Multiple Identities

For the past five-plus weeks, this career-driven feminist has transformed into a mother. A new mother, who mostly wears workout pants and "dressing up" is a pair of jeans to leave the house. I've swapped the work bag for a diaper bag and the morning meetings for cuddles and attempting to sleep when the baby sleeps. My life has completely revolved around feeding times and my goals and anxieties are now related to pumping enough milk, getting our daughter to sleep in her crib, and trying to figure out what her cries mean when she is just plain irritable.

There have been times, usually after long nights of little sleep and being unable to decipher her cries, that I have told C I'm not cut out to be a stay-at-home-mom. Then he usually gets panicky and asks me not to rush back to work and I promise I won't. I can't imagine leaving her for a full day and I still enjoy spending my days holding her and gazing into her perfectly beautiful features.

On Monday, Beula had a doctor's appointment in the building where I work half the week. After her appointment, we stopped by my department to visit with my colleagues. Everyone said that they missed me and I honestly told them I missed them as well. I said that I wish could be cloned, so that I could both return to work and also not leave my daughter.

Yesterday, I had to return to the office for a meeting and my annual performance review. My original plan was to just go in for an hour, but then there were complications that required me to be there for several hours, most of which were unscheduled. Not having enough breast milk stored yet, I decided to take Beula along. This was partially due to the practicality of her needing to eat, partially due to wanting my other set of colleagues to meet her, and largely due to making a point that I was being expected to show up at work 5 weeks into my maternity leave.

So I got dressed up in my nicer work attire, suit-coat and all, and packed up my daughter in her cutest onsie. I put my office files into the diaper bag and off we went. One of my colleagues watched her during my performance review and I brought her into the other, less formal, meetings. I spent the rest of the time walking around and visiting in my suit with a burp cloth over my shoulder and a wrapped infant in my arms. I imagine that I looked nearly as bizarre as I felt: one part accomplished professional and one part mommy. I mentioned this bizarre feeling to my supervisor, how it felt that I was sporting two conflicting identities, and then realized that this was probably a feeling I was going to have to get used to.

Flu Vaccine and Family Dynamics

I am typing this as my sweet little girl sleeps next to me. It's hard not to just stare at her perfect features all day, but I will try to focus. 

C and I both work in healthcare, at the two major competing hospitals in our city. Both hospitals have required employees to receive the yearly flu vaccine for several seasons now. If you refuse the shot for certain allowable reasons (religious, allergies, etc.), you are required to wear a mask to work during the entire flu season. I remember the rule causing some controversy at first, but now it is just automatic. 

I agree with the mandate. We elect to work with sick people that are a) more likely to transmit germs to us and b) have compromised immune systems and are at greater risks of complications if we transmit germs to them. 

Our daughter is now just four weeks old and is in the category of greatest risk for complications from the flu, being under 6 months. Also being under six months, she is unable to get the vaccine. Her immune system is just too tiny and fragile now. Therefore, the CDC recommendation is that those around her be vaccinated and that we avoid anyone who is sick. The flu is contagious at least one day prior to the onset of symptoms and then at least five days after symptoms appear. 

Being overly cautious, first-time parents, C and I have requested that anyone who holds our daughter have received the vaccine and not be ill. 

My family was extremely agreeable to this. My sister's husband who has never had the vaccine in his life and lives two hours away got the shot. My two uncles, one without insurance and poor finances, got the shot. My single, male cousin got the shot within two days of his dad mentioning it and without any specific plans to see her. Everyone at our Thanksgiving dinner was vaccinated and took turns passing around the baby from relative to relative. 

C's family has been another story. Of his three sisters, only one got her family vaccinated. They normally get the flu shot, as both parents also work in healthcare, but made sure that it was received a little earlier this year. His one sister reported concerns about how it is is made and opposing most vaccines based on this principle and his other sister didn't give a reason. His mother "never gets it" due to concerns of potential allergens and his father "was going to get it" but ended up having a UTI that day. 

At their family Thanksgiving dinner, C brought hospital masks for people to wear if they wanted to hold Beuhla despite not being vaccinated. Only his mother opted to don a mask for the sake of holding the baby. Everyone else declined, giving the strong message that it wasn't worth it. We spent the entire time with Beuhla in our own arms, with what felt like minimal interest from his siblings or their families. (His sister's family who had received the vaccine were unable to make the trip, but I'm sure they would have been more enthused to see her.)

Needless to say, C was hurt by his family's lack of enthusiasm and for them not taking his request seriously. I think it was especially hurtful in comparison to my family. I let him take the lead of deciding how to handle the situation (i.e. sticking to our original plan or giving in) and I think he was comfortable with the decision. After all, it's not like we were asking for something that wasn't also to their own benefit and we also provided a second, non-invasive, option of the masks. Personally, I have not had a strong emotional reaction, instead observing the unfolding course of events with a sense of intellectual curiosity. 

I am curious about why our two families responded so differently to this request: if it is the difference between Beuhla being the first grandchild in my family compared with the 10th in C's family, or if his family doesn't take him seriously because he is the youngest child, or if my family is more open to vaccinations in general due to our strong presence in healthcare fields, or some other reason. 

It is also been interesting to me to observe this as one of the first controversial parenting decisions we have made - How our parenting can influence family dynamics so significantly. How others' can have such strong opinions and emotions when it comes the decisions we are making for our daughter. How much easier it would have been to allow family pressure to influence us away from our beliefs and ideals. Parenting is proving to be a fascinating social psychology experiment.

Grateful

I was cleaning up my drafts and noticed this post written on October 8th, 2014. I am not sure why I didn't hit "publish" back then... perhaps something about the curve ball I was afraid of and not wanting to jinx myself. I'm not afraid anymore, just grateful...



There have been times over the past few weeks that I have been filled with such an overwhelming sense of gratitude and good fortune. I am 35 weeks pregnant and everyone is seemingly healthy. C graduated nursing school and is being asked for interviews in jobs that he is excited for. Our finances are actually on an upswing and we are starting to return to discussions of home-ownership in our future. Could life really be working out this well?

Yes, this is definitely delayed. This is where I was hoping we'd be a few years ago, when we were planning our wedding.

But then life always had this way of throwing wrenches in our plans. C couldn't find a job and we had to downsize and then downsize again. I was in a horrible job that resulted in significant mood difficulties and destabilized us from moving forward on any future plans. C got kicked out of nursing school and then had to go through a huge process to be reinstated. And then there was the infertility. 

Now. Now it seems that we are so close to realizing our initial married goals, I can actually vividly imagine it. I can picture our life how I used to be able to picture our lives when we were first engaged and married. Before all of the uncertainty and wrenches and faulty plans. Now it feels so incredibly attainable...

...that part of me keeps waiting for the other shoe to drop. It seems almost too good to be true. That it can't possibly work out this well. I simultaneously feel so incredibly fortunate and then also still on edge, waiting for the next curve ball. 

Infant Personality

People have asked what Beuhla's personality is like, and I'm never quite sure how to answer that. I don't have anything to compare it to. Is she easy? Difficult? Serious? It all seems so subjective. Here is what I know:

• Sometimes she loves to get her diaper changed and other times she screams as if we are killing her. 
• She loves to look at lights. She also likes to look at our faces when we talk to her, but would prefer lights. 
• She makes the cutest surprised face, with her tiny little mouth forming a small circle, after she has a large or noisy poop. 
• Her smiles look mischievous and she often squints her eyes as if she doesn't trust whomever's arms she's in. However, most of the time her eyes are wide in constant amazement of her surroundings. 
• She generally likes baths but hates getting her armpits cleaned. 
• She has great neck control and doesn't mind tummy time like many babies. 
• She prefers to be in the arms of someone rather than anywhere else, but is getting better about sleeping on her own. 
• She will scream bloody murder when being put in her carrier, but them quickly becomes super content and loves car rides. 

3 Weeks Old

Today my precious little girl is three weeks old. She was up to 7 pounds, 6 ounces at her pediatrician appointment yesterday and is healthy and generally happy.

We just concluded a three day period where she would not sleep for more than 20 minutes at a time without being in someone's arms and was generally inconsolable. I nearly broke down twice, but then she came out of it and has been sleeping in her crib for up to two hours at a time all last night and today. It's amazing how two consecutive hours of sleep can feel so amazing!

Sleep has been our issue from day one. She never liked to sleep in the basinet at the hospital, much preferring our arms, and we've worked daily at trying not to let this become a habit. It was common for us to put her down in the crib or cradle and her to be away and fussing again with 20 minutes. Luckily, she has generally been improving on this each day.

Eating is going well. She took to breastfeeding fairly easily and it wasn't nearly as painful or uncomfortable as I was afraid of. I often get stressed out that I am not producing enough milk, but there really isn't any good evidence to support this anxiety. I try to pump at least once or twice a day. Right now, this is used by C for one or two feedings at night, which allows a little longer consecutive sleep for each of us, but I hope to eventually start to build up a supply so that she's not always tied to me. It sometimes feels very restricting, like I have an anchor attached to me, to know that she is dependent on my breasts at such a high frequency.

