Thursday, December 30, 2010

Exciting News (x2)

Big News. Big, Big News. We have... A TOOTH!

Jack's first tooth is coming in. I can just barely see the edge of it, on his upper right gum. It's definitely giving him some trouble... we finally caved and started with the orajel and tylenol. I'm not sure if it's doing anything to help.

Just in time, Jack has taken to pursing his lips and blowing raspberries. I wanted Jack to learn how to blow raspberries -- y'know, like the horse-lips kind. It's so cute when babies do that. I've been showing him for months. He finally learned: I was so excited!! The only trouble is that it's a slightly less polite version than what I was hoping for:

video

Still, when the baby does this for 20 minutes straight at 3am the night before our big trip to Vermont, it's enough to send his parents into hysterics. These raspberries have added so much laughter to my life, I'm not complaining.

Monday, December 27, 2010

A very, very long post.



I’ve been wanting to write about Jack’s birth for some time.

I keep putting it off. Telling a birthing story is… tricky. Not everyone wants to hear it (please close your browser now, and I promise cute stories about Jack's growth in future posts). Birth is personal. Our language lacks the word to describe the magnitude of its highs and lows. Discussing pain is impolite at best, and inappropriate at worst. Plus, every time I read what I write, I hate it. I hate that I can’t convey the intensity of the experience without sounding overly dramatic. I vacillate between scientific exposition and the eye rolling land of cliché. I just don’t know how to say what I want to say. By telling this story, I am exposing myself, physically and emotionally.

But as the months pass and my memory of the event fades, I realize it’s now or never. Furthermore, I realize how shielded the other birth stories that I had heard were. I wish someone had told me the whole, horrific truth before I went through it myself.

It's a long story. I could shorten it, but I don't think I will. This blog is a place where I can be entirely honest, not knowing who exactly is reading and not worrying about what they might think. I'm off work this week and have time to pay attention to this blog, my public diary about Jack. So I'd like to relate everything about Jack's birth that I remember.

Inducing Myself

I was taking insulin shots for gestational diabetes and getting weekly ultrasounds and nonstress tests to make sure that the baby was OK. Every piece of evidence said that Jack was healthy, however, with severe gestational diabetes (as mine was), there is a theoretical risk to placental function, and a statistical increase in stillbirths after 40 weeks. I was informed that I would be induced at 40 weeks, no matter what.

I did not want to be hormonally induced, for my sake as well as Jack’s. Hormonal induction is a nasty business. It would have involved my checking into the hospital the night before. They would have attached something to my cervix to mechanically dilate it. After a sleepless night, they would start me on a Pitocin drip. I’ve been told that the tough part about induction is not just the overly painful contractions that Pitocin will generate (and those are supposed to be quite bad)… it is the long, exhausting, stressful wait before the contractions start. The doctors slowly dial up the chemicals until your body responds, and this is both physically and emotionally taxing. Giving birth unmedicated after a hormonal induction is nearly unheard of. Hormonal induction also carries a high risk of C-section. And C-section comes with its own host of complications for mother and child.

Desperate to avoid the induction, and hopeful for an unmedicated birth, I researched all home remedies available. Every resource I located pointed to a single effective method that can be used to induce contractions if your body is ready to go. There is no risk of early labor. I wished to avoid a particular doctor that I knew to be on call on Monday. So I decided to attempt home-induction on Saturday morning, 4 days before Jack was officially due.

Recipe for inducing labor: drink a particularly gross, indigestible concoction until you achieve a horrendous stomachache. The prostaglandins that are released from your GI tract produce contractions in your uterus, which starts the cascade of positive feedback that is birth. In addition to myself, I personally know two other women for who took castor oil, and for each of them, labor started within 6 hours.

Actual recipe for inducing labor: one tablespoon of castor oil shaken vigorously into 2 tablespoons of orange juice. Glug that foul, disgusting mixture once an hour for three hours*, locate the cutest onesie in your collection (moral support), and plan to spend the day at home.

*Actually, I was quite on the low end of the dosing spectrum, but you can go even lower (my friends were successful in the teaspoons range). Be patient. It takes 4-6 hours for the castor oil to reach the right spot in your GI tract, and all you need is enough to give yourself a stomachache. Less is more. Trust me.

I took my first dose of castor oil at 7:30am. I was miserable from about 11:00am-1:00pm, at which point I lay down for a nap. At 1:30pm, I felt my first contraction, and soon I had definite evidence that Jack would be born. Our Doula, Lizzie, a midwife in training, confirmed it over the phone: labor was happening.

I was elated to have avoided hormonal induction. I told Greg the news. He proceeded to do the typical guy thing and get all excited and worked up. I remained calm and happy. We cleaned the house a bit. I sent off a work email. We went for a walk, and I took a shower. I can’t remember what we had for dinner that night or what we talked about. I’m sure that many silly grins were exchanged. From the very beginning, my contractions were coming every 6-9 minutes apart, and they were mildly painful.

Contractions had just started

The Evening of 7/17

Things started to get very uncomfortable around dinnertime. By 10pm, I was miserable and unable to do much of anything except curl up in pain. I decided to sleep on the couch: getting in and out of bed was difficult, and I wanted Greg to get some rest.

I set up camp in the living room and tried to watch a movie and sleep. This was a bad idea. I kept drifting off, only to be woken up by another painful contraction. I was in too much pain to sleep, but I was too sleepy to shift my position. I stayed in one place for too long and got very, very stiff.

By 2am, labor was massively painful, and had no other way to cope except to stumble around the house, crying and leaning against furniture. I wanted Greg to sleep as much as possible, but I needed support. Jack was turned posterior (he would be born in this direction), meaning that the back of his head was pressing against my spine. I was experiencing horrific back labor. I could handle the contractions, which came and went with a predictable and bearable rhythm… it was the intense, unrelenting pain in my lower back that incapacitated me. I stayed vertical, tried hands and knees, and rocked on the exercise ball. Nothing helped. I was overwhelmed and terrified by the amount of pain I was experiencing so early on. I woke Greg up. We tried to work through the contractions ourselves for another two hours, but we felt unprepared and scared. At 4am, we called our Doula, Lizzie, and she came over right away.

