Babywearin' Part 2

Jake and I have both moved on to more comfortable/challenging/elitist/cultish babywearing options. 

This is a Hoppediz mei tai (pronounced /may'-tie/), and Jake has one in all black. He claims it's far more comfortable than any SSC (this is a particularly comfy brand of mei tai since it's made using woven wrap fabric) and he's starting to get pretty quick at tying it on himself. It can be used front or back. 

And this bring us to my latest obsession, the woven wrap. What's not to like? Luscious, finely crafted textiles? Breathabilty? Infinite tying options/styles?Supreme comfort? Okay, it's not always the easiest or cheapest or fastest to get in. This is why I still keep my Boba and ring sling handy. But I like a challenge and the process of learning a new skill, so this woven wrap chapter of my babywearing life is proving to be a fun one that will keep me interested for a while.  Check out all the cool carries one can learn!: 

http://babywearing102.tumblr.com/post/55797607285/wrapping360

Side view of a back-carry.

Wearing both in the same 15 feet long swath of fabric.

Hip carry.

Boba on the back, woven wrap threaded through the straps on the front.

I've owned only two so far: Natibaby Golden Feathers (30% hemp/70% cotton in a size 4 and Girasol Diamond Weave Dark Rainbow (100% cotton) in a 7. I've already sold the Girasol and am on the lookout for a great size 6, preferably in a linen blend. I want to try ALL THE WRAPS.

And I'm not alone. I have made so many dear, awesome mama friends through our local babywearing group. These are not only smart, savvy women who make attachment parenting look cool, but they are also textile geeks like me! Double score.

Babywearin'- part 1

I may not know much, but I know that we would not have survived our first three months (i.e. the fourth trimester) without our baby carriers. Here's what we got and what we think about them so far.

We both own a soft-structured carrier (SSC), the Boba 3G.  Mine is the cute pattern pictured here, and Jake's is a manly black with white pinstripes.  Jake basically lived in his for 3 months.  Z sleeps her best naps nuzzled against his chest, and for many months it was basically the only way he managed to eat while at home.  I was less crazy about it until recently because they were too small to wear the normal way, with their legs wrapped around my waist, so instead we'd have to cinch the carrier up really small and put them in with their legs froggied up.

This was fine when they were TRULY newborns and basically stayed in that shape all day long, but once they were squirmy, active 2 month olds, they kept trying to stand up, shoving their feet between you and the waist band.  So irritating!  The folks at The Nappy Shoppe showed us how to covert the carrier to the normal setting and adjusted it for our smaller babies using a rolled up blanket.  It was way more comfortable but a little fiddly to get them situated.  The newer Boba 4G has an infant insert built in for this. My favorite way to use the Boba now is on my back (not recommended before about 6 months), which is ideal when I'm out by myself and juggling two babies. A final word about SSC's: Jake switched to the Ergo for a few months when Harper chewed up a buckle on his Boba, and it TOTALLY jacked up his back. Also, if I could go back in time, I think I would have ordered a Tula instead of a Boba, as they are are even more comfortable and stylish.

Jake also owns a Seven Sling, which is just a big loop of fabric, sized for the user.  His is white with little red and blue jolly rogers stamped on it.  It has been used once.  It was quickly abandoned in the first week when we realized that you're supposed to carry a newborn in a cradle position like this:

And yet it's VERY IMPORTANT to make sure their chin isn't resting on their chest.  What?!  It was really stressful constantly checking and adjusting, which upset the baby being held.  It can't be made tighter or looser, so if you order the wrong size or baby grows really fast, you're going to suffer. Just say NO to the pouch!

I had a Rockin' Baby Sling, and folks, it did indeed rock.  So comfortable, so quick, so fashionable.  This particular brand sports an extra long tail (which works well with my height), a reversible fabric, and a pocket on both sides.  Ring slings take a little bit of practice and patience the first few times, but I was surprised by how quickly it became intuitive.  And I love that it is equally appropriate for a tiny newborn and a curious one-year old.  Now that they're heavier, I wouldn't choose a ring sling for a long walk or a day at an amusement park, but it's divine for quick up-and-downs, errands, etc. I ended up selling the Rockin Baby and getting a wrap-converted ring sling or WCRS (more about wraps later) that is less clashy with most of my wardrobe. (Yes, I coordinate my carrier to my outfit.  Shut up.) I wear that thing at least once a day. It's always within reach.

I also own a Baby K'tan.  I've only used the kangaroo and hug positions. When they were teeny tiny newborns, the K'tan was my favorite, particularly for talking those very important walks when recovering from my c-section.  They just snuggled up so sweetly and perfectly and went to sleep instantly.  However, since they've grown, I've started wondering if I have the correct size carrier for me, because whenever I put a baby in, we both look and act pretty claustrophobic. Between the ill fit and the general warmth of this, it's been entirely discarded. I hope to sell it soon to an expecting mama in need of something for a tiny squish.

Continued in the next post...

Breastfeeding Twins

I followed all the rules.  I educated myself by reading at least three books on the topic.  We found a breastfeeding friendly pediatrician.  I breastfed them in the first hour after birth.  I spent our first days in the hospital completely skin to skin. I fed them on demand, not on a rigid schedule.  I eschewed bottles and pacifiers until their latch was nearly perfect.  I contacted lactation consultants (six of them, to be precise).  I used a nipple shield to help with a poor latch.  I immediately took action to correct a tongue tie.  I rented a hospital grade pump.

And it was still kind of a disaster.

Because they were two weeks premature, D and Z were sleepy and disinterested in eating.  Because they didn't eat much, they didn't stimulate my breasts enough to feed two growing babies.  By the time we left the hospital, they had lost between 10% and 12% of their body weight, and we were strongly encouraged to supplement with microscopic amounts of formula via syringe, administered usually into the corner of their mouths while feeding at the breast to inspire more vigorous sucking.

But their weights continued to plummet.  I was put on a strict 2 hour feeding schedule, around the clock, no breaks.  Due to poor latches, they weren't able to feed simultaneously, so I fed one for about 45 minutes, then the other, then I took 30 minutes to nap or poop or cry hysterically before starting again.  Before long, I was hallucinating from the sleep deprivation, lashing out at family with paranoia and envy.  As bad as the schedule was, it staunched the weight loss, and I was rewarded with a 7 hour nightly block of feeding only on demand (so...every three hours).

