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?

34 Weeks Pregnant: Medical Appointments, Preparing a Nest, and Shock at the Fast Approaching Due Date

The sun is setting on our carefree childless lives.

It’s been two weeks since my last update, so here’s an update.

The weekend before last, my husband and I spent moving things from our old place to our new place, cleaning, and shopping for stuff for the new place. We also voted in the advance polls for the provincial election in BC.

The thing's first election.

Last week I had blood tests done for my thyroid levels.

The following day I visited the maternity doctor, Dr. Down. He said that he had no concerns at all with my pregnancy, but that the fundal height measurement was significantly larger than the previous weeks. He said that if my measurements continued to grow at a larger than normal rate that an ultrasound might be ordered. He thought though that the height increase could be caused by the position of the fetus. I had to agree because the last couple of weeks the fetus has been sitting up really high in my abdominal area (hello, rib discomfort!). I also still felt like I had a urinary tract infection. My previous lab test two weeks ago had not shown a urinary tract infection, but had shown abnormal amounts of bacterial growth in my urine. Since I had all the symptoms and my doctor says that urinary tract infections often present in strange ways when women are pregnant, he prescribed antibiotics and some pyridium for the pain.

At Dr. Down's office.

The endocrinologist that afternoon stated that my thyroid levels were perfect and that no increase in medication was needed at that point, but might be before the end of the pregnancy. He said that I had gained hardly any weight in the past month. Then he said something than almost made me faint. He told me to start eating ice cream before bed at night. What!? Apparently when a woman is overweight and pregnant, towards the end of the pregnancy the fetus starts using up all her sugars and this causes her body to burn fat for energy. This produces ketones which cross the placenta and this can harm the fetus. In order to prevent this, having something with sugar in the evening before bed can help hold the body until breakfast. My endocrinologist specified that it should be cheap ice cream with pectin in it which makes it harder for the body to digest and therefore will make it last in the body longer.

I had another visit to the chiropractor for an adjustment last week. While my back was doing better than it had been in a while, my round ligaments and hips have been bothering me. But a lot of this is just pregnancy. The adjustments help, but nothing will take away all the discomfort. I just remind myself every time I feel uncomfortable that I’m lucky to be pregnant and that I should never take that for granted.

I spent the entire last week taking carloads of stuff from our old place to our new place. This was grueling, exhausting, and tedious, but I was able to move a lot and unpack and organize at the new place quite a bit. Plus, carrying boxes up two flights of steps one at a time was an amazing workout.
My lovely parents in law returned to town in the middle of the last week to help us more with fixing up the new place and helping us to move stuff in and organize. The relief of having someone to help us prepare our nest helped to calm my anxieties somewhat. They also brought a bag full of some clothes for the fetus, books, and a couple of beautiful blankets that my mother in law made herself. I was overwhelmed by their kindness, love, and generosity. Naturally, moving is always a nightmare, but with help it seems less daunting. By the time they left at the end of last weekend, I felt that our new place would work when the thing arrived (with more unpacking, organizing, and preparation of the room for it).

Filling and refilling these  Rubbermaid containers is actually a really great way to move bit by bit.

I hit 33 weeks pregnant last Friday and my parents in law were there to celebrate this milestone with us. We never thought we’d be lucky enough to get pregnant again, even with IVF, let alone make it this far through a pregnancy. We feel so fortunate.

A note on moving while pregnant, I do not recommend it. Moving is gruelling and stressful and especially towards the end of a pregnancy it really takes its toll. The stress and anxiety is awful. The physical symptoms that moving causes are also annoying. I have found that my round ligaments, hips, and back are so sore from all of the moving.

The new place is providing inspiration for writing, but moving is such a hassle.

This last weekend was the start of prenatal classes at the Mothering Touch. We chose a format where we took class all day on Saturday, 9:30 a.m. to 4:30 p.m..  We have another all day class tomorrow. We also had a hospital tour last night at Victoria General Hospital as part of the package. The classes come with a handbook for the mother and a handbook for the birthing partner. They also provided snacks in the morning and afternoon (we were free for an hour to go for lunch wherever we wanted to or bring our lunch- we chose to go to our favourite Japanese restaurant, Sen Zushi, for a delicious bento box).

The class itself provided some useful nuggets like how to time contractions, at what point one should actually go to the hospital (if one goes too early, one will just be sent home), things to bring to the hospital, and essentials to buy for a baby (this is something we’ve been really struggling with because we don’t want to end up with a bunch of unnecessary stuff that clutters up the place and never gets used). We practised various positions to labour in (FYI they are all pretty weird and uncomfortable, but I guess you’re already so uncomfortable maybe being in a contorted position all of a sudden feels comfortable?), how birthing partners could help coach the labouring person through the pain, and we held ice in our bare hands and practised breathing exercises and then the birthing partner coaching us through the ice pain (I found the visualization of yellow diamonds that my husband provided to be very helpful and almost forgot to drop the ice when the time was up). We discussed pain control methods that were available at the hospital and pros and cons of each.

At Sen Zushi for lunch in the middle of our class day.

