Sunday, September 9, 2012

The High-Risk Pregnancy Specialist

At my very first doctor's appointment Dr. S suggested that I see a high-risk pregnancy specialist, Dr. T.  Dr. T is one of only a few high-risk pregnancy specialists in my area so it took some time for me to schedule an appointment with him.  Dr. T's office is in a hospital and he is often pulled away from his regular appointments.  Since my appointment was the last of the day, I ended up waiting in the lobby for four and a half hours!  I was warned by Dr. S and by Dr. T's staff that I may bee waiting for a long long time but this was crazy.  Josh was also out of town so I was by myself.  I thought I would bee fine waiting alone but all of the other women waiting were with their husbands and I felt very very alone.

Anyway, I finally got in to see Dr. T, I told him my situation and we basically started from scratch, as if I hadn't seen any other doctor.  Dr. T wanted to try to remove the IUD so he conducted an ultrasound but, as I had predicted from three other ultrasounds, he couldn't clearly figure out where the strings were.  Then he started a pelvic exam where he attempted to find the strings just by using his naked eye.  No luck.

I got dressed and went into his office to discuss my situation in further detail.  Dr. T basically said that his biggest concern was infection.  I'm not really sure how an IUD would cause an infection but maybe I'll ask about that in my next appointment.  If the IUD causes an infection in my uterus then the baby would also have an infection.  Because the baby is so vulnerable it would not bee able to fight off the infection. And just like any infection, if it became serious enough, I could become severely ill or even die.  What that all means is that if I get an infection, the pregnancy would bee terminated and I would bee treated with antibiotics.

To add to the misfortune, the risk of infection will bee present throughout my pregnancy and the most likely time to become infected is mid-pregnancy, during the second trimester.  The other aspect of this situation is the possibility of getting infected after 24 weeks, or 6 months.  In the state of California it is illegal to terminate a pregnancy after 24 weeks.  This is because in most cases a baby can survive outside of the womb after 24 weeks.  So, the question becomes, what happens if I get an infection after 24 weeks?

I will mention here that I did not get an official answer from Dr. T for this question but here is my guess as to what would happen...I would need to give birth, most likely by cesarean.  The baby would also bee infected at this point and still unable to fight it off. Depending on the severity of the infection I suppose that the baby could bee stillborn.  If the baby is not stillborn, the likelihood of it surviving pre-term labor AND an infection is quite low.  This situation would obviously bee very traumatic.

One of my big questions was how do I recognize an infection of an internal organ?  Dr. T said similarly to all infections, I would eventually get a fever.  With a visible infection, someone wouldn't usually go long enough without treatment for them to get a fever but I probably won't bee able to tell that I have an infection until I get a fever.  So, at the first sign of a fever, I need to go to the doctor right away.

There isn't anything that I can do to prevent an infection and the risk of infection certainly makes this pregnancy even more "unwanted".  As time progresses and Josh and I become more accepting and welcoming of becoming parents, we'll need to bee careful so as not to get too attached.  The more we love this baby, the more we put at risk, emotionally.

To end this post on a "happy" note... I will say that the possibility of getting an infection is lower than the possibility of having a normal pregnancy.  I wish I had more defined numbers, like 40/60 or 30/70, but the important thing here is that the odds are in our favor.

Tuesday, September 4, 2012

The Emergency Room

One week after finding out that I was pregnant, we had our first scare.  During this week we had been bombarded with information about the possible outcomes of our situation of having a copper IUD in my uterus with the baby.  We were overwhelmed and with this being my first pregnancy, I had no idea of what bodily changes to expect but was on high alert should anything go wrong.

Anyway, I was putting away some clean laundry and out of nowhere felt a bit of fluid begin to come out of me, similarly to menstruation.  I hurried over to the bathroom and saw a dark wet spot in my underwear as a bit more dribbled into the toilet.  It ended quickly but I saw blood in the toilet.