When Lizzie came, things got a little easier. She had a calming presence, and she was also able to help reduce the back labor by pressing as hard as she could at a specific point on my hips; this opened up my pelvis so that there was less pressure on my spine. Lizzie would get quite an arm workout for the next 8 hours – she kept up the hip counter-pressure until I started pushing.

Early labor was a worrisome experience. I kept thinking something was wrong – wrong with the labor for being so painful, wrong with me for being so susceptible to the pain, so unwound – but Lizzie assured me that this was all normal. With Lizzie and Greg’s support, I was able to get into a rhythm. My contractions came in doublets: two, closely spaced together, a longer pause, and then two more. I was scared, but I felt confident that my labor was progressing. We used an ipod app to track the timing of the contractions. Greg made us breakfast, although I couldn’t eat.

By 7am, I was unable to speak during the contractions and I wanted to throw the ipod against the wall. A growing urgency overcame me. I felt slightly panicked. The pace of contractions had quickened, and something felt different. We decided it was time to go to the hospital. I originally planned to walk – we are only 4 blocks away – but I was quite nauseous and did not want to throw up in public. We called the dog sitter, grabbed our overnight bag, and took a short car ride to the hospital.

The hospital: checking in

Upon check-in, the hospital required that I go through a nonstress test, where I would lay on my back and be attached to a fetal heart monitor for 20 minutes. The purpose of the nonstress test is to make sure that the baby’s vitals are good during each contraction. Its usefulness is debatable. There are alternative methods.

It’s hard to describe how lying on my back/side transformed my labor for the worse. The back labor was already incredibly painful. The contractions, which I had been experiencing in 6-10 minute intervals for 18 hours, were difficult. Being horizontal and not being permitted to move with the contractions was simply unbearable. It placed all of Jack’s weight against my spine. Before the nonstress test, I coped with the contractions by controlled, loud vocalization on each exhale. After the nonstress, “loud vocalization” became “screaming”.

A doctor came in to check me at 7:40, and it was a rude and unpleasant experience. I was 4cm, barely admittable. It was hard to believe that I could be only 4cm. In fact, looking back, I don’t believe it. I think, during the pain of lying on my back and from the forcefulness with which the doctor checked, I de-dilated. However, in that moment, the news of only being 4cm was incredibly demoralizing to me.

The hospital: laboring

Lizzie, helping keep me calm between contractions

We were admitted to a labor and delivery room, and Lizzie joined us. The nurse was amazing. She was incredibly supportive of my wish for an unmedicated birth. She asked me if I wanted to be asked for any pain relief during labor. I said “no”.

I kept changing positions with each contraction. Upright, leaning against a wall, sitting on the birthing ball, holding a birth bar, hanging over the edge of the bed, in the shower. Nothing helped. The contractions radiated from my back to my entire midsection, and the pain I was experiencing did not dissipate for a single moment. Each one consumed me to the point that I couldn’t process anything except how unbearable the situation was. I imagined I was being tortured: I would have said or done anything to escape it.

I felt certain that I would not be able to deliver Jack. I kept saying that out loud: “I can’t do this. I can’t do this”. Lizzie and Greg tried to convince me otherwise: “You are doing this”, they said. Secretly, in my head, I was begging for a c-section. Externally, I just cried and said disparaging things about myself.

I’m not sure why I didn’t ask for an epidural. I think my mental stubbornness was the only thing I had left.

At 9am, they checked me again. Unbelievably, I was 8.5cm – having dilated 4.5cm in less than two hours. Just goes to show you that cervical progression is a load of crap. While checking me, the doctor accidentally broke my water, and we learned that there was meconium in the amniotic fluid. At that point, an epidural was no longer an option. I felt some fear – that I couldn’t get pain relief even if I asked for it – but I also felt some excitement – I had gotten this far. Needles brought Jack into my body, and needles kept him healthy while he was there, but I would give birth naturally.

From 9-11am, I experienced “transition”, which is the most difficult period of labor, during which the baby begins to descend through the pelvis. I do not remember much from this period of labor.

I was so pissed at Greg for taking a photo of me so deep into labor -- I was in pain, for goodness sake! But I'm glad he did capture this moment

The hospital: pushing

At 11am, I started feeling the urge to push. I was nearly 10cm and the nurse gave me the go ahead to follow my body’s cues.

I pushed for an hour and a half. Pushing was a mixed experience. Compared to the horror of transition, pushing came with a degree of relief. Many women say that pushing through the contraction helps take away the pain. For me, each contraction was different. Occasionally, a push would feel right, and my physical effort would transform the pain into something my mind could work with. Most of my relief came from the 2 minute “naps” I had between each contraction. When a contraction came on, Lizzie and Greg would lift me up so that I could push. I distinctly remember the feeling of growing dread that came with the start of each new contraction, and the weird relief of falling back against the bed when it was over.

One of the most shocking parts of labor was the realization that even though “I” was pushing (as in, my conscious self was choosing to bear down) my body would push whether I made the effort or not. The only experience I can think of to compare it to would be forcefully throwing up – when you know it’s going to happen, and you know you can facilitate it, but you’re dreading it, and your body will do it whether you like it or not. For the last hour of labor, I would start pushing as a contraction came on, and then suddenly my body would take over and every single muscle in my body would seize into action with far greater strength than I was able to muster through my conscious effort. The way that my body would take over was violent. I felt violated by the contractions. This aspect of labor was terrifying to me, but, in retrospect, I can see how my body was functioning exactly as it should.

