I Heart My Uterus

Piper - 6 Days old.

Piper's birth was amazing in and of itself, but shortly afterward we received information that makes her existence even more stunning. The doctor that performed the c-section mentioned to us, rather off handedly, that I have a bicornuate uterus. We were in in recovery, I think, when he told us, or rather, asked us if we knew that I had this condition.

At the time, I had only a vague understanding of what that meant. A normal uterus is like an up-side-down pear - the top having the most space. A bicornuate uterus is malformed on top with a wall coming down in the middle. Basically, I have a heart shaped womb. There are a lot of variations of a bicornuate uterus - from just having a small septum that creates two little humps at the top of the uterus to ones where the septum runs all the way down essentially creating two separate wombs as well as two separate cervices. Mine, apparently, has enough of a septum to distort my fundus into two large humps instead of the smooth, round shape the top of the uterus is supposed to have - thus, the heart shaped uterus.


When the OB came by our hospital room a couple of days after Piper was born, he gave us a fuller explanation and literally drew us a picture of it. He said that this is something that is formed when you are still a fetus and there is nothing that can be done to prevent the formation and gave us some rough statistics about it. Apparently, this is also the reason that Piper wouldn't turn from the breech position; she couldn't turn. She was stuck in one of the humps of my heart shaped womb. "If only he had known this", the doc said to us, "I never would have even tried the version". He acted like it was a waste of his special skill. He also asked why I had never been screened for this deformity since I did have 4 miscarriages. We didn't know, but some questions of my own were starting to form.

Here is what I have learned and what makes Piper all the more precious to us:

A bicornuate uterus is a birth defect, there is usually nothing that can be done to repair it and it often goes unnoticed until there is a problem with a pregnancy. It occurs in about 0.1% of women. If the baby starts growing in one of the humps on top of the uterus the pregnancy will usually end in miscarriage, because that area cannot expand enough to accommodate a baby. This could explain all of the miscarriages I had.

If the embryo implants in the larger, lower part of the uterus it has a better chance of survival, about 55%. As the baby grows and starts to run out of room they often end up in a breech or transverse position and get stuck that way. There is a 25% chance of preterm delivery with these babies. Piper was born at 39 weeks, which is considered full term, so she was very lucky in that regard as well. Preterm babies can have so many problems, it's scary to think about. Some babies are born with birth defects from being cramped, or have low birth weight or an abnormal size, or general growth retardation - Piper has none of these, another bullet dodged. So, of course, pregnant women with bicornuate uteruses are considered high risk - my old doctors got that right, just not for the right reason.

Knowing all of this answers a lot of questions about what was going wrong for us, but it leaves me with a sense of frustration that none of our doctors ever thought to check for it. The diagnosis can be made with an ultrasound, how could this have been missed for the last three years? The only tests I was ever sent for were blood tests, which all came back normal. Did the doctors just not think that this was a possibility? I may never know.

I knew that Piper had a miraculous entrance into this world, I just didn't know that the miracle started the day she was conceived. It is such a wonder how all of the stars aligned and everything worked out so beautifully. And the whole issue of getting Piper to spin and not being able to do so also makes perfect sense now, too. She wasn't being stubborn, she was stuck in my 'heart'. Griffin, Piper and I are indeed very lucky to all be together now.

Happy Almost a Mother Day to Me

36 Weeks, 2 days

Today is Mother's Day. I woke up at six and drowsed in bed for a while. The house was very still. Griffin is not home and the dog and cats were not pestering me to get up. So I laid there. Piper had the hiccups and my belly bounced every 10 seconds with each one. I felt the rolling slide of her whole body moving and the little flicker of hands. I have gotten very used to feeling all of this; it will be strange when she is no longer inside me and I am all alone with myself again.

I have been battling swollen ankles and feet for the last few weeks. Work was especially stressful as I tried to get everything wrapped up before I started my maternity leave. There is just not enough time in the day for it all. If I didn't actually have to teach every period, I would have had time to wrap up all of the other stuff. I had begun new projects two weeks ago that required my help, input and attention. Poor planning on my part. I should have just rolled out the markers and told them all to draw what they want to do for summer vacation. If only.

