Strength: Delays, Detours and Yawning Potholes on the Road to Reproduction

If you saw me walking down the street pushing my stroller-built-for-two bursting with my exuberant toddler daughters, you would think that I look like a nice 22-year-old who got knocked up, popped out a couple of adorable babies (if I do say so myself), and went on my merry way.  (I’m 34 but I seem to have freakishly stopped aging about a dozen years ago.)  But my road to motherhood was, and continues to be, a difficult one.

In the fall of 2007, my husband and I decided it was time for babies.  I have a history of ovarian cysts and endometriosis, which gave me pause, but I felt optimistic that it would all go well.  I went off the pill, read up on ovulation timing, and started having vast quantities of sex (okay, that’s how it felt; my husband might disagree with the “vast quantities” description).  A few months later, I was getting frustrated so I stepped it up and bought an ovulation kit, which revealed that I was ovulating several days later than I thought.  We got the timing just right and then, Poof! Voila! I was pregnant!  It had felt like a long five months, but the average time it takes to get pregnant is six months so we felt comfortably within the normal range of things.

Our blastocysts

We were ecstatic.  I stopped drinking.  I avoided sushi, unpasteurized cheeses, and deli meats.  I took my vitamins religiously.  I did everything right.  When we went for our first ultrasound, the doctor said the fetus was measuring small and she couldn’t quite detect a heartbeat, but she said it could just be too early and proceeded with the visit as if everything was going to be fine.  At our follow-up visit a week later, there was no heartbeat; the doctor declared the pregnancy a “missed miscarriage,” which is when the fetus dies but you don’t experience the pregnancy miscarrying from your body.  Needless to say, we were heartbroken.

After an unsuccessful attempt at inducing a miscarriage with misoprostol (an abortion pill), I eventually had a D&C (“dilation & curettage”—surgical removal of the fetus) and spent a few weeks in recovery mode.  I moped around the house.  I ate piles and piles of chocolate.  I cried in the shower.  It turned out that no matter how much I knew about the statistics (up to a quarter of pregnancies end in miscarriage, a fact of which I was well aware), I never really thought it would happen to me.  It was a shock when it actually did.

While the loss of our first pregnancy was upsetting, we said to ourselves, “Hey!  At least now we know we can get pregnant!” and moved on to trying again in June of 2008, fully expecting to be pregnant again shortly.   We tried.  And tried.

Nothing happened.

And nothing kept happening.  Every single month, I got my hopes up that this would be the month: I imagined that every twinge and pang I felt was the little embryo setting inside me; I imagined that every whiff of nausea was the first sign of our future baby.  Then every single negative test result hurt, almost physically, as my hopes gave way to disappointment.  I had never known disappointment so deep and so relentless.  As the months dragged on, the frustration and anxiety grew exponentially; sex became a carefully orchestrated chore; and my mind was entirely consumed with a single thought: MUST GET PREGNANT NOW.

Infertility Drugs

At some point we had to face the “I” word: Infertility.  Infertility is lonely and isolating.   Once it becomes clear that this is what you are in the middle of, getting through each monthly cycle, much less each day, feels like an enormous weight.  Time was my enemy during this period.   The longer it went on, the more I mourned the loss of that first pregnancy.  The longer it went on, the harder it was to see other women and my friends around me getting pregnant like it was in the water.  I went completely batsh*t crazy in my own head.  I glared at pregnant women on the street.  I skipped friends’ baby showers.  I refused to acknowledge a co-worker’s new pregnancy.  (Though I thoughtfully sent her an e-mail that said, “I’ll be happy for you later.”) I de-friended pregnant people on Facebook.  (Probably some of you.  Sorry.)  I couldn’t take not being pregnant.   One night over dinner, a very dear friend told me she was pregnant.  Instead of congratulating her and sharing her joy, I made a sad face.  It was my first gut reaction and I couldn’t stop it.  (I still feel terrible about this.)  I felt like the world was out to get me and like her pregnancy was personal affront to me.  I felt completely surrounded by pregnant women—the world became a twisted, reversed “Where’s Waldo?” of pregnant women everywhere I looked—and I had a nagging fear in the back of my mind that it would never be me.  It got to the point that I couldn’t even imagine it being me.

