My Natural Pregnancy After IVF: Hopes, Fears, Trials, and Heartbreak

I found myself back in a hospital gown again . . .

I had two cycles after giving birth to my IVF baby. Then for some reason I didn’t get my period when I thought that I would. I chalked this up to irregular cycle length postpartum. Since I had only ever been pregnant once naturally (and that had taken me six years and had ended in a miscarriage at six weeks) I had refused birth control postpartum. I definitely wanted to give my child a sibling and I thought that if by some miracle I was to get pregnant, that would save me having to pay big dollars for either a Frozen Embryo Transfer (FET) since we have several embryos frozen from our last round of IVF or if those all didn’t work out even bigger dollars for another round of IVF (or possibly more than one round as many people have to go through multiple rounds).

There are a variety of figures, ranging from 17% to 33.3%, of the number of IVF patients who become pregnant naturally with another child postpartum. I had even been warned at the hospital by a couple of nurses and a doctor that they had seen IVF patients achieve pregnancy even before their first postpartum physical. It seemed impossible to me though that I would ever be so lucky as to achieve another natural pregnancy and actually see a baby at the end of it. My first baby took seven years for me to hold in my arms and I still felt demoralized by the whole experience of unexplained infertility, miscarriage, and then having to go through the physically, emotionally, and mentally challenging process of IVF.

But I still didn’t get my period. My husband was away on a business trip and I was too afraid to take a pregnancy test without him. I hoped so much that I was pregnant and would have been crushed if I wasn’t, but was sure that I couldn’t be, so wanted his support in finding out that I wasn’t. At the same time, I started craving oranges like crazy (this is my pregnancy “tell” as last time I was pregnant I ate my way through a tonne of oranges). Things started to smell and taste different. I wasn’t enjoying some foods that I usually enjoyed.

My husband returned and I took the final pregnancy test in a box that we had bought when I was undergoing IVF. It turned positive almost immediately. Then it estimated the number of weeks. We were stunned. Our baby was only a few months old and we didn’t know how we would handle having two such young children, but we were filled with hope. Then fear. What if I wasn’t actually pregnant? What if I miscarried again?

I could not believe the positive result on the pregnancy test.

We took this photo the day we found out we were pregnant. We were so incredibly happy.

 I booked an appointment to see my doctor immediately after the weekend. My doctor sent me for a series of three hCG tests to confirm the pregnancy and check that it was progressing (unlike my first pregnancy that petered out at six weeks and ended in a miscarriage). The tests done two days apart over the week showed strong hCG with proper increases. My husband and I, who had been too afraid to tell family up to this point, told our families. We couldn’t believe it. They couldn’t either.

I met my family doctor again and he said that based on the results it looked like a viable pregnancy. I went home and within the hour began to bleed profusely. I was sure I had had a miscarriage again. I was sent to emergency. I was given a blood test and sent home with no answers. I returned to a different emergency department at a different hospital for an ultrasound the next morning. Then I waited for the results in that emergency department for seven hours while a heartless bitch of a nurse told me that I was the lowest priority and they “might” get to seeing me that day, but since I wasn’t an emergency I might not be seen. I sat in the uncomfortable hospital chairs alone as my husband took care of our baby.

The doctor in the emergency department who finally saw me said that the fetus was alive and he had no way of knowing if the pregnancy would continue or not but for now it looked fine. He said I had to see a high risk obstetrician. I was referred back to my family doctor to get a referral.
My family doctor told me I would definitely have to be under the care of a high risk obstetrician because I had two subchorionic hemorrhages in my uterus (and that is where the bleeding came from). He referred me to a high risk obstetrician.

Then I had another bleed four days later.

Then another bleed two days later with more cramping.

I was sent to emergency again, at another hospital (my third). I waited all day to see a doctor, get an ultrasound, and then see a doctor again (about ten hours while my mother watched the baby since my husband was away travelling again). The subchorionic hemorrhages had increased in size but the fetus was alive and my hCG levels were good. The ER doctor tried to refer me to a high risk obstetrician but they told her that they wouldn’t take me and I’d just have to find a regular maternity doctor for now.

I had difficulty finding a maternity doctor taking patients (and one who I saw told me that this interview could all just be “a waste of time” since I had been having bleeding.) My old maternity doctor who was stopping obstetrics took pity on me and took me in.

I had been referred for a follow up ultrasound (the emergency department lost the referral, but then found it and sent it to the ultrasound booking department about a week later, after it was supposed to be done). I had the follow ultrasound about two weeks after my last emergency room ultrasound and the fetus was kicking its little leg buds around with a strong heartbeat. I couldn’t believe it. I cried with joy.

The fetus was kicking its little leg buds (on the right) during the ultrasound.

I had the normal blood tests done and the first ones to test for major chromosomal abnormalities. I had a couple of different visits with my maternity doctor.

I continued to wear pads fearing bleeding through my pants again as I had three different times in the pregnancy. I had three weeks of no bleeding.

Then it started again. But it wasn’t fresh blood this time, it was old blood. The forums I read talked about people’s subchorionic hemorrhages draining old blood sometimes. Days passed. I saw the doctor and he said it was too early to hear the heartbeat in the office with his doppler. He palpated my uterus. There really wasn’t anything he could do. He said it might be the body shedding old blood or it might be something worse. I would just have to wait and see.

The bleeding increased that night. I went to bed and the cramps that had been uncomfortable became really uncomfortable in the night. In the early morning fresh blood started. The cramps increased more and more.

I called my doctor. His assistant said she would try to get an ultrasound for me as soon possible or I could go wait in emergency again. I declined emergency care as I had already been told if a miscarriage started there is nothing that can be done.