By three weeks, they were still refusing to gain, despite the fact that I was spending nearly every waking moment with one attached to my breast.  I was demoralized and terrified that my doctor would pressure me to give up breastfeeding entirely (or make me supplement with so much formula that I might as well give up).  Instead, she put us on a program I later learned was called "triple feeding."  Every two hours went like this:

Breastfeed D (10 minutes)

Breastfeed Z (10 minutes)

Bottle feed D 2 oz (10 minutes)

Bottle feed Z 2 oz(10 minutes)

Pump (20 minutes)

Eat, nap, poop, and/or cry (one hour)

Rinse and repeat 10 times a day while caring for two babies

It. was. brutal.  Furthermore, I wasn't pumping enough after feeding to give them four ounces every time.  Enter my dear friend Temple, my angel, who generously shared her freezer stash of breast milk with me so we wouldn't have to resort to formula.  Obviously, she couldn't give us extra milk forever, and Jake, who would eventually need to go back to work, was HIGHLY instrumental to making this insane schedule possible.  I was miserable all the time, fearing we would never drop the bottles and supplementation, that my supply would never pick up, that my babies were suffering constant hunger and frustration.

We started going to The Nappy Shoppe--a natural parenting store specializing in cloth diapers, baby carriers, breast feeding supplies, natural toys, etc--on a weekly basis for their Breastfeeding Cafes.  A specialist always hosted to field questions from exhausted, freaked out moms, and they had a baby scale on site to check on regular weight gain (or do a weigh-feed-weigh to see what your baby takes in during a single feed).  Under their guidance, encouragement, suggestions, and support, we slowly, slowly, SLOWLY weaned ourselves off the triple feeding just a few ounces at a time.  At this point, we are down to only two 2 oz bottles (and two pumping sessions) per day, and the rest of the time, we feed on demand.  The kids are now about 10 and a half pounds and gaining steadily on their respective curves.

On the one hand, I've never been more proud of myself.  Whenever I see that roll of fat around Z's wrist or bury my face in D's full cheeks, I sigh with the satisfaction that I DID THAT.  I made them with my body, and now I'm helping them grow big and strong.  It's mind blowing.  On the other hand, I feel like I've had a loss of faith.  Going in, I believed in the sanctity of breastfeeding.  I believed that if you followed the rules, you would be rewarded with years of happy, easy feeding.  I believed that the lactation consultants had the answers.  But it's not always true.  Sometimes, it's a real, honest-to-god failure.

Yes, we're finally finding some success, but it's not because I'm so great or because breastfeeding is so perfect a system.  We're finally getting this to work because we had a boatload of support.  And I want to thank those people openly.  First, my husband, who took a full THREE MONTHS off from a brand new job that he loved to change two dozen diapers a day and soothe screaming babies with his mad baby-wearing skillz.  Next, to Temple and Simone, for sharing their liquid gold and ensuring that my babies never had to go hungry while I challenged my supply to keep up.  To my mother, who made and bought and delivered countless meals, who opened her house to us that first hellish week and slept in shifts with my dad and Jake so there was always someone to sit with me while I fed, even at 3am.  To Becky, my mother-in-law, for taking on the Herculean task of being my day-time help three days a week, and of course, for all the coffee!!!  To Hannah, who held my hand and wiped my tears when I thought I could not handle the guilt and fear one more minute.  To Cheyenne and Lydia and all the girls at The Nappy Shoppe, our home away from home, for simultaneously cheering me on and teaching me patience.  So many other people: Dr. Agrawal, Melissa and Courtney from NDDA, Autumn and Tom at Cafe of Life, the LCs of Baylor Hospital, the Facebook support group Breastfeeding Multiples...thank you, thank you, thank you.

Postpartum

Things I did not expect about the postpartum period:

1) Temperature regulation problems: During and immediately after surgery, I shivered and shook like a leaf.  In the four days of recovery in the hospital, I roasted and could rarely stand to have more than a sheet on me.  Once settled for further recovery at my mother's, I alternated between hot flashes, suddenly ripping off whatever clothing or blankets I could, and chills, literally chattering my teeth and huddling under 3 or 4 blankets. It was BIZARRE.

2) Swelling: Everyone knows pregnant women swell during pregnancy, particularly their ankles, feet, and hands.  But I had NO IDEA that the swelling gets substantially worse AFTER you deliver, for about two weeks.  I was looking forward to wearing real shoes home from the hospital.  Instead, there were times when the back of my legs all the way up to my mid thigh was so swollen, I couldn't bend at the knee.

3. Pain: Yes, recovery from major surgery was bound to be rough, but HOLY MOLY did I have a hard time with the pain.  I have a few theories of why I had such an unexpectedly hard time coping (maybe my body had more to recover from after multiples pregnancy, maybe I was not clotting appropriately due to my low platelet count, maybe because I was not allowed anti-inflammatories for that same low platelet count, maybe I'm actually a total wimp, etc), but one things is for sure: my first shuffle to the bathroom and back was far and away the most physically difficult moment of my life.  I nearly vomited and blacked out from the blinding pain.

4. Weight loss: I was sure that I was going to be one of those women who looks about 6 weeks pregnant for the next two years.  I was fully prepared to wear the majority of my maternity wardrobe throughout the next season.  I was shocked when 50 pounds just fell off in the first two weeks.  I'm not trying to brag; I have no idea how/why other than breastfeeding twins, and I still have some baby chub around the lower half of my body.  But hot damn, it's good to see my waist again!  The female body is kind of amazing.

5. The baby blues: Everyone has heard of post-partum depression.  Brooke Shields wrote a book about her experiences with it.  It makes the news every time some poor woman without the proper treatment does something horrible to her child.  It's terrifying and extreme, but I was fully prepared to struggle with it to some degree, seeing as how I have a history of garden variety clinical depression, for which I am normally medicated.  I figured there was no way I was going to lose two placentas (and all their mood boosting hormones) at one time and be able to quickly find hormonal/emotional equilibrium.  What most people don't know or talk about enough are the "baby blues."  It's estimated that as many as 80% of mothers experience the baby blues (though my OB said it's more like every mother, and the other 20% are "full of shit"), which is a milder form of PPD that only lasts the first two weeks of postpartum.  It does not feel anything like classic depression to me.  I did not feel listless or uninterested in things or extra sensitive to hardship.  I just felt like I was made of glass and the whole world was upside down.  I felt off kilter, disoriented, and most of all, unable to stop crying.  I cried for no reason from sun up to sun down.  It was truly wild to just weep and weep and not be able to say why.  So far, I think I have avoided true PPD, for which I am deeply grateful.

