Monthly Archives: April 2014

Two Lesbians Make a Baby: A Timeline

I thought it might be helpful to explain the year process that it took us to get where we are, or if we were friends, why I would spend two weeks drinking and running and then two weeks not. I’ve written before about the Two Week Wait, but what this timeline doesn’t convey is the emotional investment it takes. The wife likens it to waiting for Christmas morning, where you’re either going to get the best present ever… or punched in the face. So, yay. Here’s how it went.

November 2012 – Prelim Testing
Have OB appointment, explain we are about to start trying, doc gives me a Counsyl test and does the usual stuff. Get a DTaP vaccine (if you are considering a baby, you and your partner both need one!!!).

February 2013 – Meet the Fertility Center
Have initial appointment with fertility center. Send medical records over, get blood work screening, etc… Insurance comes back and denies fertility coverage. Close on our house.

March 2013 – Life gets in the way
Spend the month furiously renovating our kitchen.

April 2013 – Money money money
Finish our 2012 taxes and apply for the fertility center’s discount plan.

May 2013 – Start the ramp up
Get told that we are eligible for a 20% discount based on our income (that doesn’t sound like much, but consider treatments are $280 – $1600). Arrange the social worker visit to discuss conceiving through donor sperm and the implications for our bebeh to be. Do a practice round of ovulation tracking. Start looking at sperm banks and winnowing down choices. Screening says that I am CMV negative, which greatly narrows our choices.

June 2013 – IUI #1
Order donor materials and pick up and give to the fertility center a week before I am due to ovulate. Discover I am ovulating while my mother is in town (who I have not told about this process). Work in office visits around her time with us. 2 IUIs with one vial each time. Be wildly optimistic that it will work on the first try.

July 2013 – IUI #2
Discover that this round was unsuccessful. 2 IUIs, one vial each. Order cheap new ovulation tests once the last set runs out.

August 2013 – IUI #3
Nope. Start using new ovulation test. 2 IUIs, one vial each.

September 2013 – IUI #4 and some drama
Begin viewing menstruation as the enemy. Get a solid line on the ovulation kit. Notice a never before discussed sentence on the ovulation predictor instructions from the fertility center that you received 5 months ago that says do not follow instructions on ovulation kit, call when you have a faint line. Freak out. Call your nurse manager about this, asking why this was never discussed in all our interactions, get a very vague ‘sorry you misunderstood’ voicemail with recommendations for a $30 for 7 day kit made 7 times. (Recommending a brand does not avoid this issue! Also, ovulation testing is supposed to last 10 days) Wife calls, also upset, and gets similarly vague and annoying responses. 1 IUI with 1 vial, since we were apparently still in window.

October 2013 – IUI #5
Still no. Follow the ovulation instructions according to fertility center, have 1 IUI with 1 vial, since you had only 1 left.

November 2013 – Time for a New Plan
This continues not to work. Have a meeting with the doctor (who we have seen once in February, since all IUIs except for September’s have been done at a separate, non-Metro accessible office that does long term storage) the Wednesday before Thanksgiving. She recommends an HCG test and moving to Clomid with 1 IUI per cycle. In between prepping for their lunch Thanksgiving party, nurse manager discusses the new protocol for the test and medication with us up to Day 11. Asks if we want to speak to financial manager, after we’ve been in the appointment for 1.5 hours, while we know Thanksgiving party is taking place. Only discussions of increased costs have been about medication, which should be small, so we say no. Skip any attempts this month so we can have Thanksgiving with family and also for an emotional break.

December 2013 – IUI w/ Clomid #1 and ALL THE DRAMA
Have HcG test, with no issues. Go in for Day 3 prelim screening to see if follicles are growing properly. They are. Front desk asks me for $350 at check out. I am astounded and say that insurance covered the February screening. They say fine, give your copay and call your financial manager. I call my financial manager, who has no idea that we have changed treatments and that we can either do a lump sum payment of $1600 ($1200ish with discount) or pay per treatment. This major change in finances had never been discussed with us before, so I am breathless with anger.

