'ultrasound dependence' and other fun things.

Mr. Hope and I had our first official OB appointment today. It was...an experience.

First of all, there was a long wait. Nearly 30 minutes before we got taken back to an exam room and another 15 before the OB showed up. We shall call her Dr. Direct, because as Quirky told me ahead of time, she's very no-nonsense - a real straight-shooter. (For the record, we like this.)

The first think Dr. Direct does is say, "I'm sorry they brought the ultrasound machine out. I'm not going to do an ultrasound today. I need to wean you from ultrasound dependence."

Of course, on the ride over, Mr. Hope and I were singing, "We gonna see our baby, we gonna see our baby..." So this made him pout. I wasn't thrilled, but I didn't put up a fight either.

We went over my meds. She told me I could stop the estrogen immediately, but she wanted me to stay on the progesterone until the end of week 12 (so, a week from Wednesday). My butt isn't happy, but I lose weight on progesterone and gain it on estrogen, so I was thinking, "Maybe when I get off the estrogen I'll take off a few pounds!"

But then Dr. Direct told me she wasn't happy that I am taking HCTZ. No one at the RE's office ever questioned it, but it's the second time someone at the OB's office did. She asked me why I was on it. I told her that 9 years ago, I had high BP. They put me on a combo pill. When my BP got under control, they took me off of it...and I bloated up with 13 lbs. of fluid in like two days. My stomach got hard from it and I thought I was having heart failure. Turned out my body just got addicted to the water pill, so they put me back on it. My BP is fine (or, at least it was). No fluid build up.

Now I have to stop taking the HCTZ, starting tomorrow. This terrifies me.

She wanted to put me on a different BP medicine. I asked her if we could wait a week, because my BP was always 120/70 until I started the estrogen. Today it was 144/88. So I go back for a BP check next week, and if my BP has come down, I don't have to start a new med. If it hasn't, I have to start one right away.

This also terrifies me.

I have to start weaning off the prednisone, too. Five days at 10 mg, five days at 5 mg, and five days at 5 mg every other day. Remember what happened the last time I stopped the prednisone? MORE TERROR.

But okay, all of this is doable.

Then Dr. Direct tells us she thinks that we shouldn't go public until 14 weeks, maybe longer. Say wha? We shouldn't have sex for a couple more weeks either. Could we wait until our level 2 u/s? Um, that's not until JULY. Okay, 14 weeks it is.

(Mr. Hope is pouting at this point. Dr. Smiles had said we were released earlier to have sex, but we decided to wait until 12 or 13 weeks. Lately we've both been really randy, so it's been a lot of "Thursday, baby. Just wait until Thursday." Now, no nookie for 2+ more weeks. I. Am. DYING.)

She tries to find the baby's heartbeat with doppler. It's still early and I am "fluffy," she tells me. She'll do a quick scan to assure us the baby's okay.

So we got an u/s after all. It was over the tummy, not transvag, and the images weren't super clear. She didn't tell us the CRL or FHR, just that the baby looked great and had a strong heartbeat. She pointed out its jaw. She pointed out the umbilical cord. Yay, Jellybean!

I told her that Mr. Hope insisted we get a hand-held doppler. She told me I shouldn't use it until I was 20 weeks. If I bring it to my 18-week appointment she'll show me how to use it. Okay, we can handle this.

The results from our MaterniT21 test aren't in yet. When I got home, I called Sequenom, the people who make the test. They couldn't tell me the results, and they couldn't tell me if the test had been completed, but they did call the OB's office to ask them to tell me the results should be ready tomorrow.

What does this mean? Is my baby okay? Why is it taking so long?

I Google a little. It takes most women a week to 10 days to get the results. I stop panicking. But I can't help but feel like something might be off. I have no reason to believe things aren't okay but I need to know that for sure. I JUST WANT TO KNOW.

Other than the BP check next week, I don't go back to the OB until 4.5 weeks from now, on June 12. It feels like an eternity.

