Being in family practice and infertile

Rose-bud lips, beautiful dark eyes and a head full of hair….just a few things that immediately jumped out at me right after the delivery. The sweet babe quieted as soon as it was put on Mama’s chest. All was right with the world in that perfect moment.

Was this it? The last one? My last delivery?

Last August Adam and I discussed my involvement with obstetrics. We decided it may be a good idea for me to stop taking new OB patients at least until I made it into the second trimester of our next pregnancy. I was scared a patient of mine would have a problem while I was in my first trimester, making me worry that it would happen to me too. Strange, I know….but perhaps for some odd reason I thought if I didn’t take care of any patient’s that had pregnancy difficulties, maybe I wouldn’t either. My partners were very supportive of my concerns and my OB practice was essentially put on hold-at least I stopped taking any new pregnant patients.

Fast forward to my final delivery. Everyone is healthy. It was a “good one” in the grand scheme of things-I commented to the nurses that I was glad all went well as it might be my last. I remember when I came to this practice, my practicing obstetrics was a somewhat difficult transition for all of us. You see, in the state of Nebraska Nurse Practitioners cannot deliver babies…and rightfully so! We are not trained in this sufficiently! It is actually very rare for an NP to do anything really with obstetrics so my asking four Physicians to work with that passion of mine was a big step for them. They have been amazing since day one, allowing me to provide prenatal and postpartum care to my patients and letting me play an active role in the management of their labor as well. I have been doing obstetrics now for 11 years and the thought that the sweet little babe with the head full of hair is the last one is difficult. I just don’t know if I have it in me.

It sounds selfish, I know, but I do not know if (or even if I want to) take care of women getting the one thing it seems I don’t get to have. The one thing my Husband and I want. It’s a very odd feeling, though as this has by far been my favorite part of medicine for over a decade. It’s crazy to think that in a few month’s time the one thing I looked the most forward to on a day-to-day basis became the thing I was least looking forward to. I haven’t decided if this is for good or not. If I stop doing obstetrics, this is likely something I’ll never be able to “pick up” again. It isn’t like crocheting or riding a bike. As I said, it is rare for someone like me to even be as involved as I have been in the past, let alone stop and then just start up again someday. Obstetrics is the most legally challenged type of medicine. Experience, experience, experience is what it’s all about. Once you don’t have that experience, you should stop. This is in the best interest of the patient and the provider.

As with multiple other things right now, I am not even sure how to actually make this decision. After Noelle I knew then that I needed to decrease my involvement with obstetrics at least a little and actually put teaching Lamaze on hold. My Births R Us program has been a big part of my life for over six years. I loved educating and empowering women to be active participants in their labor experience but just couldn’t do it last year. Maybe I should resume teaching and stop obstetrics so at least I am doing some of what I love(d). As a side note, I think part of what made my classes as good as they were is that I am involved with the whole pregnancy/delivery experience. This allowed me to really relate to the couples and use my experiences to really educate them well.

And, I know I need to be realistic also. This is my career so maybe I should just suck-it-up and move forward with everything I have done for years. Perhaps it will work out in the long run. Perhaps I will once again become comfortable with the exposure to pregnant women and sweet newborns. I can’t take away all of the awkward situations after all. There will still be the kids that are brought to the clinic who’s parents act like they are a “nuisance” or a “bother” to them. These times are so frustrating. Why, God, when it seems that they don’t even want their child, can I not have a child when I would definitely cherish it?

I pray God helps me to be more understanding, more empathetic, less jealous and less judgmental….and as with everything else that He helps with this decision…

 

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New reality

After losing Noelle last year I printed this out and framed it. It is in our “happy” room. I need to remember it now more than ever.

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The biggest thing we are trying to understand right now is why God has “allowed” these things to happen to us. I think, though, that we know that we have been trying to break through a door now for several years. A door that He does not want us to go through. He clearly has another door we are to open and enter. Whether that actually includes adoption or surrogacy or neither is yet to be seen.

