Barren

Barren
(as defined by Webster's Dictionary):

1: not reproducing: as
b : not yet or not recently pregnant c : habitually failing to fruit

Infertile

 (as defined by Medicine.net): 

 Infertility means not being able to get pregnant after one year of trying.

Last April when my period returned after having Kaia, I figured I wouldn't bother starting any type of birth control.  Although we didn't exactly WANT a second child at that point, I felt fairly confident due to my previous experiences of needing added progesterone to get pregnant, that it likely wouldn't happen on its own.  And hey, if it did, that might be welcome change and a sign from the universe that we should just go with it.

Turns out, I was right.  (Sometimes it sucks be right all the time).

We've been 'not trying/not avoiding' for a year now and can now officially be classified as among the 'infertile'.  Not surprising.  I have a feeling if we had never added in the progesterone with either Aidan or Kaia we would have gotten that designation the first two times around.

What pains me to admit however, is that in January we decided that we'd start actually 'trying' and started on progesterone for the second half of my cycle.  It worked the first time in both of my previous pregnancies, so I felt it was bound to at least do SOMETHING.  January I started with 100mg of Prometrium once a day starting after ovulation.  It did NOTHING.  My luteal phase was short as always and I had spotting for a number of days before my period as usual.  Okay, I figured, no biggie.  I got pregnant with Kaia using 200mg once a day.  So, we upped it to 200mg for February...and March...and April...and the spotting continues.  My luteal phase is slightly longer, but I have yet to need a pregnancy test to tell me I'm not pregnant (which I should since the progesterone should stop the uterine lining from shedding, thus cuing me to pee on a stick).  I've yet to make it past day 27 of my cycle without spotting.

Shit.

My family doctor said she is willing to prescribe Clomid to help strengthen ovulation which will hopefully sort out my luteal issues, but if we need any further help than that, she'd refer me again to the fertility specialist we saw in the Fall of 2010.  That fertility specialist had the easiest time in the world helping me get knocked up.  One ultrasound for a follicle check and a prescription of Prometrium later and 'ta-da'!  They said it was almost too easy. Too bad what followed was not.

I don't know what to do.  I have a hard time admitting the level of my desire for another child to my doctor or my friends and I haven't even mentioned it to our families, because I'm so afraid that giving a voice to my wish will somehow make it harder if it never happens.  I still carry so much disappointment and sadness around both my pregnancies and Aidan's loss that I'm not sure I can really stand to add another defeat to the pile.

Sometimes I like to trick myself and think "Hey, maybe you don't REALLY want another baby. Let's just hold the phone and think back here for a moment. Remember how little sleep you got with a newborn? Remember the nervous breakdown you had over trying to breastfeed?  And the 14 months of pumping? Remember the quasi-sleep training and the hours and hours of nightly crying that preceded it? Oh, and hey...remember your water breaking in the second trimester...TWICE?  Remember the combined 27 weeks of bed rest?  Remember the lack of income?  Remember the stress and the worry and the fear?  Remember the preemies, one living and one dead?  The NICU?  Remember Dr. Eeyore?  Remember how they have ABSOLUTELY no idea why your placenta exploded once, let alone twice.  Remember?  Life is much better now that all that's behind you."  It would honestly be so much easier if, like friends of ours who have just one daughter and are happy to keep it that way, we didn't want any more children.  No more choices to make.  No more decisions to stress over.  One (living) and done would be so easy.

But, I do.  I do want another baby.  I have Kaia, who I am more grateful for every day. She lights up our lives.  And I had Aidan.  He made me a Mom.  Who even in his absence continues to teach me things and helps to make me a better person.  How special and important they both are to me.  How much I love them.  OF COURSE I want another child.  Both Brian and I do.  And one day, I bet Kaia will want a sibling.  I would love to make that happen.

I honestly feel that likely, our third child is possible.  Right now, he or she waits in the fabric of the universe, just waiting for our genetic material to combine, implant and begin to grow. According to the reproductive endocrinologist that we saw in 2010, the likelihood of us being able to conceive is high based on the fact that we have before, it will just take the right combination of patience, medical technology and genetic material.  I know this isn't the case for EVERYONE, but since I'm still fairly 'young', the possibility is on the higher side.  That the 'likelihood' ends at the two pink lines is what gets me.  It makes me quake in fear that there are no guarantees beyond that.

I'm just not sure I have the strength to really GO for it based on our pregnancy history.  I'm not sure I want to pour time, money, energy and hope into a pregnancy that would take more than a few pills and a bottle of wine to make happen.  If it happened on it's own, naturally and easily with little or no outside help...and things went badly again, it would be awful, and heart breaking and soul crushing. If it all went badly again and we had spent months (years?) going to doctor's appointments, multiple invasive tests, failed procedures and PAID for all of it to happen, well that's just like rubbing salt in the wound.  Maybe our current infertility is the universe's way of telling us it's just not meant to happen, and we'd be better off not tempting it again. 