My husband was away again on a business trip and I had to care for my baby alone at home that day while the bleeding increased more and more and now hunks of tissue started to come out. I was horrified and felt physically awful on top of the crushing mental and emotional blow that I was experiencing. Again.

My husband tried to get back earlier but had difficulty getting back much earlier than he was scheduled that night. I yelped as tissue coming out of my uterus hit the toilet water with loud splashes. I couldn’t believe I was going through this. And going through a miscarriage was so much worse at 11.5 weeks pregnant than 6 weeks pregnant. The amount of tissue and blood was so much more. It was harrowing.

The next day, my husband and I asked my sister to care for our baby and we went to the ultrasound at the hospital. I prepared myself for the inevitable. The technician was weird and not helpful like the past few I had had. He didn’t point the screen at all in my direction and there was no second screen, but I didn’t need one to tell me that the baby was dead and long gone. My husband peered at the screen and said he didn’t see anything. They sent in a radiologist who looked at the images and informed me what I already knew, that I had miscarried and that there was no fetus left, only some tissue. My grief was so intense I was almost numb.

My doctor called later that day to discuss the miscarriage. He said if I stated bleeding really, really heavily or seemed to have an infection, go to emergency. And if I bled for more than about two to three weeks then go to emergency. And that was it. I could go in and see him and discuss it more, but what was the point.

I spent the next couple of days cancelling my next ultrasound, cancelling my lab tests, and cancelling my next appointment with my endocrinologist who was only seeing me more frequently because I was pregnant. And I bled and bled and bled.

I sank into the grief like an icy bathtub, my numbness preventing me from even crying most of the time. Then the rage. How could this have happened again? Why had I had to suffer again? Why had this had to distract me from my recovery from my last pregnancy and getting to know my baby? Why had I had to suffer for almost three months with this difficult pregnancy (which had a lot of nauseous, dizziness, and exhaustion) and bleeding off and on for nothing? Why do people who don’t want children get them and without any effort? How could I ever trust my body again? Would I ever be able to give my baby a sibling? How could I ever go through another pregnancy knowing that 66.6% of mine have ended in miscarriage now?

Christmas, a time of the year that I already find very challenging emotionally was further mired by the bleeding, hormones, and despair that I felt from the miscarriage. My only child's first Christmas should have been a time of great joy, but I had trouble focusing on the holiday rather than the heartbreak.

Three and half weeks later I have progressed through to a profound sadness, but those questions still remain unanswered. As my bleeding is just ending now, I still don’t know if I’ll ever have the courage to try to give my baby a sibling again via FET or IVF. I am haunted by the memory of the fetus kicking on the ultrasound (I never got to see the first pregnancy’s fetus because it died at six weeks so this has intensified my grief if that’s possible), knowing that I will never get to hold this baby in my arms. I hold my living baby all the tighter.

I hold my baby all the tighter.

Two Month Postpartum Update

I can't believe I was ever this small.

One of the readers of this blog has requested an update regarding how I’m doing post partum and specifically what happened with regards to readjusting my medications after my baby was born.
It’s been about two and a half months since my first child, conceived by IVF, was born. My child was born via vacuum extraction and was healthy other than slight jaundicing. As I have bipolar disorder and a hypothyroid disorder (suspected Hashimoto’s) I was kept in the hospital for several days post birth. Also, since the baby was born via vacuum and was slightly wheezy at first and slightly jaundiced (elevated levels of bilirubin) they would have kept me there longer than the typical one night or so that they keep women for in Victoria when they have an uncomplicated vaginal birth.

While in the hospital my blood was taken more than once to test medication levels. And the child had light therapy for a day in our room to lower the bilirubin levels.

I can't get over the little feet . . .

I was not a fan of being in the hospital for that long. The nurses tried to emphasize that it was great for me because I could rest or I didn’t have to cook or do laundry. While that may have been true, I found it detrimental in a lot of ways. Firstly, resting in the hospital is very difficult even in a private room (none were available when I arrived, but there was an empty double room and they never put anyone in with me because I have bipolar disorder and they told me I needed to be able to rest so as not to risk an episode, especially postpartum). Well, the hospital is loud, including beeping of machines, babies screaming down the hall, the busy nurses’ station which was outside my door, and people constantly barging into one’s room to do tests, clean, deliver food, take away trays, deliver medication, and check on the mother or baby. Secondly, cleaning of the room was always at an inconvenient time when I was trying to rest or have a shower, etc. so it would either hamper me showering or napping at a convenient time when the baby was sleeping or I’d send them away and they would get annoyed at me for sending them away and sometimes just barge in later even with a do not disturb sign on. Thirdly, the food in the hospital was abysmal. They feed the mother, but not the father, so while I would be trying to eat whatever horrible items were delivered (even with food orders being taken daily the order was often wrong), my husband would go off to find something in the hospital (not many choices there) or nearby at a store. After several days of bad food, almost no sleep, and constant interruptions (even when the do not disturb sign was on the door), I was really owly and I told my interim perinatal psychiatrist (my regular one was away, so a colleague supervised my medication change while in the hospital) that I wanted out of there as soon as possible. I’ve always thought that home was the best place to recover from anything anyways (and it’s not like giving birth is an illness).

. . . and little hands.

I was in the hospital five nights total. I was told that they sometimes suggest that patients with psychiatric conditions stay for up to ten days to re-establish and stabilize medications. I cannot imagine staying for that long. But, it’s certainly better to sort things out there and make sure you’re stable than to go off the rails at home and risk ending up in the psychiatric section of the hospital. I was told by a previous psychiatrist that in England where she did a practicum years ago they had a hospital ward where mothers receiving psychiatric care could stay with their babies. In Canada, I’m not sure if that’s done anywhere, but it certainly isn’t in Victoria. If you require hospitalization here, you will be separated from your baby. The baby could visit with your partner or someone, but not stay with you. Obviously, this is not ideal and I think it would make treatment even more distressing and probably dissuade many people from even seeking treatment (and this is really not what we want our medical system to do).

