Posts Tagged miscarriage

So, you did IVF and it worked. What now? (preg ment)

This post is an expanded version of a previous blog post on The Stirrup Queen Ballroom.

I can’t say I am really an expert on this topic, since until now I have never managed to make it past the 7th week.  But I do have a few small suggestions.

1. Some of the scarey things that could happen to you don’t actually mean a thing with regards to the health of your pregnancy.

The first and most important suggestion, which you really must follow, especially if you are spotting or your symptoms are going away and you are afraid you are miscarrying, is to race right over to  A Beautiful Day and read her classic and extremely informative post: When IVF Works: What the RE Doesn’t Tell You.  Go ahead, go do it, this post can wait.

Now wasn’t that exceptionally informative and reassuring?

2. You might not feel 100% happy, and that’s OK.

So, now that you’re back, let’s sit down and have a heart-to-heart about how you are feeling.  Giddy?  Excited?  Elated?  If so, good for you!!

But if you have a lengthy infertility battle behind you, and especially if that battle involves prior losses, here are some words that might also describe you: terrified, numb, freaked out, anxious, sad, angry… unfortunately, these emotions, too, are par for the course for the post-infertility pregnancy.

In my recent 2ww, I had accepted my infertility and was OK with whatever would happen.  As I said to my friends after the transfer, “60% chance I start building my family with DE, 40% chance I start building my family through adoption.”  When I POAS’d the day before the beta, while I was waiting for the test I sat with my eyes shut, imagining a blank result and chanting mentally “We are going to adopt!” But within 30 seconds my husband said “There’s a second line!”

My first reaction: incredulity.  My second: shock.  My third: numbness.  I sat with that numbness for a day or so, poked at it a bit to try to find out what was going on, and unearthed a deep, smoking pit of terror.

I was OK with a BFN.  I was OK with moving on to adoption.  I am not OK with losing a baby once it has shown signs of preferring to stick around.  The stakes are now much, much higher.

And so I wake up at 3 AM and stare at the ceiling and wonder whether there will be a heartbeat at the 7w ultrasound.  Whether we are enjoying the first short weeks of a very long acquaintance.  Or whether we are already getting ready to say good-bye to the little life that we created.  Dr. Google says insomnia is a common early pregnancy symptom, according to What You’re Not Expecting When You’re Trying to Expect.  Maybe Mr. Nishkanu is pregnant too because most nights when I am awake, he is lying awake right next to me.  He is normally a pretty resilient, unworrying kind of guy but now he is looking drawn and tired.

And after 2 or more years of finally being OK being around pregnant women and young families, I find myself again reverting to that earlier heated jealousy of pregnant women.  Yes, I am ashamed to admit it, but I am jealous of pregnant women who are farther along than me, who can be more sure than I am that their baby will live.  Today I saw a woman in her 4th or 5th month, wearing a tight shirt that showed off her mini-bump, looking happy and energetic, and I thought to myself, “She has probably never had a miscarriage. She probably thinks everything will be fine.  And everything probably will be fine… for her.”  Yeah, ok, I know it is time to get a grip.

But my point is,  if you are feeling negative emotions instead of the sense of elation you expected to feel, this is totally normal for post-loss (including post-infertility) pregnancy.  If there’s one thing a person learns from infertility, it is that the dice don’t always roll in your favor, and there are no guarantees now, either.   To be honest, I think to some degree the post-infertility pregnancy attitude is simply more realistic than the naive innocent person’s.  Yes, it could go wrong.  And it could break your heart.  Life is like that.

3. There are things you can do that can help to make you feel a bit less anxious, if that is a problem for you.

Nevertheless, after some initial hyperventilating panic, I started to find some things that made differences for me – small differences, but important ones.

I found this article on dealing with fear in post-loss pregnancy incredibly helpful, especially this piece:

“When a fear is a remnant of past experience, it isn’t necessarily a predictor of future events. Your worries are not foolproof evidence that something terrible is actually going to happen. How can you tell? Try to separate out which fears are arising from your imagination and memories of what happened before, and which fears are arising from cues you are actually observing or tuned into. If a fear is coming out of imagination or memory, discount it. It’s not real.”

When I read this, it really helped me to make a mental separation between the fear and trauma from past pregnancies and the current one.  This pregnancy isn’t necessarily doomed, just because the last ones were.

I also remembered that one characteristic of anxiety is that it is often based on desperate attempts to run away from the frightening emotions that are driving the anxiety. Sometimes it helps to stop running, face your fears and clarify them, and find out what you’re really afraid of, rather than leaving them as a big, foreboding, unclear mass.

When I actually sat still and let myself really feel the bad feelings that were welling up instead of covering them up with numbness and racing thoughts, I realized that part of the issue was that I am still really traumatized by the awful D&C that I had after my last miscarriage. It was a collision course of incompetent and uncompassionate care – even Mr. Nishkanu is still traumatized from watching me cry while a bumbling nurse tried over and over again to place an IV in my hand, until I started passing out from the pain (at which point she started complaining about me being a bad patient). I promised myself that if I have a miscarriage this time, I will find compassionate, competent caregivers, and if any of my health care providers start causing me unnecessary pain or treating me rudely I will insist on getting treatment from someone else. Once I had done that, I felt a lot better.