People have all sorts of “helpful” things they say to you during infertility and after a miscarriage, and I am here to tell you people that none of these things are helpful:   "You just have to relax”; you have to stop ‘trying’"; "you have to stop thinking about it"; “God has another plan for you.”  I was seriously about to give a swift kick to the shins to the next person who was “helpful.”    My personal favorite was when my doctor, a female internist who also does acupuncture, said to me, "There's no point in worrying or being stressed out about getting pregnant because you will have a baby when God decides to give you one."  Super.  Duper.  Helpful.

Finally we went to a fertility specialist in March 2009 and were informed that our first pregnancy had been a fluke, and that IVF was our best option to have children sooner rather than later.  This was the news I was dreading.  I hated, HATED the idea of IVF.  I did not want to do it.  For weeks, I was horrible and mean and grumpy to my husband about the whole thing.  But we bit the bullet and dove in headfirst with the weeks of daily shots (sometimes multiple shots a day!), almost-daily visits to the clinic for bloodwork to test my hormone levels and ultrasounds to check on the progress of my ovarian follicles.  I was stressed out and anxious every minute of every day during my IVF cycle.  I cried at almost every doctor’s visit.  I lost my mind entirely when the process was delayed mid-cycle by 4 days due to lab scheduling issues.  My ovaries blew up into heavy water balloons and it hurt to sit down.  Then, on Memorial Day weekend 2009, we had two embryos implanted in my uterus and held our breath for the next few weeks.  Of course, both embryos took and on December 9, 2009, my two beautiful, wonderful, clever, hilarious and generally spectacular daughters were born, two months early.

We had an overwhelmingly challenging first year in the life of our preemie twins but when the dust had settled, we were ready for one more.   This past March, when my girls were 15 months old, I decided to try again the old fashioned way for the next few months, just to see what would happen, and then head back to the clinic for another round of IVF towards the end of the year.  A couple of weeks later... Poof!  Voila!  I was pregnant! ON THE FIRST SHOT!  It was crazy.  We were in shock.  Unbelievable.  I could not have been happier.

Me and my girls

During April and May, we went to the doctor twice and saw an undeniably strong heartbeat.  I stared at the  ultrasound screen for a very long time, watching the whirring of the heartbeat and feeling increasingly confident that this one would make it.  We let ourselves get comfortable with the idea that this was going to happen.  We started planning for #3: looking to move to a house in the suburbs, reorganizing the baby clothes and gear, thinking about how to handle the holidays with toddler twins and a newborn.  Then, at another doctor’s visit at the end of May, we heard those words again: “It’s a miscarriage.”  There was no more heartbeat and the fetus had stopped growing.  Again, I had a D&C.

This loss has been harder.  At first I thought that the miscarriage would be easier this time around because we already have children and so we’re not so desperate to be pregnant this time.  But that’s not how it’s working out.  I really wanted this baby.  This was our miracle.  We had been so excited for this one.  While I was pregnant this spring, part of my excitement was the extreme relief I felt that we were done with infertility, we were done with IVF and the needles and doctors, and our family would be completed without any more trauma than we’ve already been through.  But that is not to be.  In June, our fertility specialist told us that this pregnancy had been “a blessing” (read: completely medically inexplicable) and walked us through the next steps for another IVF cycle.  The prospect of facing IVF again, after having been convinced it was behind me, has added a big weight back on my shoulders.

Infertility has permanently changed my relationship to pregnancy, babies and my friends.  Despite my own joy over the two babies I ended up with, and despite the fact that I would never wish all of this on anyone, I still have a hard time with my friends who have gotten, and stayed, pregnant easily.  I know this sounds terrible but I’m never quite fully happy for them.  I feel resentful that they just decided to get pregnant, had some sex for a month or two, then, easy-peasy, went on to have one healthy, full-term baby.  I still feel traumatized by and hate the unfairness of everything we went through, from the first miscarriage to the infertility and IVF to the preemie babies to the second miscarriage. It feels horrible and cruelly unfair.  That pretty much sums it all up: It’s not fair.