So, to the medication changes at the time of birth and post-birth.

When my labour started, I stopped taking lithium carbonate. Because I wasn’t sure how long prelabour would go on for, I took lithium the night before I went into full labour when I had prelabour pains. In the middle of that night the contractions were getting worse and I went to the hospital early in the morning. That night while I was labouring I did not have my usual dose of lithium carbonate. This is because when one gives birth the rapid loss of fluids can lead to lithium toxicity if one’s on the higher dose that one was on during one’s pregnancy (some people may not find their dose goes up in pregnancy, but most people do go up a higher dose as the increased levels of blood and fluid in the body and higher body weights often require a higher dose of lithium in order for it to still be in a therapeutic range).

My dose of lithium pre-pregnancy was 900 mg. It went up to 1050 mg about halfway through my pregnancy (my levels were tested at the lab every month). After I gave birth, I was given a very low dose of lithium, 300 mg in the evening. They started at this very low dose because sometimes people become hyper sensitive to lithium apparently. I was sure dose this would not be enough to be therapeutic for me. It was not. My blood was tested in the hospital and my levels were far below therapeutic. My dose was increased to 600 mg and this was also not therapeutic. A prescription was written for 900 mg of lithium carbonate, as pre-pregnancy, and I was released from the hospital with a requisition to repeat my lithium levels in a week. Then I would go see the interim perinatal psychiatrist again at the hospital to check in with how things were going. Other than fatigue, I felt relatively good. My husband and I were both at the meeting with the interim perinatal psychiatrist and she had no concerns. She said my lithium levels looked good and told me to continue at 900 mg. She booked me to see another perinatal psychiatrist in a few weeks to check in.

The meeting with the other perinatal psychiatrist was disappointing. I was exhausted on that day after a sleep of only a few hours in total (broken into several pieces) the night before. I was asked to come in two hours earlier than my original appointment because she had a cancellation. Even though this was hard to do, I did it (getting out of the house is a lot harder when it’s not just yourself anymore). Then the psychiatrist was 30 minutes late. I was really annoyed by this disrespectful behaviour. She didn’t apologize for her lateness either. Then she stared at me for two seconds after meeting me for the first time and said, “I think you’re depressed.” Wow. If there’s any wonder left as to why people with psychiatric conditions or even concerns don’t seek treatment, this illustrates part of the problem (and what a 180 turn from the other two perinatal psychiatrists who I had dealt with who were very professional and kind). Having myself judged and/or diagnosed (and incorrectly) when I now have a child and have even more to lose if I end up being prescribed even more drugs or worse yet I have to go to the psychiatric hospital for a stay (I’ve done this a couple of times and cannot imagine having to do this now and be separated from my baby for possibly weeks).

Back to the judgmental psychiatrist though, she said she had no idea why she was meeting with me and that I should have not been seen again till later (even though my medication level was being reviewed post delivery and I had gone to the lab for another level test prior to this appointment). She also said that once I’m out of the post-partum period, about a year after birth, that I should be discharged to my GP instead of to another psychiatrist. She says the system is too overburdened for “regular” people to have psychiatrists. Then after a very short meeting she asked to see my child. I showed her the child, sleeping in the carriage, and when I smiled at the child, she pronounced in a most condescending way “oh, a smile, good, I can see you’re bonding with your child.” Right, well I’m glad this isn’t my regular perinatal psychiatrist, because I never want to see her again. And if I had actually been receiving good psychiatric care prior to going through IVF, I’d be upset about being discharged to my GP, but in light of the spotty care I was receiving pre-pregnancy, I’d rather let me GP manage my bipolar disorder in the future after I’m discharged from my regular perinatal psychiatrist. I’m booked in to see my regular perinatal psychiatrist towards the end of September (about three months post birth) for another review of my medication level and how I’m doing postpartum.

One more item, obviously it’s important to do regular blood tests for not just lithium level, but also occasional tests of kidney function as lithium carbonate can impact this significantly. I asked for a lab requisition so that I could test my lithium level before I see my regular perinatal psychiatrist in September (since obviously it would be useful for her to know if I’m on the right dose by checking what my blood serum level is). The psychiatrist who I saw was reluctant to give me one. She didn’t seem to think it was useful at all. While I am on the same dose of lithium carbonate as I was pre-pregnancy, things can change post-pregnancy and it’s important to check the blood serum level every once it a while to not just check that the lithium level is in the therapeutic range, but also to make sure that it’s not at a toxic level. Lithium carbonate for all its benefits for people with bipolar disorder, is also a powerful drug that can poison when not given at the right dose (and if it’s not at a therapeutic level, the patient can relapse with an episode that may cause them considerable distress, require PRN medications, land them in the hospital, or at the worse lead to suicide).

I think the takeaway here is that as with other areas of our medical system, one has to be one’s own advocate. If something doesn’t feel right, even if you feel like you’re being pushy, get the care you need. If you don’t demand it, you might not get it.

My pictures at the doctor before were usually solo selfies . . .

. . . now I have someone else to take a selfie with.

There have been a couple of times post birth where the lack of sleep combined with stress has pushed me and I’ve started to feel very anxious, have panic attacks, trouble sleeping, and feel like I’m starting to go a bit hypomanic. The PRN medication that I have used in the past and was prescribed to me in pregnancy as well if I felt unwell, is Loxapine. I have used this a couple of times postpartum and it has reset my mood and sleep enough to make me feel better without having to see a psychiatrist or anything more drastic like go to the hospital. It is more important than ever before for me to be self-aware and to catch things early if they start to slip so that I can avoid bad episodes or having to go on heavy doses of Loxapine or be hospitalized (I haven’t been hospitalized, both times were voluntary, for just over four years and I would like to never, ever return to that place).

