[amychristian]

Yesterday I met with a brand new OB/GYN. I liked my previous one just fine, but after the miscarriage in February I decided I needed a "fresh start." I spoke with my former doctor about this and he totally understood. I felt so guilty about leaving him, especially considering how supportive he was toward us during the miscarriage, but there's an unexplainable association that I now feel about his office that I can't shake. It was hard, like breaking up with someone, but he wished us the best of luck and gave my new OB/GYN a glowing review of me in his letter of referral. This new doctor was rated one of the "Top Doctors" in Washington, DC, so I knew I'd be in good hands, and I had read reviews online and women just adore him.

Disclaimer: This post will be long, and for that I apologize in advance. I have a really high recall rate, especially when it comes to conversation, so I am probably going to directly quote the doctor a few times. I know it's a lot to read, and it'll read like an exhaustive stream of consciousness (i.e. a "mind dump") that I won't bother to cut down or otherwise edit, but as Blase Pascal once said, "I would have written a shorter letter, if I'd had more time."

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I didn't actually go in for an annual (I am getting that next month). I went in to basically consult with him about my weird 5-week cycles since the D&C and to formally introduce myself to him (and him to me). He runs a solo practice just a mile away from my previous doctor and his office and staff were absolutely lovely. It's a cozy office that is warm and welcoming, just like my last one. I only see solo doctors, and there are just a handful of them in DC. I hate practices that are huge and impersonal and have been through them all. I felt like a number rather than a patient. I like being treated by and cared for by a doctor who knows me, someone I can build a relationship with, someone who will call me back in five minutes, someone who listens, someone who is diligent and accommodating, skillful and still humble, kind and sensitive, respectful and sincere.

It took a few minutes to fill out the paperwork, and then the doctor himself came and got me from the waiting room. He was wearing a suit and had a big smile on his face. He reached out his hand to shake mine. "Hello, Amy! I'm Dr. [Name]. It's wonderful to meet you... please, come with me." We headed back to his private office and he asked me why I was there.

I explained everything that had happened since December when I got pregnant. I explained the bleeding, the ultrasound, the D&C, the follow-up appointments, the second D&C and hysteroscopy, and the 5-week cycles I've had ever since. He took copious notes but did not ignore a single word I was speaking. He was writing while he was giving me feedback. He was genuinely sympathetic and told me that he'd do everything in his power to ensure that my next pregnancy progresses with the utmost care and attention. He said, "There's no such thing as a silly concern." That made me feel a hundred times more relaxed.

He pored over my records and said, "It's not at all unusual for a woman's cycles to be irregular even six months after a D&C, and remember, you had two, plus another minimally invasive procedure (the hysteroscopy. So your body is still reacting to the sudden change in hormonal imbalance as well as the physiological changes to your uterus." He went on to explain how and why the cycles do what they do after these procedures.

I asked him about the heavy bleeding and the clots that I passed on the first two days of this cycle and he said that was also not abnormal. He said, "People consider clotting a bad thing, and under different circumstances that might be true if the clot was prohibiting blood flow, but in most cases clots are very useful -- they prevent us from bleeding to death." He cited the example of when you sustain any kind of laceration on your skin. "You want to clot. Otherwise you'll just keep bleeding." So he told me not to worry about passing two clots. He said that after two D&Cs and a hysteroscopy, the blood accumulation in your uterus will be higher at 5 weeks than at 4, which is why I bled more this time, because my cycle was 5 weeks long instead of 4 weeks long, so there was just more blood to pass.

He told me not to worry, and that everything I have experienced, while unpleasant, is completely normal. He said, "So long as there is no infection and you're not bleeding at an uncontrollable rate, there's no cause for alarm." I asked him why we didn't get pregnant last cycle even though everything was timed perfectly and he said, "Amy, there are a thousand reasons why a woman doesn't get pregnant every time she tries, and it would be impossible for anyone, even a doctor, to speculate as to why." He said that sometimes after your body has just undergone a series of traumas (a miscarriage, two D&Cs, and a hysteroscopy) it will want to take some time to heal before it's prepared to go through any more. He said not only is it possible that I'm not ovulating on schedule (which can affect the probability for success), but my uterus is still trying to figure out how to "bounce back" to its non-pregnant state.