6. My incision: They don't use stitches for c-section scars, they use STAPLES.  It makes your belly look like Frankenstein's monster for a few days (my husband likened it to the spine of a spiral notebook), but when they remove them (which I was nervous about but didn't hurt one tiny bit), the remaining incision line is SO subtle and thin.  I was truly impressed with the medical technology.  Now, if only they had thrown in a tummy tuck for my stretched out skin!  On the downside, I still have nerve damage in that area, so even 3 months later, it feels like I've been shot with novacaine all along the scar.

Birth Story

On the Tuesday before Thanksgiving, I went in for my final prenatal appointment.  Dr. G and I went over the details of my scheduled c-section, set for the following Tuesday.  I was 37 weeks and 5 days, measuring 48 weeks.  We did the same old sonogram, cervix check, urine analysis, weigh-in, blood-pressure check, etc.  Everything was uneventful and as expected.  The kids looked huge; my cervix was closed tight, blood pressure nice and low.  Dr. G gave me some paperwork and a directive for blood work to take across the street to Maternal Observation at the hospital.  They basically needed my blood type and a few other tests before I went in for surgery.  The breathless waddle there and back nearly killed me, but I left excited about enjoying my last week with just me and Jake.  Should we go out for a fancy dinner?  Were there any documentaries on Netflix we'd been putting off?  What could I do or get for him to show him how much I appreciate his help and understanding these last few months of hell?

Later that night, Jake and I were curled up on the couch, eating frozen pizza and watching The Mindy Project when my phone rang.  It was Dr. G, saying that he was looking over my lab work from home and was slightly concerned with one of my numbers, namely my platelet count.  A normal count is anywhere between 150,000 and 500,000, but mine was a paltry 98,000.  What did this imply? Well, he said, it could be nothing, or it could be an early sign of a HELLP syndrome, a special variation of pre-eclampsia.  The final LP in HELLP stands for low platelets.  The first H is Hemolysis, meaning red blood cells breaking down, and the EL is elevated liver enzymes.  Hence, he wanted to check my liver and kidneys for other signs of HELLP and suggested I go down to Labor and Delivery within the hour for further testing.  I was flabbergasted, of course.  I gulped and asked him what would happen if I did have HELLP.  He replied that in that case, I would be meeting my babies tonight.  Jake and I took a deep breath and went about packing our bags for a four night hospital stay, all the while repeating to ourselves, "I bet it's nothing.  We'll be home by midnight."

Testing at the hospital went well.  We had a great nurse who kept us chatting and laughing for about two hours while they monitored my blood pressure and the babies' heart beats.  Finally, Dr. G, who had been watching my blood work and monitors from his home, called my hospital room.  It WAS looking like early onset of HELLP alright, and the recommended treatment was delivery.  Furthermore, if we decided to wait and see, we might compromise several aspects of our birth even further.  For instance, if my platelet count, which was continuing to fall, dipped below 50,000, I would not be allowed an epidural during my c-section and would instead be knocked out entirely with general anesthesia.  Additionally, Dr. G was about to leave town to visit family for Thanksgiving, so if something cropped up over the weekend, I would be delivering with someone I barely knew.  I called my mom around 10:30pm and told her the news.  "You're kidding!" she said. "I just took a Nyquil!"

The day before, I had met with my doula again, this time to discuss our plans for a Cesarean.  I wanted to take as many steps as possible to ensure a gentle, family-centered experience.  I didn't want doctors chatting over my open body about where they were going to get lunch.  I wanted to play my own music and to touch my babies as soon after their delivery as possible.  I wanted skin-to-skin contact right in the OR, and I wanted to delay the clamping of their cords until they stopped pulsing.  My doula would be there to hold my hand and keep me calm while my husband accompanied the babies to the warming table.  Most helpfully, she walked me through the sights, sounds, smells, and feelings of a c-section so I would be prepared.  Finally, we discussed the fact that complimentary drugs are customarily administered via IV after an epidural is placed, drugs intended to offset the nausea, anxiety, headaches, etc. that often accompany epidurals, often without explicit approval by the mom.  In her experience, mothers often become drowsy and detached as a result of these secondary medications (even though the anesthesiologist swore it has no such effect), and this sleepiness can make breastfeeding after the surgery especially tricky.  Research has shown that breastfeeding success rates are notably lower for c-section births than for vaginal births, so I felt that anything we could do to protect our chances was worth doing.  Therefore, I had a long talk with the anesthesiologist before the surgery about what I did and didn't want added until I specifically asked for it.

Overall, the surgery went as planned.  I did experience a tiny bit of anxiety as a result of my dropping blood pressure, so I was able to ask the anesthesiologist to add just a half dose (what he called "a little margarita") so I could focus and enjoy myself.  Thankfully, I experienced no drowsiness from this.  My doula took pictures in the OR and then worked very hard to help me breastfeed in the post-surgery recovery room while they monitored my vitals.  I cannot imagine now how anyone gets through a c-section WITHOUT a doula!  I was so uncoordinated and overwhelmed after surgery, so distracted by my violent shuddering and teeth chattering, I'm sure I wouldn't have had a chance feeding my babies those first few precious hours without her there.  Jake was wonderful and sweet and supportive every step along the way, and my OB was a total rock star, as usual.  Overall, despite it being drastically different from the birth I had wanted, I was able to find peace with this experience, the moment I fell in love with my beautiful babies.

Zoey Haven Lewis, born at 12:36 am, 7 lb, 6 oz, 20 1/2 inches long

Dexter Allen Lewis, born at 12:38 am, 6 lb, 15 oz, 19 1/4 inches long

The 3rd Trimester

There's so much to catch you up on, but I'll try to start from the beginning.  This final stretch of the race was pretty brutal for me.  I started to feel like every weird, embarrassing, uncomfortable pregnancy side effect out there, I had.  Swollen feet?  Carpal Tunnel?  Hemorrhoids?  Yeast Infections?  Heat rashes?  Acne? Sciatica?  Leaking breasts?  Braxton Hicks?  Back pain?  Check, ch-check, check, CHECK.  My issues with my pelvis (SPD) continued to severely limit my movement, and I'll be damned if I didn't get a nosebleed every single day.  And the stretch marks!  Oy vey, the stretch marks.  Some of them even bled.

