Then a trip to the bathroom.

Bright-red blood soaking my incontinence pad and underwear.

Fear.

I called my high-risk pregnancy practice, The Center for Maternal and Fetal Health, and spoke with a nurse, who told me to immediately go to the office, rather than Labor and Delivery, because the doctors were still holding office hours. My friend Yana drove me, took my 5-year-old son home for a playdate with her son, then took both of them to afternoon preschool.

At my doctors’ office, I was quickly ushered in and waited for only a few minutes before being seen by Dr. D, the doctor I’d seen in Labor and Delivery for my bleed in mid-January, at 25½ weeks of pregnancy. She asked if I minded pulling down my pants, so she could see the extent of the bleeding. Upon viewing the blood, she said, “If you keep bleeding, we’ll just do your C-section today.”

I told her I was relieved, that the bleeding, resulting from my placenta partially tearing away from my uterus, makes me nervous because I have a sorority sister from college who lost her baby at 41 weeks—while on a fetal monitor, in the hospital, the night before she was being induced—due to placenta abruptio, a condition in which the placenta completely separates from the uterus.

“She lost her baby in two minutes, in the hospital, on a fetal monitor,” I said. “So if know that if I started bleeding severely, I could call 911, and I’d still never get here in time.”

“Placenta previa is different from placenta abruptio,” she said. “With placenta previa, YOU die.”

Subtle, huh?

My practice is connected to the hospital, so Dr. D had Kathy, one of the nurses, wheel me down to Labor and Delivery, where I was checked in, put into a room at the end of the hall, and given a hospital gown.

My nose started bleeding profusely. Sometimes it will bleed when I blow my nose, which is a common pregnancy side effect, but I’d never had an actual nose bleed in my life. I had an overly dramatic thought that I was bleeding from every orifice, which wasn’t true, but I was feeling panicky without my husband, who was on his way from his office downtown.

Alone in Labor and Delivery, I felt intense sadness, and it took all of my strength, physical and mental, not to cry. I was worried about having my baby at 34½ weeks, when he’d likely land in the Neonatal Intensive Care Unit (NICU) because of respiratory and/or eating difficulties. Then again, my 5-year-old was born on his due date, but spent his first five days in NICU because he was born in acute respiratory distress after aspirating meconium, his first bowel movement in utero, during delivery. After he was able to breathe on his own, he refused to eat, which the NICU nurses said was likely because his throat was sore due to his initial intubation. So even at full-term, babies can end up in NICU, but I recognized that, at 34½ weeks, my baby would have a guaranteed stay.

After I’d changed into the gown, nurses took my vital signs, positioned the two monitors on my stomach to evaluate my baby’s heart rate and any uterine contractions, and inserted an IV line.

Next, a resident entered and said she needed to conduct a vaginal exam to determine if my cervix was dilated. It was just a basic exam, with a speculum inserted into the vagina, so the resident could see—with a light strapped across her forehead, as if she were a miner—my cervix. However, it was one of the most painful medical procedures of my life: I was tense; my feet weren’t in stirrups, but straining to stay at the edge of the bed, and after nine weeks of bed rest, I had little muscle tone; and the exam was long, because the resident couldn’t see my cervix because of the amount of blood in my vaginal canal. She kept removing the blood with swabs, then trying again.

I have a high pain threshold, but I was so uncomfortable that I was whimpering, so I was relieved my husband wasn’t there to bear witness. It would have increased his stress levels.

The exam revealed that my cervix wasn’t dilated, although I wasn’t sure why that mattered, since I was having a C-section. But I didn’t question any of the bustling staff members. They seemed very sure of every stage of their evaluations of me and my baby.

Next up was a meeting with a member of the anesthesia staff, then an abdominal ultrasound, during which Dr. M, the head of my high-risk practice who was on-call in Labor and Delivery, changed course. He said that it looked like the placenta was no longer covering the cervix, but right next to it, making a vaginal delivery possible. To get better ultrasound images, he sent me back upstairs to the practice’s office, telling the technician that he wanted to personally see the images, so, when she was ready, to page him.

My husband met me in the hallway as I was being transported by wheelchair to the office. Once again, my name was quickly called, after which my husband and I were led into an ultrasound room, where both abdominal and trans-vaginal ultrasounds were performed. Our baby, breech during my previous ultrasound, was head-down, and Dr. M pushed his head up and away from my cervix to get a clearer view. But clear wasn’t possible.

Dr. M said that he thought that the cervix was free of the placenta that had been covering it since my week 13 ultrasound, more than 21 weeks of my pregnancy. He showed us what he thought was the harder edge of the placenta, as compared to what he thought what was on top of my cervix—a blood clot. He asked the ultrasound technician to run a blood-flow analysis, which made him more confident, because blood would flow through the placenta only, not through a clot. All of the images consisted of shades of gray, and Dr. M admitted he couldn’t be 100-percent sure of his readings.

He then recommended that we first try a vaginal delivery because he believes that, as the baby descends into the vaginal canal, he’ll push the placenta farther up inside the uterus, enabling him to be delivered safely—before the placenta. He assured us that, in case of any complications, he’d immediately perform a C-section.

He explained that he was considering the best interests of both me and the baby, and a vaginal delivery is preferable for me because of less recovery time, and delaying delivery is preferable for the baby because, even at 36 weeks, just a week and a half away, he’d likely be able to come home with us, rather than spend time in NICU due to breathing or eating problems.

I asked, “You really think it’s safe to try a vaginal delivery, even though I’ve had two placental bleeds?”

“Yes.”