I don’t know how this is going to end up.  I can’t believe that we have been on this path for almost 4 years now and, even though we have two wonderful children, we are still struggling daily with becoming parents.   I am extremely grateful that I already have my twins and I never forget it for one second, but I feel very strongly that there is one more baby out there for us and we need to figure out how to get it here.

To those of you in the middle of infertility and loss, I have only empathy.  I am lucky to have found a fantastic group of women with whom I have regular dinners (“Lawyer Moms with Twins”), most of whom have been on a similar journey.   Of the other moms, I have had one of the shortest journeys to parenthood in that it took us under 2 years to get successfully pregnant.  Many of the women have been through years of fertility treatments and multiple pregnancy losses.  Some had half a dozen rounds of IVF.   One had 5 miscarriages  And obviously we all made it to the end game: Motherhood.  Not one of these women would say that she regrets having gone through all of that to have the children she has now.  It is worth it.  When you are in the middle of it, it sucks and seems endless.  But you will never, ever regret that you kept trying and did everything you could to get your children here.

~ Allison Harris

Salt & Nectar thanks Allison for guest blogging today. Allison is a Lawyer Mom with Twins (“LMWT”) in New York City and spends an inordinate amount of time corresponding with other twin moms.  She recently managed to find the elusive job that offers actual work-life balance, enabling her to put her expensive law school education to good use while also enjoying plenty of time at home with The Ladies, weekend yoga classes, and regular dinners out with other LMWT.  

Guest Post: The Top Ten Things I Wish I Knew in the NICU

Amelia Then

Lucia Then

When I was pregnant with my twins in 2009, my Type-A personality kicked in to overdrive and I became obsessed with preparing our lives for these two little creatures. I carefully researched products, joined my local twins club for advice and support, and took a twins preparation class (“Twiniversity 101”).   Being the control freak I am, I chose to deliver at the hospital with the best NICU in New York City and I switched to one of the best high-risk obstetrics practices, where  I insisted on weekly monitoring for any signs of preterm labor. I know that twins often come early and I was prepared for that possibility.  Or so I thought.  When my water broke suddenly at 30 weeks and my doctor informed me that the babies would be arriving imminently, I could not have felt less prepared.  I wasn’t ready.   I sobbed over and over that THEY weren’t ready.  It wasn’t time yet.  I held on for five days and then, at barely 31 weeks, my Baby A, Lucia, came roaring out with a bang, almost in the elevator.  Baby B, Amelia, was distinctively less gung ho to leave the warm, cozy womb (understandably) and she ambled out 5 hours and 12 minutes later. (Seventeen months later, this pretty much still says it all about their personalities.)  At birth, Lucia weighed 2 pounds 15 ounces and Amelia weighed 3 pounds 6 ounces.  Both girls were so tiny and so fragile, barely moving, and all I could think was that they shouldn’t be here yet.  So began our NICU journey, which continued for the longest six weeks and two days of my life.

I am part of a wonderful community of mothers of twins (and a few fathers) here in NYC.  Most of us had a long, difficult road to parenthood, and far too many of us endured days, weeks, and even months with our newborns confined to plastic incubators in hospital NICUs instead of at home with us.  I naturally turned to my fellow twin moms when compiling a list of advice a few months ago for a friend of a friend’s sister (you know how that goes) who had just had preemie twins.  The list that follows reflects my own experience in the NICU,  along with the input of many of my fellow warrior moms.   (We are indeed a special breed of mothers.  The first few months of life with preemie twins feels like intense training to a be some sort of ninja warrior mom.  Or a special edition of “Survivor: Twins.”)

