A Tour, a Meltdown, and a Precursor to Pre-Term Labor

For the week following our visit with Dr. Hill, we tried to get a tour of the hospital I’d be delivering at (conveniently across the street from my MFM Specialists). It was tough, to be honest, as there seemed to be all of these barriers to getting a damn tour. The hospital was just converted into a Children’s Hospital in 2012, with their NICU opened just this past April. It was “new”, but under construction. Labor and Delivery was on the 4th floor and the NICU supposedly on the 3rd. We were finally able to get in to see Labor and Delivery one day and, as soon as we got off the elevator, we saw ‘NICU’…but it was behind a bunch of plastic (that’s not good). Well, we were unable to get our tour at this time, and were certainly uneasy at seeing plastic covering over the NICU entrance.

Hubby and I discussed our experience over the next few days, rather, I had meltdowns over the stress of finding MORE new doctors/paying for appointments for new doctors. We know who won this battle (hubby)…We decided to touch base with other OB-GYNs in the area just in case, and we did. What we found was that, though the doctors were great, they did not have experience with this type of situation (no surprise here, and not said in a pejorative manner), nor did they give any warm fuzzies about the situation.

As an aside, at 12 weeks pregnant, Dr. Mildred Ramirez (my Houston MFM) told me no running for exercise. She described it like so… Imagine a balloon, tied off at the end, moving up and down. The only support the balloon has is the knot, and if enough pressure is put on that knot, the balloon pops. That makes absolute sense, right?! I was told that elliptical was fine, so that’s what I did – up until I was slapped in the face with the ‘high risk now’ comment.

We were onward bound at 18 weeks pregnant to a different OB/hospital just to try to have options. After having an episode of rage over parking at a structure at the new office (pregnancy apparently makes you have meltdowns and episodes of rage…who knew) because the hubby parked in some structure next to Mars, and I could not find him, we were at the next doctor’s appointment. Kudos to hubby for shrugging off and laughing at my episode of rage…

“I DON’T SEE YOUR CAR!”

“I’m right by the hospital.”

“I’ve gone all the way to the top of the structure and don’t see your car!”

“I’m standing by the doors.”

“WHAT DOORS?! THE DOOR TO THE OFFICE IS RIGHT IN FRONT OF ME AND I DON’T SEE YOU!” (Drives angrily out of the structure to find hubby. Never finds hubby and drives back to old structure because said structure was the right place to park.)

“WELL YOU’RE GONNA BE LATE THEN! I’LL MEET YOU INSIDE!” (Insert colorful expletives throughout my rage-laden outburst)

Though risky on his part to laugh at me, it did eventually calm me down.

So, let’s refer back to what the MFM in Houston told me about exercise. It made so much sense that I should not run, so I used this as a doctor test with all doctors moving forward to gauge whether or not I felt they were a match for our situation.

We met a wonderful OB at this appointment. She was top-rated in San Antonio, beautiful, and equally knowledgeable. Great time to test her.

“So, what do you think of exercise? Is running okay? Elliptical?”

“Running is absolutely fine! Elliptical makes your legs stretch too far, stretching the uterus and putting extra stress on the cerclage.”

Nope. That made little sense to me and my situation. I’m not poo-pooing this doctor’s expertise, as she is surely great for a regular pregnancy (she didn’t get high ratings for nothing)…but not mine. After that experience, I convinced hubby to do another tour at the Children’s Hospital with me. We were able to get in that day, thankfully! We were not especially blown away by the facilities, but what came next blew us away.

Our nurse, Rosemary, (who was as sweet as can be) took us on our tour of Labor and Delivery, then showed us the way to the NICU. As it turns out, what we thought was the NICU was actually area under construction for a newly-remodeled section of Labor and Delivery. She introduced us to Natalie in the NICU, a member of the transport team. You know those awesome people that ride in helicopters and rescue critical babies? She’s on that team. She was and is lovely. That is the only word for her. She took us through a brand new, state of the art NICU at the Children’s Hospital of San Antonio. We were in awe. Everyone we encountered was kind and accommodating. We knew we were in the right place just in case our girls came early.

