Avery's birth story

Ever since I caught a stomach bug that had been going around, around 39 weeks, I'd been having light contractions on and off, but nothing that developed into any sort of pattern. Wednesday morning, a day past my due date, Sammy and I went to preschool at the library, as usual. I started having the same light, almost painless contractions. I ignored them, thinking they would stop soon. They kept coming consistently through lunch with my Mom and then our usual visit to my grandmother. I started timing while I was there. 7-8 minutes apart but very short. I ignored them another couple of hours as we all got home. My mom came over to take me to my prenatal yoga class. They were still about 8 minutes apart but spaced out a bit when I got up and moved around. Yoga class was nice; I took it pretty easy. I had several more during class and some good strong ones in the car on the way home. Rebecca was waiting for me when I got home with a glass of wine (doula's orders) and Sam was sleeping upstairs.

After the glass of wine, some magnesium, and a shower, I laid down to get some rest. But laying down made them stronger and closer together, so I got up and fiddled around/tried to rest. By about 2am they were getting strong enough that I woke Rebecca up to help me through them. They were less than a minute long, but about 2-3 minutes apart. Shortly we decided to call the doula and start setting up the tub.

Heather, our doula, showed up around 3:30. I got in the tub for a while, which felt amazing. It didn't slow down the pattern of contractions. The midwife came and checked me around 4:30. Then we took a walk around the neighborhood. Checked again, was declared to be in labor but very early. I was a bit discouraged due to the lack of bloody show and the difficulty the midwife had reaching my cervix. The midwife left. Soon Sammy woke up for the day. We had breakfast, and then I got back in the tub and she helped pour water over my belly. My mom came over and helped Sammy get packed up and then took her to their house for the duration.

For the rest of the morning, under Heather's and Rebecca's ministrations, I got in and out of the tub, walked in the yard, listened to birth affirmations, tried to rest and eat, and tried various other positions and locations around the house. I also had a few emotional moments. The contractions spaced out a bit to more like 5 minutes apart sometimes. I dealt with them by saying "Hooooooh" a lot, louder and louder as the intensity stepped up. Heather suspected the baby's head was cocked a little bit, interfering with dilation. About 2pm, Heather put me in the open-knee-chest position to let her float up a bit and hopefully reposition. I stayed that way for about 45 minutes, and then Heather and Rebecca took turns "sifting" my belly with a towel. The contractions then got very intense. They started coming one right after another with no or very little break. I was kind of singing my "hoooooh" sound, very loudly, with lots of vibrato :) I was checked and made them tell me a number, which was 5. I had a little bit of a breakdown then, thinking I was still many hours away from relief. Heather and Ashley, the midwife, wanted me to put my foot up in a lunge position but I couldn't deal with it during contractions. All I wanted was to get in the tub, so Rebecca was reheated it again. I got in and was able to lift my leg out a bit for a few contractions. The tub helped a lot but it was still very, very intense. I was just hanging on for dear life. I knew it had to be transition but I also believed it couldn't be, that soon after being at 5 centimeters (which was actually generously rounded up, I later learned).

After a little while in the tub, about an hour after the belly sifting, something changed. I got "pushy", as they say. For some reason I started needing to grunt and bear down during the contractions. It was scary because I was sure this was too early to be pushing. After a few of those contractions, Heather asked me "Do you feel like you need to bear down?" My reaction was a dismayed, "I thought I was!" For some reason in my head I had translated that to "You are not bearing down right now, would you like to?" so I thought I was doing it wrong! But she assured me that yes, I was bearing down.