The flubbiness of my feet has not been my only concern; my belly has gotten so large that I have trouble doing things I normally don't have to think about to do: such as put on socks or feed the cats. I find myself holding my breath as I half bend over, half squat to get to the floor. I think I have forgotten what it is like to just go about your business without noticing that you are doing anything. I know I can't crush Piper by bending over, but she sure puts up a fight when I do.

My last progesterone shot was this past Thursday. The progesterone will stay in my system for a week to 10 days. Commonly, women having these injections go into labor sometime shortly after that seven to ten day period. So things could be happening very soon.

I am not nervous about labor or giving birth. The thought of the pain does not frighten me and I don't think I will be begging to go to the hospital for drugs. For me, the worst kind of pain is the type that is inflicted by someone else and I have had a lot of that over the past three years. My body will not create more pain than I can handle, but intervention by someone else might.

Its strange that I have actually become calmer and more relaxed about having our home birth as it gets closer. Griffin and I have been going to birthing classes and many of the other women seem to be terrified of the prospect of pain. There is only one other couple that is planning on having a home birth and we haven't actually spoken to them. Some of the women in the class are actually planning on having epidurals during labor, I wonder why they are taking a natural child birthing class.

We are planning on having a water birth as well as laboring in the birthing tub. Judy, our midwife asked us if we want to put the birthing tub out on our deck. At first it struck me as strange to give birth outside, but I am sure it strikes people as strange that we want to give birth at home. I have mixed feelings about being outside: it might rain, I might get cold, it might be too sunny and I'd get sunburned, what if my labor goes into the night and there are bats flying around us? (Actually, that would be pretty neat.) I don't care about privacy and the neighbors 'seeing' anything and that was the main concern that Judy had. Who cares about the neighbors? What about the weather?

Really, my biggest concern is what to do once Piper is here. Getting her out won't be nearly as difficult as knowing what to do with her once she has. I keep trying to picture myself hold a little, tiny baby wrapped in one of those swaddling outfits. Wrapped so tightly she barely wriggles around, I peek in and see her big eyes, her cute ears and her long whiskers. Meow. It always turns into my cat. It is so hard to picture myself holding a baby, a human baby, my baby.

Well, pictured or not, she will be here soon. I have lots of things to do yet and perhaps I should get started. I would make a list, but that would just be killing more time before I actually do something. Maybe I will look at those baby clothes one more time.

Meow.

Books, books, books

23 Weeks, 2 days

For me, the Kindle will never catch on. I love books, real books, that you can feel curl with your hand, smell the fresh pages as you turn them and hear the paper sliding between your fingers with each adjustment. Usually, I am in the middle of reading several books and I enjoy seeing them piled up with their colorful spines stacked up facing me. Currently, I am in the middle of many, many books:

Harry Potter and The Prisoner of Azkaban. I started reading this several months ago. I read the two before it as well. A friend of mine really loves them and I thought I could throw it into my rotation. For some reason, I have stalled out. I have about 30 pages to go and I just can't get myself to pick it up again. I like the idea of a series, but this just hasn't captured my interest.

I have a stack of nerd books. These are books that I don't read cover to cover, rather, I skim and read bits and pieces. The focus is split between Photoshop CS4 and Flash CS4. I have to admit that I did very little skimming in the Photoshop books. I have finished teaching Photoshop for the year and am now focusing on Flash, specifically animation, game design and script writing.

When I was teaching Flash CS3 last year, I had the kids writing scripts in the old language Action Script 2, but I know I need to get with the times and move up to Action Script 3. It is a whole other language, literally. There are a few phrases that I understand and a whole lot that I don't. When my insomnia would get bad I would lay in bed and write scripts in my head, now, I have to relearn it all. I consider this to be part of my brain calisthenics.

I also started the next book in Stephen King's "Dark Tower" series. I am on book V, The Wolves of Calla. It's a fast read. I enjoy the fact that it is the same characters continuing the same quest book after book. There is a certain flow to the books that makes them quick to get through and yet easy to remember as well. Stephen King writes in a way that is both clever and simple. I am often amused to the point of chuckling aloud. I read very little fiction and this is pure brain candy for me, but I love it.

