We had a great visit with the midwife this morning to talk about baby #3. I feel so at home with Sharon (our "hospital" midwife, and the woman who delivered #2), having a personal and professional relationship with her, and I know she really listens to me. I dragged the hubby along for our preconception appointment, somewhat for moral support, but mostly because he is completely clueless about pregnancy and childbirth and I want him to glean some info from our meetings. Of course being so clueless means that he doesn’t understand why we would even need a preconception appointment. Silly goose.
Preconception appointments might seem trivial to some, but for a woman nearly DYING to have a baby, it can mean all the difference. First and foremost, in order to conceive a healthy baby, you first need to have your own health squared away. Your care provider may ask you questions about your general lifestyle such as diet and exercise, if you have a family history of high blood pressure or thyroid disease, if you smoke or drink, or even if you regularly soak in a hot tub or sauna. These may not seem like super important issues, but they can all affect your ability to conceive- and once pregnant, can affect the health of your baby. Your doctor or midwife will also ask you questions about your cycles. Are you periods regular? How long is your cycle? Do you know when you ovulate? (All of these questions and more can be easily answered if you practice FAM (Fertility Awareness Method)! I can often tell you exactly when I ovulated, sometimes down to the hour, and without wasting money on those pesky and notoriously misleading OPKs.)
If this is your first baby, you might be asked about genetic screening at the preconception appointment. But since we already have 2 healthy babies, this isn’t really something we’re too worried about.
After all the paperwork and Q and As are done, you will most likely have a physical exam. My appointment today got cut short by a meeting among the midwives so I’ll go back tomorrow for the physical part. It’s mostly typical stuff that you’ve already experienced if you’ve ever had a PAP smear. They will check your blood pressure and take your weight. They may take a swab of your cervix. If it’s been less than a year since your last OBGYN appointment, they might skip that. I have a history of ovarian cysts and cervical problems so my midwife will check my ovaries for lumps and bumps and use the speculum for a glimpse of my cervix.
As with most appointments you’ll probably be asked to leave a urine sample so they can check for pregnancy (wouldn’t that be easy?!), your blood sugar level for a diabetes test, or for UTI (urinary tract infection).
And the least pleasant part is the blood draw. While this step is entirely optional, I highly recommend it. Your care provider can use the blood sample to check your iron levels (being pregnant can make anemia much worse, so it’s best to catch it early), HIV and STDs (of which can be very dangerous and potentially deadly to both you and the baby), and your immunities to rubella and varicella (chicken pox). I’m a complete needle-phobe and I suffer through it.
If you’ve been trying to conceive for a long time, you might consider getting your thyroid checked, especially if you have issues with hormonal imbalances and the inability to gain/lose weight reasonably. Your thyroid not working up to par can certainly effect your ability to get pregnant.
All in all, the appointment should be pretty straight forward. Of course, the most important part of this appointment should be for you to ask any questions you might have about conceiving or the early days of pregnancy. This is an especially good time to talk about and problems or concerns you might have. Don’t be shy. No matter how embarrassing you think your question might be, your doctor or midwife had heard it all before. They will be able to offer you advice or refer you to specialists that you might not receive if you don’t speak up.
Here are some great questions for you to ask at your preconception appointment:
Another reason to book that preconception visit is to use it as an opportunity to shop around for your care provider. If you are on the fence about home birth v. hospital birth or are unsure about which doctor or midwife you want there for you on your big day, this is an excellent opportunity to take them for a spin. You might walk into your appointment and be disappointed by the lack of attention you receive or you might feel like your doctor isn’t really listening to your concerns. You might even be surprised by how quickly they rush you along and out of the office. These are all huge red flags that you might want to find a different support team. It’s much better to find this out before you are pregnant. Of course the decision of who and where can always be addressed later, but I like to be prepared.
A healthy pregnancy and eventually a healthy baby all starts with a healthy mommy, so get that preconception appointment in the books!
Peace and love,
It feels like it’s been forever since the last time I felt a child wiggle in my tummy. In reality, it’s only been 3 short years since the birth of our last child. Since I started having babies at the age of 21, I’ve been one of those women who is eternally ready for another baby. Laying on the hospital bed after our youngest child was born, my first thought (after the impassioned cries of “it’s MY baby!”) was “when can I do this again?!”
