All of these lines across my face. Tell you the story of who I am.
So many stories of where I've been. And how I've got to where I am.
Why I never gave up.
We always had a clear outline of when we would start trying to start a family. Right after we got married my family and I embarked on a rather giant project at work – opening our second store. I knew there would be a lot of travel involved so we decided to try after the store was up and running. I’d be 30 and that seemed like a good time.
My whole life I have had irregular cycles, but was told my gyno that that wouldn’t necessarily mean conceiving would be a problem. I went off birth control and we started trying – we were traveling in Thailand. It was carefree. I conceived! When we went for our first ultrasound we found I was not as far along as I thought…probably a late ovulation. I was floored that I had gotten pregnant right away!
At about 8 weeks I was exercising and I felt a gush – I ran to a restroom and I was bleeding rather heavily. It was a Friday afternoon and my OB’s office was closed. They told me that it was so early that if I was miscarrying they really could not stop it so to come in Monday. I had no pain or cramping and the bleeding stopped rather quickly. We went in on Monday and there was our little tadpole. Everyone was totally surprised that the pregnancy was still there! They determined that I had a small subchorionic hematoma (bleeding between the uterus and the placenta). It is not uncommon and most pregnancies go on normally afterwards. I was shaken and nervous, but carried on.
At 18.5 weeks I started to feel a strange pressure when I peed. I thought I had a UTI and went to my GP to get tested. It came back negative. I was supposed to go to California for my cousin’s wedding that weekend. They said that I was fine and should go – so I did! I felt strange the whole time I was traveling…I flew alone and met my family in San Francisco. We went to Alcatraz, ate dinner at the French Laundry and then drove to Bodega Bay where were staying. The whole time I had strange pain in my groin. In the morning I still felt weird. When I was in the bathroom I started to have strange discharge and I called my OB. She wondered if I needed to have a bowel movement and told me to take a Colace. We went to the wedding. After the ceremony I went to pee and my mucus plug came out on the toilet paper. I panicked. I had my mom and brother drive me to the ER. We were in a totally weird part of northern CA and I just found the closest ER using Google Maps. While I was sitting in the waiting room at the ER I finally felt the need to have my bowel movement…In the bathroom I started to bleed uncontrollably with intense cramping. They rushed me into the ER. I remember a nurse asking me my name and medical info. I was in so much pain. Then she said “I had a miscarriage once and then I got pregnant with twins!” I hated her. The ER was really tiny and crowded. They found a quiet place for me and gave me meds for pain. Finally a really unfriendly doctor came and examined me. An ultrasound showed my baby still alive and well with an intact amniotic sac and no placental abruption. Then (after I had been there for 6 hours) they told me that there was no OB in the hospital I was in and that I would need to be transferred to Santa Rosa via ambulance. My mother went back to our rental house to get our things and check in to a hotel in Santa Rosa. My brother (who I am extremely close with) stayed with me as we were transferred. He was keeping my husband (back in VT) up to speed, but since no one really knew what was happening there was not a lot to report. At the second hospital there was no OB on. It was the middle of the night and she said she would come in once I had an ultrasound. They stopped giving me pain meds – I am still not sure why. I was screaming and writhing in pain and still bleeding heavily. My brother was so concerned he called my OB in VT who told him to tell them to get an OB there for me immediately! After many more hours they finally came in with an ultrasound, but it was too late. Baby was so low in the birth canal that they took me to L&D. I remember feeling SO confused because no one had told me “you’re having a miscarriage,” I was 19 weeks pregnant and I didn’t even know you could have a miscarriage that late. I remember thinking “there’s only one thing that happens in L&D” and asking a nurse “Do I have to deliver my baby?” and she replied “yes, it looks that way.” I remember feeling an urge to push, intense pain, screaming, delivering in one push. I could hear my brother crying – that moment is tattooed in my brain. I was sobbing. I fell asleep and woke up with my family there and my husband on the phone. All I could do was cry.
Due to the rather violent nature of the delivery I was left with pieces of placenta in my uterus. I had to have a D&C which required general anesthesia. I stayed in the hospital for 24 hours and then had to fly home. I will never forget leaving that hospital and thinking that I was leaving my baby there.
I asked for a full autopsy to be run on baby. Everything came back normal. Nothing wrong with baby. Sadly, the hospitals I was in neglected to note a number of pertinent pieces of info in my chart, like whether or not my cervix was open when I came into the ER. My docs in VT said that they had no choice but to chalk it up to a fluke, to try again and that I would be monitored very closely the next time around.
