10 weeks

As long as I'm still pregnant today (I have no evidence otherwise, but having had a missed miscarriage, the thought's never far from my mind that the fetus has died without my knowing it), this is the longest I've ever been pregnant. I'm two weeks away from (one way of counting) the beginning of the second trimester, and the end of nightly progesterone (yay!).

I'm exhausted because I saw the midwife right after work today--a long day. Going back to the same OB/Midwife practice where I had two bad outcomes was a little scary. Also, I have a lot of doubts--given that I wish they would have handled some things about my miscarriages better, and that I left for Dr. Special's office because I wanted different treatment, is it even a good idea to go back here? Am I trusting my baby's health with the best place possible? I haven't really shopped around that much for a practitioner. But I'm remembering why I went with this practice in the first place. I have to give birth at a hospital with a reputation for being high-intervention, supermedicalized, but this unique practice of midwives (CNMs) delivers there. A friend had the midwives catch her two children and had great experiences with them; and their statistics--which they actually bother to publicize--are fabulous, in terms of very low rates of interventions. Plus it's just me. With my trauma history, I need personalized attention; I know I need sensitive, holistic caregivers; and I really like the whole approach of empowering women to make informed, evidence-based choices--which is all the "midwifery model of care" stuff. I like the idea of having a midwife meet me at the hospital and not leaving my side till the end, even if there's a C-section, rather than having nurses I've never met before keep coming by to stick their fingers in my vagina, or residents constantly wanting to peek in. I like knowing that if I do need surgery or another intervention, I'll be with supportive people who will help me trust that it's really needed (and not second-guess myself, hopefully, as much later). I spent a lot of time with pregnancy #1 talking to them about this practice and that's why I chose it. They seemed experienced working with women like me who have avoided doctors for years because of a history of trauma.

But...that's all well and good for labor and delivery, but what about getting me there with a live human baby? If there's a problem, will I be poo-poo'ed as I felt I was with pregnancy #2? Will I be abandoned to the OB if I need an OB and forgotten about by the midwives, instead of having someone attend to things like suggesting a pregnancy loss group? (A social worker told me about the group I ended up attending; and she was pretty surprised my OB hadn't told me about it--or handed me any info on dealing with miscarriages at all). In my desire to treat pregnancy as something healthy and avoid, if possible, an escalating cavalcade of interventions, will I miss a chance to save my baby's health, or mine? How the hell can a woman scared of another loss--an even bigger one this time--have a "natural" "holistic" pregnancy and birth with midwives?

I remind myself that it was science that led me to the midwives. I'm basing this on data about healthy outcomes and outcomes that women feel good about. And I'm a pretty good advocate for myself, especially after the losses. I will speak up if I have a concern.

Today with the midwife went well. It had its ups and downs. The downs were at the beginning, when the midwife asked me to recount the two previous miscarriages, which in a way I was glad to re-tell, because they were both complicated and awful, but she was sitting at a computer and having computer trouble. I got annoyed. Is that how it's going to be? You're not going to read my chart in advance and I'm going to have to tell you about these horrible experiences repeatedly while you type into a computer? Then the midwife-in-training shared that she had had four miscarriages, and has a healthy daughter, and that she feels for me. I really appreciated that. As the appointment went on--standard prenatal health information, no doppler or exam--the midwife asked me a bit about my anxiety and trauma history, and I shared that it's just helpful for me to share that to let my providers know that I might take a little bit of time to trust people, and I really like midwives because they seem to be about empowerment, and that helps me feel safer. She validated that, and she understood why I hadn't had a pap in many years, because I've been avoiding it. Then later she said that she expects me to call more often, she wants me to call anytime I might want a check, and she expects that they'll see me more often because I've had two losses. I got a little teary (as I often do with my hormones these days), and she rubbed my back, and said it's definitely okay to be extra nervous and to be crying in their offices, and really put me at ease. I told her my concerns about being told "it's probably okay" when I'm worried it isn't, and she said definitely to keep calling back and ask to talk to a midwife if I ever feel like there's a problem. At the end she asked if I needed a hug and she gave me one. I like that she kept the previous miscarriages in mind as she was talking to me. I said that this would be my first visit to this office where I had a good outcome; where I came in pregnant and left pregnant, and she gave me a high-five. I got teary again thinking that maybe this really will be the one that ends up in a baby.