Going on walks to stay healthy.

Regarding my thyroid medications that I take for suspected Hashimoto’s (hypothyroidism), these were stopped when I went into labour (also due to the rapid loss of fluids and the fact that I was on a much higher dose of levothyroxine than pre-pregnancy, so the doctor wanted me to not go into a state of hyperthyroidism). The day after the birth of my child, my endocrinologist sent a prescription to the hospital for a new lower dose of my levothyroxine. My liothyronine was kept at the same level as it had not changed during pregnancy. My serum levels were tested in the hospital and were retested a few weeks post birth (my endocrinologist reviewed my results online and sent me instructions so that I did not have to come into the office unnecessarily now that I have a child; he’s a real professional and so considerate). My endocrinologist was satisfied with the levels of T3, T4, and TSH. He booked me an appointment to see him about four months post birth and I will repeat blood tests before then so that he can check how my levels are at that point and make any adjustments as necessary.

Because I was on lithium while pregnant, my child was tested a couple of times for thyroid function to make sure that there was no problem from the lithium exposure in utero. There was no problem. The child is healthy and well on track.

Finally, a note on breastfeeding while on lithium carbonate. I was initially told that I should only breastfeed for a week or two to give the baby my colostrum, but no longer so as to minimize the baby’s exposure to lithium. Once the baby is born, it has to process the lithium itself instead of the placenta preforming this function and as the baby is so small the impact of the lithium on the baby is much greater without the help of the placenta. I read several studies on lithium and breastfeeding before, during, and after my pregnancy. Unfortunately, there are not a lot of studies and they are not very large or long term. It is not fully known what impact lithium has on infants who are breastfed in the long-term. Some women have breastfed for months, others for very short time periods. As I mentioned above, lithium for all its benefits for someone with bipolar disorder, is a toxic drug which can poison people at the wrong doses and tends to make people who don’t have bipolar disorder just feel really sick (I’ve heard it makes people throw up and while it can be hard on the stomach even for people with bipolar disorder, especially if taken on an empty stomach it, doesn’t have this same impact for most people with bipolar disorder, in fact it generally makes us feel better).

While I was in the hospital, I discussed breastfeeding with both my interim perinatal psychiatrist who thought that around a range of a few weeks was reasonable without endangering my child. Then they sent a perinatal pharmacist up to my room to discuss the pros and cons of breastfeeding on lithium. This was very useful as I had someone to further discuss some of the aspects of medical literature I had read. She went away to further clarify some points we discussed and then came back and we discussed breastfeeding again. She thought that I could breastfeed safely for up to four weeks before I was starting to enter into a grey and potentially hazardous area. Part of the problem is that while we test blood serum levels on adults, the infant who is breastfeeding and being exposed to lithium doesn’t get tested for their lithium serum levels so we have no way of knowing what their levels are like or if they’re dangerous or even when they are tested (this has been done before) what these numbers even mean for an infant as opposed to an adult with bipolar disorder.

The other issue is that while I was in the hospital, the child spent the first night in NICU due to the vacuum birth and some slight snuffly breathing (they wanted to observe the baby). They advised that the baby should be fed formula and breastmilk to help the baby gain weight (the baby was a healthy average weight) and heal from the vacuum birth (it’s tough on their tender little heads). It was also discussed that as I have bipolar disorder it would be helpful to get the child’s father involved with formula feeding in the night to increase the amount of rest I was able to get, especially at the beginning when I was exhausted from birth and potentially fragile with all the hormones coursing through me.

Especially in light of the fact that I was supplementing breastmilk with formula, the perinatal psychiatrist and pharmacist were both comfortable with me breastfeeding for four weeks. This is what I did instead of the original plan of breastfeeding for two weeks.

When I saw the other perinatal psychiatrist a month after giving birth, she was glad that I had stopped breastfeeding. The perinatal psychiatrist's reason for me stopping breastfeeding was multifaceted. High serum levels of lithium in my blood of about 0.8 (really this is just above where lithium become therapeutic) and the baby's inability to process lithium as adults can now that they are no longer in utero. She also mentioned the lack large long term studies in impact of lithium exposure in infants (and blood testing in infants isn’t really done here and we don’t know what the number really mean in infants anyways). She confirmed how formula fed infants can be fed by anyone and tend to sleep longer than breastfed infants so more sleep might be had by a mother who was using formula (and sleep is crucial to bipolar patients). The final reason she mentioned and one that I had not really considered was the complex feedback loop in brain that is created when breastfeeding. The hormonal implications of breastfeeding can make a bipolar mother more prone to episodes.

Bipolar disorder is made more complex in women because of the hormonal fluctuations that happen with not just a woman’s cycle, but also the hormonal changes that occur with pregnancy, childbirth, and breastfeeding. Among the factors that can exacerbate bipolar disorder are hormonal fluctuations, various brain chemicals, sleep, nutrition, drugs and alcohol, levels of light, seasons, personal circumstances, stress, etc.. That is what makes bipolar disorder so complex to manage. But with careful management and self-awareness, it is possible to live a healthy and stable life and have children when one has bipolar disorder.

I hope this helps others who may be seeking information on medication changes postpartum, breastfeeding while on lithium, and just generally dealing with bipolar disorder and hypothyroidism postpartum.

For all the stress and sleepless nights, I've never been more grateful for anything in my life.

Is this a footnote?

A Week and a Half Before Our Due Date Our First Child Arrives

Our first child was born one a half weeks before our due date. Our child was healthy other than elevated bilirubin which is common in early babies and light therapy quickly resolved this issue.

