nur.sing wars--how tedious (rant)

can i just say...UGH. or maybe UUUUUUGGGGHHHHH!!!!!!!!!!!!!!!

one of the message boards i regularly post to had an all out war for the last week on bf vs ff. i agree, and will not argue, that bm is the optimum nutrition for infants. there isn't really a debate, the science is more or less unanimous. what i will argue to the end of the earth though, is that ff is 'dangerous.' i think to say or allude that is at best misinformed and at worst treacherous. example: infants *can* and *do* grow and develop normally on a diet that consists of ff in whole or in part. this is not so where the main nutritive input is, say, diet soda. or even regular soda. formula DOES supply the caloric and nutritive support needed for infant growth and development, soda does not. whatever. either way, maybe ff is perhaps dangerous if you mix it incorrectly or use tainted water in the preparation, but to call it dangerous under normal circumstances in this country is absurd.

taking it a step further, in my experience, the infants that i've seen on a partial or full ff diet do not, as a whole, differ in any substantive way from their entirely bf peers. i also think that if you took a randomized sample of high achieving amer.ican adults, you could make no estimation of their infant feeding patterns with any reliability. you would be far more successful if you tried to guess the SES, race, gender or educational achievement of such individuals. i would argue that a distressed mother and an underfed bf baby is at far greater risk of poor outcome than a relaxed mother and a well-fed ff baby. after all, the underlying point is FEED THE BABY. babies need adequate food, end of story.

one could read the above and maybe think that i am pro-ff or anti-bf. i am neither. i am just not prepared to denigrate mothers who feed their babies in a way that works for them and the baby, however they accomplish it. some are aghast that mothers could elect to ff knowing that bf is better and label these mothers as misinformed or lazy. i whole heartedly disagree. people are NOT scientific models who are always able to perfectly enact ideal situations. in the real world, people are complex and their lives are complex. their choices are complex and exist in a realm of competing motivations that don't exist in scientific models. people make all kinds of suboptimal health choices for various reasons. they don't get 8 hrs sleep/night, they smoke, they overindulge in alcohol, they get sun exposure between 10a-3p, they eat fatty foods and not enough veg, they don't exercise at moderate intensity for 30min/day 5 days/wk, they watch more than 5hrs TV/wk etc. should we stigmatize all individuals not living at goal? should we assume that their failure is due to lack of adequate information or inherent slothiness? are *we* stone throwers living lives beyond scientific reproach? i believe that mothers who have found a way to rear their infants in a way that works for their family deserve our praise and support, not our scorn.

in a larger question, why can't women and mothers support each other? as long as the baby is being fed in a way that supports growth, why must mothers judge other mothers? what difference does it make to anyone outside of the mother/child dyad how that baby is fed? motherhood is so hard and such a long haul. surely we can support each other along this path, whether their babies are bf or ff.

update

sorry for the long absence! every now and again (actually, just recently for the first time) i have a crisis of conciousness regarding my blog. it started out as a loss/IF blog, and then after the sucessful IVF cycle it sort of morphed into one of the few places i could unload my utterly all-consuming 'when-will-i-miscarry' dread.

i'm right now between 22 and 23wks, and it has started to occur to me that this could possibly happen. i'm jubilant about making it this far, but don't really want to post much in that vein because a) i'm concerned that the fertility god is so ornerny that giving voice to my internal celebration might be met with 'HOW DARE YOU' type old-testament retribution for my haughtiness. also b) what about our sisters still fighting the IF fight? i don't want to be disrespectful. finally c) there are things here and there i'd like to complain about (frikking WICKED A$$ heartburn, for one, and sciatica as a legacy of continued PIO shots for another) but does that take away from my greatfulness? i get caught up in loops and find it hard to post.