C has been the most fantastic support and father that I could ask for. He has taken such an active role that, with the exclusion of the breastfeeding issue, I really feel like it's a 50/50 split of care-taking. He plans to take his nursing licensure exam this upcoming Monday, and I am so proud of him juggling the preparations and anxiety for this with these first few weeks of parenting.

Today, as I was breastfeeding, I looked down and unequivocally realized that I am a mother. This is very real and very permanent. It made me smile that it took three weeks to appreciate this, but I'll blame the sleep-depreciation on my lack of self-reflection.

Microblog Monday: first week of motherhood

Some random thoughts after my first week as a mother:

• Many baby items are reminiscent of horror movies (eg. The creepy lullabies of the wind-up mobile, the night-vision mode of the baby monitor, etc.)
• I haven't figured out yet how to simultaneously hold the breast pump nipple guards to my breasts and turn on/off the pump at the same time. So far, this has resulted in one dropped and spilled bag.
• Babies have the best smell and the softest skin. I knew this before, but I am constantly amazed by it. 
• I am also amazed at how my body has been changing shape daily, slowly beginning to resemble what I remember as normal.
• Women's sanitary pads have come a long way since I last used them as a teenager.
• Even more than any aspect of Beuhla herself, so far my favorite part of motherhood has been watching C be a fantastic, loving father. 

Short but Dramatic: Beauhla's Birth Story

I was admitted for a scheduled induction at midnight on Saturday morning, November 1st, due to the worsening preeclampsia. The intake process took a while, and they finally inserted the Cervadil around 2:30am. The doctor at this point told us that this is usually kept in place for 12 hours, at which time they reassess if I need a second round to continue softening my cervix or if it would be ready to begin the Pitocin to initiate contractions. They warned that I might feel some mild cramping but that full contractions would probably not begin until the Pitocin was initiated. At this point, C and I were preparing for a very long night/day and bracing ourselves for the likely possibility that Beuhla** would not be born until Sunday.

I was not allowed to get out of bed for the first two hours of the Cervadil, which is why I remember that by 4:30am the pains were starting become very bothersome. It was impossible to get comfortable enough to sleep and I was mostly feeling a lot pain in my back.

Between 4:30 and 7:00am is when things started to get stressful. My blood pressure continued to rise, with the diastolic surpassing 100, and labs were coming back problematic. They decided that I needed IV medication to help with the blood pressure and ended up requiring at least a second dose to begin lowering it. Because of the high risk of seizures, I was also started on Magnesium Citrate via IV, which required complete bedrest, more frequent monitoring for the risk of respiratory problems, complete fluid and food restriction, and a foley.

The pains also began worsening. C asked if I was having contractions and I remember responding, "I sure hope so!" He attempted to time them and said that they never really achieved any regularity in terms of how often they occurred or how long they lasted. They started to get unbearable, but I felt like a real wimp because at the last check I was only 1cm dilated and kept remembering that the "real" contractions weren't even supposed to begin until after given the Pitocin. I started panicking a little in thinking I would have another 12-18 of this and then I made a deal with myself to make it until 7am before asking for the epidural. At 7am was the shift change and the CRNA that knew my mom was coming on. She came in by 7:10.

The epidural was in place by 7:30 and I felt pretty immediate relief. I could actually get comfortable in the bed and then started returning to mentally preparing for being bedridden and hooked up to IVs and the foley for a whole day.

This relief lasted for about an hour and then I started feeling pressure at the bottom of my cervix that was transient. The nurses determined that the pressure was associated with each contraction and I was  reminded again that the epidural can help with pain but not with the feeling of pressure. The intensity of pressure continued to worsen and increase in intensity fairly rapidly. I started feeling the distinct urge to push The nurse checked again and I was only 4cm dilated, which was very disheartening because the feeling to push was very distinct and growing.

Around the same time, the baby's heart rate decelerated and many more people starting hanging around the room to monitor her, with hushed voices about how to manage this situation. There were frequent calls in to my doctor and constant re-assessing of the situation.

The urge to push became unbearable pretty quickly. C and the nurse did a great job of coaching me to blow out air, which is incompatible to pushing, but each contraction was more and more difficult. I remember hearing the nurses talking, and then decided to check my cervix again even though it had only been 15 minutes from the last check at 4cm. "Stranger things have happened" said the one nurse. Turns out, in 15 minutes I went from 4cm to "8-9cm".

At this point, there was a much more frantic attempt to get my doctor in the room and a flurry of activity around me that I was only slightly aware of. My resolve to resist pushing was diminished but C stayed by my head and kept reassuring me.

My OB quickly arrived, finished getting set up, and finally I was allowed to give into the urge to push. Then the nurse went immediately from feverishly discouraging any pushing attempts to now being very adamant about the pushing. I recall being slightly annoyed by her change of pace, but more relieved that I could now listen to my body.

I likely pushed around 5 - 10 times. I distinctly remember two pushes being tied to her head and then one to get her shoulders out. I remember thinking that she must have broad shoulders, because this was most uncomfortable episode of pushing.

Our daughter was born at 9:26 am, approximately 7 hours from when labor was medically initiated. She was initially blue and took too long to cry for my comfort. I found out later that this was because she had the umbilical cord wrapped around her neck and that my placenta had begun abrupting. I did not know about this complication ahead of time, but learned that a placental abruption is a serious complication that can result in the mother bleeding out and the infant losing all sources of oxygen, which is likely the cause of her decelerated heart rate earlier in the morning. It was very good that she was born when she did.

Despite all of this, her APGAR at one minute was 7 and at five minutes was 8. She was was born weighing 7 pounds, 3.5 ounces and at a length of 19 1/2 inches. After a short and dramatic morning, we are now the proud parents of a generally healthy daughter.

**For the sake of anonymity, I have decided to retain her "place-holder" name of Beuhla for this blog. Rest assured, that she was given a more modern and fitting name in real life.

Medical leave, Bed rest, and Induction

Things have progressed quickly, in all the wrong ways. On Monday, my diastolic blood pressure was over 100 and my doctor decided to place me on anti-hypertensive medications. The protein in my urine had increased significantly by my appointment on Tuesday, at which point he said I needed to begin my medical leave and spend the majority my day in bed, laying on my left side. I was given orders for a 24-hour urine collection and he began talking about inducing me early. I had still not dilated at all, was having only minor irregular contractions, and she had not yet dropped.

On bed rest, my blood pressure stabilized for a day or so, but has been creeping back up. My 24-hour urine test came back significantly elevated. Another non-stress test on Thursday was generally normal, but took a while because she was sluggish. At this point, despite being a little early and showing no clear signs of labor, he decided it was best we cut our losses and scheduled me for an induction. I am scheduled to arrive at the hospital tonight at midnight.

I can't help but draw the parallels between how this pregnancy began and how it will likely end. Scheduled. Not-spontaneous. With my body not cooperating.

My doctor warned us to brace for a long labor since we are starting from square one. He discussed the slightly increased complications of poor lung development given that we haven't made it completely to term and the higher complication of possible cesarean delivery if my body continues to be non-cooperative. Aside from these risks, I am hopeful that we will be welcoming a healthy baby girl into this world in the next 24-36 hours. There is a sense of calmness and separateness as we each make final preparations before heading to the hospital. Here we go...

Work Life Balance

A couple of weeks ago, shortly before my health hit the proverbial fan, I was called into my boss' office. He commended me on how strong of an employee I have been and then informed me that he has submitted my name for highest consideration in a very high leadership position within the hospital. The details were relatively vague in regards to timing, but he told me that I should consider this recommendation to be solid, to begin preparing to take on this role in the future and that, essentially, he would begin grooming me for this more formally upon my return from maternity leave.

This is huge. This is the kind of thing that doesn't get offered to 30-year-olds. I spent the rest of day in disbelief and shock. This was mixed with a huge sense of honor, pride, and recognition.

I am still in shock when I really think about it. The outcome of the meeting was that I should continue doing what I've been doing in my current position, but with mental preparation and eventual logistic preparation to take on a dramatically different leadership role at some point in the future.

This poses some obvious challenges. First of all, many of the big projects I am currently working on will likely need to be handed over, but when or to whom is unknown, and I am not to let that influence my current work on them. Secondly, I had begun fantasizing about taking my foot off the gas pedal a little once having a baby, and had even considered trying to negotiate working a four-day workweek. I'm not sure if I ever would have actually felt comfortable putting those fantasies into reality, as I am generally so career-driven and value this aspect of my identity so much, but it definitely felt like the rug was ripped from underneath me in one short, vague conversation. Any previous notion I was feeling to take a step back, lighten my load, or stop trying to be so damn impressive all the time was immediately squashed. It has been replaced now with a greater drive to commit to the career and the hospital and prove that I really am worthy of such a recommendation and position.

Writing this out on a forum that has been almost entirely dedicated to my greatest goal over the past few years of having a child makes me feel uneasy. Is this what working mother guilt feels like? I haven't even had her yet and I am already giving up on the idea of putting family obligations higher on my priority list to commit more fully to my career. Yet, I am not wavering in the decision to pursue this opportunity. Maybe I'm still naive, still able to buy into the notion that it is possible to have both successful career and fulfilling family life. I have the feeling this will definitely be tested in the year(s) to come.