I just all makes me so sad.  I never blamed any of my own actions for Aidan's death or for either of the early pPROMs.  But I have such anger and disappointment when it comes to my body.  How could it fail me so badly, not once but TWICE?  How could things go so wrong?  I don't even really feel that I had much to do with Kaia's positive outcome.  It's like she lived in spite of my body's failings.  The bed rest, the gallons of water, the good food, good hygiene, all the supplements, the love and hope I clung to were only my way of attempting to counteract the absolute failure of my uterus.  That Kaia lived is only due to her own hardiness and because biology didn't screw up *quite* enough to cause her death.  Kaia lived because she, and we, got extremely lucky.  From my earliest memory my body has been deemed 'less' because of my heart defect, which my pregnancy history only seems to confirm.

The idea that I would dream of chancing all that again; that I would dare to even contemplate it in the face of my body's obvious unwillingness to cooperate smacks of hubris.  We got lucky once, what makes me think I deserve that again?  

On the other hand, I feel like I am failing that third baby of mine if I don't try. If I choose comfort, safety and physical ease over the fear of loss or hardship, what kind of mother am I?  I imagine third baby out there, just waiting for us to make him or her a reality, but unfortunately third baby brings no guarantees about how long he or she plans to stay, or how healthy he or she plans to be, or how mentally or physically healthy he or she will leave me.  There are never any guarantees when it comes to children, but I feel somehow, like we have less of a guarantee than most.  We have more of a reason than others to believe it will all go badly, more of a reason to fear the worst.  Third baby, you aren't even real and I already love you, want you, wish you were here...but I don't know if I can risk it again.

The hardest thing for me maybe, is that I know I can live without third baby.  Life will still be good.  It will still have meaning.  Because I have Kaia, I can go on.  I didn't feel that way before or after Aidan.  The desire to have a living child was so intense, so overwhelming, it was all I could think of.  I could not imagine my life without at least one living child.  Even while I stared at the ceiling on bed rest with Kaia, swearing that I would not put myself through this again, I knew I wouldn't quit in my desire to have a family. I was prepared to do anything, pay anything, risk anything.  

But I'm not anymore.  For me, primary infertility and secondary infertility are two very different things.  As much as I love third baby, he or she does not take precedence over my current child and my current life.  I have other dreams now, which I am prepared to put on hold, or delay, but not give up on, to have another baby in my life.

Which in the end, for me, is the saddest thing of all.  I know if third baby were to make it here, alive and well (which sometimes feels as impossible as a planned mission to Mars), third baby would be as loved and as cherished and as needed as Aidan or Kaia.  He or she would be cease to be abstract and would become real.

And, oh how I want him or her to be real.  

I'm just not sure I have it in me to try.

I'm sorry third baby.  Mommy's so sorry.

Imagining Three

"Aidan do you know what today is?"

"It's my birthday Mommy!"

"Yes, you're right it is my big boy!  Aidan, how old are you today?"

"I'm three!"

"Yes you are!  What are we going to do today for your birthday?"

"Go to the zoo!  I love the zoo!"

"Are we going to see the lions and tigers and gorillas and turtles?"

"Yes, and the Orange-tans too!"

"Orange-tans?  Oh right, yes, the O-RANG-U-tans, yes we can see the Orangutans too. Aidan, this is a very special day.  Three years ago you were born and you were so small.  See this picture here?  Yes, that's you.  Look at how tiny you were.  Tiny tiny feet, tiny tiny hands...tiny, tiny everything".

"I'm not tiny, tiny anymore....I'm a BIG boy, now!"

"That's true.  You are a big boy, now.  You're a big brother now too.  But three years ago, you were so, so small that you had to live in a warm plastic box for a long, long time until you were bigger and stronger.  You had tubes and wires going every which way.  Yes, see this picture?  Mommy would sit beside you and hold your little hand in mine and put my hand over your head to keep you calm and feeling safe".

"Why, Mommy?"

"Because you were so small Mommy couldn't always hold you. We had to wait a long time for you to get big and strong so you could come home.  Your doctors and your nurses and your RTs said they have never seen such a remarkable boy!  You did so well and surprised just about everyone!  Even me!"

"Even YOU?"

"Yes my baby boy.  It took you awhile, but you grew so well and got so strong and healthy, I could hardly believe it.  You barely even look like that tiny baby anymore.  Except for your feet and your nose, those look just the same.  Just like your Daddy's"

"Some day, I'm going to be as big as Daddy and drive the car, just like him!"

"That's right, you will. You're a big boy already who can run and jump and count to 10 and say his A, B, Cs!"

"A, B, C, D, E, F, G..."

"Yes Aidan, that's very good.  Okay, it's time to get your shoes on...time to go to the zoo!"

"Yeah!"

"Wait, Mommy needs a hug and a kiss from the birthday boy!"

"Love you Mommy."

"Love you too, Aidan."

***

Forever and Always my baby boy.

