A supposedly fun thing I'll never do again

My future fertility was decided by committee two days after Charlie was born, by people I didn't know.

On Monday morning, when I was finally allowed out of bed, I combed my unwashed hair, put on the single pair of filthy socks I possessed, and made sure my ass wasn't showing through the peekaboo slits in my hospital gown. Then I shuffled slowly down to the NICU to see Charlie, anxiously shadowed by my mother, who stood at the ready to break my fall if I decided that the 100-yard walk was too far.

You know, it almost was. When we walked in, the nurses surrounded me in a protective swarm and ushered me to a chair. "We're just doing rounds," one of them said. "We're about to talk about Charlie." I sat hunched uncomfortably over my incision and listened.

The doctor who was speaking looks sort of like an elf — the cartoon Keebler kind, not the ethereal Lord of the Rings kind. He's short and pink, baby-faced with silvery hair, and I'd find him reasonably pleasant if he were offering me cookies baked to a golden brown inside the cozy recesses of a hollow tree. But, no, he is instead a somber elf of doom: just the morning before he'd sat in my hospital room saying gloomy things like, "Well, we don't have a crystal ball..."

Now he was going over Charlie's case, using a lot of acronyms I didn't understand at the time, summarizing for the benefit of two physicians' assistants, three nurses, two other doctors, and a gorgeous young medical student. He conducted rounds like a fey tiny Socrates, starting sentences but demanding that others finish them. He covered the urgency of Charlie's birth by holding his ball-point pen aloft — "And he had to come out right away because Mom's platelets were...?" — and dropping it onto the floor with a noisy clatter, then turning expectantly to the student. She pursed her pretty mouth like a guppy, her lips making impotent nibbling motions, unable to come up with the right words.

Don't let her touch my baby, I prayed.  I know full well what guppies do to their young.

The doctor sketched out my medical history in some detail. Four IVFs, two prior losses, complete placenta previa, gestational diabetes, HELLP syndrome. He looked expectantly at the group as he finished: "And would it be a good idea for Mom to get pregnant again?"

I looked, too. And seven heads shook solemnly side to side. (The student was too busy gumming her tasty, tasty plankton to offer an opinion.)

I had already come to that conclusion myself, during my bouts of teary wakefulness the night Charlie was born. It had all been terribly hard. So hard to get pregnant, so hard to stay pregnant, so hard to face what lay ahead with Charlie in the NICU. And not only hard, but dangerous. And not worth the future risk.

• Gestational diabetes. This is a complication a lot of women experience, and for most of them and their babies it's little more than an inconvenience. But it left Charlie's lungs unusually immature, making his first few weeks painful and frightening for him and for us and perhaps leaving him especially vulnerable in the future to respiratory problems. The recurrence rate of gestational diabetes is around 65%.
• Placenta previa. Placenta previa isn't a common condition to begin with (.3-.5% of all pregnancies). It's even more unusual for it to be complete and to persist to term. It is not especially likely to recur (4-8%), but the risk increases with increasing age (check), parity (check), and previous C-section (check). If it were to recur, I would be looking at a 50-60% risk of pre-term delivery. And a pre-term delivery coupled with gestational diabetes puts us where we are now — or, more troubling, where we were almost a month ago.
• HELLP syndrome/preeclampsia. Studies vary on how likely HELLP syndrome — which I had, which is more immediately dangerous than garden-variety preeclampsia — is to recur. Estimates range from around 5% to 27%. There is agreement, however, that women who've had HELLP are at increased risk (40-50%) for complications in future pregnancies, including preeclampsia, pre-term delivery, IUGR, placental disorders, and perinatal death. Even without HELLP, though, in my case the recurrence rate of plain old preeclampsia is about 40%. (It would be about 60% if I'd developed preeclampsia before 28 weeks. The earlier in pregnancy it occurs, the greater the chance it'll happen again.) And a frequent necessity in cases of severe preeclampsia? (Imagine the med student chewing kelp, and an incredulous silence descending as we wait in vain for her to answer.) Preterm delivery.

Now don't get me wrong. I am not sorry; I don't regret anything that's happened because it's brought us Charlie. After the fact, he is worth what we've endured. And I'd believe that of any other child Paul and I managed to conceive. But "Has it all been worth it?" is a very different question from "Knowing the risks, could I jeopardize my own health and the health of a baby I'd have come to love by the time it was endangered?"

I realize that I'm not likely to pull off a hat trick again, with so many hair-raising complications jam-packed into one measly pregnancy. I know I'm not likely to have any of the above again except for diabetes. But I also know I wasn't likely to get them to begin with. And that there are a thousand other complications I haven't even Googled. And that I could only get pregnant through expensive, heroic effort. Could it possibly be worth the risk?

I am making gaping fish faces, chewing on the only answer that makes sense to me.

