Let’s talk about Postpartum (Part 1)

November 9, 2021 1 Comment

Peanut is now 6 months old and it feels like just yesterday but also oddly really long ago that I was in the postpartum phase of my fertility journey.

As a medical student and resident physician, I did not receive a lot of training about the postpartum period. The postpartum period is generally considered the 6-week timeframe following delivery. I knew the big pointers and things often tested on exams:

the difference between Baby Blues and Postpartum Depression
vaginal bleeding goes through different phases of coloration
the uterus size decreases over several weeks
breastfeeding does not necessarily come naturally to the birthing person and/or baby
sore nipples if breastfeeding
how to monitor baby’s weight gain appropriately

That’s about it. I would venture to say that most of you reading this know about most of those things even if you or your partner haven’t gone through the postpartum period personally.

My co-residents/baby doctors visiting us Postpartum Day 1

Learning from experience

I definitely did not feel fully informed/prepared for the recovery time after delivery. All of my knowledge was so generalized. Yes, I knew I would bleed, but for how long? I knew that I would have sore nipples if I was successful with breastfeeding, but for how long? And I figured the vaginal area would hurt after pressing a human out of it, but again, for how long? When would it be ok to start working out again? Which workouts would be best?

I had a great birthing experience, was able to do it without pain medications, but I did have an episiotomy. Every birthing story is unique and I can only speak from my own experience from the singular birth I’ve ever gone through (as the birthing person). So the experience is likely very different for someone who had an epidural or difficult delivery or there were problems with the baby.

Talking to my tribe

Speaking with my friends in Germany who have given birth and following their postpartum journey, I was reminded of how very different the postpartum period is depending on your location. It’s a special feeling speaking with others who have gone through labor and delivery because they can understand and relate so much better than someone who hasn’t. That’s essentially the case with any experience in life though really. That’s why support groups can work so well.

I asked my friends and my Instagram followers to share some of their stories and experiences with me. I want to summarize some of the things they shared over several posts. Additionally, I’d like to highlight some of the differences between a postpartum journey in the USA versus Germany. Finally, I’ll share some of the products birthing people and their partners shared with me which they found particularly helpful during the postpartum period. (I am not receiving any merchandise or financial reward for mentioning any of the products. These are purely recommendations from people who felt it made their postpartum lives a bit easier.)

Postpartum Surprises

Personally, I didn’t anticipate how hard it would be to just sit down anywhere after my episiotomy. Healing from that was really the only thing I disliked during my postpartum period. Everyone gets instructed on perineal care after delivery even if you don’t have a tear or episiotomy that needed suturing. Essentially every time you use the restroom, you have to flush the area with water to keep it clean. Now imagine a major wound healing in the perineal area. It made walking uncomfortable and sitting comfortably nearly impossible.

Add to that the normal bleeding after delivery. Going to the bathroom was such a process. Changing the blood-drenched padding, waiting for the water to be somewhat warm so you could fill the squeeze bottle with it, flushing the area, patting the area dry, applying the pain-numbing spray, and getting all dressed again, every. single. time.

Poop PSA

Speaking of using the bathroom. Let’s be very frank about pooping after delivery. (Pooping during delivery is totally normal and I assure you neither the nurses nor the doctors care one bit. If you are worried about your partner feeling some type of way about it, maybe reevaluate your choice in a partner) Postpartum pooping is not a joke. My advice to everyone having a delivery… DO NOT FORGET TO TAKE STOOL SOFTENERS! Between the hormonal changes, not drinking sufficient (if any) water during or after delivery, the organs shifting into a new place after the baby is out, and extremely decreased physical movement after the delivery, constipation is nearly unavoidable.

I was very diligent about taking Miralax during my pregnancy. In the hospital, I was given a stool softener. When I arrived back home 24 hours after the delivery,… I forgot to continue taking the Miralax. BIG MISTAKE. I have never been so constipated in my life. I was also worried about the episiotomy wound healing ok while trying to have a bowel movement. If you remember anything from this post, please remember to take your stool softeners after delivery!

What surprised the Tribe?

