was exposing my body. Honestly, I have yet to completely forgive myself, and still have healing to do. But some piece of that healing, and some piece of why I did not want to go on fertility meds unless absolutely necessary, was wanting to have some sort of evidence that my body was healed, even if my heart wasn't. I hoped that maybe pregnancy and birth would be a way to reconnect with my body, a way to redevelop a trust that I had long ago betrayed.

Somehow this seems so over-dramatic and perhaps ill-advised when it is written out, especially since so much can go so wrong during pregnancy and birth, that it's probably best to avoid putting too much pressure on the proceedings. But lesbians have to work so hard to get knocked up anyway, there's no way many of us head into this with reasonable expectations.

But here I am now, feeling crappy in the first trimester. I'm so thrilled that we have an actual baby in here, the kind with a heartbeat, but I'm still finding the experience itself challenging, and I'm trying to see if even now, I can find a way to use even the crappy parts as a way to reconnect. So far, I'm trying to listen to my body, to sleep because it says it needs to, to feed it. I'm trying not to be angry that I feel this way, and remember that so far it seems I'm doing a pretty good job growing our kid. Maybe for now, that's enough. I'm getting the feeling that as far as paths of reconciliation go, I may have picked a rocky one. Maybe I should have just stuck with the yoga.