This blog is just about my life and mostly revolves around my son, Jamie. This blog is a combination of everything, whether it may be a new recipe I tried, a good freebie I found, something funny Jamie said, or feelings I'm having about life in general. There's little rhyme or reason. I'll never win any blogging awards, but I enjoy writing about our lives and I mostly do it for my son. It's so easy to forget moments over the years. I've got all these little tidbits of our life in print and I hope that someday Jamie can enjoy them.

I called this blog Mother of Life, Mother of Loss because of my issues with pregnancy loss and the joy of finally bringing this wonderful person into the world. Truly, I feel the pains of loss, but you won't see too much of that here. I am blessed and I am, above all else, a mother of life.

After all the years of infertility and loss, Matthew and I were blessed with a surprise pregnancy. We were pregnant with twins, but unfortunately, Baby A could not stay with us. Baby B grew into a healthy and happy baby girl that we named Bella Marie. We are so blessed to have two beautiful children.

Saturday, May 31, 2008

Kidisms 5/31/08

I'm always getting a kick out of the things that Jamie says and does. Recently, my DH made popcorn and Jamie smelled it cooking. Not knowing how to tell my husband that he smelled the popcorn he exclaimed, "Daddy, there's popcorn in my nose!"

Sometimes it's just every day little things that sound so amazing coming out of their little mouths. Jamie has a cold right now and he's been coughing pretty bad. He told me the first night, "Mommy, I need medicine for my cough." It was pitiful. I gave him the medicine and he laid down and immediately began coughing again. "Mommy!!" he said, pointing inside his mouth, "Cough medicine not working!" I laughed and told him to give it a little while.Maybe it's stuff that only his mother (and father) finds entertaining or endearing.

Wednesday, May 21, 2008

Jamie's Story

We got married on November 11, 2000 after dating since 1995. We decided to try to have a baby right away. Since we were already aware that I had a condition called PCOS and would have difficulties getting pregnant we began seeing a Reproductive Endocrinologist before getting married. We hoped to get pregnant on our honeymoon. We thought it would happen for us right away. We had no idea what we were in for.

At first we just used Clomid but the follicles would not grow large enough. We were forced to step up to Follistem & Repronex. Our insurance provided no coverage toward these treatments and they were very expensive for our moderate income. Somehow we managed to keep trying. We succeeded in getting pregnant many times but miscarried each time. We had a total of 6 confirmed miscarriages during treatment. We also lost twins due at 17 weeks before beginning treatments. I began to read about various options to treat PCOS. One treatment that was recommended was a low carb diet. I tried it and had great success. I lost a significant amount of weight. Our 3rd anniversary we found we were pregnant again. I cheated on the diet and had a miscarriage.

That cycle we tried again.

11/15/03 HCG level 24
11/17/03 HCG level 17.5 (miscarriage)
11/22/03 Began bleeding
11/25/03 Began Clomid
11/28/03 Began Repronex
12/7/03 Ovidrel injection
12/9/03 IUI w/ 4 good follicles
12/22/03 Positive home pregnancy test
12/23/04 Had HCG checked - They called me later that day with the results. I was out eating dinner with my uncle and brother so they were the first people to hear the news.

This time I didn't stop the diet when I discovered that I was pregnant. I continued to lose weight during the first part of my pregnancy but my baby was thriving. I had quite a bit of bleeding early on. My progesterone levels were low and I had to use progesterone suppositories. Every time I went to the doctor I expected the baby to be dead but it kept growing. It got so bad that one night when the bleeding seemed really heavy, I burst into tears because I thought I was having a miscarriage. My husband took me to the emergency room. I was so consumed with grief that I was sobbing in the waiting room. When we finally got to the back the doctor asked me "Why do you think you're having a miscarriage?" I told him that it was because I was bleeding. He said that a lot of women have bleeding during their pregnancy. I told him that I knew that. He again asked me why I thought I was miscarrying. I stopped a minute and replied "Because I always do!" They did an ultrasound and the baby was fine. It turned out that I had some pooling of blood outside of the placenta. The cause of this blood was never determined.