Microblog Monday: Ghost of Infertility Past

This morning my biophysical profile was scheduled at the same location at my RE. The waiting room for the actual RE appointments was separate, but they utilize a shared waiting area for the ultra-sound appointments.

I sat in the waiting area surrounded by women without obvious bellies, feeling remarkably uncomfortable and like a traitor. The old emotions of hopefulness mixed with fear came rushing back to me and my level of empathy for these women soared. The one woman, sitting next to her husband, with her hand held tightly in his, kept looking me and my belly. I wanted so badly to let them know that I knew, I understood, I got it, but I couldn't figure out how to say these things.

Emotions

In approximately two and a half weeks, give or take, I will be transformed from pregnant to a first time mom. It feels very soon and very surreal.

Physically, I am ready for pregnancy to be over. I ache everywhere. I can't find a comfortable position. I had a chiropractic appointment last week, which was amazing, but the relief only lasted about 12 hours. The same is true for any foot massage I can squeeze out of C. It takes forever to get dressed in the morning, to walk anywhere, to get in and out of the car. I feel out of breath all the time. I am chronically congested to the point of C sneaking out of the bedroom most nights because of my very lady-like snoring. I am very ready to get my body back.

Logistically, the nursery is 99% complete. Moving in with my parents has created a constant need for space and storage, so there are still some things that don't have a home, but that may just be the way they stay for now. The hospital bag is nearly packed, aside from the items we are still using. Clothes are folded and diapers are bought. We received our lovely glider rocker and I have already enjoyed sitting in.

However, the threat of Beuhla coming early has definitely resulted in added stress and pressure. C is finishing up a costly review course for his nursing licensing exam and is trying to figure out if he should rush to take the exam before she may arrive or instead attempt to take it when there is an infant in the home affecting our sleep and concentration. I have several projects at work that I am trying to finish, most of which are due on November third. After that, I have made a list of additional/optional projects that I would like to accomplish but am trying to accept that these projects may or may not get done. The unknown timing makes it very difficult to plan, and I am a planner.

Aside from these less important distractions, I am still trying to wrap my head around the fact that very soon there will be a baby in our home. A baby that relies on us for her every living need. A baby that will forever change our lives. It feels incredibly overwhelming, so it's been easy for me to focus on work tasks instead. In a matter of a few hours, my life will completely shift in focus from pursuing my career and taking care of patients, to physically recovering from birth and taking care of a needy infant.

Physiologically, the difference between anxiety and excitement is non-existent. When we anticipate something in our future, be it exciting or scary, our body shifts into a fight-or-flight response. It's all about perspective as to whether we interpret those physiological signs as those of fear or of thrill and elation. Right now, I am definitely wavering on my perspective between these two interpretations.

Day by Day

My health has continued to be slightly problematic, seemingly just enough to keep me on my toes and add on a whole bunch of extra appointments and tests.

On Tuesday, I had an ultra-sound to assess Beuhla's growth. I was actually sort of happy about this because it seemed like everyone and their mother had something to say about "how I'm looking." In the same day, people would tell me how big I looked (when did that become socially acceptable?!?!?), ask if I were carrying twins, told me that I still looked small and that I had a long ways to go, and told me that it looked like I was dropping and it would be any day now. It seems like everyone is a gynecologist now, and it's frickin' annoying! So I was happy to get some objective data and be able to shut people up.

The actual ultrasound was a little disappointing because she is so big that the images weren't very clear and she insisted on covering up her face the whole time with her arm, although I was amused by her chubby little arm and hand. Mostly, I'm beyond caring about ultrasound images at this point and am just ready to meet her in real life. The good news is that she is measuring right on track, maybe a day or two ahead. I'm focusing on the "right on track" part of the message, because there is so much variance with those things. They predicted that she is 7 pounds, 5 ounces - plus or minus a pound. A pound! That's huge variability! Like I said, I'm focusing on the normal part of the results and not trying to guess birth weights at this point.

On Thursday, I had my 37-week appointment. My blood pressure had risen again, my ankles were already swollen at 9am, and there was protein in my urine. This bought me a ticket for some blood work, an order for a non-stress-test, and a conversation about the possibility of being induced early if my health continues to decline. Luckily, her heart rate continues to be pretty stable around the 130-140s and she is still in a good position with her head down. He was slightly disappointed in the internal exam to learn that I am not yet dilated at all.

On Friday, I had the non-stress test. The name is ironic to me because any extra testing that may indicate fetal distress is clearly causing me some stress, even if it's meant to be non-invasive and not stressful for her. Basically, I had to lay down for about thirty minutes while there was continuous monitoring of Beuhla's heart rate and any movements or contractions. The worst part was the discomfort of laying still for that long and some boredom. Actually, the worst part was probably the stress leading up to it and trying to figure out how to re-schedule my entire Friday afternoon of patients to fit in this last-minute appointment.

The conclusion of the test was that "she looks happy." I'm sure there are better medical conclusions, but it helps me to focus on the overall simple message - healthy baby. Then, he took my blood pressure again... and it was high, again. So the moral of the story, so far at least, is that my daughter appears perfectly healthy and content, but my own body and health are not nearly as promising.

I am returning for additional testing, a biophysical profile ultra-sound, on Monday and then another OB visit on Tuesday. C and my mother are monitoring my blood pressure from home three times per day. Basically, at this point, we're just taking it day by day. I am reassured that she continues to be healthy and nearly full term, so if the worse case scenario now is early induction I am working on accepting this as a possibility. C hasn't taken his nursing licensing exam yet, is in the middle of a review course that we paid substantial money for, and I am feverishly trying to wrap up several big things at work; but, aside from this, we are ready and there are far worse possibilities and outcomes.

Day by day is my new motto.

Health Threats

Ebola has come to Cleveland. Well, not technically, but it might as well have. A nurse from Texas spent a few days in northeast Ohio and then flew back out of the Cleveland airport with a mild fever that progressed into a higher fever by the following day and then she tested positive when back in Texas.

The entire city is in complete panic mode. Schools have shut down on account of a teacher who may have flown in the same plane, although not the same flight. Stores, banks, and churches have all closed their doors. The media can talk of nothing else.

The hospitals are on high alert, with CDC meetings and email alerts and protocols and distribution of PPE (personal protective equipment). Despite this, hospital business continued as usual. I entered the hospital and met with my scheduled patients, children with a reputation for being carrying germs. I did my job.

Internally, my mind was on my own health. I had just come from my 36-week appointment and again the concern was raised with my swollen ankles, moderately high blood pressure, and now small amounts of protein in my urine. This all adds up to returning concerns of preeclampsia, although no symptom was high enough for drastic measures and instead we're back to increased monitoring.

Ironically, the panic of the city over a significant threat that I have minimal control over has helped me to remain calm of my more realistic personal threat. They are both largely out of my control. I am doing everything in my power to minimize my risks, but short of putting myself in isolation and/or bed-rest, I need to carry on. I follow the recommendations of the experts and then I continue to live my life. Panicking never did anyone any good.

Ebola Panic is Over-rated... Panic About This Instead

Every year, often beginning in the fall, all of hospital staff get email alerts about the medical practice guidelines for managing symptoms, diagnosis, and current statistics on cases for many contagious diseases. H1N1 and the flu are usually the most popular, but this year it's begun early with Enterovirus D-68. So it was not shocking when we started getting alerts about Ebola. The hospital alerts are not panicky, more procedural than anything else. The panic messages seem to be coming from the media.

So then, in retaliation, many of my health-care worker friends and family have taken to posting alternative news articles on reasons why we should not be panicked by Ebola. I generally agree with these messages and support people getting the word out on this.

That was, until I read this article: Six Diseases You Should Worry About Over Ebola

Now, I continue to not be overly concerned with an Ebola outbreak in the US, as I was not previously. However, my anxiety about all the other more realistic threats to our unborn daughter's health has quadrupled. Seriously, I simultaneously want people to read this article for educational value and also avoid the article to avoid distress. Have I mentioned that I've noticed an increase in anxiety in this pregnancy? 

My initial delight in our due date being shortly before Thanksgiving and the rest of the winter holidays have now been replaced almost entirely with fear of exposing her anything and anyone that could potentially be carrying germs. I contemplate how it would be possible to keep her entirely encapsulated in a bubble for her first six months, or at least until spring...

Clam Bake Baby Shower

The shower was a success, despite some initial confusion from the invite over if it was actually a shower or just a clam bake. With my very large family and it being co-ed, we were prepared for a large gathering and it turned out to be just that. Approximately 60 people came, from most areas of my life.

We served the traditional clam bake meal - a dozen clams, chicken, fresh corn on the cob, and sweet potatoes. There was also salad and cornbread muffins with honey butter.

The appetizers were plentiful, clam chowder was served early, and the dessert table was massive. I had requested a german chocolate cake, which was ordered from an ethnic bakery and was to die for. It was still moist and delicious the next day and may have been all I ate for that entire weekend.

My sister had made a diaper cake and as an optional game, we had people guess the number of diapers used to create the cake. It was entertaining to see how both the males and females got so into guessing and trying to analyze the cake.

