Almost 33 weeks: More complications

Ok, so the thing I was worried about – yep.

So basically I know have a diagnosis of cholestatis. Not much is known other than its a liver condition that arises in pregnancy sometimes.

What changes? Now I’m on weekly NSTs and growth ultrasounds. Medication list is now: synthroid, iron supplements, prenatals, vitamin D and now, ursodiol (I think that’s the spelling).

Also now my end date is at 37 weeks so ~ 4 weeks from now. If I go into labor naturally, great. Otherwise, induction.

And now I’m on the high risk category with instructions to come in immediately if I feel any changes in fetal movement.

Baby, hang in there! You’re doing so well so far!

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Week 32: Not quite sure what’s going on

So good and bad stuff from the 32 week check up.

On the plus side baby’s active and moving tons and has a good heartbeat. He’s passed two Non-Stress Tests with flying colors. He kept kicking off the monitors today which was kinda hilarious. Baby has also consistently measuring in the 75th percentile so.. looks like a bit of a bigger baby. He’s already 5(!) pounds. I’m convinced I heard this incorrectly. GD is still at the barely under control point. Honestly I think I’m going to start pushing endocrinologist to start insulin, at least in the morning when it’s the least controlled. Weirdly enough, after a few weeks of looking like it’s going up, fasting sugars are totally back under control.

I’ve not been sleeping well – frequent bathroom trips, some heartburn, some in-law drama. But so far, I’m compensating by sleeping in most mornings (and trying to get away with working at home more).

The bad: Well, after last week’s doctor run, the liver function tests came back.. not great. Some of those levels are rather elevated so they drew blood again today to see if that was an aberrant day or something else. They have to wait for the bile test results to diagnose cholestatis. I don’t fully understand what this means but some of the impact of the diagnosis — well, they’d induce at 37 weeks. I’m fine with that. But mostly I worry because stillbirth probabilities go up a lot. So now I’m on weekly NSTs and supposed to observe fetal movement.

I’m trying to take things one at a time. Liver function wasn’t great but also not too bad. Everything else looks fine. And there’s nothing to do until the bile tests come back. We’re going to kick into high gear to finish buying everything we need and setting up the nursery. I should make sure that my STD paperwork reached my office correctly. And then, well, I guess as with everything over the last several years, we just hope and pray.

32 weeks: Ups and Downs

Mostly things have been going ok. Rather too hectic at work but with a deadline done today, that’s a chunk off my plate. Random off-and-on family drama but that’s a ranting post for another day.

GD is within control (barely). Still a ton of work but so far my endocrinologist would rather not introduce insulin if I can manage. Slightly anemic somehow (inspite of massive amounts of greens) so on an iron supplement.

As for the roller coaster: So I’ve been itchy a lot during the pregnancy. Last few days, my hands and feet started itching, well, I don’t know about more than usual but it got to the uncomfortable point. Perhaps it’s psychosomatic but I also know that it’s a primary symptom of a liver issue in pregnancy (one of my friends had it). I flagged it to my clinic who was immediately like “come today”. This was rather nerve wracking because I thought it was me being paranoid and they’re clearly treating it seriously. So cancelled meetings and off we went. They drew blood (that result takes 10 days to come back) and in the meantime did a non-stress test on baby. Baby passed with flying colors. And waiting on mommy. (As I write this, I’m trying to itch my feet so it’s clearly not all psychosomatic).

Depending on the test results, we’ll see but at this point, I was having to start coming in weekly or biweekly for non-stress tests because of the single artery thing. And the doctor talked about inducing early depending on the sugar levels. So.. even if I do have the liver issue, the management would be basically the same except with an added medication. Except they would almost surely induce at 37 weeks rather than wait and see.

Honestly, there are parts of being pregnant that are really cool. But for the most part, I’m going to be grateful for baby to be out (where the patients are both now independent and can be treated like that) rather than baby in. It kinda feels like my body’s not doing a great job of taking care of baby so I’d rather baby be where he’s safer.

