Reflection @ 20 Weeks

I don't know when exactly it happened, but my mindset has changed at some point.

Not only am I not thinking that these two girls are dead, I'm acting based on an underlying assumption that they will be here, alive and relatively close to when we expect. I'm employing a whole person based on this belief. Changing rooms and schedules and things like that.

Not only that, but I realized this week with my 20-week OB and perinatologist appointments that I am not expecting bad news. I am not ramping up my blood pressure for appointments.

I know that bad things can and do happen, but I'm not EXPECTING them.

Everything I've read and heard from professionals makes me think this is weird. I'm supposed to be getting more worked up as we near the point in the pregnancy that Aurelia died. But I'm not. At all.

Maybe in part it's because I know she died at a really unusual point in the pregnancy. If you look at the fetal mortality curves, her dying at 24 weeks was just odd. So, maybe that's part of why I'm not worried?

Or maybe it's just the nature of the human spirit to be naive almost and expect a good outcome?

I still looked for their heartbeats and was glad to see them, but I had zero of the feeling of desperation as I waited. I had zero feeling of they are going to be dead. Appointments involved some jokes and calmness.

Maybe part of the early nervousness came from the fact that these two girls are such a surprise and so I wasn't mentally already worked up to be pregnant? And so I had to process that?

Maybe I'm just a stupid naive fool?

But I don't think so.

And what's interesting is the doctors seem to have arrived at this place at the same time. I scheduled FOUR-week appointments with both of them. I've been doing weekly or biweekly, so this is a huge jump. No longer worried about cervix, placenta location, implications of the iud being there at conception... I know they are still going to be doing more BPPs and monitoring the placentas and some stuff like that, but the language is starting to sound like these actions are to be cautious and to take the conservative approach more than because something bad is expected.

The next appointments are at 24-weeks. Last time, that was the perinatologist appointment where they both labelled perfect and viable and the obstetrician appointment of the word catastrophic. I imagine I will have some anxiety at this point, but I completely know that it is not rational fear and I think that will help me. And I will have the perinatologist that I like and the OB who is truly probably the best practicing doctor of any specialty that I have ever known. That and a little faith and I'm expecting even my blood pressure will be ok.

One last thought I had today. I was leaving work when I realized that these two will count as people rather than medical waste now even if they do not stay alive. This may sound dark to you, but this was a very happy and peaceful thought to me.

Life is good, I am very blessed and that's really pretty much it.


- Posted using BlogPress from my iPhone

Sense of impending doom, lifted!

May sound a bit overdramatic, but the feeling was also very dramatic.  My sense of impending doom has lifted.  Feel calm and at peace and amazingly free from an expectation of being struck down.  Crazy, huh?

So yesterday went to the OB and they both looked good.  A who is on the right and a smidge lower measured 12 even and B, on the left, measured 11 and 5.  My OB described them as putting on a cirque de soleil show in there as they were waving in sync.  Nice fact about this is they were so active that I was able to feel confident they were both alive at the same time rather than waiting for the second heart flicker. 

Big improvement from last time is the fact that the OB and the perinatologist are calling the same baby A as each other.  Last time, the OB's A was the perinatologist's B and vice versa.  This was even more obvious after we knew genders since they were boy/girl.

Speaking of genders, the perinatologist said that he'll likely be able to tell their genders at my 16 week anatomy scan there.

Today, A measured 12 weeks and 1 day and B measured 11 weeks and 6 days, so both exactly one day bigger than yesterday!

They're up to 5.54 cm and 5.04 cm measured from crown to rump.  He also did a cervical length check, because the tech at my OB's office had gotten a short measurement at 8 weeks.  Both my OB and I thought the tech was just in error, but to be safe, we had them check today.  It was 4.5 cm though, so all is good on that front for now!

The peri did blow my confidence that they were fraternal out of the water.  My theory was that between my previously producing a set of fraternal twins and 8 out of 9 di-di twins being fraternal, seemed pretty likely.  Apparently those stats on 8 out of 9 include IVF and other ART procedures and the percentage of di-di twins that are identical among spontaneous twins is higher.  I still feel they are likely fraternal though.

He seemed much less concerned about any of the causes for concern (multiples pregnancy, short gestational interval, history of preterm delivery, history of fetal demise, conception occurring with an IUD in place) that I'd gotten from the OB.  Seemed pretty laid back even.  Said we would do a little more monitoring and he might be slightly more inclined to pull them early with good biophysical profiles, but that was about it.

Their nuchal translucencies looked good, I think.  They were bigger than I remember the previous three times being, but at 1.8 and 2.3, they are still not in the abnormal range and are just a bit above the 50th percentile.  The blood part adds more info as well. 

And, I forced myself to work through my weird psychological hangup over a place called The Coffee Bean.  On my way to the catastrophic appointment, I had stopped there to get a rooibos latte.  I left it in the car to cool off when I went up for my OB appointment because I was used to them being so quick.  I never saw that drink again.  And somehow I just got a hangup that I couldn't go there.  I figure it's much better than the OB or the perinatologist or the hospital, but I'm not a fan of myself having irrational hangups.  So I decided this morning that I could do it.  And I did!  And it was good. 

It really is odd the degree to which the sense of impending doom has lifted.  Here's to hoping that it doesn't return.  Next OB appointment is in two weeks and then next perinatologist is in four.  Maybe not back to naivete, but cloud of doom definitely dispersed.

And must gain more weight.  Must.  It shall be done, rawr!