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We have an entirely new reality facing us. A scary journey. Our social worker says our fear will improve with time the more we learn. We are trying to be sponges and soak up all of the information we can between books, DVDs, online groups and online education. We are required to complete ten hours of education. We were given several websites and a list a mile long of books we can choose from. Having the personality that I have when I go to these websites that offer online courses, my instinct is to purchase and watch every single one. How can we ever know enough? 

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The biggest thing I am still struggling with is the openness with adoption. Closed adoptions are no more, which is a good thing. A birth mama choosing to place her baby for adoption is huge. It means she is making a mature, intelligent decision-knowing that there is better things out there for her baby. But, oh my goodness the grief that must accompany this decision that she makes. She deserves to know about the family she is choosing to parent her baby.  And, I do believe she deserves to have periodic updates….via email or text for example. The first law firm that we met with had a wonderful basic requirement and the contact could be even more if decided upon between the parents and birth mama. They required that you sign a contract promising that you would send a weekly update until the baby is 8 weeks old, then monthly until their first birthday and then twice yearly until age 18. We are completely good with this. This works for us. This woman, this woman that is giving us the best gift of our lives deserves at least that much contact.

What frightens me (again, I am sure mostly due to ignorance) is when I read these stories time and time again in these groups I belong to about these parents who invite the birth mama and sometimes even her family to the child’s birthday parties or over for the holidays. Or, say the birth mama has other children, some parents will arrange for visits with these children. One of the education videos we watched actually discussed a scenario where the birth mama gets married and wants her birth child to be in her wedding. We were all, Wah???? One thing that has been made clear to us is that it is all according to what is most comfortable for both us and our birth mama. But, I feel like I am a selfish jerk. I read these posts from these wonderful women praising their relationship with their birth mama’s and I cringe because I don’t know if I can be as good of a person as they are.

We have also learned enough that open adoption is beneficial for the baby. Every person has a right to know where he/she came from. Every person. Research has shown that talking about adoption casually with your child from toddler-hood on up will help decrease the chances of your child from having identity issues as an adolescent or adult. Plus, there is the obvious…knowing the medical and family history is huge.

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feeling fault

We had barely turned 20 years old when we were married in 1996. We had to sneak a bottle of champagne in our luggage to take on our honeymoon…..our honeymoon at Disneyland, that is! Adam wanted to start a family right away. The guy loves children. I’d like to think that I am special to all of our nieces and nephews but I KNOW he is. He plays with them, gets down at their level. And, he has the patience of a saint! To this day when I see a niece or nephew one of their first questions is ALWAYS “Is Uncle Adam here?”.

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I wanted to go to school. In high school my goals were not terribly steep, although they always included some college at least. I thought I would go to a local community college and be an LPN. I had a phenomenal English teacher in one of my AP classes that showed me I could go further. She encouraged me to go to a larger school and maybe be an RN. I would say I caught the “bug” of wanting to go way further in my education when I was awarded a Presidential Scholarship for MSU. It was AH-MAZING. My bachelor’s degree was going to be completely paid for! We married just before my third year of college. I was not about to mess up my plans with a baby! My OCDism would NOT allow it! As my family knows, I have always been a “planner”, and I mean I plan EVERY. LITTLE. THING. Having a baby was simply not yet in my plans.

Another “bug” hit me right after we got married, though and that was my love for babies. I saw my very first vaginal birth while in nursing school and was in absolute awe of the entire process. Working on our adoption profile, we have been digging through old photo albums and look what we found! The first baby I had ever seen born. Look at how young (and skinny!) I was. Wow.

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When I started working on my Master’s degree I was the youngest person ever to enroll in the Family Nurse Practitioner program at Creighton University. Back than (gah-that sounds eons ago!), it was unheard of for a young RN to become an NP as it was mostly women in their 40s and 50s going back to school. I thrived. I loved it. I graduated 2nd in my class. Again, Adam was ready for a baby. You’d think that then would have been the perfect time, right? Not so. I still wasn’t ready. My gosh, I had just spent seven years in school and I was loving my newly-found freedom. I had (way too much) fun for about 18 months-I actually went to parties and traveled, things that most “normal college” kids do but I never allowed myself to do as I was too busy with “my plans” of go, go go!