Just another day at the office

He has creamy pink skin.  Rosebud lips. Ten tiny toes, ten tiny fingers. A covering of peach-fuzz hair on his head. He is loved.  His room is waiting at home for him.  He is 7 and a half pounds of glorious perfection.  

Except for the brain damage.

She's standing at her son's beside gazing down at him. She is sore and slow and tired, with her swollen post-partum belly covered in sweats.  Her husband stands stoic beside her.  They don't know what went wrong.  He was fine, fine, fine on ultrasound just days ago. They have just finished a conversation with the nurse practitioner covering her son's care that day.  It's not good, but it's not the WORST either.  He's got a chance. We'll have to see how he does once we finish the cooling protocol and do an MRI.  Then the real waiting begins. It might be years before we know what he's going to be like.  Able?  Disable? Walking?  Talking?  Deaf?  Blind?  Who knows.  We left our crystal ball at home today.

She's standing at her son's beside gazing down at him.  He is still.  So still.  He has tubes and wires coming out of every which way.  The amount of technology surrounding his bedside looks like it could control a missile and is equally formidable to anyone who doesn't know it's purpose. His nurse (my colleague), offers his mom the chance to do his bath.  You know, something totally normal, if she didn't have to work around the breathing tube, the umbilical lines and the urinary catheter.

His mom begins to cry.  As tears roll down her cheeks she wrings her hands and manages to choke out, "I'm afraid I'm going to hurt him!"

I'm going about my day, trying to mind my own business while charting on my patient, but standing 3 feet from her, I can't help but hear everything she says.  My dead baby mother's heart responds so keenly, as I know what she is REALLY saying.

I'm afraid I already hurt him.  I'm afraid I've killed him, or damaged him beyond repair.  He's broken and it's all my fault.

As a nurse I could tell her "it's not your fault" and really mean it.  She did nothing wrong.  It was an accident. Nobody meant for this to happen.  Not the midwife, not the pediatrician, not the doctors, not the nurses, not her husband, not the baby and certainly not his mother.  But I know, she will blame herself...we always do.

A few days later he is breathing on his own.  Learning to eat from a bottle.  He will have challenges, but he will go home.  His mom is holding him and she looks a little better.  At least she smiles back at me.

He is one of the lucky ones.

Another day, I'm over at the fridge.  Searching around for the containers holding my patient's breast milk so that I can draw it up into tiny syringes to push down the tube in his nose into his stomach where it will hopefully stay to be digested and not end up back on my shoes.

I look over into the room next door.  The lights are dim, even though it's the middle of the day.  The staff doctor is speaking quietly to a couple sitting in matching rocking chairs by their son's bed side.  They are absolutely still.  I can tell just by their posture, and the blank looks on their faces that it's not good.  His nurse leans over to me and whispers, "she's talking to them about withdrawing fluids..."  They have already been told their son is beyond hope.  Unlike other organs which can recover from a lack of oxygen, the brain cannot.  His death certificate will read asphyxia.  Withdrawing fluids will help to not prolong things.

Withdrawal of fluids is completely appropriate in this case.  It is only offered in situations for which nothing can be done, and the family has agreed to a DNR.  But as I stand there watching that couple hear a doctor speak so calmly and plainly about hastening their son's death, I remember what it's like to get that news.  Nothing can be done.  No hope.  Beyond saving.  Might as well end it now.  It hurts.  Hurts like a gut wound.  You feel your stomach dropping out beneath you.  You feel dizzy and sweaty, like if you could only just block your ears, your mind, your heart, maybe all this awfulness will just go away and leave you and your family alone.  But it won't and it doesn't.

I look at the parents.  They are so completely, totally ordinary.  A month ago she was probably at her grocery store, or in the mall, or at church or at work, getting belly pats from well meaning old ladies chirping "oh, looks like it's any day now!"  She likely smiled and then rolled her eyes as they walked away.  He probably assembled the crib and attended birthing classes feeling like a fish out of water.  Worried about being a good enough dad, and maybe even rubbed her feet after a long day.

A month from now she will be back at that grocery store, slowly walking down the aisles.  Avoiding the one with diapers and wipes and formula, because even though she was going to cloth diaper and breast feed, it's all just too big of a reminder.  He will be at work, shooting the shit with the guys...but breaking a bit inside when colleagues mention their kids.  He'll quickly look away and busy himself with something else.  This year won't be what they thought it would.  No camping trips with an infant.  No holiday parties with the 'grandparents'.  Just them, alone again in an empty house.  I can see it all because I've lived it, and now they will too.  I wouldn't wish it on my worst enemy.

***

How is it that so many babies traversing the,what? Maybe 10 cm total?, through the cervix and down the birth canal go from 'fine' in one spot, to 'dead, or dying' and the end?  It seems completely ludicrous that the only 10 cm you absolutely HAVE to cross in your life is the most dangerous of all.  Good job mother nature.  You can be such a cruel bitch.

***

Oh look at that, it's 7 o'clock.  Quitting time.  Yep, just another day at the office.  

Should have been a librarian.