But then he added that he wanted to consider my emotional state, that he’d heard that I had a friend who’d lost her baby via placental abruption, but that placental abruption is extraordinarily rare, as in 1 in 1,000 pregnancies, and that what happened to my friend is yet another 1 in 1,000 placental abruptions. He outlined the signs of placental abruption and said that I’d likely be at the hospital, diagnosed and having a C-section before either my baby or I were at risk.

He said we could evaluate the situation and decide when to induce, based on how I’m feeling emotionally.

“I just want to do what’s best for the baby,” I said.

And what was best for the baby was to stay put, rather than attempt a vaginal delivery on St. Patty’s Day.

So I was wheeled back down to Labor and Delivery for observation—for another five hours before I was released—during which I wasn’t permitted to eat or drink, just in case of increased bleeding necessitating delivery. I’d woken up at 5 a.m. to eat some Frosted Mini-Wheats and hadn’t been hungry again before my bleed started, so I went almost 13 hours without food or drink.

So I lay there in Labor and Delivery with fetal monitors strapped across my stomach, starving, emotional, and having to disconnect the monitors and wheel my IV into the bathroom every 10 minutes because the IV fluids were making me pee. And my husband sat there with his laptop on his lap, accessing the hospital’s wireless Internet so he could work. And we were both reeling, because we’d been worried about my bleeding, we’d been told we were having our baby via C-section because of the bleed, and we weren’t sure waiting and trying a vaginal delivery was the right call. Because, at the time, we never could have known.

But Dr. M was right, and we were right to listen to him.

When I was released, Mr. M put me back on complete bed rest until last Friday, the day I hit 36 weeks, his goal. In the past week and a half, I haven’t had another fresh bleed, although old, brown blood is still coming, 12 days later. But old blood is nothing to worry about.

I am now at 36½ weeks of pregnancy, and, on Friday, I will be full-term, for full-term is defined as 37 to 42 weeks. At this stage, our little man will likely accompany me home from the hospital.

And last, during my 36-week appointment on Friday, it was crystal-clear, via ultrasound, that the placenta has moved even farther away from my cervix.

I NO LONGER HAVE PLACENTA PREVIA.

So the plan is that, if I bleed again, for my placenta is still low-lying, and low-lying placentas are more unstable, I’ll be induced, and my doctors will try a vaginal delivery since there is now no reason for it to be dangerous.

If I don’t bleed, my doctors will continue to evaluate the results of my weekly exams, in which I have ultrasounds to check on placental position and amniotic fluid levels, plus non-stress tests to evaluate the baby’s heart rate and whether I’m having contractions. If any problems are revealed, I’ll be induced. If all’s well, they’ll likely let me continue until I go into labor.

This weekend I told my husband that, if I don’t have another bleed, I’ll probably not go into labor until close to the baby’s due date, April 23, since my 5-year-old son was born on his.

“You have a history of one,” he replied. “I don’t think it’s a good idea to rely on that.”

Yes, I have a history of just one, but having a biological child is a miracle that many DES Daughters don’t have the opportunity to experience. And because I was able to carry my 5-year-old son to his due date, although I was dilated starting at 27 weeks, and because he stretched out my DES (diethlystilbestrol)-induced T-shaped uterus while he was in utero, I felt confident that, if I could get pregnant, I could carry another child to term.

This time around, I admit that I’ve alternated between feeling blessed and cursed, because, rather than have premature dilation and labor as I did with my son, my cervix is long and closed—even at 36 weeks—but instead I lost one of my twins, and I’ve suffered from placenta previa.

But I don’t have placenta previa any more, and it’s rare for it to rectify itself in the third trimester. And if I can make it until Friday, I’m at term. Just four more days, and I’m at term.

He is my miracle, even according to the reproductive endocrinologist who worked with me during seven intrauterine insemination (IUI) cycles, until I achieved a successful pregnancy—me, a DES (diethylstilbestrol) Daughter with a T-shaped uterus, one-third normal size.

He is my miracle who, although I was dilated at 27 weeks of pregnancy, the result of my DES-induced uterine abnormality, and having contractions at 31 weeks, stayed put until his due date—February 10, 2005. 

He is my miracle who was born in acute respiratory distress because he had aspirated meconium (his first bowel movement, in utero), yet rallied in the Neonatal Intensive Care Unit and was released four days later, on Valentine’s Day.

He is my miracle who eliminated the issue of my blaring biological clock, enabling my relationship with my brand-new boyfriend, whom I met nine days before getting pregnant via insemination with donor sperm, to progress to marriage and my husband’s adoption of him.

He is my miracle who grew to 9 pounds 7 ounces before birth, stretching my tiny T-shaped uterus into a larger arcuate uterus, making it possible for me to get pregnant during my second in vitro fertilization (IVF) cycle this summer.

My son is my miracle who has contributed to the realization of so many of my dreams.  Yet, while his presence, from conception to now, has been so powerful in my life, he will always be my baby. 

The book Love You Forever (Firefly Books, with its 68^th printing in 2004), written by Robert Munsch and illustrated by Sheila McGraw, communicates this concept more effectively than I ever could.  I’ve had the book for five years, and I have yet to read it without crying. 

The book’s back cover reads:

“A young woman holds her newborn son and looks at him lovingly.  Softly she sings to him:

I’ll love you forever,                                                                                                                                                           I’ll like you for always,                                                                                                                                                     As long as I’m living,                                                                                                                                                        my baby you’ll be.

This is the story of how that little boy goes through the stages of childhood and becomes a man.

It is also about the enduring nature of parents’ love and how it crosses generations.

Love You Forever is a book that both children and adults will enjoy—over and over again.”