So for now, nothing I can do other than what I’ve already been doing.

On the plus side, I have a bunch of stuff to look forward to — baby shower is this weekend! Doing a photoshoot next week. Starting those birthing classes next week.

Reunions

It was my 10th year undergrad reunions last weekend. It’s a bit of a big deal for us – tons and tons of people go back and it’s a lovely way to reconnect and at least some of the friendships haven’t changed much since college so its nice to fall back to old patterns.

You know how you have dreams of what you’ll do when you (finally) are pregnant/have a baby? Well, for me, I had always imagined walking in my 10th either pregnant or with an infant or a little 2 year old trotting beside me. (Yes, I have a ridiculous amount of affection towards my alma mater).

I ended up not going but it’s for the best of reasons — I’m finally pregnant. It’s too hard to travel right now so.. I’ll make it back for my 15th.

For all that reunions can be fun, it can also be emotionally painful. Too many reminders of things not working out in life where you see everyone around present their perfect lives. If I wasn’t pregnant, I don’t know that I would have gone either — too painful to see all of my cohort who had babies with seeming ease (well, judging off of time between wedding/completion of some graduation program and baby). Other friends feel ‘behind’ on the track of life because they’re still finishing their PhD’s or not yet married or seriously dating. I’ve learnt that each person progresses through life on their own path and that’s ok. Though I do envy the ‘easy’ lives.


We had some friends visit last week – friends who now live in a different country and so haven’t seen in a couple of years. They brought along their 18 month old who was adorable and happy and sweet. But I found myself thinking a lot about the could-have-beens. So many of our friends had kids about 1.5-2 years ago and so their kids are the age that ours could have been if things worked out quickly. I keep telling myself that none of that matters, that our baby is on the way here now. But it’s very hard not to let those thoughts seep in.

I try and take the good from it. Having so many friends who are a bit ahead of me helps in many ways – I know not to freak out if kiddo cuts his teeth late (or early). walks late (or early). I know kids will grow at their own pace. I observe their various parenting techniques and catalogue them into “unrealistic for us”, “smart and should adopt” and “what were they thinking??”.

But that pang hasn’t really gone away and I don’t know if it ever will.


Hubby asked me today whether these would be our last relaxing weekends. And I realized, yeah they might be. But you know, we’ll have our parents around for the first year so we can still escape a little. And I know we’ll find our ways to keep relaxed and not go-go-go all the time.

For all that other friends recommended taking this time to eat out, do things and enjoy sleep, for various reasons that hasn’t happened to us. And I think in some ways I was feeling guilty/pressured because of that. But you know what – we have been doing things that we enjoy. Just that we’re homebodies so mostly that means renting a movie and watching it together. Or just hanging out together.

At this point, I’m mostly just impatient to get the next couple of months over with and move onto the next phase. As for what comes with that – well, we’ll see.

Week 28

We’re getting there!

Other than the GD, everything seems to be chugging along ok. My OB was commenting that there are so many things that are potentially going wrong with/for me but they all seem to be balancing out and working out somehow so she’s not overthinking it. Our little one is currently at the 77th percentile so he’s growing ok. I am a little concerned about longer term developmental issues with the single artery but well, growth is a good indicator of health so I’m telling myself not to worry too much. It does mean that the non-stress tests start in a couple of weeks – with the single artery, they would have started at 32 weeks. And if I start insulin, I’ll start those even earlier.

Other things resolved themselves – low lying placenta grew higher so I don’t have to worry about placenta previa. Baby was breech last time but now seems ok.

Certain things in the pregnancy seem to be happening like clockwork. At exactly 12 weeks, my nausea disappeared – one day, I woke up and it was gone. The moment I hit the third trimester, I started getting the random aches and pains that people talk about – pelvic, some lower back. I had noticed that my hip joints seemed… looser? Turns out this is a totally normal thing that happens in the last few months. I’m getting one of those belt thingies to help with support and manage some of the aches.