And I'm totally stressing about MaterniT21, and my high BP, and pre-e and GD and whether or not I have an incompetent cervix. I just want to feel CALM. How can I get there? How can I *stay* there?

Despite everything I like the new OB. She won't BS me. She read my chart carefully. She asked good questions. She let me ask questions. She spent a lot of time with us.

But.

I am so ready to get these test results. I need want reassurance that the baby is healthy. I've been doing a pretty good job at keeping my anxiety in check, but today it flared up again. Big time.

Does it ever get any better?

last-minute anxiety.

The night before my next ultrasound, I start to get really panicky about the baby. Like, I can be motoring along fine, and then WHAM! Instant fear. Why don't my boobs hurt as much as they did on Friday? Why haven't I had heartburn today? Where did the nausea go? Etc.

I hate this part of the process. I hate how one minute I can feel like a semi-normal pregnant woman and the next I'm playing out scenarios in my head, like how will I tell people that I've suffered a second miscarriage? Will they make me do it at home again, or can I ask the new OB for a D&C? And then I get mad at myself for being so morbid, which makes everything that much worse.

On the upside, I had a pretty good weekend. I finally finished Phase I of my freelance project (the relief of that was so intense I almost cried when I sent it off to the project manager, no joke) AND we had a great visit with Mini-Hope, too - only two threatened pouting sessions that she reeled back in rather quickly. So there's that.

I have to go into the office after this morning's appointment, so won't have time to update right away. But I promise I'll report back tonight so as not to worry anyone.

why does feeling good end up making me feel bad?

Got to see our little Jellybean yesterday. At 8w5d, she was measuring 18 mm, up five from five days ago (perfect). FHR was 161, and our favorite u/s tech, K, pointed out her head, her arm buds, her leg buds, and her itty bitty body. After a minor-league panic attack on Monday, after my nausea and heartburn had all but disappeared, this was all very reassuring.

Here's the weird thing: lately I've been feeling good about this pregnancy. My gestational sac is huge (as it should be). The amniotic sac is this perfect little bubble around Jellybean. The yolk sac, while still present, isn't enlarged like last time. My hormone levels seem to be good, the u/s have all been good, and except for that pesky little SCH (which, unfortunately, had grown a bit since Thursday), everything looks great.

But what happens is that I start to worry about feeling too good. I go on Pinterest and start pinning things like unique birth announcements and recommendations for nursery gliders to my secret "Future Baby" board, then think: am I getting too far ahead of myself?

Yesterday, when Dr. Smiles told me that the bleed had grown 5 mm since Thursday (in length, not width - it's back to looking like a skinny crescent shape), he said, "I'm sure you're probably terrified." But here's the thing: I wasn't. I haven't been bleeding red, and the spotting is so minor it's barely there. When he said that, though, all I could think was, "Should I be terrified?" And then he said, "Everything's going to be fine," but him saying that made me question whether or not it was.

Do you see how my brain works?

I had a prenatal counseling appointment with a nurse at the OB's office on Friday. Due to my weight and history of high BP and diabetes (type 2), both of which have been resolved for years, I have to do a series of 24-hour urine tests. This will check for pre-eclampsia and diabetes throughout the pregnancy. I think this first on was supposed to be like a baseline, but honestly, they didn't tell me much. In fact, I thought this was something all preggos did until I asked my friends and they were all, "I don't know what you're talking about."

If you don't know, the 24-hour test works like this: they give you an orange-brown jug in which to put your pee, and a "nun's hat" to catch your pee in the toilet. When you wake up, you flush your FMU, then catch everything after that. I drink a LOT of water, and I pee pretty frequently even when I'm not pregnant, so guess what? Filled that gallon jug after just 12 hours. Put it in the fridge and got prepared for them to tell me I'd have to redo the test later. (They didn't - turns out 3000 ml was enough pee to do the test.)