The bright side of having problems with your pregnancy is all the ultrasounds. I had one at least once a week through my entire pregnancy. When I was in the hospital I had one once a day.I gradually added more carbs with trepidation but still the baby was growing. I had many scary moments in the beginning. What I had been through took away a lot of the joy of being pregnant.

Finally, the baby began to move and I found out I was having a boy. I began to relax a little. I was having to work alone because I had to let go of my employee the day before I found out I was pregnant. I had been forced to call in people from other stores to work my center because I had been on and off bed rest for bleeding. Just when I got a new employee working with me and trained things went all wrong.

At 24 weeks I got up a little too fast at work and fainted. It was my first day back to work after one of my weeks on bed rest. I didn't think it was a big deal but my boss insisted I go to the doctor & get checked out. They wanted a note before they would let me come back. The doctor wasn't very concerned about the incident either, since I had no bleeding or anything, but decided to check me anyway. I took my time about going to the doctor that day. I had fainted about 10:00 but didn't go to the doctor until after 1:00. A friend drove me and dropped me off. I was supposed to call her to come pick me up when I was done. She had her 4 year old with her and didn't want to try to control him in a waiting room and decided to run errands while I waited. I went in and gave a urine sample, as always. The nurse came back and said that there was a little protein in my urine and they wanted to check me just to make sure. I didn't think anything of it. She checked me and then told me to hold on a second, she wanted the doctor to take a look. She sounded really calm and gave no indication that there was anything wrong so I was completely shocked when the doctor looked and said "STOP". I said "Stop what?". He said "Don't push". My heart sank. I just knew this was the moment I had been dreading, but expecting. The doctor explained that I had an incompetent cervix and that I was 3cm dilated and my bag of water was bulging. They told me to lay still and they propped my bottom up. They called an ambulance to get me to the hospital. I had them call my friend and tell them that I wouldn't need a ride. I was terrified but stayed amazingly calm. I asked them to get my cell phone so I could call my husband and they told me no at first but I insisted. My husband didn't work very far from my doctors office. At first they were going to take me to the hospital across the street, but changed their mind. They wanted me to go to a specialist at another hospital. I managed to get a hold of my husband before he got to the hospital I had originally told him to meet me at. My husband was able to reach my doctors office as they were loading me in the ambulance. He followed the ambulance to the hospital. By the time I got to the hospital I was 4cm dilated. Everything was a blur and seemed to be happening really fast. They gave me Mag. in my IV to stop labor. I felt like I was slipping away. My blood pressure was dropping extremely low. I felt so strange. The doctor came in and explained my options, we could do nothing and I would have the baby (which would have little chance of surviving) or I could have a cerclage put in. The risk of the cerclage was 1. My water breaking when they tried to push it back in and having the baby anyway and 2. infection. There wasn't really an option, but now I was beginning to freak out a little. Somehow I managed to keep control of my emotions until they had a difficult time placing the epidural. The more they poked the more I began to panic. I think that part of it was the medicine they gave me to stop labor. My dropping blood pressure made me feel confused. At least I think that is what was causing it. I gripped the nurse like a two year old whispering "I'm scared, I'm so scared" over & over again. Finally, they got it properly placed and I was off to get the cerclage.

Everything went as planned. I spent the next week and a half in the hospital. I wanted to get home so bad. Because my water was so low and the baby wasn't very responsive, even when they used the little buzzer to agitate him, they kept detaining me. That was really scary, too. They said it could be because of the low amniotic fluid or because of the medication they were giving me.

Finally, the day came when they decided that I had enough amniotic fluid to go home. I had to have my amniotic fluid & the cerclage checked twice a week. I was so happy to go home. I was put on bed rest for the remainder of my pregnancy but was allowed to get up to use the bathroom & shower. I had to take Trebuteline (generic for Brethine). It was very difficult to keep myself in bed. Things went fairly smooth for a bit, but at 31 weeks my water broke. I was told that I would be lucky if I could make it 48 hours without going into labor. They sent in the pediatrician to talk to me about what would happen when Jamie was born. It was all really scary. Nobody expected me to carry to 36 weeks.

