Making Amends

So, I've finally gone to 2 baby showers recently. I couldn't bring myself to attend a few others I've been invited to in the past years, mostly because of self pity but also not really feeling the need to break down in a room full of mostly strangers. They were both for little girls. So much pink!! I realized that even though I don't subscribe to the "pink is for girls" and "blue is for boys" theory, it really does make sense. How else are people going to know what gender your baby with, generally speaking, no hair and no other identifying factors, is? An aha! moment. J and I go to ultrasound again on Wed. I'm counting every minute. 2 days before Thanksgiving is when we lost Luke last year and this pregnancy is exactly as far along as that one was. I haven't seen an ultrasound since week 12. I definitely feel pregnant, though. There has been some clumsiness that wasn't there before, a nice side effect from my ever expanding belly. I'm as sensitive as ever. Someone made a comment tonight about my growth spurt possibly being from eating too much over Thanksgiving. I'm thinking, "there is actually a human being growing inside of me!!" MEN. (Not my husband, thankfully. ;) I broke down the day before Thanksgiving. I was feeling fine one minute and then, all of a sudden, a wave of emotion came over me. It knocked me over and I realized that it was exactly one year ago that Luke had been removed from my body through a D and C. Waves of sadness, acceptance and gratitude rolled through me all at once. It was a cleansing time. Funny how our bodies remember when our minds do not (at least not at that moment). I'm hoping to get lucky and find out if it's pink or blue (hehe) on Wed. I'll have some sugar beforehand to ensure some movement, although with this one that's never been an issue. We have my parents, my mother-in-law and 21 yr. old brother-in-law, all coming with us to the appointment. I'm thinking of paying my lovely ultrasound tech, to give us her opinion, even though it's before the standard 20 week protocol. Only 3 weeks before, though. All the bits are in place, we just need him/her to hold a baddha konasana (yoga pose with outstretched legs) for a few seconds.