Tonight, I feel so emotional about my son turning 5 that I can’t read Love You Forever.  I know I would bawl, and, considering that I’m in my 29^th week of yet another high-risk pregnancy, any physical and/or emotional stress should be avoided.

So, instead, I keep remembering how happy I was when my son was two weeks old, and a nurse at his pediatrician’s office called to confirm an appointment.  I answered the phone, and she asked, “Is this my son’s name’s mom?”

I knew how blessed I was to be able to say yes.

And, today, five years later, I still don’t take my role for granted.  My son is a gift, a miracle, entrusted to me. 

And, my husband, who chose to be his father, feels exactly the same way about him.

The genetic counselor who wrote the letter wasn’t being insensitive.  In the 16 weeks since I learned of Baby B’s death, I couldn’t bring myself to call either my IVF clinic or its associated genetics lab to give them the bad news.

Notifying both has been on my “To-Do List.” 

I just couldn’t make the calls.

But, receipt of the letter made me realize I can now handle the notification process.  Because, when I read it, I didn’t get upset.

Not at the opening congratulatory sentence.

Not when reading sentence #2, which started, “As you are busy preparing for the new additions to your family…”

And, not when reading the closing sentence, which referenced my “babies” a final time.

Four months ago, I was devastated at the loss of one of my twin boys.  But, wallowing in self-pity isn’t productive, and I have another baby inside of me, my almost-5-year-old son, my 14- and 15-year-old stepsons, and my husband to love and care for.

I recognize that, considering my DES (diethylstilbestrol) Daughter status and my DES-induced uterine abnormality, I was incredibly blessed to successfully conceive my son six years ago.  Even my reproductive endocrinologist, a woman of science, called it a miracle.

My advanced maternal age of 41 and my husband’s advanced paternal age of 43 (during our second, successful IVF cycle) were added to the mix this time, making a pregnancy even more unlikely.  But, here I am, thanks to IVF with PGD, 25 weeks into carrying a healthy baby boy.

Because I’ve been so blessed, I’ve accepted the loss of Baby B.  (But, I admit that if I weren’t pregnant right now, if I weren’t going to have the baby I so desperately want for my family, I might still be bitter.)

Because I am pregnant, because I’m far enough along that my baby could survive, today I not only called our genetic counselor, but also wrote a long e-mail outlining every stage of Baby B’s short life, from my first ultrasound, at which my twin pregnancy was verified, to my 9-week ultrasound at which the technician notified me that he had no heartbeat.

Tomorrow, I will do the same with my IVF clinic.

And, I will not get upset, for I have so much to be thankful for.

So, he stayed. 

He stayed when I got pregnant nine days after we met. 

He stayed when his friends gave him a perfect mockup of the cover of What to Expect When You’re Expecting, with theirs titled What to Expect When Your Girlfriend’s Expecting Another Man’s Baby.

He stayed when colleagues continued to ask him, “Is your girlfriend still pregnant?”

He stayed when a friend said he’d never heard of any relationship like ours—except on “The Jerry Springer Show.” 

He stayed because we had an unprecedented connection; our relationship was positive, fun, honest and filled with respect; he’s independent and self-confident; he doesn’t make his life decisions based on what other people think; and because I never pressured him.   I was the only woman he’d ever seriously dated who wasn’t expecting him to make her dreams come true.  I was taking responsibility for my own life, for fulfilling my own goals.

And, all of those people who initially teased my husband about his relationship with me recognized that our relationship made him happy, the happiest they’d ever seen him, so they eventually jumped on board, sending me baby gifts although I’d never even met some of them, celebrating with us at our wedding, and proclaiming us one of the best-matched couples they’ve ever known.

Our relationship is old news at this point, so no one is ribbing my husband about his prior choice to date a woman pregnant with the baby of an anonymous sperm donor.  But, this morning, I read the Chicago Tribune Sunday cover story by Kevin Pang, titled, “Are Funny Women Intimidating?” and it made me consider how much flack my husband may be getting because of the content of my blog.

In the “Are Funny Women Intimidating?” feature, Pang outlines, via interviews with more than 20 female improvisers, how their dating lives have been affected by “civilians”—their term for men working outside the improv community—who are intimated or embarrassed by them. 

Pang explains, “Even in 2009, we live among antiquated conventions.  No matter how much we push against what we know feels wrong, gender stereotypes still are embedded in us.” 

Pang interviewed Bernard Beck, associate professor emeritus of sociology at Northwestern University and a stage actor for 30 years, who said, “Even after a long period of transformation of women’s role in society, older, traditional images are still on everyone’s mind.  In relationships, women seem to be pleased more often with somebody who shows power, ingenuity and can put on a good show.  Men seem to more often look for a good audience.  And if the person you want to be an audience to you is instead seizing the limelight, that may not be the bargain you’re looking for.”  To read the full article, log on to www.chicagotribune.com/features/family/chi-1108-funnygirlnov08,0,4559069.story

My blog, operating since July 13, has covered my infertility and treatments, past and present; my confirmation that I am a DES Daughter, a woman whose mother took the synthetic estrogen diethylstilbestrol (DES) while pregnant, creating abnormalities of my reproductive organs; my high-risk pregnancy; the loss of our unborn son two months ago; my pregnancy symptoms; and more. 

I have been unflinchingly honest, because I am confident enough, at this stage of my life, to do so—and because, if more women had been comfortable sharing this information, more women, including me, would have been able to make educated decisions about our health, our childbearing plans, our futures.  I, for example, not knowing I was a DES Daughter, took unnecessary estrogen, via the birth-control pill and fertility medications, for almost 20 years, putting myself at increased risk for breast, ovarian, uterine, cervical and vaginal cancers. 