Taking the test got me thinking about all of the bad things that could happen after the first trimester. Gestational diabetes I'm not as worried about - you just have to be super careful with carbs, which I am to a certain degree already. But pre-eclampsia? One of the women on my secret FB group is dealing with that now and had to get induced at 34 weeks. It's so scary. And when you start reading up on the 24-hour urine test, you end up learning more about things like HELLP syndrome (one of the women in my old Resolve support group lost a baby at 24 weeks to HELLP).

It makes me think that you're never safe. That until you strap that baby into the car seat, your pregnancy could still end at any time.

And yet.

I feel this totally un-Agony-like calm right now. Like everything is going to be okay. I don't have God in my life, so this isn't the result of prayer. It's not even the result of being a super-chill person (obvi). I just feel like this time it's real. This time I'm going to get my take-home baby.

And the minute I articulate that, I think: OH, SHIT. HUBRIS IS COMING FOR YOU. DUCK AND COVER.

Why can't I just feel good? Why can't I stop feeling bad?

Will I ever be okay?

plodding along.

I should have written this update Monday, after I got back from seeing Smiles. I know there are a few lovely people who've been following my story and I honestly didn't mean to worry anyone by not reporting back. I am very sorry. 

Here's what's been going on:

Went back to Posh Clinic on Monday. They took me back for blood work while Mr. Hope was still parking the car. I see a piece of paper on the top of my file with an hCG number. It was in the 67k range. I don't  know if this was from Wednesday or Friday, as I had blood draws at the satellite clinic both days. But I do know the number is low, especially since the previous Monday it had been in the 56k range. Immediately feel sick to my stomach.

In the waiting room, start running numbers through a doubling calculator on my phone. I know at this stage that it's normal for it to take up to three and a half days to double. If the 67k draw was on Wednesday, it had a doubling time of seven and a half days. If on Friday, fifteen days. Neither one looks good.

I look at hCG ranges by week. I'm still in a great range, number-wise. Even my chart had a "HIGH" flag on it. But I'm less concerned with the overall number than I am doubling time. I know this is because my numbers never doubled properly with the last pregnancy - that it's now an anxiety trigger for me. I figure I will ask Smiles about it when I see him.

We go back for the u/s. As I'm pulling down my pants I tell Mr. Hope that I have a bad feeling. He asks me why. I tell him I don't know; I just do. He gives me sad face. My heart is racing. I'm sure it's over. I am "sure" it's over before every u/s, but this time I'm really sure.

K, our favorite u/s tech, gets right down to it. Within seconds, we see Jellybean's heartbeat. I blurt out, "OH THANK GOD," and Mr. Hope squeezes my hand. I start asking questions. "Give me a minute," she says, not unkindly. 

Heart rate is 137. I panic for a second before she assures me this is a great number for where we're at. The crown-rump length is 10 mm, only one off from where they'd predicted last Monday. These are all good things.

The bleed has gotten slightly bigger and changed shape. It's no longer a pencil eraser but a long, skinny banana. Like a crescent, or the back end of parentheses. K tells us that it's in a good place for a bleed, behind the baby and not on top of it. This is reassuring.

We don't wait long to see Dr. Smiles. I am still a ball of nerves. When I walk into his office I say, "You know I'm about to lose my shit, right? You know this is happening." (Have I mentioned how much I love my doctor?)

He goes over my meds with me and decides to discontinue the lovenox (blood thinner) to see if it will help. Then he tells me that I'm still on bed rest.

I say, "Can we talk about this for a second? What are the advantages of full bed rest over modified?"

"None," he says. 

Um, okay.

He tells me that he's sure I've Googled enough to know that bed rest can't prevent a miscarriage, but to him, resting when there's a bleed seems intuitive. I ask about sitting with my feet up so I can work. He didn't realize that I can work from home, and when he does, he says, "If you're telling me all you're doing is moving from the couch to a chair with bathroom breaks, I'm fine with that." No standing too long, no cooking, no lifting, no walking the dog, no anything other than laying on the couch or sitting in a chair or using the potty.