There was one position that worked well for me. I was up on the bed and they wrapped a sheet around the “squat bar” (this is a bar that you can hang on to, to support your weight). I leaned back against the bed and wrapped the sheet around my hands. Then, with each contraction, I pulled as tightly as I could. This position was helpful for me, because it made me feel like I was doing something, and my arms were the last part of my body that had strength left in them. My arms were incredibly sore for days after!

People – the books – say that during labor, every woman reaches a point of realizing that they baby has to come out one way or another, and that’s the point at which she works through the pain and pushes with full force. For me, this happened about 30 minutes before Jack was born. I was entirely convinced that my body was splitting in two. I was scared, and I was starting to hold back. Lizzie assured me that I was not ripping. From that moment on, I reached down for every spec of energy I had left. Originally, I didn’t want to look in the mirror, but they showed me Jack’s head and I became desperate to push him out. I roared and I screamed and I finally didn’t focus on the pain: I just pushed. And out Jack came.

The hospital: Jack arrives

The moments immediately following Jack’s birth are a very confusing time for me to explain. Let me start with my expectations.

I expected that once Jack came out, the pain would subside a little bit. I knew that some women were permitted to reach down and pull their babies directly onto their chests – I hoped that would be me. We had requested that the umbilical cord be left intact, so that the cord blood, rich in stem cells, could make it into the baby’s tiny body. I assumed that Jack would be placed against my skin. I thought we would lie there for a while, that I would deliver the placenta, and that they would stitch me up.

The part about having Jack on my chest was very important to me, for purely selfish reasons. There are many physical and emotional discomforts to being pregnant. IVF is an intensely physical and emotional process in itself. At every moment of mental hesitation – whether it was giving myself an intramuscular shot of progesterone, turning down the food that I enjoyed, or feeling my skin rip as Jack grew – I daydreamed about one thing. I pictured the sensation of having my baby placed on my chest immediately after birth. It was impossible for me to think beyond birth, because I could not imagine what being a mother would feel like… but I could imagine the baby outside of my body, and I could imagine the warm weight of a newborn infant against me. It is hard to describe how important that moment became to me.

So what actually happened? A number of things that shouldn’t have.

There was meconium in the fluid. Here is the proper medical protocol. If the baby doesn’t cry immediately, the doctors suction him to make sure he doesn’t inhale anything when he does cry. If the baby cries right away, nothing should be done, because suctioning at that point provides no benefit and could cause damage. There are many scientific studies to back it up: if a baby cries, he should not be suctioned.

When Jack was born, he cried. I remember his cry so well. It was the most beautiful sound I had ever heard. I remember the rush of emotion, the realization that he had arrived, that it was over, that it had begun. I remember his perfect face. I remember Greg exclaiming. I remember this as the most intense moment of my life. I can hardly write the words to explain its beauty.

And within 5 seconds, the doctors clamped the cord, cut it, and took Jack away from me. They suctioned and intubated him.

And then my doctor began pulling on the umbilical cord to force early delivery of the placenta.

And then I began to bleed.

And then they hooked me up to an IV and a Pitocin drip.

And then they refused to let me have my baby. I asked again, and again, and again. I will never forget the calm reaction of the doctor. To every request, she replied, “No, not yet.”

Jack was fine. He was gorgeous and perfect and crying and blinking in the bright light. Greg unbuttoned his shirt and held him close the entire time, providing him with some of the benefits of post-delivery skin to skin contact.

I was not fine. I was aching for my child. I was frozen in the intense pain of childbirth, and completely helpless to do anything but lay on the table and watch him from across the room. I was shaking violently and hyperventilating. I was hysterical, but I was so physically incapacitated that I couldn’t argue. Greg was worried for my health and could not do anything except take care of Jack. Lizzie held my hand and communicated her confidence and compassion for me with a steady gaze (as a Doula, she was not permitted to intervene with the doctors on my behalf).

I asked the doctors for my baby at least 5 times, but they wouldn’t let me have him. I still don’t understand why.

For 20 minutes, they worried about the bleeding. They reached back up inside my uterus to search for torn placental tissue. They turned up the Pitocin (synthetic oxytocin) drip, to produce contractions that would hopefully tighten up the blood vessels that were broken. I find the situation to be incredibly ironic – here was my baby, 5 feet away from me, the most perfect, whole source of the oxytocin hormone in existence, and they hooked me up to an IV to give me synthetic oxytocin. Then came 20 minutes of stitching, where they repaired some minor (let me emphasize the “minor” part) tears and cleaned me up. During this entire time, Jack was in Greg’s arms, not mine. None of it makes any sense to me.

Understanding it all

Jack, where he should be

Eventually, Jack was in my arms. It was startling to see him, to see this little being out in the world, his eyes open and looking into my own. It felt perfectly confusing and perfectly normal at the same time. I had never experienced a transition so abrubt: one moment Jack was an idea, a part of my dream, and the next moment, he was there, alive and in the world all his own.

I wouldn’t say I felt love, but I did feel shock and awe and infatuation. I felt obsessed from that moment onward. I wanted to absorb every single feature of his tiny face. I wanted to envelop his fragile body in my arms and hold him close, to never let him go. I placed him on my chest. Even after 40 minutes away from me, Jack knew exactly what to do. He hunted around and latched on without any help. He wanted to suck and he wanted to sleep.

Speaking of sleep, I was exhausted. After holding Jack for about 15 minutes, I needed to sleep. I gave him to Greg, and I drifted off. Greg took Jack to the nursery for a bath, and we were reunited in a room upstairs.

I was so fortunate. The postpartum period was a beautiful time for me. I had so much energy and felt so good after birth. The recovery was physical, and the adjustment was emotional, but it was a good time.

We never did get a picture of the three of us facing the camera, right after birth. This one will have to do.

