My plus one.

I know its been a long time since I've posted, and I have good reason.  My pregnancy flew by in between Dr's visits(2 w eek the last 2 months) and work, but it finally all came to a rather dramatic conclusion.  On April 20th, after 3 heartbreaking losses I became a "new mom" All over again. Sweet little Parker Vance came into this world at 4:49pm.  

We had been assured at our last visit that he was "At least 4lbs" But they also said his growth had petered out, so our plan to take him at 38 weeks was a go.   The last few moments of labor was the scariest, his heart rate slowed with every contraction, one even to the point of nearly stopping. I wanted my Iphone music playing loudly so I didn't have to listen to it anymore.  Before they could give it to me, I assured the nurse he was ready to come out. And he did, after just 2 or 3 good pushes. I was still pushing, in fact when they told me to stop, he was already in the Dr's arms.  He was so purple and so still, my heart broke, but he started screaming before I had the chance the think the worst.  All arms and legs, Parker weighed 5lbs and 1 oz.  His sugar was very low at first, but they gave him some formula and he evened out and stayed that way. He battled a little jaundice that first week, but other than that he is 110% a healthy little boy. His placenta was deemed the cause of his slow growth, it was very small, due most likely to the 4g4g issue.  I don't care about all of that anymore, he is here and in my arms, more baby than I could've dreamed of.  His brothers love him to pieces and so do his Daddy and I!  I will write more later, I just thought I should give a quick update!

What's normal anyway?

I've been frequenting message board about loss and the trials and tribulations of losing a baby.  And I've found that the most commonly asked question is "When will this get better".  Now that is a heavy question, and the answer is even worse; "Who knows?" .  Its hard for me to write a lot of advice on loss and coping because coping is such a personal thing. There are so many emotions that a woman(or couple) can go through after a loss.  Feelings of failure, embarrassment, anger, jealousy, and outright rage.  Of course there is also simple sadness, which turns out its never simple. 

With my 2nd and third loss my main emotion was embarrassment. I wasn't aware that a woman could FEEL embarrassed by losing a baby. But I was. I had been excited and hopeful, all of those things that a new mom should be, but I was such a fool. I should've been skeptical and cautious.. Not happy.  I realize now that this was me being a normal Expectant mom! Not a deranged fool, but you could've fooled me then.

My best advice?  My last loss was in January of 2010, so its easy for me to sit back and say this, but I will anyway; Let time do its thing. Cry when you're sad and feel normal when you can, and just let the days pass until you feel ok with your new normal.  

The techincalities of a loss. Aka the Gloom Post.

I've called my D&C(Dilation and curettage) The easy part of losing my babies, and for me it was. A D&C is defined as the dilation  of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping. It sounds harsh when it comes down to it, but for most people D&C's are not only fairly painless, but quick an easy as well.

Of course as with any medical procedure it goes without saying(but we'll say it anyway) that it is not without its complications, these complications can include risk of infection, bleeding or uterine perforation.

Like I said, for me personally My d&c's were pretty uneventful, the worst part of them was the waiting around and the knowledge of what was about to happen.  I had very little bleeding with the 1st and the 3rd d&c I had, and some period like bleeding with my 2nd d&c.

The emotional aspects of it were the worst, and there are a few things you may want to be aware of.  I do not know if this is the case with all hospitals, but the hospital I had my d&c's were Catholic hospitals. Bbirth remains were viewed as a life and I needed to make a decision about what to do with the remains.  Disposing as medical waste wasn't an option, and I'm pretty sure that I am ok with that, seeing as they were my BABIES.  They offered burial at a mass grave in the catholic cemetery near the hospital, another would be a private burial at our expense. We had no choice but to opt for the mass burial, private burials would be a bit more than we could afford.  There is something calming about knowing they were buried together though.

We were given some good advice from the hospital staff, the best advice we got was that we should name the baby. We didn't know the sex of any of them, but we were pretty sure they were boys.  It felt good to give them an identity and I recommend that to anyone who has lost a baby.  Saying "loss #1" and "loss #2" isn't as personal as saying "Tyler" or "Dylan". 