According to my midwife, who took me in at nearly 24 weeks as a high risk patient having just been diagnosed with cervical cancer, I needed to wait at least 2 years to let my cervix heal. Fortunately, the areas of my cervix affected were easy to treat and after a quick round of snip-snip-here and scrape-scrape-there, I found myself cancer free. I had suffered months of torturous preterm labor with my sweet baby girl, starting at 24 weeks and ending in a 19 minute delivery at 36+4 weeks. Having another pregnancy so close to her birth could have been very bad, so I begrudgingly decided to heed my midwife’s advice and postpone baby #3.
There has hardly been a day that passed since then that I haven’t thought “Today would be a great day to be pregnant!” When the 2 year mark rolled around and I got the go-ahead to conceive a pint-size person, my husband was quick to throw up a stop sign. We were in the middle of some very heavy life changes and we weren’t in a good place to be welcoming another child into our family. We decided to revisit the idea in a year. A long, looooong year.
And that time is now. Hubby and I sat down and had “the talk.” And we have unanimously chosen to have another baby. I can hardly contain my excitement!
Being a birth doula by trade and a birth junkie by nature, I have a whole bookshelf of books I read (and reread) about fertility, pregnancy, birth, and so on. One of my favorite go-to books is “Taking Charge Of Your Fertility” by Toni Weschler (which you can pick up at Amazon here, or at your local bookstore). If you are thinking about giving pregnancy a shot, or if you are fed up with your hormonal birth control and are looking for a reliable and natural option, you should definitely get a copy of your own! The Fertility Awareness Method (FAM) is, in my opinion, one of the greatest conception aids out there. When we were trying for our youngest, for 17 stressful months, I was at my wits end and wondering why I couldn’t get pregnant after having so easily conceived our first child. It wasn’t until I discovered TCOYF and FAM that I really got to understand my body and how conception truly works. We fell pregnant less than 3 months after I started charting.
As soon as hubby agreed to start trying again, I brushed off my copy and cozied up in my chair for a refresher course on the miracle of conception. I picked up a basal thermometer ($7 at Wal-Mart, or any digital to the tenth thermometer will do) and anxiously awaited the arrival my menstrual cycle to get started. I’m only half-heartedly charting my cycle this month and trying to focus more on familiarizing myself with my body. There is so much that happens down there! Cervical fluid changes, high or low, open or closed, temps up, temps down. And it all comes together to create a beautiful place to make a baby. The female body is so amazing!
I’m so ready to have a wiggly bundle of love in my tummy again. I’ve started taking a prenatal vitamin and am upping my daily amount of protein. I’ve already made a preconception appointment with the midwife that delivered our daughter, and I’m compiling a list of questions. I might be just a tad over-zealous.
There is no greater joy than that of bringing a baby into the world, and I can’t wait to share this journey with you.
Peace and love,
In Part 1 of this article, AFTER MISCARRIAGE: Postpartum Care for Mothers Experiencing Loss, we discussed the care a woman should receive in the first several weeks after a preterm loss (or stillbirth) to help her through the grieving process, to assure her return to vitality, and—according to the precepts of Traditional Chinese Medicine—to increase her chance of a successful pregnancy the next time she conceives.
Here in Part 2, we’ll address the question: When should we try to conceive again? It would be nice if there were one, but the answer is that there is no one answer. Conceiving life is a sacred event, and there is no single fact or consideration that can offer a single best answer for everyone.
However, since there are biological and emotional ramifications of pregnancy and loss, there are factors we should consider when deciding when it’s best to try to conceive again.
The western medical industry essentially considers one factor when making recommendations: What is the statistical likelihood of carrying the next pregnancy full-term when conception happened x amount of time after a miscarriage?”
That is indeed the ultimate question in any woman’s mind. However, the western medical industry offers studies with tremendously conflicting results to answer that question.
For example, read this quote from an article in Time Magazine:
"A new report by researchers at the University of Aberdeen in Scotland suggests that sooner may be better. The scientists found that women conceiving within six months of a miscarriage have better chances of a successful and complication-free second pregnancy than women who conceive later. But the conclusion is contrary to an earlier report from Latin America that found higher pregnancy rates among women who waited at least six months to conceive; that report formed the basis of the World Health Organization's (WHO) 2005 recommendation that women delay pregnancy for six months after miscarrying."
Information like that leaves would-be parents without clear direction and without seeing the whole picture.
In Traditional Chinese Medicine (TCM), the general recommendation is for a woman to wait six months to try to conceive again.