I spent the next 5 weeks on total bed rest in the hospital. I was not even allowed to go to the bathroom. I felt lonely and isolated. I rarely had any visitors and my husband worked long days. On top of that he had to maintain our household. We had a dog and several cats. There was no way around him going home everyday to feed and water them. I usually didn't see him until 11:00pm. He always spent the night with me in the hospital. At least I didn't have to be without him all the time. He brought my laptop to me so I could get on-line and try to amuse myself. I found it hard to use the computer except to play a few games that required only one hand on the mouse. I spent hours playing games at Still, some days I would get so uncomfortable being stuck in the bed that I thought I might go insane. I can't imagine how these women survive who have to spend half their pregnancies in a hospital. Sometimes I felt that it would never come to an end.

Finally I hit the 36 week mark. My doctor removed the cerclage and decided to induce me to make sure I had the baby before he had to go on a trip the next day. I was glad he was going to be there.

On August 3, 2004 I had a beautiful baby boy. He had some difficulty breathing and keeping his temp. so he had to spend a little time in the NICU. He didn't have to stay long, but it was still hard for me. His first couple of days the night nurse didn't want me to touch him. She said I was over stimulating him. I wanted so badly to hold him and kiss him. I would return to my room in tears. The room seemed so different. I had hated being strapped down, monitored constantly. Now the room was silent. For the first time in 5 weeks I couldn't listen to the sound of my baby in my tummy. It was nice to be able to get up and walk and especially nice to shower, but I was missing Jamie. On the third day they let me hold him. He was so cute. I never wanted to put him back down. They didn't let me hold him very long. I begged them to let me try to nurse but they wouldn't let me that day. The first night out of the hospital I came home to sleep. Our house is about 45 minutes away from the hospital. The second night we decided to sleep in the parking garage. We threw a twin mattress in the back of the SUV and camped out. I had the nurses call my cell phone when he was ready to nurse. The next night they got us a room. It was a really long walk from our room to the NICU. The rooms were really there for people who had family in the ICU at St. Mary's, not in the Women's Pavilion. My feet and legs were swollen to twice their normal size, not to mention the fact that I had just spent the past 3 months in bed. One of the nurses hi-jacked a wheelchair for us to use during our stay. I was really grateful. We had to walk 6 or 7 hallways and take three elevators to go see our baby. This was a terrible trip to take every couple of hours.

Finally, the big day came. We got to bring Jamie home on August 10, 2004. We were told in the morning but had to wait until the afternoon because we had to take an infant CPR class before we could take him home. At the time it seemed like forever. Now it seems like forever ago.

Wednesday, May 7, 2008

What is Incompetent Cervix (IC)?

What is Incompetent Cervix (IC)?

During pregnancy, as the baby grows and gets heavier, it presses on the cervix. This pressure may cause the cervix to start to open, resulting in preterm birth and possibly the loss of the baby because of the shortened gestational length. It is estimated that incompetent cervix happens in 1 out of 100 pregnancies and is the cause of 25% of all second trimester losses.

Incompetent cervix usually occurs during the second trimester, but it can occur as late as the early third trimester. With incompetent cervix, the cervix usually opens without labor or contractions. However, once the cervix has opened partially, sometimes contractions may begin. Diagnosis can be made either manually or with a vaginal ultrasound. The use of ultrasound technology has been very helpful with diagnosis, which is made when the cervical os (opening) is greater than 2.5 cm, or the length has shortened to less than 20 mm. Any shortening of the cervix should be carefully monitored. Here is a list of factors that can contribute or cause cervical incompetence…

• DES exposure
• Cervical trauma such as a D&C (dilation and curettage) from a termination or a miscarriage
• Previous surgery on the cervix, including biopsies
• Damage during a difficult birth
• Hormonal influences
• Congenitally short cervix
• Malformed cervix or uterus from a birth defect
• Uterine anomalies

How is IC Diagnosed?