Here I am at 37 weeks.

However, the babies were doing GREAT.  Both were around the 90th percentile, growth-wise, and my blood pressure, weight, urine, etc. were always right on track.   Zoey, our lower twin or Baby A, continued to hang out head down, and though Dexter (Baby B) was breech, I knew I had a doctor who would deliver the second baby that way.  I had a great meeting with my doula, going over the nitty gritty of all our birth plan questions and options, and we left saying to ourselves once again that we had found the MOST AWESOME doula; she had earned her fee with us long before the big day.  I was practicing my Hypnobabies labor preparation every night, and was feeling so confident, so happy, so eager for my natural birth.

Alas, life had other plans.  Dexter was starting to grow far bigger than Zoey, according to their sonogram estimates, and Dr. G sat me down one day and told me that I should probably start preparing for a c-section.  With his footling breech position (feet down) it was very likely that Zoey's smaller head would not adequately prepare the birth canal for his exit.  He consulted every doctor in his practice, and they all agreed: it would be incredibly risky to attempt, and if his head got stuck, those two minutes of emergency c-section (for which I would have to be knocked out by general anesthesia) might still be too long to save him from permanent brain damage.

I was devastated, both by this hypothetical scenario of horror and by the sudden change in direction.  I've been dreaming of birthing my babies naturally for about as long as I've wanted to get pregnant.  I have read every book on the subject, watched every documentary, listened with rapt attention to every birth story.  I knew it was going to be challenging, but I was so joyfully looking forward to that sacred rite of passage, that unique, enigmatic, controversial side of motherhood that leaves some women shuddering in recollection and others glowing with nostalgia and pride.  I wanted to KNOW, to experience, to be there.  I wanted to physically GIVE BIRTH to my babies, not have them cut out of me.

Now, I don't want to get mired in the politics of medicalized birth.  Some people see every new advance in obstetric care a boon to women, while others view our current model as totally crippled by interdependent interventions.  I strive to be a skeptic: I neither believe that doctors push c-sections for monetary or convenience reasons at the cost of maternal/fetal health, nor do I believe that there is something so wrong with the American female pelvis that one in three births NEED to be surgical.  All this is to say, I was deeply conflicted as to whether I should trust my doctor implicitly or dig into the research and seek another opinion.  My head was swimming with the possibilities and eventualities of every angle.  I didn't know which way was up.  And apparently, neither did my daughter, because the very next week, she turned transverse, sideways, across my cervix.  That pretty much settled that.  A c-section was scheduled for December 3rd.

The Second Trimester

What got better: less fatigued, fewer nosebleeds, much diminished rhinitis, tiny round ligament pains are gone

What got worse: heartburn, boob pain, sleep discomfort and disruptions, unbelievably intense round ligament pain that feels like my uterus is being torn from my body.

What's new: Symphysis Pubic Dysfunction! My extra high levels of relaxin have totally destabilized my pelvis, and this problem equals pain, pain, pain, particularly when I do things that involve my legs moving separately. For example, pulling on my jeans while standing is excruciating. I have been seeing a special pregnancy chiropractor twice a week and started wearing a special (super sexy) support belt. These steps have enabled me to function like a nearly normal person during the day (even though I'm usually walking like a geisha by the end of the night). The worst part is that I had to quit yoga and switch to water aerobics....way, way less cool.

As of yesterday, 26 weeks and 5 days, the kiddos weigh about 2.5 lb each, and my belly is measuring equal to that of a singleton pregnancy at 33 weeks. Cervix is nice and long, blood pressure is low, and I do NOT have gestational diabetes! Looks like smooth sailing (read: no bed rest) ahead!

So, are we ready? I've never seen Jake so excited and so impatient! We finally secured our awesome apartment downtown and have a move-in date scheduled, October 12th (wanna help?  Haha.). We have a lot of the big stuff already: stroller, glider, changing table, all on SUPER sales! And somehow they each already have more clothes than Jake and I combined. But ready? Hmm...ask me in a month.

For those who haven't yet heard, we're having a boy and a girl, Dexter Allen and Zoey Haven (names are mostly set in stone but who knows?). We love them so much, but if Dexter doesn't stop trying to play the vibes on my rib cage, we're going to have words upon his arrival.

I feel like (probably because we've been told so many times by various in-the-know people around Dallas) we have the dream team for this birth.  Between our chiropractor Autumn Gore at Cafe of Life, Melissa Espey-Mueller with the North Dallas Doula Associates, and Dr. Ashwin Gaitonde, I think we have the best chance of an unmedicated, vaginal birth possible.  Yes, we are aware that with twins, we'll just have to be flexible, but if there was a way it was going to happen, I do believe it's with these people.  We've done our homework, found brilliant people, and written our birth plan.  Everything from here on out is just a matter of letting go.  To that end, I've been practicing deep relaxation and eyes-open self-hypnosis with this program on a daily basis.  Here we go!

The First Trimester

Oh, HEY THERE.  I know you guys thought I forgot about the blog and all of you who rooted and prayed and crossed fingers for us during our IVF journey.   More than a few people have suggested that it was time for an update, but I felt kind of weird.  I mean, pregnancy is pregnancy, right?  For that reason, this may be a tad dull compared to the science-fictiony world of IVF treatments previously discussed here, but a little reflection and documentation never hurt anybody.

The first trimester went smoothly.  We saw the babes 3 times on ultrasound, and each time their heartbeats looked strong and they were growing just a smidge ahead of schedule (twins tend to do that).  I didn't really have morning sickness, but I could still smell a foul odor from about a mile away and even the thought of something gross could send me hurling for what felt like hours.  Overall, pretty lucky in the stomach/nausea department.  The fatigue, though, OH THE FATIGUE.  I felt like I was trudging through wet concrete, carrying suitcases full of iron.  It was overwhelming just to walk from my car to my classroom.  I took several naps in my car in between errands and classes.  This led to a total abstention from cooking and housework, and Jake joyfully picked up the slack.  Speaking of iron, I craved beef and steak constantly as I was building my two placentas.  Carby foods held no sway over me unless they were somehow a delivery system for more meat.  Let's see, there's been half a dozen nosebleeds, pregnancy induced rhinitis (stuffy/runny/sneezy nose), cramps, mega heartburn, breathlessness, constant peeing, insatiable thirst, round ligament pain (pinch-y little pains around the groin as your uterus grows away from it), and very heavy, sore breasts.  Other than all that, pregnancy is delightful!  Hah!