At this early stage in my pregnancy and despite my numerous doctors visits, I hadn't yet asked any questions or done any research about what a miscarriage would bee like so I thought this was it.  There wasn't a lot of blood and I wasn't in any pain but this really didn't seem to bee ok.  It was 10pm on a Sunday and I hadn't really established a regular doctor yet so we decided that the Emergency Room was the best place to go.

We headed to the ER.  The bleeding had stopped and I still didn't feel any pain but we checked in, and began the long long long wait for information.  I gave a urine sample, laid in a hospital bed, finally got both a regular and vaginal ultrasound, which all determined that everything was fine with me and the baby.  The ER doctor said that he was unsure of why I had bled but suspected that it was from the placenta attaching to my uterus.  As it "suctioned" to my uterus, it expelled some blood.

I was in the Emergency Room for four hours.  I also needed to see a regular OB/GYN right away so that they too could tell me everything was fine.  In the ER I was told that because my blood type was negative, I needed Rhogam.  I refused the Rhogam from the ER because I didn't trust the doctor very much, mostly because of his beside manner, and also thought that Rhogam would cost a lot more at the ER than from a regular doctor.  They also did a very poor job of explaining what Rhogam was.  I decided to talk to a regular OB/GYN the next morning before getting Rhogam.  I left the ER and went to bed.  I was glad that nothing terrible was happening but I certainly was not looking forward to receiving the bill.

The next day at the regular office, Dr. S was not available so I stopped in to see Dr. C.  He was very quick with me and interrupted me frequently but ultimately provided the information I needed.  He couldn't identify why I had bled but said that a miscarriage would bee similar to a regular period, in regards to how much blood there would bee, and that I would have severe cramping.  He also said that if I did have a miscarriage, I wouldn't necessarily need to see a doctor right away.

Dr. C also explained Rhogam.  Now, I'm not even proficient in the science of genetics but I'll do my best to explain it.  Because my blood type is negative, it is possible for the baby's blood type to bee positive, depending on the father's.  If the baby's blood type is positive and myself and the baby's blood were to come in contact, they would fight each other as if it were an infection.  A shot of Rhogam would prevent the fight so that both me and the baby would remain healthy.  So, I got one shot of Rhogam and was on my way.

I had scheduled to see a high-risk pregnancy specialist the following week, so I waited for, of course, more information.

Wednesday, August 29, 2012

Our Options

When I was 7 weeks pregnant we pretty much knew what was happening.  I had a copper IUD in my uterus along with a baby.  The IUD could not bee taken out without causing a miscarriage.  Because it could not bee taken out, my chances of a natural miscarriage and infection were going to bee much higher than they would with a normal pregnancy.

We also knew how we were feeling.  Josh and I both felt that this was unfair.  We had done everything (except abstinence) to prevent pregnancy but it still happened.  We were responsible, we were on track with our life plans and all of a sudden, so much was being taken away.  I had been studying for the GMAT and planning to go back to school for a M.B.A. in a year.  We would bee parents without friends or family to support us in the big city of LA.  Being a mom at 25 years old was ridiculously young; I still view myself as a kid.  And our wedding was, and still is, one of the biggest sacrifices.

The problem was the odds.  With such a high chance that this pregnancy would end, maybe all of these sacrifices wouldn't bee sacrifices.  Maybe everything could go back to normal as if I were never pregnant.  But then again, the pregnancy could bee just fine and we could have a baby.  As much of the bad stuff that we saw about the situation, we also knew that we wanted to bee parents one day and that if we continued with the pregnancy, we would grow to love the baby and look forward to everything that we were supposed to.  And with a child, all of these sacrifices would someday bee obsolete.