We would like to thank Dr. Hudson, Dr. Graham, Dr. Brody, Leigh, and all of the staff at the Victoria Fertility Centre where we underwent in vitro fertilisation to conceive our child.

From a beautiful blastocyst that was implanted into me . . .

To our first ultrasound at the Victoria Fertility Centre to a baby in our arms, the experience has been incredible.

We would also like to thank all of my specialists, other health practitioners, our family doctor, my maternity doctor, Dr. Hugh Down, and Dr. Cooper, the obstetrician, who delivered our child with Dr. Down, and all of the wonderful nurses and staff at the Victoria General Hospital.

Thank you to our families and friends for their support through this very difficult journey to have our first child.

Last but not least, thank you to all of the readers of my blog. Your comments on the blog and through social media have been a source of comfort and support for me through some of the very dark times I have had through this journey.

We want to have a second child, so I may return to this blog in the future to write about our journey to conceive a second child. If so, I will be posting the blog links to social media again.

What it's Like Having My Pregnancy Reach Full-Term After Having a Miscarriage and Having IVF

From a beautiful blastocyst to a fetus that's reached full term, this has been an incredible journey . . .

When I reached 38 weeks pregnant, four weeks ago, all I could think was I can’t believe it. I know I keep saying it, but I can’t believe I managed to make it this far. But I approached this from a different angle than many pregnant women who had not had trouble conceiving, who had not suffered a miscarriage (after only managing to conceive after six years of trying), and who had not then paid thousands and thousands and thousands of dollars for fertility treatments and drugs to become pregnant again (and I had it easy compared to other women who have more than one miscarriage and/or undergo more than one round of IVF treatments to get pregnant or are unable to get pregnant at all even after all of these costly, stressful, and uncomfortable interventions).

No one dreams that making a baby will be like this . . .

I’m not saying that “regular” pregnancies don’t come with fears and worries, I’m just saying that going through the above things changes you and puts you into a different category of fear I think. That twinge in the abdomen could be the start of a miscarriage, not feeling the fetus move for a while could mean that it’s dead. And with IVF treatments, after shelling out all of that money, even if you do everything perfectly, you still might not get pregnant, the fetus might not survive, etc.. It has been very stressful over the past year and a half having consultations with an IVF specialist, finding out we were pregnant without IVF, suffering a miscarriage, undergoing IVF, and then finding out that we were pregnant from the first round of IVF. It’s been hard to enjoy most of the pregnancy worrying that this might be the last week that I’m pregnant or that something really horrible will go wrong (again).  There has been no planning a nursery, buying baby clothes and supplies in the second trimester, or prattling on in excitement about baby names. My husband and I have been holding our breaths and just hoping and hoping that we will actually make it through this pregnancy. Whether or not we have a proper theme for the nursery or fabulous outfits for the baby have been the least of our concerns.

Strangely, I had actually had absolutely no pregnancy complications (until the minor ones pointed out at the end in my post at 38 weeks which led to a recommendation that I be induced before 40 weeks), which after the prelude to this pregnancy I found really amazing. I have not had gestational diabetes, I have not had preeclampsia, I have not had placental problems, the doctor has not had concerns about the fetus’ size or placement or heartbeat or anything. It’s been almost eerie after the last year of hell (June 15, 2016 is when I started miscarrying my first pregnancy).

The fetus in stargazer position at our last ultrasound.

There are times when I feel upset thinking about how I have not allowed myself to enjoy much of this pregnancy at all and have not reveled in the excitement of imminently becoming a mother, but there is nothing that I can do to change the past, my reality, and would I want to? Adversity make people more resilient, empathetic, and gives them a different perspective to others.

Our first ultrasound where we found out we were pregnant from IVF.

People have looked at my husband and me strangely when we’ve referred to the fetus as “the thing” or “it” even when we knew the sex, but it’s been our way of surviving the uncertainty of whether or not the fetus will actually survive. Being once removed has been a coping mechanism that we have employed to try to avoid as crushing of a heartbreak as we had with our first pregnancy that turned into a miscarriage. There is no way to avoid that crushing heartbreak, but this is just how we have coped.

Our "babymoon" was the first time we really let ourselves believe that things might work out and that was entering the third trimester.

Yes, it would be nice if I could join in in vacuous conversations about what theme to make a nursery, what the “in” colour is for a boy or a girl baby in 2017, and what is a hip name, but when I really think about it, maybe ruminating on how lucky I am to be pregnant at all is more valuable. I will never take for granted that I have a child. That child will never feel that he or she was an afterthought, not wanted, or was just an effortless sort of life stage. This child will feel that they were wanted more than anything and will know that my husband and I did everything that we could to bring them into this world and that we would do anything for them. If their nursery is not as themed or their clothes are not as matched as they could be that will be less important than them knowing that they are loved and cherished.

I know that others are not so lucky. On the IVF boards that I have read, I have seen people that go through one, two, five, ten, thirteen different IVF treatments and some of them can’t get pregnant or keep miscarrying. I don’t know how someone has the strength to go for another round after than many unsuccessful attempts. I only had to do one round of IVF and I know I’m truly lucky for that, but when I describe to other people who have never done IVF how many drugs I was on, how much it cost, how many injections a day that I had to give myself (after a lifelong fear of needles too) they look on in shock and horror. It just goes to show that it’s all relative. Until one has crossed one bridge or had one experience, one can’t know how one will feel about another experience. I never would have though that I would have the strength to get through a round of IVF, but I did. I couldn’t picture having to do a second round, but maybe when one crosses that first bridge, one finds the strength to try again and again and again. I’m not sure how people decide when to give up if they are not successful. I imagine a lot of this is influenced by finances. In Canada, IVF is more expensive than in some places in the U.S. for instance, and your private insurance may or may not cover a portion of it (ours was supposed to cover the drugs, but not the procedure itself, but then our insurer tried to slither out of this too until we fought them- then they did refund the cost of the drugs). But maybe after a while, one just can’t take the stress, physical strain, and heartbreak anymore.