regarding my earlier post, i had not thought of the "birth" until recently. and then when i did think about it, my head was populated with images of poorly-trained, sleep-deprived, hero-complexed residents at the military hospital slicing open my perineum with rusty scissor blades and yanking on poor Bean's little head with whatever instrumentation happened to be handy: forceps, vacuum, shoe horn, etc. i eventually found a midwife practice in the area that took my insurance and who i believed would not unnecessarily instrumentate (a word?) my poor hoo-ha or Bean's skull. and now i think i may be moving in about a month to six weeks to accomodate a job. so, brand-new city, and starting all over again with trying to locate providers. le sigh. i wish i could magic the baby out when that time comes.

birth providers: wwyd?

i could use your opinion or advice or reality check or something. i've thought around this situation so much i'm thinking in circles. this post is prob going to be too long too, as i sort things out.

so, i am on my husbands tricare insurance. it is military insurance, as he is currently on active duty. there is a huge military medical hospital near me (i'll call it army clinic--original huh ) where active duty and dependents give birth. the funny thing is, i have a history with this place even before my current involvement in it; i happened to spend 2 mos rotating there in L&D full time as an elective in nursing school. there are pros and cons to this place.

pros: it is completely, 100% covered. every lab, every test, every IV, every everything. all of the births i witnessed there were professional, and even the ones with unexpected turns of events were handled well. they also have a level III nicu, where i also spent time, and which i was impressed with.

cons: if i deliver at army clinic, there is no opportunity to meet the staff who would be present at my delivery ahead of time. none. there's no way even to narrow the universe of people it might possibly be. whoever will be with me that day or night is whoever is on duty that shift at army clinic. if my delivery crosses shifts, then the personnel that i've gotten to know the previous 12 hrs shifts as well. i have always known this about the army clinic, both because it was that way when i rotated there, and because they told us about it in 'orientation' . but, to be honest, it didn't bother me as much before, because i think part of me never thought i'd make it this far. now that i'm about halfway there, i'm starting to think i might make it the whole way. thus, the newfound concern.

another con about army clinic is they do things their own way: for ex, i could not get an NT scan through them at all, so i had to pay out of pocket for one through another provider.

what i'm worried about: what worries me is the instrumented vaginal delivery. as odd as it sounds, i'm really not worried about a planned c-sect. i have confidence that whoever is my provider is proficient at c-sections. further, i have a bicornuate uterus so my risk for c-sect is higher in the first place. i've made peace with that along time ago. frankly, i'm just going to be happy to have a real live baby, the planned c-sect doesn't bother me. in fact, if i could just plan a c-sect right now i wouldn't even have an issue. the vag delivery where nothing goes wrong doesn't bother me either. what worries me is the worst case scenario: the stuck baby, the crash c-sect, the bottoming out heart rate, the dystocia, the forceps, the vacuum, the episiotomy, the 4th degree tear, the retained placenta etc. etc. etc. THOSE are the situations where i want to be able to be able to concentrate on nothing but myself and SB, where i want to take for granted that my provider is skilled and qualified, and has done thousands of these before and i'm in good hands. in short, i want to be able to trust my provider so that in a worst case scenario, i don't also have to worry that they might not know what they're doing. its sorta like what nicole said in her thread, she trusts her doc to make the right call re: her induction. i want to do that too...but i have no opportunity to do that because i can't meet anyone ahead of time. instead i have to trust the institution that whoever is there when i'm there knows what they're doing. i feel like it's alot different to trust a whole clinic than to trust one person or even a group of people.

so, i wrote an email to my old ob-gyn whom i've known for-EVER and who has known me for-EVER and who did my laparoscopy. i have utmost trust in her. the problem is, her practice doesn't take tricare. i called the hospital where she delivers and they do take tricare, i just have to switch the version of tricare that i have. if the hospital didn't take tricare, i couldn't even contemplate this switch because it would just be too expensive. but they do. her flat fee is $3200 which includes prenatal appts, vag or c-sect delivery, and postpartum care. it's a significant discount from what she generally charges. labs/sonos are NOT included.

pros: trust is not an issue. i know her. she is very good, very skilled, very experienced. if she busted out the forceps, i would not worry that my babe would end up with a mashed skull. i know she would never cut a senseless episiotomy. she would always treat me with dignity and respect.