Still, it took me a while to process birth. I don’t like anticipating things, and so my way to prepare for childbirth was simply to not think about it. That may have been a mistake, because I never truly prepared myself for how challenging it could be. The last piece of advice I received was actually from my boss, who told me as I was leaving the office: “I hope that birth is the most traumatic thing you ever experience, as in, I hope you never have to go through anything more traumatic than this will be”. I remember brushing off his comment, but now I understand it. Birth is very violent, and I felt... tricked... to find out that we enter the world through such violence. Nobody warned me that life began with such horrific trauma. For a while – weeks – I felt foolish for my choice to give birth naturally. What was I thinking? How could I have been so stupid? Something must have been wrong with the birth. Why does it have to be that way?

I had read so many natural child birthing books, where they try to convince you that you can do it. They talk about how you can deal with the pain, how birth doesn’t have to be painful. But they missed the point. It is indescribably painful. It is incredibly violent. It is overwhelming and terrifying. It is the most biological powerful process I can imagine. Giving birth is not something you do. It is something that is done to you.

And in its own way, birth is beautiful. The moment that I pushed Jack out of me, that I saw his face and heard his cry, I thought, “I’ve got to do this again”.

Crazy, right? No, that moment and that thought felt more right to me than anything else in my life. I do believe there is something about natural birth, about the flood of hormones, the contrast of the extreme trauma with the beauty of life… it is how it should be. As one friend put it, "This is how we enter the world: intense pressure, and then release. What more important lesson is there?"

Giving birth to Jack was not empowering or strengthening. Perhaps it is more appropraitely summed up as humbling and life-altering. Many people have asked me if I was glad to have given birth without medication. Initially, I wasn't sure. I would mumble something self deprecating about my foolish choice and sum up my confusion as "I'm not sure". Now I am sure: yes, and I hope to one day give birth naturally again. In no way do I think an epidural is a bad choice. If anything, experiencing birth has taught me how varied our experiences are. If anyone had even hinted at the possibility, I would have taken one. If I had not dilated so quickly, I would have taken one. If Lizzie and Greg had not been there, I would have taken one. However, by the same token, I do not regret the natural birth. I am, in a strange way, grateful for the experience. I believe it was the right choice for me, and although I cannot be certain, I believe it was the right choice for Jack.

Jack, born on 7/18, 8lb even

And so Jack is here, and his horrifically painful birth is a memory for me, stored away in the back of my mind and forever clouded by my tangled emotions and muddled recollection of the postpartum days. Much remains for me to process and understand. There are lessons in the experience. Perhaps, given a lifetime, I might learn some of them.

For now, there is simply love, existence, and movement towards each new day.

How I will always picture my baby

Sweet Times

Have I mentioned how much I like data, especially plotting data?

I loved being pregnant. I can't describe how much I loved being pregnant. My hormones on a normal day might be totally out wack, but something glorious happened while Jack gestated: I felt good, like, really good. My skin cleared up, infertility treatments were over, my stress subsided, and I basked in the glow of my increasingly round belly. Leg cramps and round ligament pain? Who cares, when you feel the baby kick and stretch! Not all women feel so good during pregnancy -- I was really lucky.

Yet, I still had some trouble, and it had to do with my blood sugar. During pregnancy, it is normal to become increasingly insulin resistant as you near term. This is nature's way of ensuring that your baby gets a high dose of glucose and can put on lots of fat in the last trimester. Sometimes nature goes a little overboard, and your blood sugar gets to be so high that it puts your baby at risk.

A friend of mine was just diagnosed with gestational diabetes. She came over this morning and I loaned her my glucose meter, so that she can keep track of her blood sugar until she is able to see the high risk doctor. I feel so much for her, because I know how stressful gestational diabetes can be.

Gestational diabetes is just awful, just terrible. It's hard to describe the awfulness. You are 100% focused on growing a little being, doing every single thing you can to ensure its future health and happiness... but what you eat is potentially hurting your tiny co-pilot. If you're like me, you thought you knew what "healthy" was, you had careful, obsessive plans for your good nutrition during pregnancy, and you get thrown for one hell of a loop when you find out that your whole food philosophy needs to do a 180. There you are: forgoing whole wheat pasta with fruit salad, and instead sneaking a glug of olive oil onto your egg breakfast and asking for extra meat with your carefully portioned serving of bland rice. You have to stop eating fresh berries (in season, in Connecticut!), and instead find yourself peeling back the plastic on a pre-packaged mozzarella stick and pounding down the peanut butter. How can this possibly be healthy, you wonder? You are stressing out about every single morsel of food. Food becomes the enemy, and it is a necessary evil.

There are no hard and fast rules. Every doctor will tell you something different. Current research keeps bringing the glucose targets lower, and lower, and lower. And here's the real awful part: no matter what you do, it will get worse. No matter how good you are, your insulin resistance will increase and your blood sugar will keep going up. By the end of it, even with insulin injections before each meal, the most I could tolerate for breakfast was 3/4 cup boiled quinoa (30g carbs) with 1 tbsp heavy cream, 1 tsp agave nectar and a handful of nuts on top. Then one cheese stick an hour later, and one piece of fruit after that. Even a single slice of rye bread (unsweetened) sent my sugar soaring. Stressful. So stressful.

Sometimes I would explain that I had gestational diabetes, and a person would react with surprise: "But you're so thin!". I hated that. Gestational diabtees has nothing to do with being thin or not being thin, just like infertility has nothing to do with being stressed or not being stressed. Gestational diabetes is not the woman's fault and it cannot be prevented. So much about reproduction is assumed to be under the woman's control, and yet so little of it is.

So how do you know if you have gestational diabetes? First, you go to a lab, drink 75g of glucose, and have your blood drawn 1 hour later. If that result exceeds cutoff, you take the 3 hour test: 100g of glucose. Here are the cutoff values:
  • Fasting: 95 mg/dl
  • 1 hr: 180 mg/dl
  • 2 hr: 155 mg/dl
  • 3 hr: 140 mg/dl
If you exceed 2 values, you've got The Diabetes.