I assume that we will only have 1 additional screening on Day 11, so it makes sense to pay per. He transfers me to nurse manager who tells me I could have up to 5 screenings. I am flabbergasted at the amount that had not been discussed with us in November and very angry. Talk again to financial manager, ask why all of this is a surprise and what my options are. He essentially says that because we did not see him in November, none of these updates were made in system. He also says that we have to decide if we do lump sum or pay per before we begin treatment and I confirm that this means the Day 11 screening. He agrees. This is 2pm. At 4pm (30 minutes before their office closes for the day), I get an email from him saying I need to decide by COB. Go to the office and pay the remaining $1200 and change to the office. Take the Clomid. Have Day 11 screening – follicles have grown but not enough. Come back at Day 13 – follicles have grown maybe enough? Weekend nurse talks to us just in case about IUI plans, discussing two IUIs based off a procedure paper we have never seen befpre, when we had been told one. She goes to check with her doctor supervisor, who tells her that it’s just 1 and if we trigger that night, we get the IUI the following day. Phone call says no, come back tomorrow. Come back at Day 14 (December 22nd), get told yes, today is the day for trigger shot, come in on Tuesday (12/24) for IUI. Respond that this is utterly contrary to what we had been told the day before, what the hell? Get told to hold, get a call back 10 minutes later, saying the doc was wrong and come in on the 23rd. Wife gives trigger shot like a bad ass, IUI with 1 vial. Stay sober for Christmas and New Years. Go on progesterone suppositories.

January 2014 – IUI w/ Clomid #2
Go in for bloodwork pregnancy test. Get told by nurse manager that it “doesn’t look good.” Go off suppositories and have terrible, terrible cramps with my period. Cry. Wonder what, exactly “doesn’t look good” means and if, somehow I was actually pregnant and that was a miscarriage and she was just terrible. Fire nurse manager and get a new one. Send email listing all of the things that I wasn’t sure about from last round that previous nurse was vague and dismissive about to new nurse manager, who consults with doctor and gives us a long, involved email back answering all of our questions. Wonder why we didn’t fire other nurse manager sooner. Day 3 follicle check, all good. Begin new round of Clomid. Go for Day 11 monitoring on MLK day and am told that I have 2 follicles bigger than standard rate and that I will probably need to trigger tonight. Panic because I’d just dropped the prescription off on Friday and was waiting for insurance, thinking I had until Thursday. Pick up prescription without insurance copays. Nurse calls and says to do trigger shot, come in on Wednesday. Doctor calls 10 minutes later because he feels the need to warn us about risk of multiples, despite the fact that this is our second round of IUI with Clomid and doctor had discussed with us at November visit. Wife gives trigger shot like a bad ass. 1 IUI (#10 since June) with one vial, the last vial we had on hand. Start progesterone.

February 2014 – Good News
Start craving nachos and have difficulty sleeping, neither of which are noticed as symptoms at the time. Go in for blood work. Brace myself for another no. Just miss the nurse’s call – her instruction is to call Wife if I’m not there. Call Wife the instant I realize I miss the call in my office. She asks if I’m OK, I ask her to confirm it’s a no, she says, actually it looks good but with qualifiers. My beta levels are where they’re supposed to be (132), but I need to come back in 3 days to see if they’re even higher because it might be a false, chemically based pregnancy. Continue progesterone until they tell me to stop. Freak out. Go in for blood work 4 days later. Nurse calls and says I had a “fantastic rise” to 1000+ and that I need to go in for blood work *again* in two days. Freak out again. Go in for blood work. Chew my fingernails off waiting for the call. Am told again, yes, we’re still good but we can’t confirm if there’s anything in there, come in two weeks for an ultrasound. FREAK OUT. Ultrasound. OMG THERE IS A BABY IN THERE. They show us the heartbeat. I cry. They give us pictures and tell us to come back in 10 days. Nurse manager goes through care instructions, including weaning off the progesterone (THANK GOD, it is not fun!)

March 2014 – Still Pregnant
Wean off progesterone two days before ultrasound (I don’t know why they call it weaning, you just stop!). 8 week ultrasound. It’s still a baby! It’s bigger! It has a heartbeat! We have officially graduated from the fertility center, with prenatal care instructions and stuff to give my doctor. Dance like a crazy person and tell family.

So there you have it. The entire process took over a year from start to finish, including emotional breaks, time off to get finances together, etc… The whole process insemination process cost us just about $8,900, including $4,330 for 10 vials of donor materials. I also tallied how much it would cost us if my company had granted us infertility coverage – all total? About $4,900 with copays, a difference of $4,000. But granting same-sex couples infertility benefits would be too expensive for the institution (NO SERIOUSLY, THAT’S WHAT HR TOLD ME).

I do recommend advocating for yourself if you find yourself in this position, including excessive research. I thought our first nurse manager would do a much better job than she did keeping us informed. I know that we were probably one of the least hands-on of her patients (IUI vs. IVF), but we were also new to the experience and needed a little more hand-holding through the experience than she was wiling to give (as our December experience proved!). Instructions were also given inconsistently and at times, I felt like she had to be reminded who I was while on the phone with her. All said and done, personality is important and if you don’t click with the person who’s supposed to be working with you through the entire experience, for the love of god, get someone else. I wish we’d fired her in September, the other time I felt really let down by her.

