Light and Momentary

Paging Dr. Freud

I have lived with this brain of mine for a long time -- 38 years, to be precise -- and I was pretty sure that my anxiety of late was just jangling neurotransmitters, and not anything more serious. (Can neurotransmitters jangle? a teeny tiny tintinnabulation?) I was already feeling better by yesterday evening, and so I was blaming it on the caffeine. (I'm pretty sensitive to caffeine. I am informed that my reaction to a cup of coffee when I've been off of it for a while is funny stuff.) But I woke up this morning to a dream that suggests it's not just the caffeine.

In my dream I was pregnant. Twice. Somehow I had conceived again, just a few weeks from the end of this current pregnancy, so that I was carrying one big eight-month baby and one tiny two-week embryo. (I learned about superfetation this summer, after I'd spent nine years as an NFP instructor telling people that progesterone suppresses additional ovulations. I'll have to add a "virtually always" to that spiel in the future. NB: there are no reported cases of women conceiving at 36 weeks, but my unconscious wasn't going to let details stand in its way.) In my dream, I knew that I would be delivering this baby shortly, but that I would have to stay pregnant until August with the new baby. Then I would have two babies, eight months apart. How was I going to manage that? Seventeen months of pregnancy and then a newborn arriving right when the older one was crawling well? In my dream I was striving valiantly to have a good attitude but I felt so overwhelmed. It wasn't one of those dreams where you're kind of aware it's a dream, and whatever is happening may be annoying but you know it's just temporary. This was reality: I was having twins. Weird not-really twins.

I can't tell you how relieved I was to wake up. It's absurd, I know, but it took me all day to laugh about it.

Coed Basketball

In early April, I went into the adoration chapel at our parish and knelt down in front of the monstrance. Immediately, a quiet voice called my name. It said, "You're pregnant. It's a girl."

I, alas, did not say, "Be it done unto me according to thy word." I said, "That is REE-diculous." I said, "I can't be pregnant. It's just not possible." By the time I left the chapel, I had persuaded myself that I had imagined the whole thing.

As I found out a few days later, I was pregnant. Today I learned that we're having a little girl. Also, that she is beautiful.

Having four boys attracts a fair amount of attention from strangers. They say, "All boys? Oh, you poor thing." I always lift my chin a little higher and say pleasantly, "I love having four boys." When they say, "Hope you get a girl this time," I say, "I'm not sure I'd know what to do with a little girl. And my boys are great." I always want to say, "I will delight in the children God has given me. I have been blessed beyond measure and I will welcome a fifth boy with open arms and a glad heart." --only a diatribe like that tends to put off random strangers at the library, so I just think it quietly instead.

But of course I'd know what to do with a little girl. We will have tea parties, with fairy cakes and finger sandwiches. I will knit her lacy socks and make her the prettiest First Communion dress you ever saw. Ruffled or plain, I'm on the job. We will read all the Anne books. Twice. And when we read the Little House series, we will talk about the fun stuff, like "Sunbonnets: Pros and Cons," and not the fine points of building a house without screws or nails.

She is only 11 ounces right now, so it will be awhile before she is interested in cucumber sandwiches. But just between you and me, internet, I've got plans for this little one.

0.460694698355

"Oh, halfway!" said a friend yesterday, when I told her I would be twenty weeks along today. I said, "No, I'm not halfway." (I was a little cranky because she had just commented on big I was. She was thinking I was earlier in the pregnancy.)

Twenty weeks isn't the halfway point of an average pregnancy, because for the first two weeks of a standard forty-week pregnancy you're not pregnant. On average, a woman is halfway through gestating at 21 weeks.

I, however, am...above average. (Note the positive spin I am attempting to give this, like focusing on the "advanced" in "advanced maternal age.") My boys have all been late: 6 days (Alex and Marty), 10 days (Joe, and I started telling people who commented on my belly that it was actually my pet watermelon, because late pregnancy messes with my head in a big way and I cannot handle questions like "Didn't you have that baby yet?"), and 8 days (Pete). Mean length of gestation: 273.5 days. I haven't told anybody my actual due date since I was pregnant with Alex, and this time around I just say, "I'm expecting the baby to arrive between Christmas and New Year's."

