Pregnancy. And stuff.

WARNING: What follows is a detailed journal of our transition from not pregnant, to pregnant, to ready to tell everyone that we are expecting. In the (very long) ramblings that follow, I talk about hormones, my cycle, morning sickness and a whole host of other things that you may not want to read.

Cliff Notes Version: We are due 10/31/10. Scroll down for an ultrasound picture. Shhh! We haven't told the kids yet.

The Novel Version:

On Friday, Febuary 7, my home ovulation predictor kit showed a positive LH surge. We had been attempting to conceive since our wedding (December 26, 2009) and this was my second cycle that we had been "trying", and only the first cycle wherein we "caught" my LH surge (we did not effectively use the OPK in the previous cycle.) I had not been on any contraception since my surgery on August 12, 2009.

My cycles had been varying in length since my surgery and since I went off the NuvaRing. The last few cycles were 24-26 days in length. By day 28, I was feeling like there was a possibility that I was pregnant. I felt different. I didn't feel PMSy- I wasn't breaking out- and I was soooo tired, all the time. On Friday, February 19, my home pregnancy kit was positive. I contacted my doctor (a reproductive endocrinology and infertility specialist- the same one who performed my surgery) and she scheduled an appointment for the next day.

On Saturday, February 20, I saw my doctor and had labs drawn. Based on the first day of my last menstrual period, my due date would be 10/28/10, but based on the date of my LH surge (and probable date of conception), my due date would be 10/31/10.

Sat., Feb 20, 2010: 4 weeks, 1 day (13 days post ovulation): hCG= 80.5, Progesterone= 30.1. Recheck labs scheduled for 2/22/10; goal is to see progesterone remain greater than 20 and for hCG to double or nearly double.

Mon., Feb 22, 2010: 4w, 3d (15 dpo): hCG= 207.3 (!!!), Progesterone= 26.1. Plan is to continue to check labs until hCG>1500, at which time they will do a transvaginal ultrasound; I am scheduled to have labs again on Friday. They are considering me as 4w, 1d rather than 4w, 3d because my LH surge was "late." I am wondering if this "more than doubling" of my hCG is related to the timing of my labwork... or if it could possibly be related to having more than one fertilized egg...??? According to this information, my levels could be consistent with twins:)

Fri., Feb 26, 2010: 4w, 5d (19dpo): hCG= 916.9, Progesterone= 21.7.... Again, the hCG level is higher than expected and could be consistent with twins. I was concerned about the dropping progesterone level, but the doctor stated that as long as the level stays elevated (greater than 10) there is no need to be concerned. Plan is to repeat labs and a transvaginal ultrasound on Thursday, March 4 (5w, 5d or 26dpo). We should be able to tell if there is more than one baby at the ultrasound, and maybe (it would be a stretch) see a heartbeat!

Thurs., March 4, 2010: 5w, 5d (26 dpo): Progesterone= 14.4. No hCG done. Doctor is concerned that progesterone has now dropped to less than half of my initial levels, when it should actually be rising (progesterone levels should peak for the first trimester a little later, and still be rising throughout the entire pregnancy.) Started on daily progesterone injections. We did have an ultrasound and saw the yolk sac. Not much else. But thankfully, only one:) Besides the injections, the plan is to have another ultrasound on Thursday, March 11 (6w, 5d or 33dpo).

Mon., March 8, 2010: I was pretty riled up about the need for the progesterone injections. I guess it was one thing to have concerns about the pregnancy, and something else entirely to have those concerns validated. Also, after 4 days of injections, my butt is sore! I am supposed to continue the injections daily until the end of the first trimester. Around week 9, the placenta forms and takes over the progesterone production, so by the end of the first trimester, my progesterone levels should be good.

My little nudger is about the size of a lentil bean right now, but it's crazy how something so little can make such big problems. I had been having "morning sickness" on and off since about week 4, and last week I started taking vitamin B6 twice a day at the suggestion of my OB. It helped, but today was horrible. I spent the first hour of my shift trying not to vomit. People at work are starting to figure it out (the combo of being sick and cutting out the caffeine is pretty much a giveaway.) I guess I am going to up the B6 to three times a day.

We haven't told our parents yet, although since we plan to spend the weekend with John's folks, I think we will have to say something to them. Otherwise, it might be hard to explain why we are disposing of a large syringe and needle each night, and why I am not drinking coffee, and why I am drinking milk. I am hoping to see a heartbeat on our ultrasound on Thursday, which would make me feel better about telling them. Of course, I would tell my mom first, because she might be disappointed if I didn't:) John wanted to tell them sooner, but I just feel like with the possibility of problems, I don't want to disappoint or hurt anyone who doesn't have to be hurt.

