It feels important to share these things now, while we are in the thick of it, with no way of knowing the outcome. I have briefly shared that Jason and I (mostly me) are struggling with secondary infertility. For a year and a half or so we were actively preventing pregnancy, mostly due to trying to figure out how to handle everything already on our plates, especially Tristan's disability. There's still a lot of intimidation with all of that but when I reflect on a future with no more children my heart shatters.
I can't imagine Tristan growing up with only occasional visits from older siblings, being home alone with just Mom and Dad once Rowan graduates in a few years. I feel devastated thinking of never being pregnant again, never having the opportunity to have my child lie on my chest seconds after birth instead of in a plastic box for days. Jason and I continue to work on me making peace with the fact that even if we are able to have more children, it may be another similarly difficult experience. There are no guarantees, but I am already on medication to address those concerns with many plans for additional interventions if or when conception occurs. For many reasons I never really felt pregnant. My weight preventing a cute belly, Tristan's size and placenta location minimizing awareness of fetal movement, gestational hypertension ruining my cognitive function for my baby shower, etc. And as much as I love my children, I desperately crave raising a child from the beginning, no other parents' opinions, no part-time garbage, no constant involvement of others to be able to meet my child's basic needs. Again, I may never have another biological child. If I do, it may not be as smooth as I hope. But I'm not ready to give up.
There has been a fair amount of wrestling with these complicated feelings. I felt so strongly in the beginning my children all needed to be equal regardless of biology. The same birthday and Christmas budgets and savings account deposits, the same level of investment, the same amount of love. Many of those things can't even be quantified, but it's funny that knowing how strongly I've always felt about meeting children's unique needs individually, it was (and is) still so hard for me to be okay with that. Sometimes that means being okay with Tristan getting a little more for birthdays or Christmas because he has less financial support than our older three. Sometimes that means missing something for one because another cares more about having the support. We're still struggling significantly with estate planning, but where I used to feel so adamant everything would be split equally, I now have to acknowledge the realities of Tristan only having one set of parents and his special needs potentially requiring long-term financial support. So. Complicated!!!
Something else that continues to challenge our faith: I have felt called, since very early childhood, to someday adopt a sibling group from foster care. I can clearly remember being about 3 years old, definitely younger than any of the actors playing the children, cuddling my Care Bear (no idea which one), watching a movie about 4 children running away to avoid being split up in foster care. I remember thinking "I'll take them!" and having been determined since that day to one day do so. My wonderful husband was so aware of how important this dream was to me that he researched, before we ever got back together, how the legal repercussions of a woman scorned and a deeply flawed system might prevent me from achieving that goal if we were to be married.
Here is why that is so important: Jason and I have always intended to foster and adopt. Then we had a child with a pervasive brain injury. The statistics for abuse with children with disabilities are just...too much to even process. The number of appointments Tristan has now combined with the level of support children going through foster care would likely need feels absolutely insurmountable. We feel paralyzed regarding fostering and adopting due to our fears for Tristan's safety, especially with his current verbal skills and motor control, as well as the likelihood of somehow meeting the needs of all the children who would be needing our support in that situation. We don't want to fail. Mistakes are inevitable in parenting but true failure is unacceptable. So something I have spent 35 years confident God has chosen me to do now feels like putting my child on the chopping block. Talk about being stuck.
I never thought I would be comfortable with seeking fertility support. I felt so opposed to IVF, especially as someone whose lifelong goal included adoption. I didn't like the expense and it felt so wrong to me to invest so much effort in creating biological children when I knew myself to be fully capable of loving children I didn't make. But I found as we drove to consult with the fertility specialist, I had to warn Jason I knew certain limits still existed for me, but not as many as had in the past. The grief of co-parenting children with people who despise me on principle, the emotional complexity of always being a backup (at best), and then confronting numerous lifelong challenges when I finally got my dream of creating a child, well, it's pushed me to an emotional place I definitely never predicted.
I love my OB. He has done amazing things for me and Tristan, and I feel confident he saved Tristan's life. Medical knowledge says he did exactly what should have been done, and no doctor would have taken Tristan when we now know he was in distress based on the information we had then. Now, of course, plans are very different for how we will handle a similar situation if it presents. We're just...unique. But the last couple years since having my IUD removed and failing to conceive, I've met with his nurse practitioner multiple times. Recommendations have been to use better means of predicting ovulation, and, you guessed it, managing my weight. This was the recommendation despite my advanced maternal age, lengthy difficulty conceiving, surgical history, increased fetal risks with the passage of time, etc.
