Only one

As you all know a possible future outcome for us is we never have another living child and M continues to grow up as an only child. I have been wondering about this. How would I feel if this happens? How would S feel? How would my parents feel? How would S's parents feel? And most importantly how would M feel?


I'm going to concentrate on the how would M feel question right now.

Obviously I think it is best for M to have a brother or sister. If I thought it was a bad idea we would never have started trying for another child. S has an older brother. I have a younger brother. As a child we would play together, we got on well. To me life seems very lonely as an only child. I know M can have friends to play with but he can't do that every evening and every day of school holidays or weekends. Will he be okay playing on his own? Will he be okay interacting with other children? His friends already have siblings and he is not yet four years old. Will he feel different being an only child?

There is so much more to consider. And truthfully I am not sure I am ready to think about it all yet. I still hope to have another child one day, but I think I will look into this more. If only to try and reassure myself that we will be okay if it happens. So you can exect more blog posts on this in the future.

In the mean time I wanted to share this interesting article about only children with you. It made me think.

I am interested in your views on this. If you are an only child do you think having no siblings has disadvantaged you in any way?

Not much hope

Well I am still here. Now 34 years old. My birthday was just over a week ago. I was 31 when I got pregnant with Orson and 32 when he was born. Seems like such a long time ago.

Nothing much has changed in my life lately. I am still not pregnant. Beginning to think it will never happen. When I lost Orson in July 2010 I found so many blogs of women who had also lost babies - most have either had babies since then or are now pregnant. It is the same with women I have met in forums. It gets very hard hearing so much good news when I don't have any to share myself.

I am trying to be positive. Trying to concentrate on the future. But I cannot escape the fact that my life isn't how I would like it and there is nothing I can do about it. I am trying to concentrate on Christmas. But I remember the last two Christmases. I discovered I was pregnant with Orson around Christmas time two years ago. I found out I was pregnant again about this time last year. At Christmas I had so much hope for this year. 2011 was going to be a very good year. But instead it has been very poor. Two miscarriages and six months since my last one and right now I am still not pregnant. I want to believe 2012 will be a good year but right now I don't have much hope for it.

Results: Unlucky

Image: tungphoto / FreeDigitalPhotos.net

You may recall back in September I wrote a post saying that I had finally been tested for everything recurrent miscarriage related? Well I have finally got the results.

I have to admit I was hoping that they would find something wrong that was easily correctable. Something that explained losing Orson and both miscarriages. Of course no magic explanation exists and I knew that that 50% of the time the results all come back normal even when things clearly are not normal (so the miscarriages keep happening even with normal results).

So I expected my results would probably be normal. I was correct. I'm normal. Both me and S had completely normal chromosome results, my barrage of thrombophilia  tests were normal and my antibodies are fine too.

So what does this mean?

Well as you already know a sample of pregancy tissue from my June miscarriage was sent off for tests and they came back positive for Trisomy 22. Trisomy 22 pretty much always results in miscarriage. The Doctor today said that women who have one Trisomy 22 pregnancy have an increased chance of another Trisomy pregnancy, and in my case that would probably be a Trisomy 22 pregnancy. I was reassured that the chance of that happening is low, the chances of a normal pregnancy are much higher. I do like my statistics so asked about the chance she guessed that where the chance is normally 1% with me it is 5%. Although another Trimsomy is most likely to occur with chromosome 22 it could happen on any so early in pregnancy I would be offered all the Trisomy screening tests.

So for now we just keep trying to get pregnant and hope our luck improves. If I get pregnant I need to  take asprin (just in case) and take the normal dose of folic acid (I asked about a higher dose and was told it is not needed). I was reassured that I just need to phone the hospital early on in a new pregnancy and they will get me seen and scanned before 12 weeks.

Of course I still have to get pregnant. It has never taken us so long. I am beginning to doubt it will ever happen, but I will save those doubts and worries for another post.

Trying

Trying to conceive.

Trying to get pregnant

Trying for a baby

One thing they all have in common is the word trying. Trying is included in these phrases because there is a chance you might not succeed. Those of us trying to get pregnant are all too aware of this.