The best advice I can give anyone suffering a loss is to let time do its thing. Cry when you feel like crying, and don't beat yourself up when you are having a good day. There is no time range for healing, none at all. Keep in mind the people that love you, they may do & say things that you find insensitive, but they just don't know unless they've been through it themselves.

IUGR and another "small" problem

Wikipedia(my new found love) defines Intrauterine growth restriction(IUGR) best(and simply): "IUGR refers to poor growth of a baby while in the mother's womb during pregnancy."  A broader definition would include the fact that an IUGR baby measures below the 10th percentile for its gestational age(and may include the 10th percentile)and whose abdominal circumference is below the 2.5th percentile. 

Of course simply put, there is nothing "simple" about IUGR. There are so many possible contributing factors. Poor Maternal nutrition and lack of oxygen to the fetus are leading factors. Aafp.org(<- click) has a great list of probable causes, ranging from chromosomal abnormalities, diabetic causes, hypertension, infection and our very own blood clotting diseases.   

IUGR does have some unsettling facts that go along with it, it does increase fetal morbidity, in fact it is the 2nd leading cause of infant death. However, as the AAFP stresses, early detection & appropriate management can reduce the risk of infant death.   

Which comes to my next topic, and my clear recommendation. Detection of the problem?  Amniocentesis can help!

Amino-oh no..

Prior to this pregnancy if I was asked if I would like to have a amniocentesis I firmly objected. In my brain Amnio's were only used to rule out down syndrome and to give a person an option to abort. I am pro-life(although I do respect the opinions of others) and it wasn't a consideration of mine, not to mention there are some risks involved..   In fact when I found out my little one was small at 20 weeks, the Specialist threw the amnio word around and I must've had some rancid expression on my face because he said "I'll guess you aren't wild about that idea?"  "No, not at all" Was my response.  When, 2 weeks later, we went back and the baby had barely gained a single ounce he recommended it strongly, and we did it right then and there.  He wanted to check for infections & chromosome abnormalities. By this time we already had our 4G4G explanation, but he wanted to rule anything else out since I have had 2 relatively normal pregnancies that the 4G4G did not have an effect on.    I laid on the table while he did an ultrasound, looking for a good pocket of fluid, he poked around and made sure it is was a good spot(My placenta is anterior, so that complicated things a bit futher)  Finally they told me, "This will hurt a bit"  I am not normally a wuss, but I wasn't looking forward to this at all. There was pressure, and pain. I swear I could feel it through my feet, I tried my best not to tense up, but you do have a long needle in your gut, so you try it.. :-P .  The nurse asked if I was alright, "Yes"*moan* A few seconds later she asked if I was alright again, I Said "yes" once more, then she explained "Oh I meant him" Pointing to my dear husband who was a shade of green I didn't recognize on him.    It was over and done before I knew it, and I was advised to take it easy the rest of the day, no work for me, which was the best news I'd gotten by then.    All of my tests came out alright, and we concluded that the Lovanox was the best bet for me.   He has been growing, so hope is not lost yet.. 

I do recommend the Amnio's now. Its peace of mind.. No wondering about what could be going wrong. Its just not a fun procedure!  As I said before there are some risks involved, so please make sure your Doctor informs you of them.  Complete disclosure is a blessing. The main risk is fetal loss, but recent studies indicate this risk is about 1 in 1,600.  I was pretty comfortable with those stats, and mine went just fine. I was sore for a few days after, it was great sympathy fodder too HUH? I mean.. It shouldn't displace you for too long. If you have any concerns of course you should call your Dr. :)

What next? Oh what the heck lets talk about Blood again..

