Sunday, March 8, 2020

2nd Birth Story - Part 2

The feeling after giving birth without an epidural was amazing. I was on a high and I couldn't believe I'd done it! It was a goal of mine that I wasn't sure I could accomplish, and I did it. I'm still super pumped about it.

We were able to do do immediate skin-to-skin, delayed cord clamping, etc. I remember delivering the placenta, and David cutting the cord. About an hour or so after the doctor left, I started feeling pain down there. The nurses thought it may be from the stitches, but I knew it was something beyond that. Finally, they took a look and discovered I'd developed a large (and painful) hematoma. Most likely it was caused by how fast the baby came, and the fact that I was on aspirin. They were able to get me on some pain medication, which helped, and then they had to put in a folley catheter since I couldn't urinate.

It was so nice being able to stay in the same room and have the baby with us. I was able to try breastfeeding and work with the lactation consultants from the comfort of the room. The only concerns we had this time with the baby was getting him to gain weight. His jaundice levels seemed ok. The more pressing concern was the pain from my hematoma and my inability to urinate. The doctor wanted to remove the catheter after 24 hours so as to prevent infection, but even after removing it, I was unable to urinate on my own. The nurse (and a student) set up a sitz bath for me, which felt good. Finally, the nurses had to straight cath me since I really had to pee. The relief didn't last long though, and I was afraid they'd have to cath me again, but finally, I was able to urinate a little (the pain meds helped), which was a big relief. Since the baby was born after midnight, we were able to stay an extra night, and we opted to leave that Thursday. 

As far as the hematoma goes, the plan was to keep an eye on it and see if my body would absorb it, while also managing pain with medication. The OB wanted to follow up with me in a week. 

We checked out around 2 in the afternoon, stopped to get diapers, and then headed back to the house where we were planning to meet the birth photographer so she could take pictures of the toddler (and my mom) meeting the new baby. It was absolutely the sweetest thing to see my daughter meet and love on her baby brother; it brought me to tears.

The past (nearly) four weeks have been a whirlwind full of appointments with the pediatrician, blood draws (and a few jaundice scares that turned out to be ok), appointments with lactation consultants, the chiropractor, a cranio sacral therapist, etc. At my one week follow up with the OB, she said part of my hematoma had gone down, but another part may have swelled more, so she wanted to see me in another week and then possibly surgically evacuate it. The following week, I went back in and we went ahead with the procedure. Unfortunately, that meant that the wound had to be packed (by someone else) twice a day, which was a painful and tedious process. Luckily, after a week, I went back, and she said the wound had healed/closed, and I no longer had to pack it. Right now, I am (mainly) off pain medication, which is a big step for me, though I'm still in pain.

He is such a good baby. He sleeps really well, and really only cries when he's hungry. I often have to wake him just to feed him every few hours. The toddler has been adjusting well. She loves her baby brother and constantly comments about how "cute" he is or says he's "sad" when he cries. It's a big of an adjustment with her getting used to my mom being here and helping to care for her, and also shuttling her to and from daycare. I'm honestly a little worried about how I'll handle things when my mom leaves and I need to care for both of them by myself while David's at work, but I think we will slowly get into a routine. 

Right now, I'm just going to soak in the time left we have with my mom here, enjoy my naptime snuggles with the baby, and continue recovering.

I just love my little family.

2nd Birth Story - Part 1

On Friday, February 7, 2020, at 9:40am, I went in for my 37 week appointment at my OB's office. I had had a couple borderline high blood pressure readings, but ok bloodwork, but that morning, my blood pressure was at 140/80 and I was 2 cm dilated and 50% effaced. She had me do an in-house urine culture and then go get my blood drawn. She wanted me to move my following week's appointment up earlier (since she'd be going out of town over the weekend) and if I had another high blood pressure, she'd induce.