Here are some of the responses I received when I asked, “What surprised you the most about the first few weeks after birth?”

How I slept with the light on because I was afraid of everything!
How awful breastfeeding is./The struggles relating to breastfeeding./ That breastfeeding is not a given and works right away
All the blood. All the belly. And how quickly it went away!
The impact of sleep deprivation on every. Single. Area. Of my life
How little sleep I actually needed
My joints did not feel strong for a long time! They almost felt wore out. Boo!
That first post-birth poop. Nothing prepared me for that lol (Remember people, stool softeners are your friend)
No time for anything – even though we were two people. Sometimes hardly found time to eat
How tired/emotional I felt, how terrified I was of doing something wrong
Bladder control after, cramping while nursing, overproduction of milk
Crying for no reason!
How the baby was emotionless until week 4-6. Cried at birth, but within 10 minutes just quiet and examining.

I can relate.

I could relate to quite a few of these. It took me a few nights to figure out just how much light I needed in the room to sleep and function when the baby was awake. I tried different night lights and having the lights on in the hallway. Eventually, I landed on just having the light from my Owlet base station be enough for me to see in the dark once my eyes adjusted. That is still all the light I have on during the night now.

My breastfeeding experience was rather uncomplicated except for the sore nipples. Oh my. It is quite the transition from not using your nipples and trying to avoid wardrobe malfunctions to having them constantly being used and whipped out in all sorts of settings. I’ve been a rather flat-chested person for most of my life. The engorgement and sudden seemingly Pamela Anderson-sized boobs were an experience. There were definitely a few days where it hurt pretty bad for the first 30-60 seconds when the baby latched on. With time, lots of nipple cream, and repeated use, the pain disappeared and the cracks healed. My boobs had a different shape, size, and consistency to them multiple times a day for the first several weeks. Eventually, those changes become more subtle.

Sleep deprivation was not a huge issue for me. It just feels like I have been on call for the past 6 months lol. Medical school and residency definitely trained me well. A while back, I learned that breastfeeding parents don’t interrupt their sleep cycles like non-breastfeeding parents do when they are awake with the baby. The body is wired in a way that allows breastfeeding parents to quickly fall back into the sleep cycle pattern they woke up from. Mother Nature’s way of trying to help with the sleep deprivation a bit, I guess.

Postpartum awareness

Society at large knows more about pregnancy than it does postpartum. There is also the weird fact that pregnant bodies are admired and praised while postpartum bodies are immediately judged and misunderstood. I hope to raise some awareness about postpartum and normalize it. It’s the fourth trimester and belongs to pregnancy as much as the first three trimesters with the baby still in the belly. It has its own unique challenges and I would say a much steeper learning curve than any of the trimesters with baby still on the inside.

I would love to hear from you about what surprised you the most about your own or your partner’s postpartum journey! Let’s share our experiences so postpartum parents don’t feel so alone in their experience and soon-to-be postpartumers are a bit more prepared for what’s to come!

mfg

Herstory, Motherhood

How to make a baby. No birds or bees necessary.

July 31, 2021 No Comments

Fertility treatments are on a spectrum of how much is involved in achieving a pregnancy. On one end, you have home insemination kits where you buy the sperm and it gets injected into the vagina. The sperm then have to find their way through the cervix to the uterus, up the fallopian tube where they hopefully find an egg coming their way. On the other end of the spectrum lies IVF. This can involve many hormone shots, egg retrieval procedures, fertilization of the egg with a single sperm, genetic testing of the embryos, and implantation into the uterus.

My journey as one step up from home insemination. No turkey baster for me!

Intrauterine Insemination (IUI)

The procedure I had performed was called intrauterine insemination. In other words, washed sperm is injected with a syringe and tubing that has been placed through the cervical opening directly into the uterus. It’s essentially a fast pass for the sperm because they don’t have to find their way through the cervix themselves. “Washed” sperm means that any mucous and non-motile sperm have been removed. This leaves the good swimmers left and increases the chances of pregnancy.