My blog is successful, attracting more and more readers—and extraordinarily loyal readers.  My website and blog have been operational for less than four months, yet 62% of my readers have visited more than once, 40% have visited nine or more times, 31% have 15 or more visits, 21% have more than 25 visits, and 8% have more than 50 visits.  Further, 2% have more than 100 visits, even though I’ve only posted 84 blogs.

I receive e-mails from women undergoing infertility treatments, those who’ve lost their unborn children, those who are scared because they took estrogen during their pregnancies and fear that damage has been done to their children.  They call my blog “inspirational,” “educational,” “informative,” and want to reach out to someone they know understands what they are experiencing.

But, while my blog is attracting more and more positive attention, my target audience is women, not the men who might harass my husband.  So, I asked him if he’s being teased, and he said, “Of course.”  He said he’s asked why he can’t “control his wife.”  He’s ribbed because I’m open about my DES deformities and pregnancy symptoms.

And, he said he just laughs with these men because he is proud of me.

In the final paragraph of the “Are Funny Women Intimidating?” article, author Pang states, “Then came the realization:  This was never about funny women.  It’s about weak men.”

Well said.  Well said—by a strong man…

Strong men are rare, but my husband is one of them.

With no knowledge of my DES exposure, I was unable to protect myself and inadvertently put myself in more danger by taking birth-control pills for more than 20 years to regulate my too-short, 20-day menstrual cycle; by injecting myself with estrogen and wearing estrogen patches for three intrauterine insemination (IUI) cycles in 2004 to combat my DES-induced infertility, resulting from my underdeveloped, one-third-normal-size, T-shaped uterus, complete with uterine lining too thin to support successful embryo implantation; and injecting estrogen for two in vitro fertilization (IVF) cycles this year, once again to overcome my DES-generated infertility.

In short, being bathed in synthetic estrogen while in utero, which puts me at increased risk of breast, uterine, cervical and vaginal cancers, screwed up my reproductive system to the extent that estrogen was recommended in order to normalize my menstrual cycle and enable me to bear children.  And, this extra estrogen has elevated all of my cancer risks. 

Only because of this website and blog, which I started immediately before my second IVF cycle, did I learn that I am a DES Daughter.  My mother has since confirmed that she did take medication for nausea early in her pregnancy.

However, only after receiving the book DES Voices: From Anger to Action from DES Action USA, the nonprofit organization whose mission is “to identify, educate, provide support to, and advocate for DES-exposed individuals, as well as educate health care professionals,” did I learn of danger of not only having taken birth-control pills, but also having undergone infertility treatments involving injectable estrogen. 

But, I received the book on Thursday, August 6, the day of my embryo transfer, so my estrogen injections had been completed a week and a half prior.  Any damage had already been done.   

Since August 6, when I had two male embryos placed into my uterus, then read DES Voices cover to cover, I have been scared that I have vaginal cancer and that, if I were pregnant, my husband and I would be forced to make a decision, depending on the severity of the cancer, about whether and how to pursue treatment based on how it would affect me and our unborn child or children.

On August 17, I received confirmation of my pregnancy.  I was thrilled, but frightened.  I shared my fears with no one, not even my husband, because I didn’t want to worry anyone needlessly. 

On August 26, an ultrasound confirmed that my high levels of Human Chorionic Gonadotropin (HCG), the pregnancy hormone, did signify twins.  Once again, I couldn’t help but be thrilled; the feeling was spontaneous.  But this news also meant that, if I did have cancer, we could put two children, not just one, at risk.

On September 18, I learned, via another ultrasound, that I had lost Baby B a few days beforehand, in his eighth week.  With this devastating news, I, who’d been feeling miraculous after weeks of positive ultrasounds, realized that I am, as we all are, immune to nothing.  Harm, loss, tragedy can forever change any of our lives—at any time.

It wasn’t until September 25, my 10th week of pregnancy, during my first examination at the Center for Maternal and Fetal Health, the local hospital’s high-risk pregnancy group, that I had my first-ever DES Daughter Annual Exam.  It is a special, more-thorough physical and pap smear designed to identify any DES-related abnormalities, particularly clear cell adenocarcinoma—cancer—of the vagina and cervix.  (For the specifics of the Annual Exam of DES Daughters, as recommended by the Department of Health and Human Services’ Centers for Disease Control and Prevention, click onto www.desaction.org, then the DES Daughter tab on the left.)

Because I’d already had an annual pap smear in May, which had shown no pre-cancerous or cancerous cervical tissue, this exam focused on my vagina, where pap smear samples are not usually collected.  And, instead of scraping off just one tissue sample, my doctor gathered four, one from each quadrant.

He also conducted a visual inspection and told me that he thought all of the tissue looked normal.  But, I couldn’t relax until receiving the lab results.

Although I have been blessed in many ways in recent years—meeting my future husband nine days before getting pregnant via donor-sperm insemination, being able to conceive and carry my 4-year-old son, when many DES Daughters remain childless, and getting pregnant, at age 41, during my second IVF attempt, in my life each and every miracle has been countered by tragedy.

I was unlucky in utero, which is an early start.  My DES exposure has negatively affected me since the onset of menstruation at age 13.  I’ve suffered from infertility.  I’ve lost seven unborn children, most recently Baby B, to whom I’d grown extremely attached, having seen him on multiple ultrasounds. 

So, with my history, I could imagine being pregnant at age 41, filled with such joy, then finding out that I have cancer.

But, my pap smear results came in while we were on vacation last week, so I now have physical proof in my hands, a lab report that definitively states, “Negative for intraepithelial lesion/malignancy.”