In my case, I failed the 1 hr test. I hit 187. If you hit 190, many doctors will skip the 3 hour test and diagnose you with GD right there. My doctors weren't concerned. I took the 3 hour test: 76, 140, 141, 139. Now, of course I didn't exceed cutoff... but... notice anything funny? My glucose didn't drop, at all. That's weird. That's really, really weird. I can't emphasize the weirdness enough. It is not normal for your body to be unable to clear glucose after 3 hours.

You're fine! My doctors at the group practice I went to told me over, and over, and over again. You're fine! You passed! Celebrate!

I celebrated by engaging in a google-freakout and buying a glucose meter. I tested at home: 130-160 after every meal, and we're talking 130-160 after things like a normal serving size of brown rice. My sugars were too high for a healthy pregnancy. I brought the values back to my doctor.

You're fine! You passed! You don't have gestational diabetes! Don't worry about the numbers! Cut back on the carbs a bit, and your numbers will be fine.

The scientist in me got a little obsessed. I read everything I could get my hands on. Normal pregnant women don't go above 120. I continued testing. 140. 150. 160. My weight gain slowed -- significantly. Back to the doctor.

Well, you're probably fine. Your baby will be fine. If you're stressing about this, go talk to the nutritionist, maybe she can help you cut out some more carbs. But hey, you passed your 3 hr test! Isn't that great?

The nutritionist spent a good deal of time frowning and rereading my food log. And you're sure they won't treat you with insulin?, she said. She helped me figure out a few more places where I could cut out carbs in my diet. 160. 170. 180. I slowly stopped gaining weight.

Next doctor's appointment: OH MY GOD YOU'RE NOT GAINING WEIGHT GO SEE THE NUTRITIONIST!!! *

*It's hard to put the absurdity of their priorities in context. The baby sees blood sugar. That's it. My blood sugar was high. The baby was gaining a ton of weight. End of story.

The second nutritionist was horrified by my doctors. I was eating 120g of carbs a day (normal would be about 240) and my sugars were still high. She didn't know what to do. She suggested I try to get transferred to a high risk doctor. She gave me the name of a nurse: Nancy. Talk to Nancy, she said, Nancy will help you even if you don't get transferred.

I called high risk. I talked to Nancy. That night, I started eating carbs again. Over the next week, I would lose 3 pounds. My blood sugar remained high. Far too high.

I received a phone call. My doctor was confused: why had I called Nancy? I explained the issue, again. OK, said the doctor, we'll put you on this experimental drug that pregnant women aren't actually supposed to take (it happens to be teratogenic in the first trimester)... that'll fix your sugar and it will be so easy for you.

Inside my head, I lost it: just give me the goddamn insulin. This isn't about easy! I know how to inject it. Insulin will enable me to eat. It will protect my baby. Insulin is extremely safe, when used properly. I firmly requested to be transferred.

So the high risk doctor put me on insulin. Insulin: the wonder drug. I can't tell you what a relief the insulin was. We had to crank my dose up pretty damn high, but eventually, the insulin did its job and my blood sugar normalized.

Let me give you the timeline of events:

26 weeks: failed the glucose tests
28 weeks: picked up a glucose meter, noticed the high values
34 weeks: FINALLY got to see the diabetes doctor
35 weeks: started taking insulin

Now the real kicker just happened recently. I went to see a diabetes doctor last week. I told her this story. She asked if I was officially diagnosed with gestational diabetes. I said that her guess was as good as mine. She asked what my pre-breakfast dose of insulin (humalog) was. I said 18. Her jaw dropped. She said "18. As in 1-8? That's a LOT of insulin". I said "I know. Tell that to the doctors at my group practice". She looked at my chart... no diagnose of gestational diabetes, anywhere!

My advice to pregnant women everywhere? If your glucose tolerance test results are elevated but still "normal", stop eating sugar and find yourself a blood glucose meter. The cutoff values set for glucose tolerance tests are a load of crap. They were designed, originally, to predict the likelihood that the mother would develop type II diabetes. They were not designed to protect the health of the child... that job appears to be up to the mom.

4 days before Jack was born. He would be a very healthy 8 pounds!

Sunday, December 26, 2010

Top Ten

1. The sleep deprivation both is and isn't as bad as you hear. Yes, you will go crazy. Waking up every 1-2 hours for weeks -- months -- on end? There are no words to describe how it will eat away at your ability to function. You will be crabby and short tempered and you may just find the mayonaise in the dishwasher and the forks in the fridge door more frequently than you care to admit. But the good news is that you can and will survive (mostly because you have no other choice!)

2. Good sleepers are born, not made. I'll be the first one to admit how wrong I was in my assumptions about baby's sleep habits. Now I get it. You've got to work with the cards you're dealt, and some babies just don't sleep very well. We started off doing everything "right", and one day, Jack simply stopped staying asleep. Of course the parents who happen to have good sleepers are certain of their methods (try convincing them otherwise), but once they happen to give birth to a child who wakes up every 20 minutes or screams bloody murder until you just pick him up and help him settle, they'll change their tune.

3. Babies have incredible personalities from the get-go. You will be astounded to realize how much you can learn about the kind of person they are from when they are so very tiny. They will make you laugh and smile and cry, and even though they will be dependent on you for their physical care, their personality development is all their own.

4. You will be amazed by yourself. Pregnancy. Birth. Lactation. Sleepless nights. Love. Rocking. Soothing. Patting. Singing. Smiling. Giggling. My oh my, will you be amazed by yourself. You will discover love and devotion like nothing you ever imagined yourself capable of. You will see these traits in your partner, too, and you will love them more than you ever thought you could.

5. Sometimes you won't be proud of what you feel. Nobody warns you about this part, but it seems to be fairly universal. Just like their are moments in time when you can't stand your spouse, there will be moments in time when you can't stand your baby or yourself. You will wonder what's wrong with the two of you. The situation might feel hopeless. You will be angry and frustrated and full of tears. But it will pass. It will always pass.