I'll be halfway in 10.75 more days (she said pedantically).

Doctor Says...

...don't sweat it. Take the propranolol every day if I want to. He's not worried at all, not in the slightest, about a 10mg dose.

My interim plan is to take it just on the days when I want to run. I'll go back in a couple of weeks for a prenatal, and I'll time the medication so I've got the maximum dose circulating at my appointment time. If the baby's heart is blipping along at 150 bpm, then I won't worry about fetal bradycardia. Even though the doctor's not concerned, I'd just like to make sure.

I don't think I'll go back to the cardiologist unless my arrhythmia gets worse. (It may; I had an episode late in my pregnancy with Pete that was more intense and slower to resolve than anything since then.) From his perspective, my diagnosis is so not a big deal -- benign, easily managed with low-dose medication, just an annoyance that makes me glad to live in the 21st century.

Phew! Thanks for the advice, everybody!

Risks and Benefits Again

I have a benign heart arrhythmia. Before I got pregnant, I was taking 10mg/day of propranolol to control it. I stopped taking it as soon as I found out I was pregnant, thinking I'd rather deal with the arrhythmia than expose the baby to any unnecessary drugs. (Also, taking pills made me gag.)

When I called the OB's office to set up a first prenatal, my doctor's partner was worried about the propranolol. My doctor, on the other hand, said, "Oh, no, it's one of the safest things you can take to manage an arrhythmia in pregnancy." I knew that there were risks associated with taking the drug in late pregnancy, but I had thought that I could take it from the feeling-better stage until close to term.

I have been itching to start getting some exercise again, but I have to take the medication for that to work. If I try to go for an unmedicated run, I last about 300 yards. I can push myself to keep going, but after 10 minutes or so I'm going to throw up in somebody's yard. With the drug, I can chug along for half an hour or more -- or at least I could before I spent all that time lying on the couch.

Pregnancy is hard on my mental health -- it really cranks up my usual tendencies toward anxiety and hypersensitivity. Exercise is good for my mental health, and, obviously, my physical well-being too. I went for a couple of gentle runs in the past couple of weeks and was excited to get back in the groove.

So I was really bummed when I went to pick up my prescription refill and the pharmacist cautioned me sternly about propranolol in pregnancy. It's a category D medication in the second and third trimesters. It's associated with a whole lot more problems than I knew.

Some of the difference in her reaction and my doctor's reaction has to be related to dosage. In some of the research they were looking at women taking 16 times the dose that I take. But the pharmacist had that information in front of her -- if she was concerned, shouldn't I be concerned?

I guess if neither my OB nor my CNM is worried about my taking 10mg/day, I don't need to have a cow about the pharmacist's reaction. One possibility might be to take a pill only before exercising, maybe 3 days a week, and live with the arrhythmia the rest of the time. (It's been better than usual since I've been pregnant, which is the opposite of what I expected.) Maybe I could also request a referral to go back to the cardiologist for more information about the whole pregnancy/arrhythmia thing -- my OB said he wanted to talk to the cardiologist anyway.

I'm upset that something I thought was a great idea (getting more exercise, with a little pharmaceutical assistance) met with such a negative reaction. (See above re: pregnancy, mental health, adverse effects.) The list of potential side effects for the baby is troubling, but I don't have good information about incidence, dosage effects, etc. I'm not sure what to do. Any thoughts?

Risks, Benefits, Looming Catastrophes

I saw my OB this morning. He is a very pleasant guy, UK-trained and personable, and he seems to be convinced that I'm going to have a catastrophic hemorrhage when this baby is born. My two younger sons were born at home, one with a family practitioner and one with a CNM. While I would go back to the hospital in a flash if this pregnancy turned high-risk, I plan to stay home this time too. We've had an HMO for a couple of years now, and along with prenatal visits to my midwife I'm seeing an in-network OB so I can have my tests covered. I was up-front with him about my plans to stay home as long as I stay low-risk.