cons: $3200 is a LOT of money for us right now. especially when that seems to be a floor, not a ceiling, as what if i need extra labs/a sono at the end for some reason? money would suddenly become a huge factor in the delivery, where it isn't now. plus, i'm spending on what is essentially a luxury item. it's not like i don't have care and would have to pay for the delivery no matter what. i have full coverage, and would be not using my coverage (wasting it) and then paying out of pocket for sort of the same service. it's not money i have to spend.

there is one more option. i could ask her to recommend to me someone within the tricare network that delivers at this other hospital (not army clinic) that takes tricare. then i could try to meet everyone in this other practice in the next 20 wks to try and get comfortable with them. it would cost alot less, but i don't know if i can meet and get comfortable with someone or someones that fast. i'm sorta under the gun as i only have 20 wks left. i would have thought of all this before hand, but i really just wasn't sure i'd make it this far.

thanks for making it this far through this rambly post. now, wwyd?

bad reasons to have children

i guess there are alot of really good reasons to have children--and probably twice as many really bad ones--but having comfort in your old age is probably NOT a good reason to have children.

my grandpa has two children (my mother and uncle), two grandchildren (me and my sister) and two great grandchildren (my sister's twins), but since the death of his second wife he just feels lonely. he definitely feels like his children and grandchildren don't visit often enough, and don't do enough for him when they visit. i know i'm guilty on this score...but since the first half of any encounter with him is chock full of guilt "who did you say you were again? my granddaughter? oooooohhhh, i thought my granddaughter FORGOT about me. it's been SO. MANY. WEEKS. since i've heard from you, i thought you didn't REMEMBER that you had a grandfather." cue repeat x10 minutes, or until my end of the conversation falls completely silent long enough for him to take note. (maybe he would use a different guilt tack if he were aware of how rampant alzheimers is among his peers where 'WHO did you say you were?' actually inidicates genuine confusion on the part of the inquisitor...but somehow i doubt it.)

anyway, one gets the feeling that the feckless children and grandchildren are something of a dissapointment to the grandfather. and, honestly, he has a point. i live close enough to him that i could and probably should visit alot more often than i do.

i guess it just makes me think that being a parent will probably bring you nothing like what you thought it would...or at least you can't count on it bringing you what you hoped for. you can hope to get something back from it at the end, but there are no guarantees. just ask grandpa nathan.

my a$$ really hurts

so, the irony is thick being a health professional and all, but i'm pretty sure i gave myself sciatica with all of the self PIO injections into my buttocks. today i had excruciating pain with **walking**. that's right, walking. and since people tend to need to walk, i spent alot of today gimping around hurting quite a bit.

so, my sisters in the IF wars, watch where you shoot yourself because the sciatic nerve is unforgiving if tampered with.

in other PIO news i am just NOW--mind you, 6 or 7 wks since my last shot--gaining feeling back in the old top half of the tusheroo in general. for a while it was just straight numb, and then i'd have deep tingly itchy feelings, and when i went to scratch i couldn't actually feel my own fingers on my skin. now i get zings as the traumatized nerves and tissue slowly regain feeling, combined with feelings of warmth and itching. the rebirth of my a$$.

science babe seems to be doing ok, as far as one knows from the doppler, which is the good news at least.

jiving and surviving

hello blogger my old friend
i've come to talk with you again.
because the blog as yet unwritten,
attached to the LOL kitten,
and the post, that was planted in my brain
had this refrain--
you must get your a$$ up from where it is sittin!!!

my only big news is that the NT screen that i got thanks to leah is neg. downs risk is 1 in 7901 and trisomy 13/18 is 1 in >10,000.

i also must say that the purchase of a doppler has done more for my fragile mental state than the SSRI's, relaxation tapes, and tepid baths combined. i realize i'm setting myself up for disaster by saying it (saying what? did somebody say something? ptu! ptu! ptu!).

this semester is KILLING me. praise jeebus that it's almost over. today my preceptor scolded me for not completing a history and physical on a brittle diabetic patient in under half an hour. well, my dear, you frequently fail on that score as well. so bite me.