This is an enormous relief to me, because the stress of not being able to work wasn't doing me a damned bit of good.

I ask about the hCGs and how they're not doubling any more. He tells me he doesn't care about that, because they plateau at a certain point anyway. But he didn't care about my ridiculously low hCG last time around, and we all know how that ended.

So then I say, "Be straight with me. What are the chances that this baby is going to make it?"

He chews this over for a second, then says, "Ninety-eight percent." 

"Really?" I say. "You're that confident?"

"Yes," he says. "I am."

As we leave the clinic, Mr. Hope says, "Those are really good odds." And he's right; they are. If someone told me I had a 98% chance of winning the lottery, I'd buy a ticket, no questions asked.

And yet the broken part of my brain thinks, "How can he be so sure?" and "What if I'm in the other 2%?" and "Why am I still terrified I'm going to lose this kid?"

At home I log onto my work laptop and see that I have 550+ emails backed up. This is with me checking sporadically on bed rest. We have a big event scheduled for the next day and I dive right in. Initially I think I'll work for two hours and then rest, but I don't. I work for five hours straight before feeling so exhausted that I have to lay down on the couch. 

I figure I'll update my blog in the morning. But when I wake up, the day of the event, I log on early and just never get off. I work steadily, with only a short break for a therapy appointment with Quirky and another to talk to Mr. Hope when he gets home for work, until eight o'clock. Seriously, it was 8 p.m. when I finally logged off. I got on the couch and was passing out within a couple of hours. 

So that brings us to today. Tomorrow morning, it's back to the clinic for another scan. I will say that I've had less discharge the past two days on modified bed rest than I did on the four and a half days of full bed rest. I hope this means the blood is reabsorbing or working its way out. I can handle modified bed rest, but during my session with Quirky I apparently talked without breathing for 20 minutes (I know she was thinking MANIC). I think this is because I went from working in an office where I'm in meetings with different people all day to being at home all by myself for most of the time. I think I miss interaction.

I'm starting to catch up on day job but am still behind on the freelance project. The project manager is getting antsy. She knows my history and I told her about being on bed rest but now being on modified. Her response was "Great! How far have you gotten?" Since I lost almost a full week, and went on bed rest literally the day after she asked for the last status update, the answer is NOT BLOODY FAR. But I didn't really say this. I just told her I was plodding along.

This is kind of how I feel about my life right now. I am plodding along. I get up, I do some stuff, I go to bed. Waiting for something to happen, or to not happen. Time moves slowly and quickly all at the same time.

I don't know what it will take for me to feel comfortable with this pregnancy. I felt good for two days after we saw the heartbeat and then I gushed red. So now I feel like nothing is guaranteed, it could end any second, and feeling comfortable just means setting yourself up for disappointment. It's not healthy, but it's where I am.

Tomorrow I will be eight weeks. We lost Nugget between weeks 8 and 9, but the weight week ultrasound already showed a slower heartbeat and signs of lagging growth. The gestational sac was too small, the yolk sac too big. All of my sacs are appropriately sized right now. So, maybe tomorrow. Maybe if the growth is appropriate and the heart is beating strong and there's no sign that Jellybean is going the way of the Nugget, maybe then I'll feel better?

Maybe?

the big bleed.

I'm attempting to write this post on my iPad, since I'm currently confined to prone positions not conducive to using a laptop, so apologies in advance for any formatting errors.

Let me start by saying that I have been overdoing things. I take responsibility for this. When I went out of town for Easter, I did a lot of walking. I did it slowly, without raising my heart rate, but it was more than I should have been walking. When I cart my company-issued laptop back and forth to work, I'm carrying well over my 10 lb. limit. I feel dumb taking the elevator to the second floor at work, so on Wednesday, I did the stairs three times.

Then, around 12:30, I was working at my desk, coughed hard, and felt a gush of wetness. To be honest, I thought I may have peed myself a little. So I went to the bathroom, even though I'd just gone  maybe 10 minutes prior.