He said, "I am going to do a diagnostic ultrasound for you, so I can give you peace of mind." I didn't even have to ASK him for it! My last OB/GYN refused to give ultrasounds for GYN purposes and said he only did them for OB patients. I told him I was worried that another clot may have formed, or that something else was wrong. So we proceeded to the ultrasound/exam room. I undressed and he came in with one of his nurses.

He used the transvaginal ultrasound and the screen was nice and close so I could see everything. He has one of the newer, fancier ultrasound machines and the screen was enormous. He first looked at the cervix and said, "Mmm hmm... looks great..." and then he showed me my uterus.

"Perfect. See that?" I gazed in wonderment. There was literally NOTHING there. It looked like a fuzzy TV screen. There were no black areas, no solid white areas, just fuzziness, which is a good sign. He probed around and explained everything I was looking at. He pointed to where the endometrial lining was and said, "This all looks perfectly healthy and normal. There are no clots, no cavities, no polyps, and no adhesions. The lining is perfect for what we'd expect to see a week into your cycle." Even to the untrained eye, you could tell that everything looked great.

Then he turned the probe to the left and showed me my right ovary (its like driving and flying -- turn to the left goes right, and vice versa). "The right ovary looks great too, see?" I did see. Then he turned it to the right and showed me my left ovary. "And this ovary appears to have a maturing follicle on it. See?" It totally DID! It was a very small black spot. It was really exciting to see it!

Then I got dressed and we went back into his office and talked for another 15 minutes or so. We discussed general health, TTC, and grieving over the loss of our last baby. He said, "I know it never helps when someone says, 'It takes time,' but you need to consider that conceiving isn't just about the physical. When you're distressed, especially after such an enormous loss, your mind becomes a very powerful agent over your body. Your cycles may be a week longer than usual, but you are still recovering from both physical and emotional trauma, and your body is responding accordingly."

He said that we should take it down a notch stress-wise, but he never once said, "I think you should wait." What he said was, "I don't see any reason you can't try every day, but remember, if your body perceives inordinate amounts of stress then your mind and body will sync up, thereby matching each other and making it that much harder on you, physically and emotionally." He said it's basically a vicious cycle -- you start stressing about your stress and then comes failure and you stress again about the failure. He recommended that I keep track of my cycles (as I've been doing) and he even said, "I'm not suggesting that you stop charting or anything of the sort. Just bear in mind, you are young and healthy, and you shouldn't have any trouble conceiving when all of you is healed and ready." He told me that if we still have lingering doubts about TTC right now that we should "trust our instincts" because pregnancy is hard enough to endure under the very BEST of circumstances when you're NOT still grieving, and he said, "I would never advise anyone to tackle the first trimester of pregnancy while they are still recovering from the loss of their last one. Sometimes deciding when the time is right just requires a little more introspection, and the decision to try is always yours and yours alone."

He said to call any time with any questions I may have, and he said, "We treat the broad spectrum of health issues here, so even if you have a sore throat or a nagging headache, please call me, I am always here to help you with anything you need." He then gave me a giant teddy-bear hug and said, "Take care of yourself... my door is always open." As we proceeded out, he said, "Schedule your next appointment and let me know how things are going. Give me a call in two weeks. It was really great to meet you and we'll see each other soon." With that, I knew I had found my new doctor. I was so thoroughly impressed with him and I can't wait to see him again! He was so friendly and intelligent and compassionate. I wish all doctors followed his example.

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This has been an interesting experience for me. I still don't know if we're actually going to try this month, but it's just a few days away and I still feel really torn. Benny thinks we should wait a couple of months, whereas I feel this constant conflict inside of me. I want to get pregnant. I know that for certain. I just don't know if I'm ready to do it again so soon. It'll be almost four months next week since the miscarriage and there's this nagging little voice in the back of my head that is repeating, "You're making this way more complicated than it needs to be!" But the counter-argument is just as strong. "You're not emotionally, or even physically ready to be pregnant again." Both are valid points and I feel incredibly torn between desire and fear.

I am at least relieved to finally know for sure that I have physically healed and there is nothing wrong with my equipment. I have a sneaking suspicion that this cycle is going to be normal. I just have a feeling it's going to go back to 4 weeks this month. I start OPK testing around CD 10 and I have about a hundred of those strips. The question that looms on the horizon, though, is -- will I be going anywhere NEAR Benny that week? Part of me thinks I should stop being so neurotic and just go for it, and part of me thinks we need to wait. That last 2ww was pure torture (as many of you recall from the TTC board) and I just can't go through that again. But I'm a charter, and the whole NT/NP thing is practically incomprehensible to me. I NEED to chart. It's part of my lifestyle. I am not someone who does anything casually. I crave data.