Sitting on our bookshelves for over a year is the book What to Expect the First Year this is the second book in a series on pregnancy and childcare. I had been picking up and putting down the previous book What to Expect When You are Expecting, but some little part of me fears it is jinxed. We purchased that book during the first pregnancy and every time I got pregnant again I would start to read it and then miscarry. I don't believe in jinxes, but I don't handle the book too much now, just in case. When we bought the second book in the series, I never got a chance to crack it open, so I figure that one is 'safe'. Perhaps it is actually the third in the series. I believe there is a primer book on how to get pregnant, but I have never needed that one.

What to Expect the First Year could be really helpful for me, as I know nothing about babies. It's almost comical how clueless I am, but I feel like this may work to my advantage. I have not been trained the the ways of baby rearing so I don't know what the 'right' thing to do is in any situation. In new situations, I tend to trust my instincts and I think they will serve me well when it comes to raising our kid.

I also like to do a lot of beforehand research on anything I am not familiar with. I try to investigate both sides of any coin that may be flipped my way and choose the more logical approach. Numbers speak to me and statistics have a lot of sway. Right now may be the only time left for me to do this kind of leisurely research before Piper is here screaming or turning purple or gazing mindlessly at the wall (or some other scenario that I haven't come across). I will use this time wisely and read, read, read.

I am also reading 3 Beatrix Potter books. One is a biography of her life, one is the companion book to a show of her work from the Tate and the third is her collected stories. She was a fascinating woman and her stories are so different from today's children's books. We all know the gist of Peter Rabbit, but her original story takes on a slightly darker tone than the one we all repeat. Actually, all of her stories do.

There is no neat, wrapped up 'happy ending', rather, they are tales of learning from your errors which are mostly character flaws. The protagonist doesn't get off scott-free in the end, there is usually some price to be paid for his mistake, whether it be going to bed hungry or losing your tail to a cantankerous owl. The moral of these tales are much more true to life. One cannot just say 'I'm sorry' and all will be well again, there is often a pound of flesh to be paid somewhere to someone.

In addition to the dose of reality, her illustrations are beautiful: watercolor and ink. It is a pairing that I have fallen in love with and am seeing over and over. Ralph Steadman did a lot of his work with this combination as did Tim Burton, two artists I greatly admire. The play of soft, flowing watercolors to the sharp, biting black ink is brilliant. Crisp, vivid and purposeful.

Yesterday, five more books came in the mail: Ina May's Guide to Childbirth, Special Delivery: A guide to creating the birth you want for you and your baby, Home Birth: A practical guide, The Diaper Free Baby and Baby-led Weaning: Helping your baby love good food. I have started on Home Birth: A practical Guide and will try to get through a book every few days. I am arming myself to the teeth to ensure that I am making the best decision I can through the knowledge of others.

I may choose to dismiss some information, because my logic may get in the way of some of the ideas. I know that there are many ways to do the same thing, often with different outcomes. After absorbing some information, I allow myself time to consider it and discuss it with Griffin. If it makes sense to us, I will add that bit to my collection of things we will try, if it seems illogical, it gets pushed aside (and possibly ridiculed by us in the future). Perhaps, in the heat of the moment, the things that once seems so logical to us will blow up in my face, that is a chance I will have to take. Nothing ventured, nothing gained.

My books are surrounding me now. There is a fire roaring in the fireplace and my cat is curled up next to me purring. The hardest part of this lazy Sunday morning will be deciding which book to start reading first. Of course, I must put down this laptop before I can do anything else. And so I will.

Making the Move

22 Weeks, 1 day.

We met with the certified nurse midwife yesterday. Our appointment was at her home office and of course we arrived early. She didn't mind, invited us in and we sat down in a cozy room. She asked a couple of basic questions: where we lived, my due date, what week I was in and confirmed that we were looking to have a home birth.

Then she asked us if we had questions for her. I didn't know where to start, so she did. She practiced originally as a labor and delivery nurse starting in 1986 and then began doing home birthing in 1997 after going to midwifery school and doing an internship. She has delivered over 700 babies and assisted with another 1100 births.

She told us about her track record for home births. With her first time mothers have a 10% transfer rate to a hospital. That is pretty good, I had read it was 25% on average. She has never needed to do a transfusion for a mother although she could. She told us about her experience with different situations and what she would do. Her level of knowledge and confidence really made me feel comfortable. An OB would never do this - they wouldn't be expected to defend themselves and prove that they would be a good doctor for you.

