Category Archives: Pregnancy after IVF

The bearable heaviness of being

Yesterday a year ago was the day our little miracle was conceived in a dish in a laboratory in Amsterdam. Now he is sleeping in his pram in the other room. 3 month old and more beautiful and amazing than I ever imagined. The gratitude I feel is indescribable!

Since M was born on the 17th of August in London, life has been a roller coaster. I have been meaning to write a million times, but just never had the time or energy to do it. I kept postponing, but the longer I waited the more there was to write about. Thus making it even more difficult to get down to business and actually do it.

First there was the birth. I needed some distance from it before I could write about it. Now I’m not sure that I can adequately reflect my experience because time is a healer and as the days goes by it reconfigures how we make sense of experience. So I will try to describe it as objectively as I can.

I was induced with prostaglandin gel at 10pm the 16th of August. It was an in-patient induction, so I stayed in hospital while my husband had to go home. No one expected anything to happen anytime soon, because my cervix was still firmly closed. Nevertheless, within a couple of hours my contractions started and got quite frequent and strong. I dealt with them alone, without pain relief and behind only a curtain in a hospital ward full of other women.

Close to 6am in the morning my waters broke and my husband was allowed to join me again. However it wasn’t until around 10am they finally moved me to the labour ward where I got my own room with space to move around and my own toilet and shower. I remained fully closed despite having strong contractions every three minutes. Both midwife and consultant was ready to start the syntocinon drip since I wasn’t progressing, but we managed to talk them out of that intervention for the time being. I knew that my contractions were plenty strong enough and had they hooked me up on the drip at that stage I would have most likely ended up becoming extremely overstimulated with the risk of causing distress to the baby.

Instead I was thankfully allowed to continue naturally, dancing around to reggae music which proved to be a fantastic way for me to deal with labour and the pain. I managed with just the music, deep breathing and my husband massaging my back etc. After some hours I suddenly started progressing very quickly and went from fully closed to fully open in just under three hours. The staff had not seen anything like it 15 years apparently, so I started attracting lots of attention amongst midwives and consultants. By this time it was 5pm and everybody now expected that I would be dropping that baby on the floor in no time. I felt happy and empowered both by my ability to manage the pain successfully and the minimal intervention. Apart from the one dose of gel that had kickstarted it all, natural child birth seemed to be within my reach.

But it wasn’t meant to be. My contractions slowed and nearly disappeared and I never got the urge to push. The midwife and consultant held off and waited as long as they could to give me a chance once again, but after a couple of hours with nothing happening, they had to put me on the drip. The baby had to come out. This time we didn’t object. I knew I didn’t have strong enough contractions. My body had done so well up until this point, but couldn’t manage the rest. The syntocinon went in my veins and the contractions picked up a bit, but they never became very strong again. Not even when they kept increasing the dose. I had to push with all my strength and will instead and finally, with the help of ventouse (suction), my son was born at 8pm on the 17th of August. In the process they cut me, i.e. did an episiotomy. I had indicated in my birth plan that I did not want one, but in the heat of the moment I did not have much choice but to agree. I have been paying the price ever since in the form of infection, break-up of the stitches and permanent damage to muscle tissue.

In the moment I didn’t care of course. My son was born. He was alive, well and healthy. It was, and still is, all that matters! His birth involved more intervention than I would have wanted, but more importantly less then what I had feared. And I still feel empowered by having avoided pain relief and being able to give birth to my son – albeit with a little help. The only thing that makes me sad is that because of the ventouse delivery he didn’t get to stay on my chest for much skin-to-skin. He was only on my chest for barely a second before he was whisked off to be checked over. My husband had the first real skin-to-skin with him while I was being stitched up.

Then came the postnatal complications on day 9 after the birth in the form of three infections at the same time. Mastitis, wound infection in the stitches after the episiotomy and urinary tract infection. I fainted, ran a fever of 40 C (104 F) and ended up in the hospital on a drip with intravenous antibiotics etc. I was ill for quite some time and trying to cope with taking care of a newborn. At the same time I was also expressing my milk every three hours, 24 hours a day because our little boy was tongue-tied and could not breastfeed. Blogging was the last thing on my mind!

On top of it all, we were still living with my mother-in-law and dealing with the insecurity and worry associated with my husband struggling to find a job. Being in a creative industry where jobs, let along good jobs, are rare and the competition relentless.