He has spent a fair amount of time telling me I could bleed out and die.

When my second son was born in an Edinburgh hospital, I was quite anemic going into the delivery and the third stage was actively managed (i.e., more tugging on that cord than I was comfortable with). I lost an estimated 850 ml of blood, but the hemorrhage was easily controlled -- one shot of methergine and that was that. I have no wish to repeat the experience, since the recovery was rather grim, but I also don't think it's an enormous red flag in my obstetric history. I have since had two perfectly normal births with utterly unremarkable third stages, and while I accept that I could hemorrhage again, I'm not losing sleep over it.

When I met my midwife during my pregnancy with Pete, the first question I asked her was what she carried to manage PPH; she said she always had pitocin, methergine, Cytotec, and IV fluids. I live half a mile from the hospital. I will pre-register there, just in case. I will transfer in a heartbeat if there is a problem. My midwife is licensed and legal; she would accompany me, chart in hand.

It doesn't seem very likely to me that I'm going to exsanguinate under those circumstances. Hemorrhage, maybe; lose my uterus, remotely possible; die, improbable. Call me an optimist.

I spent some time this morning trying to respond to the doctor's concerns: I didn't have even a hint of uterine atony after Pete's birth. I'll reconsider my plans if I'm anemic in the third trimester. My midwife can take the same first steps to intervene at home that she can in the hospital. I think, though, he has it burned in his brain: Homebirth = Too Risky. (Oddly, he has focused exclusively on the risks to me, not the risks to the baby.) But I believe I have read every paper published in English on homebirth safety in the past 15 years, and the results are clear: planned attended homebirth is a safe option for low-risk women carrying full-term vertex singletons. (Don't even get me started on Amy Tuteur, who should serve as a caution to any would-be amateur epidemiologists.)

I  am feeling a little cranky today because I threw up my breakfast (at 16w5d! on Unisom! enough already!) immediately before going to the doctor to hear about my impending demise. But I will end on a happy note: I am grateful for this baby, whose kicks and flutters are making me smile every day now, grateful for a thus-far low-risk pregnancy, grateful for my midwife. My first visit with her was such a welcome contrast to my first OB visit. Afterward I told my husband, "I wish every pregnant woman could see someone like her." I'm glad I can.

Unexpectedly

When I found out I was pregnant, I immediately thought I'd have to give up my fellowship for next year. Both Elwood and my advisor encouraged me not to be hasty, and in the weeks since then my advisor and I have talked a lot about how I could meet the requirements of the fellowship after this baby arrives without losing my mind. I have been gobsmacked (in a good way, a grateful kind of gobsmacked), by her flexibility and willingness to work with me.

But I have been a little worried about talking to the professor who administers the grant. She is very careful about following the rules, which specify that I am supposed to be acquiring teaching experience and putting in a specified number of lab hours, and she is also 15 or so years older than I am. She came up through the ranks when it was much harder to be a woman and an academic than it is today, when it was still acceptable to say things like, "You're pretty smart for a girl," and I think she remains ambivalent about the compromises required of her as a mother who was also a scientist.

This could, it seemed to me, nudge her in either of two directions. She might think that I need to pay my dues, and man up (woman up, it has to be, since this issue is far less painful for men than women), and teach next spring as originally planned. Or she might think that it's about time for the department to make it easier for women to be mothers and scientists at the same time.

I just didn't know. I knew it wouldn't be a disaster, since even if she recommended that I decline funding for this year, we'd figure it out financially. I was dreading the conversation anyway.

Then I got an utterly unexpected email from her. She was talking about rescheduling a meeting, and she said, "Now that I am experiencing life without day care, I realize again what a tremendous effort you make to work on your Ph.D. while raising your boys.  If you ever need to make special arrangements for your involvement on the grant, please know that we will be very willing to accommodate your needs, whatever they might be." She went on to suggest some specifics that could make my life much easier in the spring.