You see, when choosing a hospital, especially if you are high risk or elevated high risk, it doesn’t matter what the labor and delivery facilities look like. The Children’s Hospital of San Antonio is in the process of renovating, but at the time the rooms were similar to the Golden Girls’ Miami pad – outdated with pinks, greens, valances, and flower borders. Bleh! It was the NICU that just blew us away. In case our girls came early, it wasn’t about me, it was about them. It was always about them.

Advertisements

Here’s the Boring Part of the Story

Shortly after speaking to the surgeon that performed the trachelectomy (probably on a spaceship somewhere just above Houston because that’s what aliens do to abductees probably), we realized that the trek to Houston from San Antonio may no longer be feasible. The “what ifs” started surfacing…We had initially planned on shacking me up in an AirBnB location in Houston at 24 weeks pregnant, but were really concerned with cost and travel at that point of my pregnancy. We also wondered, if my pregnancy was so high risk, what if there’s an emergency and we can’t get to Houston? No one in San Antonio knows us or our case, which could be dangerous! We had no idea just how high risk the pregnancy was…

Dr. Mildred Ramirez, the MFM at Texas Children’s Hospital, was amazing in the short time we met her. I met with nurses, a nutritionist, a geneticist…we just felt so at ease with the standard of care at the hospital. I mean, they house the number one Neonatal Intensive Care Unit specializing in Cardiology. Did I botch that name up? Probably. We voiced our concerns to her, asking for a referral to someone local. She linked us up with Dr. Peter Nielsen at the Children’s Hospital of San Antonio, which mirrored their standard of care to Texas Children’s since it was in the Baylor network.

Just a few weeks later (at 17 weeks pregnant), we walked through the doors of Maternal Fetal Medicine office for the Children’s Hospital of San Antonio. Dr. Nielsen was not in, so we met with Dr. James Hill (which did not immediately sit well with me since there was a switch made without us knowing). While we waited to meet with a strange, new face, I googled Dr. James Hill. West Point graduate and retired Colonel? Okay, yes. Went back for a MS at Stanford? Yup, right place. (Those aren’t his only credentials, but those are the familiar and quite impressive ones.)

Within seconds of meeting Dr. Hill, we knew we were in the right place. He listened intently as we spoke of our concerns and told our story. He is very methodical, which we appreciated, and also has a dry sense of humor, which was also appreciated. (If you ever see him, do not let his serious demeanor fool you…he’s awesome and can easily make you feel at ease!)

At this appointment, he really said something that drove it home for us. I mentioned our initial intent to stay in Houston at 24 weeks pregnant because we were high risk. His response was, “You’re high risk now“.

Ugh. Wow. 17 weeks pregnant and, to that point, everything was smooth sailing; little-to-no morning sickness (with twins, no less), no issues getting around (except the feeling of being a beached whale while on the couch Netflix and chilling), still going to the gym and walking or doing elliptical with light weights, and I was all belly with two, beefy baby girls. We were so pie in the sky to that point. Any time thereafter I tried to describe the situation, I was met with a look like I had two heads and was making it up that bed rest was needed and that I shouldn’t be driving. You can’t make this situation up and it’s most certainly not a relatable one to the normal baby maker.

We had no idea, but we were in for a wild ride that was yet to come… well, all things considered, our ride was about to turn into an amusement park ride at Cedar Point that hasn’t been considered yet – think Millennium Force meets Demon Drop meets Top Thrill Dragster (which is sinking deeper into the ground, by the way), all of which are combined to make a two-year-long ride. Boy were we happy we made the choice to stay in San Antonio…

Trachelectomy Sounds Like What an Alien Would Perform on an Abductee

Since I’m carrying twins and pregnancy scares the hell out of me, I found it important to gym it up as much as I reasonably could. This meant only elliptical and maybe light weights with the arms. No running, no sexy time, no baths, no swimming. So basically, have zero fun during your pregnancy and occasionally question whether or not you’re cut out for motherhood.