At this point, I was ok with being induced, since we'd already made it past my first baby's birth date, and we were at a safe time to only concern was who would watch my toddler, since my mom wasn't planning on coming until a couple weeks later. I talked to my parents and my mom was able to change her flight to come a week early, that Sunday, February 9, 2020. I went through the weekend feeling a little nervous about my blood pressure and urine protein level, and kept wondering if I should go to the hospital or just wait things out. Ultimately, I decided to wait until Monday morning, February 10, 2010...but before I could even call the OB office, I got a call from the nurse with blood test and urine results; I was trending toward preeclampsia so the doctor wanted me to go in at 1:30pm, and if I had a high blood pressure, I'd go to the hospital and be induced. The reading ended up being 148/100, one of my highest, and I was diagnosed with "gestational hypertension" and was sent to the hospital. David and I had planned for this, so we'd brought our bags and had my mom and the toddler all set and taken care of at home.

I was immediately admitted and we got settled into our room (2511). To my relief, I was reassured that since I was not in the preeclampsia stage yet (just gestational hypertension), that I would not need to be on magnesium this time. My amazing doula, Kristen, arrived shortly after I was admitted. The first induction gel was administered at 3:25pm (3 cm, 70% effaced, soft anterior). After waiting an hour for it to kick in, we went to walk around for an hour. We talked to Kristen and agreed for her to go home for a short time before coming back for the night. They administered the second gel at 5:50pm (same stats), and we repeated the process. I developed a headache at 6:36pm and started to feel the start/stop of contractions at 6:39pm (though they'd been going on for awhile). The third gel was administered at 8:26 pm (3 cm, 80% effaced, -2). At this point I was wondering if they were going to have to administer pitocin (which I didn't want for various reasons), but by 10:55pm, I was really starting to feel the contractions and I was 5 cm dilated.

At 11:11pm, I was between 8-9 cm and at this point, things were very intense and painful. I used my "code word" several times with Kristen and David (which meant I wanted pain relief), but thankfully, Kristen and the nurse (Kerissa) were able to talk me through things, and suggested I get into the tub. (This is when the birth photographer arrived too, just in time!) I immediately felt better in the warm water, though I was told I'd need to get out of the tub sooner than later since I was progressing so quickly. (When I got into the tub, I felt the need to push already.) By the time I got out at 11:23pm and they checked me again, I was 10 cm dilated!

At this point, the doctor had arrived, and it was show time. I couldn't believe I'd made it to this point without an epidural. I was lying on my side, clutching the side of the bed in the fetal position with my legs clamped shut. I didn't want to move, but finally I willed myself to lie on my back, which was a better position for delivering. It was time to push, and I could only manage to get myself to push for short counts of time. I kept thinking to myself, "why can't I push for longer? I feel like if I can just hold out for longer, he will come on that last count." I remember being super annoyed with the fetal monitor around my belly, and wanting it to be removed. The doctor tried to help me with pushing, telling me to hold my breath, push, and then breathe out. She told me to curl my body over the baby. Finally, things clicked. I realized I needed to continue holding my breath when pushing, rather than breathe out on the push. After the second time, to everyone (including the doctor's) surprise, he was here! After about 30 minutes of pushing, he was born at 12:08am, and he was absolutely perfect.

Saturday, October 13, 2018

Pre- and Post-Egg Retrieval - What Worked for Us

I've been thinking about writing about the lifestyle/diet changes we made pre- and post-egg retrieval as well as pre- and post-transfer. There are some things I wish I had known about before we got started (like cutting out alcohol and caffeine several months beforehand), so I thought it might be helpful to share these with anybody who is getting ready for an egg retrieval!

Now that I have 2 egg retrievals under my belt, I thought I'd share what worked for us. I will preface this by saying that I am not a doctor, and that not everything I am sharing was specifically recommended by my doctor. A lot of what I ended up doing came recommended by other people going through IVF, research studies/articles, other fertility clinics, etc. I will try to link to resources where I can. Please don't feel like you have to do any of these things, or that you messed things up by not doing these things. My thought process is this: Since we are investing so much into this--financially, emotionally, physically--I want to do whatever I can (reasonably) do to improve things, whether that is egg/sperm quality, number of eggs retrieved, quality of embryos, implantation rate, etc. I figure, even if there isn't scientific proof behind things, if it's not going to hurt, why not give it a shot so that I don't regret things later? I'd rather know I tried my best than live with the "what if?" later on. 

Scroll down to the bottom for Conclusions, or a recap of what I discuss in this post.