Josh and I felt like we had a decision to make; to either continue on with a high risk pregnancy and sacrifice so much that we had been looking forward to in the coming years OR to terminate, leave the health risks behind and get the control back to move on with our life plan.  We also knew that we needed to make that decision sooner than later because the longer we waited the more attached we'd become and the decision would become more and more difficult.  It was really challenging to face this type of decision alone.  There were many reasons why Josh and I didn't tell anyone about this situation:

1.  I was only 7 weeks along.
2.  We were still coming to grips with the fact that I was actually pregnant.
3.  We didn't know if we were going to terminate or not.
4.  I felt ashamed, as if I had done something wrong.
5. We were scared about what our family and friends would think.

So, we discussed our options, our old plan and a new plan, what is important to us, etc.  After weighing the pros and cons, we decided that continuing with the pregnancy would bee the best decision for us.  With this decision we had to become committed to becoming parents in 8 months but not get too attached for fear that we would lose the baby because of the IUD.

One of the biggest reasons for choosing to continue with the pregnancy was that we are in a loving and committed relationship.  Although the timing wasn't right, we did want to bee parents and given our backgrounds we felt that dealing with a possible miscarriage would bee more bearable than accepting a decision to terminate.  So, we developed a brand new plan.

Tuesday, August 28, 2012

Medical Specifics

The next step is to take some blood tests and get a very detailed ultrasound.  They hope that the blood tests, which measure hormone levels, come back normal and say that the baby is healthy and is progressing normally.  A more detailed ultrasound will also provide info about the baby's health but more importantly where exactly the IUD is located.

Getting my blood drawn was no biggie and no different than I had expected.  However, the ultrasound was quite different.  The doctors office had told me to come in with a full bladder so that the ultrasound would bee as clear as possible.  And boy did I follow doctors orders.  I was very uncomfortable in the waiting room but fortunately I didn't have to wait too long.  The technician started with a normal ultrasound on my belly.  That wasn't much fun.  The wand was pushing on my bladder and I couldn't wait to go to the bathroom.

With the normal ultrasound, the technician did not get the detail she really needed, so she told me to go to the restroom and come back to begin a vaginal ultrasound.  I had briefly explained my situation to her and of course she knew what was happening based on my chart.  The wand was put in and she did her thing for at least 15 minutes!  It seemed to take forever!  At one point she turned on the sound and a strange, deep pulsing noise came out.  I didn't know what that was but later found out that it was the baby's heartbeat.

Regardless of the issue, I'm usually pretty stoic during a doctor's appointment.  I suppose it is because I feel that the health professional should only bee concerned with what is biologically happening with me, not emotionally.  I hold back the tears and also the pain almost always.  My dad says I'm a "trooper" because of my lack of emotion.  This appointment was no different.  Before the 15 minutes was up the technician asked if I wanted to see the screen.  At this point in my pregnancy, I was still angry, sad, shocked, and just not ready to become attached to something that seemed to bee such a burden.  I was also by myself.  Josh was working and I knew that I would want him there for any kind of emotional reaction that seeing the ultrasound would produce.  So, I simply said, "No, thank you."  

The results of the blood tests said that everything was progressing normally and the ultrasound didn't tell anything different.  The IUD was still unable to bee removed because it had turned sideways in my uterus pulling the strings up with it.

At my follow-up appointment with Dr. S to review these results I got a few more of my questions answered. I had been wondering what would happen if I wasn't pregnant but wanted the IUD removed.  What would they do to get it out?  Dr. S said that they would use a camera and other tools to go into my uterus, locate the IUD and it's strings and pull it out.  However, they aren't able to do such an invasive procedure in my case because the camera and other tools would almost certainly disrupt the embryonic sac and I would miscarry.  

I was also wondering about other possible risks to the baby, like a physical or mental disability, because of the IUD.  Dr. S said that the chances of developmental problems were not increased because of the IUD, mainly because the IUD is outside of the embryonic sac and unable to influence the development of the baby.  