Anyway, after our experiences with two doctors mentioning selective reduction, I tried like hell to contact the surgeon that performed my trachelectomy and implanted the abdominal cerclage (sounds like I was abducted from my trailer in New Mexico and tested on by aliens with the names they have for these things). My first attempt was all for naught. MD Anderson has this really cool portal where you can ask questions. I thought I was clear, but I tend to write novels for questions. They told me that, although I was not asking for prenatal care questions, they would have to defer to the maternal fetal medicine specialist for any questions. I sat on that answer for about a week, lost sleep, probably had one of those shower epiphanies, and tried again.

One evening about one to two days after I posed my question once more (at 12 weeks pregnant), I received a phone call while I was working on my fitness (one of the last times I could do so for the duration of my pregnancy). It was the surgeon who performed the trachelectomy calling me from his personal phone. See a theme here? These doctors are top in the world, but take the time and care (cuz who knows if this bish is going to stalk them) to call me from their personal phones. It was Dr. Pedro T. Ramirez (ladies, hubbies, wives, boyfriends, or girlfriends – I hope you’re taking note of all of these doctors in the instance you experience any of this – you will not regret your experience with any of them). He was very kind and took his time to listen to me. He insisted that, although there is nothing documented, there have been successful multiple pregnancies with this abdominal cerclage. I was relieved. This, by no means, meant that our pregnancy journey would be easy, but it did mean that we made a great choice to keep our two little nuggets. (Imagine if we had not…)

I hurried over to hubby to tell him the news. We were both excited and happy to have heard from an amazing surgeon personally, and to have heard straight from the horse’s mouth that we made the right choice to proceed.

*Disclaimer – I don’t live in a trailer in New Mexico.

“Are you pregnant or not?” Includes fun pictures :)

You don’t realize it, but the whole fertility process happens quickly! Within ten days of an IUI or IVF procedure, you know if it worked or not. On February 10, 2017, we went in for our first IUI procedure. Within ten days, I was a little less optimistic. I felt crampy, which was a sure indicator that I was going to start my period. On day eleven, I had lost hope. The cramps were intense and so was my mood.

Normally, I could give two shits what people think about my personality. I’m quirky, weird, socially awkward, and oftentimes poke at people when I don’t want to be around them. Well, on Tuesday February 21, 2017, I sat in my office, bawling because I’m so goddamn weird. Stupid shit comes out of my mouth when I’m nervous, and to boot, that stupid shit came out during an interaction with an executive at my work. Good one, Ursula, you need to cry this one out.

“Why am I so @#$*ing awkward?!”

(sigh) This was later my first inclination that I needed to take a pregnancy test. Not wanting to jinx it, I waited. Hubby kept bugging me, “Are you gonna take a test?”

“No. I’m gonna wait and schedule an appointment with my OB to be sure it’s an accurate test.”

Lies. On the night of Wednesday February 22, hubby went out to the gym. I took action and did the whole, less-than-glamorous pee on a stick thing. Was that a solid line with a faint line? My heart dropped and I grinned from ear to ear. I took a pic of it and sent it to my dearest friend, Jenny.

“I’m shaking…is that a second, faint line?”

“It looks like it :).”

It said I was pregnant. Shaking, I hid the test and planned to take another in the morning. I was going to go to my OB to take, yet another, and plan my next steps to tell hubby the news.

That night, I dropped hints of a special lunch or dinner just to spend time with him during a stressful week. At first, he was ok with lunch. YES! I only have to keep a secret for a few more hours! Then, hubby drops a bomb on me – either dinner tomorrow or we wait until the weekend. COME ON! I CAN’T WAIT THAT LONG!

The next morning, since I have to get up so early to paint my face, I was up before hubby and took another test – when it is supposedly pure, concentrated pregnancy on a stick. Sure enough, this one read, clear as day, “Pregnant”.

Holy shinoly!

“Are you gonna take a pregnancy test today?” Hubby asked.

“Yeah, I’m going to see if they can do a blood test to be sure instead of taking an at-home test.”

Lies.

“Ok, call me as soon as you know!”

Well, the doctor’s office confirmed what I already knew – pregnant. I did have to go in for blood work that Saturday to run checks and balances, so the lie I was about to tell was only a white one.