My body is changing so fast.  I've been in maternity pants since week 8 and have had ligament pain (usually a blessing of the third trimester) since week 10.  Twin mamas are advised to put on more weight, obviously, but also encouraged to put in on earlier.  The recommendation often repeated is 20 pounds by 20 weeks (so long as you were a normal, healthy weight before).  That's clearly more weight than the babies alone need, so I'm storing it in all kinds of attractive places like my rear, thighs, and upper arms.  The theory is that you'll need those stores once your stomach is too compressed to keep packing in the food later, and twin babies need major nourishment toward the end since they're usually born many weeks early.  Also, breastfeeding two babies at once demands CRAZY calories, often more than an exhausted mother has time to consume.  All this makes sense logically, and I'm dutifully putting on exactly what's recommended...but deep inside I'm freaking out.  Those of you who know me well know that I've always struggled with my weight, and only about 3 years ago I was officially obese.  However, I lost 70 pounds through Weight Watchers and jogging, and though I'll never be skinny, I've eeked into a healthy weight range.  That was a hard-won victory over food addiction and genes, so packing on these "storage" pounds is emotional territory for me.  So just...you know...tell me I'm pretty.

Emotions are running high anyways with all these hormones.  Did you know each placenta makes it's own dose of estrogen, progesterone, etc?  So, I've got double everything. Sheesh.  Plus, I also stopped taking my anti-depressant shortly before beginning IVF.  I've been on and off it since high school, and at this point in my life, it's easier just to stay on them preventatively to keep me stable.  But, I'm not comfortable subjecting my babies to that drug, so for now, I'm just relying on a healthy diet, exercise, meditation, and journaling.  Most of the time, I'm fine, but there are days when I'm trapped in a funk of disinterest, malaise, and generalized pessimism.  It's as if my brain goes, "Nope, can't feel good today.  Seratonin tank on empty."  Prenatal yoga, which I couldn't start until the second trimester, is helping BIG TIME.

Man, this ended up being long.  Guess I shouldn't have waited so long to sum up three entire months!

Could it be twins?

Jake and I have been wondering lately, because we put back both our good embryos, whether both took.  According to Dr. Google, the signs could include:

1. Elevated HCG levels.  We've had this checked twice.  For day 15 past ovulation, a normal level is 150.  Mine was 480.  For day 18 past, normal is 450.  Mine was 1874.  A healthy doubling rate for hcg is every 48-60 hours.  Mine had doubled within 32 hours.

2. Excessive Morning Sickness.  Nope.  None at all.  Never mind then.

3. Early weight gain.  Hang on.  I've definitely managed to put on about 2 pounds while eating excessively healthfully.  Hmmm....

4. Extreme fatigue.  God YES.  I mean, I know all women suffer in their first trimester with fatigue, and I can't compare it to what it would be with one baby, but it certainly FEELS extreme.

5. Ultrasound confirmation.  Oh yeah, we had this yesterday.  And there's totally two little dudes in there, each with a perfect little heartbeat.  Here goes nothing!

A Whole New Kind of Wait

Due December 12, 2013

The Two Week Wait - Dos and Don'ts

Do

• Calmly submit to daily assault by giant needle.
• Try this process with both lying down and standing up.  One might leave slightly less debilitating pain in that hip for the next 48 hours
• Peel a whole pineapple and cut cross-wise into five equal sections.  Eat one section, including the core that tastes like wood, every day starting the day of your transfer.  Some hippies think the bromelain helps make the womb stickier
• Keep your feet warm.  Wear socks.  Eschew the ballet flat look even though you're 6 feet tall and it's spring.  Socks and shoes.  Acupuncturists claim that warm feet = warm uterus.
• Actively seek out relaxation activities (excluding all the awesome ones listed in the next section). Schedule a massage.  Meet with your acupuncturist.  Start a visualization ritual.
• Hang out on the forums for neurotic women just like you.  They understand your need to overanalyze every tiny thing.  If you need a dictionary to know what's going on, try this.  
• Remember that you're incredibly lucky to have had this opportunity, regardless of how uncomfortable or stressed you are.

Don't

• Take baths or use heating pads, no matter how much those progesterone shots make you long for some intense heat therapy.
• Drink wine, coffee, tea, or soda.  You will really need some wine, but no, you can't have any.
• Exercise or exert yourself in such a way as to raise your internal body temperature.  You'll just have to continue not going to the gym you don't belong to.
• Lift anything heavier than 10 pounds.
• Don't have sex.  Orgasms cause uterine contractions.  It's like an earthquake for the poor embies.
• Start home pregnancy tests too early.  That way lies madness.
• Freak out too much about your weight fluctuations; this is a bloaty, floaty time.  You may also be craving inordinate amounts of dietary fat.  For instance, I just chased my morning oatmeal and blueberries with chips and guacamole.
• Call your husband a filthy name right before he has to stab you with a very long needle.  He was only asking to use your car for five minutes.
• Stab your husband right back with the needle, even if the mental rehearsing of it brings you unbounded joy.
• Scream at your husband for not immediately replenishing the milk and butter.  He did not know that your every hope hung on buttered toast and steamed milk when you woke up.
• Punch your husband for reacting so calmly to the above cursing, stabbing, and screaming.  That's how he deals.
• Tearfully explain to your husband every morning how sorry you are and how unbelievably moody and out of control you feel.  He knows.  Just....shut up.

Overjoyed

Jake and I held our breath and grabbed for each other's hands when the embryologist came in to tell us about how our two soldiers fared over the last few days.  We had gotten past the point at which they would call and say "Don't come.  Both arrested," but for all we knew, we would still be putting in only one sickly looking embryo.  I braced myself for the worst and tried to keep breathing.

"As you know, two fertilized, and both look very good.  One has eight-cells, which is ideal, so I graded that a 6, our highest grade.  One has 9-cells, which might still be great, but because it's not the desired 8, I grade it a 5.  They both look very good."