I've grown to have a love/hate relationship with blood over the last few weeks. I mean on the one hand you depend on the junk, you're not a whole heck of a lot without it, now are you? On the other hand it can cause so much trouble if you don't understand it, whats going on, or how to fix it.  I've got the "whats going on" part down, you can read my previous entry about the dreaded 4g4g Polymorphism if you'd like.   I wanted to write about a few of the other blood troubles that I've met(although not closely dealt with) along the way.  I also want to write about the "How to fix it" part of the above mentioned dilemmas.

First of all, clotting.  When I first started being tested for issues, my original Doc threw our a cluster of probably causes of fetal loss.  Most of them were thrombosis issues(read: clots) And there quite a few to choose from.  First there is "Antiphospholipid syndrome", "Factor V Leiden",  "Lupus Anticoagulant" and then of course there is the 4g4g polymorphism(which he did NOT mention, but its probably because he didn't know), which has no wiki-link. I have become jealous of those of you with wiki-links to go along with your diagnosis.. *SIGH*  All of the above accomplish the same sinister goal, coagulation of blood, in one way or another.  No sorry, not just "coagulation of the blood"; OVER coagulation, unnecessary, and excessive coagulation of the blood.

Why is this problematic, specifically for pregnant women(not only, just specifically)?  Well, when you are pregnant your body naturally produces more clotting factors, making a pregnant woman SIX times more likely to develop a blood clot than normal..  Not only that but your uterus is growing and expanding, Pushing and moving which can compress important vessels in your body, slowing the blood down and creating the potential for clotting.(click for source)   There are actual benefits to your body creating these extra clotting factors, you lose less blood during delivery. I think in a way its a lovely design... Unless of course you have an ugly friend in your body(see list of ugly thrombosis issues above).  There are ways to prevent clots, and to speed up the blood flow, and thats where my next topic of discussion begins.

"The Fix"

i was under the impression when I started taking baby aspirin that I was going to be lucky enough to not need anything but that tart tablet every day.. Boy was I wrong.  At 24 weeks my Dr started me on Lovanox. I got the Non-optimistic, Non-pessimistic, merely REALISTIC speech "This is for your benefit, not the babies since at this point in understanding 4g4g we just don't know if it will benefit HIM at all"  Not exactly a vote of confidence, but I'll take it.  The shots are taken twice daily. I've been on them almost a month and I will say its 70% mental 30% painful which are decent odds if you really think about it.  I've learned to inject in certain spots faster than others, because those hurt the most. So unless you're going for the long slow torture method, you just really wanna go "balls out" for those areas.(IMO the higher you go the more it hurts, just my opinion though ;) ) I've also come to learn the spots that I don't feel at all, but I've abused those spots in the last few weeks, so they're bruised and unpretty.. So I'm going for the fast shots right now.  All in all its pretty simple, make sure you're in a reasonably clean environment, get your hand sanitizer and your alcohol prep pads out.. I pinch the area on my belly that i'm about to "shoot up", then make sure you activate the safety shield once the shot is out of your body and dispose. I use an empty detergent bottle for my leftover goodies, they hold a ton of syringes!   I usually sit still for a moment or two because I have to "reforget" what I just did or I can't go on with my day with shuddering at the thought. lol I am pregnant after all, so dramatics come easy for me!

Anyway take heart if you're going through this with me.. Its not something I'll soon forget but in the end I hope we can all say "It was SO worth it!"

Blood blood! I'll try not to get too technical.

When my Specialist told me that I tested positive for 4g4g polymorphism of the pai 1 gene, he got blank stares in return, and if I was to guess when he realized this was my issue, he gave the lab results the same blank stares because he doesn't seem to know a whole lot about it.  It isn't rare, but its just not commonly heard of, as in it has only just begun its revelations in the scientific world. There isn't much data about it and when I googled it I got a lot of Mumbo jumbo that I couldn't really decipher. 

I do remember this from my "blank stare" conversation with the specialist; THROMBOSIS.. Thrombosis is  defined by dictionary.com as : intravascular coagulation of the blood in any part of the circulatory system, as in the heart, arteries, veins, or capillaries.  And if it helps intravascular is "within the blood vessels."  And Coagulation is defined as "to change from a fluid into a thickened mass; curdle;congeal:"   So if you add all of that together Thrombosis is a clotting of the blood inside of the veins.