While my uterine abnormality still makes my pregnancy high-risk, I’ve already proved that I can carry a very large child to term, to the full 40 weeks of pregnancy.  My son was a whopping 9 pounds, 7 ounces when he was born on his due date.

So, yes, I am a DES Daughter, which has created life-long problems for me—and will continue to haunt me.  I can’t change the decisions I made before knowing my DES Daughter status.  But, now that I am informed and educated, I will protect myself vigilantly.

And, today, I’m 41, in the second trimester of my pregnancy, and cancer-free.

Baby A is now 3.34 cm and is “right on target” with his growth.  Once again, I was able to see his miniature body on screen, but today I could make out not only his head, but also his arms, legs and tiny “tush.”  Thankfully, his heart was beating away, looking like a flashing light, and the ultrasound technician let me hear it, determining it as “very strong.”  I can’t express the relief I felt, seeing for myself that he is still alive.

Baby B is located right next to Baby A, so I saw him again today too.  He looked so normal that I found myself looking for the visual of his heartbeat, expecting last week’s diagnosis of death to be a mistake. 

But his body was static, with no pulsing heart. 

I asked the technician if my body is absorbing Baby B properly, and she said, “Well, you can see the difference in the sizes of the [gestational] sacs, so this one stopped growing.”

That’s not what I had asked.  And, Baby B’s gestational sac was always smaller, but she wouldn’t have known that, because she’s never performed an ultrasound on me before.  But I stayed silent.

She then said, “In four or five weeks, you probably won’t see anything there.”

Each of the three ultrasound technicians has been so robotic.  Working in a high-risk practice, I assume they often have to deliver bad news, so perhaps staying emotionally distanced is how they cope.  But, it’s hard to be on the receiving end.

However, the nurse who worked with me today was very knowledgeable about my history and very sensitive about Baby B’s loss.  So was Dr. M, the head of the practice.  He told me to make a follow-up appointment for three weeks from now, then stopped and said, “But, if you get nervous, you come in whenever you want.”

Dr. M reiterated what I’d heard from Dr. H last week, that we will never know why Baby B died.  He said, even though he was deemed chromosomally normal via preimplantation genetic diagnosis (PGD), he may have had another abnormality.  Perhaps his heart wasn’t developing properly.  Or maybe his placenta was bad. 

He said that my protocol is now changed from a twin one to just one for patients at risk for pre-term delivery.  I’m at risk because of my DES-induced uterine abnormality, which can result in incompetent cervix.  Incompetent cervix can also occur because I’ve had part of my cervix removed because of pre-cancerous cells, but he seemed less worried about that, based on the location of the tissue removed.

We discussed my nausea, all-day, every-day nausea that forces me to eat bland carbohydrates only because they’re all I can keep down.  I had only two days of virus-related nausea when I was pregnant with my 4 ½-year-old son, and I had no pregnancy-related nausea prior to learning last Friday that Baby B had died.  And, now for six days straight, I’m vomiting or gagging or simply unable to contemplate eating.

My sweet husband has been so worried about me because of the nausea.  Around 3 a.m. this morning, when we were both suffering from insomnia, he told me that I needed to discuss it at my appointment.  He said, “This isn’t normal,” and “You were never sick when you were pregnant before.”

I answered, “Well, supposedly every pregnant is different.”

Then I added, sarcastically, “And, this time I have your DNA inside of me.”  (I conceived my son as a single woman using donor sperm.)

He laughed—and laughed hard.

“Well, you asked for it.”

And, I did.

Dr. M said there is no link between Baby B’s loss and my nausea.  He said losing a twin makes it less likely that I’d suffer from morning sickness.  He believes my nausea is simply tied to where I am in my pregnancy, that it is very common for it to kick in at this point.  He’s not worried about it as long as I stay hydrated, which I’m doing, and as long as I’m not losing weight, which I’m not.  I’ve gained a pound since last Friday, probably because I’ve eaten only carbohydrates for a week.

Dr. M said that, if my nausea becomes more severe, he can “prescribe something,” but I said, “That’s how my mother took DES, for nausea.”  So, I’m paranoid.  I’d rather suffer through this, as long as it isn’t hurting Baby A, which he assured me it is not.

So, I’m a complete mess, traveling with a plastic bag in case I get sick on the go.  Afternoons and evenings are my worst times, when I walk in slow motion through our house, trying not to jolt my sensitive stomach.  I drink Ginger Ale.  I eat English muffins.  I eat plain bagels.  Lipton Noodle Soup.  Crackers.  Cheerios.   

This afternoon, as I lay in bed while my son was at school, I looked though all of the materials given to me by the nurse today.  On the Visit Summary printout, I saw that my diagnosis is “Elderly Multigravida with Antepartum Condition or Complication.”

Elderly?

Knowing that age 35 is the beginning of “advanced maternal age,” I wondered if being over 40 makes me elderly.  So, I looked it up.  Elderly is the term for pregnant women 35 and older, a “gravida” is a pregnant woman, and a “multigravida” is a woman who has been pregnant more than once.

So, that’s me, not only an elderly multigravida, but once with an antepartum condition or complication.

Humbling.

But, my Baby A is OK, which makes me happy—elderly, nauseated and all.

Each night as I lie next to him for a few minutes while we talk before his bedtime, he caresses my hair and says, “I’m sorry one of the babies died.”

And, I say, “I know.  So am I.”

Sometimes he asks to listen to my stomach, to see if he can hear anything.  He asks specifically where Baby A and Baby B are located.  I’ve told him that Baby B won’t be moving or making noises anymore, and he accepts that.