So many of our family and friends brought us such wonderful gifts. It was overwhelming to see the large pile. When it came time to open up the gifts, we reassured everyone that it was completely optional and then the party pretty quickly separated into the women following us inside for the gift-opening and the men staying outside with the booze and appetizers. I heard afterwards that they had their own share of fun while we were engaged inside.

To break up the gift-opening, we played a game in which we divided the room into two teams (pink and yellow). In between every 1-2 gifts, my sister would read a little story about either C or I as babies or toddlers and the teams would take turns trying to guess who the story about was about. It was actually really funny to hear them discussing their reasoning and everyone seemed very entertained by our stories (turns out, C was quite the trouble-maker as a child and I got into my fair share of mischief as well...).

Overall, the day was very long but very much a success. Many people stayed well into the evening and it seemed like everyone had a good time. I was happy that it seemed like just the right amount of baby shower, but definitely tended more towards Clam Bake and Party. Plus, now that it is over, we are much farther along in being prepared for our little to arrive.

34 Weeks

34 weeks today. Six weeks to go. Time is a funny thing. Six weeks simultaneously feels both so short and also so long. Our joint calendar looks a little silly. September and October are full, little dots on almost every day with different appointments and engagements and to-dos. Then in November, there are no dots designating plans. The calendar is empty. Our life as we know it ends. We don't know exactly what to expect, but we're both prepared that it will be life-altering.

The fatigue has continued to be my biggest symptom, sometimes feeling nearly unbearable. Pair this with the many nights of pure insomnia, the kind where you lie awake pondering the meaning of life because you're brain has no intention of turning off, and I am often irritable and frustrated. On these days, my whole body feels sore and achey and my eyelids feel extra heavy. My feet continue to swell by the end of many days, but I have officially given up on professional work shoes and have found that wearing tennis shoes to work has been very helpful for this symptom. Heartburn, indigestion, and an occasional racing heart are also still present.

My little girl is relatively active, but not usually in a distracting way. I tell people that she moves around just enough to let me know that she's doing well, but it is not obtrusive. She tends to prefer to hang out my right side, which annoys me a little because I'd prefer symmetry. Today, her heart rate was approximately 150 bpm and all of my vitals were good. There are often times in the day where she positions herself in such a way that I feel all of my internal organs being smushed, breathing becomes painful, and I seriously question how she can possibly get any bigger. Then, I look in the mirror or down at my belly and remind myself that I still don't look that big. People have started making comments about how it looks like I could have her any day now and I get annoyed by this. I don't feel that I look this way yet and am most definitely not yet waddling (most of the time).

My weight is up approximately 30-32 pounds, depending on the day. This is more than I would have originally liked and more than is technically recommended considering I started off in the "overweight" category, but my doctor is fine with it and, surprisingly, I am too. Mostly, I've just accepted that it is what it is and I'll worry about it later. I do often still fantasize about developing a healthy eating and exercise plan once the baby is born. Fantasize is the key word here because in my current state of exhaustion and discomfort I can't possibly imagine starting anything like this now. I think this is also why acceptance of my weight gain is also so easy. I can't imagine doing anything different anyways. I only sometimes get upset when my face looks fat at certain angles and I did nearly cry on the day of our baby shower when I attempted to put on my wedding ring after months of avoiding this and it didn't even fit over my knuckle. Otherwise, my body image is alright. I have developed numerous stretch marks across my abdomen, a few small ones on my hips, and even a couple on my breasts; surprisingly, these don't upset me in the least.

Baby preparations have made huge strides in the past two weeks, thanks largely to two separate baby showers that I will talk about more specifically later on. We have our lamaze class this weekend. I still want to sign up for the "baby basics" and "breast-feeding basics" classes, but otherwise the logistical and physical preparation is nearing completion. The mental preparation is another story and probably nearly impossible. How can you possible mentally prepare for your world to change in such a dramatic and life-altering way?

Microblog Monday: Flushing Out The Edema

On Sunday, I spent the whole day with my feet propped up and drinking glass after glass of water, trying to flush out the swollen feet and ankles that occurred after an entire day of being the guest of honor at my baby shower. After 80 ounces of water and, what feels like, as many trips to the bathroom, I am still concerned that I won't fit into my last pair of work shoes today!

Sprinting the Marathon

I returned home from the professional conference, one time zone away, on Saturday night. From last Wednesday through this time, I had spent over 8 hours per day in lectures and professional luncheons and practice sessions. I spent the evenings making professional connections and connecting with old colleagues and friends. I slept in a hotel bed without my now beloved pregnancy pillow. It was both high intellectually stimulating and emotionally and physically exhausting.

Sunday morning, we were up and heading out for the day to spend time C's sister and her family while her husband graciously replaced the car breaks. I spent the time connecting with their 6-year-old who is notoriously shy and difficult to engage. This made it all the more precious that she became a chatterbox when it was just the two of us, playing Legos, and I sat back and let her take the lead in the play. We didn't get home until later that night, just in time for me to wash my entire maternity collection (just over a week's worth of clothes) to prepare for the coming week.

By Tuesday, my sister had arrived in from out-of-town to help prepare for the shower this upcoming week. I would work as a psychologist over the day and then come over to a house-guest and more preparation work in the evening. There was no down time. It was lovely to see her and spend time with her, but she liked staying up late to talk and bond.

Tonight, my best friend from graduate school arrives in from out of town for the shower. We are taking them out to dinner after work to celebrate the success of her IVF (11 weeks on Saturday!!!!!). Then Saturday I will be up early to finish ready-ing the house, decorating, and preparing the final food options for the party. The party is expected to go into the night and there will be several more house-guests staying over until Sunday.

Last night I completely melted down. C made one snippy comment that I took too personally and that was the end of me holding it together. I was exhausted and it wasn't over yet. I haven't been sleeping well. My muscles ache and my feet are swollen. There is still so much left to do and yet my body is not cooperative to accomplish anything in any expedient manor. Then I feel guilty that C and my parents are doing a large majority of the work around the house. I feel like a princess and I despise those types of people. I just want to sleep. I feel like an ungrateful jerk, but I would choose sleep over a baby shower and seeing my friend that I haven't seen in several months.

I really need to get better at moderation, pacing myself, and not sprinting through my marathons.

Feedback to Time Magazine

As a doctoral-level psychologist and a women personally diagnosed with infertility, your article made me cringe on several accounts and is horrendously offensive to both the infertility and the mental health communities.

Let's begin with the title, specifically the word "crazy." This is not an accurate term used to describe any type of mental illness as recognized by the American Psychological Association or American Psychiatric Association. In reality, this term perpetuates the stigma of mental health that prevents countless numbers of people from seeking and receiving needed treatments. The term is also strongly associated with significant mental health conditions, such as psychosis and dissociative states, which is not what the actual study was focused on.

Additionally, the study did not address the question of "why?" as the title states, but rather looked at a variety factors that may be related to mental illness. The study was strictly correlational, looking at relationships between different variables, and does not, or cannot, claim any causal relationships, including the answer to "why?"

The title is inaccurate and the subtitle, stating that "it's less about the children," depersonalizes the entire experience of infertility. It is as though we could substitute children for promotion and make the same statement, "It's less about the promotion and more about thwarted dreams." No, Belinda, it is all about the children, or lack thereof.

Throughout the article, the language used by the author is insensitive and very reflective of her lack of understanding about the inability to fulfill a basic biological drive that is so interwoven in our society it is inescapable. Women, and men for that manner, do not "let go of the idea of having kids," or "get over that particular life goal." Fertility is not the equivalent of home ownership, getting an advanced degree, or traveling to that one destination on your bucket list. Infertility is a medical disease recognized by the American Society for Reproductive Medicine and the World Health Organization, among others. As you would not ask someone to "get over" the goal of beating cancer or "let go of the idea" of receiving a heart transplant, it is equally unfair to suggest this from the infertility community. Instead, the appropriate term to use would be acceptance. Mental health professionals can be very helpful in the process of accepting that a disease will not be overcome; accepting that the cancer is terminal, that a transplant is no longer an option, or that a couple will not be able to create a biological child. We do not help patients "get over" these major obstacles, but rather come to terms with the current reality.

There is growing research in the psychology literature, that acceptance is an important factor in mental health functioning across a variety of populations. I believe that this is the underscored outcome from the study, but this message is lost in the sea of inaccurate, insensitive, and stigmatizing wording from the author.

I sent this letter to the Times feedback email. I am not normally one to take a stand, but this article hit too many nerves...

Anxiety

Over the past few weeks, I've noticed a dramatic increase in anxiety with myself. It is usually very situationally specific, but then turns quickly into a near panic attack. Luckily, my coping skills are enough to keep it at bay without becoming full-blown panic, but the sensations are unpleasant to say the least.

I first noticed it last Friday when C was driving us home from a work event during a torrential rain. We were leaving downtown at the same time as a sporting event was getting done, so traffic was bad. The rain was horrendous. My breaks need fixed soon, and I could only focus on this and then having flashbacks to the accident I was in a few weeks ago, which also occurred in a mildly rainy and traffic situation. I made it home by only looking out the side window (so I couldn't see the break lights) and holding on to cars' door handle so hard that my hands were sore the next day.