but i digress. this weekend i will be at jazzfest. ste.vie won.der baybeeee!!!! heeyaw!

ultimate

so i play a sport called ultimate frisbee. technically, it's a no-contact sport, but there is alot of incidental contact with other players and the ground. i've played for about 10 years, but haven't played at all this spring.

last night i stopped by a teammates for dinner after work and he asked me if i was going to play tomorrow. i said no and reminded him i was pg (he knew, but i don't look it so i figured maybe he forgot). neither he nor his wife (also on my team) gave me any grief about it, but the wife casually mentioned that she knows other women who played up to 5mos pregnant and even beyond.

the more i sat with that, the worse i felt. i love ultimate, and i hate letting my team down, but there's no way i could take the risk of even incidental contact. and to avoid all contact basicaly means taking no risks while playing. i've spent years trying to teach myself to play more aggressively, i don't want to start trying to play more passively. and it isn't worth the worry. if i did fall or get run into (which doesn't always happen, but always could) it would take days of reassuring sono's for me to even feel remotely ok. so i know i can't play. i can't even put myself in the mindset of the 5mos pg woman who does play...does she figure she won't have contact? does she just assume that everything will be ok if there is? otoh, i feel bad that maybe other pregnant women in my position are doing more, and maybe my paranoia is restricting me even beyond what i thought it was. it didn't occur to me that pg women played much past getting a hb (the limit i set for myself) and now that i know they do, it makes me feel a little bit bad about myself. :( oh well.

on unrelated good news, my doppler came last night and after i got a 9v battery for it this morning i heard the HB. strong, regular, 160's. i think if i can get the hb every morning maybe...maybe...maybe...i can let myself think beyond just a few days from now into the months ahead. maybe. i've passed other milestones where i thought that would happen and it didn't, but hopefully this will help.

stupidest...logic...ever (or, trying to get my NT scan)

so, bad news first: i talked to the attending dr of maternal fetal medicine at BethNav on monday, voicing my concerns with being offered a distinctly substandard aneuploidy screen, particulary when such a policy is distinctly at odds with acog guidelines. she informed me that acog states merely that all pregnant women should be offered _A_ screen, not the _BEST_ screen...and they just simply have too many patients to do an NT on all. i told her that given the 80% detection rate for serum alone and 95% for both combined, they'd surely miss quite a few downs cases that they could have otherwise detected. she said they are aware of that, it's just how it is. she offered me a cvs though, which is essentially a core biopsy of the placenta carrying with it the attendant risk of damage to the fetus or m/c. so, i can't get a 5 minute, non invasive screen, but i can get an expensive, risky, labor intensive procedure i don't really need? interesting. maybe she offered it because she assumed i'd say no, which is of course what i'm saying.

the good news: i am getting an NT scan, paying for it out of pocket, and with the help of the lovely and talented Leah it should only be $300-$400. praise be for fellow stirrup queens with connections! the scan is next tues at 830a, wish me luck!

inspired or truly stupid...time will tell

so, i think i'm going to order this doppler. it's a good one, and i lie and tell myself that it has another use besides my paranoia...i can use it on my patients on the rare occasions when that is necessary. surely a use that justifies the $550 price tag, nu?

not much up here. i'm still getting by sono to sono, hb to hb. 12wks tomorrow. tomorrow i'm also going to try and get the hb by doppler (similar model) after clinical. hopefully it won't be as agonizing trying to find it as last time, but will instead pop right up :).

i also don't look pregnant at all to anyone but myself. but last week my loving and adoring spouse did comment that i'm getting a bit fuzzy in the under-chin area. and yet, we're still married as of this week! i'm such a softie.