Last fall I kept meaning to post about this fellowship, which was simply providential. I am sitting here tonight and re-reading her email, feeling gobsmacked again. It seemed like a crazy idea to work on a PhD with four young children. I would have guessed it would be impossible with five. But these gifts keep falling into my path: a great fellowship, a fabulous advisor, this email out of the blue. I keep on working, and it keeps on working out. How cool is that?

Brighter

One heart, whooshing right along. Four limbs, waving at us. Nine weeks exactly, based on today's length, which clears up the confusion about dates. Now I know which improbable occurrence actually occurred.

When the image first appeared on the screen, I saw no movement. The doctor said nothing. I thought this was a bad sign. Finally I said, "I'm not seeing a heartbeat -- are you?" "Oh, yes, right there," he said.

I still didn't see it. He turned the sound on and there it was, unmistakable. I cried. Then I wiped my eyes and figured out I'd thought the head was the trunk and vice versa. No wonder I'd had trouble finding the heart -- I was looking for it in the brain.

What can I say? This is my seventh pregnancy but only my fourth ultrasound. I've never had one this early, and it's easier to tell which end is up later on.

So I told my mother, and it went well. I still have to tell my MIL, but maybe that will go well too. Elwood should be home late tonight and I am ordering pizza for dinner. Two nights ago I was reading Julie & Julia and it left me with an insatiable craving for a bacon and jalapeño pizza. Not for the tarts or the stews or any of the French food, but for the takeout pizza they ate when dinner bombed. Jalapeños are about the worst thing to throw up because they leave you with that nasty burning in your nasopharynx, but I may throw caution to the winds and order some anyway.

Thanks for your sympathies -- I am feeling much better.

Gloomy

First trimester gets me down.  Nine weeks, two days, pretty much miserable. I have lost my cheery determination to get through it with aplomb and I am just hanging on by my fingernails at the moment.

Elwood is out of town, which is part of the trouble. He's back late tomorrow.

Over the weekend I started taking a nightly Unisom tablet, because I was spending my days oscillating between being thisclose to throwing up and being a smidge further away from throwing up. It seemed to help a lot over the weekend. But I think the Unisom and the extra weekend sleep helped in equal measure, and it is not practical for me to sleep twelve hours a day right now.

Tomorrow is my first prenatal visit and I am a little worried. I am afraid that a negative test at 15dpo bodes ill for this pregnancy. They are going to do an ultrasound, and I am about 60% persuaded that it will show a little motionless embryo, or an embryo whose heart is beating 80 times per minute because of a lethal chromosomal anomaly.

But. Each day has enough trouble of its own, right? Could have been something harmless like an expired test, right? Also, the turtle tank filter will probably not short out if I don't go and add more water tonight, right? I am sadly neglecting poor Turtle right now, because he gives me the all-overs in my current condition.

So. I am going to load the dishwasher, quick like a bunny, and finish the rosary, quick like a bunny would do if bunnies prayed the rosary, although since bunnies don't load dishwashers either I suppose I'm not too concerned about zoological accuracy here, and call it a night.

Update tomorrow.

Better

I think the pharmacist made a mistake and gave me Emesis instead of Premesis. I am imagining the ad campaign: Syrup of ipecac? So last millennium. When your vomiting is irregular and infrequent, ask your doctor about Emesis. Perhaps George Weasley was behind the counter and slipped me some Puking Pastilles with the helpful end cut off. I don't know what happened, but the prescription that was supposed to cut my nausea seemed to ramp it way, way up instead. Ugh.

Last night I was trying to talk myself down. You're stressed about the weekend. You know you're always sicker when you're stressed. You can take an incomplete if you really can't finish those papers for your psychology class. You'll feel better in a few weeks. It's going to be all right. It wasn't working very well. There's a point on the nausea spectrum where I lose perspective. There's probably an algorithm: dry heaving ≥ 3 = wailing + gnashing of teeth.