My heart goes out to those who are struggling with fertility issues. I think this is one of the most painful things that people suffer from in our society, particularly because it is shrouded in a veil of silence and shame. I have been vocal with people I know and meet and in this blog because I think that people need to start talking about this important issue more to reduce the stigma and perhaps create lasting change.

I feel like I’ll never be the same again after the heartbreak and stress that I have suffered on this fertility journey, but at the same time, our experiences make us who we are, and having more empathy, compassion, and resilience is probably a good thing. The key is to not let it make me feel bitter or like a victim. And part of that process is by feeling empowered, taking charge, and for me this has been in the form of speaking out about fertility issues in public and on this blog to increase the visibility of this often hidden issue. I want to try to decrease the stigma of infertility and fertility issues. In my mind there shouldn’t be any shame associated with this.

In some places, the government funds or partially funds treatments like IVF, but not here in British Columbia. The government funded medical system will fund a visit to a fertility doctor and diagnostic tests to determine what might be causing infertility or fertility issues, but our system does not fund the treatments themselves. So that means if one is diagnosed with some type of infertility, male or female or both or the more mysterious unexplained infertility or one is single or in a same sex couple, etc. and one wants to have children and a procedure like in vitro fertilization is recommended to conceive, the entire cost of this procedure will be paid for by the person having the procedure unless they have some sort of health insurance that covers some amount of the procedure or the drugs required for the procedure or potentially both (and that’s assuming that the insurance company doesn’t deny your claim for no reason). Funding of Artificial Reproductive Technologies (ART) will never change unless people are more vocal, demand it, or if it is seen to be a significant and important societal issue. I’m not advocating that it should be funded, but many think that it should be and they may complain and grumble about this, but they don’t do so in a public forum where there is actually a hope for government people seeing their dissatisfaction with the status quo so that there is any hope that it might be changed.

I must own that I was nervous about speaking out about this journey in the beginning on a blog, using my name, pictures of myself, and sharing so many details about my journey, but I felt that in order to be authentic and true to myself I had to. Yes, I could hide in the shadows like so many people who have fertility issues, but if I spoke out, maybe I could help someone else who was suffering from fertility issues. Even if I only helped one person, I thought that that would be enough to make it worthwhile. The hits on my IVF blog climbed far faster than they did on my other three blogs and since its creation, 14 months ago, my IVF blog has had over 58,000 hits from countries all around the globe. Creating and maintaining this blog has been an overwhelmingly positive experience. So many people have reached out through comments on the blog and through various social media channels to give me support and share their own stories of fertility issues. Struggles with fertility are a lot more widespread than I had ever imagined and will likely become more so as our age of marriage and childbearing continues to climb or it will appear to be so as more and more people start to speak out publicly about their fertility issues.

I would like to thank my husband and family for not attempting to censor me at all in my blogging. They have allowed me to be myself, express how I’m truly feeling, and try to convey to others what this experience was truly like for me. No doubt we’ll be back here again in the future when we try for our second child, but in the mean time, thank you to everyone who has read my blog, shared it, commented, and reached out. It is only through having a meaningful relationship with other humans that we can evolve as a human being and as a society as a whole.

This thing is ready to come out of me . . .

38 Weeks Pregnant: Nesting Instinct, Appointments, My First Ultrasound in 16 Weeks, Non-Stress Test, and the End of an Era

I'm in full on nesting mode around here.

The week has been a blur as I've continued to feel driven to get things done, prepare for the baby's arrival, organize the house, stock up on food and household supplies, and finish packing the hospital bag, a bag for the baby, and food to take (I've been told the rations for mothers are meager and they don't even feed the fathers).

Stock up on tea, stock up on groceries, prepare for the siege.

My husband looked on in confusion at my flurry of activity and told me that I should rest. Well, read on and you'll find out that maybe my body just knew.

Pancake Sunday again. I'm being spoiled by my husband.

I had family over for tea a couple of times, I went for a massage, I went to acupuncture, I had my teeth cleaned at the dentist, I had a chiropractic adjustment, and I stocked up on stuff. My sister gave me a bunch of stuff for the baby from her place and found a crib and a change table for me online, which helped to calm my worries that we did not have what we needed. And I generally freaked out trying to picture what each room, time of day, and activity would be like with something as foreign to me as a baby around. While I had done and acquired basically everything I thought that I needed, my task list kept growing even as I checked things off.

My bed at home has a complicated configuration of pillows, well so does the acupuncture bed.

At acupuncture with the skinless man on the wall.

Waiting for my appointment with Dr. Down.

On Thursday, I was scheduled for an ultrasound and non-stress test at Victoria General Hospital. I was nervous, picturing each worst case scenario, including the fetus being in a breech position, the fetus being in distress, there being something wrong with me, and the day ending with an emergency C-section or induction and me becoming a parent in an expedited fashion.

The weather has been gorgeous in Victoria.

The ultrasound happened first. The fetus is head down. That is a relief because they apparently can't change position at this late stage, so it's stuck there.

The technician pointed to the ultrasound image of the fetus' head with eye sockets staring straight up, its spine to mine (this was the only pictures the technician could really get because of the position of the fetus and you can't take your own pictures there, so I have none). They call this head up position of a fetus the "stargazer."

The two black dots in the middle are the eye sockets, gazing upwards in the :"stargazer" position.

 The name of the position reminds me of that Oscar Wilde quote:

“We are all in the gutter, but some of us are looking at the stars.” ― Oscar Wilde, Lady Windermere's Fan.