In the hospital in Santa Rosa my mother said to me: “Nina, you can choose to be a warrior.” Through deep despair I knew that I wanted to be just that. That moment will stay with me forever and always. Coping with my loss was one of the most profound experiences of my life. I never expected it to hit me so deeply and so I embarked on what ended up being two uniquely intense and amazing journeys – a medical journey towards meeting my “take home baby” and a spiritual journey towards knowing my truest self.
At first I was just devastated. I cried for weeks. Because I was so far along my milk came in. It was physically painful, but mostly emotionally destructive – a physical reminder of everything I should have had but didn’t. My husband was my rock. During that first week he would sit with me for hours at a time and just hold me while I cried. He never left my side. I was terrified to leave the house – to face the world and have to tell all the people who knew I was pregnant that I wasn’t any more. I would repeat “I’m not pregnant any more” over and over – I was in disbelief.
I gathered my courage and went back to work. It was good to be busy. I started seeing a therapist. I got acupuncture to even out my crazy postpartum hormones. I started working out again once I was healed from the D&C. It was all positive, but I had a giant hole in my heart.
My doctors told me I could try to get pregnant again any time. After three months I still had not gotten a period. I started feeling desperate to be pregnant again. I started reading a lot about fertility…everything I read about irregular or very long cycles pointed to a hormone imbalance called Polycystic Ovarian Syndrome (PCOS). I started taking my basal body temperature. The more I read about PCOS the more it sounded just like me! I asked my OB to test me for it and sure enough I tested positive! After a couple long cycles with no ovulation they decided to help the process along with a little Clomid. After a 50mg round of Clomid with no ovulation they tried a 100mg round and poof! PREGNANT!
Now let’s go back to that feeling of desperation because that became my deepest work. I cannot discount the emotional work that I did in the 8 months it took me to get pregnant again. In therapy I worked through so much…starting with a deep anger I harbored for my own body. It had let me down. It would not do what it was “supposed to do” – conceive and carry a baby. My therapist did a lot of mindfulness work with me and showed me that it was OK to really FEEL feelings. My aunt, a spiritual teacher and author, also gave me a book she wrote called Broken Open. It is all about how the hard things in our life become our opportunities to grow in to a better, stronger version of our selves. Instead of breaking apart we can break open and a new self is born. This book because my spiritual guide and I learned to let myself feel. Perhaps my greatest gift was the strengthening of my relationship with my husband. I have always been a person who took pride in not needing anyone. I loved my husband, but refused to believe that I needed him. When I was broken I allowed myself to need him – it was terrifying and I had to work really hard at it. He stepped up every time. We did countless therapy sessions together on this. Our love became something so big and so strong because of this work. It is my forever gift, a true silver lining. I would like to marry him all over again so I could tell the world how much MORE I love him now than ever before.
Ok, so I got pregnant! I started feeling it very early. I spotted. I went to my OB and my HCG was through the roof. They did an early ultrasound and found that I had THREE embryos!! I almost keeled over in the office. At our second ultrasound a couple weeks later the third embryo had been absorbed, which felt like a relief. Now we had to decide what to do with the two…Originally they had been suspicious of cervical shortening and recommended cervical measurements starting at week 16 – they also wanted to give me Progesterone shots to prevent another preterm delivery. However, neither of these courses of treatment are proven successful with multiples. So we had to decide – keep twins and forge ahead with no treatment, or reduce the pregnancy to one and get more preventative care. After much deliberation we decided to keep our two. Every expert we consulted thought felt that one loss was not enough evidence to show that I could not carry to term.
At 10 weeks I bled again…just like in the first pregnancy, a huge gush, panic, a trip to the doctor, babies both ok, subchorionic hematoma. Now everyone was concerned. My doctors were concerned that the early bleeding was leading to my later loss. Zach and I made the very difficult decision to reduce the pregnancy to one baby so I could give that baby the best possible chance of making it to term with cervical measurements and Progesterone therapy. We traveled to Brigham and Women’s in Boston for the procedure. It was a hard day, but we felt like we made the right decision. This is a part of my story that I don’t usually share because I’m afraid of being judged. While I’m a spiritual person, I’m also a person who believes in science. Medicine and science – the way the body works is science. The statistics were in my favor with this course of action. I know some people will think I am heartless or wrong for this, but that is their path. This was mine and I still feel I made the right decision for me, my body and my family in that moment.