It was at this point I started crying.  They're BOTH good?  We have TWO that look promising?  My terrible ovarian reserve didn't end up hurting us at all.  I couldn't even process my relief and gratefulness.  I had to restrain myself from kissing the doctor.  The fact that I was only wearing a sheet is probably all that kept me in that bed.

I love them so much.

Thing 1 and Thing 2

Tuesday morning the doctors confirmed that I had at least two follicles that were ready for harvesting, which means it was time to pull the trigger.  Literally.  I had to give myself a shot called the "Trigger."  It's meant to mimic the LH (luteinizing hormone) spike that normally occurs during the cycle to encourage the eggs to get too big for their britches.  I needed to take it EXACTLY 35 hours before they would harvest my eggs.  Three days later, that sucker still hurts.

Wednesday was a wonderful IVF reprieve: no appointments, no shots.  Thursday morning, I went in for retrieval.  They put me under mild, sleep-inducing anesthesia since, let's face it,  nobody wants to be wide awake while doctors shove a giant needle up their vagina.  Once I woke up again, the doctor informed me that they got four eggs.  Not great, but better than I was expecting last week.

After that, the nurse showed Jake how to give me the progesterone injections...in the arse.  As you can see on the above chart, progesterone is supposed to raise significantly after ovulation to support any developing pregnancy.  The problem is it's made by those little yellow spongey-looking things, the same ones that will be thoroughly mangled and drained by the egg retrieval process.  Though progesterone-in-oil intra-muscular injections are rumored to be quite painful and though the needle looked comically large, Jake did a great job!  I didn't have to curse at or kick him even once.  Before we left, Jake left the doctors with a fresh cup of baby batter.

The next morning, we got the highly anticipated fertilization report.  Apparently, that fourth egg wasn't mature enough to even be fertilized, so they tossed it aside.  The three remaining eggs got the ICSI treatment, and now two are actual oocytes (fertilized eggs).  They look like this:

See the two little circles in the center?  That would be Mama DNA and Daddy DNA.  They're snuggling and thinking hard about how to begin dividing.  Because we had planned on putting back two anyway, there's not much point in waiting for a Day 5 transfer, an option many couples take as they wait for the hardiest oocytes to develop into blastocysts, proving themselves worthy of transfer over all the other losers.  Hence, we'll stick them back in at the earliest opportunity, day 3, Sunday.  It's sad that we won't have the option of picking through a bunch for the best-developing embryos, but I'm just grateful that we even have two to work with at this point.  We're remaining very guarded with our optimism, but it's far from over.  We're still in this.

Boo.

It's official.  I suck at making babies.

Even on the uber aggressive "poor responder" drug protocol, I am responding poorly.  I may only get 3 eggs out of two weeks of intensive drug dosing, a truly pitiful and dismal showing in the world of IVF. For best results, I should be getting closer to 15, though my antral follicle count prior to starting led them to believe I would make at LEAST a solid 8.  But 3?  Pathetic.

You may wonder why I would need 15 eggs to make a single baby, when most women do it just fine each month with just 1.  To begin with, of 15 retrieved eggs, not all will be mature enough to fertilize, only about 60-70%--down to 10 eggs.  Of those, which we'll fertilize with the ICSI method, only 70-80% may fertilize--down to 8 embryos.  At this point, we let them grow a minimum of 3 days; many embryos may die in the dish, some will fragment or fail to thrive, and a few may look ready to transfer, we'll say about 30%--about 3 embryos left.  Of those, the embryologist will grade them to decide which have the highest probability of implantation and implant the best two, freezing the other one only if it looks really strong.  After implantation, each embryo transferred has a 45% chance of making it to a live birth.  See why you'd want as many as possible?  See why I feel totally screwed and hopeless right now?  3.  Harumph.

Meanwhile, still sticking myself three times a day and shelling out even more money for a few more boxes of Gonal-F.  I'm also now going in every day for monitoring, rather than every other day.  I expect we'll do the egg retrieval by the end of the week.  I'm afraid this post wasn't very entertaining.

Slow and Steady?

I'm about halfway through the stimulation phase of our IVF cycle, and I've had three monitoring appointments so far.  The point of these is to ensure that I'm being pushed hard enough by the drugs to be successful, but not so much that I'm at risk of Ovarian Hyper-Stimulation Syndrome (OHSS) (aka super scary ovarian explosion disease).    The things measured at each appointment include: thickness of the endometrium, number of visible follicles, diameter of biggest follicles, and the estradiol levels.  Here's my lady-bits' report card.

• The endometrium should be between 6 and 14 mm thick.  Right now, I'm at 8mm.  Woot.
• The total number of mature follicles before egg retrieval should be 5-8, as well as many smaller ones.  Right now, I have 3 leading ladies.
• Mature follicles measure around 18-22 mm in diameter.  My 3 are about 9mm across.
• Estradiol levels vary widely from woman to woman, but the key is that I should be roughly doubling my number every 48 hours.  Additionally, each mature follicle produces roughly 200 pg/mL.  My three measurements on Monday, Wednesday, and Friday have been 85, 101, and 220, respectively.

Soooo, I'm not growing eggs like gangbusters exactly, which is a tad discouraging since I'm on the maximum dosage of the aggressive protocol.  I keep imagining myself driving a really old car, in which I'm pushing the gas pedal all the way to the floor and only getting a tired put-put-put sputter.  The Doc acknowledges I'm showing some really low numbers, but she said the important thing to focus on is that I AM growing.  Trying to stay positive and keep my cortisol levels nice and loooow.  Sigh.  Well, who ever said making a baby was fun?  Oh, wait...

Shooting Up

I could be way off here, but I find this one of the most unusual and perhaps even fascinating aspects of the IVF cycle.  The injections...

Currently, my doctor has me following the Microdose Flare Protocol.  There are a number of different drug regimens out there, each differing slightly to accommodate the woman's unique infertility profile.  The Microdose Flare Protocol is a pretty aggressive course.  It is often cited as the "poor responder" treatment; you give it to women once they've already proven to have a hard time making eggs during an IVF cycle.  Why give it to me on our first try?  Take a look at this excellent chart below:

This shows AMH (Anti-Mullerian Hormone) levels for women over time.  Testing AMH levels can gauge the extent to which someone's biological clock is ticking away faster than the woman next to her.    The hormone being tested here is excreted by the small follicles in the ovaries (the little pockets where the eggs grow), and it gives the doctor an idea of just how many eggs are in reserve.  If you follow the solid curve on this graph, you'll see the average AMH levels for any particular age.  For someone my age, it should be about 20.  Mine is 7.2, which is right around the 25th percentile.  Another way to look at this chart is that I have the egg reserve of the average 39 year old.  This means I'm 30% less likely to produce enough eggs in this cycle to be successful.  Hence, BE AGGRESSIVE!  B-E AGGRESSIVE!

