A Little Bit Pregnant

This is an essay I wrote about living between 2 worlds...

“Your hormone levels aren’t high enough to confirm pregnancy, but they are higher than we would expect if it was an ectopic…”. “So, what does that mean? Am I pregnant?”

“We’re really not sure. This is very unusual.”

Only I could be ‘a little bit pregnant’. Who knew it was possible to be between two worlds in this way - neither pregnant, nor not pregnant?

After 3 years and 7 stim cycles of IVF (that’s the full gamut of injections which give you an oestrogen high, scans, surgery to harvest the eggs, and embryo transfer a few days later, followed by a two-week, prayer-filled wait, during which your happy hormones plummet and leave you in the pits of despair), Chinese medicine (delightful home-brewed concoctions of sticks and seeds and murky water that stink out the house and make you gag as you gulp them down) one miscarriage and around 40 failed embryos, we had a breakthrough. It was coincidentally the week that we had a long-awaited appointment with one of the leading gurus of IVF who told us you “should be holding a baby by now, not still trying to conceive”. He was prepared to “try one or two cycles, but it’s time you think about egg donors if you really want a baby”. Things were dire.

How is it possible, especially in the highly controlled and monitored world of IVF, to not know if someone is or is not pregnant? They suggested retesting my hormone level (Beta HCG) in a week to see if it had gone up. For anyone who has spent years trying to get pregnant, a week is a very long time. And anyone who has spent more than 5 minutes exploring fertility treatment knows that these hormone levels double every 2 days in early pregnancy, so there was no way in hell I was waiting 7 days to find out if I was pregnant or not. I know I should have been an expert in patience after 3 years, but I had already done the due diligence of the 2 week wait here, and the experts couldn’t even tell me if I was or was not up the duff!

That week was one of the longest and most complex waits of all the years of IVF combined. The anxiety was intense- as with every IVF cycle the tension between hope and despair is overwhelming. Every day brings an emotional rollercoaster and a psychological battle with hypervigilant attention to body sensations: “Are my breasts tender? What was that feeling in my pelvis? Am I nauseated?”

After that exhausting week riding the emotions in the gloomy renovator’s delight that we had just moved in to (in the subconscious acceptance that we would need a new project to focus on) whilst looking into the egg donor process and wondering if I had the stamina for such a journey, I was finally relieved and elated to find that those sluggish hormones were following the right trajectory and increasing at the desired rate. I was officially pregnant!

I knew it was early days and still precarious, and sure enough, less than 2 weeks later I had the tiniest amount of spotting. It was evening, as these things invariably are. Medical and emotional crises rarely happen conveniently within office hours.

‘Should we call him? Is it too late at night? it’s only a tiny spot…”

“Yes, you should call” declared my husband. “This is his job. And you won’t sleep. You will stress all night, just call... ok I’ll call...”

Unphased by the evening phone call, my obstetrician gently comforted “it’s a small spot and probably ok. But given your history I would like to do a scan in the morning”. I slept slightly better for the reassurance.

The next day, as I drove the long 15 minutes to East Melbourne, I consciously slowed my breathing and focussed on the traffic to distract myself from the mounting fear. Fingers crossed, palms sweaty, heart beating loudly, I walked into the office and was immediately ushered into the scanner room. The obstetrician wasted no time. He had the ultrasound probe on my pelvis detecting a heartbeat within seconds. I could breathe. It was strong, fluttering away at its rapid rate. A tiny butterfly on the screen.

I am a nurse and am sensitive to the nuances of silence and the subtle signs of stress on a specialist’s face. So yes, I could breathe, but something was wrong. After he showed me the foetal heartbeat he showed me the amniotic sac, and the massive blood clot sitting in there. To say it dwarfed the embryo would be an understatement. At least a third of the amniotic sack was filled with blood. A boulder in comparison to the tiny butterfly. Should it dislodged, it would take with it my tiny 7-week-old, Artificially Inseminated, 3-year-in-the-making, embryo. The only remedy was to stay still for 2 weeks – “do nothing, do not move” and hope the clot reabsorbed.