After she said that, I reached down and felt inside. I could feel the bag of waters there. I told them I could feel her coming down. The midwife came and checked me in the tub and said we were good to go. All of a sudden there was activity all around. Phone calls were being made, like telling the nursing assistant, previously told to take her time, to stop taking her time and step on it! The contractions spaced out a bit and I was so, so happy for the break. The midwife said we could stay in the tub and I couldn't decide what to do, but ultimately Rebecca reminded me that the plan was to go upstairs, and I'm glad I did. Everyone was busy hauling gear and everything upstairs. I got on the bed on my hands and knees, and pushed like that through a few contractions. Sometimes pushing felt good and sometimes it was terrifying and I cried and fought it instead. But I could feel myself making progress. Holding some pressure to keep her in place between the contractions was hard! I was so tired. I had a hard time holding myself up and decided I wanted to flip over. I got on my back sitting up a bit and started pushing that way. During one of the pushes I felt a pop and gush as the membranes burst. The midwife was checking heart tones between contractions as she came down. I think hearing that her heart rate was down a bit (even though it was still fine) gave me some extra motivation because I think in the next 1 or 2 contractions, I pushed through that burning ring of fire. People were saying stuff to me, instructions, that I had a hard time really understanding but I got her head out and then I heard them say "No more pushing, no more pushing." I got that! It was an incredible feeling. The midwife felt for a cord around her neck, then asked me when I was ready. I wasn't sure so I just said I was! I pushed some while she wiggled the baby right out. Delivering the rest of her hurt more than I thought it would, but it took almost no time and she slipped out and then she was on my chest and it was *amazing*.

making decisions

So, this is a post about homebirth. but before I talk about homebirth, I'm going to talk about breast cancer. Bear with me.

When I was newly pregnant with S, my mother (51 years old at the time) was diagnosed with breast cancer. An aggressive, fast growing cancer, caught early. She had a lumpectomy, chemo, and radiation, and was declared cancer-free. After examining our family history, which includes several great-aunts and great-great-aunts with breast cancer, along with various other cancers, she decided to have a genetic test run. They look for specific mutations on two genes -- BRCA1 and BRCA2 -- that are associated with extremely high rates of breast cancer. Mutation carriers have up to an 80% lifetime risk of breast cancer for women (6% for men) along with a very high rate of ovarian cancer and increased risk for various other cancers (melanoma, pancreatic, prostate, etc).

As you can probably guess, since I'm talking about it, they found such a mutation in my mother's DNA. (On BRCA2, to be specific.) We found this out while I was either still pregnant with S, or she was a tiny baby.

This type of mutation isn't like cystic fibrosis and such where both parents have to be carriers for it to affect a child. If one of your parents has it, you have a 50/50 chance of having gotten that particular gene, too. And if you have it, you have it. My brother and I both got tested - it's easier when they know exactly where to look - and we both got unlucky. That means our daughters, 4 now between us, all have a 50/50 chance of having it too. S was 8 months old when I got my results.

There are a few approaches that genetic counselors suggest for BRCA positive people. The most conservative approach is merely increased monitoring. Starting mammograms early, doing MRIs as well. Having your tubes and ovaries out once you're done with childbearing is often suggested. (It reduces ovarian cancer risk, obviously, but it also decreases breast cancer risk because of decreased hormones that can "feed" breast cancer.) The most controversial, radical step that BRCA women take is double prophylactic mastectomy.

My mom just had hers done, less than 2 weeks ago. I'm helping take care of her as she recovers - mastectomy with immediate reconstruction, especially if they use your own tissue from your abdomen instead of implants, it is no walk in the park. It's major surgery. My mom was in the hospital 5 nights. She had 4 drains, still has 1 in. Her recovery will take weeks. And I'm in there, seeing the incisions, watching her barely move around, sponge-bathing her.

And I'm planning on doing this, myself, in about 10 years. If nothing drastic changes in cancer technology, of course.

While I sat in the waiting room with my dad as her 11-hour surgery progressed, I was thinking about how someone with BRCA mutations makes this decision.

You can look at study after study about your risk of developing this sort of cancer, and that sort of cancer, and how much you can reduce your risk by doing this or that. And it's important to do this research. It's also important to look at the risks and drawbacks of the interventions themselves. Could frequent and early mammography be harmful? How will losing my ovaries at age 40 affect my quality of life and my risk of heart disease and bone loss? What about hormone replacement to offset that a bit? What are the risks of the procedure to remove my ovaries and tubes (and uterus as well, most likely)? What are the risks and drawbacks of surgery to remove my breast tissue? Then you have to consider the emotional implications of various outcomes. How much do you think it will suck to get cancer, even if it's caught early? How much do you think it will suck to have biopsy after biopsy, or be told "we'll keep an eye on this area and look at it again in 6 months" every 6 months at your mammogram? What if you were unlucky in surgery and had [poor outcome x]? What if you were unlucky in the progress of your cancer, and you end up dead at 52 even with the recommended monitoring?

Theoretically, there is a "correct approach" that, implemented across the board, would extend the average lifespan of BRCA+ people the most, more than any other approach.