Right now, I'm taking three injections a day.  I use insulin needles and inject them subcutaneously (just below the skin).  It really doesn't hurt at all.  I find it way more painful to play with Harper for five minutes.

Lupron (2x/day) - This stimulates my pituitary gland to produce more of its own luteinizing hormone (LH) and follicle stimulating hormone (FSH).

Gonal F (1/day) - Synthetic version of FSH.  This one has to be mixed daily.  I pretend I'm a chemist.  I might get some of those sexy goggles and a white coat just for this ritual.

Low Dose HCG (1/day) - Synthetic version of LH.  This one is premixed, but they want me to combine it with the Gonal F in a single syringe.  It's nice because there's only one tiny prick for two drugs, but it sucks because getting both of these combined takes roughly twelve steps (no hyperbole here), and by my way of thinking, that's twelve unique opportunities to screw up.  (I wanted to film this unbelievably complex series of actions, but Jake assures me this would be weird.)

All this is to push my eggs to go bananas right now.  I went in for my first monitoring appointment today, and it seems like everything is going relatively smoothly.  They were able to see 9 follicles on the ultrasound, though they were very small, and my estradiol level was 85.  Trying to figure out whether that's good or not is really confusing.  I'll get back to you guys on that one.  Keep your fingers crossed, y'all!

Snowquester

After confirming ovulation last week, we were instructed to place a phone order with Freedom Fertility.  Tuesday afternoon, a large box arrived, overflowing with syringes, needles, glass bottles, alcohol swabs, even our very own biohazard "sharps" container.  Talk about playing doctor!  All that was left to do was stick a few of the meds in the fridge and wait for my period to arrive.  As a snowstorm started rumbling up the Shenandoah Valley, I snuggled under the covers and watched YouTube videos of calm, smiling women stabbing themselves in the belly for the chance at a child.  I prayed for strength.

When we woke up the next morning (a little late, as it was a highly anticipated snow day) we noticed that our power was out.  Oh well, we thought.  We'll just have to wait a while to get started on our day. We rescued the precious Leuprolide and HCG from the fridge and buried them in a plastic bag in the snow.  We hung out for a while, reading, knitting, worrying about the food in our fridge/freezer, then decided to go find someplace nearby serving hot food to cheer us up.  A dismal drive around town revealed that absolutely everywhere was out of power.  I was starting to get some major mood swings, partly from PMS but also greatly enhanced by the synthetic estrogen I've been taking.  Every few minutes I was hanging from the rafters silly, then collapsing in a pile of tears and self-pity.  Honestly, all I wanted was a warm bath and my heating pad.

The next morning, we woke up to an even colder, still dark apartment.  I was starting to lose it.  I had a paper due at class that night which I had lost an entire day to work on, my hair was a grease pit, and damn, my PMS was getting intense.  Bonnie called, wondering if we should meet for our injections lesson, in case my period didn't come until the weekend.  We agreed that would be best, but Jake had a meeting scheduled with a professor, and I hated that I would have to just drive up another day to get the baseline data done.  Just like that, Aunt Flo showed up, and Jake's professor canceled their meeting.  Was our luck finally changing?!  We drove up to Charlottesville in separate cars, played with some needles at Bonnie's desk until I felt confident I could do it, and had what essentially felt like a drive-by ultrasound.  We were instructed to start our shots the next morning.  Jake drove back, assuring me we would have power by the time I got back.  I just couldn't believe I was going to class at once so filthy and so unprepared.

Of course, the power wasn't on when I returned home at 10:30 pm.  In fact, the electricity company had changed their projected time of repair to late the next night.  I started blubbering immediately.  I couldn't do my first set of injections in the dark.  I couldn't go to school in the morning still dirty.  I couldn't worry any more that the snow was keeping our meds the right temperature.  I couldn't face the rest of a night full of cramps without my heating pad.  I....just....couldn't.  I wanted a hotel room with a mini-fridge, or I was going to explode.  Since Jake's not suicidal, he found a room within seconds while I packed up our meds and a change of clothes.  The only place nearby that offered mini-fridges was about $20 more than the next cheapest place, but like I said, I was a woman on a mission.

This is when Lady Fortune decided to give the Lewises a break.  At check in, the staff hooked us up with an extra-small room at a special discount, HALF the price of the competitors without mini-fridges!  This room was auspiciously nicknamed "The Baby Room" by the staff.  I couldn't keep from grinning.  There were cookies and hot coffee in the lobby, next to a sign reminding us of the full breakfast buffet in the morning.  We sighed with deep satisfaction and ambled up to our room, congratulating ourselves on making such an excellent decision.  Though the room was small, it had everything we needed, and we enjoyed a warm, clean, relaxed night of sleep.

The next morning I self-administered my first injection (not a big deal at all, it turns out) and went to school.  A few hours later, I got a beautiful text message from Jake: the power was ON.  Hallelujah!

The "Told Ya So" Dance

When last we met, I was patiently for ovulation to occur.  Morning after morning, I kept getting turned down.  It was like the 9th grade Winter Dance all over again.  I called Bonnie, my new best friend IVF nurse, and asked her what would happen, hypothetically speaking, if I didn't ovulate this month at all.  She gently broke the news that it would be unwise for us to proceed with the planned drug protocol before confirming that I can ovulate on my own.  We would just have to wait until I did, maybe even a few months, if that's what it took.  Harumph.

So, the morning-stick-pee-sigh routine continued for another week, to no avail.  But meanwhile, my body was sending me some pretty unequivocal ovulation signs.  I won't get into the lady secrets here, but if you're interested, check out Taking Charge of Your Fertility.  I honestly consider it an indispensable owner's manual for anyone in possession of a vagina.  Now, what's a girl to do?  On the one hand, expensive technological tools are telling me that I didn't.  And yet natural methods are positively shouting that I did.  My girl Bonnie knew how to settle this one: a quick blood test to check for progesterone.  I was warned NOT to get it drawn at my local hospital, since they send out their samples and take several days, but was directed instead to nearby Staunton, 45 minutes away.