I am exhausted. All the time. I spent the weekend reading and relaxing and napping and occasionally doing some mommy/housework stuff, and I was still exhausted almost every minute of the day. I think my exhaustion is worse since I started the progesterone, but my ability to sleep soundly is impaired. Before the shots, I could fall asleep and be out like a stone in minutes... and sleep soundly all night (and most of the next day.) Now I am sleeping more fitfully, and finding it harder to fall asleep. Also, I have breast soreness. Horrible, constant breast soreness. And sometimes, my patients jam their arms/legs/shoulders into me (most of them on accident, I think), and I nearly cry. I don't remember pregnancy being this hard with Abigail. I wonder if this is the effect of the 7 years between when I was pregnant with Abigail and now, or if it is simply a greater awareness of my body and what to be expecting.

Thurs., March 11, 2010: 6w, 5d (33dpo): Today we saw our baby's heart beat! Holy Toledo! Seeing that little pixel flickering on the ultrasound machine screen made this so much more real to me. Our little nudger is measuring 6 weeks and 2 days in size. With the evidence of a heartbeat, the risk of miscarriage is less than 5% (in healthy women. Our risk may be higher since the concern for cervical incompetence is higher.) I will have one more ultrasound next week with the infertility doctor, then I will begin seeing a regular OB, while being followed by the high-risk maternal-fetal medicine group. If everything looks good at the next ultrasound, my doctor will consider allowing me to stop the progesterone before the end of the first trimester- maybe around week 10. Let's hope.

I told my mom and sister tonight. They are both excited, although my sister said something to the effect of "well, it took you long enough! You've already been married for 10 weeks!" It made John and I think; we didn't actually plan to become pregnant this soon- we were kind of going to wait until John was in his final year of fellowship (it will be a "chief" year, so his salary will go up a bit, and he will be much closer to "attending" status) to actually become pregnant. But our doctor was so concerned that we would have problems and that my body would need so much extra help, that she encouraged us to start trying right away (generally, you have to have been "trying" for 6-12 months to have access to infertility drugs.) So this pregnancy is still a bit of a surprise for us. We never expected it to happen so soon, but I am so glad it did!

Tues., March 16, 2010: We told John's folks on Friday night. They are pretty excited, and can't wait until we give them the go-ahead to tell everyone else. While they love their 2 granddaughters, this is the first time they will have the "pregnancy" experience. I also had my first dream about the baby over the weekend. I dreamt the baby was a girl. Hmmm.

The weekend was a blur of exhaustion and morning sickness (such what a misnomer- let's call it all-day and most of the night sickness.) Sunday night I tried the last over-the-counter remedy that my doctor had to offer: half a tablet of Unisom at bedtime. Monday was much better- only mild morning sickness that went away by noon, and today, nothing so far! John did some research, and apparently, the company that markets Unisom used to market the drug as a morning sickness reliever, but the FDA kept asking for more and more studies to show the safety of the pill. There were never any studies that showed it was unsafe, but the company decided to take the other drug off the market because the cost of conducting more studies was not worth the potential profit from the drug. Thankfully, the doctors didn't forget about Unisom:) Added benefit: I am sleeping so much better!

I am 2 weeks and 1 day off caffeine. Oh. My. Word. I am okay, but still feel like I don't really "wake up" until 10 or 11am.

Thurs., March 18, 2010: 7w, 5d (40 dpo): That little pixel was flickering at a rate of 162 beats/minute today:) John thought that this was a good sign that our little nudger is a boy, but of course, the old wives' tales say that a heart rate greater than 140 bpm is a female and under 140 bpm is a male. But that is not really accurate unless you are already in labor or something. The sesame seed was measuring 7 weeks, 4 days, which is right on, and a significant increase from last week. Our doctor was very pleased with how things looked, and thusly said.... WE CAN STOP THE SHOTS AFTER TOMORROW NIGHT! Hooray! She also said that we are ready to "make the switch" over to the regular OB. (This is the same doctor who did my surgery in August, so I kind of feel like she was "cutting the cord" so to speak.) Very excited about our promising prospects, but still, sad to say goodbye to the doctor who has really meant so much to us in the past year.

I am feeling pretty good. I've been taking half a tablet of Unisom at bedtime, and my morning sickness is much more bearable. I see the nurse at the OB's office tomorrow to get all the intake paperwork and to go over the general dos and don'ts. Then we will see the OB on Friday, April 2.

Thurs., March 25, 2010: 8w, 5d (47 dpo): It was strange to not wake up and rush off for an ultrasound. But it was kind of good, because I had a horrible stomach bug Tuesday night and yesterday. I enjoyed a bit of a "lay in" this morning.