1.     You may not fall instantly in love with your baby/ies. You always imagine that just after your baby is born, the doctor will lay the baby on your chest, you’ll gaze into each others’ eyes, and you’ll immediately be overcome with a powerful love for your new baby.  This is not what happens when you give birth to premature or sick babies.  The second that baby emerges, there is an army of doctors, nurses, interns, residents, neonatalogists, and other assorted random people in the room who will whisk your baby/ies away before you even have a chance to realize that you’ve just given birth.  I didn’t even get a glimpse of my babies until many hours after they were born, and that was only for a couple of minutes.  I was not able to hold Lucia until about a week after she was born.  Amelia was less stable, so it was even longer before I was permitted to touch her, and I only held her a handful of times during her first month of life.  Our emotions were impossibly complicated during those early weeks:  We didn’t feel “love” for our babies so much as an overwhelming sense of responsibility; we were in a state of limbo in which our children were “here” but they weren’t really here yet; we had children but we didn’t feel like we were parents yet.  If you had asked me during that time if I had any children, I would have hesitated before answering.  It wasn’t until Lucia and Amelia were about 8 weeks old that I was able to say “I love you” to them and that I really felt as though I loved them.  But once I started, I couldn’t stop!  (I’m pretty sure that by the time they are 13 years old and I am still telling them I love them 56 times a day, they are going to be really annoyed.)

2.     Pick a primary nurse to care for your baby/ies.  After a few days of getting to know the staff, it’s a good idea to pick a couple of nurses who you particularly like and ask the charge nurse that these nurses be assigned to your baby/ies as much as possible.  Each nurse has a different style and different ideas about the best way to care for babies.  The conflicting information from all of the different nurses about every little thing from the best swaddling technique to proper pacifier size will drive you nuts.  Having one or two nurses you know and trust will help your own peace of mind and ensure continuity of care for your baby/ies.

3.     You do not have to spend every waking moment in the NICU.   The NICU nurses are the best babysitters you will ever have.  Take advantage of this time to go out to dinner, see a movie, or get a massage.  This is easier said than done when you have a baby or two in the hospital, but it is important to take a little time for yourself while you can.  (Full disclosure: I was never able to put this into practice.  I spent every waking minute at the hospital, with the exception of New Year’s Eve when I found myself drunkenly sobbing while pumping and dumping in the bathroom stall of crowded bar. But you should learn from me and not do that.)

4.     Having your twins come home together is overrated. Twins rarely are released from the hospital on the same day.  Baby A usually is a little stronger and is ready to go home before Baby B, who has a few more issues to overcome.  (This is a fact and I asked around at the hospital repeatedly but could not for the life of me come up with a medical explanation as to why this is the case.)  In our case, Lucia came home over a week before Amelia.  When we were told they would not be ready on the same day, I went into a panic at how we would manage to have one baby in the hospital and one at home.  It seemed too overwhelming.  But after the fact, I think it worked out for the best because we had a little time to figure out how to incorporate one baby into our home before introducing the second one... at which point the complete chaos began and there was no turning back.

5.     You absolutely, no question, without a doubt can breastfeed your baby/ies and you can breastfeed exclusively.  Breastfeeding premature twins is the hardest thing I have ever done in my life.  It is also the best, most rewarding thing I have ever done in my life.  I have heard a lot of women say, “My babies were in the NICU so I couldn’t breastfeed,” but having babies in the NICU does not preclude breastfeeding.  Right after my girls were born, I requested that a breast pump be brought to my room and that a lactation consultant stop by to help.  From day one, I pumped for 20 minutes every 2-3 hours.  At first I used the lactation room in the NICU, then I requested the hospital provide me with a pump to keep in my little corner of the NICU.  I rented a hospital-grade pump for my home.  (The Medela Classic is the best, most powerful pump, followed closely by the Medela Symphony.)  I bought a Medela Pump-in-Style totebag and a handpump for my purse to cover any rare moments when I was not at the hospital or at home.  I pumped the bejeezus out of my poor, sore, screaming breasts day and night.  I drank gallons of water every day.  I ate cheeseburgers as much as possible.  I produced enough milk for Lucia, Amelia, and a small country.  I kept the NICU freezer stocked with my breastmilk at all times and I made sure that every nurse who got anywhere near my babies knew that they were to get only breastmilk in their feeding tubes.  I ended up breastfeeding for nine months, exclusively for six.   (Once the feeding tubes were out towards the end of the NICU stay, making the transition to nursing was a monstrous challenge.  So much so that it is a topic all its own, one for another day.)