Posted by Julie at 10:22:15 PM in The doctor is IN, Welcome to the bad place. Population: You

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A supposedly fun thing I'll never do again

My future fertility was decided by committee two days after Charlie was born, by people I didn't know.

On Monday morning, when I was finally allowed out of bed, I combed my unwashed hair, put on the single pair of filthy socks I possessed, and made sure my ass wasn't showing through the peekaboo slits in my hospital gown. Then I shuffled slowly down to the NICU to see Charlie, anxiously shadowed by my mother, who stood at the ready to break my fall if I decided that the 100-yard walk was too far.

You know, it almost was. When we walked in, the nurses surrounded me in a protective swarm and ushered me to a chair. "We're just doing rounds," one of them said. "We're about to talk about Charlie." I sat hunched uncomfortably over my incision and listened.

The doctor who was speaking looks sort of like an elf — the cartoon Keebler kind, not the ethereal Lord of the Rings kind. He's short and pink, baby-faced with silvery hair, and I'd find him reasonably pleasant if he were offering me cookies baked to a golden brown inside the cozy recesses of a hollow tree. But, no, he is instead a somber elf of doom: just the morning before he'd sat in my hospital room saying gloomy things like, "Well, we don't have a crystal ball..."

Now he was going over Charlie's case, using a lot of acronyms I didn't understand at the time, summarizing for the benefit of two physicians' assistants, three nurses, two other doctors, and a gorgeous young medical student. He conducted rounds like a fey tiny Socrates, starting sentences but demanding that others finish them. He covered the urgency of Charlie's birth by holding his ball-point pen aloft — "And he had to come out right away because Mom's platelets were...?" — and dropping it onto the floor with a noisy clatter, then turning expectantly to the student. She pursed her pretty mouth like a guppy, her lips making impotent nibbling motions, unable to come up with the right words.

Don't let her touch my baby, I prayed.  I know full well what guppies do to their young.

The doctor sketched out my medical history in some detail. Four IVFs, two prior losses, complete placenta previa, gestational diabetes, HELLP syndrome. He looked expectantly at the group as he finished: "And would it be a good idea for Mom to get pregnant again?"

I looked, too. And seven heads shook solemnly side to side. (The student was too busy gumming her tasty, tasty plankton to offer an opinion.)

I had already come to that conclusion myself, during my bouts of teary wakefulness the night Charlie was born. It had all been terribly hard. So hard to get pregnant, so hard to stay pregnant, so hard to face what lay ahead with Charlie in the NICU. And not only hard, but dangerous. And not worth the future risk.

• Gestational diabetes. This is a complication a lot of women experience, and for most of them and their babies it's little more than an inconvenience. But it left Charlie's lungs unusually immature, making his first few weeks painful and frightening for him and for us and perhaps leaving him especially vulnerable in the future to respiratory problems. The recurrence rate of gestational diabetes is around 65%.
• Placenta previa. Placenta previa isn't a common condition to begin with (.3-.5% of all pregnancies). It's even more unusual for it to be complete and to persist to term. It is not especially likely to recur (4-8%), but the risk increases with increasing age (check), parity (check), and previous C-section (check). If it were to recur, I would be looking at a 50-60% risk of pre-term delivery. And a pre-term delivery coupled with gestational diabetes puts us where we are now — or, more troubling, where we were almost a month ago.
• HELLP syndrome/preeclampsia. Studies vary on how likely HELLP syndrome — which I had, which is more immediately dangerous than garden-variety preeclampsia — is to recur. Estimates range from around 5% to 27%. There is agreement, however, that women who've had HELLP are at increased risk (40-50%) for complications in future pregnancies, including preeclampsia, pre-term delivery, IUGR, placental disorders, and perinatal death. Even without HELLP, though, in my case the recurrence rate of plain old preeclampsia is about 40%. (It would be about 60% if I'd developed preeclampsia before 28 weeks. The earlier in pregnancy it occurs, the greater the chance it'll happen again.) And a frequent necessity in cases of severe preeclampsia? (Imagine the med student chewing kelp, and an incredulous silence descending as we wait in vain for her to answer.) Preterm delivery.

Now don't get me wrong. I am not sorry; I don't regret anything that's happened because it's brought us Charlie. After the fact, he is worth what we've endured. And I'd believe that of any other child Paul and I managed to conceive. But "Has it all been worth it?" is a very different question from "Knowing the risks, could I jeopardize my own health and the health of a baby I'd have come to love by the time it was endangered?"

I realize that I'm not likely to pull off a hat trick again, with so many hair-raising complications jam-packed into one measly pregnancy. I know I'm not likely to have any of the above again except for diabetes. But I also know I wasn't likely to get them to begin with. And that there are a thousand other complications I haven't even Googled. And that I could only get pregnant through expensive, heroic effort. Could it possibly be worth the risk?

I am making gaping fish faces, chewing on the only answer that makes sense to me.