Exercise: 3 Months and Prior
This is absolutely something you should talk to your doctor about. They will let you know if you're at a healthy BMI, and what you can do to help achieve one. Doctors generally recommend achieving a normal BMI, as "obesity has been found to alter mitochondrial function and increase oxidative stress, leading to reduced fertility and egg quality. It can also alter hormonal balance, disrupting ovulation." If you have some time before starting Stims--maybe you're saving up money, or waiting for a good time--this is a great time to start exercising and improving your overall health.

Exercise: During/After Stims
You should definitely consult your doctor about exercise during/after Stims, and during/after the 2WW. My nurse said I could continue my normal cardio/strength training during the early stages of injections (days 1-5), but by day 6, I would want to decrease intensity and focus on non-impact exercises (yoga, light elliptical, swimming, etc.). The main concern with strenuous exercise during Stims is that the medications will cause your ovaries to enlarge as the follicles start growing. According to the Southern California Reproductive Center, "You need to protect your ovaries during this sensitive time and avoid strenuous training. Your IVF cycle is not a time to push any limitations...Your body is already working extremely hard during your IVF cycle, so take the time to acknowledge yourself for that." One thing to think about after egg retrieval is the risks of ovarian torsion or ovarian hyperstimulation syndrome (OHSS), so following your doctor's orders and avoiding strenuous exercise are very important here.

Diet: 3 Months and Prior
I read an article that said that "given that egg and sperm maturation takes up to 3 months, it is ideal to stop/reduce alcohol consumption for at least three months before attempting pregnancy." I didn't know this prior to my first egg retrieval, so I had a minor freak out and wrote all about it here. I came to the conclusion that it wouldn't hurt to reduce/eliminate alcohol/caffeine in the 3 months prior to IVF (for both you and your partner), but that ultimately, it is not going to drastically compromise your chances. Knowing this information, we eliminated caffeine/alcohol from our diets 3 months before our 2nd egg retrieval, and I think it did make some improvements for us!

My nurse did encourage me to take a prenatal vitamin before we started Stims. Memphis fertility specialist, Dr. Amelia Bailey, recommends that "a woman planning pregnancy should start taking a prenatal vitamin with DHA 6 months before conceiving." She (and other other specialists) also recommend Coenzyme Q10 (CoQ10), DHEA, DHA, folic acid (as needed), and Vitamin D (as needed). CoQ10 is helpful for overall sperm and egg health. Vitamin D insufficiency and deficiency in women attempting to get pregnant has also become an increasing concern. (This article is really helpful if you're thinking of taking any of these mentioned vitamins/supplements.) I personally just took a prenatal vitamin, fish oil, and Vitamin D supplements before and during Stims.

According to Dalene Barton-Schuster, Certified Herbalist and Birth Doula, "The life cycle of sperm, from production to maturation for ejaculation, ranges from 42 to 76 make a plan for increasing fertility and boosting sperm health, you should start at least 2-3 months prior to giving sperm for IVF." CoQ10 is said to improve men's sperm motility and count. There are also many articles claiming that selenium, Vitamin C, zinc, and other vitamins/supplements can help improve male reproductive health. Three months prior to our 2nd egg retrieval, David cut out caffeine/alcohol. He also took a multivitamin, 200mg of Ubiquinol (CoQ10), and the Daily Wellness Company's Fertility Blend for Men daily. The Fertility Blend for Men is something I stumbled upon a few weeks prior to our first egg retrieval. It has great reviews online, and contains many of the recommended supplements to boost male fertility, such as L-carnitine, Vitamins B/C/E, zinc, and selenium.

Here's a helpful article on pre-conception vitamins written by Sarah Yang for the Bump. Here is an article on nutritional guidelines for your fertility treatment published on the Southern California Reproductive Center's blog.

Diet: During/After Stims
My nurse told me that during Stims, "the recommendation for caffeine intake is less than 600 mg" per day and that restricting "all caffeine intake is preferred." She also said that "no alcohol intake is preferred/recommended." I checked and she said that it would be okay to drink caffeine-free Diet Coke and decaf coffee. I had eliminated diet sodas and artificial sugar from my diet once I became pregnant, so it was easy for me to continue avoiding it during my 2nd egg retrieval, though I've added in the occasional Diet Coke or Splenda now that I'm done breastfeeding. (We don't plan to do our next embryo transfer for awhile.)