My pregnancy was rather normal after that. At 16 weeks I started having my cervix measured under ultrasound weekly. I also started weekly progesterone injections. I continued therapy where I worked diligently on being mindful of the overwhelming nervousness I was experiencing, especially with the 19 week mark approaching.
Then…the unimaginable happened. Again, right at 19 weeks gestation I started to feel “off.” I went home from work early, took a nap, and woke up in pain. We went to L&D where my OB was on duty. She did a pelvic exam and my cervix was completely open. On ultrasound they could see that my bag of water was below the cervix and the baby’s feet were in it. It was too late. My hospital experience was 1000x better than the first time. They gave me an epidural for the pain and they did not make me deliver the baby. When it dropped far enough my doctor reached up and gently removed it. I was with my husband and my doctor and I felt safe. But still…I was devastated.
Back in my cave. It was the exact same time of year – October. My milk came in again. More crying. It was like the weirdest de ja vous. People act strange towards you when something sad happens…people don’t know how to deal with it. Most of the time they ignore that it happened – thinking that if they mention it they will make you upset. Some people are so uncomfortable they can’t even speak to you and just walk by with no eye contact, like you are dead. When something sad happens twice it gets even weirder. My anxiety about facing the world came back triple fold. I stayed home for two weeks before finally forcing myself to go back to work. I was operating in a fog of depression and anxiety.
I became convinced that I was broken and could never have a baby. I started furiously researching adoption and reaching out to friends who had gone through the process. And yet, at the same time I wasn’t quite ready to throw in the towel on having a baby myself. My OB ran a million tests to make sure I didn’t have a bleeding disorder or a clotting disorder. Everything came back normal. Then they referred me to a Maternal Fetal Medicine specialist at the hospital..More about that soon. I began seeing a Naturopath who completely changed my diet (no sugar of any kind including any carbohydrates, dairy, fruit, etc) to keep PCO tendencies in line. I started working out again which became my mental and physical escape. I would do Crossfit every day after work and on the weekends. The endorphins washed my pain away. And of course, I kept seeing my amazing therapist. My work in therapy became very intense – learning mindfulness techniques and ways to calm my worry, fear, desperation and sadness. I learned that feeling sad about my losses and enjoying the life I was living did not have to be mutually exclusive. I could enjoy life AND be sad sometimes. Being happy didn’t mean that I had forgotten or that I had given up. I learned to let go and to enjoy my life again, even though I was still determined to become a mom.
Zach and I met with the head doctor at MFM. We ran through everything that had happened in both of our pregnancies. She seemed very hopeful, and though she could not determine what happened, she created a very comprehensive plan for us to move forward. First we would meet with a Reproductive Endocrinologist about getting pregnant. Then once I was pregnant I would take early Progesterone to maintain endometrial health and hopefully prevent any subchorionic bleeding. I’d be monitored for cervical shortening weekly starting at 16 weeks and begin Progesterone injections at that time as well. She felt strongly that the losses were related to the early bleeding, but she couldn’t rule out Cervical Insufficiency or anything else based on my history. My care plan was very comprehensive and involved a lot more monitoring than most people get. I felt like I was in very good hands, and yet I was terrified. I wasn’t sure if my heart could handle any more loss.
We met with the RE. She was amazing. She set really clear expectations for us about how long the process would take. She reminded us that it is a process and that even if we didn’t conceive right away, each try would shed more light on what my body needed to get pregnant. I was learning that everyone’s body is unique and just because certain things work for some people there’s no magic bullet. Everyone needs something a little different – and the process shows you what that is. It felt good to be getting care that was specifically for ME. Our plan was as follows: Use a lower dose of Clomid to stimulate an ovarian follicle (It was clear that 100mg overstimulated my ovaries which lead to three eggs being released – the goal was to get one egg). Ovary stimulation would be monitored by ultrasound and then ovulation would be forced with an HCG injection. Ovulation would be confirmed with a Progesterone test, and if I did ovulate I would then do a second HCG injection to keep the Corpus Luteum really healthy and strong and producing lots of Progesterone. Then we could decide if we wanted to do an IUI (Intrauterine Injection) or have timed intercourse. If we conceived we would immediately start Progesterone therapy and then on to MFM’s course of action. We went along as planned…everything happened just as it should have. At three days before ovulation I had two healthy follicles. At one day before I had one giant healthy follicle! We chose to try timed intercourse rather than IUI since we had conceived by having sex successfully twice before – we didn’t feel like we had an issue with sperm meeting egg, just getting egg out! Our RE told me exactly when to inject the HCG and when to have sex. Timed intercourse was stressful. There was a lot of pressure, but we tried really hard to make it easy on ourselves. I ovulated! We did the second HCG injection and then we waited a painfully long two weeks. They told me not to take a home pregnancy test because I had injected HCG (the pregnancy hormone) and it would probably come up positive even if I had not conceived – but I did anyway ☺ It came up positive! I had blood drawn at two weeks past ovulation and it confirmed I was pregnant. Now the scary process of staying that way resumed….