At the hospital tour of Victoria General Hospital, we were told which entrance to go to if we arrived in the night vs. the day, where the maternity floor is, what a birthing room looks like and what’s in it, what the rooms look like where the mother and baby are taken after (there are private rooms and shared rooms), and some of the other rooms and features of the ward. The woman giving us the tour told us some useful things to bring to the hospital, what not to bring, strategies for feeding the birthing partner (food is only provided to the mother), and other useful tips (she’s been a doula for years). I had seen some of the floor from when my sister gave birth, but seeing more of it, and hearing some tips, dos, and don’ts was helpful. It will be less alien when we end up there in around six weeks.

I was on antibiotics for one week and the symptoms seemed to mostly disappear, however, naturally since I’m six weeks from my due date and the fetus is kicking and pressing on my bladder I still have urgency and frequency of urination that are more than in my pre-pregnancy life. Also, the antibiotics seemed to cause diarrhea and nausea towards the end. However, those could just be symptoms of the late pregnancy. Who knows. All I know is that I had a massage scheduled earlier this week and after getting on the table I was so sick that I had to rush to the bathroom and then cancel the massage. I also may have overdone it with all of the moving, packing, unpacking, and cleaning of the old and new place. It’s hard to tell.

I also had acupuncture this week. My visits will be switching from monthly as they have been for the past many months, to two weeks from now, then weekly to prepare my body for the birth. Mention of preparing my cervix and perineum for the birth via acupuncture sounded strange, but I guess there are points for that that someone figured out years ago. In any event, it won’t hurt and may help and it’s mostly covered by insurance, so why not try it?

I had my lithium levels tested at the lab this week and reviewed my results online at myehealth.ca which is where Life Labs reports results of patients (if you sign up to access your results online you find them there). My levels were excellent and my kidney functions were totally normal. This means that I do not have to return to my perinatal psychiatrist before the birth (unless my results are out of range in a month when I retest or I have an episode, but hopefully it will be relatively smooth sailing from here).

At the lab again for yet another blood test.

This week I’m feeling continuing round ligament pain, hip and back pain, and significant rib pain (and shortness of breath) as the fetus occupies even more of my abdominal cavity and grows bigger by the week. I suspect the rib pressure and shortness of breath has contributed to the panic attacks I’ve been having this last week on a daily basis. Although, maybe it’s the stress of moving and the fast approaching due date.

Time is running out.

I feel exhausted, but the drive to nest is interesting and has given me strength to move more than I would have thought that I’d be able to. I’m still not napping during the day and I’m sleeping a fair number of hours at night. I just know I have to keep going, so that I’m ready for when the thing arrives in around six weeks and my life changes forever.

33 weeks pregnant.

34 weeks pregnant.

32 Weeks Pregnant- Aches, Pains, Cramps, Kicks, Grief, Blood Tests, Appointments, Moving, and Probably Less Than Two Months Left

The spring in Victoria is full of flowery delights.

It’s high time for a proper update. The last time I provided a full update on my pregnancy (I’m not including the babymoon post), I was 25 weeks pregnant. Today I am 32 weeks pregnant or just over seven months pregnant. While I was on that babymoon (read upon our French Polynesian babymoon on our travel blog), people were still surprised (and some disbelieving) that I was pregnant, let alone in my third trimester, but there’s no mistaking it now. Over the past few weeks, my belly has grown a lot and is really sticking out now, as the thing has lodged itself high up and its head or perhaps butt is jutting out of my high stomach. I can’t say that this placement is particularly comfortable, especially for my cramped lungs and other organs, but I really doubt if any particular placement is comfortable. I’m just grateful that it's still alive and that I’ve made it this far. I still have trouble believing that I’m 32 weeks pregnant, when I didn’t even think I’d be lucky enough to get pregnant a second time after my miscarriage, even from IVF, let alone carry a fetus for this long (and without any complications at all so far).

I'm still wearing this same tunic as in my second trimester, but the stomach has filled out a lot, so its length has definitely decreased.

I have not noticed any fetal hiccups as some women do when they’re pregnant, but the strength of the kicks from the fetus has definitely been increasing. I notice them more often now too. Sometimes it feels like the thing does a complete somersault in my uterus, which is a totally weird sensation. I can see the shape of my belly change sometimes as it changes position. My husband is already clearly besotted with the thing and spends his spare time away from the office, at home, talking to my belly, singing to my belly, and stroking it.

I have also noticed an increase in “annoying” symptoms over the past few weeks, these include lots of bladder pressure (somebody likes sitting on it and kicking it) and some urgency too. I definitely go to the bathroom a lot, even in the night. I sometimes feel like I won’t make it to the bathroom in the middle of the night in time if I sleep more than about two hours (it doesn’t help that I’ve been really thirsty and drinking water like a fish through the day and night), especially since getting out of bed has become more of a production between extracting myself from my nest of pillows and just trying to maneuver my heavy and unbalanced body out of bed and then trying to straighten up with the stiff round ligaments in my abdomen and my achy back.

I just touched above on the problems with round ligaments during pregnancy. They have been particularly annoying over the past few weeks. They get very tight and sore, especially when I go for long walks or sit for too long. I feel elderly, as I try to straighten up from sitting or get up from lying in bed, just because my round ligaments are so stiff that I have to slowly straighten up and consequently straighten them to avoid painful spasms (round ligaments support the uterus in the abdominal area and when a woman is pregnant they become much more stretched than usual, which can lead to pain and spasms).