also: thanks to everyone for their suggestions regarding the NT screen madness. it is truly an astoundingly wretched policy to withhold the screen from those that want it. i looked into getting it elsewhere (i.e. on the civilian side) and it is prohibitively expensive. i would have to be seen by my old ob-gyn, pay out of pocket, be referred for a sono and pay for the sono, radiography tech and radiographer all out of pocket. in the state where i live, it would actually be cheaper to wait until the 18wk scan, and then get a late 2nd trimester abortion if i had to. it's definitely not good policy, but it seems to be the best of my limited options. :(

acog who?

my ob care is through the military, allegedly at one of their flagship institutions. i'm being seen at be.thesdanaval.medicalcenter. interesting then that at such a premier institution i'm unable to get a NT screen, my requests for same and ACOG guidelines nonwithstanding. apparently, they do sequential testing and only offer NT scans to those women whose 1st trimester analytes are abnormal. while this seems like a good idea, serum anaysis alone only detects 80% of possible aneuploidy, whereas serum analysis + NT scan has a detection rate of 95%. if i were working with a tiny clinic in a remote area that didn't have appropriate equipment or trained sonographers i would understand. but that is not the case, at "the president's hospital." if acog guidelines suggested that only women of a certain age or risk factor should be offered the combined NT and serum screen i would understand. but acog guidelines are clear: "Women need to be aware of all the different screening options that are available, including their detection rates and limitations, so that they can choose the test that's best for them." if i didn't want the NT scan it wouldn't matter. but i do. it is very odd to me that i'm being denied such a simple screen at, allegedly, one of the nation's top medical institutions. what could possibly be the reason for BN to be so far outside the normal standard of care? cost cutting? abortion politics?

i heard the hb today by doppler; i'm 11w. i have a retroverted uterus so it didn't come up right away and i scared myself half to death. i'm going to wait a week before trying again. part of me thought, that as i'd made my 1st maternity clothes purchases this weekend, that it wouldn't be there as payback for such a wanton display of hubris. like DD said in her post, i guess things will be ok but it's hard to mentally work myself around that. if someone asks if i'm pregnant, the answer that feels most right to me is "technically". i feel bad because i feel like it's keeping me from bonding with the lil bean, but i keep waiting for the second shoe to drop. maybe it'll get better in the 2nd tri?

i honestly couldn't say it better myself

so this post might be cheating, but every now and that i come upon a sublime post that says just exactly what i wish i could say, if i didn't sputter out into an incoherent rage each time i tried. i'd like to refer you now to julie's 3/24 entry at a little pregnant for a spot on discussion about what's so insidious and nasty about this whole j.lo twins THANG.

it's not that fraternal twins at age 38 after years of wanting and trying to become pregnant doesn't scream IVF (umm...but it most surely does)...it's the denigrating way she denies it. no one is asking j.lo to be a mascot for IF (for that i'd like to nominate z.braff if only because he's so damn cute!), but if she could just refrain from being insulting in her she-doth-protest-too-much denials that would be much appreciated? k? kthxbai.

how to quickly lose your mind in one easy step

so early this week i reluctantly stopped lov.enox...no longer being hemoconcentrated following my bout with OHSS/paracentesis/abdominal bloating from hell. even though the shot stings like crazy i quite was sad to give it up, because i got pg and stayed pg (so far) while taking it. so rather like a basketball player and his lucky underwear, i wanted to make it to 12 wks before deviating from my medication regimen in any way. alas, not to be. plus, i figured if i was homozygous for MTHFR (and being ashkenazi, it's a reasonable possibility) i would be treating that simultaneously. i've never been tested for clotting disorders, so it's possible. at my appt this week i asked the resident if i could stay on the lov.enox...she contacted the maternal-fetal specialist who essentially said no can do regarding the lov.enox, because if i do have a clotting disorder it won't cause problems until 20 wks or so, and since i'm no longer hemoconcentrated there's really no need to continue the shot. is that supposed to be comforting? i'm supposed to wait until 20 wks to see if a problem develops? Not Even Remotely Comforting.