Then another miracle came our way. When M was 4 weeks old, my husband got that phone call we had dreamt of, but hardly dared to hope for. An offer of a fantastic job in higher education which would provide all the things most other jobs in his industry never will, i.e. decent pay, job security and pension. The only catch was that it is not in London, but in a smaller university city approx. 2 hours from London and they wanted him to start two weeks later. Commuting would be unfeasible so we had to move there. So in a matter of about 10 days we managed to find a place to live in our new city and relocated in time for my husbands job start on the 1st of Oct. This would be stressful under any circumstance. With a baby of barely 6 weeks and with me still struggling to recover from the various postnatal complications it was a whole other ball game. By this time I had only just managed to recover from a second round of mastitis which had once again left me extremely ill with high fever.

I finally had to accept that I had to give up on trying to breastfeed. M had had his tongue-tie division done the very day my husband got the call, but after being so used to bottles he still didn’t manage to latch on and I was still having to carry on with my gruelling expressing schedule day and night in order to ensure that he got as much of my milk as possible. However, it was time to call it a day. As the doctor pointed out, I am apparently extremely prone to mastitis making it too risky to continue.

It was extremely difficult to let go of the idea of breastfeeding. I wanted to breastfeed with all my heart. I know it is best for baby and I had never even imagined not doing it or that there could be so many obstacles making it unfeasible. Once again I was faced with the experience of not being able to do what is natural, taken for granted and commonly believed to be simple and easy. Once again I had to let go and accept things as they are. And realise that it does not matter.

Having lived with infertility for so long has taught me to do precisely that. Now as I mix M’s formula and feed him with a bottle, I no longer think about it. I no longer feel sad that I never got to have the experience of breastfeeding my baby. Just as I no longer feel sad that we could not conceive him naturally in the first place. There is no more sadness, because he is here! When I look at him I know that it does not matter how he was conceived. It does not matter how he was born. It does not matter how he is feed. All that matters is that he is here and he is growing, thriving, smiling, laughing, chatting, trying to ‘sing’ along to the reggae music he loves and of course also crying a lot when he is hungry, tired, needs changing or for some other unknown reasons. I appreciate it all.

This is not to say that I don’t feel tired or overwhelmed sometimes. I do, and I have many times throughout the last three month, because it has been heavy to say the least. Taking care of a baby is in itself pretty heavy at times. But it’s also bearable. None of it has really seriously rocked my boat so to speak. Because it matters. Because it is labour of love. Because it is the stuff of life.

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Our miracle is here!!

Our beautiful baby boy was born Friday 17th August in the evening – 22 hours after I was induced. Weighing 3270g and 53 cm. I still can’t comprehend how amazing he is!! We are all doing well. I will write more later – at the moment we are just trying to find our way with a new baby. 🙂

12 hours to go…

… says my pregnancy countdown as I’m writing this. My due date is tomorrow and we have decided to go with medical advice and accept induction at 40 weeks. Two days ago I went in for a second membrane sweep, but although it had been 12 days since the last attempt, there was no progress at all. It was impossible to do a sweep on me. My cervix is still tightly closed and the baby is not engaging at all. The doctor said they would have expected to see at least some development at this point, but since there is none it’s very unlikely to make any difference to postpone induction a few days or even their usual policy of 10 days past the due date for low risk (and non-IVF) pregnancies.

Basically there are strong indicators that I will need induction no matter what. So if there is only a very slim chance of any benefits to waiting, why take the risk and the worry. Especially since they do not actually investigate how well the placenta is working at this point. With this we feel at peace with the decision and in acceptance of intervention once again. Whatever it takes, whatever happens – it will all be worth it!!

In thinking about this over the last two weeks, I have come to realise that I’m not attached to any particular idea of a natural and idealised birth experience. I only care about the end result of holding a healthy baby in my arms, while of course hoping that the process to get to that point will go as smoothly as possible and involve as little distress as possible for both me and baby. But I would never even consider giving birth anywhere else than in a hospital and I trust the professionals there to deliver my baby safely by whatever means necessary. ‘Mother nature’ is also cruel and cannot necessarily be trusted. The millions of women and babies who have died and still die in childbirth in places and times with no access to medical help, is testament to that.