On the other side, my back has been bothering me on and off. Partly I think it’s just the increased weight and the counterbalance which is now on my stomach, the fetus, but the other part I'm guessing has to do with when the fetus is in a particularly uncomfortable position and perhaps poking an appendage into my spine- this seems to cause spasms in my low back/hip area.

My hips are definitely feeling less stable and more stretched out (and not in a good way) and I find myself walking slowly and hobbling when I first get up from sitting or from bed.

Even last week, I was taking my 7 km walks, but this seems to be getting a bit much, as it takes me a couple of days to recover now (stiff round ligaments, back, and hips) and the maternity doctor thinks that perhaps shorter walks and more time with my feet up is what I should be doing now.

In general, I feel awkward (not that I’m normally a graceful swan). I have noticed an increase in spontaneously losing my balance when I’m just standing around, dropping things, running into things (still trying to get used to this new bigger form), my walking pace is slower and more laboured, going from sitting to standing takes longer and is even less graceful, getting out of bed makes me feel like a beetle stuck on its back, and I’m getting tired more easily.

I feel like I'm moving as slowly as this fuzzy caterpillar.

This week I have suddenly experienced some abdominal cramping (but no bleeding) and it comes and goes at random. From my reading, this appears to be Braxton Hicks contractions (which are false labour pains and frequently occur in the third trimester as a way for the body to prepare the uterus for real labour). I have not been enjoying them (although I doubt that anyone does). They feel like menstrual cramps to me (although they don’t bother some women). I’ve put a heating pad on intermittently over my abdomen and back to relax and soothe the area and have taken Tylenol, but really there’s not much one can do.

Now a note on my current mental state. On the babymoon, I experienced some anxiety and panic attacks, but this was mostly due to the stress of travel (particularly that awful, awful, awful Air France flight on the way back, not that the one on the way there was great either), and the hotness and humidity of the air, which made my shortness of breath go from just annoying to panic attack level (cooling down in the ocean, snorkeling, seemed to cure this every day though). My mood on the babymoon generally improved as I was able to be around my husband all the time and felt reassured by his presence (he had to be away for most of the first almost six months of the pregnancy due to work).

A benefit of having my husband around at home is occasional treats like these Easter blueberry pancakes that he made for me.

Upon returning home from the babymoon though, the unexpected sickness of our almost 16 year old cat and having to say goodbye to him the day after we arrived home was devastating. I spent at least the first week in bed for almost all day and all night. It’s been hard to be in this place where we live now, looking at all the places where I used to see him sleeping, not having him steal my place on the couch, not having him keep me company in bed sleeping in in the morning, not having him keep us company all the time, and the almost unbearable silence. This place is empty without him. I have never lived without at least one cat since I was six years old. This has been utterly shattering and the stress of this on top of the pregnancy has pushed me to my limit. However, I’m dealing with this better now than I would have earlier in the year when I was going through a mixed episode of my bipolar disorder and part of my improved coping ability is because my lithium levels are at a good level again (and part of it is normal seasonal fluctuation of mood for me).

How do you say goodbye to your cat of 16 years?

Now on to the medical appointments. When I returned from the babymoon, I was 28.5 weeks pregnant. This made it the perfect time to go to the lab to have my gestational diabetes screen done. This blood test is done from 28 weeks onwards usually. My blood sugars were found to be in the normal range, so I don’t have gestational diabetes. They also tested my blood for things like my iron level. This is still on the low side, but in a normal range thanks to taking ferrous fumerate supplements since the second trimester. I am to continue taking these iron supplements even for a while after giving birth to ensure my body has adequate iron.

My maternity doctor has done two check ups on me since I’ve returned (from 28 weeks onwards the appointments go from once a month to once every two weeks). He says that my blood pressure is still perfect, my fundal height measurement is still in the normal range, the fetal heartbeat sounds normal, and he has no concerns at all about my pregnancy. After the struggle my husband and I had to get pregnant, it has been almost eerie hearing from the maternity doctor each appointment that he has no concerns at all about the fetus or my pregnancy. It feels almost too good to be true, but we’ll take it.

What is with the lighting in medical office buildings? And the wall colours?

When I returned from the babymoon, I also had my thyroid levels tested again at the lab. They were found to be at good levels (thanks to my endocrinologist increasing my dose of levothyroxine just before I left for the babymoon, in anticipation of my body and the growing fetus requiring more) and therefore my doses of levothyroxine and liothyronine remained the same. He was particularly pleased that I only gained two pounds in the five weeks since I had seen him (my maternity doctor is much less concerned with me gaining some weight in the pregnancy). My levothyroxine dose is at about double what it was before I was pregnant. Levothyroxine dose requirements tend to skyrocket during pregnancy for a few reasons, increasing blood volume and fluid in the pregnant woman, increased weight of the pregnant woman, and the fetus’ demands increasing the metabolism of the pregnant woman dramatically. As I have explained in previous posts, poor thyroid levels in pregnancy can lead to tragic consequences including miscarriage and a lower IQ in the fetus.