Some things I’ve been doing to control GD are turning out to be really good for my overall health/body. I’m hydrating a lot – that’s always good (the glucose measurements are higher when dehydrated). The exercise – I definitely get my 10k steps per day. It’s actually kinda amazing to me — in my first trimester, for various reasons (post-implantation being careful, nausea, deadlines), I was essentially a couch potato. Maybe 1kish steps a day. Now it’s just part of what I do. That being said, I am finally hitting the stage where I’m trying to push for insulin because walking this much is just.. less feasible now. BP is consistently at 110/70 (from my usual 120/80). I’m not sure if that‘s good but at any rate, there’s a consistent effect.

And funny thing – in spite of the getting-bigger tummy in front of my body, my weight is exactly the same as 16 weeks ago. As far as I can tell, I’ve lost most of the excess fat in my back. Bra size is down. Maybe other places? Hard to tell.

For all the random worries with pregnancy, mentally I’m just so much more at peace now than this time last year or even six months ago. The weight of the uncertainty is much lighter. Of course, those fears will never go away but it’s more muted now. I’m taking great comfort from the fact that baby seems strong and active (he kicks me all the time).

I’m so curious to meet him and see if his personality matches what I’m guessing! I think he’s going to be a good south Indian kid who’s addicted to coffee like all the rest of us – whenever I drink coffee, he gets super active. Also probably drive us nuts with his energy. Hopefully a decent sleeper? A lot of his movement seems to be during the daytime. Also a very touch sensitive baby – one time when he was kicking a lot, I started to rub my stomach and he calmed down.

The part that I’m terrified of in the months ahead isn’t L&D – I figure that’s going to be hell but fast and done with. But the newborn sleep deprived stage – no idea how I’ll survive that. I suppose like everything else in life – grit your teeth and push through. And try and enjoy the little moments.

To-do Lists

Part of the reason I’ve been so stressed these days is the sheer amount of work to get done before baby gets here (10 more weeks!). Unfortunately a bunch of this is also non-negotiable. The to-dos:

  • Write and submit a first author paper (*cough* and do the analysis). This one’s on a deadline with 4 weeks to go so I can’t really push it off.
  • Analysis for a second paper. Also due in a month or so.
  • Debug/chug things along for a third project
    • Ideally re-write/re-submit that paper as well.
  • Chug things along for project #4. Thankfully no real deadline here other than to spend a few hours a week on this.
  • Submit a research statement for a workshop (umm, this was a super last minute thing that my PhD advisor told me about two days ago and is due next week. And if I get in, it’s going to be an interesting trip to pull off).
  • Give a talk in one of the labs
  • Buy everything for baby
  • Set up everything for baby
  • Baby shower
  • Plan maternity photoshoot
  • Work out maternity leave plans (I have parts of this done but it now includes things like Hubby is traveling after I go back to work and therefore I need to figure out how to cover that time)
  • Work out in-law coping strategies (long story)

Some of these are perhaps lower priority than others. Like I can imagine many people thinking ‘photoshoot – who cares’. Well, in this case, I do. I love having photos to document times like this. And after struggling to get to this point, I want to remember it and have pretty pictures to keep in my memory.

I finally wrote up a list with dates which really calmed me — there’s still time to get these things done. I’ve also been increasingly dumping things on Hubby’s plate (baby monitor, stroller – he can do the research for a change).

One thing I’m glad I managed to settled is an arrangement between my two labs where I work full-time in one than the other instead of splitting my time 50-50. Effectively, I wasn’t getting enough done on either side and with the deadline, it was making me awfully tense. The other consequence of that is one of the guys on project #3 got ‘promoted’ up into co-primary person status with me. I suppose it takes away some of my ownership but it’s also not the worst thing since I’m going on maternity leave anyways. I was so wary of bringing this up with my bosses in case it looked like I wasn’t capable of doing my job. But at some point, enough was enough. Other things factored in like one of the research assistants who was supposed to be putting in 20hr/wk was putting in.. like 2. I’m not kidding. After 2 months of this, I just threw him under the bus (figuratively) because frankly, I don’t have the time or energy to make up for someone’s lack of planning.