Lastly, I wanted to know how an IUD pregnancy would affect my future fertility.  If Dr. S had told me that I will not bee able to have a baby on my own terms after this one, then Josh and I would need to think more about our options.  However, she said that if the IUD caused an infection in my uterus, then my fertility may bee in jeopardy.  For example, if an infection occurred, it could possibly bee so severe that it blocks my Fallopian tubes preventing me from releasing an egg every month and the ability to get pregnant.  In general, if everything were to go as normal, my fertility would not bee affected.

Upon leaving Dr. S's office, I was referred to Dr. T, a high-risk pregnancy specialist.  I was told to see Dr. T to get more information about the risks of my pregnancy for both me and the baby.

Friday, August 24, 2012

The First Doctors Visit

At the time of my first doctors appointment I'm 10 days late, I've taken two home pregnancy tests, and another at the doctor's office for their records.  I'm sitting in the waiting room filling out tons of paperwork and I'm nervous and scared for what the doctor is going to say.

Once I am in the exam room Dr. S asks me what is going on and I tell her, "I'm 10 days late for my period and I've taken two home pregnancy tests that have both come back positive so I am looking for confirmation that I am indeed pregnant and if so, the next thing to address in the copper IUD that I still have."  She looks at the info in my folder and gives me confirmation that I am pregnant based on the test I had taken just a few minutes earlier.

She then wants to see about this IUD.  She explains that it needs to bee taken out because if it is left in my uterus there is a higher chance than normal of miscarriage and infection.  So, Dr. S initiates an ultrasound but has trouble really seeing anything.  To try and see things better she does a vaginal ultrasound where a lubricated wand is inserted and produces the fuzzy black and white image just like a regular ultrasound does. She sees the embryonic sac in my uterus and she sees what she thinks is the IUD.

There's a problem though.  The IUD has shifted.  Normally it would sit at the base of the uterus like a 'T' with the strings coming out from the bottom of the 'T' and hanging past the cervix.  If it were still positioned that way, she would bee able to pull those strings, without ever going inside my uterus, to get the IUD out.  I should mention that before she noticed the IUD, Dr. S said that if she takes it out there is a 25% chance that I will miscarry because it is possible for the IUD to puncture the embryonic sac as she takes it out.  However, taking that 25% chance and removing it is better than leaving it in as the chances of miscarriage and infection are even higher.

So, my IUD isn't sitting normally.  Dr. S doesn't know why, it could bee a number of reasons for why it shifted but it is now lying on it's side like '|--' and it is further up in my uterus.  This means that the strings, which is the only real way for them to pull the IUD out, have also been pulled up into my uterus and are not hanging past my cervix.  The entirety of the IUD is in my uterus and they don't have a way of getting it out safely.

Now that we were pretty sure that the IUD wasn't coming out, Dr. S said that there was a 50/50 chance of having a normal pregnancy.  If it isn't normal, I would either miscarry or get an infection.  I should have asked more questions at that point but was too overwhelmed with all of the news I was getting.

Oy vey (my apologies for possibly spelling this wrong)!  I didn't know what to do from there.  It was kind of out of my hands.  Dr. S requested that I get a very comprehensive ultrasound and blood work panel done just to fully verify the position of the IUD and make sure that the pregnancy was progressing as normal by analyzing my hormone levels.  After all that I would come back to see her at the end of the week.

After leaving the doctor's office I called Josh and told him everything that was going on.  I cried and cried, but knew that I didn't have all of the answers yet and hoped that I would get some at my next appointment.

Wednesday, August 22, 2012

The Reality

In May 2012 Josh and I got engaged and I started planning our wedding.  Fortunately we didn't make any solid plans nor put any deposits down on venues, caterers, etc. because on July 6th, after being 10 days late I took a home pregnancy test that couldn't have been more positive.  The blue cross appeared immediately and never went away.  Our world was turned upside down and who cared about our wedding anymore.