But practically speaking, when it comes down to someone making their individual decision, in the end, it doesn't really matter what the "correct approach" is. There are too many factors to consider for it to be that simple.

You don't get a do-over. You are an individual, not a statistical group. You have to assimilate the available information as best you can, digest it, and *make a decision*. And as informed as you can be, it's going to come down to this:

What makes you feel safest?

It may not be what is actually safest, in terms of your best chance to not die of cancer. Even though that is, theoretically, the yardstick everyone should use, right? Let's not die of cancer? But the steps you have to take to reduce your risk as much as currently possible may not be steps you are willing to take, for various reasons both empirical and emotional. The steps are not without their own risks and costs.

And I think, for the most part, that people inherently understand this when the decision is about surgery to remove your breast tissue. It seems to make sense that some people might decide to do it, and some people might not. That the accounting for you will be different from the accounting for me. That either way, the decision might end badly, with me kicking myself (if I'm lucky enough to be alive to kick myself) and wishing I'd chosen differently because oh crap, now I'm dying of cancer and if I'd just had the surgery... or oh crap, I've had 7 surgeries in 4 years to deal with complications from my reconstruction.... or whatever bad outcome might happen. And that I have to choose anyway and be responsible for that choice.

For me, deciding to plan a home birth after a c-section has been a lot like deciding whether or not to have prophylactic bilateral mastectomy.

It's friggin' complicated.

There are a million factors to consider. A million fears and what-ifs. I got to the point where I was scared to give birth anywhere. And then I sat back, realized I had to make a decision and own it, and I had to figure out where I feel safest. And just because I have decided that for now, I feel safest at home, doesn't mean I think you're an idiot if you decide you feel safest at the hospital or with a repeat c-section. And if I'd come down on the other side, it would be vice-versa.

There is no right answer, ever since our crystal ball broke.

It's not about the candles and the music and the coziness of being at home. It's not about bragging rights or "naturalness" or the "experience". I've HAD a c-section, and I know how much even a relatively uncomplicated one can suck. I don't want another. Nor do I want a dead baby. Nor do I want to die. I have done research, looked at arguments both for and against, and in the end I decided that if I go to the hospital, I'm very likely to have an epidural, and if I have an epidural, I'm very likely to end up with another c-section. I've weighed that against the small risk of something going terribly wrong at home that could have maybe have been fixed at the hospital, and then I've weighed THAT against the even smaller risk of something going terribly wrong at the hospital that could maybe have been avoided at home.

It's not simple math. It's not even complicated math. There isn't a solution in the back of the book to refer to.

It's a decision I have to make, and it's consequences I will have to deal with, either way.

update

um.... so yeah, i guess my posting rate is going to be about once or twice a year.

what's going on? after that last loss, we couldn't do any more ivf and didn't have any more samples of S's donor. so we switched donors and went back to unmedicated IUIs with charting and OPKs. our thought was, we would try for about 6 months and if it didn't work out, we were done.

the first cycle, the timing seemed great, my chart looked perfect, and i didn't get pregnant.

the second cycle, the timing was crap and my chart looked terrible. i tested while ML was out of town, at 10dpo, just to confirm it was negative... but it wasn't.

i held my breath for 16 weeks.

once i started feeling movement i started believing we might actually have another baby. after the last experiences, neither the positive test nor seeing a heartbeat at 6 weeks reassured me in the slightest, and even after seeing everything ok at 9 weeks and 13 weeks and hearing the heartbeat on the doppler, i still wasn't ready to actually believe. the anatomy scan, after i'd started feeling movement already... i went into it with a thousand times more dread than excitement. sure that there would be terrible news. but there wasn't.

even now, at 26 weeks along, with a genuine ruckus being kicked up in my midsection on a many-times-daily basis, i'm still waiting for a shoe to drop.

it's a girl.

a baby sister for S. her name will be A. her nursery is all set up, all S's old stuff brought out and ready. and i'm still terrified. there is no time when you can relax, when you're pregnant after loss. i'm trying to strike a balance between honoring that fear and where i've been, and also allowing joy in and savoring what will certainly be my last pregnancy.

how it happened

the first time i saw the line, i thought i was seeing things. i was 8 days past a 3 day transfer. i tried again that evening, at my mom and dad's house. i didn't tell anyone i was about to test again. i just came out onto the patio and showed them.