Another thing I’ve been struggling with is just the sheer number of meetings I have – 12 hrs each week. Maybe this is normal in some jobs but in a postdoc, you really really want to have large stretches of time to just think and work. So now with the full-time in a lab, I think I can start skipping some meetings which will be a bit of a relief!

Even with that, there’s still a ton of work to be done. And then there’s the baby-related planning/work. Oh and the weird family-related stress points (short version of long story is in-laws insisted on coming right when baby is born even though it would make more sense to come in the fall. And while they’re helpful, they’re also the type to have a lot of expectations of “but this is the way we’ve done it for generations.” My diet is definitely going to be a sticking point. As are decisions about sleep training and breast feeding. So I’m trying to create a firewall so I don’t have to deal with all this when I’ve literally just given birth).

So.. mostly I’m trying to manage by tackling things by due date and urgency. And trying not to panic. There’s still time. And things will get done as they always do.

“Enjoy life now”

I’ve been having a lot of ups and downs lately (more downs frankly). A lot of this is just the sheer amount to do that’s overwhelming me.

I was talking to a friend and asking “will this just get more exhausting post-baby?”. And she was like “try to enjoy this time, it’ll be way harder afterwards.” Which isn’t particularly encouraging. But also honestly, I cannot imagine that once baby is here my lifestyle being more restricted than it already is.

Because of GD (primarily though perhaps other things too), I don’t go out much anymore. And by not much, I mean that since November, I’ve gone out to eat.. 3 times? Something like that. (And I love to eat and try new things and experiment with food). It’s just too much stress and energy. We still visit friend’s houses sometimes but it’s much easier if they come over and I can eat my meals in peace.

I can’t imagine that my life gets more restricted with a baby. Then at least I can leave baby at home with his grandparents for a night while hubby and I go out for dinner. Or I can strap baby on and go out for an ice cream or to the park. If I get hungry while out, I can grab a scone and not overthink it.

What I realized today is that such advice usually comes from people who have had an easy time of it pre-baby. They got pregnant easily and didn’t have to change much lifestyle-wise through their pregnancy and then once baby came, *bam*, huge changes. Hubby and I on the other hand — we’ve been having a restricted lifestyle for years now, first through fertility treatments and now through pregnancy. We’ve had to time going out with injections, vacations with treatment cycles (or just skip vacations altogether), plan for 7am blood tests, coordinate stresses at work with all this. Now that’s switched to timing going out with my finger pricks, making sure I can walk after a meal, packing food to go anywhere.

My mom was saying that one of her nieces said something similar. How she just wanted the baby to come so she could go back to only worrying about herself. And I don’t know details but I think her story is similar — PCOS, lots of fertility issues, GD, not an easy pregnancy.

We’ve actually been lucky — my parents have been able to come out and help with various things so Hubby and I could concentrate on work. And baby. But I can tell that several friends are jealous of how ‘easy’ we have life when mom can cook everyday and dad takes care of groceries and we don’t need to add too much for a relatively smoothly running household. What they miss is that even if we don’t have our baby here yet, we have a lot more needed to run the household than they did. If we don’t have time to cook, I can’t afford to just eat out or grab some takeout. During treatment cycles, I couldn’t carry groceries or laundry. (Perhaps my doctor was extreme but hell, it worked.) Not to mention, the sheer number of doctor appointments both during treatments and now. So while yes, having parental help has been a godsend, it’s not like our life is easy even with that. All it means is that I have the luxury of working out my diet/lifestyle instead of going straight to meds.

