controversy

Just the other day, a friend with twins posted this link on her fb page.

http://www.nytimes.com/2011/08/14/magazine/the-two-minus-one-pregnancy.html?pagewanted=all

In short, it was about women who after finding out they are having twins, request a "reduction" procedure so that they only continue to carry a singleton pregnancy. The physical, emotional, financial burdens of such a pregnancy would be too much for them to handle. Most of these cases were couples who conceived after prolonged IVF treatments, where the risk of multiple gestation was higher to begin with.

My first reaction, and one that I posted on my friend's link was that this is the natural slippery slope that occurs in these controversial issues. What started as abortion for only extreme cases has become abortion for inconvenience, or "therapeutic abortions" as they are called in the medical community. And what started in the Netherlands as legalizing euthanasia for extreme cases where the patient is mentally capable of agreeing, has a terminal condition with intractable pain, has now allowed parents to euthanize their babies with a variety of handicaps. The Groningen Protocol allows children under 12yo to be euthanized since they cannot give "consent." A medical article that my husband found shows that most of the babies that are being terminated is because of spina bifida. This is not a life threatening condition, and they are completely cognitively normal. How does it fulfill "hopeless and unbearable suffering" of the euthanizsia protocol. I am saddened that the medical community assist in these procedures, when they know that these children can thrive.

How far are we going to go in our society to uphold freedom of individual choice at the expense of those who cannot speak for themselves? What kind of world allows one person to decide whether another should live or die based on physical or mental capacity?

Another interesting point from the article was that people who are otherwise pro-choice had a real problem with "reduction" from twin to singleton pregnancy, to the point where they became uncomfortable assisting in them. I find this bizzare and completely inconsistent with their values. Why is abortion ok for things like bad timing, but not to decrease from twins to singletons? I hope that this article challenges people's pro-choice views.

And I notice that people really shy away from commenting on theses controversial topics on social media. Why not? I really believe that in my lifetime, twin reductions, euthanizing infants and the hadicapped, and an even looser definition of marriage will openly exist where I live. The slippery slope is inevitable.

I am frightened by where society is going and how I will arm my child with a solid sense of right and wrong, and a reverend fear of God.

new post

What! How is it that it's been almost 2 months since my last update?! I appreciated all the support in the forms of emails, texts, phone calls, face to face conversations, and prayers spoken on my behalf that I've received over the miscarriage. It's a blessing to have good friends :)

Clearly, the key to maintaining a blog is to keep writing, as soon as I think of something, cuz if you wait, the topics will seem out of date, lame, and you don't remember what you were feeling after the fact.

So what could I have talked about...

Single parenting? (although to call me a single parent probably does an injustice to single parents out there).

The perils of finding a house cleaner? (i know, poor me).

My addiction to Masterchef? (don't you wish they gave you actual cooking tips? Only a few more episodes!)

Miscarriage.

Last week, I had a miscarriage. I have been blogging about the experience but not publishing it until now. The events of the past 2 weeks now feel like a life time ago. To be honest, I was sad for a few days only, but I've long come to accept that it was not meant to be. There are moments when we talk about the plans we had started to make because we were expecting #2, but now have to be put on hold, that the sadness comes back just a little. The other day, we talked about giving my SUV a good cleaning to sell so we could buy a minivan...but wait, we don't need to do that now.

For any of my friends who read this and might ever go through such an experience (hopefully not), I would be more than happy to talk about it with you. I knew I did wish that I had someone who had gone through a similar experience, who had to make a difficult decision, to talk to at the time.

The following are entries I had written, from when I first found out I was expecting to today.

I couldn't get it to publish in reverse order, so you'll have to start reading from the May 11, 2011 entry.

June 16, 2011

How much I blog seems to be proportional to how anxious I am. So I guess haven't been that anxious for the last week because everything happened according to plan. The medication worked. I took a second dose "just to be sure" on recommendation of the nurse, but I was pretty sure things passed that first night. It was not as unpleasant as I thought, but I was glad that I took 3 days off work, and had the 2 weekend days.