In the stall, I pulled up my skirt and pulled down my underwear. That's when I saw it: The crotch soaked through with bright red blood.

It was one of those strange, out-of-body experiences. I remained very calm. I took wads of toilet paper and cleaned myself up. I put another big wad in my underpants as a makeshift pad. I stood up and saw that there was blood on the toilet seat. I spit on more TP to clean it up. Flushed again, washed my hands thoroughly, checked the back of my skirt for a spot, found none.

I walked into my office, shut the door, and called the RE's office. "I need to speak with a nurse or Dr. Smiles," I said. The receptionist asked if she could take a message. I told her I was bleeding bright red, enough to soak through my underpants, and I didn't know if I was supposed to go to the ER or what. She put me on hold. When she came back on the line, she told me that they wanted to see me and could I come in?

I put on my Out of Office message, shut down my laptop, and started packing up. Calmly filled my empty water bottle. Climbed into my car. Took a quick work call. When that was over, I started to cry.

I'm skipping steps here. I messaged Mr. Hope, of course. We talked briefly. I messaged the BFF and Gumbo. I let a couple of close coworkers know what happened. I had to email Quirky, too, as I was supposed to be meeting with her the same time I ended up driving to the clinic. I took a towel from my trunk and put it on my seat before I got into the car, to make sure that I didn't bleed through. We just bought the damned thing, after all. Haven't even put a thousand miles on it yet.

Halfway into the hourlong drive, I started to feel crampy. I hadn't had cramps before then. I felt wetness. I was convinced this was the end. Sure, it could've been a subchorionic hematoma (SCH). I knew from my FB group that they're common in IVF pregnancies. But there was a lot of cramping. Too much cramping. It was over. I could just feel it.

This is how convinced I was: When I arrived at the clinic (one of Posh Clinic's satellite offices), I had to pee. I always have to pee. I asked where the rest room was. Then I leaned in and said, "I'm bleeding and cramping. Can I have a specimen cup in case something comes out?"

There was some fresh red on my makeshift pad, but only a watery pink when I wiped. I took a pad from the clinic's supply and put it in. Still no spot on my skirt. This felt reassuring.

They took me back for the ultrasound pretty quickly. It was a tech I'd never worked with before. She was very straight-faced, no emotion showing whatsoever. She stuck the probe in me and very quickly found the heartbeat, strong as it was on Monday. Jellybean had grown 2 mm in two days: perfect. I started sobbing on the table, enough to make it hard for her to do the scan. I kept apologizing, but I couldn't stop crying. I had been so sure it was over.

There was a bleed. A small one, the size of a pencil eraser, on the outer edge of the gestational sac. Not far from the yolk sac. It hadn't been there two days ago, at least not that they knew of. I asked if it was an SCH. She said no.

When I saw Dr. Smiles, I started crying again. He calmly handed me tissues. He told me that the bleeds were really common. That the endometrial layer bled easily. There was a lot going on, what with the placenta attaching and all. "I'm not nervous," he said.

"I'm glad YOU'RE not," I said.

And this is when he put me on bed rest. I was surprised. I asked about sitting in a chair with my feet up, thinking that I could work from home. "No," he said. "I need you laying down."

I let Mr. Hope know that this was the plan. I told him I'd need a babysitter. There was the dog to contend with. I was really freaked out. If I'm being put on bed rest, it must be serious, right?

I talked to Quirky on the way home. She was confused that the u/s tech had said it wasn't an SCH. Like me, she thought it was the very definition of an SCH. She was surprised that Dr. Smiles had put me on bed rest. Typically, she says, doctors will just tell you to take it easy.

We talked a lot about my anxiety. About how I was completely certain that I'd lost the baby. How my infertility PTSD has pretty much fucked my ability to enjoy any part of this pregnancy. She told me again that my intellect is my worst enemy. That I needed to stop Googling things. That I had to stop seeking data to try to figure out what's going to happen next.

"There's no way to know," she said. "Your numbers were great but that doesn't guarantee anything."