Incompetent cervix is not routinely checked for during pregnancy. Because of this, it is not usually diagnosed until after one or more second or third trimester losses have occurred. Generally, these early miscarriages have minimal contractions or bleeding and the birthing process is completed rapidly. Women can be evaluated before and during pregnancy by ultrasound. If you have any of the factors that can potentially cause incompetent cervix you should have regular pelvic ultrasounds. The ultrasound can be used to measure the cervical opening or the length of the cervix. A manual pelvic exam can not detect funneling. Funneling is where the internal portion of the cervix, internal os (portion of the cervix closer to the baby) has begun to efface. The external os will be unaffected if diagnosed in time. In other words, the cervix is starting to open inside, but has not begun to open outside.

What is the treatment for IC?
If you are diagnosed after a second trimester loss or prior to pregnancy and it is suspected that you will have problems with the strength of your cervix, a preventative cerclage can be performed between weeks 12 and 16. It is said that the earlier you have the cerclage performed the more likely the pregnancy is to continue.

Sometimes a physician discovers a partially dilated and shortened cervix during a routine pelvic examination during the mid-trimester of pregnancy. If you are diagnosed with incompetent cervix during pregnancy, a rescue (or emergency) cerclage can be performed. For diagnosis made during pregnancy, you must meet certain criteria before a cerclage can be performed. You should be on bedrest following a rescue cerclage. You are not eligible for the cerclage if you have:

• Increased irritability of the cervix
• Your baby has already died
• You are more than 4 cm dilated
• Your membranes have ruptured

What is a cerclage?

A cerclage is a suture used to sew the cervix closed to reinforce a weak cervix. It is usually done between weeks 12 and 16. A cerclage will usually be removed between weeks 36 and 38 to prevent problems during labor and delivery. There are three different types of cerclage. They are the McDonald, the Shirodkar, and the Trans Abdominal (the Trans Abdominal cerclage can be done in a few different ways and may also be called the Hefner - or Wurm - procedure, the Uterosacral cardinal ligament, or the Lash). The McDonald and the Shirodkar are the most commonly used methods.

The McDonald cerclage is the most common, and the easiest to perform. It is done with a 5 mm band of suture placed on the cervix when there is effacement of the cervix or a history of prior incompetent cervix. It is usually removed at 37 weeks in an uneventful pregnancy (Certain problems, like infection, preterm labor or premature rupture of the membranes, make earlier removal more likely).

The Shirodkar cerclage is usually placed higher on the cervix than the McDonald cerclage. It is often used when a previous McDonald cerclage has failed or when the cervix is more likely to open up after suture. The cerclage is usually placed entirely under the skin, and because it was left in place, it originally required a cesarean delivery. Today, most physicians perform a modified Shirodkar, in which the stitch can be removed and a vaginal delivery can occur. Ask your practitioner which procedure they perform.

A Trans Abdominal cerclage is used when the cervix has been extensively biopsied, damaged, or removed. It is also used in cases of higher-multiple pregnancies. The suture is inserted through the abdomen above the pubic area. It is usually placed between weeks 11 and 12. Barring complications, the cerclage will then be removed at 37 weeks. If problems arise, the cerclage can usually be removed through the vagina. When the pregnancy continues to full-term, a cesarean section is performed and the suture left in place to protect future pregnancies. After two pregnancies, the cerclage may have to be replaced.

Are there any risks to having a cerclage?

The risks of having a cerclage are minimal. Most physicians feels that a cerclage is a lifesaving procedure that is worth the possible risks involved. The risks are…

• Premature rupture of membranes (1-9%)
Chorioamnionitis (Infection of the amniotic sac, 1-7%) (This risk increases with gestational age at onset of IC and is at 30% for a cervix that is dilated more than 3 cms.) This risk can be minimized by taking antibiotics following the procedure
• Preterm labor and premature rupture of the membranes
• Cervical laceration or amputation (This can be at the procedure or at the delivery, from scar tissue that forms on the cervix.)
• Bladder injury (rare)
• Maternal hemorrhage
• Cervical dystocia
• Uterine rupture