I think one thing that non-IF folks tend to underestimate is the sheet mental load of juggling all this. It’s constantly on your mind – what you can eat, where in the cycle you are, how to say “no, I don’t want to hang out” because your beta is that day and you want to have space to just cry if you need to. And I’m not finding GD all that fun either — there’s too much mental effort involved (for the record, if I thought starting insulin would decrease my stress, I would but I’m not sure it will). And that just because you don’t have a baby physically here doesn’t mean that your life is free and easy and unrestricted and you can do whatever you what.

Background stress

I was talking to my mom the other day about something that was bothering me i.e. stressing me. And she made a comment about how she knows that things are ok in my life when I start talking about that topic.

She mentioned how she’s noticed that everyone has their things that cause them general stress. These might not be small things but they’re ever present. But when something major is going on, that eclipses any of the lower lying stress.

When I thought about it, I realized that, at least for me, this is absolutely true – I have certain fallback ranting topics. And honestly, I’m really lucky. For the last couple of years infertility related stress has basically dwarfed everything – a lot of the time, even work stress. And I’m incredibly grateful to now be stressing about both smaller things like what stroller to buy to bigger things like gestational diabetes. Some are easier than others but none are anywhere near as emotional draining and difficult as the roller coaster ride of IF and its treatments.

When I was talking to a friend about how difficult I was finding pregnancy (this was right after the GD diagnosis), she made a good analogy: A lot of my friends are/were in med school or phd programs. Neither is easy. But I always envied those in the med programs because while it was hard, it seemed tractably hard. You knew how well (or poorly) you were doing. You knew what the path was. You knew how to achieve the next step. PhD programs on the other hand were the opposite – for so much of the time, we were wandering, unsure of even if we were doing well let alone how to do better. There was rarely a clear goal in sight but rather just slogging hoping something comes out of the work. That’s rather akin to pregnancy vs IF. Pregnancy can be physically hard and challenging. But you know the end post and you know that if you hang on, you’ll get there. IF on the other hand is this whole realm of not knowing what the next step should be or if it would work. I’m simplifying, of course, but the general idea carried over.

And sometimes I still wish I had gone the med school route 🙂

24 Weeks

Viability! We still have a ways to go but somehow reaching this point feels like a milestone to me. Baby, you have to hang on for a while longer but so far, you and I, we seem to be doing ok.

Pregnancy Symptoms: Ok, tummy has definitely popped. But still most people don’t seem to notice – I suppose my normal clothes are forgiving enough to hide a bump. I’m slowly shifting into maternity clothes (mostly just leggings – enough of my regular clothes fit that I might not need much else). And clothes I buy now should ideally work post-partum as well. Also maternity pants/leggings/PJs are sooo comfy. Stretch marks magically appeared a couple of weeks ago. Ah well, it happens. And in more unpleasant symptoms I’ve been getting some heartburn (which as far as I can tell is entirely related to position) and some lightheadedness (low BP? I can’t tell. All I know is its definitely not sugar related).

Gestational Diabetes: Sugars are under control. With a lot of work in diet/exercise. I went through a funk last week about the whole thing – mostly I’m feeling trapped at home because going out is so difficult. I carry my own food even when I go to friends’ houses. I can’t eat out easily. Even something like shopping is hard because I need to eat every couple of hours and there’s nothing in most cafes/restaurants that I can eat. I keep telling myself that it’s only a few more months. Once baby is here, I’m strapping baby on and going out for an ice cream. And waffles.

That being said, this experiment of the last couple of months has made it clear to me that this is my ideal regimen. But right now it’s too restrictive for the long term so I’ve been thinking about ways to make it more practical post-delivery.