Eisprung

Eisprung is the German term for ovulation. Literally translated, it means egg jump. I’d like to think of my eggs as little athletes who have to jump to get where they want to go, lol.

Before the IUI could be performed, I had to predict when my ovulation was going to happen (i.e. when the egg gets released from the ovaries). To do this, I would start using an ovulation predictor kit (available at drug stores/grocery stores and online)about 4 days after my period ended. Each woman has her own cycle length. I had recorded mine for many months prior to starting to try to conceive using an App. That way, I had a pretty good estimate of when things might happen since my cycles were fairly regular.

Ovulation occurs about 14 days before the next menstruation starts. That’s only helpful information if you know the average length of your cycle. Otherwise, when your period starts, you can only say you ovulated about 2 weeks prior. That’s not helpful when you need to know when you’re going to ovulate for a procedure. There are some physical signs you might be ovulating soon. The consistency of the cervical mucous changes to become more watery around the time of ovulation. This allows for sperm to more easily get through the cervix to their destination.

Smile! You’re about to ovulate!

To use the ovulation predictor kits, you have to either pee on the tester or dunk it in a cup of pee in the morning and wait. The one I used showed a smiley face if your ovulation was likely to happen in the next 24 hours. The test looks for the LH (luteinizing hormone) surge. The surge in LH triggers ovulation.

For the first round of IUI, my smiley face unfortunately presented itself the day before my family medicine board exam. I wouldn’t have been able to move that so I spoke with my doctor and decided to do it a day later. This drastically decreased my chances of it working out. However, I had ordered two vials of sperm and was only going to be in the area for two months. I didn’t want to pay for storage or shipping fees if I would’ve had sperm left over.

Not surprisingly, the first round didn’t work (even with my fertility dance). I wasn’t too upset about it since I knew the chances were slim.

Round two went much more smoothly.

Making a baby with my mom in the room

My mother was with me for both of my IUI sessions. I felt it was really nice to share that moment with her and I think she quite enjoyed it as well. Great story to tell my child someday.

So when the smiley face showed up the second time, things really fell into place. I was able to get off of work to have the procedure done the next day.

First, we had to show up an hour before the scheduled appointment to sign off on the sperm. This allowed the fertility clinic to process the frozen sperm for the procedure. An hour later, my mother and I were sitting in the exam room. A nurse practitioner came in, verified my identity, and had me verify my sperm donor’s information on the vial. Then I laid back, relaxed, put my feet up and the NP injected the sperm into my uterus. Afterwards, I laid there for about 10 minutes. That was it. Pretty uneventful. Not painful. And less fun than the alternative way of getting pregnant.

Two lines!

Two weeks after the IUI and on my last day of residency, I took a pregnancy test and it was positive!

My excitement was contained. I was very happy that it worked. I had never been pregnant so I was excited that I now knew I could become pregnant. Knowing how many more steps there were until I would be able to hold my hopefully healthy baby, my reaction to the positive test was not comparable to that in the movies. But I was definitely excited for the many milestones ahead and knew that with each of them, my excitement would grow.

Check, please!

One of the questions I often get is how much this all costs. I can only say what I paid. Each fertility journey is different with MANY different factors that can effect the cost. Some fertility clinics have all-included packages or reduced prices for self pay. I was self pay since my health insurance didn’t cover fertility treatments at the facility.

My expenses, including office visits, genetic testing, labs, imagining, IUIs, and sperm came to about $3,750.00 total. Each additional round of IUI would’ve cost me about $820 (sperm + IUI procedure).

I was grateful to be a position where I was able to save up and afford this. It would be nice to see health insurances increasing their coverage of fertility treatments. Maybe not primarily in my scenario but rather for people dealing with infertility. Infertility is a medical disorder, it’s not something people choose to have. My opinion is that it should be treated as such and be funded like other medical disorders are too.