Everything was going according to plan. One embryo was at home in my uterus. I was on Progesterone suppositories (100mg twice a day) and would start my more comprehensive plan with MFM at 16 weeks. My OB scheduled me for bi-weekly check ups instead of monthly just to ease my mind. I worked diligently with my therapist to control my worry and create a nice, stress-free environment for baby. They asked that I go on pelvic rest so I stopped Crossfit and just did some easy walking in the afternoons. I remained strict with my diet per my Naturopath’s recommendation. The first trimester seemed like a bazillion years long, but I made it with no bleeding.
At 16 weeks we began our MFM monitoring. Every Friday morning we would go to the hospital and see our baby squiggling around. They would measure the length of my cervix and then one of the docs on the MFM team would come check in with us. Every Tuesday I would go to my OB’s office and get a Progesterone shot in my butt. I spent a lot of time in doctors’ offices! ☺ Every week going to our MFM check-up I felt insanely nervous. Afterwards I’d feel a sense of relief – like I could get through the next week without too much worry. 19 weeks was looming in my future every week…closer and closer we got.
My worry was so big the morning of our 19 week visit. I just had this feeling like something would be wrong. I was so programmed to think that it would all end again. The ultrasound tech that day was a “Say nothing” kind of person. At this point I had seen my own uterus and cervix under ultrasound that I pretty much knew what was seeing. My cervix looked different. When the tech pressed on my stomach it would open slightly at the top. I said “that doesn’t look good.” He responded that I had what was called “funneling” and that my cervix was shortening – it was only 2.5 centimeters long. He left to get the doctor. I burst into tears. Zach and I waited for the doctor. One of the docs we met with regularly and whom we loved came in. He explained that due to the consistency of issues arising at this exact same gestational age and the results of my ultrasound it was clear that I was suffering from Cervical Insufficiency (a rare disorder where the cervix begins to efface prematurely with no pain and for no reason). He said he had conferred with the rest of the team and they all felt I was a good candidate for a cervical Cerclage – a small stich placed around the outside of the cervix. He said I would need to wait until Monday since you can’t have surgery unless you have fasted for 8 hours prior. I told him that I had not had breakfast yet – just a coffee. I begged for the procedure that day, worried that I would not make it to Monday or die of worry. He agreed based on the fact that I had not eaten. There was one space in the OR in L&D available at 3pm. We were moved upstairs to wait. It was a huge mix of emotion – terrified that something was wrong, relieved that they had finally found out what happened to all those other babies, worried that the procedure would not be effective….a million things were swirling around in my brain. Late in the afternoon they finally prepared me for the procedure. I had to have a full spinal and spend the night in L&D after. The procedure was fast and the doctors seemed really positive about it. They were very pleased with how much cervix I had left to stitch. I remember my doctor saying “If a cerclage is going to work for anyone it will work for you!” After surgery they monitored me to make sure that my uterus didn’t start to contract. They gave meds to control some small contractions and Tylenol for pain. I was sore and tired. We finally went home.
The rest of my pregnancy was filled with worry, but as the weeks went on excitement started to trump the nerves. Milestones like 24 weeks, 30 weeks, etc made it more and more real. My OB continued to administer progesterone shots until I was 36 weeks. They saw me regularly and checked on my stich when I was feeling worried. At 36.5 weeks they removed it quickly and easily right in their office. I asked to see it – it was a like a tiny blue zip tie. All I could think was that tiny little thing held my baby in for all those weeks! Thank goodness for that tiny little stich! I immediately dilated to 3 centimeters when the stich was removed.
I made it two more weeks and then got to experience the joy of meeting the little person who I had waited so long (nearly 3 years) for. I had a really amazing birth – quick, complication free, with one of my amazing, caring, awesome OBs. Zach was a wonderful birth partner and I was able to have no pain meds or medical intervention. I delivered in the water which was lovely. Our beautiful daughter Teal Eloise Minot slipped gently into this world on Oct 1, 2015. I will never forget the moment I met her. She is the reason I never gave up.
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