She asked us to tell her about the pregnancy and what we were looking for in a birthing experience and why. I told her about the miscarriages and who we were currently seeing for care. I told her that I wanted to be home with my family included, if they want to be. I said I would like to invite my mother and father-in-laws and my brother and sister-in-law. (I think my brother would jump out of his skin, but I would invite him anyhow.) I said I wanted it to be fully natural and not be rushed. I didn't want things to spin out of control, which I think happens in hospitals far too often. She nodded a lot and asked questions that ensured me that she was listening to what I was saying and not just planning on what to say next.

She told us that she could do all of the prenatal care from here on out and we wouldn't need to continue going to the OB or perinatal group. She said she is affiliated with an OB in Morristown if we do run into any problems before 37 weeks. I told her that we had one more appointment in 5 weeks at the perinatal group for an ultrasound to check for growth. She said it wasn't necessary for us to continue to have ultrasounds and that the development of the baby could be palpated at this point. I wondered why my OB never did that.

I don't really have a problem leaving the OBs, frankly, I am glad to leave them. There are 3 doctors there and although they are very nice, they don't know me from Adam. In fact, they have gotten our due date wrong several times and keep asking the same questions about the previous miscarriages over and over even though this is all in my chart. The only thing they do every 4 weeks is check my blood pressure, weight, check my urine for protein and sugar, check the fetal heartbeat and then send me on my way. It always seems like a waste of time for us.

On the other hand, the perinatal group does all of the ultrasounds. It's wonderful getting to see Piper moving around inside me. They usually print out a few pictures for us to take home. Since we have now 'graduated' and don't need to be seen every two weeks, it seems like this is just going to be a novelty to keep seeing her through ultrasounds.

Now we have to decide whether we will go to the scheduled ultrasound appointment. The midwife said we didn't need to, but she didn't say we couldn't go. It's up to us. Griffin and I talked about it afterwords. He said he would be fine going one more time. The real question is whether he would be fine not going one more time. That is the question.

I have read over and over that ultrasounds in the third trimester are not necessary unless there is a problem, but we like the ultrasounds. It's so cool to see her and not just feel her inside me. I believe the next ultrasound would be our last one anyhow, so how could one more hurt? Do we care that it is unnecessary? Maybe this is why health insurance costs so much. Well, we have time to think about it.

We talked for almost an hour with the midwife. She asked questions, we asked questions and I felt like I knew more about her in one hour than I know about the OB I have been seeing for the last 2 years. It's a much more personal experience.

We told her that we were considering a waterbirth and she said she does a lot of them. She explained what we would need to get and how the logistics would work. It seemed to be pretty much as I had read.

I asked her again if she thought we were good candidates for home birth and she agreed. She said it's not for everyone and she can usually tell after speaking with a couple whether it is a good option for them. She said she would not take on anyone for home birthing that she thought could not handle it or if it would be too risky for mother and child.

Finally she told us that we would need to get a copy of my records from my OB's office. I thought about how fat my chart now was: filled with information about failed pregnancies. It also has all of the information from the NJ Perinatal Association. So much stuff that we want to put behind us. My only fear is telling the OB that we don't want to use them anymore. I don't know why that scares me. When we were there last time and I asked about a midwife, I could almost see the hackles going up on the doctor. They can't say 'no', can they?

We left the appointment feeling really positive about the whole thing. I asked Griffin if I sounded like a nut talking to her and he reassured me that I didn't. My reasons for wanting a home birth are equal parts emotional and logical. The thought of going to the hospital to deliver Piper makes my skin crawl. The last 4 times I was in a hospital was to have another failed pregnancy removed. I don't associate hospitals with anything good. Hospitals are where you go if you are sick, I am not sick. I am going to have a baby!

It's - Natural?

21 Weeks, 6 days.

The cat is out of the bag. Well, maybe it is coming out in super slo-mo, but it is definitely coming out. More and more people at work are actually approaching me and asking if I am, indeed, pregnant. I am getting more comfortable with the idea of discussing my condition with folks outside of my 'pregnancy inner circle'. Although tickling me somewhere in the back of my mind is the thought that I am jinxing this whole thing by talking about it to virtual 'strangers'.

I am not a mystical person. I don't believe in jinxing or bad luck or karma - good or bad - and yet, still I get that miserable little tickle once in a while. Pushing it down and away has become easier over time, but there are days when it rears its ugly head too often.