Luckily, the next day was one of Rockbridge County's famous snowless snow days.  I headed out to Staunton, surrendered my bodily fluids, and THEN was told that they would send it out late that night.  Grrr.  More waiting and anticipation.  Luckily, I knew where I could get a killer eggplant parmesan sandwich.  What?  That's totally related.

That night I could hardly sleep.  Did I?  Didn't I?  I DID!  Naw, you don't know crap.  The next morning's results couldn't come fast enough.  When I finally got a call from Charlottesville, I was shocked to hear that they did not yet have my results and were wondering when I was going to get that done.  WHA?!?  My disappointment turned to fury a few hours later when the lab in Staunton called to say that they had messed up my blood work, something about a red top instead of a gold top, or something completely asinine like that.  Needless to say, Bonnie had to talk me off the ledge.  We decided that, even though it's far, I better just hoof it up to Charlottesville to get my blood drawn right on site and not by idiots.  As a perk, I had a good excuse to skip a faculty meeting.

I had hoped that the results would be ready within two hours, before the office closed, but no such luck.  However, I got the call right when they opened the next morning.  I evidently shouted, "YES!" so loud into the phone that my friend Susan came over to hear the "apparently orgasmic news."

The March of the Pills

Our first appointment ALSO entailed getting started on our pre-IVF drug regimen.  They won't pull out the big guns until I start my next ovulatory period, but in the meantime, we're doing the following:

Both of us:

• Ciprofloxacin - preventative antibiotic.  Even minor infections can dramatically decrease the chances of IVF success.

Just me:

• Metronidazole - a special antibiotic JUST for the ole bat cave.  It comes with a three feet long applicator.  Fun.  Toilet acrobatics.
• Baby Aspirin - increase bloodflow to the uterus and make sure that future home is super comfy and lush.
• DHEA - a hormone supplement to support my production of estrogen and androgen.  Hopefully, this will make up for my egg reserves, which look like they ought to belong to an old lady.  All I know is I'm crying at especially poignant television commercials and breaking out with the acne of a 15 year old boy. 
• Estradiol - basically, a synthetic estrogen.  Again, geriatric eggs. 

We also got some blood work done, basically to make sure we're not teeming with chlamydia and ebola (news flash: we're not).  Jake has to get his swimmers tested ONCE AGAIN, presumably so the lab techs can point and laugh at those poor little guys one last time.  I had to get my AMH and thyroid levels tested again, too.  AMH came back confirming the above mention egg problem.  Thyroid came back a little weird, but subsequent blood work ruled out the need for synthetic thyroid medication.

I'm now off of birth control and waiting for ovulation.  They want me to ovulate at least once before we get going on this, so I've been drowsily peeing on those ovulation predictor sticks every morning for about two weeks.  The big O is a tad elusive this month, which figures, since I normally ovulate like clockwork.  Side note, did you know you can actually urinate onto plastic incorrectly?  Because I am a princess and like my toilet routine to be as high tech as possible, I splurged on the more expensive DIGITAL ovulation predictor kit on my way home from our appointment.  Twice, TWICE, the message that appeared in the window was a picture of an arrow pointing to a booklet.  Thaaaat's right.  This pretentious piece of plastic told me to go back and read the directions as to how I might more efficiently or perfectly pee onto it.  Since going through a box of those with no coveted "smiley face" result, I have downgraded to the less persnickety but far more inscrutable CVS brand.  Now, I'm supposed to compare the density and pigment of two pink lines.  Who has time for this nonsense?

On a more grim note, being off birth control has been tough these past two weeks.  Why was someone infertile taking birth control, you may ask?  Well, endometriosis is an inflammatory condition that is triggered by the ebb and flow of hormones.  Staying on the pill kept everything nice and quiet for the last year, and I was able to get by with only a few advil and a couple of hours on the heating pad a night.  Now, it's a mental battle every day just dragging myself out of bed.  The pain makes me sleepy and depressed, neither of which I have time for right now.  Come on, ovulation!

If I have a legitimate cycle this month, we'll get started on stim drugs as soon as my period arrives, possibly the beginning of March (cue ecstatic squealing and clapping). If not, we'll have to wait yet another month, which, though I know is nothing in the grand scheme of things, will totally bum me out.

Decisions, Decisions

Another thing we had to do at our appointment was sit down with our doctor and go over some very important decisions.  Some were easy to make.  Use ICSI?  Duh.  Freeze any leftover eggs?  Of course.    Assisted Hatching?  No need.  How many embryos to implant?  Hmmmm....

Okay, so for a woman of my age, here is the textbook recommendation.  If they are good quality embies, put back one.  If they are less than ideal, put back two.  The doctor explain that we could be more conservative and only put back one, regardless of quality, OR we could be more aggressive and put back two, regardless of quality.  With the former option, our chances of conceiving at all are lowered.  With the latter, our chance of conceiving twins as opposed to a singlet is 1 in 2.  Jake and I stared at each other awkwardly for a few minutes and debated in our usual, snarky, hyperbolic style.  "You know how I feel."  "No, you said you want to do what's best.  That's not clear here."  "I want to do what's most effective."  "Well, most effective isn't necessarily best.  Putting back five would be most effective!"  The doctor jumped in here to make sure we understood that nobody is cramming five embryos into a 30 year old.  She must have thought we were getting heated, because she handed over the form and told us to think about it over the next few weeks.  She was staying out of it.

However, with a few minutes left to ourselves while waiting for our next meeting with the IVF nurse, we knew our decision: the aggressive course, two embryos, high possibility for twins.  Essentially, we just know that we'll regret it terribly if we don't conceive after only putting back one.  From that moment on, we've been sort of deliriously giggling and joking about how crazy our future life with twins will be.  Jake's been peering, with wrinkled forehead, into his cramped backseat, trying to picture TWO carseats shoved into that tiny M3.  I've been mentally rehearsing trying to get from the parking garage in our future Dallas high-rise to the apartment door with two infants and a single sack of groceries.  When we talk about signing up for insurance at his law firm, he'll say, "Well, it's cheap for me but more expensive when I add you and..." "The TWINS," I finish.  And we both crack up and whimper a little simultaneously.

Dear Lord, one will REALLY suffice, but I promise I'll be gracious if you double our pleasure.