I had a similar reaction when C was driving me to the airport yesterday. Again, it was during rush-hour and the there was a slight drizzle. I couldn't even maintain a conversation. I should probably mention that C is a very capable driver and I have never been in an accident with him.

Then, last night, I was watching the news and saw the Obama speech and the subsequent commentary on Isis. I began to panic that a) we will be raising a daughter in what is seeming like an especially unstable time in our global history**, and b) I have to fly back home in two days and there are a lot of talks about the possibility of attacks here. Then I began to get immensely panicky that I was in a hotel by myself and desperately wanted to C here to comfort me. Needless to say, it was not my best night of sleep.

I have read that anxiety can be increased during pregnancy. One of my friends actually began taking an SSRI due to significant and unmanageable anxiety. I didn't fully appreciate this until now. Currently, my anxiety is very specific and controlled. I plan to continue monitoring this closely and take action if it starts to generalize or become impairing. In the meanwhile, I'm chalking this up to another lovely symptom of harboring a life.



**As an aside, I have heard that parenthood makes you view world events from a more personal standpoint and I have been questioning my increased sensitivity to the many global crises. I feel like I need a reality check - Is this an especially unstable time or am I being extra-sensitive and forgetting about the similar events in our recent history???

My Problem With Breastfeeding

I came across this article from The Onion, titled New Study Find Link Between Breastfeeding, Always knowing What's Right for Everyone, and it resonated with me.Sometimes ideas are best conveyed in the form of satire.

I have every intention of breastfeeding and I am well aware of the numerous potential benefits that it poses for our daughter's health and our bonding. I have nothing against women who breastfeed or those who do it publicly. I do have a problem with the be-all-end-all message that often goes along with these benefits and the high-and-mighty attitude that some advocates flaunt.

One of my first jobs out of graduate school was working in a Feeding Disorders clinic, treating young children with significant oral aversions and often failure-to-thrive or malnutrition. Not a week went by where I didn't hear the guilt pour out from mothers who attempted to breast feed their babies but, for numerous reasons, were unable to get their babies to grow and thrive. Some infants were incapable of properly latching. Some had such strong reflux or unidentified allergies that they became so averse to the idea of feeding that they refused all attempts at breastfeeding. Some mothers did not produce enough milk. Almost every mother carried around a huge burden of guilt because of the strongly held belief that feeding your baby should be a natural, automatic, and easy process.

In my dealings with infertility, I have become additionally sensitive to the message that anything about our bodies and reproductive systems should be automatically easy and natural. Or that the "natural" method is always the better method and that anything other than this is considered less than. 

Breast feeding is great, and so is natural family planning or getting knocked up the old fashioned way, if it works for you and your child and your beliefs and your lifestyle. But breast feeding isn't the only option and the benefits of breastfeeding don't always outweigh the negative consequences that come from a more challenging experience. For some mothers and children, it does not promote bonding but rather resentment and guilt. For some mothers and children, it does not result in healthier babies. It is not a one-size-fits-all, perfect solution for everyone. It is not always better and the implication that mother's who chose or are forced not to participate in breast feeding are less than or unfit in some way should make us all feel a little unsettled.

Self-Care

In this time of relishing my last weeks of being able to be selfish, and yet my body feeling like it's at war with itself, these are the ways that I have taken care of myself:

• I purchased a pregnancy body pillow. I am not going to say it's a miracle cure like some of the Amazon reviews make it out to be, but I have definitely noticed an improvement in my sleep. I am waking up less, sleeping a little more soundly, and able to fall asleep a little easier when I do wake up, at least for the reasons of discomfort. Unfortunately, it doesn't solve the heartburn or leg cramping issues... 
• Regular chiropractor appointments. I am lucky that my insurance will cover a fairly generous amount of chiropractor appointments per year and also that these appointments include a targeted deep tissue massage of the offending areas. I wish that massages could be covered alone and then I would get these weekly, maybe daily if I could find the time. I walk into the appointments feeling stiff and walk out feeling like mush. 
• Prenatal yoga. I have only done this handful of times because it hard to work it into my schedule, but on the days that I go I have really enjoyed it. I am not normally a "yoga person." In the past when I have tried yoga, I usually have found myself being bored, agitated, and too self critical. Somehow, this prenatal yoga class is different. I end up feeling relaxed, stretched, and energized. 
• Sleeping in and taking naps. Part of my brain tells me I need to be more productive, but I am have been ignoring this part rather effectively and allowing myself to get extra sleep in the morning, or the afternoon, without guilt. 
• Occasional spa treatments. As someone who has always struggled a little with my weight, my body image has been difficult to manage these past several months. I have managed this by focusing on aspects that are not related to my weight and shape. I have gotten a few more pedicures than I would have normally and have had two facials so far in this pregnancy. Pampering my skin and focusing on these aspects of my body has helped to minimize my overall dissatisfaction. 

How do you take care of yourself?

11 Weeks... to go.

I had lunch with a colleague this week who is 36 weeks pregnant. She reports that her OB has begun doing internal checks and she is already showing some effacement and dilation. She told me that this made her feel a little sad, as she's not sure she's "ready to not be pregnant" yet. She likes being pregnant.

I am not one of those people.

My goal of infertility treatments was never to be pregnant, it was to have a baby. From the stories I've heard, I have not had a very difficult pregnancy by far. But I wouldn't go so far as to call it enjoyable.

I think I was secretly hoping that what they say about the second trimester being so much better than the other two wouldn't apply to me. It turns out that I am very stereotypical. Up until a last week, my "bad hours/days" were far outnumbered by the "good days/hours." Now, my sleep is disrupted significantly nearly every night, making my days a constant fight against ever-increasing fatigue in an effort to continue being a productive working member of society. Interestingly, the disruption is different every night. It's like trying to plug a water leak with your finger - every time I figure out how to manage one set of symptoms, another pop up.

I had several nights of not being able to get comfortable and find a good position, but getting a pregnancy body pillow has helped with that overall. Intermittently, the heartburn still takes over and will keep me sitting vertically for half the night. Then there was the night that I felt itchy all over and started feeling a little psychotic that there were bed bugs biting me. When I do fall asleep easily, I find myself waking up in the middle of the night with horrible leg cramps. And finally, I am still prone to getting pretty nasty bloody noses right before bed, which requires a good half-hour of care to keep it at bay.

I know, cognitively, that the best place for our baby to be right now is in my body. She is not ready to be born and will be much better off with some more time to grow in this nurturing environment. I truly want was is best for her. However, if some new science came out to convince me that she would be considered full-term by next week, her birth weight would be six pounds, and she would be fully developed enough to not require any medical intervention... heck yes I would want this pregnancy to be over!

Balance

Yesterday, I woke up still exhausted after a night of disturbing dreams, cramping legs, and an inability to get comfortable. I had great expectations for accomplishing things, but felt too tired and crabby to begin any tasks. As I was sitting there in a funk, C reminded asked me how many Saturdays we had left before a newborn would be relying on us for every. single. need. The answer (assuming baby comes exactly as planned...): Eleven.

Two of those Saturdays will be consumed with baby showers, one with a wedding, and another one I will be out of town at a conference. So, in reality, the number of Saturdays that I have to wake up when I want to, sip my coffee in silence, and enjoy mindlessly watching HGTV until I am fully awake and alert: Seven. And then my life will be forever changed and my Saturday mornings will probably never look the same again.

With his unspoken encouragement, I allowed myself to be a little crabby. I turned on the TV to a home-remodeling show and enjoyed sipping my coffee. I enjoyed the silence and I enjoyed the selfishness in my Saturday morning routine with a greater appreciation.

We wanted this for a long time. We spent many years and thousands of dollars working towards this goal. There were many days that my life was consumed by the task of having a baby. But this was a different type of consumed then actually having a baby. Entering the third trimester, I find myself becoming more anxious and apprehensive. Not that I will be a bad mother or that our little girl will be healthy and happy, although those worries definitely creep in also. I find myself anxious about losing my sense of me. Losing my own goals and aspirations, losing my hobbies and my friends, losing my ability to be introspective because I am too wrapped up in caring for someone.

When I first went away to college, I remember having similar fears. I knew I could do well academically, but I was not confident that I could be both a good student and have fun. I was worried that I would have too much fun that then suffer academically. Or that I would be too focused on my grades and then be miserable. It turns out that these fears were mostly unfounded. I ended up doing a good job of managing a social existence and still thriving academically, with only the occasional exception. I had achieved a sense of balance that I didn't know was possible.

I hope I am able to find this same sense of balance with motherhood.

Third Trimester: Ready or Not

Today I enter week 28, the third trimester. In 12 weeks, give or take, our little girl is expected to arrive.

The day started off well with my return OB appointment. My blood work came back well, so we can officially cross gestational diabetes off the list! My blood pressure was super low at the appointment and he was satisfied with the fluctuations from our monitoring over the past week. Current concerns of preeclampsia are also on hold and, overall, he was very pleased and relieved with my current health. I spent the rest of day convincing myself to also be relieved and get over my worked-up state I had put myself in over the past week.