He makes statements like, “I wanted Baby B to be named Whiplash”—a character in the Ironman television series—that make it obvious he’s just 4.  (He wants Baby A to be named Ironman.)  But then he’ll follow up with adult-sounding statements, such as, “Maybe your body will absorb him,” which he overheard from Dr. H, who counseled me after we learned of Baby B’s loss.

Two nights ago, he asked me if God could walk on water.

I said, “God can do anything He wants to do.”

“God will do anything we want Him to do?”

“No,” I corrected.  “God can do anything He wants to do, but it is not necessarily what we want Him to do.”

Because we’d just been talking about Baby B, I continued, “For example, we didn’t want Baby B to die, and he did.”

My son was silent for a moment, then said, matter-of-factly, “So, God killed Baby B.”

I thought for a minute, recognizing the importance of my response.  Then, I replied, “No, God didn’t kill Baby B.  He just didn’t stop him from dying.”

Then I started with the rationales, the ones I need to believe in, even though the doctor said we’ll never know why Baby B’s heart stopped beating a week ago.  “I think that maybe there was something wrong with him, that he was sick and could never have lived.  So, God didn’t make him die, he just let him die because it was best for Baby B.”

My son was quiet for a few minutes, to the point where I thought maybe he had fallen asleep, but then he said, “I think maybe Baby B was a robot baby.”

“Oh…”

“And, maybe his system just shut down.”

Last night, after he started off with, “I’m sorry one of the babies died,” then continued with, “I wanted two babies,” he said, “We’ll have to bury him.”

I explained that Baby B won’t be born, that hopefully he will just get smaller and smaller inside of me, until he disappears. 

“Even the tiny speck?” he asked, remembering that Dr. H said Baby B may end up as a tiny calcification that will look like a white speck on the ultrasound screen.

“Even the tiny speck.”

“Oh.”

I’ve explained that Baby B is now a guardian angel, that he will watch over us and Baby A.  And, my son wants to know if Baby B can see through buildings, if he has wings, if he can fly.

My conversations with my son, who looks at the world with innocence, affect me.  Since we learned of Baby B’s death last Friday, I’ve thought day and night about this issue of God and His/Her role in our lives.  What I’ve determined is that, although I had originally felt that God was “fucking with me,” He/She doesn’t have that kind of time.  And, what I’ve been taught, as a Catholic girl, is that God permits free will—and its resulting fallout.

So, 42 years ago, when my mother was pregnant with me, God didn’t intervene when her beloved doctor, misled by pharmaceutical companies, prescribed her an anti-nausea medication that included diethylstilbestrol (DES), the completely useless synthetic estrogen that seeped through the placenta into me, deforming my reproductive organs.   

And, God has let “nature takes its course” ever since, although my “nature,” my body, is now unnatural, for my uterus was never fully formed, it was in the shape of the letter T, and it was one-third normal size before I carried my son to term, because of the profit-above-all-else pharmaceutical bastards. 

So, I’ve lost baby after baby because of implantation problems and miscarriage.  But, God isn’t participating.  God didn’t take Baby B from me.

I will never know if the reason Baby B died is because his gestational sac wasn’t fully attached to my uterine lining from the first ultrasound, if although the progesterone-oil injections made him able to reattach within one week, his developmental delay in those critical first days was too much to overcome. 

I will never know if he had some sort of other problem that made him, in the end, “incompatible with life,” a term used by our genetic counselor, who managed the preimplantation genetic diagnosis (PGD) of our embryos.

I will never know if this loss, my seventh loss of a child, is due to DES or something else.

But, I’ve finally come to terms with the fact that this loss has nothing to do with God.

And, for this realization, I have my 4-year-old son to thank.

Me neither.

I didn’t expect to be single when I turned 35, the beginning of “advanced maternal age.”

I didn’t expect to have my only child, at age 36, as a single woman who conceived using anonymous-donor sperm.

I didn’t expect to suffer from infertility as the aforementioned single woman trying to have a biological child.

I didn’t expect my infertility to be a result of a misused, misrepresented medication, the synthetic estrogen diethylstilbestrol (DES), which was given to my mother when I was in utero.

I didn’t expect to meet the love of my life nine days before getting pregnant during my seventh intrauterine insemination (IUI).

I didn’t expect my son to have a father figure in his life from the day he was born.

I didn’t expect to get married at age 38.  Actually, I was 38 ½…

I didn’t expect to marry a man who had been married before. 

I didn’t expect to be a “second wife.”

I didn’t expect to be a stepmother.

I didn’t expect to throw myself into these roles, to read every book about being a stepmother and mother to sons, to be in weekly Family Systems Therapy in my attempts be the best wife, mother and stepmother I can be—and to still come up short. 

I didn’t expect to be pregnant at 41.

I didn’t expect to have such a difficult pregnancy this time around, considering that my formerly one-third-normal-size T-shaped uterus is now a larger arcuate uterus, my uterine lining is now sufficiently thick, we’d done preimplantation genetic diagnosis (PGD) of our embryos, and I’d already proved that I could carry a 9 pound, 7 ounce child to term, to his actual due date.

My life is made up almost entirely of circumstances, events, relationships that I never would have imagined. 

But I love my husband and feel that he is the best match for me I’ve ever found—and vice versa.

My son is an absolutely amazing little person, fully of humor and affection and empathy.  Yesterday, I vomited in the morning and stayed in bed all day, and, when I took a bath in the late afternoon to try to make myself feel better, he knocked on the door, peeked around it, and asked, “Do you need help with anything?”  He’s 4 ½…

And, I love my stepsons and, even though I didn’t bear them, I would do anything for them, and I have always put them and my son first, above anything related to my husband, me and our relationship.  Maybe that hasn’t always been the best for my husband’s and my relationship, but they’re children, so how do we not make them the priority?