I wish this wasn't such a hard decision to make.

Thanks, ladies, for letting me get that all out. I'll keep you all posted regarding what we decide to do this month. Either we try or we don't. Whatever the case, I will still be around to cheer you all on and support you. I love it here too much to ever leave. This is my sanctuary.

Amy

[amychristian]

My response to another JM member from the TTC forum:

First, thanks to Hollan and Amy for your comments. Amanda, my last doctor was actually wonderful (dare I say as wonderful as this new doctor) but I decided I wanted a change, and while I was very sad to leave him, he was extremely understanding and supportive. He said it's not that uncommon for women to associate feelings of failure and loss with one particular doctor or practice, even if we know intellectually that it's not their fault and it says nothing about their practice. It's just an uneasy feeling going back there after. He said that for some women, it actually brings them closer to their doctors while with other women, it drives a wedge of discomfort between them. Either way, he understood, and sent me off with his blessings. I'd still recommend him to every woman I know.

Knowing that I've physically healed helps a lot. I get so paranoid about my health when things aren't perfect. And these 5-week cycles (not to mention how heavily I was bleeding, the clots, and the extreme cramps) were really starting to make me nuts. I really needed to see it for myself. I needed that extra level of reassurance, and that's what this doctor gave me, and I couldn't be more grateful. He told me to just continue taking my prenatal, B-Complex, and fish oil supplements and to keep exercising and eating healthy. Check!

As for loss, it's a very difficult thing to explain, even to those who have been through it. I had a chemical pregnancy in 2008 and I thought that was bad (and it was) but this was so very different in a way that I just can't explain. Baby stopped developing around 10.5-11 weeks and I had a D&C at 12w5d. Losing a baby after you've just endured the first trimester is excruciating on the heart, the body, and just your overall health. Imagining that D&C, every time I think about it I feel sick. When my last doctor couldn't locate the heartbeat (I will never forget this day as long as I live), I felt everything from depression to guilt to anger to confusion and most of all, disappointment like I've never experienced before in my life.

I wrote at length about it in the Belly Book, which was my pregnancy journal. I had baby's ultrasound picture from 8w3d in there, and then I wrote this excursus on how I felt after the D&C. I felt alone and empty. I felt like a failure. I felt robbed. I put away everything I had bought for baby, and tried to navigate through the grief without a compass. I just dealt with it differently every day. Some days were harder than others. My OB/GYN prescribed some antidepressants and anti-anxiety meds, and I just went off them a couple of weeks ago, and it's been like an emotional slingshot back to reality ever since. I just didn't want to be on any medications if and when I got pregnant again.

I don't feel nearly as bad as I did in February, March, and April, but from time to time there are pangs of sheer emotional torment that remind me of how I felt the day I found out. There are just certain things that trigger the emotions. But there are also days when I see pregnant women, or kids playing in a schoolyard, or when I talk to a pregnant friend, or when I watch a delivery on a TV show, that I am reminded quite warmly of how much I want children.

Though my pregnancy was not ideal (I was very, very sick and had some bleeding later on), I'd go through it all again in a heartbeat if I thought my heart could take it. I don't know if I'm just waiting for some kind of unambiguous sign or what. I am trying to identify the most powerful feeling I have, and right now that feeling is anxiety. But running a close second to that is my will -- my will to get pregnant again and have a healthy baby.

I've said it before... Miscarriage, such as the one I had, isn't something I'd wish on my worst enemy. It hurts you in a way you'll never forget. I was talking to my precious husband a few days ago about "degrees of loss" and while this loss hurt a hundred times worse than my chemical pregnancy, you can never really measure or otherwise qualify the loss of a baby. A dear friend of mine lost her son three weeks after he was born due to a congenital heart defect. He underwent surgery but passed away a week later. I can't even begin to imagine what that felt like for her. She went on to have another son who is perfectly healthy, and she is one of the strongest people I know. She turned her son's death into something positive. She said he made her a better wife, a better daughter, and a better mother, and to me that demonstrates remarkable courage and resilience. So, I don't want to "rate" the pain anyone goes through when they lose a baby, whether it occurs a few days after that positive test or three weeks after your child is born. Something in your heart breaks and just stays broken. You can only try to strengthen the rest of you. Grief is a hard path to follow because there's no right or wrong way to do it. It's very individualized.

