What made the second c-section birth better

I was really dreading having another c-section.  Mostly because the memory of the first one is fresh in my mind – how painful it was to sit up, much less walk for the first few days.  I remember feeling helpless in the hospital bed, unable to sit up enough to reach my son who was crying for a diaper change.  It was a terrible feeling – not just the pain, but the inability to move like I wanted to.  Afterward, I wasn’t looking forward to the restrictions – not being able to lift my son, or go up stairs too much, or even drive for a few weeks.  But without an option, I had to resign myself to the repeat surgery and its aftereffects.

I did have the option, though, in hospitals given that my doctors practice in three different area hospitals.  I chose (after discussion with the doctor who would be performing my surgery) the smaller, local community hospital that’s near my town.  With my son I went to a large city hospital with a full NICU unit, just in case there were any issues with my son and his size.  With my daughter, who was growing really well and above average on her weight, I felt less of a need to make sure I had a huge medical facility.  Neonatal care was available at that hospital if I needed it.  And now looking back, I enjoyed that hospital stay much more than I enjoyed the one at the larger hospital.  While I realize my experience is highly specific to these two hospitals, I thought I’d outline some of the distinctions that made my second visit a more pleasant one.

1. Convenience.  The community hospital is less than 10 minutes from my house, while the city hospital is 30 minutes on a good day.  With a little one at home, being so close was handy for my husband to run home and take a shower, and for my mother and sister who were helping to care for my son and who don’t know the area well.  For my 6am check-in appointment for surgery, it was nice to only leave 15 minutes early rather than more than half an hour.  And there was no charge for parking.

2. A smaller, quieter facility.  I was the only scheduled section the day I gave birth; and from what I could tell I was one of the only people in recovery for a while.  My recovery room was the furthest from the nurses’s station and entrance – the last one on the floor – so it was furthest from outside noise.  When there was a code red or blue in the hospital, it was difficult to hear from my room.  No one was wheeled past my door.  It was nice.

3. Nurses were friendlier… and they actually came when called.  In the large hospital it might have taken an hour for a nurse to come in when called.  In this case, if my nurse wasn’t available they sent someone else in – which was the case when I wanted to stand up for the first time.

4. Pain control was more of a priority.  Seriously, you should ask about this at any hospital you are considering.  In the bigger hospital, you had to call for your nurse to bring you pain medication – and as mentioned in the previous bullet, that could take an hour before they even showed up to see what you wanted.  This time around, the nurses and the lactation consultant stressed making my comfort a priority – if mom isn’t feeling good, she’s no use to anybody, especially the baby.  The nurses were always concerned about my pain level.  Yes, I did have to call for medications a few times, but they were prompt and sometimes scolded me for waiting so long to call (since I wanted to see if I did need them or not… and I really did).

5. I had more than 5 minutes with a lactation consultant.  Her office was two doors down from me, as a matter of fact.  She asked that I call for her at every feeding while she was on her shift.  She sat patiently with me, reassured me I was doing everything right, and told me how much further along with breastfeeding I was than people are usually.  She checked in before she left to teach a class.  I saw her a lot and I didn’t feel guilty about it one bit (unlike at the other hospital when I was told, “You know, people usually only see a lactation consultant once before they go” after I had seen her twice).

6. I felt listened to.  When I was concerned about my daughter’s weight loss, her constant crying, her constant nursing (to what felt like no avail to me), all of my nurses were patient and explained options to me.  When I described what happened with my son, they listened but reassured me each pregnancy is different.

7. Even the cafeteria workers took pride in their job, even if they realized the food they were delivering wasn’t so great.   They were very kind to me, always offering to make something off the menu if nothing sounded good.  (I never took them up on that offer).  One morning the woman had an extra food tray (like I said, I was at the end of the hall which usually meant I was the last to get food), and she gave it to my husband so he wouldn’t have to go to the cafeteria and pay $3 for yogurt.  Super nice.

8. Between my husband and I, we had a connection to at least two of the nurses who treated me throughout my stay – that we knew about.  One of my surgical nurses during the birth was connected to me through someone at work, and one of the head nurses requested to be my nurse because she knew my husband and his family from high school (she was the nurse there).  While sometimes people might find it annoying to know someone everywhere you go, I can tell you this much – I don’t mind knowing people at a hospital, since I think you’re bound to get better service because if you don’t, then everyone will know about it.