Anyway, this is just what happened with me. You will, undoubtedly, be different.

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Healthy Pregnancy Counseling – Shame in a Phone Call!

Perhaps I’m being unkind characterizing it as such. But here’s the deal. My insurance has a healthy pregnancy program which involves a few 15-30 minute phone calls from a nurse during my pregnancy, with the intention of reducing ER visits and unncessary C-sections. More importantly, if I sign up to do it through my work, they’ll pay me $200. $200 buys a lot of diapers / pays for 4 midwife copays, so I signed up early on.

And… it’s… fine. They sent me the Mayo Clinic Guide to a Healthy Pregnancy for free, which, hey, free pregnancy guide! Which I’m glad I read, because I found that my 5,000iu Vitamin D supplement is actually too high for right now and so I reduced to 4,000. They also suggested adding DHA supplements, which is especially important because I hate fish and am not getting it that way. They also nagged me about going to the dentist (which I’d already had set up because I believe in getting regular six month dental checkups unlike my wife some people).

But… but… ugh. First, they identify risk factors and told me that my fatty fat fatness was a risk factor, as was the fact that we’d conceived using a fertility center. And proceeded to talk to me about the importance of exercise and proper nutrition. To which I responded my basic “I’m not eating ho hos dipped in fudge lying on the couch. I eat properly and am calorie counting, am at the gym 3-5x per week and walk 10,000 steps a day.” At the time, I was in the throes of heartburn, nausea and insomnia, so I wasn’t eating as much as I should and didn’t really want to go to Zumba because I thought I might throw up. So, you know, that. But, as often happens when I talk to insurance companies, they don’t seem to understand Health at Every Size and continue to talk to me like I’m a 5 year old. So, that’s fun.

They also didn’t understand home birth and midwives. They clearly have questions they have to answer on a form, but couldn’t comprehend that a) I would not be working with a doctor and that there was no doctor supervising the midwives and b) I would not be going to a hospital unless absolutely necessary. So that was fun.

The final, ‘wait, what the hell are you talking about?’ was about exercise and breathing. They told me the standard, heart rate stays at 145 or below (which I’m trying to follow, but don’t wear a heart rate monitor. I just try not to get too out of breath in classes). They also told me that I should call my doctor / midwife every time I get out of breath. Every time. Whether exercising or not. Which is ridiculous because one of the fatigue issues I have with this kid is that I get winded more easily. I revisited them about this on the second call and they reiterated, even if you’re at the gym, exercising or whatever, if you’re even slightly out of breath, call your doctor. I mean, clearly this is a CYA on their part, but if I followed this instruction to the letter, I would be calling my midwife daily. Which I’m sure they’d love as much as I would. How does that even go? “Hello, midwife? I just carried my laundry basket up two flights of stairs and now I’m slightly out of breath. Do you think the two might be related?”

Second Trimester!!!!

Last week marked my entry into my second trimester, yaaaaaaaaaaay. So far, so good. I’ve actually started gaining weight again (and it’s really weird that I’m happy about it, but I lost 5 pounds in the first trimester due to nausea / heartburn / I’m not sure). I’m still dog tired, but the heartburn is beginning to resolve itself, either because my body has decided to give me a break or that the papaya enzymes are actually working.

I’ve heard the second trimester referred to as the honeymoon trimester and I’m crossing my fingers that’s the case. I’ve restarted Body Pump on very light weights per the midwife and may start walk/jogging again (I tried once but it gave me lower abdominal pain, so I’m not sure I want to try again). I miss wine and spicy foods, but I didn’t have either that frequently, so I’m not feeling the lack that much. I really miss coffee, especially since it’s becoming iced coffee season. But I’ve had it occasionally and it’s not been that bad, so maybe it’ll be a weekend treat. I’ve decreased my walking, since the fatigue has made me even less likely to get out of bed to walk the dog and then walk a mile to work, but I need to get back to it, even if it means going to bed at 9pm.

I’m finishing up my grad school classes for the spring, which is fun when all you want to do is sleep and watch bad TV. I’ve got two summer sessions so I can just take one class in the fall and two in the spring and still graduate on time. I should be able to do it, I think, but it’s nerve wracking and part of me just wants to drop the program and focus on fixing up the house and being pregnant. But I have to ignore that part (and continue to work on fixing up the house in between papers).