I think that eating healthy is something that is great to do now for yourself and for your future baby! There are a lot of diet changes you need to make when you become pregnant, so it doesn't hurt to start getting used to those changes now.

I had never given much thought to holistic medicine (except for chiropractic) prior to IVF, but my fertility clinic actually has an acupuncture facility right in their building, so it was something I looked into. Some studies have shown that "when used in conduction with Western fertility treatments, acupuncture increases conception rates by 26%." Others say that "acupuncture is not harmful and most of those so treated swear by it. For the nay-sayers, what can be said with certainty is that at the very least acupuncture has a 'feel good' aspect to it and in most, evokes a psychological benefit that should not be discounted." My thoughts are that it's not going to hurt anything, so why not give it a shot? I didn't do acupuncture prior to my first egg retrieval, but I did do it for about a month prior to my 2nd one, and I think it did make some improvements for us the second time around.

My main suggestions for Before Stims (preferably 3 months or prior):
  • Exercise and get to a healthy BMI
  • Eat healthy--limit/eliminate caffeine/alcohol, fake sugars, trans fats, processed foods, etc.
  • Take prenatal/multivitamins, CoQ10, and other recommended vitamins/supplements
  • Acupuncture (talk to your acupuncturist, but you can start 3 months prior, or even 3-4 weeks prior to Stims)
My main suggestions for During/After Stims:
  • Limited non-strenuous exercise (as discussed with your doctor!)
  • Continue to eat healthy--eliminate caffeine/alcohol, fake sugars, trans fats, processed foods, etc.
  • Continue taking prenatal/multivitamins, and other recommended vitamins/supplements as needed (and recommended by your doctor)
  • Acupuncture (talk to your acupuncturist about what they recommend for during Stims and leading up to the embryo transfer...)

Tuesday, August 15, 2017

Our Birth Story - Part 2

Everything that happened immediately after the birth is a bit of a blur. One of the side effects of magnesium is extreme drowsiness. I remember holding baby skin to skin, David cutting the cord, breastfeeding, and then at one point, both myself and the baby getting extremely cold. I remember them taking her away from me when this happened.

A few hours later, the nurses came in and said they wanted to try to help me move down to the postpartum floor, but I was so sick that I was unable to get out of bed. Every time I sat up or tried to get out of bed, I would get so lightheaded and almost pass out. At one point I just started throwing up, so they let me stay in bed a little longer until I was feeling a little better. Eventually, they got me down to the postpartum room, which I must say, was a lot less glamorous than the labor and delivery room. The second nurse I had wanted to put me back on high blood pressure medicine, which I remembered my labor & delivery nurse taking me off of. When I questioned her about it, she mentioned another doctor's name (not my doctor) so I immediately got concerned. I called the Labor & Delivery department and they spoke to my doctor who spoke to the nurse and got things straightened out. I was worried we got off on the wrong foot, but that nurse turned out to be the nicest one.

The next few hours were torture because I was unable to get out of bed to go see the baby, and they were unable to bring her to me. They were concerned about her weight/size and at the time, I was adamant about not wanting them to introduce a pacifier, nipple, or formula. I wanted to exclusively breastfeed, which is pretty difficult to do when you can't physically be with your baby. They kept me on the magnesium for 24 hours after the delivery, so for the next 24 hours, I laid in bed with a catheter (which they inserted while I was awake), trying to keep food down. A nurse and then an assistant came every hour to check my vitals, blood pressure, uterus, etc. Someone from phlebotomy also regularly came to take my blood. In the wee hours of the morning, a girl from phlebotomy came and missed my vein twice and I just lost it and broke down in tears. I was worried about feeding the baby, and I was only making tiny amounts of colostrum, which David painstakingly helped collect into a small syringe which he would then take down to the NICU. Both her nurse and doctor came up to see me in my room to assure me she was doing ok and they were taking good care of her, which meant so much to me.