My weight is up 22 pounds based on the official office weight, which is actually pretty consistent with my weights at home. This is more than I would have liked, but not too excessive so I'm mostly just accepting it. My hands, feet, and ankles are swollen according to my standards, but not enough to be medically concerned. My back and neck still ache at times, but last night I actually slept entirely through the night! Previously I had been waking up 3-4 times out of discomfort. The heartburn is mostly controlled with daily medication, but I do still get occasional breakthrough heartburn episodes. I still get tired more often, but it's not unbearable. The heart palpitations are currently my biggest issue, although my doctor said that occasional palpitations were normal and not concerning.

Baby "Beuhla", as we have officially nick-named her, is quite active these days. It is still rare for me to feel her from the outside, and I haven't felt her for long enough to get C involved, but I feel her internally at least several times per day. Personally, it seems like every time I put my hand on my abdomen to feel her, she stops moving. C told me that she's probably stubborn like her mother.

C officially graduated from nursing school last week and I couldn't be more proud of him. And also more relieved. It was a rough road. He's now in limbo while the state processes his background checks and applications so that he can eventually sign up to take the licensure exam. It it said to take up to 8-10 weeks at times, and my fingers are crossed that he'll be able to take the exam before Beuhla arrives. The thought of him trying to study and take the test with an infant who's awake every two hours does not sound like a good idea!

I have been having daily conversations with patients about my maternity plans and how this will affect them. I have several lists that I'm generating: discharged, "on-hold" during my leave, or transferred to a colleague. There are still a lot of patients between specific lists at the point, waiting to see how they do with the transition back to school. As long as the timing stays relatively on track, I'm hopeful that I will be able to have solid plans for all of the patients.

We still have not bought anything else for the baby, but have procured a jogging stroller and Boppy from his sister, so there is currently a pile of baby gear in the office. I may have had a minor freak-out last week about the fact that the nursery is still very much an office and that it needs to be painted and emptied by the shower date so that we can start filling it back up with baby stuff. Since then, we've begun to empty out some of the office stuff and have worked on figuring out exactly what colors we wanted to paint the room. We're settling on gray and yellow - gray walls with yellow accents. I think the first thing I might actually buy for the baby is paint! Writing this out loud sounds a little ridiculous. Oh well.

On the one hand, twelve weeks does not sound like very much time at all. I have a feeling it is going to fly by with everything that I want/need to get done. On the other hand, bringing home a baby still feels like and incredibly surreal idea. It was a muggy 80 degrees out today and November seems a far ways off. At least at this point, I am feeling optimistic about my health and our ability to get everything in order in time.  Ready or not, here we go!

The Dust Settles and Worry Begins

I've realized over the past few days that I know a lot about infertility, but much less about actual pregnancy, or more specifically, pregnancy complications. Ask me about the most common infertility medications, general statistics on success rates of various procedures, and costs associated with each option, and I can rattle off the answers without much thought. But then knowing the standard treatment options for gestational diabetes and I start to get confused. I don't know the statistics associated with preeclampsia and premature birth or the usual blood pressure readings and trends in your 27th week of pregnancy. It's funny how I could tell you "good" and "bad" beta numbers for each of the first few weeks of pregnancy, but the blood pressure readings seem so "grey" to me.

Since the initial shock of walking into an appointment expecting only the usual routine and then walking out with concerns of two different significant complications, I have had a lot to learn and absorb. Remember when I said that I wasn't nervous two days ago? Well, I take that back.

Now, every symptom that I experience is no longer interpreted as normal, but instead evaluated with caution and concern. I have had two nosebleeds, one of which was pretty significant with big, gross clots. My feet and hands continue to look swollen. Most concerning to me, is that I have been having a racing heart rate at various, random times throughout the day. I used to have a racing heart after doing activities that otherwise wouldn't have had big impact, like climbing a flight of stairs, but were otherwise understandable. Now my heart will race when I am driving, or sitting down for dinner, or rolling over in bed. It's hard not to feel panicky when my physiological signs are definitely those of panic!

I also haven't been sleeping well because I can't get into a comfortable position. I am exhausted and try to nap but then my heart races again. My muscles ache because they are so tired. I generally feel unhealthy and sickly. There is likely some somatisizing going on...

I started panicking about the lack of preparedness for a baby. The office/nursery is still 99% office. We still have no place for the baby to sleep. There is not a single outfit to be warn. C tried reassuring me that if she born now, or soon after, that she won't being coming home for a while anyways, but I didn't find this reassuring at all.

I also get worried about work. I have put forth great effort and thought into a maternity plan that has me working until at least the beginning of November. This didn't account for a potential bed-rest situation, or a reduced hours situation, or a "take-it-easy" situation. I've had a hard enough time getting my one (fake) boss accepting my current plan that the thought of adjusting this plan is nothing I am looking forward to. I know, I know, this should be the least of my concerns right now. The thing is, as a psychologist, I do feel an ethical and personal obligation to the patients that I care for. I appreciate that I am no good to them if I'm not taking care of myself first, but they still deserve consistent care and a reasonable transition plan if necessary.

27 Week Reality Check

My sister (AE) was visiting from out of town and wanted to attend my regularly scheduled OB appointment. I warned her that it is usually a little boring, but that she would be able to hear the heartbeat.

It turns out the appointment was a little more eventful than I had anticipated. My ankles and feet are more swollen than he would like, especially given a morning appointment. My weight had increased a too much over the past month. My blood pressure was "trending up" at 140/80. There was sugar in my urine (1000 mg/dl).

That's right... he is worried about both preeclampsia and gestational diabetes. I got an order for five vials of blood and instructions to check and record my blood pressure twice per day. While I had been  having monthly appointments, he now wants to see me back in a week for closer monitoring.

At this point, I'm not scared or anxious. I feel that I am good hands and he is on top of my health. I also live with two nurses who can monitor me daily if needed. No, I am not nervous; I am frustrated and disappointed.

I think I started taking a healthy, uncomplicated pregnancy for granted. It was as if I had paid my dues with the infertility, and felt like the universe owed me this. I knew in the back of my mind that PCOS puts me at a much greater risk of developing gestational diabetes, but I didn't let this knowledge significantly influence my lifestyle. I could have eaten healthier. I should have exercised more. On the flip side, I shouldn't have pushed myself so hard at work and entertaining guests.

There isn't a clear diagnosis of either condition at this point, but I do feel a significantly increased urge to make my health, and the health of our daughter, a much greater priority.

Trial Run: Hosting the Niece

The last few days, C and I were hosting one of his nieces. She is eleven years old and his God-daughter. He had brought up several times over the past year how he would like to host her and do something special, given their special relationship, and we finally made it work.

She came up with her family for C's graduation party and stayed out late with us on Saturday. Sunday began by Cand her running a 4-mile race through Cleveland, which ended in the baseball stadium. C said he could have done better himself, but their 5K time was about 35 minutes, and he was really proud of her. Later that day we went swimming for a few hours in my parents pool. She left her swim-suit in her parents' car, so we had to make an emergency run to the store. Trying to find a swimsuit at the end of the season, that is appropriate for a girl just entering Middle School, who is going through a slightly awkward phase of pudginess and is in-between kid and adult sizes, was slightly stressful to say the least. After the pool, we made dinner and she helped with the cutting and putting together kabobs. It turns out she is not a fan of most of the usual vegetables that go on kabobs, but did make an attempt at mushrooms and a red onion. She also attempted to put on a slice of cucumber and a strawberry... We finished the night with a campfire and s'mores.

On Monday, we started off the day with a kayak trip. She has previously gone canoeing, but only in a canoe with her parents. I remember kayaking being so much cooler because you were in complete control of your own boat. I was right. She was in heaven. Her skills were actually pretty good and she enjoyed exploring the river. We only had one dramatic incident of a "bug" falling into kayak, prompting her to try to stand up to shake it off (for non-kayakers - NEVER stand up in a boat!), then ended up jumping out to bathe herself in the river-water, then refusing to get back in her boat but agreeing to stitch boats with me. C responded very well - calm yet empathetic. I was just trying not to laugh at her drama.

We also watched a few classic movies, Jaws and My Girl, and had pizza dinner in Little Italy at an authentic Italian restaurant. The following day, we went to a famous pancake diner for breakfast, one of largest candy stores in the world to pick out some good-bye goodies, and then drove her to the meeting point two-hours away and half-way between our home and her parents'.

She was superbly behaved and one of the most well-mannered kids I've ever seen. The visit was exhausting. At one point on her last night here, C was in a bathroom and I was enjoying a moment of piece and quiet, when she appeared and said, "What are we going to do now?" in her sweet little voice. I wanted to laugh and cry.

At one point, C gave her a choice when I would have just given her one option instead. I pointed this out and he became concerned and asked, "Was that bad parenting?" I laughed and responded that it was just different approaches. I think he was genuinely concerned, but he was so sweet with her. He woke her up in the morning, got her breakfast, dried her wet swimsuit, and made sure she had everything packed up on her last day. He was exactly the kind of uncle/father I would expect from him.