Why six months? Why wait at all—especially when many women do conceive again so quickly after miscarriage?
Waiting exactly six months is not necessary for all women, and some women may require more time. Here are the factors considered in TCM when recommending a wait period:
• A woman’s body has experienced huge hormonal shifts, and the body requires time to readjust.
• A woman has experienced a loss of chi (“energy”), blood, and jing (described in western terms as “kidney strength” or “life-force”)—an abundance of which is required to carry, deliver, and nurse a healthy baby.
• A waiting period helps the mother rebuild strength—not just to assure that the next pregnancy goes full-term, but also to increase her chance of a healthy postpartum recovery; of a healthier, stronger baby; and—down the road—a healthy menopause and golden years.
Though not often discussed or understood in western medical circles, the postpartum time can be one of great strengthening or significant diminishing of a woman’s health and vitality long term. I contacted internationally acclaimed Dr. Ning X. Fu to discuss this issue.
Before coming to the United States, Dr. Ning X. Fu, O.M.D., Ph.D taught at the Chengdu University of TCM and the International Acupuncture Training Center in Beijing. She was also an editor of the Journal of TCM and Pharmacology Information. Now in the States, she is a senior professor at Five Elements University of Traditional Chinese Medicine and has a private practice in Silicon Valley. This is what she had to say:
“When I first discovered women in America have no recovery time or care after miscarriage I was shocked. In China there is a government-mandated period of three weeks in which she has leave from work and receives postpartum care. Without proper care, the chi and blood loss in her body after miscarriage can lead to blood stasis (or stagnation).
For women who miscarry, it is often easy for them to conceive again — but it is also easy for them to miscarry again.
This is because the chi deficiency, blood deficiency and blood stasis, in the short-term, can make it difficult to carry full-term. In the long-term it can lead to fibroids, tumors, and cancer.
The resting period is a time to fortify the woman’s chi and blood, remove stagnation, and restore her body to strength. In addition to three weeks of rest and care, the mother is advised to wait until six months after her miscarriage to try to conceive again.”
Our discussion so far has addressed a few of the physical reasons for waiting. There’s another issue to discuss: Grief.
Miscarriage can be traumatic for women—and trauma leaves physical and emotional wounds that require time and attention to heal, even if a woman had postpartum care in the first month to several weeks.
From my personal experience, after my second miscarriage the sight of blood (even in basic food preparation) would send me into a state of anxiety and grief that could last several minutes or hours. Being immersed in the birthing world, I frequently hear stories from mothers about the ways they are haunted by grief, guilt, and anxiety after their miscarriages, even years later.
Though these responses are common, they are not to be ignored. Conceiving again in that state—of course—can bring joy and help lift one into a healthier state. But is it ideal to conceive in that state? Is it ideal to embark on any new and significant life journey from a weakened position, or in the hopes that it helps us bounce back? The answer to those questions is personal, and I asked professionals in the industry for their input.
Elly Taylor, a relationship counselor and author of Becoming Us said:
“Following a miscarriage (and I have had two myself) it is not uncommon to go through a process of mourning. There is no right way or wrong way to grieve, but cycling back and forth through feelings of shock, denial, anger and depression are common. Expressing these feelings in our own way or through a creative outlet—such as writing, singing, dancing, or painting—and sharing them with a good listener, dissipates the emotional energy of them and allows our body to recuperate. Using this time is also important from a relationship perspective: going through this process as a couple can bring us closer.”
Angelique Chelton, CLC, CBE, SBD is a Certified Lactation Counselor, Certified BEBE Educator, Stillbirthday Birth & Bereavement Doula and Director of Education & Training for Stillbirthday. This is what she had to share:
“Families who consider conceiving soon after a pregnancy or perinatal loss may want to carefully weigh that decision. While there is no one right path, each family needs to think about what the decision to conceive means for them in their personal situation- only they know what will be most healing and healthiest for them.
Will trying to conceive and/or being pregnant soon after a loss allow the family needed emotional and physical space to do the work of grief? Will the family have the energy and emotional resources to focus on the subsequent pregnancy as fully as they’d like? How will acute grief emotions impact a baby in the womb?
A family is ready to conceive when they have made peace with the death of the child who has been lost—conception before this time may complicate integration of a family’s grief experience and the emotions surrounding the subsequent pregnancy.”
We’ve addressed physical health, mental health, and now…what about age? A question that could likely be on the minds of readers 35+ is: Aren’t I wasting precious time if I wait?