A few hours after they took me off the magnesium, I was finally well enough to be wheeled down to the NICU to see the baby. Oh my gosh, I fell in love! It was difficult to see her hooked up to so many tubes and monitors. She was hooked up to a Bili Blanket due to jaundice, and they had the cutest little eye mask on her. When David and first seen her like that, he returned to my room and told me she was getting the "blue light special." The nurses even drew some eyelashes on her eye mask, and so I always joked that she was tanning in a tanning bed.

After her weight fell to 3 lb. 11 oz., they decided to put in a nasogastric (NG) tube to help feed her and were also giving her IV nutrition. I tried to breastfeed, and she seemed to be latching, although she kept falling asleep at the breast. One night when David and I were collecting my colostrum, we noticed that it kept flowing! He suggested I try pumping again (when previously I had not pumped out anything), so I gave it a shot, and to my surprise, collected a decent amount of milk! From that moment on, I was able to pump more and more. I was discharged from the hospital on Monday, 6.26.17. Thankfully, the NICU had a family room available for David and I to stay in, which was right off the nursery, so we moved right in. Luckily, the dogs were still boarding at the vet's kennel.

After making some progress and gaining weight, they decided to try a day without the NG tube and strictly breastfeeding. This was the most exhausting day. The nurses called me almost every hour (sometimes two) to come feed her when she awoke. Unfortunately, the next day, she had lost all the weight she'd gained which meant she was not transferring milk. The nurses and lactation consultants kept assuring me that she would get better at breastfeeding as she got older/bigger, and not to get discouraged, but I was so upset and felt like I had been starving my baby. The doctors made me feel much better though, so we talked about a few alternatives such as bottle feeding, formula, and a _____. One evening, the nurse helped me take a pre-feed and post-feed weight to see if the baby was transferring milk. Unfortunately, the scale was inaccurate and she actually weighed less the second time. Next, we decided to try the ____. The lactation consultant tried a pre- and post-feed weight again, but she remained the same. I finally relented to giving her a bottle. The nurse and doctor helped me come up with a compromise: I would breastfeed her for ten minutes, and then give her a bottle of breastmilk. David and the nurses had talked to me and made me realize that yes, it would have been nice to strictly breastfeed as planned...but things didn't go as planned. She came 5 weeks early, and with that, some of my plans had to change. I realized that this didn't mean I couldn't still breastfeed her later. The goal was to get her to a healthy weight, so that she could go home and we could learn to breastfeed as she got older/bigger. The next few days, she started gaining weight and doing a lot better. The nurses removed her IV (which kept coming out), and she was even taken off the Bili Blanket (though she was later put back on). After nine days, the doctor felt she was ready to go home! It was perfect timing. The last night she was there, my mom had flown in, and it was the first night that the family room was unavailable. We were able to take my mom home and I got a good night's rest in my own bed. The next day, the nurses told me the baby had passed all her tests (hearing, car seat etc.) and we were finally able to take her home in a car bed (since she was still too small for her carseat). 

The past 6.5 weeks have been exhausting, but amazing. My mom was able to stay with us for a little over 4 weeks (7.1.17-8.2.17), and she was a lifesaver. She cooked for us everyday, took care of the baby so we could rest, watched the baby so we could go out on a couple dates, and helped me re-organize the house (including multiple closets and cabinets). I was a mess when she finally had to go home. I didn't realize how exhausting caring for a newborn can be. The baby has not been wanting to sleep in her crib or pack and play and instead prefers to sleep in our arms or the rock and play, which is not ideal for long-term sleep. We finally got this co-sleeper bassinet which has helped a little. She still grunts and groans a lot during her sleep, but the good thing about it is that if she cries, we can reach over and soothe her with a pacifier, or pick her up to feed her without getting out of bed. 