I've been feeling fine these past few days, and today, went for another blood test to make sure that the pregnancy hormone had indeed dropped by quite a bit, and it did.

Decision

Had the weekend to mull things over...and over... and over again. Fun times. Was lucky enough to speak to 2 obstetrician acquaintances, which was helpful. One thought that the chances of me miscarrying naturally on my own were slim, which made me not want to wait any longer. It was driving me a bit crazy, wondering if every little twinge of something was the start of the process, and anticipating cramping with every little spotting.

I called the pregnancy loss clinic today and decided to try the medicine first, which has a 60-80% chance of being successful, and avoiding the need for surgery. The nurse was very nice as expected. At the end she asked if i was a pediatrician. I wonder how she knew what specialty, must have look it up. She offered me some sterile gloves which she says she doesn't normally offer her regular patients. How special I felt...

One thing that made me feel better was when she told me more people chose the medicine than surgery. Up until this point, I had been getting conflicting opinions from the few people who knew. Now I felt like I was making a reasonable choice. Surgery always has more risks, even though it's over and done quicker with less pain. So I'm going to take the medicine tomorrow afterwork, and hope for the best.

It is a strange thing to control the loss of your own pregnancy. I have not yet decided if I'm happy to have known this early rather than finding out down the road either by bleeding naturally or at the next scheduled ultrasound in a month. I've been rather distracted at work and in the evenings. I'm either vegging out in front of the TV or reading about miscarriages. Tonight, I read a forum on other people's experiences with the medication route: anywhere from only a few hours of bleeding and mild cramping, to passing out on the floor and being rushed to the hospital needing a blood transfusion. Good thoughts to have, I know. I've also been having nightly dreams about miscarrying. They do not disturb me, but just an indication of how much this has been on my mind even though I'm not experiencing much in the way of overt stress in the day.

I hope to have "good news" to report soon. I know, calling this good news feels wrong, but I'll be happy to put this behind me.

More waiting

I called the early pregnancy loss clinic today, and was greeted with this low pitched, kind voice, who sighed a lot in sympathy. These nurses are clearly well trained. Towards the end, I mentioned I was a physician, and wondered if I lost some of her sympathy right there. But no, she was really nice throughout.

Anyway, I was given 3 choices: letting nature take its course, medicine to help speed up the miscarriage, and a surgical D&C. Throughout the day, I spoke to friends, husband, mom, and have changed my mind a couple of times, and may continue to change it again. Ideally, it happens naturally on it's own in the next few days and the decision will be made for me. I've been reading on lay and professional sites about the pros and cons, and there is surprisingly little helpful information out there, just a lot of scary statistics on the risks of a D&C.

Why is it that I spend my evening from 8-10pm watching crap TV, and 10-11pm reading about medical options for a miscarriage!

Originally written Jun 3, 2011 (without a title)

Today, bloodwork came back showing that the pregnancy hormone had actually decreased from where it was 2 days ago. A sure sign that this is not a viable pregnancy. I was not surprised, as I've been mentally preparing for this for the past 2 days. And at least the level didn't rise just a little bit, giving more uncertainty.

But I had more questions: do I just wait to see if I will naturally miscarry on my own? I'm kind of scared that will hurt a lot. And if I wait, how long do I wait for? There might be a risk of infection if I wait too long. If I don't miscarry on my own, when should I have the surgical procedure? What are the risks of that? Can it cause decreased fertility down the road? Those were my practical questions. My family doctor called, and suggested I contact the "early pregnancy loss program" at the local hospital tomorrow. He wasn't able to tell me much more. I am use to waiting now.

Today, I was not as sad as I was 2 days ago. I started googling all sorts of things. Man, there are a lot of miscarriage forums out there! It's something that people talk freely about after the fact, usually after they've had a normal pregnancy in the interim; but not something people talk about at the time. I wonder if I have to take much time off, and what I should tell my office. I'd like to keep it vague, and deal with it privately. this did not end up happening: 3 of my colleagues, 1 nurse, 1 office manager had to be told so I could take the time off.