6.     Get to know the medical professionals caring for your children and make a point of meeting with them every single day to ask questions, no matter how minor. Introduce yourself to the pediatrician/s assigned to your baby.  Introduce yourself to the charge nurse.  Get to know the nurses in your area of the NICU.  If your NICU is in a teaching hospital, find out what time rounds are and stand next to your baby/ies each day as the interns present to the attending.  If you are in a large and crowded NICU, this may be the only way you’ll learn exactly what is going on with your babies and follow their progress.  Be ready with questions.  Jump in with questions during the presentation if there are words or concepts that you don’t understand.   Each morning when you arrive, ask a nurse to notify the pediatrician that you would like to see him/her at some point during the day.  If you are not proactive, you may discover that the hospital staff are too busy and overwhelmed with their own work to keep you in the loop.

7.     Ask for a tour of the NICU, any materials on premature babies,  and to explain all of the instrumentation, monitors and other tubes wires and blinking lights attached to your baby/ies.  Days went by before anyone felt the need to explain the 83 different tubes and wires coming out of my babies’ noses and mouths and attached to their little arms, stomachs and feet.  Lights would blink and alarms would sound and we had no idea what was going on.  About a week after my babies were born, one of the staff members offered to take me on a tour of the NICU.  As part of my exit package when we were discharged from the NICU, I was given all sorts of brochures on having premature babies that explained what to expect in the NICU, the terms most commonly used (“brady,” “apnea,” “desat”... what???), and what all of the different monitors measure and what the numbers all mean.  Let me tell you, this would have been helpful BEFORE I was walking out the door of the NICU.  I was really irritated.

8.     Nurses are the best teachers of newborn care.  The one advantage of having babies in the NICU was that by the time they came home from the hospital, we were pros at newborn care and felt totally comfortable taking care of our babies.  The NICU nurses have fabulous tips for how to best swaddle, hold, position, comfort, change, burp, bathe, and feed your baby/ies.  Learn from them.

9.     Do kangaroo care. “Kangaroo care” is when you strip your baby down to its diaper and hold her against your bare chest while resting in a chair or rocker for a couple of  hours or so.  Studies have shown that kangaroo care can improve outcomes for premature and sick babies and can shorten the amount of time spent in the NICU.  Kangaroo care is trickier than it seems because a nurse has to help you finagle all of the tubes and wires to transfer the baby from the isolette to your chest and then back into the isolette a couple of hours later, and while many nurses will be great advocates for you and happily assist, some nurses just can’t be bothered.  I had many more nurses in the “can’t be bothered” camp and I wish I had pushed for more kangaroo care time with my babies.

Amelia Now

Lucia Now










          

 

 

 

 

10.  This will all be a distant memory before you know it. I promise.

~ Allison Harris

Salt & Nectar thanks Allison for guest blogging today. Allison is a Lawyer Mom with Twins ("LMWT") in New York City and spends an inordinate amount of time corresponding with other twin moms.  She recently managed to find the elusive job that offers actual work-life balance, enabling her to put her expensive law school education to good use while also enjoying plenty of time at home with The Ladies, weekend yoga classes, and regular dinners out with other LMWT.  

Shower-PALOOZA: Part One

Not only am I pregnant, but two of my closest friends from college are also due within weeks of me - one with twins! In an effort to save our friends multiple car trips, we scheduled both Aimee's and Erin's baby showers last weekend. It was a party planning bonanza and I thought I'd share some of the adorable details.

First up on Saturday was Aimee's shower celebrating the arrival of twin boys - Noah and Charlie. Our theme was "A Perfect Pair."



Brown and green were also the colors in her nursery and we tried to use baby items she could take and use in their room - blankets,  onesies, and a name banner. The adorable invitations above were from Paperlicious. We played a Twin Baby Babble Word Game that I designed to match the invitations. We also had a "Pear Tree" where everyone could write their hopes for the babies on little paper pears to hang on the tree. The momma-to-be took them all home in a little book at the end of the shower.

Everything went beautifully and we passed out Doublemint gum as party favors as everyone was leaving.

Just in case you have a twin shower around the corner - I'm sharing a free printable version of the Twin Baby Babble game with all of you our dear readers!

Enjoy!

- Sarah Stewart Holland