And, this pregnancy is hard.  Others’ reactions to my pregnancy have made it even more difficult, almost intolerable.  But, my pregnancy with my son was difficult too, and it was worth every blood test, every ultrasound, the hospitalizations, the best rest, the anxiety, the 60-pound weight gain, the 17 ½ hours of labor, the three epidurals (because the first two didn’t take).  He is worth any misery I experienced—and then some.

And, this baby, dubbed Baby A, who is hopefully still alive inside of me, he will be worth it too. 

So, no, my life isn’t what I thought it would be.  I’ve come to my later-in-life happiness in unconventional ways.  But, while it isn’t what I’d expected, in some ways it is far richer and more rewarding than I ever would have imagined. 

And, our little Baby A, whom I guess doesn’t need to be called Baby A anymore, since he’s the only living baby inside of me, will enrich our lives even more.  I know it.  Otherwise, I wouldn’t have undertaken this complicated, sometimes painful, journey through infertility to high-risk pregnancy once again.

This knowledge of how much Baby A will enrich our lives comes from the experience of raising my son.  Therefore, this knowledge also makes the loss of Baby B all the more devastating.

Losing yet another child, a child whom I had seen in four previous ultrasounds, a child whose tiny heart had been pulsing inside of me, a child who had grown teensy little arms and legs, isn’t part of what I thought my life would be like.

I’ve lost seven unborn children.  My husband has lost two, our baby girl embryo who didn’t implant in June and now our son. 

This isn’t what we thought our lives would be like.  But, we have no positive alternative but to keep living the unexpected, complex lives we—and God—have made for ourselves.

My 4-year-old son stood next to me, so he could easily view the ultrasound monitor, so he could see his brothers, how they’ve grown since he saw them at the in vitro fertilization (IVF) clinic, and hear their hearts blipping. 

But, today there was only one heartbeat. 

Baby B died within the past few days, based on the doctor’s analysis of his growth.

The technician calmly told me she didn’t see his heartbeat.  She was emotionless.  She said she was sorry.  She said she wished she had better news.  She said that Baby A looks fine, as if to compensate for the loss of his twin.

I didn’t react.  I couldn’t react.  My 4-year-old was right there.

She asked if I was going to see a doctor after the ultrasound, and I said I had only a nurse appointment, so she said she’d notify the nurses of my status, then return.

While she was out of the room, I explained to my son that one of the babies had died.  He hugged me, with tears in his eyes, and said, “But I wanted two babies.”

Feeling as if I was outside of myself, I reassured him.  I said that it was OK.  I said that there must have been something wrong with Baby B.  I said that we are still going to have one baby. 

But I shouldn’t have said that, for we could lose both.  I think I was trying to reassure myself, as much as him, with that wishful-thinking statement.

The technician returned to say that one of the doctors was going to meet with me, but there wasn’t a room available, so we would have to wait in chairs in the hallway.  She said they didn’t want us to have to go back out in the waiting room.

So, my son and I sat down to wait, and I tried to call my husband.  I tried his work phone twice, and twice it went into voicemail, so I called his cell.  During the work day, I NEVER call his cell, so I thought doing so would alert him that there was an urgent matter.  It went into voicemail too.

A nurse came to retrieve us, weighed me, took my blood pressure, then another woman, who never identified herself, asked me if I’d had an ultrasound.  I said yes, that that’s how we found out that Baby B is dead.  She then escorted us to Exam Room 4.

I tried to call my husband again and again.  I needed him, but kept getting his voicemail.

This is when I lost it.

I tried not to, because of my son, but I’d just found out that I’d lost my baby, I know that losing one could mean the loss of both, and it became impossible to act as if that didn’t matter.

So I cried.  My son walked over from the rotating stool he’d been playing with, and he hugged me.  I told him that I’m sad that one of the babies died, but that I’m tough, that I’ll be OK.

I tried my husband’s cell phone again, with no luck, and I kept crying.

My cell phone rang, with its caller ID showing that my husband’s colleague Jessica was calling.

I picked up and said, “Jess, we lost one of them.”

“I’ll get him now,” she said.

He got on the phone a minute later, and I told him that we lost Baby B.  He asked how I knew, and I told him there was no heartbeat.  He said he was on a conference call that he couldn’t get off of, but it should only last a few more minutes, then he’d call me right back.

A few minutes later, Dr. H came in.  She is the only doctor in the practice with whom I’ve met, so it was a relief that it was her, rather than some stranger.

She said she was sorry.  She said that Baby B had grown since my last ultrasound, that his three-day lag behind his twin had become about a week’s lag, so he must have died within the past few days.

She said that Baby A looks great, that he has little arms and legs, that he is “staking out his territory.”

She said that we’ll never know why we lost Baby B.  While we did pre-implantation genetic diagnosis (PGD) with our IVF cycle, it is impossible to test for every possible abnormality.

I asked, “What happens now?  What are the chances that I’ll miscarry both?” 

She said that miscarrying both is possible, but she thinks the odds are slim.  She explained that I had two separate pregnancies, two genetically distinct babies in two different gestational sacs.  She said that, considering how strong Baby A appears to be, it is unlikely that the loss of Baby B will affect him.  She said that my body is probably going to reabsorb Baby B over time, that during each ultrasound his gestational sac will be smaller, that eventually he may simply be a calcification that looks like a white dot on the ultrasound screen.

With that, my cell phone rang, and it was my husband, so we ended the consultation, and my son and I left the office.