Correction

Before I wrap up this post, I did want to make a correction to my previous post. I have since then learned that it actually IS possible for single women and lesbian couples to have fertility treatments done in Germany. I had someone come visit me a few days ago who is currently pregnant, a single mother by choice and had her procedure done in Germany. Apparently, the laws have changed somewhat which created a gray zone in the legislature. This made it possible for fertility clinics to start offering the services. So YAY to that!

mfg

Herstory, Motherhood

The Workup

July 15, 2021 2 Comments

Greetings from Germany! Peanut and I have been in Germany for almost two weeks now. Family and friends are stopping by to get to know peanut and I’m eating a ton of yummy German food.

In the last post, I explained how I chose my sperm donor. Before I could try becoming pregnant, however, there was a list of things I needed to do first. Keep in mind that each person’s fertility journey is unique and every clinic has its own unique protocols. I can only speak from experience about my journey with the clinic I chose.

The R.E.I. Specialist

No, not someone who is really into camping and works at the Recreational Equipment Inc. but rather a Reproductive Endocrinology and Infertility specialist. First on the list was a consultation with an REI specialist. As I had mentioned, a lovely woman I met during residency, who was finishing up her REI fellowship, recommended I have a consultation with her friend and co-fellow. This was during the beginning months of the pandemic, so it was a virtual visit.

We discussed my general medical history, sexual history, and desire to conceive. She explained the process and the steps that would be necessary to move forward. She ordered some basic labs as well as labs more specific to fertility such as follicle-stimulating hormone (FSH) and anti-mullerian hormone (AMH). Sexually transmitted infections testing was also done. A pelvic ultrasound was ordered to take a look at my ovaries and uterus. A hysterosalpingogram (HSG) was ordered as well. An HSG is a radiological procedure where a contrast solution is injected into the uterus through the cervix to show the contour of the uterus and assess if the fallopian tubes are open.

I also opted to have genetic testing performed to look for an exhaustingly long list of recessive genetic disorders. My sperm donor did not have genetic testing done prior to being allowed to donate. The sperm bank I used now requires all new donors to be tested. I really wanted this particular donor and felt that if my recessive gene test panel was negative, then I could move forward with him. For those of you who don’t remember how recessive genes work, both parents have to have the recessive gene AND pass it on to the child for it to affect the child. So, if I wasn’t positive for any recessive genetic disorders but the donor was, my child wouldn’t be affected. They could still be a carrier for the disease but I’ll end the genetics lesson here. Thankfully, my entire workup was unremarkable.

The Cardiologist

Prior to my REI appointment, I had an echocardiogram done to assess my heart. I have always had somewhat hyper-mobile joints and am quite tall with low back issues at times. The possibility of Marfan’s disease had crossed my mind on several occasions. I was never too worried about it until I was seriously contemplating becoming pregnant. It didn’t necessarily help when a physician assistant at one of my rotations told me the story of how she knew a girl whose mother died during childbirth from aortic rupture due to undiagnosed Marfan’s syndrome. Thankfully, my heart is fine.

The Geneticist

Despite the normal echo, I also met with a geneticist to discuss genetic testing for Marfan’s syndrome and other connective tissue disorders. I had a genetic connective tissue disorder panel done. Again, thankfully it was all normal. Now I felt like I could definitely move forward with trying to conceive and carry a child.

The Psychologist

A mandatory step prior to trying to conceive with the fertility clinic was meeting with a specialized clinical psychologist. We discussed my desire to become a mother, why it hadn’t happened with a partner yet, and how I plan to raise the child. She gave me really great insight into several topics.

Motherhood: this means different things to different people. There are also different aspects to motherhood and you may use all of them or just some. Motherhood can mean contributing your DNA to create a child and/or being pregnant and/or raising a child. I am very, very fortunate to be able to have all three aspects with my child. Some people use surrogates or require an egg donor. Some (myself hopefully included someday) adopt and raise children. These people are all mothers. For some, certain aspects might be particularly important. I really wanted the experience of pregnancy and knew I would be very sad if I couldn’t.
Sperm donor children: apparently, there are online sites where you can register with your sperm donor’s number/sperm bank information and find other families that used the same donor. This way, the half siblings can meet up. I do not plan on doing this unless my child decides they would like to. Then, I’ll support it 100%. My family is big and I have a lot of friends, so I don’t currently feel the need to expand that even further.
Single mother by choice: there is definitely a community of women, like myself, who have decided to be single mothers. There are websites, forums, Facebook groups, etc. where I could go and find support should I need it.
Raising a donor child as a single mother: the psychologist told me that there are multiple children’s books available that address this topic. In today’s world, there are so many different types of family structures raising children: mom & dad, mom & mom, dad & dad, single mom, single dad, step-parents, grand-parents, aunts & uncles, etc. I have to raise my child showing them all these different structures so that they don’t feel like someone (“dad”) is missing.