I will be following up with my endocrinologist again next week (four weeks after my last appointment), after I go to the lab to have my thyroid levels checked again. My endocrinologist told me that the levothyroxine levels will have to be decreased overnight as soon as I give birth (this is because as I mentioned above, my dose is way higher now than it was before and if I stayed on that dose after birth I would go from euthyroid or normal thyroid levels to hyperthyroid, which has its own share of nightmare symptoms). My endocrinologist shared some parting advice with me at the end of the last appointment. He told me to have small frequent meals to control my blood sugar (and avoid dramatic spikes), so that the fetus would not grow at too fast of a rate- he said that I would appreciate this during childbirth. Duly noted and given that my internal organ space is being monopolized more and more by the thing, I can’t really eat big meals anymore anyways, so small, more frequent meals seem to be the way to go.

Beautiful blue flowers in spring.

I had my lithium levels tested the week after I returned from the babymoon and then went to my perinatal psychiatrist for an appointment. My lithium level was perfect, I was feeling better than I had earlier in the winter/spring, and she had no concerns. She says that unless my levels get out of wack before the delivery (I will continue having monthly blood tests of my lithium level, which I can then monitor online) or I feel unstable, she doesn’t have to see me until after I give birth (she will maintain me as a patient for at least some months after the birth until I am discharged again into the care of my regular psychiatrist).

The perinatal psychiatrist informed me that when I go into labour, I will stop taking my lithium carbonate that day and will not take it the day after (I’m on a higher dose now than I was before I became pregnant and when the body rapidly loses a bunch of fluid in childbirth, taking the same dose of lithium after the birth can lead to lithium toxicity). Two days after the birth, the hospital will take my lithium level and the supervising psychiatrist will then start me on an appropriate lower dose of lithium carbonate. I will then likely be discharged from the hospital (they sometimes keep women after childbirth who have a perinatal psychiatrist for up to ten days if they’re not doing well, but this is uncommon and most people are out in a couple of days, which I guess is much longer than women who don’t have a psychiatrist who are pretty much kicked out of the hospital right after the birth).

My perinatal psychiatrist warned me again to maintain my boundaries against people who cause me a great deal of stress and distress and could impact my mood and mental state and could thereby contribute to a destabilization in my condition which is currently stable. Unfortunately, most of these people are related to me, so it creates a very awkward situation for me (at a time when I should be able to turn to my family, I must turn away for my own health). She told me that if people are not willing to change and be kind a respectful towards me and stable enough to depend on, not only would it not be good for me, but that now I would have a baby to think of and I can’t risk exposing it to people who are haphazardly in and out of my life, intermittently drunk and/or abusive, and who refuse to apologize for past wrongs or to make any effort to get help for their various problems and conditions. I know I've had my share of problems in the past, but I have put an incredible amount of work into seeking help, working on myself, and righting past wrongs. I wish that others would or perhaps could do the same.

I will be seeing my maternity doctor again next week. The MOA at Dr. Down’s office told me that the only test that’s really left for me to do is a "strep screening" (for Group B Streptococcus bacteria that can pose a risk to babies and can be passed to them from an infected mother during childbirth) at 35-36 weeks. Depending on the outcome of that test, antibiotics may be required. In anticipation of this, my naturopath placed me on a particular strain of probiotics that will hopefully prevent me from needing antibiotics. Who knows if this is likely to help or work, but I don’t really enjoy taking antibiotics, so I’ll try anything.

My mood can't help but lift when I photograph and haiku about the delights of spring.

There is no doubt that pregnancy and babies are a big industry and there is an astounding amount of “stuff” available. I’m still wearing the same non-pregnancy bigger clothes that I bought in my second trimester plus some pre-pregnancy dresses and tops that I wore earlier in the pregnancy. The only maternity item I bought was a shirt from Old Navy and personally I don’t think it’s that great. I would definitely continue to populate my wardrobe in my next pregnancy (if I’m lucky enough to get a second pregnancy) with non-maternity clothes in bigger sizes. Maternity clothes seem to be really expensive and really not that great (plus a lot of places seem to use artificial fabrics and I’m not going to wear those no matter how desperate I am). Yes, I don’t have a lot of selection of clothing, but who cares? It’s not like I’m going to look at my most glamorous at this point anyways, as I hobble around with my sore back and ligaments, groaning, and wondering what I’ll have for my next snack or why I have to go pee again. Regarding shoes, so far I’ve been able to keep wearing my sandals, runners, and mukluks and I haven’t needed anything more than that, so other than the reef shoes that I had to buy before the babymoon (my existing ones were too tight) and the flip flops I had to buy on the babymoon when my feet were really, really swollen from flying and the heat and humidity, I haven’t needed to buy new shoes (but I have noticed my more form fitting shoes are tighter due to both some swelling and the ligaments relaxing in the feet- who knows if my feet will go back to normal after the pregnancy or not- some women actually change shoe sizes). Oh, and by the way, with less than two months to go now, I’m still able to wear my engagement and wedding rings, but I do notice my fingers are definitely swollen- who knows if I’ll have to take them off before the pregnancy ends (a lot of women do).