I told my husband that I felt better, which he thought meant that Baby B wasn’t really dead.  I explained that he was, but that the doctor had reassured me about Baby A. 

Then I revealed something I’d never voiced to him—or anyone else—before.  I was so attached to Baby B, our little underdog who came back from near-death weeks ago, that I’d been afraid that I would love him more than Baby A. 

And, now he’s gone, my tiny less-than-one inch to whom I’d become so devoted.

And, what I don’t understand right now is the reason.  Because, as we all say, when we need to be reassured that there is some grand plan that explains our suffering, “Everything happens for a reason.” 

Why did this little guy implant, because I would have been fine if only one embryo had done so?  My husband and I had only hoped for one child, never considering, based on my difficulties with embryo implantation, that two would ever have been possible. 

But, once I knew that there were two of my husband’s and my babies inside of me, I loved both of them, and I wanted both of them, but I was told in that first ultrasound that Baby B, smaller in his “considerably smaller” gestational sac that was separating from my uterine lining, was likely dying.

And, I spent a week coming to terms with that, the loss of him. 

But, at the ultrasound a week later, a week after doing once-daily progesterone-oil injections, he was fully attached to my uterus, he had grown, and he had a heartbeat.  So, I assumed that the problem had just been an implantation issue, way too common for me with my DES-induced misshapen uterus with too-thin uterine lining. 

I was overjoyed.  But I was still cautious.  But, then two days later, I had another ultrasound, and both babies had grown, giving more reassurance.

And, then last Wednesday, I had yet another ultrasound, and, at this point, Baby B was within a couple of millimeters of Baby A, which could have just been due to margin of error.

So, with all of this good news, I started to get comfortable with the concept of having twins.  I imagined their close twin bond.  I imagined every member of our family reveling in twice the love.  I starting seeing twins everywhere and asking their parents about them.

And, now Baby B is gone.

So what is the reason for him to have lived these past 3 ½ weeks, for me to go from acceptance of his death, to pure joy at his comeback, to boundless love for him, only to have him die now?

I feel like I will be able to cope and move on if I can just understand the reason. 

My doctor has already said I’ll never know.

So, I just have to have faith, although right now I feel like God has been fucking with me. 

How many babies do I have to lose? 

Why did I have to experience the horror of seeing my dead baby on an ultrasound screen this morning?

Why do I have to live day to day, for the next few weeks, with the knowledge that I have two babies inside of me, one living and one dead?

What, please, is the reason?

After doing in vitro fertilization (IVF) with pre-implantation genetic diagnosis (PGD), my pregnancy with twins was confirmed by blood test on Monday, August 17.

I had my first ultrasound at my IVF clinic on Wednesday, August 26.  The technician identified my twins in their gestational sacs, but said Baby B was separating from my uterine lining, and his sac was considerably smaller than Baby A’s, leading her to believe that Baby B was dying.  She said that, if my body absorbed him, making him a “vanishing twin,” Baby A would be safe.  But, if I miscarried Baby B, I would perhaps lose Baby A also.  I started doing one-daily injections of progesterone oil, and I waited, anxiously, for the next week’s ultrasound. 

My second ultrasound was on Wednesday, September 2.  Baby B had miraculously reattached himself to my uterine lining, both babies were growing, and I saw both of their heartbeats.  I cried.  I was overjoyed.

But on Thursday, September 3, I started spotting. 

I increased my progesterone-oil injections to twice a day, per the IVF nurse, whom I paged.

I had another ultrasound the following morning, on Friday, September 4, as part of my initial consultation with the Maternal-Fetal high-risk pregnancy group at the local hospital.  The technician identified two subchorionic hemorrhages in my uterus, but also both heartbeats.  She also let me listen to the heartbeats, showed me how both gestational sacs were securely attached to my uterus, and reassured me that the hemorrhages weren’t affecting either of my twin boys.

Five days later, on Wednesday, September 9, I had another ultrasound, my final one at the IVF clinic, as part of my close-out consultation.  Once again, I saw that my twins’ tiny little macaroni-sized bodies, yolk sacs and gestational sacs had grown; viewed their pulsing hearts, little lights flashing inside their translucent forms; and heard their heartbeats.  All of this reassured me.

But I started bleeding again on Sunday.  Once again, I had no cramping or pain associated with the bleeding, so I tried to stay calm.  The spotting was lighter than before, and it stopped the same day, so I relaxed a bit.

All week, my body has continued to exhibit positive pregnancy signs:  I’m exhausted; I’m starving; I have acne; my stomach is growing daily, it seems; the veins on my chest are still prominent; and my breasts are still sore. 

But, my body has deceived me before. 

Five and a half years ago, I knew from my blood tests that my baby was dying, that the miscarriage would commence shortly, but my body kept exhibiting pregnancy symptoms until the miscarriage started, making me convinced that some mistake had been made—that blood samples had been switched, or my baby was making a miraculous comeback. 

From that experience, I know that my body will continue to do its job, fighting to sustain these babies, until they’re gone.  So, my body can’t be trusted.  My body doesn’t recognize pregnancy problems; it, like me, overlooks them, in its valiant attempt to protect its offspring.    

Because my body can’t reassure me, only ultrasounds can.  And, while I go in tomorrow for an appointment with the Maternal-Fetal group, it is only an appointment in which a nurse will explain every aspect of the practice to me.  But, while I won’t be able to see my babies, I will be able to hear their heartbeats.  So, at least I’ll have that to sustain me.

But, after four ultrasounds in three weeks, I crave the full ultrasound experience.  I want to see my babies, not just hear them. 

I might resort to begging.