As Katie suggested to me, some women find it helpful to repeat positive  affirmations to themselves, such as “No matter what happens, I am pregnant today,”  “My baby has a good chance to live,” or “My body is taking care of my baby’s needs.”  They work best if they are things that you can really believe – if you are scared of a miscarriage “I won’t have a miscarriage” probably won’t do much for you, but “I will find peace, whatever happens” might.  You should note when constructing an affirmation for yourself that your subconscious doesn’t understand “not”, so something like “I will not let fear destroy my pregnancy” might get turned subconsciously into “I will let fear destroy my pregnancy.”  It’s therefore best to formulate your affirmations as positive statements, eg. “It’s safe to enjoy my pregnancy.”

A lot of women who have worries about their pregnancy get comfort from living one day at a time, reminding themselves that no matter what happens, they are pregnant today.   It can also help to break the pregnancy up into smaller goals – make it to the second beta, make it to the 7w ultrasound, make it to the end of the first trimester… and celebrate every small victory you make it through.  From my experience with miscarriage I can say that I never regretted the time I was happy and I thought the pregnancy would work.  If anything, I wished that time had lasted longer.  So I don’t think you need to feel that if you are enjoying your pregnancy now that you will regret it later if something goes wrong.

I find The Anxiety + Phobia Workbook a good source of longer-term coping strategies. I am working on the strategies suggested there for consciously blocking obsessive worrying but I’m not particularly good at that yet…

Being kind of a research geek, I also found it comforting to read about Denise Cote-Arsenault’s research on how women who feel when they are pregnant after loss in an attempt to educate health-care providers about how they should treat these women. Her article “One Foot In, One Foot Out” explains the coping mechanisms that women use to deal with post-loss pregnancy. My favorite part of the article was this:

“Although the metaphor, One Foot In – One Foot Out [i.e., that women do not fully commit to the pregnancy], seemed ubiquitously applicable, each woman’s response and situation were quite unique. These differences were easily shared and accepted by the other participants, sending the message that getting through the pregnancy was so difficult that no one would pass judgement on how it was managed. How to ‘do’ pregnancy was certainly individual and each woman, not others, knew what was best for herself.”

And that really matters here.  In the end, each of us has to find her own way through – there is no one “right” way for anyone to approach pregnancy.

You might find some comfort out of some of the other measures I mention in my post on Anxiety and Infertility.

If anyone has additional suggestions I would love to hear them – please add in the comments (lord knows I can use some more suggestions myself).

4. You don’t have to read the dreaded pregnancy books to find out what you should be doing, just this next section.

I don’t know about you, but I can’t stand to read regular pregnancy books because they are all so dang happy and positive.  In fact, they seem to presume that you actually will have a baby at the end.  What a crock!   I therefore asked a less infertile friend of mine to report back what you are / aren’t supposed to be doing while you are pregnant.  Let this tide you over until you can stand to look in those books.

  1. Don’t eat: raw or undercooked: fish, meat, eggs (including homemade mayo or soft-boiled eggs), cold meat (including luncheon meat) unless you heat to steaming before popping it in your mouth, raw milk products, moldy cheese (e.g. brie, blue cheese), artificial sweeteners, alcohol.
  2. Take your prenatal vitamins with 800 mcg folic acid.  Also take a calcium supplement, or your teeth and bones will start to suffer while your baby is making his/her teeth and bones.  Most prenatals do not provide enough calcium by themselves.
  3. Do not get overheated (whirlpools, saunas, exercising in hot weather, etc.).
  4. Avoid all your favorite illegal drugs.  Check with your doctor before taking over-the-counter medications. If you are smoking, try to stop.
  5. It’s probably a good idea to take fish oil capsules, but check that they have been tested for mercury first.  In general, fish would be good for your baby’s developing brains if it were not full of toxins; you need to be careful what you eat and it is a bit complicated.  The guidelines for which fish are OK to eat are here.
  6. Reduce caffeine consumption to the equivalent of 1 cup of coffee per day.  And I don’t mean one of those Starbucks Grande cups either.  Be very careful with herbal teas, because many ordinary herbal teas such as chamomile or lemongrass are bad news to drink while you are pregnant.
  7. A healthy diet with lots of fruits and vegetables, low-fat protein sources, and unrefined carbs is always a good idea.
  8. If you are feeling nauseous, frequent small meals are a good idea.  If you are feeling really really nauseous then just focus on getting in enough calories and don’t worry about general nutrition.  “Enough” calories is generally about 300 more calories than you would usually eat.  But it’s not unusual, if you have severe morning sickness, not to gain weight or even to lose some in the first trimester.  Your baby won’t starve, it gets first dibs on the nutrients.  But definitely talk to your doctor if you have any concerns or if you’re having trouble keeping food down.
  9. It is generally OK to exercise when you are pregnant, in fact it is a good idea.  Check with your doctor about the limitations they would have for you.  Chicklet has a great post on what generally is/isn’t a good idea when it comes to exercising during pregnancy.