Personally all those years of infertility has taught me not to celebrate or have blind faith in ‘the natural way’ or be attached to any idea of ‘mother nature’ as a superior force. Of course I wish I could have gotten pregnant easily and naturally by making love to my husband rather than by way of doctors and IVF procedures in a hospital, but the reality turned out to be what it was. I no longer mourn that fact. It is what it is and my gratitude to modern medical science, and the intervention that got me pregnant, is limitless. The miracle of life is as amazing under these circumstances as in any other. Maybe even more so.

Tonight at 9pm I will be admitted to hospital to begin the induction process and I will stay there until the baby is out one way or another. It will be prostaglandin gel to start off with and probably a second dose later if nothing happens. Later again they might break the waters and eventually if labour is still not progressing they might put me on a syntocinon drip. They told me there is a risk that induction will fail and in that case a c-section will be considered. Thus prepared, we hope for the best while accepting to take each step as it comes and deal with whatever happens. In the end of the day no labour and birth is guaranteed to go smoothly. Anything can happen to any of us in that situation. Natural low risk labour can end up involving serious complications and drug-induced high risk labour can work out just fine. As with life in general you just never know what you’re gonna get!

IVF and early induction at 40 weeks?

Yesterday I went to the hospital for the first membrane sweep. It failed. The consultant couldn’t reach my cervix, which is still long, closed and posterior. The baby also has not fully engaged. So all in all, the conclusion is that labour looks likely to be far off. The conditions are unfavourable as the consultant put it. At 38 weeks this is not really that surprising, but it does bring the prospect of medical induction to the forefront since the general practice at the hospital is to induce IVF pregnancies early at 40 weeks, i.e. on my due date the 17th August. They will attempt a sweep again on the 14th which is just 3 days before my due date, but with the way things are looking I have my doubts whether there is any chance that it will help trigger labour naturally. Consequently I’m also starting to doubt the planned medical induction at 40 weeks. This I wonder might pose greater risks than allowing the baby to go overdue. Especially if the next sweep attempt reveal that conditions are still unfavourable.

So I have been google searching like crazy to try to find evidence for why IVF pregnancies should be induced early at no later than 40 weeks. It seems to be common practice in a lot of hospitals in the UK going by forum posts and the like. Although there are also many examples of this not being the case. The advice women, who have gone through IVF, are being given is clearly very inconsistent. And the evidence for the risk of going over the due date is sketchy at best, as far as I can find out. The reasons given are usually similar to what we have also been told – namely that the risk of still birth is higher due to the placenta not functioning as well beyond 40 weeks in IVF pregnancies.

Based on the lack of evidence there seems to be good reason to question the plan of induction at 40 weeks if the cervix is still not showing signs of being ready. We have decided to wait and see whether we should postpone the induction date. Maybe things will start happening in the mean time. Move on downwards baby boy 🙂

Full term in the midst of the olympic buzz

Last night we celebrated hitting the 37 week mark while watching the opening ceremony of the olympics. For us the countdown to the olympics has had a very special meaning because it’s taken us almost as long to get to this point as it has taken London to make the olympics possible. Now it’s all happening right around the corner from us here in East London while we are waiting in anticipation to meet our little baby boy. Everything is buzzing with a typical London combo of excitement and chaos. The chaos part is the worrying bit, because the hospital where I’m giving birth is right in the epicentre of it all. In fact it’s the officially designated hospital for the olympics. Not that the maternity unit as such will be affected by that, but the journey to the hospital will…

On Thursday 2. August we will get a taste of how difficult it is going to be to get there. I’m having a ‘membrane sweep’, which is the first step in the process of induction they have planned. We have been told that they want to ensure that I do not go over 40 weeks because it’s an IVF pregnancy. Apparently there is a higher risk of stillbirth when overdue because the placenta does not work as well anymore. Whether this has more to do with higher maternal age than IVF as such is difficult to say since the two factors often coincide. In any case, we do not see any reason to take the risk so we will go along with the plan.