9. I had two anesthetists with me during surgery.  In the large medical center, I had a nurse anesthetist.  She was great, sure.  I flinched during the spinal – actually, I tensed up pretty bad, which you’re not supposed to do – and later I realized it was because I was ticklish on that side on my back.  So the second time, I warned everyone who would listen that I was ticklish, and to please warn me when things were happening with the spinal.  And the second time, I had two people working on numbing me – a nurse anesthetist and the actual anesthesiologist.  They were both phenomenal, but it also added two more people to help talk me through the process and keeping watch over my vitals and state of mind.  It helped they both had a sense of humor and put me at ease.  Whereas the nurse hadn’t warned me during the birth of my son that lightheadedness, nausea, and a sense of panic are all side effects of the anesthesia, the anesthesiologist was very forward in asking how I felt and told me to tell him the minute I felt anything different.  I told him once I started feeling lightheaded, and he put a hand on my forehead and said, “Yep, you’re getting a little sweaty, a little clammy.  Don’t worry, perfectly normal.  We’re going to give you a little something to make you feel better.”  That. Was. Awesome.  I couldn’t have asked for a better team.

I hope you will be able to ask some tough questions and take a critical look at your birthing center, wherever it may be, and think about what’s important to you.  Privacy, quiet, pain control, accessible nurses…  You may think you know what you want – if you’re like me you think you don’t want a lot of pain medication, but then you do – so just keep an open mind, and I wish you the best of luck.

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How the candidates compare for infertility advocacy

You’ve seen the memes, heard the “zingers,” and probably even exchanged your own play on words about Big Bird, the 47%, or the binder.  But what have we heard from the presidential candidates on the topic of infertility – their views, their stands, where they draw the line in the sand?  Very little.  And my attempts at using Google to find a neat answer proved fruitless.  So over the next three weeks as we head toward election day, I’ll be taking up some time here on the blog to talk about some of the important issues related to the cause of infertilites.  Today’s post will start with abortion, and how that very public and long-standing debate could shed light on decisions affecting infertility treatments.

Please note that while I’ll do my best to research information and present facts from an unbiased view, I can’t say I won’t let my opinion leak out here and there.  An open, transparent, and respectful discourse is what we need in this country, so please leave comments and I promise to moderate them fairly.

Our catastrophically polarized and, at times, completely immobile nation stops the public discourse of women’s health at the old standby, abortion.  In this venue, we can neatly sum it up that Democrats are pro-choice, Republicans pro-life.  The VP debate left abortion and women’s rights to the ending minutes of the debate, referencing each candidate’s Catholic faith and asking them to reflect upon their positions.  Representing the larger dichotomy currently tearing the Catholic Church apart internally, Biden clings to the social justice side while Ryan sticks to the preservation of life side.  But regardless of their personal beliefs, we at least discovered a fundamental difference in how these two men  – and ultimately, parties – would handle the question on the national level.  Biden stated very clearly he would not legislate his religion; overthrowing Roe v. Wade as some conservatives are aiming to do, would essentially be doing that.

Wait a minute: I thought the Republicans were all for personal liberty and keeping the federal government out of citizens’ lives?

So okay, you’re probably thinking, I don’t really care about abortion because I can’t get pregnant anyway.  Let me then continue down the religious road for a minute here, and again I’ll be sticking with just the VP candidates because we have clear records of their stands from the debate.  Both men claimed to adhere to the teachings of the Catholic Church and their decisions about when life begins (at the moment of conception) and all that.  Attention infertilites, do you know where your personal religion or faith stands when it comes to seeking infertility treatments, including medications, IUI, and IVF?  If you don’t and having that support of your faith through this soul-searching time is important to you, there is no time like the present to do a little Google searching yourself.  Go ahead, this blog post will still be here when you get back.