Checklist complete

Luckily, my entire workup was unremarkable and I received the green light from the psychologist to move forward with trying to conceive. I selected my sperm donor and ordered the sperm. Although the fertility clinic recommended I order four vials of sperm, I only ordered two. They had told me that most people conceive within three rounds of intrauterine insemination (IUI) (I’ll go into more detail about this in a future post). I was only going to be in the Ohio area for two more months before traveling and then heading out to South Dakota for work. If it hadn’t worked in two rounds, I would’ve established care in South Dakota and would’ve shipped more sperm there.

My appointment with the REI specialist was June 1st, 2020. My first round of IUI was July 14th. It took about a month to get the entire workup completed. I was then able to start the routine for the IUI. That will be the subject of my next post!

Svikki MD

On a different note, things are in the works for my next assignments! The first assignment will be somewhere in Ohio from September through December. In January, I will most likely be out in Oregon for 7 months! I’ll share more details once things are locked in.

As always, feel free to reach out with any questions you may have. I’ve really loved the outreach so far and getting to speak with people about sperm donor pregnancies. Really exciting news pertaining to this came out of France this week. France has passed a law allowing single women and lesbian couples to get fertility treatment! This was previously only allowed for heterosexual couples. Similar rights exist in 10 EU countries, the UK, Norway, and Iceland. Germany is unfortunately not one of the 10 EU countries that allow single women and lesbian couples to receive fertility treatments.

I am so thankful I was allowed to pursue my dream of motherhood on my own terms.

mfg

Herstory, Motherhood

So many choices

June 24, 2021 1 Comment

It has been a great 7 weeks so far as a mother. We took a two-week trip to Wisconsin to visit family and have been back in Ohio for almost two weeks now. There has been some increased crying over the past two weeks but the nights are still very manageable. We’ve applied for the American and German passports and received the American one in the mail yesterday!

Ok, so let’s talk about the process of how I got pregnant a bit more. I’ll share different parts of the journey with each post. I already shared why I decided to become a single mother by choice in my previous post. As I had mentioned, I happened to meet a reproductive endocrinology and infertility doctor during residency. She gave me some recommendations on sperm banks she liked working with. That is where I began the journey.

Choosing a Donor

If you were to line up the men I dated over the past 10 years, you’d notice they are quite the diverse group of fellas. They all had fairly similar personalities, however. Something obvious would be that the majority of them were black. Over the past 10 years, when envisioning my future children, I often envisioned them to be mix-raced due to the men I was dating. When it came to choosing a sperm donor, however, I decided to choose a caucasian donor.

Although I mainly dated black men in my life, I did not think it was fair for me to have a mixed-race child that society would see as black and not have a partner present to help that child navigate the world (especially in the USA) as a black child. I don’t know what it’s like to be black. I’m aware I live in a world that (besides my gender identity), is built for me to thrive in and I do not have the same obstacles. Although I intend to adopt in the future and there is a chance my adopted child will be black, they already exist in the world and I am giving them a loving home to grow up in. In that case, I will also make sure they have exposure and connections to that community.

So once I decided on my donor being caucasian, I narrowed down the list with a few aspects. I wanted the donor’s description to be as close as possible to someone I would be attracted to. I first narrowed it down to donors who are taller than me. Then, I eliminated the blondes. Although I’ve dated a blonde or two, they usually aren’t what I’m attracted to. That narrowed the list down to around 10 donors. I requested extended profiles for each of them.

Tell me everything!