A membrane sweep is viewed as the natural approach done prior to medical induction. It involves manually stretching the cervix and sweeping inside to try to encourage the release of prostaglandins, which are hormones that help trigger labour. It sounds rather unpleasant, but if it means a chance of avoiding medical induction it is worth the try. How effective it is is questionable. Presumably there should be about 50% chance that you go into labour within 48 hours. But it depends on how ready the cervix is at the time. If it doesn’t work they will do another one a week later. If nothing has happened by my due date (17. August) it will be time for medical induction. By then the olympics will be over, so it will be easier to get to the hospital. But I’m so hoping to avoid medical induction and I’m also just ready for him  to come out now. So fingers crossed for an olympic baby!! 🙂

Third trimester

I can’t believe the third trimester is here. Today I was thinking back to that moment when a tiny bundle of 8 cells, invisible to the naked eye, was transferred to my womb. Now 6 month later I’m constantly feeling the baby kicks and my bump is growing ever bigger. How amazing it is. And still unbelievable despite the fact that it is also so very real.

I haven’t been blogging for quite some time, because I haven’t had much to write about that has any relevance to what this blog is about. Life has not been so easy lately, but I’m trying hard not to let it overshadow the joy of finally expecting a baby after years of infertility. Therefore I also don’t want to use this space to write about those other things in life that can be difficult.

All I can say is that life’s challenges are definitely not easier to deal with when you are pregnant. The hormones are doing their bit, I’m sure, to significantly lower my ability to cope. In addition it’s hard to deal with the fact that our situation is not how you would want things to be when you are about to have a baby. That overwhelms me with sadness and worry sometimes. Praying for a job for hubby and our own place to live.

Nevertheless, expecting a baby is also giving us a much stronger sense of meaning and purpose than we have ever had before. Yes life can be a struggle, but at least now we are fighting for something more than just ourselves.

Booking appointment and kicks

Today I’m 23 weeks and as of yesterday finally all booked in for maternity care in London. The booking-in appointment at the hospital antenatal clinic where I self-referred was at 8:30 in the morning and we ended up being late… Traffic was horrendous meaning that a 15 minute journey ended up taking almost an hour. Welcome to London! 🙂

Anyway once we got there we were seen by a midwife who booked me in by spending ages asking loads of questions about our social and medical history. They took all the blood tests and did a quick scan since I’m still not in possession of my records or test/screening results and scan reports  from Amsterdam. I have tried calling and also sent a letter recorded delivery. Still no response. It makes me wonder if my file is still missing… But maybe at this point it does not really matter much anymore.

The midwife booking me in did not seem to know anything about the issue with the marginal insertion of the cord which the obstetrician in Amsterdam told us represented a risk at birth. But because it’s an IVF pregnancy it seems to be standard practice here to provide obstetrician-led care at the hospital antenatal clinic all the way through, i.e. both antenatal care and birth. So as far as we understood this means I will mainly be seeing obstetricians rather than midwifes. The first appointment with an obstetrician is in two weeks. Hopefully we will then be able to get the issue with the cord investigated further (see update below). Although the ultra sound technician who did the quick scan yesterday told us that it’s not something they normally check for in the UK. I am also curious why an IVF pregnancy is viewed as a risk factor generally (see update below). We have not heard this before and since it’s not a twin pregnancy I wonder what it’s all about. Has anyone else been told there are more risks associated with IVF pregnancies then normal pregnancies?

Regardless, I’m happy to be offered consultant-led care at the hospital in any case. It’s not that I’m particularly worried. I just prefer medical professionals with as much knowledge as possible.

All that aside, everything seems to be going great with my pregnancy! My bump is growing and the scan yesterday revealed that our baby boy is indeed growing as he should. I’m feeling his kicks and movements daily and it’s absolutely amazing. My husband has been able to feel them from the outside as well for the last 2 weeks or so. The kicks are getting stronger by the day and I love it every time he gives me that little sign of life. It’s a strange, fascinating and wondrous sensation. That combined with my growing bump makes it so much more real.

*Update: Two weeks after the booking-in appointment we got to see a consultant, but it did not yield any more information about the umbilical cord issue. Apparently here in the UK they do not regard marginal insertion as a problem and we were thus more or less told not to worry about it. They do however view IVF pregnancies in general as more risky – particularly with regards to being overdue which they said involves a higher risk of stillbirths. They are therefore planning to induce me at 38 weeks.

Read more about about marginal insertion of umbilical cord here: http://www.jultrasoundmed.org/content/21/6/627.full.pdf+html