6. You will be a junky, and act accordingly. We are all addicts. We are addicted to our babies. Sure, we decided to be parents because we wanted to give life to and care for a tiny being, and this aspect is selfless. But let's admit something here: we are addicted to our babies, in part because of how wonderful they make us feel. We want to hold them and kiss them and smell their hair. They calm us and we can only go so long without. They feel the same way about us (for a while, at least), which is pretty amazing when you think about it.

7. Yes, you will be that parent. You will sniff your kid's butt to see if he needs a diaper change. You will videotape his bodily functions and share them with others. You will wipe away snot/drool/spitup without thinking twice. You will pull pictures out of your pocket at the slightest hint of interest from others. You will tell inane story after inane story. You will love it. You will have no idea how foolish you look. You will be so smitten with your new addition that all else will fade. And you know what? That's just fine. Indulge and enjoy.

8. Yes, you will also be that parent. You will be frazzled. You will martyr yourself at times. You will be so focused on your child that you will lose track of other people and other things. You will be crabby and short tempered. You will be very upset by things that other people won't understand. You will be late and have bad hair. A lot.

9. You might lose a bit of yourself. Who am I kidding? You will lose a lot of yourself. You will forget who you once were. Your life will be so completely different that you don't recognize the new person. And you will miss that former life, no matter how much you enjoy the new one.

10. Your child will be totally perfect. In between teething, growth spurts, mental milestones, regular illness, vaccines, diaper rash, and good old fashioned bad days, your child will be, clearly, 100% perfect. All the other times don't count. And those moments when his or her personality shines through... they will be so spectacularly beautiful that the addiction will be reinforced and you will find yourself musing about when to have another one.

Bonus! 11. If you don't have them already, you will develop masochistic tendencies

Allrighty Then

video

Sweet, orange, and all over my living room


I love nursing Jack. It's one thing my body does right. I'd nurse the kid for quite a while, if that wasn't so socially weird.

But this isn't actually a post about nursing. This is a post about the opposite of nursing. This is a post about carrots. Boiled. Pureed. Thinned out a bit. Fed to one gurgly, happy child.

We did it: we gave Jack his first solid food. And as weirded out as I was about Jack entering this new phase of babyhood... we had so much fun. He loved it. He made a mess. He opened wide and chomped down again and again. I didn't feed him quickly enough at one point, so he grabbed the orange carrot on his tray and started chowing down on that, too.


What next? Avocado? Banana? Peas? The world is his messy, face-smearing, giggle-inducing oyster.


For your lazy-Sunday enjoyment, here is Jack eating his first meal. Enthusiastic chomps are at around 2 minutes. Appreciative burp right at the end.


Enjoy, Jack!


Friday, December 24, 2010

We have different issues...

How does a mama choose a suitable outfit for Christmas dinner with husband's family?

Well, there are the physical issues to accommodate. Leg region is smaller, belly region is larger, boob region changes size throughout the day. Then there are practical considerations, too. Top must enable discrete top-down nursing in front of others (low cut v-neck) but also must fully cover the ugly-as-hell-nursing bra (turtleneck). Preferably a heavy weight fabric to hide potential flyaway milk, but light enough to avoid looking like a two-tiered Mr. Snowman. Ideally, top is festive and holiday themed (glittery, red or green, beaded, or last year's Christmas gift). It must be clean, and by that I mean not covered with any of the following substances: drool, spitup, poo, or flecks of the coconut and walnut studded cake frosting from this morning's decadent creation. Oh, and it's like 30 degrees outside and 75 inside, so layering with a perfectly matched sweater is a plus.

How does a baby choose a suitable outfit for Christmas dinner with husband's family?

Parents choose for him. The more absurd the better. Milk stains and drool? Totally acceptable. Accessory that's irresistibly close to mouth and hands for gnawing on during the car ride? Excellent. Last minute trip to Old Navy to purchase the perfectly coordinated blue button-down? That's the one.


Happy holidays, all. :)

Thursday, December 23, 2010

If I was smart, I'd've bought stock in the company

*edited to fix the preg test day count

This is going to be a rambling post. I have a hard time being succinct about reproductive issues. I have so much to say and it is not a topic that I can filter easily. Bear with me.

I've spent hundreds of dollars on pregnancy tests. No joke. When you're infertile and you never get your period, Preg Testing happens... frequently. Very frequently.

In the beginning, it totally makes sense. You've been off the pill for a month. You don't get your period. So you test. Negative.

Negative, negative, negative.

Then you go one step further and buy the ovulation kits. Now if there's anything more expensive than preg testing, it's ovulation testing, because the levels of hormone they are designed to detect vary considerably through the day, and your chance of catching the peak can be slim. So you end up testing quite a bit.

In my case, you test several times, the ovulation predictor kit (OPK) says WINNER, you wait two weeks, don't get your period, get all excited, preg test, see that it's negative, then do another ovulation kit and vaula -- look, you're ovulating again! Amazing. Repeat ad nauseum. You decide you must be ovulating every 7-10 days. You must be super fertile! Tee hee hee.

And then you go to the doctor (many, many times), finally have the right blood tests ordered, notice that your LH to FSH ratio is a whopping 7 to 1 with a few other hormones through the roof, google yourself into a coma, and months later get the doctor on the phone to finally, officially, answer in the affirmative when you ask: "Do I have PCOS?". Duh. And then have her suggest you go on the pill to regulate your cycle.

(Glad she remembered it was an infertility consult.)

Anyway.

I've taken a lot of tests, pee-stick variety and otherwise. Our house was always littered with sticks. And my veins are getting slightly mangled. I had to have blood drawn the other day, and the phlebotogmist took one look at my left arm, frowned at the scar tissue, and asked if she could see the other one. I tried to add it all up and realized that in the 9 months that I was treated by the Big Guns Infertility Doc, I had something in the range of 50 needles inserted into the crook of my elbow, maybe more. Ouch.