we started panicking about twins. two embryos. omg. see, when i last updated about the cycle, we had like 4 follicles. we got 3 eggs, and 2 grew into nice 8-celled embryos by day 3. this was *the only* scenario in which we ever would have transferred two embryos. and so we did.

i had my blood test a few days later. i talked them into doing it 9 days after the transfer instead of 13 because of the weekend. my beta was 40. then it was 265 on 13 days after the transfer. a lovely doubling time of 35 hours.

then a long time of just waiting and feeling dizzy.

then the night i was 5 weeks, i started getting nervous. this was when i started spotting last time, and the next day was my miscarriage. so when i woke up in the morning, 5w1d pregnant, i was snuggling S in bed, and then i got up. i was wearing no underwear, just pajama pants, and i felt like i needed to go wipe a bunch of progesterone suppository loveliness off. but as i lowered my pants i saw blood.

it was a lot of blood. not like, oh shit i'm hemmoraghing, but definitely like "i am not pregnant any more." i collapsed on the bathroom floor. i touched myself and brought back fingers covered in brown blood. i sobbed. ML came and got poor, traumatized S. my mom came. we cried. we called the doctor. i couldn't believe it. what was wrong with my body?

it was a sunday, so we had to bring the on call doctor in. he was my favorite doctor. i was glad it was him. we went in and i prepared to see the worst. instead it was... ok. there was a bleed next to the gestational sac, but the sac (just one) looked fine. i took it easy. the bleeding tapered off.

a few days later, at 5w4d, we went for our scheduled ultrasound. still looking good. couldn't see a heartbeat yet, but that was normal. then 6w4d, another ultrasound. still good, and a wee little heartbeat. 7w4d, still good, heart beating away. we were finally taken off pelvic rest, and celebrated that (gently). we were relaxing. we were going to have a christmas or new year baby.

the dog got out. it was my fault. it was late at night. i ran barefoot around the neighborhood, and then i biked. it was an hour and a half of exercise in the middle of the night.

the next day was the day before my ultrasound. at first i thought it was just the normal progesterone suppository discharge. it's yellowish. it's pretty yucky. but it was just a little browner than normal, that afternoon. a little later, it was more definitely something. i figured the bike riding had irritated my cervix or something. that night, i showed ML the spotting. but i still wasn't really worried.

the next day, ML had to work and couldn't come to my appointment. because of the spotting, i asked my mom to come with me to the appointment. she drove me there, and did reiki on my uterus. i was nervous, but not really. the doc was the same one, my favorite guy. he reminds me of a friend of ours.

i said, "i've been spotting a bit, but not much, and it's brown, which is the only reason i'm not hyperventilating right now." "you're 8 weeks 3 days, right?" "yes." (they count me as a day earlier than i count me. i considered myself 8w4d because that's what the ivf.ca calculator said. but that's fine.)

i get up in the stirrups. the nurse put a dvd in to record the ultrasound, like they always do, but didn't start it (that would be unlucky, to start it before they see the heartbeat.) the image shows up on the screen, and immediately i know. there's the sac, the sac looked normal. but inside the sac, it looked all... exploded. not all together and neat. and the past 2 ultrasounds, i could see the heartbeat right away. "there it is," i'd say. this time i told my mom, "i don't see it." "you don't see what?" "the heartbeat. i don't see it." i started hyperventilating. the doctor didn't say anything yet. he said he needed to get a better view. zoom in, zoom in, recenter, zoom in. meanwhile my world is crumbling.

then he finally said the words. "i don't see a heartbeat."

it looks like it grew to 7w3d. so right after the ultrasound the week before. i am crushed. this isn't fair.

Works for me: babywearing

This post is for a link-up for A Ruby in the Sunrise

I have worn S in so many places, doing so many things. I'm not one of those people who gets all into the stylish carriers and different fabrics and whatever, but I have had several different types of carriers, all inexpensive.