A $30 Leap of Faith

Just before we went out of town for Christmas, I logged onto the group for our local mothers of multiples group to search old forums for thoughts on car seats.  While I was on the site I happened to see a classified in the corner for 16 Dr. Brown’s bottles.  As these were the ones that have worked well for our boys, I clicked through.  It happened to be a mom that I knew from before either of us were pregnant with twins as our older sons would play together when we happened to be at the local elementary school at the same time on the weekends.  And I took a leap of faith.  I emailed her and set up buying them from her.

This may seem like a very small thing, but it was taking concrete action based on an underlying belief that two living, breathing children will join our family this summer.  This might be the normal assumption, but it hasn’t been my general mindset.  But taking that $30 leap of faith has really helped me in transitioning to a world in which I consider the logistics of a successful pregnancy and not just how to handle their possible demise.

On a related note, last week I saw the grief counselor that we had seen after Aurelia and Chiron’s birth.  I found it was really useful to talk through what I was feeling and thinking in general and I had two big realizations from the appointment that perhaps make it one of the best hundred dollars I’ve ever spent (the boys’ clothes still wins though). 

First, my anxiety/craziness is rational.  Yes, I am a bit crazy.  Yes, my body responds physiologically to my obstetrician’s office with a fight or flight reaction that is reflected in my elevated blood pressures.  This is all true, but it’s okay.  It is reasonable that I feel this way and I do not need to be upset or worried about the fact that I’m a bit crazy.  I do not need to apologize to anyone for that craziness.  I do however appreciate that those around me who know the anxiety acknowledge it and support me in reaching a positive place with it.  And as always, I’m blessed with an obstetrician who completely gets this insanity and not only doesn’t judge me for it, but goes out of her way to support me in it.  And hallelujah, she isn’t pregnant this time and so won’t be out for a maternity leave! (Not sure I should be celebrating that someone else is done, but I am ;-) ).

The second one is the one that I really think is critical and has made all the difference in the world as to my mentality and general attitude.  I didn’t write anything last week after we got back in town after Christmas and before New Years and this was primarily because I was uncomfortable acknowledging the degree of distress I was feeling and I was also uncomfortable trying to hide it.  I’m pretty much what you see is what you get.  And prior to my appointment on the 29^th, I had honestly been in a place for the previous couple days where it wasn’t just that I feared they had died, I felt sure they had.  Note, I had no reason to feel or suspect this, but I still did.  I was convinced on some non-rational level that they had both somehow died, my body hadn’t noticed and I had a missed miscarriage.

What do I think today?  Well, it’s been a week since my last ultrasound, yet I still feel confident that they are both with me, growing and with beating hearts.  I feel comfortable in the lack of negative evidence, such as cramps or bleeding, and no longer am driving myself to search for positive evidence that can’t exist, i.e. a massively expanding midsection or a development of morning sickness that I’ve never known.

So what was the realization that has resulted in this huge change?

It is impossible to distance myself from those in my own body and while trying to do so will not protect me or make me feel less pain if something bad does happen, it can prevent me from bonding and attaching as I’d like to and thus I am better off to freely give my heart to them as they already have it whether I intended them to or not.

The bottles were the first leap of faith towards that realization.  Then I added in a very helpful conversation with my obstetrician that made it absurdly obvious that she is willing to do whatever will make me feel the most comfortable and an hour of just being able to talk through what I’m feeling and thinking and I got there.  I know this will be a work in progress in terms of ups and downs and that there are still many hurdles and dark spaces out there that we may come to see.  But I know myself and I know my strength and I know I can face them when they come and so I do not need to live in fear of the unknown or produce anxiety in myself about what may be.  For whatever may be, I can manage it.

It kind of comes down to the same attitude that has caused me to feel certain about my relationship with Aurelia.  There is nothing that I can do to undo her death.  And I wouldn’t choose to undo her life, even if I could evening knowing how it would end.

I have my next ultrasound and obstetrician appointment on Monday and will be a day shy of 10 weeks then.  As always, I've produced a pretty good set of questions.  Even if they didn't want to do the extra monitoring, it might be a good idea to keep having appointments every week to two weeks just to keep the question log from getting too long.

And as a final bonus, the ultrasound shot from last week as well as the cardiac activity confirmation on each.  The tech announced when we walked in that she was just supposed to check my cervix length and not look at the babies.  I said that I was almost certain the doctor had wanted their growth checked (since we are trying to age this pregnancy as there is no LMP and this is harder with a twin pregnancy) as well as confirm cardiac activity.  She looked at a sheet of paper and said that wasn't the case.  Rather than flipping out, I calmly asked if she would just quickly confirm cardiac activity for my sake (aren't we all proud?).  She agreed and also gave us one quick shot of them.  When we got upstairs, my obstetrician was more than a bit annoyed and questioned if she had to absolutely spell everything out and questioned why we would not have want them looked at thus affirming that I was right.  As a result, she's just going to do the ultrasound herself Monday instead of sending me down to the tech.

I didn't take a shot of the cervix measurement, but it did alarm me a bit (see, I'm not completely recovered from my alarmist nature).  At first she measured 2.2 cm, which would be a PROBLEM for eight weeks.  She then said something to the effect of, "oops, didn't see the curve" and so came in at 3.7 cm.  My cervical length at 24 weeks last time was 4.37 and then at 28 weeks after preterm labor and dilation was 3.7.  My doctor wasn't concerned about the relative difference and anything over 3 is fine, so I'm not very concerned, just mainly bothered that I don't feel much confidence in the accuracy of the measurement that was taken.

I really don't think I have an incompetent cervix, so I actually don't have much anxiety on this issue, but I would like a nice clear value and so will be happy whenever the perinatologist takes over the cervical length measurement.