even more reluctantly i stopped the PIO. a word about PIO. that shot SUUUUUUUCKS. it is thick, and deep IM, and currently my backside is covered in knots and bruises. i even ended up with sciatica down my left leg from multiple deep IM injections into the same area. so, it's not that i like the shot at all. it's that despite multiple assurances that 'the placenta takes over progesterone production at 6-8 wks' i know there are women for whom that is not the case. i also know that you can have a perfectly healthy fetus, but if you don't have adequate progesterone, you don't have a pregnancy, end of story. i also know, that fertility wise, i happen to fall into a rather small percentage of women who need IVF to get pregnant. further, i happened to fall into an even smaller percentage who get severe OHSS. so, at this particular junction i'm *not* interested in playing odds games. however, i can't write prescriptions for myself (yet) and so the best i could do was secure a pro.metrium script for the next several weeks...and i'm sure earn a few "crazy lady" doodles next to my name on my chart.

so my last PIO was thurs eve and i woke up yesterday (sat) with a small amt of pink spotting. i spotted all day. you can imagine the lovely state i was in. i think i put so much progesterone up my vag that i'm suprised it wasn't stuck shut. by yesterday eve my attempts at remaining calm had failed me and i paged the IVF dr on call (mind you i have been passed off to OB at this point, but at my appt last week i was really unimpressed with the level of knowledge they seemed to have regarding early pregnancy, complications etc.). thankfully they returned my call and i drove an hour to the clinic on sat night at 7pm for a thorough wanding.

science babe looked great. waving it's little arm and leg buds, bobbing it's ginormous, egg-like noggin. it's father has a ginormous head, the ramifications of which are just becoming clear to me now. hb 164. i'm sure the collective IVF team thinks i'm just a big pile of crazy at this point, between the begging for shots, wheedling for pro.metrium, saturday evening scans, etc. etc. etc. however, in my defense, spotting 3 days after discontinuing PIO will cause panic. it just will.

oh well. this gets better, right?

Ok

i begged, borrowed and stole my way into a quick sono this AM and it is still there. Someday, at some point, this will seem less tenuous. i hope sometime sooner rather than later.

crazy doesn't necessarily mean wrong

so, i've decided not to rent or buy a doppler until another U/S confirms a hb. Ditto for any maternity clothes, including bella band. so, i'd better not gain ANY MORE WEIGHT until i have another u/s or i will be utterly without clothings to cover my shocking paleness with.

i guess i'm happy that i haven't had any morning sickness to date (the only thing i had vomiting with was the OHSS) but a little bit of pukiness just to let me know things were OK wouldn't be terrible. famous last words i know, but i thought i'd put it out there.

tomorrow i have OB "orientation" at beth.esda na.val. possibly the most inconvenient place to get to EVER. i can't wait to see what the orientation entails...if it's anything like the IVF orientation was, i'd call it a solid waste of my time. but i'll go if i can get another sono out of it. *crosses fingers*

it has occured to me recently that perhaps t.o.m cr.u.i.s.e was not so much crazy as just more brilliant than our feeble minds could comprehend...seriously. if i had his kind of $$ to throw around i would not hesitate, pass go, or collect $200, but instead simply dash my bruised, knotty PIO heinie down to the nearest sonogram store and plunk down some cash.

sono glow=2.5 minutes

i am utterly exhausted all the time, as well as vaguely nauseous and more than a little backed up. my body, it is a wonderland.

my mind, however, is a deep black pit. it wonders if i should fabricate symptoms to go to an ER where i can spend 5 hrs waiting just to get a sonogram to tell me there's still a hb. it's a good thing i'm too lazy to listen to myself much.

i'm contemplating renting a doppler, but i can't tell if that will lessen the crazy or make it worse :?

ba-thump

we transferred two but there was only one, measuring 7w1d (i'm 7w2d), hr 145, otherwise normal looking for an embryo the size and shape of a bean.

***exhales***

i know it's shortlived, but i'm hoping the sono glow lasts at least 24 hrs. :)

oy

well, the hb scan is weds am and i am brimming with DBT's for the occasion. my head is going to be a particularly unpleasant place to be for the next 36hrs or so.

does being on PIO mean any m/c signs are masked? does anyone know? i'm just wondering...