TBH, the whole conversation bummed me out. Mostly because I knew she was right.

I drove home. I got on the couch, laying on my left side. I asked my boss to call me. He did. "I didn't want to have this conversation yet, but I'm 7 weeks pregnant...."

"First of all," he said, "congratulations."

"Oh. Right. Thanks."

We talked about some logistics. I'm supposed to be going on a work trip this week, just a one-day thing into the city, but we both assumed (correctly, as it turned out) that I wouldn't be able to go. We talked about a longer trip scheduled for this summer. No, I wouldn't be too far along then. I could still go. (Knock on wood.)

The next day, the BFF came over to Agony-sit me. It was so sweet. And so appreciated. We talked. We laughed. She picked up a banging lunch. She walked Precious Pup. I made a couple of conference calls. Most of my meetings had gotten canceled, courtesy of the boss. Glam Coworker said, "He's worried about you. He doesn't want anyone bothering you." It was sweet, but at the same time, a little disturbing. I really don't want anyone thinking that I can't do my job.

I hadn't had any red blood since I'd gone to the clinic. Until about five minutes before the BFF was scheduled to leave, that is. It was just one smear of bright red, but it was enough to make me feel sick to my stomach.

The next day, after a glorious shower, I resumed my couch position. I watched something on the DVR that made me think of my mom. I bawled my eyes out. I was convinced that when we went back to the clinic, I'd find out Jellybean was gone.

Right before 11, the BFF showed up. I drove to the clinic. The closer we got, the more terrified I felt. I had her come back with me for the u/s. It was the same poker-faced woman from Wednesday. I pointed out to the BFF what I thought was Jellybean. The u/s tech corrected me. "That's the yolk sac," she said. "I don't have the embryo in focus yet."

But then there was Jellybean, heart still beating. And there was the tiny hematoma. I'd really been hoping it would have resolved itself.

The baby had only grown 1 mm in two days. It should have grown 2 mm. When the tech didn't give me a print out of the u/s, I started to worry. Was the yolk sac enlarged? Was something wrong?

"Everything looks beautiful," Mini Smiles told me when I saw her. The bleed was really small, she said. Nothing to worry about. I asked Dr. Smiles if it was an SCH. "It's sort of the same," he said. But not entirely. It has something to do with the placement. Like, a true SCH has to be under the placenta or something. Whatever you call it, it was keeping me benched for a few more days.

I've been riding the couch all weekend. And have been trying to write this post for literally days. On your side isn't a great angle for typing on the iPad. And Blogger's mobile site kind of sucks.

Tomorrow morning we go back for our fifth ultrasound. I haven't had fresh red since that one small smear Thursday night, but I am still spotting tanish brown with a little dark brown from time to time. I thought the spotting would have stopped once they took me off of the progesterone suppositories (I now take 200 mg of oral progesterone each night before bed). Is it from the hematoma? Is it from something else?

I know that symptoms come and go in early pregnancy, but my symptoms have been practically nonexistent. My right boob is sore, but my left one isn't. I used to have heartburn but don't really any more. I feel a little sick when I'm hungry. I am hungry, like, all the time right now. The past few days I've been stuffing my face and not gaining any weight. First real pregnancy bonus, but not a hardcore symptom.

So of course I have all of this anxiety about tomorrow. Will Jellybean have grown appropriately? What will the heart rate be? No one's measured it yet, just said it was strong. Will the bleed be resolved or will it have gotten bigger? Why am I still spotting? Can anyone tell me if this baby is going to make it? Seriously, Smiles, just pull out your MD crystal ball already.

Sometimes I start to cry out of nowhere, because I'm so convinced that this will end in loss like the last one. That I will never be a mother. That maybe I'm not meant to be a mother.

I know these are self-destructive thought patterns, but I don't know how to stop them. Plus, hi, bed rest is so dead boring. All I do is watch TV, read, or think. Lather, rinse, repeat.

Sigh.