Explanation and Our Story

I wanted to take a minute or 15 to talk about our story. I wanted to explain to those who have trouble understanding why it has been so difficult for me to carry a baby to term. Also, this is something that I needed to do. It just took me 2 1/2 years to get to this point. I guess I'm a slow learner. :) I wanted to do this because it takes a while to explain this and many times, in passing, I've had to explain to people that I had a smaller than normal uterus, which is true. There was not nearly as much space for a baby to grow and mature in my uterus as in a normal uterus. However, I've been met with some comments such as "I've never heard of that before", hence this explanation. These comments have been hurtful at times because when anyone is experiencing problems with fertility, it puts you at an extreme sensitivity. So, I've spent a lot of time at home over these past couple of years, needless to say. Also, let me add that the name of this blog is dedicated to a song by the Dixie Chicks about infertility. Both sisters endured it. When I was in utero (in my momma's belly!), something went wrong, not drastically wrong, I was still born with all fingers and toes, just a little wrong. The funny thing is, I wouldn't discover this until the age of 31 during a pregnancy ultrasound. In every female, ducts termed Mullerian ducts are present. These ducts go through a transformative process during gestation (in utero) in order to form the reproductive tract and organs. There are 11 different types of Mullerian Anomalies, or differences of the uterus. This doesn't include retroverted or tilted uteri, which are just differences in the positioning of the uterus in the body. Mullerian Anomalies are pretty rare and present in only 3% of women. My Mullerian ducts ended up not fusing together totally, which resulted in me being born with a septum in my uterus. A septum is best defined as a piece of tissue with no blood flow (avascular). Septate uterus have either a sub-septum which stretches across the inside of the top of the uterus and comes downard (fundus) or a complete septum which stretches across the top and then all the way down the middle of the uterus to the cervix, where the birth canal begins. Mine was a sub septum extending 2 cm. downward from the top. Septate uteri are associated with a very high miscarriage rate. The miscarriage rate is 80%-90%. This is because the fetus either implants on the septum and quickly miscarries early because there are no blood vessels to sustain the pregnancy. Or, due to intrauterine growth restriction meaning that the baby simply grows out of room to grow or the placenta attaches to the septum even if the baby implants away from the septum, thereby resulting in no nourishment from mother to baby and baby dying in utero. Normally, the uterus stretches like a balloon. When a septum is present, think of a balloon being attached to a piece of cardboard. Because the septum is fibrous and not stretchy, that part of the uterus cannot stretch to accomodate the growing baby as a normal uterus stretches. In the uterus, strong blood flow is invaluable. When a woman gets pregnant, there needs to be blood flow in order to nourish the baby's growth from the placenta. The placenta feeds the baby the nutrients in order for it to grow and go through the transformation process from a ball of cells to a baby. It's truly a miracle!! Jonathan and I had our first miscarriage at 6 weeks in July, 2005, due to the baby implanting on the septum, most likely. We became pregnant again in August, 2006. We were so excited. We were monitored closely because of the loss the year before. I was put on high dose progesterone. The side effects were fatigue and weight gain, fun for me while pregnant!! I found out at a 6 week ultrasound when we saw the baby's heartbeat for the first time, that I had what the ultrasound tech termed a "bicornuate" uterus. I had never heard of such a thing!! Basically, it looked like a heart shape instead of the normal pear shape, on ultrasound. I researched on the internet and found out about what could happen, but chose to believe that we'd be one of the lucky ones that goes close to full term. We went into the 12 wk. ultrasound and felt very confident because we saw our little guy kicking and waving. My parents were with us and it was a very special moment. I was told to take it easy, to not walk, do yoga or lift anything over 5 lbs. because the placenta had moved downward to avoid the septum. This is called placenta previa and it usually resolves itself in a normal uterus as the uterus stretches. I followed the doctor's orders and didn't do any activity. At 15 weeks along, almost into the 5th month, I felt like something was wrong. I won't go into the details. Jonathan and I went into the OB/GYN's office where the doctor examined me and said that everything seemed fine, but when she went to look for a heartbeat with the Doppler, she couldn't find it. She sent us in for an emergency ultrasound. I could tell immediately that something was horribly wrong by the look on the ultrasound tech's face. Our baby had passed away. We had to have a surgery to remove the baby. Fortunately, the funeral service nearby offered to cremate the ashes of the remains. We found out that our baby had been a boy. We named him Luke Donavan Irvin. Jonathan and I held a memorial service with our family. It was a very sad time. Losing a baby is something every mother worries about, but most times they don't have to go through the pain. It affected me for many months. I became depressed which is a natural process of grieving. I joined an online group of women all over the world who were going through the same experiences of dealing with a Mullerian Anomaly. We were referred to a reproductive endocrinologist. He performed an ultrasound and then an hsg, which is where dye is inserted into the uterus and through the fallopian tubes in order to see the shape of the uterine cavity. Let me say that most women would prefer a root canal to an hsg, it isn't pleasant. I was told by my RE that he though that my uterus was not bicornuate, but septate. Bicornuate is another Mullerian Anomaly that looks almost the same on ultrasounds, hsg's (x-rays with dye) and MRI, but the outcomes for pregnancy are drastically different. In a bicornuate uterus, the outside contour of the uterus has a cleft or indentation also resulting in less stretching of the uterus. These pregnancies either go into pre-term labor in the middle or third trimesters or they have to deliver between 32-26 weeks by c-section. I was asked if I wanted to have a surgery to remove the septum. Of course I replied an emphatic "YES"! This surgery was done by 2 doctors in my case. The first doctor goes in with a hysteroscope to look at the inside of the uterine cavity and the other doctor goes through the navel with a laparoscope to look at the outside contour. If there is a cleft on the outside, it is labeled as bicornuate and nothing can be done to fix it. If there is a septum present on the inside, the surgeon can then resect it, or try to fix it. In my case, this is when the diagnosis of "septate uterus" was 100% confirmed for the first time. CO2 gas is put inside the abdomen to inflate so the doctors can see and work. In my case, he used a cauterizing wand to remove the avascular tissue away from the top. The other doctor used a light shining through the outside so that my surgeon would know when to stop cutting so as not to create too much scar tissue or perforate the uterus. It is a surgery that you want to have done by a very skilled reproductive surgeon and one that many women with larger septums need to have done twice because of the limited time allowed for the CO2 gas to be in the body. I was put on high dose estrogen to help the scar heal smoothly so that if future pregnancies implanted in that part of the uterus, problems would be reduced. I won't go into the side effects from that, but let's just say it made me into a super b**tch!! Poor Jonathan. He has been such a trooper. I then had a follow up hsg wherein they insert dye into the uterus to look at the shape of the uterine cavity. We were nervous and holding hands, but once we saw the image of the screen, the heart shape was gone and it looked normal!!! The radiologist, reproductive surgeon and my OB/GYN all told me that the surgery was a success. We were told to begin trying to conceive again in 3 months. We were anxious and became pregnant just shy of the 3 month mark in June, 2007 but we lost this one just a week after finding out. This could have been due to normal process, perhaps chromosomal, or perhaps because the fetus tried to implant where the scar tissue was. I was devastated again, but my reproductive endocrinologist assured us that this was something that happens to 1 out of 4 pregnancies. The problem these days is that the pregnancy tests on the market let you know that you are pregnant days before you even miss your cycle. I am definitely on the impatient side, so I have found out with these tests as soon as possible. Many women have very early losses but never even know because they aren't testing early. Dr. Bachus (amazing doc!!) told us to wait a few months and try again. He also recommended grief therapy. So, I started seeing a grief therapist and it helped a lot. I met other women who have been through the same thing face to face. Many times, much worse than myself like having to experience stillbirths or their babies dying 3 days after the birth. We waited 2 months and are now pregnant again, almost to the end of the precarious first trimester. I have just graduated from my reproductive endocrinologist to a regular obstetric doc. We will need to have ultrasounds every 2 weeks to check my cervix and make sure that it isn't dilating too soon. Because of my surgery and having it manually dilated several times, I am at higher risk for incompetent cervix which, if it dilated too soon would result in pre-term labor, and possibly fetal death. If they find that it has begun to dilate, I will have a cerclage or stitch put in to try and hold it until I reach or get near to 38 weeks. Most likely, I will need to have a scheduled c-section because it puts me at risk to have strong contractions and I could never have pitocin, which is used to induce contractions during labor if it isn't moving quickly enough. I feel eternally grateful, firstly, to my husband for sticking by me this entire trying time and for being a rock, really really my rock. Secondly, to my mom and dad, mother-in-law, Phil, father-in-law, Greta and my sisters for offering a shoulder to cry on and words of encouragement. Then, to my doctors and therapists for helping us through this difficult situation. I also feel extremely lucky to be one of the ones who has made it through and has a great forecast. Let me add, too, that I won't be satisfied until I'm holding this baby in my arms. Then, the real worry starts, right!? But, I have a peace that has been developed through these difficult times that I can't control my situation, only respond to it. I also have been asked to be moderator of my online group of 500+ amazing women all over the world, which has been such a blessing. And, this pregnancy came about EXACTLY a year after the pregnancy with Luke. I feel that everything has come full circle, that God has granted me patience and that these circumstances needed to happen because there were invaluable life lessons contained therein. I only had to learn to accept them. I hope that you this sheds some light on our personal situation. Not only that, but I hope that there is some sensitivity to others going through infertility treatments or recurrent miscarriages. There are many many women out there that have these experiences. Thank you all sooooo very much for your support and taking the time to read this. Much love, Jessica