After the appointment, over the phone:

“So, did you take a test?!”

“No, she wants me to go in to a lab Saturday morning for a blood test. They ensure 100% accuracy with blood tests. Do you wanna meet for lunch? It’s been a stressful week.”

“Ok. So we go Saturday?”

“Yup! Bright and early! Where do you wanna meet for lunch?”

Once it was decided, I worked fast. I went to the bookstore and acquired two books:

20170223_105025

I ran home, threw the pregnancy tests in a baggie, along with the sonogram card and books, and went to meet hubby for lunch.

Quick on my feet, I thought up my plan. Hubby was currently studying for a certification, so I knew exactly how I would tell him we were expecting. Once at the restaurant, I met him at his car with a bookstore bag with all of the loot in hand. He gets out and,

“So, I went to the bookstore and got you a couple things to help you study.”

I shakily hand him the bag. He looks inside and pulls out what he initially thought was a calculator and I grow silent.

20170223_105820

“WHAT?!”

“Yeah, I lied. I took a test last night, one this morning, and confirmed with my doctor that I am pregnant.”

20170223_105840

It worked. IUI worked the very first time. I hope he doesn’t hate me for sharing the next one, but his girls will love it when they are old enough. My guy is the best and this shows his raw emotion in the middle of a restaurant.

20170223_112311

Stay tuned, though…We are not in the clear yet.

If You Want Children, Get Them However You Can

Our amazing doctor was able to save one of my tubes. That being said, we were still not in the clear quite yet. Our next adventure would involve IUI or, potentially, IVF. Before we get into our chosen route, which will be a dead giveaway in the description below, let me educate you on the differences between IUI and IVF because I got them mixed up as well. They are definitely different, so be careful if anyone tells you they had to go through one or the other – prego women can be sensitive and will attack if you don’t keep that trap of yours shut, so check yo’self before you wreck yo’self.

IUI, or intrauterine insemination, has HUGE differences from IVF. These include, but are not limited to, the following:

  • Eggs are NOT removed from the body
  • Eggs are NOT taken to a lab to create precious embryos

Like IVF, IUI follows a strict timeline, so if you’re going to go through the process, get yourself a planner if you haven’t got one already. Your cycle starts on the first day of a full-on period after 2PM, so count out to day twelve and call your doctor to schedule an ultrasound. (Make sure you remind your hubby every hour of every day the sacrifices and steps you are taking to ensure he gets a family. And ask for presents; big, exorbitant ones. Also remind him that he only steps in to the process provide his “seed” and that his level of discomfort to produce said seed does not match your level of discomfort.) On days three through seven of your cycle, you take either Clomid or Letrozole. In my case, it was Letrozole, which is slightly less potent (we will get to why this can be chosen later). On day eleven, you take and ovulation test. If it is positive, call your doctor. On day twelve, go in for your ultrasound. They will do this transvaginally, so get ready and pray that they use warm gel. At this time, they will count and measure the maturity of your egg(s). They must be at least 18mm to proceed with the next step. If they are not, go home, call your doctor, and schedule another ultrasound for day fourteen. Go into your ultrasound on day fourteen and have them measure. If your follicles, or eggs, are mature, call your doctor. On day fifteen (or thirteen if your eggs are mature then), if you’re me, expect a phone call from your doctor’s personal cell phone to warn you that there is a potential for twins and that it is VERY risky to proceed. There are no documented cases of twins with my cerclage, so “selective reduction” is an option that one can opt into in this event. Once you discuss the risks with hubby, call your doctor back and receive instructions to give yourself a “trigger” shot in the belly. (*Please note that, during this time, it is a choice to consume an alcoholic beverage as there is no harm done to the process. This could be your last adult beverage for months since, after this day, you should not consume ANY sort of alcoholic beverage.) It’s a super tiny, ultra thin needle with miracle juice that forces you into ovulation within the next 36 hours. On day sixteen (or fourteen) take hubby with you. Hubby will be hopeful that there are “materials” to help him along with his production process, but sometimes that won’t happen and he will be left to his own devices. He could also be stuck in a room with no cell reception, so proceed with caution because the pressure is ON! Also, try not to embarrass hubby by yelling out in a full waiting room, “Would you like me to come with you?!”