I. Am. Furious. My counselor finally, very uncharacteristically, called out my intense shame and urged me to see a specialist to find out if in fact my weight was actually to blame. She wisely recognized weight is only one of many factors with an impact on fertility, and that my belief my current inability to effectively care for myself AND my family was preventing me from getting pregnant was a nasty cycle I couldn't seem to break. Here are some things I read when scheduling with the specialist enthusiastically recommended to me, which the NP absolutely should have known and used to make wildly different decisions in my care:
*If all fertility factors are perfect, at age 38, the best anticipated monthly fertility rate in a woman without infertility is 8%/month.
I am currently 38 and my fertility factors are certainly far from perfect, including trying unsuccessfully to conceive for the last 2.5 years.
*Infertility can be one of the most devastating experiences in a person’s life. The thought of losing one’s ability to have a baby can bring hopelessness and despair to the strongest of people. Fortunately, virtually all forms of infertility can be overcome. By learning the causes, one can pinpoint the barrier and customize the treatment to achieve a successful pregnancy.
*For every cause of infertility, there is a very effective treatment designed to overcome it.
After reading how difficult it is to conceive at my age under perfect conditions, I of course turned to Dr. Google to find even more cause for fury at not being referred almost immediately after failing to conceive as intended:
*If you are older than 35 and have not gotten pregnant after 6 months of having regular sex without using birth control, talk with your obstetrician–gynecologist (ob-gyn) about an infertility evaluation.
*20-30% of infertility cases involve problems related to the fallopian tubes
*A ruptured appendix can [...] cause a tubal infection. Surgery can also damage your fallopian tubes [...] scar tissue will often form on the outside of the tubes and uterus.
My appendix ruptured when I was 23 and was left untreated for 3-4 days. I have since had 4 abdominal surgeries with the 4th specifically targeting scar tissue removal unrelated to fertility but causing pain so intense I was at times rendered completely immobile.
*High blood pressure that develops during pregnancy is more common in older age.
Tristan's growth restriction and subsequent brain injury seem to have been caused by the gestational hypertension I suffered starting in my 33rd week of pregnancy.
*There's a greater risk of premature birth and having a baby with a low birth weight [with pregnancy after 35].
Been there, done that, straight-up TERRIFIED of it happening again.
*The risk of chromosomal conditions is higher [with pregnancy after 35].
*The risk of pregnancy loss is higher [with pregnancy after 35].
Not a single reason to not refer me to a fertility specialist 2 years ago, other than I DIDN'T ASK because I was too damn busy blaming my appetite, hating myself. I trusted if there was the possibility it was anything else, my provider would have said so and taken appropriate action. Pathetic. Disgusting. Inexcusable. Devastating.
So. We met with the incredible fertility specialist whose care is sought internationally but available only 35 minutes away from our home (so amazing!!!) and laid out a start to a plan. I would meet with a maternal fetal medicine specialist to get recommendations for both prenatal and pregnancy care (FREAKING LOVE HER!!!). Jason and I would have various tests (mostly me), including what is called an HSG to assess fallopian tube function. Naturally Jason is perfect.
When my HSG test showed absolutely no flow whatsoever in either tube, I was wrecked. I had to fight back sobs because, as per usual, I had kids to pick up in a half hour who didn't need to deal with a crumbling parent. It took me hours to tell Jason, and a full week to talk to him about how I felt about his financial concerns that followed because I was too devastated to do or say anything productive. Again, lots and lots of processing complicated emotions about how I should versus actually do feel.
Unfortunately it was a couple weeks before we could check in with the doctor, at which point he recommended a second HSG test due to the ease with which we conceived Tristan and the possibility such an extreme lack of flow could be due to my muscles reflexively resisting the dye rather than actual tube damage. I was so afraid after how badly I shut down with the first disappointment, but I agreed with his logic, as did my husband. I asked how we could ensure we could be confident in the results this time. My doctor prescribed valium for muscle relaxation, and my very sweet friend from church got me to and from the appointment. The doctor recommended ibuprofen and I took it the first time, but not the second due to the lack of significant pain the first time. Well. To put it kindly, I am an arrogant moron. You'd think I'd have learned my lesson after my pain tolerance nearly killed me with my appendix. Nope.