Being with Noah cushioned the sting of loss quite a bit, he's all of the good things in life packaged into a huggable smiley bundle. If he is all the children I'm meant to have, I can live with that too. Really. I know I'm getting ahead of myself, but that is what I am thinking at this time.

I wonder when we can try again, and the logistics of that with my husband being away for the next 6 months. Maybe the siblings will be 4 years apart in age instead of 3 years. I can learn to deal with things not falling neatly into my plan.

Everything in my life has followed a predictable pattern, but children wasn't going to be one of them. It's ironic that we thought we had the perfect timing down, and then get a reminder that none of it is in our control at all.

I want to have faith that God has a better plan.

The hazards of modern medicine

At six weeks, I went to see my family doctor to get the preliminary tests one gets when one is pregnant: syphilis, HIV, Hepatitis, Rubella immunity, and the pregnancy hormone in the blood. He discussed having a dating ultrasound. I declined. I was certain of my dates. So just book me for the standard ultrasound later on, said I.

Then I came home and discussed it with my husband, who thought it would be a good idea just to make sure the pregnancy is intrauterine, that is, in the uterus, and not ectopic, like in the fallopian tubes. The only way you find out about the latter without an ultrasound is by having symptoms of abdominal pain and bleeding and can potentially be life-threatening later on. Ok, so I call my doctor's office back and say that I would like a dating ultrasound. One gets book...and so starts the snowball effect that is more tests and more worries:

The ultrasound shows only a gestational sac, and no yolk sac, and no fetal pole (the bunch of cells that make up the fetus). This could just mean that it is quite early. The estimated gestational age from this ultrasound says the pregnancy is actually 2 weeks less developed than what I calculated from my dates. Not likely that i was THAT off in my dates. So they recommend blood tests for the pregnancy hormone every 2 days to make sure that it is rising properly, and another ultrasound in 2 weeks to "document viability of this pregnancy."

I was in fact quite annoyed after the ultrasound, not worried, annoyed. I was 99% certain everything was just fine, and it was just the result of having unnecessary tests too early. And upset that this has led to uncertainty, and the need for more tests. Argh!!!

So I call my doctor's office again, and arrange everything. Get the first blood test done the next day, and keep checking the computer for results (probably not kosher to access one's own medical results just because I can, but I wanted to know, so that I can compare it to the blood hormone test I had 2 weeks ago). Finally the result it up and the level only rose by about 70% in 10 days, and the standard is for it to double every couple of days!! Was this another sign of a possible non-viable pregnancy destined for miscarriage? Now I start to worry a little bit. I look up normal values for the level of this hormone based on the gestational age. One website says I am way too low, another gives a much broader range. What do I believe? How can my levels be bang on for my dates 10 days ago, and now so low, relatively? Is this why I haven't had an inkling of nausea or fatigue? Was it from drinking coffee?

From a purely medical point of view, it seems like the signs are pointing to a nonviable pregnancy. But the hopeful in me has other thoughts: "every woman and pregnancy is different," "maybe it's a lab measurement error," "maybe asians are different," "maybe I was off with my dates."

I have to wait 2 more days to do the blood test again, and 2 more weeks for the ultrasound which will be more definitive. It was hard to think of anything else other than this tonight, so I'm blogging (to be published later).

When I think about the possibility of a miscarriage, it makes me sad, even a bit teary. I remember that before I became a mom, when I heard from people who had experienced a miscarriage, I actually thought those friends were a little overly emotional. After all, a third of all conception leads to miscarriage and it's not a bad thing because it means there was likely a chromosomal abnormality, and the fetus would have never lived. So it was like nature's natural selection, God sparing us from an abnormally formed baby. But now I get it.

From the moment you find out you are pregnant, your mind invariably imagines a baby growing inside you, you holding them, watching them sleep, being kissed by their older brother, etc. And now that might not be a reality. So now that I'm faced with a real possibility of a miscarriage (with a faint hope that all is still well), I get it.

Now, need to stop reading on the internet about blighted ovums, and wondering why I did the ultrasound in the first place.