There’s no single way to address this concern either, so I’ll just share my story with you. I conceived naturally the first time I tried at 38 and miscarried. I waited for 6 months, tried and conceived again, and miscarried again.
Now I was 40. Could I really spare even a day to wait again? Not according to most recommendations one would likely hear. It was a very difficult decision, but we concluded that, again, the physical and emotional healing time could not be skipped and we decided to wait. Then, during the waiting period, urgent family matters had us traveling back and forth overseas for several months—not a situation in which we felt it wise to conceive. Six months turned into waiting another entire year—and then we conceived again, and had a beautiful home birth when I was 42.
In lieu of the one answer to “when to try again,” here is an answer: No matter how long you decide to wait (or not), allowing yourself and finding support to move through the grief, and giving your body the assistance it needs to return to vigor and strength after loss, will greatly support the cause.
This article is intended for informational purposes only and should not be used as a substitute for professional medical care.
Image: Together We Dream, used with permission by artist Sofan Chan
 In TCM, this entails—under the care of a professional—varying combinations of the following: rest, special postpartum exercises, massage, a special postpartum diet, certain prohibitions (i.e. no cold beverages), acupuncture and herbs.
No one starts out trying to conceive (TTC) thinking about IVF. When my husband and I decided it was time to get pregnant, my daughter from a previous marriage was 9... and she was a birth control baby, so at 34 years old, I expected to be pregnant in no time at all.
However, my journey wasn’t so easy. After almost two years of trying naturally, a tube removal, three failed IUI’s, and a suspected ectopic that resolved itself, later, my doctor told me it was time to try IVF.
The process is an emotional roller coaster, to say the least, but even with an only 40% chance of success, I didn’t care... my heart ached to have a baby with my husband, and I would have done practically anything.
There are many different protocols, mine was pretty standard and this is how it’s supposed to go:
This is how mine went:
That first time of giving myself a shot in the thigh was pretty traumatic. My husband was at work and I called him for some moral support. He wasn’t much help “just stick it in your leg,” so I hung up on him. I then kept putting the needle at my skin and chickening out... thinking to myself that this was crazy! I finally managed to do it, by squeezing my thigh and slowly and easily adding more and more pressure until the needle finally went in. Really? It was a piece of cake, didn’t hurt, it was just a mental hurdle. After that, in a weird way, I looked forward to my shots... it was like a daily reminder of what all this was going to bring us... a baby.
Lupron is nasty stuff. It pretty much forces your body into early menopause. Side effects vary, but for me... I was moody, bloated, gaining weight like crazy and the HOT flashes... OMG... the hot flashes. I would wake up soaking with sweat. I would be going about my day and a hot flash would hit me from nowhere. And, lucky me! The dosage I was on wasn’t enough to keep my body from ovulating on its own. It is extremely rare for someone to ovulate while on Lupron...”impossible” was what the nurse said when I asked a month or so before. Yeah, NOT impossible.
After my cycle was cancelled, there was a bit of a panic waiting for my period. On doctor’s orders, my husband and I had sex (ya know... to clean out the pipes) the night before I found out I was ovulating on my own... 14 eggs ovulating on their own. Odds were slim, I only had one tube and the doctor thought it probably didn’t work, but the possibility of getting pregnant with a football team was a scary thought! And, like a true infertile couple, we had the conversation...”should we have sex again?” Maybe we could catch one (or 5) of those eggs and get to skip the rest of this awful process. We decided to not take the chance.
Turns out, we didn’t need to worry. My period came 5 days later when my hormones crashed. If there had been the beginnings of a football team, they had nowhere to implant.
I started the protocol all over, with the exception of skipping the birth control pills. After two weeks of Lupron injections, I went for an ultrasound.... I had over 10 estrogen producing cysts. Cancelled again.
It had been four months trying to get through one cycle of IVF. Depressed doesn’t even come close to what I was feeling. I was a fat, depressed, hormonal, hot (literally) mess. However, I was a fat, depressed, hormonal hot mess that wasn’t giving up. I just wanted to get through the entire process once and I didn’t care how many tries, or how much money it took to get there.