After the ultrasound, it was back to the waiting room to await the non-stress test.

Waiting for my non-stress test at the hospital.

The non-stress test consisted of lying on a bed, propped up for 20 minutes with two different monitors pressed to my belly with elastic straps holding them on. I was given a button to press if I felt fetal movement. I also had an arm band for blood pressure monitoring on. My blood pressure was taken twice from my right arm and found to be on the high side, very strange for me (I usually have low blood pressure. My feet were really swollen that day too. When my blood pressure was taken from the left arm, it was much lower. My pulse was around 60 and the technician asked if I was "one of those yoga people." Nope.

The fetus had several rapid accelerations in heart rate during the monitoring, which is what they want to see. I kept having contractions as I had while getting the ultrasound and the technician could see these in the monitoring strip. She said that the ultrasound was normal. The only thing slightly off was that there was a bit of a high amount of amniotic fluid. This can vary every 24 hours though. The technician said that if my membranes were to rupture at home, I should immediately lie down on my left side and get to the hospital ASAP to reduce the risk of the fetus moving into a bad position in the excess amniotic fluid (such as sticking an arm over its head or getting the cord above its head. She said that they would dip my urine sample, consult with the obstetrician, and call my maternity doctor, Dr. Down, to see what he wants me to do next. Then they would come find us in the waiting room to tell us when my follow up appointment might be, either with an obstetrician or for another non-stress test or both or maybe neither since we were getting so close to the end (38 weeks the next day).

We sat in the waiting room again. We were an hour and a half past the appointment start time by this point. We weren't expecting to be at the hospital so long, but we were also glad it didn't seem that there was an immediate risk of us being held there and me induced. We want the rest of the pregnancy to prepare!

Past noon, about two hours after we arrived, we were told to go get more parking because we'd be there about 1-1.5 hours because I'd be seeing an obstetrician and having a consultation with an anesthesiologist (I have severe psuedocholinesterase deficiency so my maternity doctor requested that I have a consult in case any interventions are required).

We bolted a quick Tim Horton's lunch after we bought more parking and returned to the ward as the technician called me on the phone wondering where I was- gee I wasn’t expecting to spend hours at the hospital in a ward where I can’t eat or drink anything.

We were immediately shown into an exam room. The obstetrician joined us. She said there was only slightly elevated amniotic fluid, but with my blood pressure going elevated there were concerns about waiting for my due date. She said that the fetus is measuring at 7 pounds 6 ounces right now. All a fetus does from weeks 38 onward is put on fat, but they're fully functional by that point. She performed a pelvic exam (a particularly unenjoyable experience when you're already having contractions) and said that my cervix is 3 cm dilated already and the head of the fetus is engaged in the pelvis. She opined that since I'm 38 weeks pregnant the next day, the benefits to waiting were outweighed by the potential risks such as the fetus changing position when my membranes rupture to preeclampsia in me with associated risks like seizure, placental abruption, and potentially death. She said I could wait and see and it might be fine, but I was in a perfect position to be induced now and have the baby this weekend. Either way I should be rechecked  with another non-stress test on Sunday or Monday if I have not been induced yet. I asked her what she'd do if she were me. She is after all the expert. She said she'd be induced.  So that's what we're going to be doing. Well, that is if it doesn't happen naturally before then- the obstetrician did say this was a distinct possibility.

Next we waited for the anesthesiologist. Usually the muscle relaxants that I can't process aren't used anymore in surgery and anesthesia, but it's better that everyone is crystal clear about what I can't have (when I was given one of them during a surgery before my deficiency was known, I was out and unable to breathe on my own for about 12 hours instead of 2, thanks to ventilators though people like me won't die if this happens, but it's pretty scary for everyone that's awake and not particularly good to do).

We were still waiting a couple of hours later and asked a nurse if the anaesthesiologist would be seeing us that afternoon or not. We didn't want to be rude, we know they're very busy, but my feet were continuing to swell and we were both thirsty, hungry, tired, and stressed. She went to page him again. I was brought a ration of a slice of cheese and a tiny packet of digestive biscuits with a cup of apple juice. I really don’t know how they expect a pregnant woman or anyone for that matter to withstand almost six hours without anything to eat or drink. It seems unreasonable. I was grateful that we had had that five minute lunch earlier or I would have been in full on apex predator mode, roaming the ward in search of prey.

The anesthesiologist appeared about 20-30 minutes later and reviewed what might happen if induction happened and I needed pain relief, including the pros and cons of narcotics versus an epidural and what was required if a C-section were to occur. We of course reviewed my pseudocholinesterase deficiency and he said that it was a very good thing for him to know because some drugs that cause me problems are used in C-sections (they usually aren’t used in normal anesthesia anymore). He said that he didn’t need any blood work and that we could leave and the hospital would call us when we were on the list for induction.

My husband and I left the hospital about six hours after we had arrived there and went home in a full on state of shock and panic. There’s nothing like finding out that a major deadline has just been moved up by two weeks or more and there’s nothing that you can do about it. I continued to have cramps and feel nauseous and kind of dizzy.

We decided to go out for dinner at Sen Zushi for one last hurrah. I continued to feel signs of early labour as I devoured the delicious Japanese meal. We returned home and went to bed feeling uncertain about whether I would beat the hospital and go into active labour that night. In any event our hospital bags, food, and the car seat were all in the car and ready to go.

Out to dinner at Sen Zushi. We need to stock up, because we won't be going out for a while . . .

I was very uncomfortable last night, having to go to the washroom every hour, being very thirsty, having cramps, and nausea. In the morning, I didn’t feel as crampy- well that was until I got up and about, then it hit again and it felt worse than the day before. I feel gastric distress, headaches, and dizziness. I’ve still been able to carry on with tidying the house, errands, and generally fretting though, so I guess I’m not in active labour yet.