I know where my Church stands.  Both my husband and I happen to be Catholic.  And when we started discussing options like Clomid, we looked it up, partially out of curiosity, partially to know how much we would be allowed to say to a priest without being excommunicated.  Clomid, fortunately, is permitted, as is surgery to correct infertility and other medical procedures meant to enhance reproductive chances.  IUI and IVF, however, are against the Church’s teachings (as are birth control pills).  And the Sanctity of Human Life bill, co-sponsored by Ryan, would effectively define life as starting with conception and criminalize – yes, criminalize – the practice of IUI and IVF.

Remember when women used to run off to doctors in alleys or drive to Mexico for abortions, risking their lives because they weren’t legal in the U.S.?  Now picture infertile women doing the same – this time hoping to get pregnant in the first place.  How did the pendulum swing so dramatically?

Choosing a fertility clinic/doctor

I am fortunate enough to live in a metropolitan area where I actually had a choice in reproductive endocrinologist offices.  I realize not everyone has that kind of choice and that I am very lucky to have had the opportunity to seek assistance from both for different reasons.  But when it came down to choosing which one to stick with for my treatment, after some investigations it became pretty clear.

There are two clinics each within 25-30 minutes of my home, and the only ones available for a 50 mile radius.  Fertility Clinic A has been in the area for 25 years, has one doctor and two physician assistants.  Fertility Clinic B has been in the area for maybe 15 years and is one of three locations in the state.  Clinic B also has a spa associated with it that includes services such as acupuncture, yoga and other exercise programs, massage, nail care, waxing – basically the works.  My friend B. actually used Clinic B because of their suite of services and their locations, which allowed her to travel to her home and still receive the same level of care with familiar faces.  Clinic B was my first introduction to fertility clinics by way of B., who wanted to sign up for yoga classes together.

Now, if you are lucky enough to have a choice in clinics or doctors, you can always start the decision making process by looking up the statistics on the Society for Artificial Reproductive Technology’s website, which publishes IVF success rates for every clinic in the country.  But numbers don’t always tell the whole story.  Some clinics might turn you away if they deem you too high risk, which might offset their numbers.  And personally I like percentages rather than wholesale figures.  For instance, Clinic B’s SART report shows over 1500 attempted IVF cycles in 2010 while Clinic A had about 200 IVF cycles reported in that same timeframe.  No doubt a lot of this is attributed to the largess of Clinic B, with three locations and at least one or two doctors at each.  Maybe the smaller number of Clinic A would make people feel nervous – do they have enough experience to really help me (even though they’ve been around for 25 years)?  So consider the percentages: of Clinic A’s 75 IVF cycles in women less than 35 years of age, 53% resulted in a pregnancy.  Clinic B had a whopping 652 IVF cycles for women younger than 35, but only a 36% pregnancy success rate.  There’s much more detailed information on the SART website about these numbers, so be sure to check it out.  Unfortunately, the numbers only detail IVF procedure success, not other therapies such as IUI or medicinal treatments.  It still left me with a little bit of uncertainty as to who to pick.

I decided to try some of the alternative medicine and spa services available through Clinic B, which by the way is a spa open to the public.  I signed up for a month of yoga for fertility classes last summer, took a free fertility nutrition workshop, and enrolled in a “ladies’ night” event where you could sample 4 different mini-spa services in one night.  The yoga was probably what you’d expect a yoga for fertility class to be – easy, relaxing, not very strenuous at all and probably couldn’t count as bona fide exercise.  The nutrition workshop was kind of interesting but a little too on the hippy-side for my taste (the instructor brought hemp pesto to try with almond flour crackers as an example of one of her recipes), and she kind of started by saying that while we could base our nutrition on the Chinese medicinal tables and our own idea of our symptoms, the better way is to meet with an acupuncturist to get an accurate idea of issues with your chi.  I get it, it was a free class, you’d probably expect them to sell you on something.  But it was the ladies’ night’s atmosphere that led me to really shy away from the place.  I paid $60 for what I thought was going to be 2 hours of services, and because of the disorganization turned into 3 hours.  The first part was meditation, where about 20 of us (there were about 60 women total) sat with a therapist who led us through guided meditation.  But then she asked us to share “Who came to meet you in the garden?”  I felt extremely uncomfortable sharing my personal experiences.  Next up was a chair massage, which I would do again with the same masseuse in a heartbeat, and was the most genuine part of the whole experience.  Then it was time for acupuncture – that was really the reason why I went, to see what it was all about.  The acupuncturist asked, “Any pain? What are you working on today?”  “Well, I’ve been trying to get pregnant…”  And after telling him an abbreviated story, he essentially said, “Clomid doesn’t work, acupuncture does, I’ll get you some handouts and my card.”  Having just started the clomid that left me with little hope and wasn’t the reaction I expected from someone who presumably gets his business from the clinic downstairs.  The night ended with a mini-facial (“I would recommend you make an appointment for the cranberry scrub”), a paraffin hand wax and “makeover” which was really just getting matched with a Jane Iredale (all natural) foundation and lipstick.