Now for the coolest part…

Within two hours of hubby’s production, the sperm is “washed”. During this time, they put the sperm into a machine that uses centrifugal force to pull the sperm from the semen (semen, mixed with the ph of your vagina can be toxic and kill off the little spermies). This is done twice to make ensure you’re getting the best of the best! From there, millions of little hubbies are put into a tube with a sugar water mixture where they are happy and healthy – like a theme park for sperm. Once the two hours are up, wifey returns for the finale and doc tells hubby his sperm are the Michael Phelps of sperm. This process should only take about five minutes, but, as you know, nothing can be easy for us.

At this time, our normal specialist, Dr. Woodard, was doing her rotation across the street at MD Anderson, so a different doctor was to help with the insemination part. This doctor, God bless her for dealing with me, could not find the opening to my uterus. Half an hour later, Dr. Woodard was messaged and offered to come over to help. It turns out, she had just as much trouble. You see, scar tissue had formed over my uterus after two surgeries, preventing entry to my uterus, so the opening was near microscopic. They had to dilate me. If you’ve ever bumped an old wound that has scarred over, you know that this can be painful. Imagine this on one of the most sensitive parts of your body and then times that by a million. It was absolutely PAINFUL! The dilation came with an ultrasound to help find where the opening should be, as care was taken so that they did not puncture my uterus.

Hubby was right there by my side holding my hand the entire time. I could see the worry in his face and the love and care in his eyes. He was never going to let me forget how much I mean to him and how much it meant to him that we were moving forward with this whole process. He’s my rock through everything!

After some tears, dilation, an ultrasound, and an hour and forty minutes, the catheter with our special little ones was in. Once this process is complete, you lay horizontal for twenty minutes (we opted to stay for thirty to ensure optimum swimming potential).

Once the process is all complete, you are given a potential for a 20% chance that the first time will work, but you must always remain optimistic.

Off we went on our three hour drive home…hubby with his crotchety and sore wife. Three hours.

The Saga Continues…

Hubby, always thinking positive, mentioned going back to Houston for a second opinion. Yes, that is exactly what we did! Once there, we were met with kind and compassionate eyes. That was my doctor, Terri L. Woodard. Go ahead, look her up; she’s as beautiful outside as she is in, with the brain to match! It’s insane the amount of effort that God put into this woman to create someone that could and would help people. Just phenomenal.

While there, I was subjected to another HSG. Guess what? This time the doctor did it herself AND my hubby was allowed in the room to hold my hand. See a theme here? Effortlessly, she found the opening to my uterus. She did her thing with the dye to see if the tubes were open. It was true, both tubes were blocked. Her warm, caring expression somehow didn’t disappoint or alarm us, so we seemed to accept our fate.

Once the test was complete, we met in her office to discuss a path forward.

“It’s 50/50, but I think I can save one of your tubes,” said Dr. Woodard

“What, really?!”

“Yeah, I think it’s worth a try! The other is completely blocked, so that will have to come out, but the other may be salvageable.”

Hallelujer! 50/50 was better than zero! To be clear, they tie your tubes when you have a blockage to prevent ectopic pregnancies…Just a side note there.

We scheduled my surgery and went home in greater spirits. We knew that the three hour drive to Houston would be, and was, completely worth it. The medical center there has top notch doctors that genuinely care about their patients. Not only that, but even the office staff and nurses are spot on! I had once dealt with an office worker in San Antonio that kept repeating Dr. Anderson when I told her I was trying to get a follow up appointment after my surgery at M.D. Anderson. Ugh, no, it’s the top cancer treatment center in the country, not a doctor, honey.

We returned a few weeks later, hopeful that the surgery would be a success, and it was! One, “beautiful” tube remained.

That was it. That was the official start to our journey to baby. It was right before Thanksgiving 2016 that this all went down and we were able to enjoy our holidays. This was not the end, though, as there was more in store for us soon.