*Stay with me here*

Since I didn't get a lot from googling "4g4g polymorphism of the pa1 gene" I just googled Pa1 gene.  Basically this is the gene (located on the 7th chromosome for the record)  That releases a substance in your blood referred to as Tissue plasminogen activator  or "tPA". tPA is a protein directly responsible for breaking down blood clots. tPA is commonly used in clinical medicine to treat only embolic or thrombotic stroke.(*Source wikipedia)

Now 4g5g polymorphism is more commonly known and it referred to in this wiki article . But it doesn't mention the 4g4g specifically.  LIke I said 4g4g is more newly unearthed..  From what I gather (read: I am not a Doctor so who cares what I say, this is just what I understand from reading)  4g5g decreases clotting capabilities in your body 4g4g increases your clotting capabilities. 

I don't know what the normal #g#g is, or if there is no normal, you're just one or the other.  I do know this I have 4g4g blabbity blabbity, and therefore I am more likely to clot, which having eliminated every other blood clotting disorder we can only conclude this is what is responsible for my 3 lost babies, and is responsible for my slow growing (IUGR) baby that I am carrying now. *sigh*   

I think I got a little more technical than I intended, but like I've said my goal is for someone to type in 4g4g and get a real explanation.  I know I didn't and I've been dealing with the realization that I know *nothing* for 4 weeks.  I feel a little more informed and hopefully, if you googled and got me, you feel more informed too!


My hope is, in the end, I can say "I have this, and it stinks, but I took the blood thinners and my baby made it.. So even if they tell you there "may be no hope", there is."

Lets talk progesterone

Healthywomen.org says

"Progesterone is one of the hormones in our bodies that stimulates and regulates various functions. Progesterone plays a role in maintaining pregnancy. The hormone is produced in the ovaries, the placenta (when a woman gets pregnant) and the adrenal glands. It helps prepare your body for conception and pregnancy and regulates the monthly menstrual cycle. It also plays a role in sexual desire."

I had never heard of a women having low progesterone. After my first I waited a year to get pregnant again, the first thing I did when I found out I was pg was call my Dr. He had me come in to have my progesterone checked. Typically during pregnancy they like to see your levels at 20, mine were at 9. Although this wasn't my answer in the end, I feel like progesterone is a huge place for anyone suffering repeated losses to start. It such a simple fix, pills, cream, or a suppository are the most common methods of use(i've heard of injections as well, but I don't know how common that is). There is some debate as to which is better, I've used both pills and suppositories during my pregnancies and found pills to be the easier method since the suppositories require 30 minutes of lay down after insertion.

Among the debate is when to start and when to stop taking it. Obviously If You know your progesterone is low you should start taking it ASAP. Many suggest after ovulation even. Do you know though? I didn't. I started taking it at 10 weeks during the pregnancy in question, 2 days before my missed period during my next pregnancy, and my current pregnancy I started at 4 weeks, give or take. The first two were losses, and I've been off of the progesterone for quite some time at this point in my current pregnancy. My suggestion is to become familiar with your doctor and most importantly your body and you can make the best decision for yourselves.

As far as stopping, most Practitioners will humor you and allow you to continue to take it past the 12 week mark, however if your baby is growing properly up to that point your placenta will take over the job of the progesterone and it becomes taking the meds for the sake of taking it. I stopped at 12 weeks this time, reluctantly, but my dr assured me that it wasn't necessary anymore. Talk to your doctor about how you really feel about it. A good relationship with your doctor is priceless when you are a repeat miscarriage offender.

Ok so like I said in the end progesterone isn't my real underlying issue, but it was an issue to look for in a big way.

** And as a side note I was told during this pregnancy that Progesterone is the little devil that causes morning sickness, which explains why I've never suffered from morning sickness!  So if you're puking your guts up, take heart, thats a good sign.. :-\