At lunch today, two more people found out about our happy news. I am no longer actively hiding my pregnancy, however, I cannot bare to think about shouting about it from the rooftops. It just came up in the lunchtime conversation and I spoke about it as if everyone knew and it was no big deal. That alone, was a challenge for me.

A colleague of mine that ate lunch with us is also awaiting the birth of his offspring. His wife is due a couple of weeks before I am. I used to despise other people who were pregnant when I was having miscarriage after miscarriage. I was really bitter, but now it was actually quite pleasant to discuss our upcoming events.

We talked about due dates and finding out the sex and then the topic of birthing came up - I brought it up. I asked if they were planning on having a natural childbirth. His initial reaction was 'yes' and then he amended the statement by saying she was planning on having an epidural. I told him that was not 'natural' and he responded with something like 'Is that not what you meant?'

Apparently, he was thinking 'natural' meant not having a c-section. If it comes out the normal route, then that was the 'natural' part of giving birth. Natural childbirth, right? I found it rather comical.

I told him that we were considering having a home birth. Now, this always raises some eyebrows and he was no exception. My colleague responded with something like - that's really 'interesting' or 'cool'. Since we are mostly nodding acquaintances, I assumed he might be holding his tongue and his true thoughts on the matter.

I thought about this for a while today. It's so strange how we have come to think that there isn't any other option for giving birth other than doing it at a hospital. And that as long as the baby comes out through the birth canal, well, then that's natural enough. The fact that the mother is numb from the belly down, pumped full of drugs and attached to several different monitors all beeping and flickering never enters into the equation. Even if you do it without drugs, the whole hospital setting really doesn't seem so natural to me either.

Most of the time when I discuss home birthing now, I get some variety of a negative reaction. Some responses are strong and on the verge of calling me an idiot and having a death wish for my baby and others are more polite and merely hint at my lunacy. I am developing a thick skin.

Tomorrow, we will meet with a midwife whom we may choose to have help deliver Piper. She started out as a labor and delivery nurse and then moved over to midwifery and home birthing. I am really interested to hear what she thinks about our risk factor, both with the miscarriages and my advanced age. Thirty-seven is considered geriatric in the motherhood biz.

I have been thinking about how I will react if the midwife tells us that home birth is not a good option for us. She is the expert after all. I expect to hear that from an OB, but will be disappointed if a midwife tells us it's not a smart idea. So, what will our next move be? A birthing center? Back to the old hospital option?

Moreover, how would I deal with the possibility of being in labor and finding out that I just can't do it at home? What would it be like to admit defeat and go to a hospital to deliver? Could I stand the barrage of I told you so's that would surely follow? Maybe my skin needs to get a little bit thicker still.

Graduation!

21 Weeks, 4 days

Yesterday we had another appointment at the NJ Perinatal Associates at St. Barnabas Hospital. We have been going there every two weeks for the last two months to have my cervix measured. It's an invasive procedure, literally. There is no dignity in pregnancy and I have gotten used to be prodded in all sorts of embarrassing ways. My cervix has been measuring long and closed. Often, the doctor will congratulate me on it as if I had some ability to control this accomplishment. They have been checking my cervix to be sure I am not going into PROM again. Of course, last time my cervix was fine and my water broke anyhow. I won't complain about the kid glove treatment, it has given me peace of mind.

Before the ultrasound to check my lady parts, the tech always does a sonogram to just give us another peek at Piper. She tried with all her might to get Piper to turn her head and smile for the camera. Piper would not cooperate. Proving, once again, that our stubbornness runs in her genes.

Then the doctor came it. He did his exam and complimented my nice, long cervix. Good job! After scrawling down some notes he announced that we have graduated. This was the last check they were going to do on my cervix. Clearly everything is going along just fine and it is now unnecessary to keep measuring it. The next time they want to see us is in six weeks. Six weeks! Wow. I felt like I had won the lottery.

I asked the doctor if he would consider this a 'low risk' pregnancy - he started shaking his head before I could finish my question - which was if you don't take the other pregnancies into consideration. He smiled a bit and nodded. Yes, this is a normal pregnancy. It's so nice to be normal.