Continuing on the topic of "stuff," once you’re done with the pregnancy, there’s a whole host of baby stuff that various sources say that you can’t live without. Unfortunately, every list is different. Even the most “bare bones” lists seem to include things that seem unnecessary to me. But who am I to judge? I’ve never had a baby before, so how would I know what I need. Hopefully the prenatal classes that my husband and I start next weekend will make it clearer what we must have. I don’t want a place crammed full of unnecessary stuff, but on the other hand I don’t want to be without what I actually need (especially because I don’t see myself being out and about shopping for a while after the birth). My mother-in-law gave my husband and I a concerned look when we showed her what we had so far for the baby when she was in town last week- a free bottle that we got from a maternity store (that I never bought anything from), a stuffed turtle that Le Meridien in Bora Bora gave to us, and that was it. While my mother-in-law was here, a box arrived from Indigo- my husband and I had finally spent our gift cards from a couple of Christmases ago and we bought a onesie (but it’s in a 6-month size, so not useful for a while), a three pack of bibs (who knows if you need those only when they start eating food or from the beginning, I don’t know), and some washcloths. So, yeah, we don’t really have anything at this point, but given that we’re moving (see below), what’s the point in loading up now, and having to move stuff, and not having anywhere to put it in the mean time?

Moving is always a nightmare, but I’d say it’s even more of nightmare when you’re 7-8 months pregnant. My ability to lift has been drastically curtailed, my stamina for cleaning is less (plus certain cleaners are not recommended and you can’t paint), and I feel even more anxious than I normally would about having things unpacked and ready in short order, because I’m due on June 23rd and who knows when the baby will actually show up. We’ve been looking for a place to move to forever, but had no luck due to market conditions (Victoria has an even lower rental vacancy rate than Vancouver now, 0.5% vs. 0.7%, oh and Toronto is 1.2% by the way, but since it’s the centre of the universe, people there are having even more dramatic struggles than us) that have led to not just a lack of inventory, but also skyrocketing prices. Anything that did look affordable (almost nothing because we were looking for a house) was either shocking or in a terrifying neighbourhood/ way out of town, or both. We wanted to rent a house (because buying a house in Victoria is not affordable or a good investment in our eyes, the average price in the core is $950,000, yet the average household income is $88,000- how does that work?!), but rental prices have gone up so much and there are practically no houses available for rent (they’re all being sold on the hot market where everyone in Victoria now looks at their house’s BC Assessment figure and thinks that they’re a millionaire because on paper they very well might be now so they must cash in- but I digress).

All of a sudden, out of the blue, my cousin who had just moved, kindly offered to rent me his house, as he had taken it off the market and had decided to hold it instead. The house is close to where we live now, in a safe and quiet neighbourhood, and has the space that we need now that it’s not just going to be just my husband and I. The house also had some maintenance issues though and the deal was that we would fix them up ourselves. So, we called the people that we knew that we could rely upon to help us in our time of need (and panic), my husband’s parents. They gladly dropped everything and came down the next week and spent a week here helping up to fix up problems in the house and clean it up. They’re coming back next week for another week to help again. Then we’ll be able to actually move into the place in mid May or so, barely more than a month ahead of my due date. It will be tight, but I’m just so relieved to be moving, and so grateful that my cousin is renting us his place, and that my parents-in-law are helping us and reassuring us that the place will be suitable and in good condition for us to bring our first child home to. I still can’t believe how lucky I am to have my parents-in-law. It’s true that you don’t get to choose family, but at least you can choose a partner who has the family that you wish that you had always had and they can be there for you in a way you never thought that a family would be or could be.

25 weeks pregnant. This was just before we left for the babymoon.

The difference in my stomach at 31 weeks was very noticeable.

32 weeks pregnant, less than two months to go (unless it's late).

25 Weeks Pregnant: More Blood Tests, Acupuncture, Chiropractor, Packing for the Babymoon, and Another Year Wiser

Current mood . . .

On the weekend, my husband was only around for just over 24 hours before returning back east to work for the week. We went out on last minute errands for the trip we'll be leaving for tomorrow (our "babymoon" in French Polynesia- for more on that see my travel blog).

The cat is not happy about the prospect of us leaving.

I spent the rest of the weekend alone preparing for the babymoon and packing.

Monday, I was at the lab bright and early to have my kidney function and lithium levels tested. I talked to the MOA at my perinatal psychiatrist's office about whether or not I would be attending the scheduled appointment with her the next day. I was to check my lithium levels online and if they were at a therapeutic level then I was to cancel my appointment and come in after the trip. Annoyingly, though I was in at 8:00 AM for the tests, the results weren't posted until about 6:00 that evening, so I had to leave a message cancelling the appointment with the perinatal psychiatrist the next day as I found that my lithium levels were still within a therapeutic range and my kidney tests were normal.

At the lab again.

The next day I talked to the MOA at the perinatal psychiatrist's office to reschedule my appointment for mid April after I return from the trip. I will of course have my lithium levels and kidney function tests done ahead of that visit as I always do. My lithium levels though therapeutic now, may not be by the time another month has passed as they have been getting lower again (and I certainly don't want to destabilize while I'm pregnant).

I took some beautiful walks this week around Victoria.

On Wednesday, I had my monthly visit to the acupuncturist. This visit instead of being on my back or my stomach, I was situated on my side. I could choose which side and since there was a picture of a waterfall on one side and a picture of the creepy fleshless acupuncture man on the other side, I chose my right side so that I could look at the waterfall. My acupuncturist put needles into my head, ear, my back, my lower legs and left me for what turned out to be too long for my rapidly diminishing bladder space. After she rapidly removed my needles I practically ran to the washroom before I even paid.  I will return to see her in a month.

Me and the creepy fleshless acupuncture man . . .