I decided to research euphemisms for trying to conceive (30 seconds on Google searching for "euphemism trying to conceive.") I didn't do too well but instead found an article which was kind of funny. If you have ever spent some time trying to conceive you may find this funny too so I thought I would share it with you. The full article can be found here. I am in no way trying to imply that the article or website is at all factually correct, hopefully you know I know it is not. My intention is not to offend only merely to make you laugh. It was just the start of the article that I found funny and so that is what I have reproduced below for you:

Breathe: A Guy's Guide to Pregnancy
By Mason Brown

Trying to Get Pregnant

Getting pregnant doesn't just happen. You have to work at it (unless you're dating an unwed teen, in which case pregnancy can occur via contact with a doorknob).

Amazingly enough, science has proved beyond doubt that the odds of conception are inversely proportional to the desirability of conception. A simple graph renders this concept easy to grasp.

This immutable law of nature results in a curious corollary — the more financially successful a couple is, the more likely they are "trying" to have a baby. "Trying to have a baby" is a euphemism for "rogering like feral weasels," which is in turn a euphemism for "having sex often."

Some couples proudly announce that they are trying to have a baby without realizing that they are presenting an unsavory visual picture to their audience, who immediately conjure up the image of the naked wife doing a headstand while her husband cheers his mighty swimmers onward. More often than not, this visual image is uncannily accurate.

Still others try to conceal their efforts, feeling that failure to conceive reflects badly on themselves. Unfortunately for these shy souls, it is all too easy to tell when a couple is really making an effort. In such cases, one or more of the following symptoms will appear:

FOR THE MAN

Drowsiness
Irritability
Heightened desire to watch SportsCenter

FOR THE WOMAN

Normal post-coital glow replaced by grim attitude of soldier in the trenches
Constant concern over husband's choice of briefs rather than boxers
Neck strain from standing on her head after sex

Obviously, if a couple would really, truly make good parents, then all efforts to conceive are rendered futile. Nature abhors functional families. So, if you really want your wife to get pregnant, forget fertility clinics — institute divorce proceedings. Just remember to have one last drunken, abusive fling before separating. You'll be a daddy in no time.

A story: Mr K's bad mood

When I was in my very early twenties a friend told me a story about someone we knew who I will call Mr K. She explained that he was in a bad mood. He was in a bad mood every month because his wife got upset when she got her period. My friend had to spell it out to me - Mrs K was upset because getting her period meant she was not pregnant. The couple had no children.

I was young, I had just left university and although I was in a relationship with S we were years away from thinking about having children. It was a bit of a revelation to me that to someone trying to get pregnant getting your period wasn't just a minor inconvenience. Even after my friend had explained the situation I don't think I truly understood how upset the couple might have been. They could just try again next month right? And what difference is a month or two anyway? And isn't it easy to get pregnant - isn't that why people use contraception?

At some point (I am afraid I am hazy on time scales) I remember signing a card for Mr and Mrs K and we gave them flowers. Mrs K had miscarried. It took years but eventually they adopted two children. They finally got their family.

At the time I never fully appreciated how hard it must have been for Mr and Mrs K to try for a baby for such a long time, to miscarry, to continue to try and fail, to apply for adoption and to wait to see if they would get any adopted children. I also want to add that I didn't know Mr K very well and never met his wife (just to defend my young self a little for my ignorance).

I haven't thought about Mr and Mrs K in years, but the other day when I got my period I found myself remembering my friend's story about Mrs K being upset at getting her period. Whilst I am sure that even now I do not fully appreciate how difficult Mr and Mrs K's journey to have a family must have been, I do feel that I have much more of an understanding now. And I certainly get how getting your period is upsetting if you are trying to get pregnant.

Image: dan / FreeDigitalPhotos.net

Tests

Image: Ambro / FreeDigitalPhotos.net

Everything felt very bleak after my last miscarriage. I felt like there was no point in trying for another baby because I will just miscarry again. I have a little more hope now. But what would really improve my hope would be tests. I really want tests to determine if there is anything wrong with me or S that is causing my miscarriages. This week I got slightly closer to my goal of getting these tests.