Anyway.

There are many things I still feel resentful about, when it comes to my infertility. Much of my bitterness has faded, and we were so fortunate to become pregnant relatively quickly. Once we got to the Big Guns Doc, we had wonderful medical care. We gave birth to a healthy, happy baby... I'm not a religious person, but God, it's a miracle, it's such a miracle. The technology, the care, everything... it's just incredible that Jack is here. I am grateful for all of these things, yet I still know that the pain of my experiences will never fully recede. I am a member of the infertile world, and here we have a generalizable truth: infertiles are denied so much potential happiness.

One of the things I feel most bitter about being denied is the ability to be surprised by a pregnancy test. I never pictured what my wedding would look like, but I did picture what a positive pregnancy test would look like... I pictured a monumental moment, a shock, a realization, a permanent and sudden change.

Pregnancy tests ought to be cut and dry -- you either are you aren't -- but we lost the chance for things to be cut and dry a long time ago.

When you are undergoing fertility treatment, they often give you a shot of human HcG to trigger you to ovulate. HcG is the hormone that preg tests detect, so if you test in the 10 days window after the trigger shot, you might get a false positive, until the artificial HcG fades away and the embryonic HcG takes over. One cycle, I decided to test until the line went away. I was so sure that I would be pregnant. I figured I'd watch the line go away, and then it would be glorious to see that line get darker and darker as my pregnancy grew.

Well I didn't get pregnant that cycle and watching that little line go away was one of the most fucking depressing moments of my life. I don't recommend it.

Still, I learned that by day 5 or 6 post trigger, I'd be in the clear for preg testing.

Unfortunately it's not just about the trigger, though. There are ectopic pregnancies and chemical pregnancies and missed miscarriages and vanishing twins... There are beta values to be drawn, progesterone shots, injections and injections and ultrasounds and measurements and... worry, fear, pain.

During our IVF cycle -- the cycle that resulted in Jack, I waited 5 days after embryo transfer (10 days post trigger, 3 days post potential embryo implantation). I couldn't sleep that night. I think I woke up every hour. Finally, at 6am, I gave myself permission to preg test. There was a faint line.

I crawled back into bed.

"Well?" Said Greg.

"There's a line" Said I.

And we both knew what that meant: hope, and possibility of crushing disappointment.

It would be a while before I felt sure of my pregnancy. There would be many more preg tests, much posting to my online IVF support group, much worry and bleary eyed comparison of increasingly dark lines, values being reported back from the lab, more googling and calculation of doubling times, ultrasound results and tears and then happy news. Eventually I would feel fully and completely pregnant, but it would take months.

For some reason, I felt pregnant last week. Maybe it's my PCOS flaring up again, but I had some symptoms and I just... I just needed to test. In the minute or two before I had the results, I had a silly little dream enter my head. I imagined the test was positive. I imagined putting the test in a box, wrapping it up as a Christmas gift, and I imaged the happy news greeting Greg on Saturday morning. I imagined what his face would look like when he saw it. I imagined what my face would look like when I knew my body did something amazing. I imagined what it would feel like to not be an evolutionary dead end. I imagine something incredible: sex begetting baby. I imagined surprise and mystery.

Of course yesterday's test was negative. And I'm fine with that -- I have no wish to be pregnant right now, and I won't be upset to go through another or several other IVFs if I have to. Going through IVF was far easier than not being pregnant. But I know if I do it again, there will be apprehension and worry and the possibility of crushing disappointment and as I imagine this process... the feeling of trauma returns to me and I scurry into the tiny, protected corner of my brain, the part that knows with certainty it will not work, the part that cannot be hurt by continued failure.

So, while I feel the edge of (past? impending?) trauma, I also can't help picturing the other possibility. The other Rachael. The non-bitter, non-cynical one. The one who doesn't hate her reproductive self, hate her screwy hormone and lacking femininity. I can't help picture a pregnancy that I could feel confident in. I can't help picturing the awe and beauty of conception occurring in my own body.

I know that Rachael can't exist anymore. But the preg test yesterday made me imagine her for just a moment.

Wednesday, December 22, 2010

The Parental Police


Parental Truism #2781: No matter how confident you are in your motherly (or fatherly) prowess, you will still be made to feel completely inadequate over really random shit.

Truism #2781 certainly holds for the obvious issues - take a crying baby, for instance. Sometimes babies cry, and sometimes, no matter what you do, they just won't stop. You can know this fact -- that babies cry -- and you can still spend an hour berrating yourself for your inability to console your crying child. That's my issue. Other women might get upset if they can't get dinner on the table, or have their kids dressed nicely. Whatever it is, there are plenty of obvious, everyday happenings that can make you feel like less of person.

Truism #2781 also holds for more insidious topics, events that swing at your self esteem out of left field. Take, for instance... our Christmas card. We had a professional photographer take pictures of Jack when he was born. Greg and I picked out the photo we wanted: a cute shot of the five us...Tori, Me, Jack, Greg, and Zane. A family photo.

We decided to use this photo for the Christmas card, tried a few card layouts, and soon realized that the family photo, although lovely, only shows Jack as a bundled lump in our laps. We wanted to show him in action. So we picked out a few more recent photos and put it all together on one card.

Since printing our own cards, we've received quite a few Christmas cards from friends and family. And then I noticed something... all of the Christmas cards featured just kids, no parents.

And then I proceeded to freak out for the next hour and a half.

Is there some unspoken rule that Christmas cards should not have adults on them?

...

Do I direct enough attention away from myself and towards my baby?

...

Will the other parents be judging me?

...

Am I a selfish mother?

...

Again, you think I'm joking.

(Warning: this is what happens when you wake up every 2 hours for 5 months straight.)