Last week, David's parents and our sister-in-law came to meet the baby. Our sister-in-law is a photographer back in NC where we used to live, and I was so excited to fly her out here to take photos of the baby and the nursery. David took his family to Sedona and to the Grand Canyon, and we got to spend a few nights together eating dinner and just catching up. This is my first full week home alone with the baby. Yesterday, I took her out to run some errands including stopping to get my tires fixed, and going to the grocery store and Target. Everything with a baby takes extra time, and I feel like I'm always late to every appointment. I'm a slave to the breast pump, and I'm running on only a couple hours of sleep, but I could not be more in love with this tiny human being. She is amazing. :)

Monday, August 14, 2017

Our Birth Story - Part 1

On June 23, 2017, at 10:10am, I went in for a routine NST at my OB's office. I had had a couple of high blood pressure readings and some higher-than-normal creatinine levels in my blood work, so the doctor had put me on bed rest and had me coming in twice weekly for NSTs. I also had low fluid, so I was drinking water like crazy (nearly a gallon per day) and it seemed to be working. At this appointment, my blood pressure measured extremely high and there was protein in my urine, so the doctor sent me to Labor & Delivery for blood work and monitoring.

As I drove across the street, the thought occurred to me that I could be induced that day and that baby would be here 5 weeks early...but at the same time, I thought that maybe my blood pressure would come down and they'd just send me home. I called David and told him what was going on. He, of course, wanted to come to the hospital to be with me, but I told him not to worry about it yet, because I still had the hope that I'd be sent home. While in triage, they monitored my blood pressure, which was not coming down, and ran some blood work. Finally, around 2:43pm, the results from the blood work came in, and the nurse informed me that the doctor wanted to admit and induce me! The doctor came to see me and informed me that I had reached the severe preeclampsia stage and that she would induce me that night. She would come back in the morning, as she didn't expect me to go into labor until then.

Looking back on it now, I was extremely calm given the circumstances. I told David not to come yet, because even with inducing, it could take 1-3 days before I'd go into active labor. Instead, I gave him a list of things to do at home including washing baby clothes, packing my hospital bag, and bringing the dogs to the kennel. I was moved into one of the labor and delivery rooms, and I got settled in. My good friend, Amy, came to visit and brought me a phone charger and some treats. I was so glad she was there, because they put me on IV Magnesium Sulfate which was awful. I immediately got really hot and uncomfortable. Then they started inducing me around 5:20pm using prostaglandin gel. Around this time, David arrived at the hospital, so I felt a lot better. At 5:27pm, the baby was at -2 and I was 1 cm dilated, 60% effaced. They applied a total of 3 gels every 2 hours (7:30pm, 9:30pm). At 7:49pm baby was -3, I was 1-1.5cm dilated 60-70% effaced. To be completely honest, much of that night is a blur to me, but I remember that I started feeling period-like cramping after a couple gels, and then full on contractions in the middle of the night. At around 1:00am, I felt dampness and asked a nurse to check if my water had broke, and it had--on its own! At 2:56am, baby was -2, and I was 3.5 cm dilated, 75% effaced. They gave me Pitocin at 3am.

While this was going on, David was sleeping. I didn't want to wake him up because I felt I had time and could power through some of the less painful contractions until full on labor started. At 6:03am, the contractions were approximately 4 minutes apart and becoming more and more painful. I had the urge to push/bear down whenever the contractions came, even though I knew I should avoid doing so, so as not to inflame the cervix. When the contractions would come, they would get progressively more and more painful and peak, and then diminish, just like a bell curve. At the peaks, I felt myself clutching the bed rail as hard as I could. (I now know that the baby was a lot lower than we thought, and I was progressing much quicker than we all thought, so the pressure I felt down there was really baby's head pressing on my cervix.) At this point, David was awake and texting my doula for me, because I could no longer do it myself. At 7:19am the nurse checked me again and said "She is definitely a 6." At this point, I was in so much pain and ready for the epidural. (Up to this point, I had been refusing it because I wanted to go as long as I could without it so as to avoid a c-section.) The on-call anesthesiologist was at home and needed to get to the hospital, and then administer the epidural, which would take 45 minutes to begin working! I was so happy to see him when he came in at 8:02am. (-2, 6 cm, 80%) I don't remember much, except that he was extremely tall and that not long after he administered the epidural, I felt so much better. I was finally able to take a nap. The plan was for the doula to come around 10:30-11:00am, when it would be closer to pushing time...but at 9:09am, the nurses told me I was fully dilated (10 cm) and would start pushing soon! At 9:40am the doctor came and I began pushing, and baby was born at 9:59am and 31 seconds!