Dr. Down, my maternity doctor, called me personally today to go over me being on the induction list, what happens if I get bumped, the follow up non-stress test if I am bumped, and what happens if I go into active labour before induction. I appreciate his excellent care, kind manner, and vast knowledge.

My husband and I just keep wondering whether my body will do it itself or whether I’ll be on a Pitocin (artificial oxytocin) IV drip this weekend and having my water broken being induced into labour or whether we’ll be bumped from the list and will not have the induction happen until next week. In any event, it looks like our pregnancy journey is ending and our journey as new parents is about to begin.

38 weeks pregnant.

37 Weeks Pregnant: Acupuncture, Massage Therapy, Maternity Doctor, Lab Tests, and Reaching Full Term

We're enjoying the sunsets at our new place.

Today, I reached 37 weeks pregnant. Of course, all pregnancy sources seem to contradict each other or vary at least slightly, but many seem to agree that once a woman reaches 37 weeks pregnant, the fetus is considered full term (but full term can range up to 42 weeks, after all not all babies have a day planner). I never thought I’d be fortunate enough to reach full term or anywhere near to full term or even get pregnant again after my miscarriage, and having to rely on IVF, so today is huge for my husband and me.

The spring produces such beautiful flowers like peonies.

Last weekend, my husband and I went looking for more “stuff” for the fetus. The mind-boggling array of baby carriers (and cribs, changing tables, strollers, car seats, etc.) on the market is enough to make a new parent’s head spin. And just when you think you’ve thought of everything, the salespeople will throw other suggestions at you. For instance, if you buy an orthodontic soother, then there’s the soother clip to think about . . ..

Baby carriers seem to have an astounding number of buckles and straps.

Monday, I had acupuncture. Lying on my side for the almost one hour of the appointment, with needles sticking out of my lower legs, arms, head, and back, proved to be uncomfortable as my back is getting more and more done with this whole strain and my ribs feel out because something is burrowing into them. At acupuncture at this point they have started to “prepare” my body for labour which involves targeting some specific points that relate to the uterus and cervix.

Tuesday, I went for massage therapy again. My hobbling walk seems to grow a little worse each week as my ligaments stiffen and my body protests a little more loudly at the added weight and off balance nature of my current form. Even rolling over on the massage table from one side to the other is more challenging now. My back, legs, and pelvis are all stiff and sore, but I’m just grateful that I’m pregnant and that the pregnancy so far is going well according to all of my doctors.

Wednesday, I saw my maternity doctor again. I will be seeing him weekly from now on. He says that my blood pressure is good. My fundal height measurement was normalish to slightly big, but he thinks that it’s because the baby has lodged itself into a very high position in my abdomen and is sticking out quite a ways. He said that it looks like the fetus is trying to stand up inside of me. No wonder I’m uncomfortable. The fetal heartbeat was normal. Then the fun stuff happened- not only did I have to have a Strep B swab done (this is done at 35-36 weeks pregnant to determine of the pregnant woman has Strep B and will need an antibiotic shot at the time of childbirth- results are still pending), but I also had to have an exam of my cervix to check that everything is as it should be. He also tried to determine the position of the fetus. He thought that it felt like it was head down, as it should be, but was somewhat disturbed by how high up the fetus seemed to be and how much it was sticking out and did not want to be wrong, therefore, he ordered an ultrasound and non-stress test to make sure that everything looks good and that the fetus is not in breech, that the amniotic fluid is at a good level, etc.. I will be going to this ultrasound next Thursday at the Victoria General Hospital. I have not had an ultrasound since 22 weeks, so it should be quite different this time around I would imagine.

I'm getting sick of giving urine samples (before every maternity doctor appointment).

Waiting for my examination with the maternity doctor.

Today, I had a big batch of blood tests for my thyroid, kidney function, and my lithium level. Everything looks fine. My next tests for these levels will be post birth (and my medications will be changed at that point to prevent toxicity from the lithium and going hyperthyroid with too much thyroid medication post birth).

Waiting for more blood tests.

I spent the rest of the week organizing the house, gardening, preparing hospital bags in case I go into labour early, meeting with a friend for tea, and for lunch with my father. My lovely mother-in-law sent us a box full of receiving blankets and burp cloths that she made of cozy flannelette and some with terry cloth with beautiful stitching, pretty colours, and patterns. She also found more light receiving blankets for us. My husband held up the burp cloths with bewilderment and intimated that he had had no idea what his mother and I had been speaking about on the phone the other day when we were talking about this box of cloth, but now he understood their purpose. It's going to be a steep learning curve for both of us. My husband and I have been chipping away at preparing a room for the thing, but it’s somewhat difficult when different items are showing up from various corners of the world (that we ordered online) and my husband’s work schedule is so demanding (and because we don’t know what we’re doing). It is slowly coming together though.

Other than the sore ligaments, muscles, and skeleton, I’ve been experiencing hiccups of a dyspeptic nature, nausea at times, thirst, fatigue, headaches, rib discomfort and breathlessness, and intermittent Braxton Hicks contractions. It seems that all of this is normal for this stage of pregnancy. The fetus is so strong at this point, I find some of its motions quite startling at times. My husband is amazed by its activities and how big it has become and says that he’s just ready to bring this to a close and meet it. I disagree! Not only would I rather the fetus come closer to its due date for its health reasons, but also, I’m not ready. I still have many lists of things to do, things to buy, and if I’m honest, I’m petrified about whether or not I’ll perform adequately as a parent. Plus, it’s easy for my husband to say that we should just get this show on the road, he doesn’t have to physically go through childbirth . . ..

37 weeks pregnant.