The cat (or nudger, rather) is kind of out of the bag at work... I declined taking the admission of a patient over the weekend because he had 3 of the TORCH infections; I might have taken him if he had only one infection- HIV, for instance, is really not much of a risk to a health care worker who is careful about standard body precautions and sharps. But three of the infections- one of which is highly contagious? No thanks. This is something I never really thought about when I was expecting Abigail, but now, as a nurse working with very ill and immune-compromised patients, I think about it a lot. I already talked to my doctor about H1N1. 25% of pregnant women who contract H1N1 die; the risk of exposure for a nurse is not negligible. However, I did receive my vaccine last fall, and along with the use of hand hygiene, masks, and common sense (as well as the guidelines put in place by my hospital at the guidance of the CDC), I think this is pretty preventable, and much less of a risk than other diseases for which we do not have a vaccination.

Friday, April 2, 2010: 9w, 6d (53 dpo): We had our first visit with our OB this morning. Because I work at an academic medical center (and will be receiving all of my care there), we don't have the luxury of meeting and working with 1-3 doctors that comprise the practice... instead, we have the potential for seeing a different resident or attending physician with each visit. In a "normal" pregnancy, this wouldn't be a big concern, as a healthy woman with a healthy pregnancy sees her doctor more for weight, blood pressure, and blood glucose monitoring- and answering questions- more than anything else. Because we have more risk factors, we are slightly concerned about the lack of continuity in our care. Additionally, we will be followed by our OB, but will also be followed by the high-risk group and consult with the hematology group as well. This means that we have to become experts on the care that we need so that everything happens when it is supposed to happen. Now, more than ever, I am so thankful that my husband is used to navigating the (sometimes complicated) world of academic medicine. I guess it is also reassuring that he knows and/or has worked with many of the doctors who are involved in our care:)

Today's visit was very status quo- we loved the doctor we saw (we are big on being able to laugh with our doctor and not take ourselves too seriously). We also had another ultrasound- our doc tried to use an external monitor to hear the heartbeat, but we are a touch too early to do that. So we got an ultrasound:) We are telling John's sister (who is up visiting from Mississippi) tonight, and are excited to share our latest photo! John and I are both looking forward to telling his grandparents next weekend.

Thursday, April 15, 2010 (11 weeks, 5 days): Somehow, I missed posting a little ditty last week. But that's okay, because today, I give you a picture:

This was taken on Tuesday. At that time, the baby was measuring a few days "big." For those who are not familiar with ultrasound pictures, this picture shows (L to R) the forehead, nose, upper and lower jaw, belly, leg (bent into fetal position, so you can see both the hip and knee joints bending), and a squiggle on the end that is the umbilical cord. You can also see the spine. And yes, all babies have a disproportionately large head/forehead at this stage:) Baby's heart rate was 170 beats/minute.

Baby's first naked picture! Heehee!

I am feeling a lot better and have not taken my nausea medication for a few days. I did throw up this morning, but I think that was because our milk was expired- not morning sickness. I officially cannot comfortably fit into my jeans (I can squish in if I really try, but it's really hard not breathing for long periods of time...). I am craving meat. Lots and lots of meat. And cheese. And cucumbers, tomatoes, pineapple, pears, onions (heartburn!), chocolate, Craisins, hamburgers, Thai, and food from one of our local restaurants (The Warwick.) And pizza, but I craved that pre-pregnancy, so I don't think it counts.

We are waiting on the results of some tests, but as long as those come back okay, I think we will be telling the Interwebs the news! Be excited- we are:)

Thursday, April 22, 2010 (12 weeks, 5 days): So, we officially got the results of our testing today, and everything looks great! Thank God. Also, I have been off the nausea medication since last week and have felt great! I am sleeping better (not super yet, but that is partially because Seven is sleeping in our room since she is not supposed to be alone overnight- did I mention she picked out her spay stitches last week? Yeah.) I like sleep. A lot.

I am looking forward to coloring my hair this weekend as my "end of first trimester" celebration. I know that there are mixed feelings about that issue, but according to everything I can find in the literature- and according to the professional opinion of my doctor- it is unlikely that coloring your hair can actually harm a baby, and if it did, it would only be in the early parts of pregnancy when the nervous system was forming.

Wednesday, April 28, 2010 (13 weeks, 4 days/"3 months along"): We told the world (or, at least the blogosphere/facebook) last week, and it's been great:) I am feeling good, and my little bump is getting bigger. I decided this weekly journal is ready to take flight in the interwebs. So kudos to you if you made it all the way through. Hope I didn't disgust or offend. Check back for more updates- we have another OB visit on Monday and plan to take Abigail along to surprise her (and tell Anna later that day:)