I saw a Consultant this week who explained that the sample of pregnancy tissue sent off after my ERPC had Trisomy 22. This means the pregnancy had three chromosome 22s as opposed to the normal two. He suggested that there is probably only a 1% chance that either myself or S are carriers of Trisomy 22. More likely it is just a random mutation caused when the egg or sperm was created during the dividing process known as meiosis. Normally an egg or a sperm has just one set of each chromosome if something goes wrong during meiosis and a sperm or egg ends up with two copies of a chromosome and that sperm or egg is fertilized the resulting embryo will have three copies of a chromosome instead of two. Trisomies can happen on lots of chromosomes. The most famous Trisomy is Trisomy 21 - it's better known name is Down's Syndrome.

I of course Googled Trismy 22 and found out it accounts for around 3% of first trimester miscarriages. Pregnancies with it rarely progress past the first trimester.

The Consultant explained that everyone has a chance of having a Trisomy pregnancy and that chance increases with age. Because I have had one Trisomy pregnancy now he believes my chance of a second one is increased. He didn't say by how much. And a second Trisomy could occur on any of the chromosomes, including 21. He guessed that at my age (33) the chance of a Down's Syndrome baby is normally around 1 in 600 and now I have had one Trisomy pregnancy is is probably about 1 in 400, so still very small. In any future pregnancy I will be referred to the Foetal Medicine Unit at my hospital at around 11 to 12 weeks to discuss the Trisomy issue.

We are also being referred to the Hospital's Recurrent Miscarriage Clinic. The Consultant agreed we not only need to be tested to see if we are Trisomy 22 carriers but for other miscarriage causes. He said the Clinic will also be able to explain the odds of Trisomies reoccurring more accurately. I am really pleased after all I have wanted tests for ages. But at the same time I am still a little disappointed because it takes so long. We were told to expect a letter giving us an appointment within a month. No idea when the actual appointment will be. The NHS is very, very, very slow.

We asked the Consultant whether it is okay to try for another pregnancy, he agreed it is fine. He tried to end the meeting happily by explaining that it is not unusual for women with my pregnancy history to have healthy babies. I am trying to convince myself I will be one of these women.

Time for some statistics

image: nuttakit / Freedigitalphotos.net

It is time for some statistics.

Before go on I should probably point out that I have no idea if any of the statistics I am going to quote are correct. I have added links to the sites that use them but often the sites themselves do not say how they came up with the statistics so who knows if they are correct.

Getting pregnant

To start with here are the statistics nobody tells you when you are young and being warned to always use protection otherwise risk an unplanned pregnancy. Nice and scary when you are impatient and trying to conceive though!

90% of couples in which the woman is under 35 will conceive naturally after one year of actively trying according to the NHS. 30% conceive in the first month and 60% within six months according to Babycentre.

Miscarriage

When you are lucky enough to get that positive pregnancy test these are the next set of statistics to worry about. These stats are curtesy of Babycentre.

What is the chance of miscarriage in first 12 weeks? After a positive pregnancy test, there's about a 20% chance of having an early miscarriage. Late miscarriage (between 12 and 24 weeks in the UK) is less common. It happens in about 1% of pregnancies.

Stillbirth

Now for the statistics that Orson fits into...

In the UK 17 babies are stillborn or die shortly after birth every day (ref: SANDS ) In the UK stillbirth is defined as death of a baby before birth at 24 weeks gestation or above. In England and Wales 5 out of every 1000 babies are stillborn (just over 3000 a year) (ref: NHS )

pPROM

And what about the chance of pPROM? Only around 2% of women experience PPROM.
(ref: RCOG ) Since pPROM is where a women's water breaks before the onset of labour before 37 weeks I would imagine many of the cases will have a positive outcome because the water will break so close to term. I have not seen any statistics on early pPROM but I suspect it is rare. And the chance of having pPROM before 24 weeks and continuing the pregnancy for another 10...? I think it is very rare, after all there must have been a reason the doctors told tell women whose waters break so early they will miscarry within 3 days.

What does it mean?

And what do all these chances mean (apart from that I have been using the Internet too much!)? Well nothing really. Any of you reading this blog of course knows that statistics really don't mean very much. We have all been unlucky with statistics. We can't predict what will happen, we just have to hope and be positive. Still on a bad day it is hard not to be disheartened by these statistics.