If you ever have the opportunity to sample services, even peripheral services like these that might be offered by your clinic, or a support group – go ahead and give them a shot before making your final decision.

While Clinic A has none of these fancy offerings, I was afraid of going to Clinic B and having them sell me on the services as part of my treatment plan.  The spa at Clinic B was already trying to sell me tons of products (they really looked at me funny when I didn’t buy anything in the gift shop); what would their medical staff be like?  I know B. saw an acupuncturist regularly, and at $60 a rip I felt like it would be a financial drain (“the more often you go, the better it works”).

It turns out there were a few more philosophical and humbling differences between the two clinics as well.  Clinic B’s entire building smells good.  It smells like the spa, like sugar and flowers and fruit and all kinds of other yumminess.  The clinic’s waiting room has 12 inch travertine floor tiles (money!), a fireplace, leather couches and recliners, dim lighting, bookshelves and DVD racks (all available for purchase), and a K-cup machine for you to make a nice beverage.  Clinic A has tile floors and carpeting, two separate waiting areas (one for the lab and one for your appointments), innocuous magazines to read and tvs tuned to news stations, bright and sunny lighting, and a single-serve coffee maker (not a K-cup) available to use.  One significant difference – Clinic A has a fragrance-free philosophy.  As fragrances are the #1 cause of VOCs (volatile organic compounds – not good for anyone, especially infertilites and fetuses), no one in their office wears perfume or lotions with fragrance and they ask their patients to do the same.  There are no scented candles or air fresheners or nice smelling scrubs in the bathrooms, as there are in Clinic B.  For me that was a signal that this place was about business more than appearances, and helped make me feel confident in making that choice.

Sure, there’s lots to be said for patient-doctor relationships too – you just have to feel that it’s right for you, that you’re in good hands.  But I also urge you, if you have the capability to choose, to consider reading between the lines of the entire business model before committing yourself, your partner, and your future family to a clinic.

The perks of going caffeine-free

Since this is National Women’s Health Week, I thought I’d take the time to convince you to give up that cup of joe everyday.

Sure, for every report or research out there that says coffee or caffeine is good for you, there is another one that pops up saying why they are so bad.  I’m not going to go point-counterpoint on this topic; that is a zero-sum game.  Instead, here’s what to expect if you do decide to give up caffeine (and coffee) entirely – based on my own 18 months of abstinence.

I’ve long been soda-free, for the better of 8 years since I gave it up to lose weight.  Coffee was a harder vice to abandon.  Getting to caffeine free was a gradual process – one which my husband carefully orchestrated every morning mixing regular coffee grinds with decaf until I was weaned off of it.  And once I was fully decaf, I gave coffee up entirely.  It felt pointless drinking it and I found just as much satisfaction in changing up my morning breakfast to include water, milk, or decaf hot tea.

First, the switch to decaf coffee is a pretty atrocious one.  If you’re a true coffee connoisseur, I highly recommend only drinking high-end decaf coffee, as in Starbucks or Dunkin Donuts.  I spent many mornings forcing myself to drink Folgers decaf and trying to get the taste of ashtray out of my mouth.  Yuk!  Save yourself the torture and go gourmet.

Second, be prepared to have more lasting energy without caffeine than with it.  A little after I became de-caffinated myself, I noticed that I would come home from work with energy – raring to go.  I wasn’t exhausted every day.  I wasn’t losing steam at 3pm.  I wasn’t falling asleep after eating my lunch.  What was this strange new feeling?  Nothing else in my routine had changed – not my exercise, not my stress level, not my diet – except for caffeine.  Score!  You wouldn’t think that giving up caffeine – the same one you turn to for that 3pm slump – would prevent the fatigue that you treat with caffeine…  But it does.  I promise.