I've never really kept track of my cycle but I had a general idea of when to expect it and never thought that I would miss a period until we had started to try to get pregnant.  A month and a half earlier, at the end of May, my very Christian co-worker told me about a dream she had.  She dreamed that Josh and I had to move up our wedding because I was pregnant.  I didn't think much of it but a few days later I tried to remember when my last period was.  I started to panic because I hadn't kept track and felt like I was late.  I cried off and on, worrying about being pregnant for about a week.  Finally it came and I was super relieved.

I had decided from that scare that I was going to keep track of my cycle and with the added convenience of my new iPhone, I found an app to easily help me do so.  Unfortunately the app only helped for one month.  At the end of June when I was scheduled to have my next period, it didn't come.  I gave myself a few days before panicking because maybe my cycle had always been longer than 28 days, I didn't know.  30 days, 34 days, 38 days... at that point I pretty much knew that something was wrong.  The terror was a little bit easier to handle though because I knew for sure that I was late whereas a month earlier, I had no idea.

So, I took that home pregnancy test, it came out positive and Josh and I spent the rest of the night sitting on the floor in each other arms crying, confused, overwhelmed, worried, and a whole lot of other emotions that I had never wanted to feel when finding out I was pregnant.  This was not how it was supposed to bee.



We started to get concerned about the IUD.  Was its presence going to affect me or the baby?  When did I need to see a doctor?  How did I get pregnant?  We did a minimal amount of research on the internet, so as not to get more freaked out than we already were and decided to go see a doctor as soon as possible.

I had just gotten a new insurance plan and hadn't found a primary care physician yet so I called the nearest OB/GYN in my network and went in first thing on the next Monday morning.  I took their pregnancy test, they confirmed that I was pregnant and wanted to get me in to see a doctor right away given that I had an IUD.

I'll get into the medical mumbo jumbo in my next post...

Tuesday, August 21, 2012

The Plan

As of now, August 2012, I've had a copper IUD in place for roughly two and a half years.  After getting the IUD things were peachy.  I didn't have to worry about being overly emotional because of hormones nor getting pregnant.  My relationship with Josh became stronger and stronger.

I've always wanted a family and a career.  And it seems natural to me to establish a career before a family.  For me, the proper order of life-changing moments goes like this:

  1. Settle into a job
  2. Become financially independent
  3. Get married
  4. Buy a house
  5. Start having kids
I understand that for many people this order may bee different but for my friends and family, this is the standard.  I'm also a PLANNER.  It is very difficult for me to move onto the next phase in life without knowing what comes after that and looking forward to it.  For example, before finding out I was pregnant, I was beginning to settle into my job, starting a savings plan, and on my lunch break, I was planning my future wedding.  I'm always looking far into the future, maybe even a little too far.

Anyway, Josh and I have been living together since October of 2010.  A few months prior to moving in with each other, he was offered a very well-paying job in Los Angeles.  Although I had a decent job and an awesome apartment of my own in Denver, I desperately wanted some adventure.  I wanted to move away from home and become independent.  I also really liked the idea of being closer to a beach.  So, Josh took the job and moved from Denver to LA.  Shortly after, I quit my job and followed him.  We found an apartment and within one week of moving, I found a new job in LA!

We lived our lives, explored LA, built upon our relationship, started to pay off debts, and became adults.  In October 2011 we moved to a different apartment, started to pay off more debts and then in May 2012 got engaged!  After almost four years of being together and one and a half years of living together, we decided to move to the next step.



Throughout May and June we decided to plan for our wedding in September 2013 in LA.  Since all of our family and friends would need to travel to LA, we would make a weekend out of it, rent a large vacation home, have the reception on the lawn, make it a family affair.  Long ago I had my wedding colors picked out and I created a Pinterest account to gather ideas about all of the other stuff.  We established a budget, which would require me to save a large chunk of my paycheck every month for the next year, but I had paid off all of my debt so that was not going to bee a problem.

Life was coming together and I was right on plan.