As my husband and I sat discussing renovations to distract us from the tedium and anxiety of 2 weeks of strict couch rest, there was a knock at the door. An unexpected visit from a friend we hadn’t seen for months and with him a friend I had been close to until she moved to Ireland a few years prior. Keen to catch up over a few drinks they sauntered in and started chatting excitedly. This should have been a joyous reconnection, but I was caught off guard and flummoxed. I couldn’t explain what I was going through. It was too raw, too personal and scary to talk about. Emotions are uneasy territory in my family and to discuss such a private issue without forethought was beyond my shattered capability. I couldn’t engage with her, and I was fearful that if I moved I would lose my baby. To this day I can only assume that she thought I had become a horrible person, dismissive of her and her journey to parenthood. Nothing could be further from the truth. But I couldn’t face this happy parent who had conceived in an instant and had a healthy laughing toddler at her feet.

I lost a friend that day - the collateral damage of the long-term emotional stress of IVF- and for that I am deeply sad.

There were other complexities to this pregnancy, risks of genetic abnormalities. “There is no point stressing about something until it happens” my husband wisely counselled. We were pretending to enjoy cake and hot chocolate in Carlton to soothe our emotions after the discussion with the genetic counsellor. She had talked us through the statistics but did little to help my fractured thoughts and feelings. “Just enjoy the pregnancy” my husband said- the voice of reason. “Stressing now won’t change the outcome.”

I did enjoy being pregnant. I had crackers by the bedside and ate chips and bacon every day to get me through the morning sickness. Overall, I felt pretty good, and enjoyed the preparation for parenthood.

Bless that embryo for clinging on so hard in that first trimester, but this baby didn’t realise that it needed to let go when the time was right. Forty weeks came and went- nothing. Forty-one, still nothing. We had daily CTG’s/foetal heart monitoring to check the baby was ok. I loved the sound of the CTG. Listening to the heartbeat on loudspeaker was so calming. When I worked in the Emergency Department, we would occasionally monitor babies, and I would turn the volume higher than necessary so the soothing rhythm would waft through the entire unit.

I hoped for some degree of ‘natural’ in this labour and birth if possible. In my late 30’s, I was a high risk for a caesarean. To add another complication my back went out at forty-one weeks. I was on crutches. I could not walk, let alone pace, rock, squat as I would need to in labour. That wasn’t the only issue. This kid was still going nowhere! It was snug and happy in its warm bath of amniotic fluid. So, induction it was - and that was far from pleasant! Seven hours in, I was not progressing – it was to be a long night ahead. And then, I clued in that the heart monitor had lost its typical pattern of acceleration and deceleration. There was too much deceleration. The young midwife rushed off to get the senior who sent her immediately to call the obstetrician.

Time slowed as my heart raced, and I fought the panic overtaking my whole being. Again, the calm authoritative voice of the obstetrician - “the baby’s heart rate is dropping, and the baby is in distress”. I already knew that, and I knew what it meant. This was why I had chosen this obstetrician as I knew I could trust him implicitly. I’d seen him in emergencies, and I knew he had what it takes to not only manage the medical crisis but also keep me focussed and calm. “This is what we are going to do...” he said as he rushed the trolley with me on it along the corridor- “we are going to do a caesarean and we are going to get this baby out of here as quickly as possible...” Staff scuttled around the theatre room setting up as we arrived. “It will only take a few minutes, then we are going to take the baby to the resuscitaire and give it a quick check and then you are going to be holding your baby… Okay?”

I was not okay. I was hyperventilating. I am used to being in control of the emergency. I am usually the one calling the shots and giving the medication and advising patients in calm but assertive tones that things are under control. Now I was panicking, I could not breathe. I didn’t want to see what was happening, but I knew. I hated the drapes, and the smells and sounds overwhelmed me. I could feel the tension, despite the pretence of a cheerful delivery in progress. My heart pounded in my ears, and I felt like screaming. I was powerless and scared: scared for me, terrified for my baby.

Then there he was- my boy - tiny and red and crying - and he was okay. My husband was crying and laughing, unsure where his attention should be now. I was still in shock and trembling with relief and exhaustion. Then I was holding him, my long-awaited baby.

It took weeks for me to process all that had transpired. Again, it was my obstetrician who pulled me through. “We can talk through every detail of the delivery, if need be, in order to help you process it and be okay”. He spent over an hour talking with me about the emergency caesarean, acknowledging that it is “common to feel traumatised - birth is traumatic”. He normalised and legitimised my feelings. It was a game changer. I went from crying, exhausted new parent with PTSD to typically tired mother who could now focus on her baby. After our 5-year journey of investigations, treatments, trauma and loss, I had finally moved from one world to another.