So I just went to bed early, and thankfully was not awakened by nausea in the night -- probably because that stupid pill was out of my system. I am back to ordinary-sick this morning, and hoping hoping hoping that it was really just the Premesis making me so much worse. Did they change the formulation? Did I get the batch with the secret mustard ingredient? No idea. But I'm grateful to be a paler shade of green (sung, of course, to Procol Harum's tune).

Yea, Verily

I was going to write a silly post about morning sickness, kind of a King James Leviticus at a 21st-century Kroger. Last Friday Elwood offered to make spaghetti with clam sauce for dinner and I blanched a little and said, "You know, levitically speaking, clam sauce is an abomination in the eyes of the Lord." Which was code for, "I can't eat that but the kids are listening."

(Parenthetically: I don't know exactly why I have told the entire internet about my pregnancy but have not told my family. I guess I think my mother and MIL will worry and perhaps one of them will say "I told you so" (Lordy lordy I hate to hear "I told you so"), and if my children know this weekend then the grandparents will know before they leave here. About which more below. But I am pretty much operating at maximum capacity here, and can't handle anybody else's worry on top of all the other stuff that needs handling. So mum's the word.

(We are hosting both sets of grandparents this weekend, and an uncle and a cousin, because it is Marty's First Communion and Petely's third birthday. If I were picking a time to throw a party, it would not be the weekend in which I needed to pull together a final draft of two chapters of my early research project along with revisions for my advisor's in-press publication. But you don't always get to pick, so we'll take our celebrations where we find them.

(Our car went belly-up last week -- the fuel pump failed in the church parking lot as I was trying to take Marty to CCD. Except there was no CCD that night. I suppose the timing was providential, because if I had been clued in and skipped that trip, I would likely have been stranded on my way to campus the next day. But buying cars is one of my Least Favorite Things Ever, so it's hard to see providential anything there. Will keep squinting. It seems to have worked out -- an hour ago I signed my name to the title of a 2000 Honda Odyssey. Long may it last.)

Anyway: I was going to write this silly post that went, "Know ye that the sauce of clams is verily an abomination unto the Lord, and know ye likewise that [fermented cabbage, the actual name of which makes me gag] is a further abomination in His sight," but I decided not to. It was partly because I got queasy enough that I didn't think I could write it without gagging my way through it. It was also because I thought it might sound like I was affirming Voltaire and making God in my own image. So why am I telling you about it?

Yesterday morning I woke up feeling dreadful. Just awful. I hate to throw up first thing in the morning because it makes it harder to stay on top of the nausea for the rest of the day, but it was only force of will that kept my stomach contents discontentedly in my stomach. I was nibbling at some cottage cheese, which we don't usually keep in the fridge but which is good preggie food -- high-protein, bland enough to be tolerable on the way back up as well as on the way down. Marty saw me eating it and said, "What is that?"

"Cottage cheese."

He asked, "Isn't it an abomination in the eyes of the Lord?"

And, queasy as I was, I laughed out loud.

Advanced

I called the doctor's office today to see if they would give me a prescription for Premesis, because after a week in which I thought, "This nausea isn't too bad. I can function like this," my inner Emeril decided to kick it up a notch and I have had a green and wobbly couple of days. Premesis is not a miracle cure but I have found that it cuts my nausea by about 30% -- enough to let me be vertical and not couchbound.

Anyway, the nurse had some questions for me and then said "...schedule screenings blah blah blah advanced maternal age..."

Ahem.

I know I just went on and on about my aged eggs, but it's a different thing entirely when a stranger calls them my aged eggs. Whippersnapper.

I'm going to focus on the advanced part. Advanced is good, right? Everybody likes to be advanced. Better than beginner any day of the week.

Ready

Come on, ladies, how could I be pregnant? I have an early research project to defend, a semester to finish with five papers left to write, a poster presentation to prepare for early June, two different publications in progress with my advisor, and that's not even the whole of it. I also have 15 years' experience with licit and effective means of avoiding pregnancy, and a husband who is 100% on board with not having a baby at this time. I can't be pregnant.