After she left, we both commented how well it went. She seemed to really enjoy herself and we successfully tired her (and us) out. Before climbing into bed, at the end of our long day of transporting her back, C remarked, "Being a parent for two-and-a-half days in exhausting."

In all fairness, it was more difficult because she is not our child and we didn't know all of her likes/dislikes/etc. and also this wasn't her house so she couldn't just entertain herself at any time. On the flip side, she was eleven and relatively self-sufficient. We got her food ready, but didn't have to feed her. She bathed and dressed herself. She got herself in and out of the car and generally packed up her own clothes. So yes, being a parent for two-and-a-half days was exhausting, and fun, and exhausting.

I Haven't Forgotten the Blog

I read my subscribed blogs daily, get inspiring thoughts, and then flag them to return later and comment. I never do. I have random flashes of blog ideas and thoughts I want to share, making mental notes to express this later. Then 10 days go by and I realize that I've been essentially been off the grid. When did that happen? I've been here, thinking and reading, but there is no evidence of any of it. What have I been doing?

I think I've actually been doing less introspection and more living. In the practice of mindfulness, we learn that there are two states of living - thinking and being. I've been heavy on the doing, on the being.

I spent much of the weekend helping my mom re-organize the house and tackle the "have a place for everything, and everything in it's place." We now have a place for everything in the dinning room, kitchen, living room, hallway/closets, and laundry room. The family room and foyer are still works-in-progress, as are C's and my bedroom, office/eventual-nursery, and den.

We then went outside to tackle some of the flower beds; weeding and mulching and planting. Yes, this is late in the season, but having the baby shower at their house has lit a new fire under my parents to re-invest in their home.

All this work upset my back (still guilty of occasionally forgetting I am pregnant) and I spent the evening soaking in the tub.

The other weekend day, I went to work to get caught up on paperwork and also to work on some big projects. I was in the office for about four hours and got half of everything I wanted to accomplish finished, but it still felt good to cross things off my list and be productive in the quiet of the hospital when no one else is around.

We then went shopping for supplies to entertain C's nieces who will be visiting with us next week and also stuff for the home, to assist with the organizing and decorating.

C was busy studying for his very last final of nursing school. It was stressful and he was on the verge of the failing, and the stress was felt throughout the house. We found out on Tuesday that he passed the test, and therefore the class, and will now officially be graduating in just over a week!

I spent a lot of time on the phone with my best friend from graduate school who had her IVF transfer. Then there was the waiting. Then there were the results. She is pregnant! Two positive betas and an ultra-sound scheduled in a week. I am so so so happy for her, I can't even begin to express it.

I also spent a lot of time on the phone with my sisters. My cousin broke up with his live-in girlfriend. My sister is trying to hook him up with her friend. My other sister is planning to come visit in a few weeks and trying to plan the trip. There is always some sort of family drama.

At work, I became involved in several big projects. I started a new practicum student working under my supervision and oriented her. I interviewed potential candidates to be hired as my assistant, with goal to expand the practice significantly. I met with my boss and my administrator on beginning the process of an internship program and submitting for a grant, which was very highly received. These are all exciting endeavors, but also overwhelming and very time intensive. Sometimes I question my motives for signing up for these things at this point in time, as if I am trying to prove something: Having a child does not change my career ambitions.

I caught up with some old friends and colleagues. On three different nights after work I had dinners/happy hours planned with work colleagues. It was nice to be connected to people outside the office environment.

We were also working on finishing up the baby registry, finalizing and ordering the baby shower invitations, and beginning to work on addressing all the envelopes.

Yes, I have been living. It's been good, but exhausting. At times it feels like avoidance. Avoidance of introspection. Avoidance of the huge life change that will be occurring in about 14 weeks. In the practice of mindfulness, they talk about the necessary balance between thinking and being. I'm not great at balance, but being has been a lovely reprieve from mourning.

In the Water

There are a number of pregnant women at the one hospital that I work at. A large majority of the employees are women in their twenty and thirties so this is to be expected I suppose. Now, I am one of them.

Except I'm not.

The comments that I've received have really begun to get under my skin. First, there are the benign comments about "everyone is pregnant," which seem to imply that that this is the trendy thing to be doing right now and we all just decided to jump on the bandwagon together. Yep. I saw all those baby bumps and then decided I needed one of my own so I just went right ahead and got myself knocked up.

Worse, is the comment about people "not drinking the water" because apparently that is how babies are now made. First of all, this is just asinine and ignorant and I can't stand dumb comments from people who should otherwise not be so dumb. More importantly, this comment implies that making a baby really is that easy. Just drink the water. For those still struggling, message me and I'll give you the address to the hospital so you can stop by and have a sip from the tap. This is all it takes. Every time I hear this, it takes every ounce of my being to not scream that I wish I could have gotten pregnant that easy, but unfortunately I have the scars and the missed work and the medical bills to suggest otherwise.

Finally, I am cordial with one of the therapy managers and we both like to complain about how busy we are to one another as we pass by in the hallway. The other day, she decided it was appropriate to complain about all of the people working under her that were going or had gone on maternity leave and how inconvenient this was for her, as the manager, to figure out coverage, and how they should have timed it better. I know the last part was a joke, but I didn't care. It still shows the complete lack of understanding and acknowledgment that having a child is not easy for everybody and that the inconvenience of managing coverage does not even begin to compare with the "inconvenience" of infertility. To put it mildly.

I frequently wish I was more quick-witted. Usually I think of these responses too late for them to be of any use in the situation. One day though... one day someone is going to get an earful.

Something Borrowed

I am extremely fortunate to have fallen in love and married a man with three older sisters. First this was because he is exceptionally understanding of women. I'm sure it's possible to avoid the chauvinism if you weren't raised in a house of females, but I definitely think this helped. Currently, it is because we have three older siblings who are all done with having children and have a lot of mothering advice and a lot of leftover stuff that they are excited to part with. Unfortunately, this last part has resulted in some challenges that I hadn't anticipated.

As C's one sister said this week, "if you don't want to register for anything, you won't need to." This is probably an accurate statement. So far, we've been offered a cradle, crib, jogging stroller, two bedding sets, two cloth diaper sets, a Bumpo seat, a bouncer and "jump-a-roo", two carseats, a Boppy breastfeeding pillow, bottles, and a breast pump. I am probably forgetting things. This is a lot of stuff!

I am so incredibly grateful for all of it and then I simultaneously feel like a stuck-up jerk for not wanting to accept it all and not knowing how to go about turning it down. The issue, that I have a hard time even typing without cringing at how this sounds, is that while all of this stuff is good, it is not necessarily all of the things that C and I would have picked out ourselves. C has been researching strollers and carseats for a while now and has some strong ideas on the brand and type he is interested in, which is not the brand that we are being offered. The crib is a completely different wood and clashes with the other existing furniture in the nursery and the bedding sets are really just not our style.

Plus, there is the fact that we do both have large families and are now having two baby showers and really do need to be able to register for something.

So I'm an asshole and am not accepting every single (free) thing that is being offered by his especially generous family. C and I have both spent many hours talking this out and are, luckily, completely on the same page. We are looking at this in a sort of mathematical, logical sense. We compare the approximate value of something and then weigh that against our style/preference differences, while also taking into account if it would make sense to have more then one of any one thing.

For example, cribs are very expensive and while the wood choice clashes with the other furniture, the cost savings of not having to buy a crib outweighs our style preference. Crib - check! The bedding sets, on the other hand, include a bunch of things that we don't necessarily want or need (bumpers, quilts, etc.) and compared with a few sheet sets and a dust ruffle, our style preference wins out. This way the room will still feel like our own. The jogging stroller is great and while it probably could have been our only stroller, C and I compromised by accepting the jogger but then also registering for an all-purpose stroller with coordinated infant car seat. I'm not sure if the specific cloth diapers or bottles are what we will like, but it probably doesn't hurt to try them out and if we end up preferring different brands then we can always purchase more of those later on.

There are also some complications with who, how, and why things are being offered. C's one sister is completely finished with having children. Their youngest is five and they are content with their three girls. Her offerings are easy to accept. On the other hand, his other sister has four children, with her youngest being three, but would like to have more some day. She is very Catholic and envisions a large family. Unfortunately, her last two pregnancies has also ended in misscarriages. When she has offered things, it has come with an underlying tone of sadness and longing, which results in me feeling guilty.

I have a hard time with saying/doing things that could potentially hurt other people's feelings, even if that means not standing up for my own wants and needs. It's something I need to work on. It has also made some of these conversations very difficult over the past few weeks. Because I am truly grateful for all of the generosity. And because it feels wrong to turn down support of any kind. But also because we need to do what makes us feel comfortable and what is best for our family.

Viability

We are at 24 weeks today. Viability.

Ever since hearing about this, I thought the concept was odd. Yesterday, neonatologists would likely not have provided intensive intervention to save my daughter, but today a vast majority of them will. Yesterday, her chance of surviving outside the womb was less than 50% but today it is now greater then 50%. Of course, those chances are based on receiving extensive medical intervention and she is still likely to suffer long-term complications. The official recommendation is still that "intensive care should be an optional choice for fetuses at 23 and 24 weeks gestation" but should be offered "to every fetus at 25 weeks or more." (citation) So I suppose I should continue to be nervous until I reach the end of this week?