The extended profiles were about 30 pages worth of information on each donor. They covered information including:

Donor Fertility History
Donor Health History
Nutrition
Exercise
Medical History
Exposure History
Tobacco Use
Alcohol Use
Caffeine Use
Work History/Experience
Sexual History and Relationships
Family Health History
Ancestry
Children’s Medical History
Personal Essays
Personal Characteristics
Physical Features
Psychological Profile
Detailed Family History of Father, Mother, Siblings, Grandparents, Aunt and Uncles

As you can see, that’s a lot of information. I’d venture to bet that is more than some people know about the person they decided to procreate with.

My donor was the third profile I read from the ten I requested. Everything was perfect for me except for a cat allergy (and there is loratadine for that should my child inherit that particular trait). Some important aspects for me were Family Medical History, Psychological Profile and Physical Features. His personality is similar to mine and we have many of the same interests. The personal essays were interesting to read. While my donor had a very genuine and kind reason for wanting to be a sperm donor, others were less impressive. My favorite answer from one of the donors when asked why he wanted to be a sperm donor was “honestly, I didn’t know I could get paid for this!”. While I appreciate your honesty, bro, no thanks.

I was visiting my father at the time I was vetting through the profiles and would read them out loud to him. When I excitedly read my donor’s profile to him, he asked if I was choosing a donor or my next boyfriend. I guess that is a good sign.

Show me the money!

You can spend a fortune on choosing a donor if you so please. Firstly, different sperm banks have different prices for a vial of sperm. It was recommended that I order 4 vials. I only ordered two, but more on that in a later post when I talk about the process. The sperm bank I went with charges $500/vial. There are sperm banks that charge upwards of $1000/vial.

Besides the extended profile, the other extra thing I paid for was some childhood pictures of my donor. My sperm bank does not provide current photos of their donors but does mention celebrity look-a-likes. Other sperm banks do supply a current photo for a fee. The only other extra item my sperm bank offers is an audio file of the donor. I opted not to purchase that (although maybe I will in the future). Other sperm banks have a plethora of extras you can purchase. This can quickly make the sperm donor choosing process an expensive one.

Call me, maybe?

One last thing that was very important to me: an open donor. This was important to me and also strongly recommended by the reproductive psychologist I had an appointment with (more on that in a future post). This means that my child will have the option to contact the sperm bank and obtain contact information of the donor when they turn 18. In a day and age of DNA test kits, the last thing you want is your child to take a test, find their biological father and that person wants nothing to do with them. I will support my child’s decision, whichever way they decide to go with this.

What’s in a name?

That which we call a rose, by any other name would smell as sweet. That might work for Shakespeare and his Montague and Capulets. But what do you or your child call the sperm donor? Do you always say “sperm donor”? I don’t really want my child to refer to that person as “the sperm donor”. I still have a bit of time before this actually becomes a topic of discussion with my child, but currently, I am leaning towards referring to the sperm donor as their father when talking to others. When it comes to talking with my child about it, I still haven’t decided how exactly I’ll refer to the sperm donor. Supposedly there are children’s books available for these situations. I’ll have to find and buy them soon.

I feel father is a formal name for a person whose DNA helped create a child. The term “Dad”, in my opinion, is reserved for the person who raises the child. There are many different family structures in the world and I’m interested to know how other families have decided to handle their titles.

Gratitude for the Donor

My fertility journey could not have gone more perfectly than it did. I had an amazing pregnancy, wonderful delivery experience and now have a beautiful, healthy child to hold and call my own. Although I don’t know who the sperm donor is, I am grateful for him. I’m grateful that he decided to become a donor. The other candidates I looked through weren’t nearly as great on paper. In a way, I know a lot about this man from the information in his extended profile (granted he was truthful about his supplied information).

Potentially I’ll get to know more about him in 18 years if my child decides to reach out. But even if that doesn’t happen, I am content with the information I do know and believe that he is a person I would enjoy being around. I’m sure I will see glimpses of him and his family in my child when I don’t recognize certain aspects as being from me or my family.

One thing I do know, is that I will speak kindly about this man to my child because without him, my child wouldn’t be who they are.

mfg