It’s funny because in someways I’m healthier than I’ve been in a long while. My Hba1c is at 5.4 — lower than any other measurement of that in the last 4 years (which had been stable at 5.6). I’m back to my yoga-days flexibility (umm, except for forward bends. Tummy makes that a bit hard). I’m losing weight, sorta. My weight itself is the same as it was 12 weeks ago. Which means baby (and placenta) are gaining weight but I am losing weight if that makes any sense. And over the last week, I’ve noticed other signs that are consistent with this theory — my bra cup sizes are a bit too big, my back fat is almost gone, my arms are a tiny bit slimmer. I used to be worried about it and so I check in about each time with my OB but she’s pretty happy with things. And we’ve been doing growth ultrasounds and baby’s in good shape.

Emotionally: Enh, I’ve been better. The GD has been getting to me a bit. As is the huge piles of work both at work and at home. I’ve been arguing with Hubby because I feel like he’s not taking enough off my plate wrt setting things up for baby. Yes, it’s early. But we have the space for the stuff for now and not doing it is just extending my checklist and stressing me out. I feel like even though baby is due in early August, I’m mentally planning for an early arrival in July and so want everything in place by June. And there’s a huge amount of my non-work time that goes into management of my diet/exercise and I don’t think he quite gets the mental load of all the management.

My patience for unasked for comments (which was always low) has gone even lower. A few weeks ago, I sent a (I thought) nice pic of myself+tummy to my family chat group. M-i-l’s comment: “Cute tummy. But you look thin.” Which was really unnecessary and possibly well meant but after I spent hours each work working out my diet and more hours exercising all to ensure health of the baby with as little medication as possible and an enormous amount of discipline to keep all this up — that was not appreciated. My diet/exercise is more carefully thought out and calibrated than hers (or hell, anyone she knows).

My mom (who has diabetes) took a cue from me and is doing a very similar exercise. She’s seeing fasting numbers that she hasn’t seen in years. And realizing that she might not need half the meds she’s on. Together… well, I’m sure there are friends of ours now who are like “don’t pick up or we’ll hear another monologue on carbs and sugars.”

I think we’ve become huge advocates, not for following this diet exactly but rather using your body’s cues to guide your diet/lifestyle. Not everyone is the same, and other than some broad principles, I don’t think one person’s optimization helps another.

Baby: And last but not least, a check in on baby. Baby is strong. He’s super active and moves/kicks a ton. I still can’t differentiate between the two. Est weight is 1lb 10oz. In 66th percentile for size. So in spite of all the single artery cord, GD, everything.. he seems to be thriving.

We told one of our close family friends that we were expecting and in the conversation, it came up that I got the flu during the pregnancy. And he said the nicest thing – ‘That the baby survived the flu and is doing ok now is a really good sign for the baby being strong and healthy’. And it feels a little like that. This little embryo is a triumph over so much for us. You have a lot to live up to, little one!

Reactions to Glucose Monitoring

Monitoring glucose 4x a day necessarily means that some of that monitoring comes during my work day. I’m been… not shy about it. I mean, I try and do it discreetly but half the time, it’s during a meeting. And I really don’t want to be poking myself and checking the bathroom where there’s barely any counter space. So I just do it on my lap or at my desk. And if I’m at a friends house, I just do it wherever.

It’s been an interesting social experiment watching people’s reactions. And here are some of them:

  • “Is everything ok? Are you feeling well?” (This was genuinely meant and I had to explain, I’m not sick, I’m pregnant. He was really sweet about it.)
  • “Eww.” (This was from someone whose spouse is a cardiologist. And I was at my desk in a corner so if you don’t want to see blood, don’t look.)
  • *Does not break eye contact with my hands* (We were having a conversation. And she never ever broke eye contact with my hands while I was doing my thing even though I was looking at her more than my hands.)
  • One guy was really chill about it – I explained it was gestational diabetes and then we started talking about issues with medical treatment.
  • Another guy I could tell wasn’t sure what was going on and wanted to ask but decided not to (I like him – I think he suspected various things but didn’t want to intrude).
  • “You have to check 4 times a day!!” (Yes, it’s a lot of work but seriously you commenting about how difficult it is doesn’t make my life easier.)