Thursday, I was at the chiropractor for a final adjustment before the trip. I'm feeling tense in my mid back and somewhat sore in my low back. I will return to see him in a month.

Friday, I celebrated my birthday and being 25 weeks pregnant, with a beautiful walk in the morning and then my husband returning to town (sick with a cold) in the afternoon. I flew around the house making final preparations and packing for the Babymoon. This evening we're having dinner with friends at my favourite Japanese restaurant in town, Sen Zushi.

We are leaving tomorrow for three and half weeks. I'm nervous to travel because I've never travelled on a major trip pregnant before (only the short week that we spent up at my husband's parents' place and in Vancouver at Christmas), but returning to paradise, French Polynesia, should more than make up for my anxiety right now. I'm looking forward to enjoying time with my husband in a beautiful locale. This blog will be on hiatus until my return, so to see what I'm up to please visit my travel blog (www.tworestlesswanderers.blogspot.com).

25 weeks pregnant.

23 Weeks Pregnant: Daily Walks, My Husband Away During the Week, A Forced Visit to the Naturopath, Planning a "Babymoon," Ruminations, Worries About the Future, and Was That It Moving or Am I Having Weird Indigestion?

Current mood . . .

I honestly never thought I'd make it this far into the pregnancy. After years and years and years of trying to get pregnant, having a miscarriage, and then being told the mournful statistics of how unlikely it was for me to have  a live birth from each round of IVF at my age by my reproductive endocrinologist, Dr. Hudson (28% chance of a live birth at my age), I just kind of assumed I'd have to try several rounds of IVF or that I'd get pregnant and miscarry again or that I'd just never be pregnant again. Being already pessimistic, going to law school, practising law for years, and then having years of bad luck really did a number of me. But here I am, 23 weeks pregnant today from a single round of IVF at the Victoria Fertility Centre.

This week, I have been experiencing continuing ups and downs with sleep (including nightmares, trouble getting comfortable, having to go pee really often through the night, and sometimes waking from panic attacks). My ears keep plugging and unplugging. This seems to be an extension of my congested sinuses that couldn't be connected to those two colds anymore and must in fact be from all the increased blood flow that I'm experiencing because of pregnancy (congested sinuses and ears are common in the second and third trimester). My hands seem to be more swollen than they were and I'm wondering how long it will be before I have to take off my wedding ring and engagement ring. My shape is changing steadily with each passing week too. I've had a bit of eczema acting up this week (some women get eczema acting up, while others notice an improvement during pregnancy).

On the advice of my perinatal psychiatrist, who told me that I need to get out of my head and house more and walk every day, I have been walking every day (except for over last weekend when my husband was at home and I wanted to spend every precious moment with him before he left again for the week, plus I was exhausted). I must say that while it's been nerve racking leaving the house, on some days more so than others, it has felt good once I am out of the house. While I started with a few kilometers per walk, I went up almost immediately to 6.5 km most days and even did 9 km on Wednesday (but that was overdoing it, as I was even more sore and was so exhausted the next day that I could only walk a couple of kilometers).  My hips and legs have been sorer than they would usually be going for long and brisk walks (and it's hard to be as brisk as I used to be between hauling around extra weight and gasping for air while being pregnant), however, it seems to make me less uncomfortable at night in bed when I go for a walk that day.

With views like this a walk seems like a reward on a sunny day.

Another benefit to the regular walks is that I have been sleeping much better on days when I go on long walks than on days when I don't walk or go or a short walk (like last night when I slept just 4 hours). The beauty of the walks I can go on near to my house is breathtaking (and that's not just the breathlessness of pregnancy). I have been watching early spring come to Victoria, including spotting the first cherry blossoms in my area two days ago. I don't mind it when it rains much and I've been lucky lately (especially considering that I have no raincoat that fits). I would say that the daily "exposures" to my anxiety over leaving the house (exposure therapy is used to treat panic disorder and anxiety by forcing a patient to do exposures where they face their fears by doing what they're afraid of repeatedly until it becomes less scary and then hopefully not scary at all- this is one of the most effective treatments for panic disorder and one that I had do extensively a few years ago when I was first diagnosed with panic disorder) have been beneficial in more than one way (sleep, less restless uncomfortable feelings at night, a mood boost, and lower anxiety). I have also had a friend come on a couple of walks and having someone to talk to other than the cat has been a treat (since my husband is away all week for work).

There's a herd of deer that spends the spring and summer in the Ross Bay Cemetery.

They make themselves at home.

The first cherry blossoms that I spotted this year.

I would say that even having my husband away all week, every week, has been easier to deal with since I've been walking daily. My psychiatrist is right that getting out of my place and seeing something other than this place has been good for me. A man even stopped to tell me a joke in the graveyard when I was wandering through there the other day alone and this gave me a laugh and a brief fleeting moment of social interaction when I otherwise would have had none.

I've been craving fruit like crazy.

My husband made me delicious blueberry pancakes last weekend before he left again.