In 2003, the beauty of being a Family Nurse Practitioner came to reality for me. I joined a busy family practice and was offered the opportunity to start obstetrics. Shortly after joining this practice, the MD I worked with didn’t make it to the hospital in time and I delivered my first baby in November, 2003 (someone had to catch it, amIright?!). I remember shaking afterwards. It was terrifying and wonderful at the same time. Later, I was given an envelope with this Polaroid photo that the nurse’s had taken for me.

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Following this was a seven-year whirlwind of family practice. I saw everything. I took care of pregnant women, labored with them and helped with or delivered many babies. I saw my share of babes with problems but thrived on researching the best way to care for these kids and finding out the best specialists for them to see. I watched these kids grow up, doing their kindergarten physicals and so on. My time here was full. I worked many hours and honestly did not have time to even really think about slowing down to have a baby….yet. By this time, we had been married for well over a decade and had our routine. We had pets but otherwise, came and go as we wanted. We traveled, spent money when we wanted to, loved on my baby brother (aka boy) and spoiled our nieces and nephews to pieces. To this day, I am so thankful for the time I spent in this community. Every Mama that ever came to me gave me a gift. Her trust; and I loved her and her family for that.

In 2010 I needed to slow down. Simply work less; no longer cover the ER, etc so we moved to a community closer to my Sister and her six kids. What a blessing to be closer to them! Working normal hours, Monday through Friday allowed me to actually envision having a baby. We bought an awesome home and set aside a room as a nursery, fondly calling it “the baby’s room” for the next 4 years. And, we filled that room with every single little thing a baby could ever need. Friends and my Sister were amazing to us, giving us their “gently-used” baby items knowing we were gearing up and getting’ ready! A crib, car seat, stroller, swings, bouncers, breast-pumps, exersaucers, you name it….we probably had at least two!

We were ready.

In hindsight, I have questioned myself every day since I lost my first baby. I question my decision to wait. If I had agreed to start a family in the beginning years of our marriage as my amazing Husband wanted, would it have worked. Did I wait too long? Are my eggs too old? Maybe I did this. I caused this. My gosh, my Husband….this man that I love more than any earthly thing, deserves to be a Daddy and I messed it up for him. He could be with any other woman and have a baby. It’s me. My body is the one that isn’t working. The guilt is suffocating.

But.

I know better. I know that my Husband loves me more than anything also and that I am who he wants. I also know that my God knew these last three years were going to be exactly the way they were all along. He knew I would be typing this exact blog post. Perhaps we would have had a successful pregnancy but also perhaps our child may have been ill, I may have not made it through the pregnancy (this happens), or maybe my depression would have gotten out of control. I actually wasn’t diagnosed with depression until when my Mom was very sick in 2003 but looking back, I likely had it off and on for years. Depression during pregnancy and postpartum depression is the most common complication of pregnancy. A fact, many do not realize. I could have become suicidal, for all I know.

I simply know that God has and always has had a plan for Adam and I.

 

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Handmade?

Well, hand-assembled is more like it. Geesh, just a mere year ago cuties like this could only be found at little boutiques. But no longer. Now you just go to your local craft store and voila! Except for the cute lil’ hat that is. That was made by a patient of mine back in Tecumseh. It was the only one I had remaining when I left there and it was always too small for the babies I delivered so was left over and since our great-niece is a preemie it works wonderfully!

I am sending these goodies off and then our hopes are to walk our niece, Adam’s Sister and Mom through some naked baby photos with them. This is only because photographer Uncle Adam isn’t there of course!! When Heather was at our house last summer she and her sister couldn’t get enough of a couple of books we have on our coffee table, one of which is Tracy Raver’s Sleeping Beauties (she is actually a Nebraska photographer).