Third, you’ll have to find another use for all that over-the-counter pain medication you have, because you won’t be taking them for headaches.  I used to get headaches fairly frequently – enough to keep a stash of ibuprofen in my work bag, my purse, and my car.  I can’t tell you the last time I had to refill any one of those little containers.  There are only two conditions that give me a headache anymore: dehydration and getting Aunt Flo.  No more random headaches in the middle of the day.  I can’t control Aunt Flo, so if I get a headache it’s my own damn fault for not drinking enough water, which brings me to my final bonus for going au natural

Get ready to have a little extra spending cash from not getting that coffee, latte, diet soda, or energy drink “just to get you through” whatever you have to do.  Water is free.  Even if you get a water purifier, the cost is significantly less than the $1.50 they’ll hit you up at the vending machine or the $2.50 in a restaurant.  Your body is made of 60% water; your nervous system relies on the conductivity of water for all its little messages to get where they need to go quickly (including the brain, which is 70% water).  Coffee and soda are both diuretics, depleting your body of the water it needs to function at its peak with every swig.  Do what’s best and go get a nice cold glass of H2O.

Don’t ignore the gifts you have been given

I believe that everything happens for a reason.  Even if you’re not sure why it’s happening at the moment it’s happening, I believe that there is a reason for it that will be revealed in time.  I have to feel this way, if only to find relief from the things that have been so challenging in my life.  And for some reason, I was chosen to be an infertilite and as I’ve come to discover over the last year, I’m not alone.

According to Resolve.org, infertility affects 1 out of 8 American couples. I started on this journey with the same guilt I imagine many modern educated working women might feel: Did I wait too long?  Would it have been easier if I hadn’t gotten that degree, or focused on establishing a career?  Is this my punishment for “being selfish” and making sure that I would be in a position to offer a child an emotionally and financially stable family life?

You can lose yourself in those arguments, and you can beat yourself up all you want – but it doesn’t change the fact that you are where you are right now not because it’s a punishment, not because you were self-centered, but because you were doing what you thought was best – as any parent would do.  You are meant to be on this journey for some reason too big for you to understand right now. And I know that it’s not easy to accept that fact, to just “let it be,” so my advice to you is to seek solace in the gifts of the life that you do have. Daily, simple gratitude for the small gifts of everyday life, however silly it may seem, helps give meaning to a time during which you might feel your most helpless and unsettled.

I need a daily reminder myself to not get lost in feelings of guilt, depression, and failure.  I remind myself daily that even if it doesn’t seem fair that I carry this burden of a perilously small uterine cavity, one tube, and low ovarian reserve, it is the card that I’ve been dealt and nothing can change that, except for an honest appraisal of my options and acceptance of my choices. In recognition of the strength that it takes millions of people – women and men alike – to cope with, heal, and resolve infertility, here is a list of life lessons that I am grateful to have learned since my infertility diagnosis.  How many of these are also true for you?

  • I celebrate being a better advocate for my health.  Having a rare congenital anomaly as the primary source of my infertility plays a large part in this characteristic. I had to learn a lot about my anatomy, and quickly, to be able to keep up with doctors and explain to new practitioners the procedures I’d already been through. I’ve read a lot of medical studies in peer-reviewed journals about pregnancy outcomes in women with Mullerian anomalies. I’ve researched the pharmacology of fertility drugs trying to understand just what was happening whenever I took them. I’m dying to see what my MRI results looked like. I’m thrilled that my reproductive endocrinologist has an online patient portal where all of my medical documents are kept and that I can read for myself. I’m not thrown or surprised by terms my doctor throws around, and I’m not afraid to ask about them anyway.
  • I celebrate making lifestyle changes for the better. I’m not perfect, but I have increased my whole food intake and eliminated a great deal of processed foods from my diet. The processed foods I might eat (such as soups, stocks, tomato sauces, cereals) are either organic or have very little additives to them.  Over a year’s worth of abstinence from alcohol has made me a seriously cheap date, but I don’t miss it. And I read cosmetic labels as religiously as I do nutrition labels.
  • I celebrate the wonderful family I do have.  Even if it is just my husband and I and a chihuahua who likes to cuddle under your shirt when the temperature is below 75.
  • I celebrate the life I have created for myself.  I’ve paid off my student loans. I have a great career and I work with amazing people. I get to travel for my job and I am always learning something new. I can buy things that I need or want, and I live in a nice town in a home that I put a lot of work into. All things considered, I am truly blessed.