I received a message over the weekend from my old naturopath (the one that my husband and I went to for months and months and received supplements and acupuncture from in the hopes of avoiding IVF and conceiving "naturally," only to find that we had to get IVF after all). She said that in order to keep selling me the prenatal vitamins that I buy from her (and sometimes probiotics too), she would have to see me for a follow up visit, since it had been almost a year and "the college" requires naturopaths to do this (all I could think was what?! They require an annual visit to dispense multivitamins and yet they let all this other crazy stuff that we read about in the newspaper happen with naturopaths? Shouldn't they focus on making sure naturopaths advise people, including parents of seriously sick children to get medical advice when they need it, instead of giving them herbs or whatever and in some cases having tragic things occur?!). But I digress. Since I like the prenatal vitamins that she has there (they have real folate instead of folic acid and some people may have difficulty converting folic acid into folate and since she got me scared about this a year and a bit ago, I've only taken folate to be on the safe side- I can't help the risk aversion being a recovering lawyer), I scheduled a visit.

Having to go for an unnecessary visit made me grouchy.

I was told that my visit to the naturopath could be quick, but of course it ended up being not quick. I was there 45 minutes updating her on what medications I'm taking (still all the same) and how the pregnancy is going (normal, maternity doctor has no concerns at all). While she does have some interesting nutritional suggestions (she really got my husband and me onto turmeric last year), some things really annoy me. One example was when I told her that I had managed to get a few okay sleeps with daily walking and she said in that smug manner that all people who have had children before seem to use "well enjoy it while you can because you won't be resting for the next few years." (chuckle, chuckle). No, it's not funny, especially when you suffer from bipolar disorder and a series of bad sleeps can trigger an episode. I don't need to be any more terrified of being a parent than I already am. Anyone expecting a child, unless they are the calmest person in the world or delusional, is terrified about the future, they don't need your sanctimonious and smug laughter and stories to scare them more. It's not helpful, just leave out comments like that. Everyone knows that new parents don't sleep well. Sorry you didn't get a gold medal for your sleep deprivation, but there's no need to boast about it to me because I'm not going to give you an award either.

Another example of an annoying thing in my appointment with the naturopath was when she started in on breastfeeding counselling. I told her that because I'm on lithium carbonate for bipolar disorder (which she had just confirmed that I was still taking), unfortunately I will only be allowed to breastfeed for a couple of weeks to give the baby the colostrum and then I will have to feed the baby formula. She initially seemed to protest, until I reminded her that lithium carbonate can be toxic and that when we can't test the levels in an individual they are dangerous. Despite this, she prattled on and on about strategies for breastfeeding and co-sleeping. As if I don't feel bad enough that I won't be able to breastfeed my child when everyone in my family has harped on and on about it my whole life. I already feel like a failure (even though according to research, I shouldn't feel a failure, and this is more common of an issue than people talk about due to the militant breastfeeding shaming in our society that currently occurs).

She took my blood pressure and pulse and confirmed what my doctor always says that I do NOT have high blood pressure and that I seem perfectly healthy.

Quit prodding at me and give me my prenatal vitamins.

At the conclusion of the appointment, which I was trying to rush along, as I had really had enough, she gave me a packet of various articles on pregnancy and a recipe for an easy cereal to make ahead of time for eating while I'm trying to feed the baby in the morning and beseeched me to come back in my third trimester. She also tried more than once to tell me that I should have a doula present with me when I deliver despite the fact that I have a doctor and I'll be delivering in a hospital (years of law school and practising personal injury and medical malpractice ensured that I would choose this route for childbirth). The whole interview was kind of annoying, but at least it's over with and I have some articles to read and a couple of recipes I could try if I needed to. I'm not opposed to approaching health and pregnancy in as well rounded a way as possible, I just don't like it when I'm made to feel guilty for having an incurable mental disorder which requires me to be on a particular medication for life and that medication makes me unable to breastfeed. What am I supposed to do? Go off of my lithium and then destablize, get hospitalized in the psychiatric ward again (this time pregnant), and spend the remainder of my pregnancy there and get put back on psychotropic drugs, or worse yet, wander off, do harm to myself, and then have an even worse tragedy occur? No thanks, I'll stay on my prescribed psychotropic drug that is effective for treating my potentially lethal mental disorder and I will follow my specialist's advice. Yes, it's too bad I can't breastfeed, but that's life, and I might not have a life if I didn't take lithium carbonate (bipolar disorder has the highest suicide rate of any mental disorder).

I spent a good part of this week making lists for our trip, finalizing accommodations (quite difficult on some of the more remote islands in French Polynesia and requiring me to start polishing up my rusty French), communicating with various travel insurance providers over specifics of their travel insurance policies as related to pregnancy, and starting to make piles of stuff to bring (and trying on bathing suits- nope those won't work, I'll have to go shopping). I'm anxious to go on vacation while I'm pregnant, but I'm also excited. I think the time away and intensive time with my husband will be very good for me. I can't believe we're going back to French Polynesia, where we had our honeymoon nine years ago, to have our last vacation before the baby comes. Read more about the vacation (or "babymoon" as some people call it) on our travel blog, Two Restless Wanderers.

As beautiful as spring in Victoria is, I'm looking forward to French Polynesia.

I will miss him though.

But being in French Polynesia again will make up for missing my kitty.