5. It is OK to complain.

If you have been infertile for any period of time you have probably gone through a period of severe annoyance at women who complain about their pregnancies, and thought to yourself “I would gladly trade my infertile state for your nausea, lady” or even “God, if you let me get pregnant, I will not complain about anything.”  Now a miracle has happened, you have your nausea, and you know what?  It kind of s*cks.   Granted, it doesn’t s*ck anywhere near as much as not getting pregnant does, but that doesn’ t make it a walk in the park either.  It is extremely common for infertile women to feel that they should not complain about their pregnancy, that they have to be happy about all the weird things that happen to their bodies and all the discomforts and anxieties that come with it.  This is not my attitude.  Yes, you should probably not expect much sympathy from people who are suffering from infertility, and it would probably be kind to take your complaints elsewhere.  But I don’t see any reason why, just because you got the short stick and had to walk a trail through hell to get to pregnancy, you now also have to draw the short stick and don’t even get to complain.  Complain away, just be sensitive about who you complain to.

p.s. If you don’t believe me, then please ask A Beautiful Day.


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What to think about when you’re thinking about peeing on a stick

So, you had your IVF cycle, and now you’re in the hell that is the 2ww.  And (a) you are sure you are pregnant and/or (b) you can’t stand the not knowing, so you’re thinking about doing a home pregnancy test.

I have for you a cautionary tale.

Now don’t get me wrong, I am not philosophically opposed to POAS (peeing on a stick).  My personal belief is that one should always POAS before the beta, because do you really want to have a heart attack every time the phone rings on beta day, bust out into tears while talking to the nurse, and then have a hysterical crying jag right before some important meeting because the nurse chose that time to call?  I don’t think so.  No, you want to have privacy and plenty of time after finding out the result to either celebrate with your sweetie or to lean on each other’s shoulders as you plumb the depths of some serious depression.  But in my opinion the POAS should happen as close to the beta as is possible while still leaving the necessary private dealing-with-the-news time.

Let me tell you how I came to this conclusion.

On my very first IVF cycle, I had realized the necessity of the therapeutic pre-beta POAS, and the time I selected for it was the Sunday before my Tuesday beta.  That was late enough that I could be confident of the FRED results, but left plenty of time, if necessary, to mourn with the sweetie before the workday began on Monday.  I POAS’d, and it was negative.  And mourn we did.  For several hours.  Then we somehow scraped ourselves together and made it through the rest of the day.

Tuesday morning for some reason I decided to POAS again – I guess under the theory of you never know.  And for sure you never know, because this time – this time it was positive.  And I had never, ever in my life seen those two pink lines.  Time for a celebration!  Woo-hoo!  All the crying and moping around had been for nothing – what a waste of time and emotional energy!

Then on Tuesday afternoon I got the call from my clinic.  My beta was 48; the clinic’s cut-off for a viable pregnancy was 50.  It was the start of low beta/low doubling hell, which dragged on for weeks – long enough that an RE at the clinic suggested that he give me a shot of methotrexate to “help the process along”.  Fortunately, I had recently discovered A Little Pregnant, so I knew what “help the process along” was a circumlocution for, and how completely not safe it would be to have a methotrexate-induced abortion while my husband was out of town and there was no one to take me to the ER if necessary.  I miscarried naturally the next week.

If there is something I learned from this series of events, it is that peeing early doesn’t give you any certainty. You can have a negative even though you are pregnant.  Worse, you can get a positive and actually be pregnant but it is irrelevant if the pregnancy does not stick around until beta day, or only shortly thereafter.  And at this point in my reproductive history crap pregnancies that yield positive sticks are a dime a dozen.

Note: after this experience Mr. Nishkanu also begs me in heart-rending terms not to POAS early, when I am tempted in a moment of weakness.

Sadly, I have actually come to the point now where, as awful as it is, the 2ww beats what inevitably seems to come after it – the horrible pain of mourning and the slow hormone-addled depression and anxiety which comes after almost every IVF cycle.  At least in the 2ww you have some hope, even if it has been horrifically beaten down by fear.  I have come to the point where I don’t want to POAS, and I don’t want my beta either – I’d rather just wait and see if my belly ever gets bigger and put off the seemingly inevitable pain.  That’s not practical, so I stick with the POAS at the last possible minute.

Now my story doesn’t have to be your story.  Obviously there are a lot of people who have better outcomes.  But also there are a lot of people who use POASing in different ways to manage the stress of cycles, and who find that peeing early is better for them to deal with the anxiety of the 2ww.  So figure out if this assvice fits you before trying it on.

p.s. Just after I finished drafting this, Mr. Nishkanu said to me, “I think we have been using the wrong strategy with the pee tests.  I think we should have started with the pregnancy tests really early and done one each day.  That way it wouldn’t be such a big shock when you actually do it.”  So much for the consistency of our household philosophy.

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