Consultant appointment; causes of pPROM and stillbirth and the future

I finally had my consultant appointment yesterday. This appointment seems to have many names, follow up appointment, 6 week appointment, counselling appointment... but essentially it was to discuss my pregnancy with Orson, where I am now physically and emotionally and then the future.

After the appointment I was of course sad. However I was surprised how well I coped during the actual appointment. Normally you are supposed to have the appointment 6 weeks after your loss. In my case it has been over 3 months. But I was calm during the appointment and even found myself laughing at times. Had I had it 6 weeks after Orson died I think I would have been in tears for most of the time.

I had lots of questions for my Consultant, she said she would put everything we discussed in writing to me but here are her answers as best I remember.

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Why did my waters break (pPROM) at 21 weeks?

Obviously the Consultant does not know for sure but in her opinion I had pPROM because of the heavy bleeding I had in the first trimester. I bled at 6, 7 and 8 weeks and was diagnosed with a large area of haemorrhage / haematoma. She thinks that is why my waters broke. Possibly also the Step b that was found in vaginal swabs also played a role.

Why did I go into labour at 31 weeks?


The Consultant was almost certain that the infection I was diagnosed with during labour actually made me go into labour. She does not know what the infection was, possibly Strep b or some other anaerobic infection. I got it simply because my membranes had been ruptured for so long.


My blood cultures came back with a Staph infection however the Consultant thought that may have been contamination from when they took the blood and that it is far more likely that I had a different infection that just wasn't identified or the Strep b that was.

Why did Orson die in labour?

We did not have a post mortem so cannot be certain but the Consultant thinks that Orson had the same infection that I had. She believes this was the cause of his death.

The tests run on the placenta, for example genetic testing were all okay.

Would it have made a difference if I had realised I was in labour sooner (I could have been at the hospital an hour earlier)?

No. The Consultant thinks that if I had been at the hospital an hour earlier they may have been able to do an emergency c section (Orson had a weak heartbeat on an ultrasound scan 10 -15 minutes before a second scan showed there was no heartbeat). Had they been able to resuscitate Orson and assuming his lungs were sufficiently developed she thinks he would have died aged one or two days old from the infection that I had.

Was the risk of stillbirth much lower than the risk of delivery bearing in mind I had so much blood loss etc. the week Orson died?

Yes. If I had been a few more weeks along then I would have had a scheduled delivery. However at 30 - 31 weeks bearing in mind how little amniotic fluid I had after 21 weeks Orson's lungs may not have been sufficiently developed and he needed the extra weeks. He may not have survived even if he didn't have the infection. In most cases where preterm labour occurs at this stage they would have had time to deliver. We were just very unlucky.

What are the chances that pPROM will happen again?

Assuming my pPROM was caused by the bleeding then 1:50. If I get past the first trimester (1:4 chance of miscarriage) then the Consultant thinks it is likely I will get to take a baby home but that it is likely to be premature or early.

When can I try to conceive again?

Anytime. After a couple months physically I would have been ready. However the Consultant stated that women who get pregnant within a year after stillbirth find it emotionally much harder to cope with the pregnancy than those who leave it longer.

What treatment is there for a future pregnancy?

After an early scan I would see the Consultant at around 12 weeks. I would be tested for infection and after these results were known they would decide on treatment. Possibly if I had Strep b still they may give low dose penecilin from around 18 weeks. However this may have other effects and cause other infections.

From 16 weeks I would have vaginal ultrasound scans to check my cervix was okay. I think she might have said every two weeks for a few weeks.

From about 28 weeks I would have growth scans every 4 weeks.

What about the flowing treatments:
-cerclage?

In my case this is unlikely to be of benefit. The Consultant does not think I have a weak cervix and a stitch may introduce infection.

- progesterone?

This is used for women who have had preterm labour. The treatment is going out of favour and is being used less now. However according to the Consultant I do not fit into this category as I showed the opposite tendency - I didn't go into labour for 10 weeks after pPROM.

- vitamins?

Taking multivitamins for pregnant women will not do any harm. The Consultant said when I pressed her on this that she would recommend it and to ensure they include vitamin d and folic acid.