**Everybody loves BABIES!!!!**

Yay!! We finally got our chance to watch it. It was only in the theater briefly here so we had to wait until it came out on dvd and I purchased it this week so Adam and I could watch it while in the hotel and it was everything I had hoped it would be!!!

Here is the trailer to just fill you in if you haven’t heard of it (it is only 2 minutes long)…It is a movie but has no narration.

There are a few things that we found so interesting but not at all surprising.

  • The births: the baby from San Francisco must have had something wrong (they didn’t show anything of that) but they showed all sorts of monitors hooked to her and IVs plus we noticed little bruises, etc. Were they pointing our technology in the US? We also noticed the birth from Mongolia to be a very detached birth. In that I mean the mother didn’t even hold the baby after birth. The most “skin-to-skin” type of birth (which research all over the world has shown is the best) was the one in Namibia, Africa.
  • Bonding with babe: Everyone seemed to bond with their baby pretty well except once again in Mongolia. That isn’t to say they didn’t it just wasn’t as frequent. In fact, that infant stayed on its back the majority of its infancy…on the same bed, literally.
  • Bathing: Mongolia was in a bucket. San Francisco in a shower, even a Hot Tub at one point! Namibia has pretty much no water so as gross as this seems the mother was literally spit cleaning the infant.
  • Toys: The infant from Namibia played with rocks, bones, sticks~even was teething on these. The one in Mongolia didn’t really play with anything as he was always bundled up tight on his back until he was almost a year old. The infants from Tokyo and San Fran had you name it at their disposal for toys. And, they went to all sorts of organized play groups as infants…and in each of these groups they seemed overwhelmed. In our favorite scene (close to the infants birthdays) it shows the infant from Tokyo sitting in her room surrounded by all of these wonderful toys and she is picking up one and can’t get it to do quite what she wants it to and gets frustrated and throws herself on the floor and crys, then grabs another and this continues on….and the movie flashes over to the infant in Mongolia who *SURPRISE* is no longer on his back but is now sitting up on the floor but tied to the bed so as not to get into danger I assume but he was able to reach a roll of TP and man oh man was he having a ball! He was giggling and smiling….all with a roll of TP. And they kept going back and forth between this little guy having fun with TP to the little frustrated girl in her toy-store like bedroom throwing herself on her floor over and over again.
  • Medical care: everyone had it except for Namibia. Even in Mongolia there was a nurse/doctor home visit that weighed the infant, etc.
  • Development: The producer did a good job at spanning across all four infants and comparing that they all do the same things at the same time pretty much no matter where they are EXCEPT for the infant from Mongolia. Poor guy….he was late to walk. And, I really really wonder if this isn’t because he spent probably the first nine months of his life bundled up tight on his back (in fact I am sure this is why). And is this how they raise their infants (as in a belief) or is it because his mama was so busy working outside~she was seen milking cows at one time??? The movie actually ended with the lil’ guy finally standing and gaining his balance….it was great!
  • Odds & Ends: Clothing is so over-rated. 🙂 These Namibians and Mongolians have this figured out….The mother of the infant in Namibia wouldn’t let his hair grow out. In fact she kept it short with a knife. I especially found the pacifier that they gave the Mongolian baby fascinating: it appeared to be a piece of intestine with a match stick to prevent him from sucking it to deep (ingenious!)-hee hee.

These are just a few of my observations that I can remember right off hand…a great movie that everyone should see. I have a friend that uses some of the Montessori principles for play with her little one. I like the one where you do not have gazillions of toys/books out for the child at any given time. They can get so over-stimulated. Adam and I talked a little bit about this actually last night after watching the movie and he was all about it….especially after the hilarious TP scene…

Overall I think in the US we are overstimulated and therefore it is hard for us in general to “slow down” for an extended period of time without getting antsy~and I am saying this as an adult so imagine this for our children. Are we providing so many organized events/activities for our children that we are stunting their imagination/creativity? From a medical standpoint this is something I have long-wondered and have wondered if this contributes to obesity in kids and maybe even some of the behavioral problems that parents come to me with all of the time?

Hmmmm….