Overall, though, I still don’t really feel pregnant. No weird cravings or anything, except for cheese & ice cream, which I basically wanted all the time anyway. I’m not sure how I’m expecting to feel, but I thought I’d feel different. (But Christina, you say, perhaps the fatigue, heartburn and how difficult exercise is are indicators that things are different? WHATEVER) It’s funny, I don’t feel pregnant in day to day life, I just feel fat. Fatter. You get the idea. I’m sure it’ll be different when the kid starts kicking or when my stomach pops, but it still just weirds me out.

Birth Plans, Podcasts and Nervousness

First, a caveat. This is about what my choices entering into the birth experience for my first birth experience. I have absolutely no judgements about others’ choices for their birth experiences. It is up to the person giving birth and their medical professional how they choose to deliver their baby and me and my judgement have nothing to do with it. The natural birth movement can get very preachy and it’s extremely off-putting to those who made other choices or did not have them. In conclusion, everyone has their own road, if someone else’s road is different than yours, that is their road, you are not allowed to have an opinion, THE END.

When we got final confirmation that this round was successful, the next daunting task we were faced with was choosing who would deliver this kid. This was a little nerve-wracking. I knew I didn’t want to deliver in a hospital unless it was absolutely necessary. I’ve had friends who labored in a hospital, had medical interventions and ended up with unwanted C-sections. Add a wife who spent time working at a midwifery collective in college with very strong opinions, and it was time to start looking at midwives.

I didn’t really want to labor in a hospital. I had heard enough stories about pitocin, which led to epidurals which led to C-sections, as well as horror stories about epidurals that don’t work on back labor or only take on one side of your body. Hospitals also want you to labor according to a certain timeline and, depending on the hospital, will push you to medical intervention if you go past them. I am not the best at standing up to authority and imagine I’d be even worse while trying to squeeze a baby out of me. I preferred not to deal with any of these complications, so I’d long decided that I didn’t want to labor at a hospital. I liked the idea of a birth center, but I didn’t like being kicked out 4 hours after delivery, so my best option was a home birth.

Complicating all of this was that I had recently switched to the cheaper version of my health insurance at the beginning of 2014. I had signed up for the luxury version, which offered infertility coverage, but as I discovered too late, did not extend those benefits to same sex couples, since there was nothing medically wrong with either of us. If, after a year of medical interventions, I had not been knocked up, THEN they would start covering. (This is part of another post I’ve been thinking about, which is coming eventually. Hopefully before the kid does) The cheaper version covered far less if I went out of network (60% after deductible vs. 80%) and had an out of network max that was $500 more than the higher end version. $500 is far less than we were paying in premiums and if I somehow got knocked up, of course I’d deliver in network.

Then I started looking into midwives and birth centers and realized that choices for a home birth in Maryland were few and far between. Maryland has very specific laws about home births and if I wanted to stay at home, I had two choices in the Washington, DC metro area. One of those took my insurance. Guess which one we picked! We took the tour and spoke with midwives at the final two candidates. While I really liked the one that didn’t take our insurance, cost was not to be sneezed at.

Interestingly, This American Life‘s Facebook page recently linked me to two podcasts by Longest Shortest Time, one about the author’s birth story and one interview with Ina May Gaskin, the godmother of home birth. If you have a spare hour, take a listen to both. It’s actually made me feel better about my decision to labor at home, despite some pressure from my family (this is the same family that automatically assumes I am unhealthy and eating hohos dipped in fudge because of my weight).

It’s really hard trying to plan and control for an unknown. I’m not the best at pain or being physically uncomfortable and I worry I am not going to be able to handle what’s coming. On the other hand, this is something that women have done since… well… forever. We’re going to take the classes to help through all of that. We’ll make a plan. And in the end, we’ll just have to roll with whatever comes and I’ll have to be OK with it because it’s about what’s best for me and best for my tiny parasite.

First Trimester Screening

On Wednesday, we had our first trimester screening. It was a sonogram and I was expecting it to follow the same trajectory as the fertility center sonograms. 5 minutes, some blood and done.

Instead, it took two hours. Apparently, as part of the first trimester screening, they need the baby to be in a very specific position to measure skull density. On its back, looking up in profile. Instead, my kid did variations on this

Go awaaaaaay!

Go awaaaaaay!

or showing us its butt. For two hours. The tech had me use the bathroom, chug juice, do a little dance, and nothing. would. make. this kid. move. until the very last second when I was about to give up. Happily, our tech was delightful, kept reassuring us this was completely normal and made really great conversation. It also meant we got to stare at the baby on the sonogram for two hours, which left me on a high that lasted until the end of the day.