I waited another cycle and started the protocol all over again, with an even higher dosage of Lupron. My doctor guaranteed I wouldn’t be ovulating early this time. The problem? I was only going to have six mature follicles. Six may sound like a lot, but just because six are retrieved, doesn’t mean that six will fertilize. And normally, all that fertilize don’t turn out to be embryos that are suitable to be transferred. My RE only transfers blastocysts... that’s a 5 day embryo. My odds of having two blastocysts out of only six eggs weren’t so great. I almost cancelled myself. Wouldn’t that have been funny....
The day for my egg retrieval finally came! I took my prescribed valium for the 100 mile drive to the clinic…praying there was no accident on the Interstate to make us late and miss the window for retrieval. By the time we got there, I was high as a kite and giggling my head off. They took me into the procedure room, hooked me up to IVs and gave me a twilight sedative and off to sleep I went. They sent my husband to a room with some magazines so he could do his business.
The actual retrieval process is pretty gruesome, I think. Basically an ultrasound guided needle goes through the vagina wall, finds a follicle and sucks out the contents, along with the egg. I’ve read about this being done in other countries without sedation and, yeah, no way... just the mental picture of that hurts. It’s amazing what women will put themselves through for the chance of having that precious little bundle. Anytime my husband needs a reminder of what I went through, the phrase “needle through vagina wall” shuts him up pretty quick! Heh!
I was pretty sore for the next couple of days. And bloated. With egg retrieval came the risk of Ovarian Hyper Stimulation Syndrome (OHSS) and it can vary from a nuisance to slightly dangerous to deadly, in extreme cases. I was instructed to eat and drink food with lots of sodium to help flush extra fluids out of my system. I also had to weigh myself daily (yuk), any gain of over 3 pounds and I was to call the doctor right away.
The morning after egg retrieval, the doctor called my husband with the fertilization report. They retrieved eight eggs. Six were mature and five fertilized normally. All in all, that was an excellent result for us. Waiting the next four days until transfer day was pure torture. I thought I would get an update along the way as to how my little embryos were doing... but no such luck. I called once and was told if there was nothing to transfer, they would call me the morning of the transfer and let me know. Torture!!
The morning of the transfer, I was scared to death of the phone ringing...and certain that they’d wait until after we made the 100 mile drive to tell us that we had to just turn around and go home. Fortunately, that wasn’t the case. The doctor came in and showed us a picture of two perfect blastocysts... the results after five days of my eight eggs. My husband got to sit in and we watched via ultrasound the embryos being transferred into my uterus. It’s really pretty amazing.
And then? We get to wait again. My pregnancy test was going to be in 9 more days.
Everyone that is TTC knows the pull of the stick. POAS is its own science. However, when it comes to IVF, it’s a bit different. The shot of HCG to force ovulation stays in your system for a while. It varies for everyone. It can be gone as soon as a week or stay as long as 12 to even 14 days. That meant for me, at 4dp5dt (four days past five day transfer or nine dpo) that positive that was showing up on the stick was just more uncertainty. Was I pregnant? Or was there still HCG from that shot in my system? Same question for the positive on 5dp5dt.
The morning of 6dp5dt, I had my answer. Negative.
However, that afternoon, I started feeling not so hot. One thing they tell you is that pregnancy can make OHSS worse. And even though my bloating wasn’t bad enough that I needed medical attention, the fact that I was starting to feel bad was a clue and I had to get home and POAS as soon as possible.
Positive! I then grabbed the negative from that morning and squinted at it. Although it had definitely been negative within the time limit, after drying I could see the faintest of lines.
The next morning, 7dp5dt, positive again! And darker! The positive on 8dp5dt meant I couldn’t hold it in any longer and I called the nurse to confess I’d been POASing early. Could I please go for the blood test today?!
The beta results for 8dp5dt (13 dpo) was 93. I was pregnant! But now, we got to wait again... and wonder... was it just one? Or two?
I was pregnant with twins. I lost Baby B at 9 weeks 4 days. My perfect daughter, Peyton, was born at 38 weeks 6 days gestation, weighing 6 lbs 3 oz and 19 1/2” long.
IVF was such a blessing for us. Sure, it cost us $20,000 and turned me into a lunatic for a relatively short period of time, but just being given the chance was worth all of it. Every. Single. Bit.
I came across this video that gives a very good explanantion of fertility and how endometriosis affects it. It is presented by the American Fertility Association. It also explains that there are options even if you have been diagnosed with endometriosis. I appreciate these medical videos but I still believe in mind over matter and if you want a baby badly enough, no disease will stand in your way, no matter how your baby comes to you.
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