Medically, I got some helpful advice on what to eat, since these days nothing feels edible, but at least if I have a few things I can make sure I'm getting my protein and calcium. I got a million blood tests and a urine test; and I scheduled the dreaded pap test along with a general physical (breast exam--I hate that, that's why I've avoided it for years, but I did lose a half-sister to breast cancer that appeared while she was pregnant, so I'm going to do my best to face down this fear; and MFP will be there with me; also I scheduled it with this same midwife, at her suggestion, since we've already had a conversation about my history and my issues with it) for four weeks from now, and at that exam, they'll have the doppler out to hear the heartbeat. But no scans. THAT is the difference between midwives and OBs; they don't do ultrasounds. Right now I'll only have an anatomy scan at 20 weeks. Can I really trust enough that I'm still pregnant, that I'm OK, without a scan? Given that the second trimester is new to me, maybe I can approach it with fresh associations. Also, for me, the scans themselves make me incredibly nervous in advance, and I have to take a long time afterward to come down emotionally from the anxiety. We'll see how this goes. This is a tough time--no movement, I'm hardly showing at all, and no scans, either.

But there's always the possibility of getting a scan at MFM--Maternal Fetal Medicine, where I'll go for genetic testing. I should get in in the next few days...I'm anxious about it (this seems to be a theme). I am hoping to get the cell-free fetal DNA blood test, a very new (2011) and simple blood test that's more accurate than anything else in telling you whether the baby is healthy. A friend told me about it. It could also tell us the sex, but I don't want to know right now, I think. I'm 35, which means I have a 1 in 350-ish chance of having a child with Down's syndrome, and a higher risk in general of having a child with any kind of chromosomal abnormality. I wondered if I could take some reassurance, in a way, from my previous miscarriages, as though they were signs that my uterus was being choosy about only growing chromosomal healthy embryos. It's surreal that I'm undergoing genetic testing at the very time there are attacks on women who choose abortion after getting results that indicate Down's. Obviously, I am 100% opposed to these cynical ways of doing nothing to help people with disabilities, yet placing them on the front lines of an effort to attack women. I have always approached this with this book in mind, which talks about one family's experience of disability, and which says that most parents of children with Down's just don't want to engage with the genetic testing debate because it does absolutely nothing to help their children--no funding for the specialized care they'll need, no greater access to educational opportunities. Also, the author made a point I hadn't thought about before: that finding out earlier about a child's condition can be really helpful; it can help you make sure you have the necessary medical attention at the ready, as well as connections to support. And I'm sure that having consciously chosen to parent a child with a disability can only help the parents and child in the years ahead. The truth is, I honestly don't know what I would do. The decision would involve MFP. Like most women, as studies show, I would likely terminate. But I also am already deeply attached to this fetus. Frankly, I just want to fucking know. And there are so many other things I'm worried about besides Down's. There are chromosomal disorders that make it impossible for the fetus to even live to term, or live more than a short time after birth. Given my age and my history, I will feel a lot more confident doing basically responsible things like re-arranging work responsibilities for the spring, and buying some new, bigger bras or clothes, and in general, telling people beyond super close friends that I'm pregnant, once I hear back about these test results.

I know there's no magic moment when I go from "in danger" to "safe." I have to live with that. But I do hope this feeling of being an imposter goes away--not feeling like I'm pregnant "enough" to go to prenatal yoga class, or to buy a baby book or something--if I'm in the second trimester and I have healthy test results. Well, if it doesn't go away I hope it lessens. I guess what I hope is that trust grows. I suppose that's the theme of this post. Trust in myself to advocate for myself and to make good choices about my health care; trust in my caregivers to be compassionate, skilled, competent and kind; and trust in my body, that I will do the best I can in this pregnancy. I think about women who've suffered stillbirths and I realize that that last one--trust in my body--may just never happen. I guess it's trust that I'll do everything in my control, at least. Maybe I can't trust that I'll bring a baby home--it still seems almost impossible; even as we're reading packets from the hospital about packing a baby outfit; that seems so outlandishly unrelated to what I'm doing now, just trying to continue this pregnancy another week at a time. But I would like to trust enough to *hope* I can bring a baby home. Hope never killed a baby. Maybe it's even time to hope enough to start knitting for mine.