The first carrier I ever tried was a hand-me-down Peanut Shell from my cousin. My cousin is about 8 inches taller than me, so it was probably the wrong size. I took S for a walk when she was a few days old in it, and it felt awkward and not safe. I tried it a few times after that but was never satisfied. I never used a pouch again.

wrong and bad

After that, I tried a wrap. I got this one - I think it's a Hug a Bub or something like that - off of a trade site. It was essentially free; I only had to pay for shipping. I loved this. When we do have another baby I want a gauze and/or linen wrap, gauze for hot weather and linen maybe for back wrapping a little baby. I was never really able to get S on my back in this wrap - I think it's just a bit too stretchy. I didn't get too fancy with wrap methods. S would come to work with me, or on sight-seeing trips, or to our church, or on walks. And when she was itty bitty, it was often the only way I could get her to sleep.

this is a happy baby

going for a walk

hanging out, staring at me

again, happiest baby in the world

When she was getting a bit heavier, around 6 months, I got an unpadded ring sling from an Etsy seller. It was quick and easy, though not quite as versatile as the wrap. But this became our go-to for several months. It leaves one hand quite free and the other one not so free. I don't think the padded rails in other types of ring slings are really necessary, but then again I've never tried one on.

on public transportation

looking at butterflies

so comfy

sleeping in the sling while mommy eats

By the time S was 9 or 10 months, we needed a better back carry solution. So we got a mei tai - again, one of the least expensive ones on etsy, made by a work-at-home mom. This has been our main carrier ever since. It doesn't have fancy features like a pocket or a sleeping hood, but it is very easy to get her in and out of, whether front or back. Even though S is usually walking these days instead of being carried, and is happy enough in an umbrella stroller for longer trips like the zoo, we still use it occasionally.

nursing in the mei tai while being an activist

on the beach

at the zoo

being an activist is tiring

We do own one other carrier - a snugli that ML insisted on registering for before S was born. It's been used 3 or 4 times, maybe. It's just too complicated.

Crappity

Well, the last post's "tomorrow" didn't go so well. Half and half, really. The sperm made it, but the ultrasound revealed a measly 2 follicles on one side and 4 on the other. I've had another ultrasound yesterday. More bad news. 4 follicles total, all around 8-9 mm. This isn't good, I'm only 29 and maxed out on the follistim. We expected more.

So the follistim isn't stimming my folls enough. The doc suggested having a blood test to check ovarian reserve; it may be that I have endometriosis without symptoms.

We're going to continue the cycle. At most 4 eggs can be retrieved. There's usually attrition at each step along the way, so maybe 3 will be mature, 2 will fertilize, and 1 will keep developing enough to transfer. If we're lucky.

We really don't want to increase the risk of a twin pregnancy. So I'm not sure what will happen if we're incredibly lucky and have 2 embryos. 3, we could freeze the other 2 and have a good shot at a FET. But that's extremely unlikely. Freezing 1... I'm not sure that's really done. It's too likely that the one embryo just wouldn't survive thawing... And we obviously don't have a good track record with that, although it was ML's embryos that time. 7 out of 9. Yikes.

But let's face it, we're probably not going to be lucky.

When/if this cycle doesn't work, we are done with IVF. We have no more funds and we do have the option of picking a new donor, so we can do cheaper IUIs.

I really wanted the kids to have the same donor. And once we made the decision to use my eggs, the idea grew on us that it was good they'd actually be full siblings.

But really it's not a huge deal, is it? It's ok. It'll be ok. The important words in the first sentence of that last paragraph are "I really wanted the kids..." full stop.

try, try again

well, the last time we saw our heroes, we were starting a new frozen embryo transfer. we had 5 embryos left on ice.

4 of them did not survive thawing.

1 did, and was transferred, but it didn't take. i imagine that it likely stopped developing shortly after transfer. i'm not sure why i think this. i just do.

that left us with... 0. zero. none. no embryos left.

so back to the drawing board. what to do? we have very little left of our donor's donations to work with. unless we want to pick a new donor (we do not want to pick a new donor) our only real option is ivf. but whose eggs? last time, it was ML's. but that did not go so well. i am 3 years younger and with a proven egg, know what i mean? S is proof my eggs work. but poor ML. she got really attached to the idea that she could have a little bio baby. but we worked it out, we talked it out. there were many issues to consider. we decided.

me.

i am on day 4 of stim right now. tomorrow i go to find out what my follicular area is up to. hoping we see good things.

oh hey guess what we are having another logistical clusterf*ck

i don't EVEN want to talk about it

it's about the sperm going from Northern Clinic to Southern Clinic but it can't just go from there to here, it has to go somewhere else first.

whatever. i think it's worked out. tomorrow. i'll find out tomorrow. tomorrow is kind of a big deal.