They also have a small blood draw which, I kid you not, involved pricking my finger and squeezing drops of blood onto a piece of paper. We’ll get results nowish, but everything seemed to be good.

The next day, I was super sore. I think I must have been tensing muscles for the entire sonogram, since my abs, butt and calves were all painful. I also started having some unexpected dizzy spells on Thursday and pounding headaches, but I’m pretty sure the two aren’t related and that finally cleared up after two days of lazing around my house practicing good self care.

Heartburn Help!

A few weeks ago, in a moment of desperation, I submitted a question about how to resolve my heartburn issues to The Kitchn. Well, happily, they ran it on Friday. While I did not get the magical recipe list I’d been hoping for, I got some good advice on how to help resolve this. Ones I’m looking forward to trying out:

  • Baking soda in water
  • Apple cider vinegar
  • Giving up my pride and taking some damn zantac

I’ve tried papaya enzymes, which really does nothing, unless it’s supposed to be some kind of long term solution, in which case, I don’t have the patience for it. I’ve got a huge bottle at my desk, so I’ll keep taking it with meals (and plenty of water, because it leaves a chalky aftertaste that is nauseating), but blerg.

Honestly, I’m pretty sure it’ll end with the Zantac, but getting to that last step is hard. I really wanted to go as chemical free as I can in this pregnancy. I can count on one hand the number of times I’ve taken Tylenol. I finally gave in to this week’s super high pollen counts and started taking my claritin. I’ve drastically reduced my caffeine intake. And I’m not even sure it’s worth it, but that’s the narrative, right? If you do anything, your child will have adverse effects and if you don’t, your child will definitely have adverse effects.

I was really kind of hoping to get some magical recipe list to work from with this post. I’ve really lost my cooking mojo along with all my energy. The extra thought required to make a meal is just exhausting. Neither the wife or I really want to cook lately – stress and general fatigue are taking tolls on both of us for different reasons. It’s going to have to change, well, a lot of things are going to have to change with the arrival of this little stranger, but this is a big one. I’m planning on having my 8 month nesting freezer attack, but we’ll have to see what happens. We even tried a trial of Plated (referral link) to try to jumpstart us cooking again, but to no avail. (Plated review – it’s a great service, but at $12 per person per dish and $20 shipping, it’s definitely not cheaper than takeout).

Oh well. It’ll get there again.

 

 

Exercise is Not Just Getting Off the Couch

In hindsight, I had two clues that this round of Clomid took. The first was that I started thinking about mozzarella sticks and nachos, foods I haven’t eaten in months / years. The second was that on a quick walk to get some lunch, I found myself a little out of breath, something that would never normally happen.

Like the rest of the time, when you’re pregnant, you should get 4-5 workout sessions of 30-60 minutes per week. Except when you’re pregnant, getting up the flight of stairs is twice the challenge it used to be and your heart rate is supposed to stay below 145. And heavy weight lifting is out.

Tell this to the fat jogger who loves nothing more in the world than BodyPump. Immediately, my preferred forms of exercise was out. (I’d actually been told to stop jogging earlier than that, to avoid ovary torsion.*) Which meant that my weekly Pilates was still fine until the first trimester, according to my instructor,** yoga was good and then I had to do the elliptical. I find the elliptical to be the personification of boredom. Plus, now my dog is super antsy because we aren’t jogging any more. Plus, with nausea, heartburn and fatigue, the idea of lacing up my sneakers and heading to the gym is… not appealing. I switched from Wednesday BodyPump to Wednesday Zumba, which is great. I used to love an old Zumba class and this instructor is super fun.

But, again, as I am hitting the magical second trimester, a lot of this is resolving and I am having the energy to get my workout routine where it used to be. The midwife gave me the OK to do jog/walk intervals, so my dog will love me again, AND the OK to do BodyPump with very light weight the entire time, so I will love my life again.

The hardest part of exercising while pregnant is that you can’t push. I’m a pusher. I’m a run until my feet fall off, let’s see how high I can kick, sure, let’s add 10 pounds for this biceps track kind of exerciser. I love being sore the next day and wear it with a badge of pride. But I can’t do that anymore. Doing 30 gentle minutes on the elliptical doesn’t feel like work to me. I barely sweat. But, somehow, I have stopped being just me. Though I am my own distinct individual, I am also strangely making another one and by being gentle to myself, I am being gentle to it. It’s a process, but I’m doing my darnedest.

*Is that or is that not a terrifying thing? I’m terrified!

**Pregnancy Pilates is actually a thing, but not a thing that my student instructor knows about, apparently.