I had a lot of trouble falling asleep last night. I couldn't get comfortable despite all the pillows (including the rip off defective maternity pillow from eBay that the crook seller refused to refund) and only sharing the bed with the cat (who takes up roughly 1/3 to 1/2 of the king size bed). I had a bit more caffeine than usual yesterday and a bit later than usual, so maybe that contributed, but I couldn't stop worrying about things that could go wrong on the trip, where we're going to live when we have the baby or what if we still have to keep living here, and thinking about my family. I don't think the pregnancy book that I was reading before bed helped, it was going on about preparing the baby's room in the part I was reading last night, letting your partner paint it, etc. The book also irritatingly keeps talking about how you should not be surprised when your mother is obsessed with your pregnancy and keeps talking to you about it, giving you suggestions, and talking about when she was pregnant with you or when you were a baby.

What if no one in your family talks to you or takes any interest in your pregnancy? What if your mother is dead, is a alcoholic or drug addict, is incapacitated by a mental disorder, or is generally absent from your life? Why do almost all the pregnancy books I've read keep going on and on and on and on about how your family will react and all saying the same thing? Not everyone comes from a functional family or a family at least that will take any interest in a pregnancy. Some of us either don't have one or more parents, have parents who are addicted to alcohol or drugs, have mental disorders, and/or can't or won't be actively involved in their pregnancy.

What the books are saying makes me feel even more alone, even though I know I'm not alone. Rates of drug and alcohol abuse in the world are extremely high (and this is with them being underreported) and mental disorders impact many families (and underdiagnosis means that more people are impacted by them than official numbers would indicate). Plus some families are just assholes. Not everyone is going to have someone asking them about their latest ultrasound (or any of them), wanting to know what the sex of the child is, giving helpful suggestions or commiserations over what's like to be pregnant and afraid of the future, or helping to pick out things for the nursery (if you happen to have one). Some of us will not have their family talking to them or wanting to know anything about the pregnancy or the future grandchild, nephew, or niece (or even wanting to know which it is) or even if the fetus is still alive or if you're still alive.

I lay awake thinking about how if I were to find a place to move to, unless I wrote about it on this blog, and someone in family happened to read this blog, they would not even know that I had moved. I thought about what it will be like having a child and my family not even knowing that I've had the child, what the child is, what the child's name is, what the child looks like, what it will be like not having any help at all. But my psychiatrist says that I can't allow myself to stay in the pattern I've been in with my family. I must set boundaries and keep away from abusive and unhealthy behaviours by them for my sanity and for the good of my future child. I can't allow myself to have family members hurling abuses at me (sometimes when drunk, sometimes when sober), then denying that they said these things (whether because of a blackout from alcohol, forgetfulness, or pride) or justifying why they said these monstrous things to me, never apologizing for hurting me, acting in an okay manner for a while, and then exploding again shaking my soul to its core and causing me further anxiety and depression.

This pattern that has been with me my whole life with my family cannot continue now that I have a dependent creature to think of that's not feline. It's excruciating to not have my family involved at all, but I can't risk the child being exposed to what I was (not that my family wants to be involved at present). My psychiatrist was unequivocal that unless things were to change drastically that I should not expose my child to my family and the chaos that surrounds it. I must think of what is best for the child even if it feels painful. I wish that people would stop saying how great it is that I live in the same town as my parents and sibling when it's really not and they have no idea what it's really like for me. Quit assuming everyone, it's making an ass out of u and me.

So, to the writers and editors of these lacklustre pregnancy books that I've been reading, not everyone is in the same boat and you shouldn't make it seem like they are. It hurts worse to hear about perfect, functional families when you are pregnant and hormonal than it would when you're not (even though it does then too). It wouldn't take much to add a couple of sentences to these books about how you can turn to a close or trusted friend(s) or to your in laws or even to just your partner if your family is not supportive (in my experience, people will come out of the woodwork or step up in ways you never imagined before and while it may not be the same as having your family involved in the pregnancy, it's your reality, it's different, but it's okay). Or perhaps just state that not everyone will experience support from their family, but that they will find a way to get through it. But all of these books are written in such a simplistic and summary manner, I doubt that they will ever add something as complex as this. It's out of their depth (especially since some of these books seem to spend inordinate amounts of time on frittering things like being bored of your limited wardrobe in pregnancy, being afraid of how your appearance has changed, and how to decorate a nursery- come on!).

I was feeling kind of worried at the end of last week, after having seen my doctor about the hemorrhoid (it's getting much better with the epsom salts baths and Proctol ointment and witch hazel by the way) and him asking me if I was feeling the thing move inside me. I hadn't really been feeling it move, or at least not what I could recognize as movement. I had in the past a bit (I think), but then I didn't for about a week. Last Friday night, I felt some twitching again. I felt more movement many of the days this week. The thing seems to like it when I'm in the bath and sometimes when I'm in bed.  It feels stronger than it did before, so I think it's not indigestion, gas, or a muscle twitch in my abdomen, it must be the thing! It's so strange. This morning when I was trying to fall asleep, I felt like I had a tiny eel thrashing around in my abdomen. My husband has tried putting his hands on my abdomen when I've told him I feel something strange (when he's around on the weekend), but he can't feel anything yet of course, it's too faint.

It must be really hard for the partner of a pregnant person to not be able to feel for quite a while what their pregnant partner is feeling. My husband is much more liberal with talking to my abdomen and stuff though than I am, so he is bonding in his own way. I still feel pretty scared to get attached in case it doesn't work out, but with each passing week, I have felt my fear falling away a little. I suppose it will just take time. And maybe seeing it in the flesh in about 17 weeks will be believing.

23 weeks pregnant.