The photographer in me also happens to be reeeaaaaaallly bothered by the fact that I only took one out of the four photos and, as a group, the color balance is totally, completely, visually irritatingly, off.

Sigh. I've done it again. Somehow, through some small mechanism, I've totally ruined Jack's chance at a happy future. All the families will judge me for my Christmas card and not let their babies play with mine. *

*(Can I be dramatic for the sake of humor? :) )

So, time for a reality check.

Who really cares? Who, other than myself, is going to inspect our Christmas card so closely? DUH. Nobody. There are no parental police for things like Christmas cards.

Still, it's nearly impossible to avoid Parental Truism #2781, and so I will suffer through inadequacy for a little while longer.

But then there's Parental Truism #2782 to consider: no matter what, the choices you are make are always, smugly, 100%-ly... right... all of the time. Even when it involves improperly conjugated adverbs.

Tuesday, December 21, 2010

Wow.

Oh my god, it gets worse. The rankings I gave you from before were for elementary school. New Haven High Schools? Less than 20% of students meet state minimum requirements.

I knew it was bad. We were always planning on private school or a nice CT suburb* for high school. Still, I'm horrified to realize that it's this bad.

There's just no excuse

I am an employee of the Yale School of Medicine and I am funded by a grant from the National Institutes of Health. Neither my employing institution nor my funding agency provide me with healthcare. If my boss hadn't scrounged up some $$ for me, we'd be paying $1200/mo out of pocket for Jack and I. As it is, I pay full taxes on my healthcare, to the tune of nearly $400 a month. Do you know anyone who is gainfully employed that is taxed on their own healthcare?

We live in New Haven, the site of Yale University -- one of the top ranked ivy league universities in the country. And on a list of 137 school districts in Connecticut, New Haven ranks the 6th worst, with only one third of students meeting state testing goals. Folks who live in the family-centric neighborhoods of New Haven generally pay more than $1000 per month in property taxes, and the privilege of supporting such an affluent community is to enroll our children in the 6th worst school district in the state. Private school runs upward of 20k per year -- 30k for high school. Would you send your child to a New Haven public school?

I try to avoid voicing sour grapes on this blog, but I also try to be honest about what's on my mind.

These are the issues that are on my mind: cost of living, childcare, healthcare, education. We are trying to live in the city we work in. We are trying to walk to work and avoid using our car. We are trying to be good community members. We are trying many things, but I feel like we're fighting a losing battle.

There's just no excuse!

Sunday, December 19, 2010

Deer in headlights

Greg and I are very different people. He likes to collect piles of paper on the dining room table and leave them there for eternity. I prefer to throw things out. He wants french fries and pizza and eggplant parmesan. I want lattes and ice cream and cookies. He's funny. I try.

We fight -- all the time, actually, like any healthy cohabitors do -- but it's always about dumb stuff. Who left flour on the refridgerator handle (me), who didn't put their jeans in the laundry pile (him), who's going to let the dogs out when it's -10 with windchill (neither of us), or whether the forks should point up or down when you put them in the dishwasher (don't even get me started).

Yet, despite our superficial differences, my husband an I have and incredibly solid relationship that is based on our common values. When it comes to money, religion, career, politics, family, geography, food...really, truly, we are in synch. We just don't disagree about that stuff. And one nice personality trait that ties together our mutual core values? We both love to plan, oh how we love to talk about the future. Greg's obsessed with stability. I'm about as goal-oriented as you can get. We both have our eyes on the carrot -- the same carrot.

The problem with this shared trait is that we're both such obsessive planners that we never actually decide on a plan to follow. Imagine detailed scenarios (about 20 of them), all of which are very specific and very complicated, and none of which can actually be predicted with any certainty. We just talk. I want him to make the decision. He wants me to make the decision. Neither of us would like to be held responsible for the result of a decision. When we got engaged, it was sort of like, "should we?" "maybe" "what do you think?" "I guess it could be good" "so we're going to get married?" "yeah, I suppose we are" "huh, is this the part where we're supposed to kiss?". The baby conversation was particularly entertaining, given my subsequent infertility (we had no idea exactly how out of our ability to plan having a baby would be). Those early conversations looked something like, "Well if we had the baby in March and I was doing XYZ and you were doing ABC that would be great because then we could take a trip to Cape Cod in September and it'd be the perfect weather for stroller walks"*. Etc. Sorry, I'm boring myself.

*The scenario may be fictional, but the level of detail is not.

Today, Greg and I went to see a house. The house itself is perfect for us. It is very nearly our dream house. It sits on waterfront. Greg could dock his boat in our backyard. The rooms are nicely situated. It is light and beautiful inside, and thoroughly updated. We can afford it. The neighborhood, the school system? Not so much a dream. They're a nightmare, actually... something that would work in the short term, but not in the long term.

(Hence ensues 8 hours of mind-numbing conversation about the various possibilities for a nanny or private school system, and whether I'll be an academic or working for some big pharma company and if this will destroy all chances of moving to spot X on the map, and if and when there will be another baby, and whether I'll have health insurance or not, and etc, etc, and etc.)

This conversation is exhausting.

The house is really great. We could never afford anything like it in a better location. Its personality and size fits us well. But we also would not be improving on what is frustrating us now -- the crime, the lack of neighbors, the absurdly high taxes, and the daycare dilemma. It isn't really a long-term house. It's a short term house.

We're so close to making a change in our lives. My job runs out -- permanently -- in November. I'm working on a grant that I won't know about until June. If the grant falls through, I'll be on the job hunt. A big change is coming. There are the stable options and the exciting options. There are the money makers and the family prioritizers. There are so, so many paths we could follow, and the choices are making us dizzy. Greg and I are not good at sitting and waiting during this uncertainty. We want to plan. We want this stressful time of not knowing to be over with.

There's Jack to consider. It's all about Jack, now, it's all about our family core. And it's such a new thing. How can we base all of our future decisions on something we don't even know much about yet?

I have no answers.