Infertility does not define me but it is an undeniable part of what makes me who I am today. It’s not something we talk about as a society. Older, successful women without children are often portrayed in stories and on television as cold, uncaring, manly, or bitter; did that stereotype develop from the thick skin you need to develop to live in a world that fails to understand the full impact of infertility?  Too often we judge childless couples for not having (or wanting) children rather than consider what they may be going through, and the strength it takes to pretend like everything’s okay.

We are fortunate to live in a nation at a time when more options are open to infertilites than ever before, through better diagnoses techniques, improved medication, a range of amazing reproductive technologies, and wider acceptance of adoptive families. Do I know how my journey is going to end? Absolutely not. But I am certain that whatever path I choose, I will not be the first one to have had to walk down it.

I celebrate that I do not have to be on this path alone.

To learn more about the disease of infertility, go to http://www.resolve.org/infertility101

To learn more about National Infertility Awareness Week, go to http://www.resolve.org/national-infertility-awareness-week/about.html

This is your brain on Clomid

You know how you get those printouts at the pharmacy with your prescription that tells you all about your side effects?  You know how they say mental or mood disturbances are an extremely rare side effect?  Yeah, me too.

Don’t believe it.

Every woman I’ve talked to who has taken clomid (and for the record I am on generic clomiphene citrate) had warned me about the mood side effects.  Wild mood swings and depression were the chief complaints.  I didn’t believe them, because when I took the medication I didn’t feel anything.  It felt a lot like a sugar pill to me, with the lack of immediate side effects – compared to other medications which tend to make you feel woozy, drowsy, hyper, relaxed – in other words, make you feel something.  But when I started my first round of 50mg clomiphene citrate and I didn’t feel any differently – and didn’t notice any change in how I was thinking – I believed I had escaped that side effect.

In fact, it wasn’t until the second round of clomid that I began to realize, “Hey, this isn’t me.  This isn’t normal.”  Having suffered through depression on and off through my teens and 20s, I thought I’d be able to recognize the signs.  I was entirely fooled, until I started taking cheap shots at my husband and realized, “Stop! What did I just do?  And why?”  The worst thing was, acting so bitchy felt entirely natural to me even if it really isn’t my nature.

Here’s what I went through (and continue to battle, now on my second round of 100mg): A complete and utter lack of desire to go to work – every day. A negative view of everything happening – at my job, at home, on tv. I become a human Eeyore, a grey cloudy sky following me everywhere I go, drenching everything I encounter with sad and morose overtones. My husband can’t do anything right, and (exasperated sigh!) my life is soooooo stressful and overwhelming.  I couldn’t stand to be around anyone. Grrr!!!

The pharmacist ought to hand you a little placard with your prescription that reads, “Don’t mind me, I’m on clomid.” Maybe a warning sign is more appropriate.  But I advise informing those you love about what’s going on, why you might be acting strange.

Only you know yourself best.  So make sure that when you’re on any kind of medication that affects your mood, you keep up your usual lifestyle regimen that you have come to expect.  Keep exercising – it is the only thing that returns me to my “normal” state during the 5 day cycle of hormones.  Keep eating healthy foods.  And, if it makes you feel better, indulge yourself in a retreat: give yourself a pedicure, get a massage, or lay on the couch and do nothing – and don’t feel guilty about it.

One cognitive effect I have experienced which actually has a physiological impact is that it makes you think you’re hungry even when you’re not.  Maybe it is a psychological way to cope with the depression and mood swings, to eat chocolate and comfort foods.  But either way, I’ve had to train myself to stop snacking as often as I had been – because only a short week to 10 days after starting clomid, my body would begin to see the rest of its side effects.

To be continued…