Griffin and I made the next appointment which will be in March. I will be 27 weeks and change at that time. My next OB appointment is not for another four weeks. We have nearly a whole month with no doctor visits! It's amazing. Wonderful. A relief.

We had been seeing a doctor or giving blood nearly every week, I can't believe they are letting us go so long. I feel like a little kid who had their training wheels taken off. We are flying solo for four long weeks. How will I survive without the doc stroking my cervix's ego? What will do with our free time? I guess we will look to meet with a midwife now. That will occupy us for a while. We can discuss the possibility of home birth with her. Mind you, I only said possibility.

What Are You - Crazy?

21 Weeks

The pregnancy has been going along swimmingly. It's amazing how I am actually thinking about the process of giving birth now. Part of me thought for a long time that I might never get there. It's as if I feared my body would just keep rejecting the idea of incubating this creature for a full nine months, but now, I am thinking it will actually happen. Therefore, I have been thinking about how I want this to happen.

We watched the movie "The Business of Being Born" and another movie "Pregnant in America" - okay, not just movies, documentaries. They both dealt with different birthing options and focused on natural childbirth and home birthing. The idea of giving birth at home initially seemed insane to me. It's unsanitary! There is dog and cat hair on the rug and crumbs in the kitchen! But when I start to think about hospitals, I think that that is where you go when you are sick. I am pregnant, not sick. I don't need an operation, I need to do what women have done for thousands of years.

Americans are obsessed with the idea of health care, but health care to many of us is having a doctor cure what is wrong with us by taking a pill or preforming an operation. If we examine our lifestyle, what we eat and how we live, perhaps we may find with a few changes we don't need so much 'health care'.

I used to think that there was no way I could stand the pain of expelling an eight pound baby from my body, but over the last few years that has changed. I have experienced pain, both physical and emotional, that I never thought I could endure. The pain of labor, the process of delivering this much desired, much anticipated baby will be nothing like the pain I went through this summer having to end my pregnancy at 20 weeks.

I told a young friend of mine that Griffin and I were considering home birth and she was appalled. She had the same reaction that everyone does - what if something goes wrong? How will you get to the hospital in time? Women give birth in hospitals all the time and end up with problems that doctors can't fix. The infant mortality rate in the United States is higher than virtually every other first world country. Why? Perhaps because we treat birthing as a health care issue and not as a natural process.

We have an appointment at the OB today. I will be proposing home birth with a midwife to them. What do you think the response will be?

Tune in later for the exciting results!

___________________________________________

And now the exciting conclusion....

The nurse took my weight and blood pressure. All fine. Gained a few more pounds. BP nice and normal. The doc came in and talked about blood test results and the level II ultrasound results. She talked as if it might be the first time we were hearing this information. I chuckled to myself. Did she think we would sit idly by and wait to hear about results days and weeks later? She checked by fetal heartbeat. Nice and regular. Of course, the NJPA group at St. Barnabas does that and a lot more every two weeks, the nurse that shoots me in the ass every Thursday checks it too and I have a home FH doppler, so I can check it too. I waited for the moment to ask.

Any questions? Yes. Are you affiliated with any midwives? A look of alarm passed over her face. The answer was no. Not surprising. She told me there were some midwives that worked out of the hospital in their own group. And then she started in on how I need to continue being under their care. I told her I had every intention continuing my monitoring, but this was about the birth.

She told me that they were willing for me to have as natural of a birth as possible at the hospital. I smiled and nodded. She reminded me that this is still considered a high risk pregnancy. Did she need to even mention that? I am well-aware, thank you. When I assured her that I would continue my care she seemed to relax a bit.

Ultimately, she conceded. As long as the rest of the pregnancy is as normal as the first half has been, she supposed it would be alright to use a midwife. I nodded. It didn't really matter what she said, we are going to do what we want anyhow. Of course I didn't mention that I wanted to do this at home. Perhaps I would save that tidbit for another time. I would like to speak to a few midwives first and pick one that has similar views to ours. I don't think that will be hard to find.

I was very happy to see that my insurance does cover care by a midwife. There are board certified midwives that are in my insurance plan and somehow that certification means a lot to me.

We have another appointment at the NJPA high risk pregnancy group on Monday. Maybe I will bring up the home birthing there and see what their reaction is like. I find it all a bit amusing. "What are you - crazy?" There's nothing natural about having a baby.....