Here's where it gets mildly graphic so skip ahead if you mind. I've never been told this before, but we learned during the first test my cervix sits pretty high in my pelvic girdle. Maybe my pregnancy and/or delivery with Tristan shifted it, who knows. So, my doctor pulled out all the stops to get us solid results. He used a long wide speculum and still required several adjustments to get the view he needed. I'm talking him, the nurse, and the nurse practitioner observing him allllllll up in my business with lights and whatnot. Talk about making a girl feel special.
When he was still having difficulty, he used what Google leads me to believe was tenaculum forceps (I think he just called it a grasper) to basically get a good grip on my cervix. Not my favorite but still manageable. He was prioritizing getting a really good seal so the pressure would force the dye to go where we wanted. Oh boy did it. I was uncomfortable the whole time but that was just....awful. I've learned I really despise internal pain because really, you're just screwed. There's no heat, ice, massage, repositioning, it just straight-up sucks.
When I got home Tristan was minutes from getting off the bus and I forgot to take the recommended ibuprofen and prescribed antibiotic to fight off the risk of infection. I hadn't rescheduled my clients for the night since I was reasonably confident I'd be fine, and I was right so I basically went straight to work. I. Was. Hurting. The last-minute cancellation and empty slot between my other clients were brutal. I don't think I've ever cramped so hard in my life, including postpartum. The tenderness felt very similar to appendicitis but yay, no feeling of being on fire.
I finished with my last client and basically collapsed. I couldn't stand to be touched and could barely move. When the chills started I realized what a mistake I had made forgetting the antibiotic, and I'd even left it in the car. I had to ask Jason to get my various medications, and when I read the instructions realized I'd also forgotten the antibiotic had to be taken with food. Jason was kind enough to make me popcorn which I slowly ate while I shuddered under my blanket and cried. I'm not sure my husband has ever seen me cry from physical pain before. It's exceedingly rare. But he was, as always, very good to me.
I remember lying there on the table with all the uncomfortable painful things going on praying, doubting, worrying about how I would emotionally collapse if all this horrible pain was for nothing. I could physically feel the onslaught of tears waiting for the excuse. To be able to readily see (and feel, OWWWWWWWWWWWWWWW) that the results were what we had hoped....it was miraculous. He kept checking to make sure I was (relatively) okay. I kept telling him I'd be fine if we got the results we wanted and to do whatever he needed to do to make that happen. The results we have now give us a lot more options for trying more natural methods first, and then less prohibitively expensive ones if initial attempts aren't effective. I am so deeply grateful.
I've evaluated since Tristan was born how and when I would share the next pregnancy, as I always intended for there to be one. I announced Tristan within days, out of joy and excitement but admittedly also fear. If I were to lose that child, I wanted to celebrate first even if I had to grieve later. I still feel that way in theory, but I also remember the many hours family members waited and texted, wanting information concerning Tristan's arrival. I was adamant everyone would wait until I could see my child and know for myself he was safe. That was 5 hours. Jason's mother and my grandmother especially struggled. My grandmother is a type 1 diabetic and I had to force her to eat because she was so worried she was fasting to a dangerous level. I want to revel in joy again even if grief may come later but....the heartache of last time is still healing. So I just don't know. Whenever I do share the next announcement (because I do intend for it to be when, not if), please know what tremendous courage and vulnerability it will take after last time going so horribly awry. I am deeply afraid of another agonizing outcome.
I guess I want to share this for a lot of reasons. Maybe the top, so that this hopefully not hypothetical child knows how badly they are wanted and also, they and I and my husband never forget Mommy is freaking AWESOME. The meds, the labs, the numerous blood pressure checks, the appointments, the horrible painful tests, all of this before this child is even conceived. After, we anticipate LOTS of shots, lots more meds, lots more blood pressure checks, lots more appointments, and realistically a whole lot more physical pain and discomfort. I want to honor myself in this moment and remember.
But also, for friends I know are having or have had similar struggles. Friends whose challenges, reproductive and otherwise, are so readily, lazily, dismissively, disrespectfully blamed on weight. Friends who feel ashamed their bodies aren't doing what they were made to do, what they want most in the world. You are not alone. You are not to blame. You matter. The answers exist. Go find them, and tell me how I can help.
Little one, you are so loved. Please come soon. Your mommy already misses you, so very much. I dream of you. We can't wait to meet you. We can't wait to hold you. We can't wait for another little Payne. Hurry love. Hurry.
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