I'm not particularly nervous. Nor do I want her to come quite yet. She still has a lot of maturing to do and we still have a lot of preparing to do.

We still only have one set of receiving blankets as far as supplies go. There are some other items in the works, but I'm saving that for another post. Our registry is growing, but it is still far from complete. The office is still an office and C still has two more full weeks of nursing school before it can be transformed into a nursery. His last classes are turning out to be much more challenging than we were hoping for, so any physical or mental preparation that is not completely necessary is being put off until after this time.

I am definitely in full-swing pregnancy mode. I look pregnant and people call me out on it all the time. I am beginning to have daily conversations with patients about my maternity plans, although right now it is all very tentative and just meant to reassure them that there are options and plans in place. They will not be forgotten or stranded in psychological distress. That is assuming that I make much closer to my due date of course. Just because I'm viable, doesn't mean that any of us are actually ready for this.

My belly is expanding, but I am still not taking any bump pics. It just seems weird to me and I'm not comfortable with it. I think I'm still not completely comfortable with myself. The other day, C and I had a long conversation about if he still found me attractive... dangerous territory, I know. He said that I'm like, "Special Edition Katie" and that I look different but still good.

I am starting to develop stretch marks near my belly button. I also have a few on my right breast, oddly enough. I think my breasts have held steady at two cup sizes larger then normal, but they feel huge. My feet get very swollen at the end of the day, especially with the heat. I bought a pair of shoes, but then returned them for a larger size because I was nervous about the expanding feet situation.

Other symptoms are still the same. My canned remark is still that "I feel good, except for the days that I don't." I get winded easily. I get super tired at times. The heartburn likes to make itself well known every once in a while. My sense of smell still likes to me gag at random, otherwise mundane, scents. Round ligament pain is still present at times, especially when I have the nerve to stretch, and some days my back gets so sore that I swear I walk as if I were 9 months pregnant instead of just six. I have been getting some leg cramps at night, but nothing major. I am starting to get gassier and my bowel habits are much less consistent.

I have gained about 17-18 pounds, which is higher then I am comfortable with. Between Marv, then the week-long vacation, and then Marv again, I have taken a permanent hiatus of eating for health and have instead been eating for comfort. This week I began making an active effort to change that and am trying to set guidelines and limits for myself without being unreasonable to the fact that I am still pregnant.

The baby is much more active than just a few weeks ago. The sensations are still not especially impressive and I swear I can still buy how some women would just mistake them for bowel movements. She doesn't yet have a name, but we have a few top candidates that we're trying out. In the meanwhile, we've jokingly given her a place-holder name of Beuhla, which was one of C's first nursing patients and apparently a very lovely old woman. The humorous part is that sometimes people think we are serious about this name and try to give us a supportive response but it is very clear that they are stretching to say something nice.

All in all, Baby Beuhla seems well and is officially past the imaginary viability threshold, but she and C and I still have a long way to go until we're all really ready for her arrival.

Doctor Visit(s)

Last Monday I had our five month OB visit. Five months. It seems unreal.

At this point, the appointments are fairly mundane. He asks about my symptoms and gives me some advice on how to control them (take the daily anti-heartburn medication) or reassures me that they are nothing to be concerned about (swollen feet comes with the gig and the heat). He checks my blood pressure and ankles for swelling, then measures my belly. Then he gets out the dopplar and listens to the heartbeat. It's typically in the 140s and always pretty cool to hear.

This time he mentioned that I will be getting my gestational diabetes screening test after our next appointment. He then said that I had two options: 1) drink the nasty glucose drink, or 2) eat two full sized candy bars. Seriously. He said that he offers the second option because so many people were avoiding the test completely and/or unable to tolerate the drink if they did attempt the test. He said that die-hard scientists would probably hawk at this, but he figures that it is only a screening measure and that if it comes back positive I'll have to go through the real deal. I like this attitude. Of course I chose the candy bars. Now I have a month to decide which two candy bars I want to eat. C thinks they'll make me sick, but I'm fairly certain he underestimates my capacity for chocolate.

Later on that week I returned for a second appointment, this time to make sure things were still ok after the car accident. This time, the doctor checked my whole body for bruising and asked about the details of the accident in depth. He asked about any concerning symptoms, primarily bleeding or severe cramping, of which there were none. Then he checked the baby's heartbeat - still in the 140s. He said that if I were farther along he would order a non-stress test but that these aren't typically conducted this early in the game. So that was all. Everything looked ok and he will follow me again at my next month test, so long as I don't call earlier with any concerning symptoms.

As of now, I feel fine. Nothing concerning.

However, I do still have a bad habit of forgetting I'm pregnant and over-exerting myself and then paying for it later. It was a nice day yesterday and I had a few cancellations and was actually caught up on my work so I decided to go for a walk. In the heat of the day over my lunch break. With my work shoes, unsupportive ballet flats. I walked out into the city, enjoying the views for about 20-plus minutes. Then I realized a) was really hot, b) I was out of breath, and c) I still had to get back to the office. So after another 20-plus minutes back, my feet were swollen and being cut into by my cute shoes and my back and legs had some odd muscle pains that left me walking like I was already 9 months pregnant or 85 years old. Yeah, I did that to myself. I do not need to report these symptoms, or my stupidity, to the doctor. We'll leave that one between me and the blogging world.

More Baby Shower Thoughts

I realized in writing this post, that I have some more to say about this whole baby shower thing. Remember how I've said that I'm not one of those girly-girls who gets all googley-eyed with cute things? Maybe I never said this specifically, but I'm not. I was always more of a tom-boy/nerd who cared much more about school and education and my career then boys and parties and frilly things. Babies usually fall into that frilly-cutesy thing category. Whenever people go, "awwwwwwww", I get  nauseous. About anything, really, but babies are really big in bringing out the "aww" in people.

Usually, baby showers make we want to gag. Especially girl baby showers, because they're all pink with bows and ruffles and doilies and crap**. At first, I wanted nothing to do with a baby shower.

So what changed?

Well, first, my mom told me I had to have shower. It wasn't in a forced way, but more of a social expectation, weird if you don't, sort of way. So I started paying attention to other people's reactions, especially now that I am showing more. Turns out, most people get really excited about babies. They love to talk with me about them, giving advice, and share their own experiences. They get excited about cute baby objects and about re-living when they had babies of their own. Maybe it was just the bitter infertile in me, or maybe it was just me, but I hadn't fully realized how much joy this seems to bring to other people. Probably other fertile people, but other people nonetheless.

Secondly, there is the whole party aspect of things. I do like to see my family and friends. I do like to have a good time. If I could do this shower in a way that it was fun, make it more of a party then a stuffy shower, then that would be nice.

Finally, there is the issue of money and baby stuff. Infertility is not cheap. Babies are not cheap. Infertility plus babies are especially pricey. C and I really would like to be able to move out my parent's home someday and I have just recently gotten the courage to re-examine our savings plan that was completely depleted in project "making-of-baby". So if it's completely socially acceptable to host a party for the sole purpose of people buying you necessary stuff, then who am I refuse this.

Since my sisters are largely out of the planning process and my mom is never really the idea person, I decided that if we're doing this, we're doing it on my terms. There will be no pink or purple and no ruffles or hearts. It will be a party with alcohol and music and good times and good food. In the evening so that people stay and have fun. The shower part will be minimized and the party part will be maximized. And if people want to talk with me about baby stuff, that will be just fine. And if people want to avoid talking about baby stuff, it will not be shoved down their throats. I don't like attention anyway.

So here is the plan: It is a northeastern Ohio tradition to host Clam Bakes in the fall. There is clam chowder along with appetizers and then a "bake" includes dozen steamed clams, grilled chicken, fresh picked corn on the cob, a sweet potato, and a roll, all served with melted butter. My parents used to host one yearly, but have gotten away from it the past few years because of weddings and other obligations. It was one of my favorite memories as a child and teen. So we will be hosting a Co-Ed Clam Bake Baby Shower. When people are eating the chowder and appetizers, I will open gifts in one room of the house while football is playing in the other room and music is on outside. Watch me open gifts if you want, or feel free to enjoy the rest of the party. Then after the chowder and gifts, we will serve dinner and the baby stuff will be over and the partying can begin. There will be no obligatory games, although we are throwing around some ideas of optional, play-if you want, sort of activities (e.g. trivia or "guess the baby picture" type of stuff where we can reveal the correct answers later on in the night without stopping the flow of the party).

I am actually sort of excited about this idea. Which is odd for me to get excited about these sorts of things. I think this could be fun. And not make me want to gag. And help us procure some more necessary baby essentials. So hopefully it's a winning idea all around. 

**I should probably apologize for offending people throughout this post... I'm sorry and I do not think less of you if you get mushy for hearts and your favorite color is pink. Also, I do sometimes find myself (internally) saying "awww" at cute pictures or videos of babies and animals. I do have a heart, and I'm sure it will probably become exponentially softer when holding my own baby in my arms.