I hope that my sadness doesn't keep me from wanting to try. I am trying to work through these feelings on a daily basis because it's all very overwhelming. I still miss the baby I lost, and I don't want to get pregnant for the wrong reasons. I don't want to "replace" the baby I lost. I will never forget him, but I can't let that anchor me in a sea of grief indefinitely.

I don't think the anxiety of fearing another loss will ever go away -- until that baby is safely placed in my arms after I deliver. But after my conversation with my husband about degrees of loss, I've come to realize that we risk losing people every day, at all stages of life. I've had friends and family members pass away, and I grieved those losses similarly. There is a void there that no one and nothing can fill. The pain of losing one baby does not magically go away when you get pregnant with another, and I only just realized that. Loss takes its toll on your spirit.

I know we'll have a child. Maybe a few. I am confident in that. And my husband said, "If we're going to have children, and we are certain, why delay the inevitable?" And he's right. I do kind of feel like I'm just wasting time by being so neurotic about all of this. I am leaning towards trying this month because the justification for not trying isn't stronger than my reasons for wanting a child. It's just there -- the constant reminders of how I felt. I took a beating, but I kept my head above water. There were days you couldn't forcibly get me out of bed, but I tried as hard as I could to power through my grief and move on. I know that when I do get pregnant again, not a day will go by when I won't worry about miscarrying, and that's the saddest part. I will never be able to experience pregnancy with joy and enthusiasm ever again. I will constantly be on the lookout for warning signs and weird symptoms and interpreting every little ache and pain as the worst possible scenario. That's the kind of scar that miscarriage leaves on you, and it's almost impossible to fully recover from that. But I also refuse to let the loss of my baby turn me into someone who lives in fear. I want to honor him without bulldozing over his memory. I want to mourn respectfully without putting my entire life on hold. There is a fragile continuum that needs to be realized, and that is truly the hardest thing to achieve.

Whenever we do decide to try, I will put my whole heart into it, but that fear will never go away. I know that this is something I will carry for the rest of my life. I understand that you cannot replace one life with another, but I cannot remain in a state of grief indefinitely. I said Goodbye and grieved as best as I could. I thought it was over with. But then when I thought I was pregnant last month, it really made me wonder if I was truly ready. It does take a great deal of strength and introspection to come to any sort of conclusion. I just have to reconcile these emotions and try for another baby because, in the end, that is my greatest desire. I refuse to let grief keep me from achieving the life I want -- the love of my life, Benny, and the children we make together, who are reflections of our love.

Children are the only truly unique thing you will ever have the opportunity to do in your life. In a world where we all have the same stresses, the same responsibilities, the same mortgages, the same cars, the same jobs, the same clothes, the same possessions, the same everything, children are the one thing that that you and ONLY you can do that is wholly unique and diverse from every other living thing on the planet. They are the product of your biological achievement. We have existed for billions of years in some form, from single-celled organisms to fish to primate to humans, and each one of us is here today because our ancestors were genetic winners. We are programmed to want our genes to carry us into the next billion years. You are the result of AGES of biological warfare and competition. I recognize this and understand, and I am humbled by that. I want a baby who will be the apple of my husband's eye and the culmination of the love we've shared for so many years. We want to be a family. We want the 2AM feedings and constant diaper changing and breast-feeding and butt-wiping. We want our home to be full of cries and laughter. I cannot let my grief keep me from realizing the family that I know we both want.

[MomtoCTSK]

Your doctor sounds wonderful. I hope that with your renewed confidence and a great doctor standing behind you that TTC, when you decide to do it, will be a much more enjoyable less stressful situation. If only more doctors were like this one.

[JessP]

What a wonderful experience you had. Sounds like the new doctor really helped. Good luck with your decision as to when to try.

[amychristian]

I really want to try this cycle. I will be ovulating soon and it's frustrating NOT trying. I feel like it's a perfectly good egg -- wasted. And my doctor even SAW the follicle on my ovary on Day 8, so I know it's a'comin'!

I don't know what to do. I can just sense ovulation right around the corner.

To try or not to try. That is the question.

[tobi4]

I can tell you that if it were me, I would have to try. If I didnt I would get wrapped up in the 'what ifs'. Thats just me though. Good luck with whichever way you decide!