For me, this level of contentment is significant, for I’ve spent more than half of my life monitoring my biological clock, making varying decisions as it ticked, tocked, blared, then declared war on anyone in its way.

At age 18, I entered Miami University as a Psychology major. However, upon taking an introductory Psychology course during the first semester of my freshman year, I learned I’d have to go to school for five years after college to earn a Psy.D., as opposed to a Ph.D., in Psychology, so I changed my major. Considering that my primary goal was to be a mom, spending so many years in school—starting my counseling career upon earning a Psy.D. at age 27—seemed a waste.

I never dated for fun: From my first date at age 15 until meeting my husband at the tail end of 35, I evaluated each and every man based on whether or not he’d be a good husband and father. I remember being at a grab-a-date event my sophomore year at Miami University, with my date, a recent love, blowing me off by telling me that it was obvious I “was looking for something,” and he “wasn’t it.”

I was 30 for the year that I lived and worked in London, England, as start-up manager and acting director of the British Film Institute’s (BFI’s) London IMAX® Cinema, a period in which I worked countless hours. When the BFI approached me about extending my contract, the concept of being in London past the launch of the IMAX 3D Cinema, having a normal life in one of the world’s most spectacular cities, was appealing—except that I was turning 31. I knew I didn’t want to stay in London for the long-term, so staying seemed useless, for I didn’t want to fall in love, get married and have children in a city in which I had never felt at home myself.

My desire to find “The One,” then to beat my biological clock, was the primary determinant in my decision-making regarding career and associated city, country, continent. And although I did partake in many experiences, I gave up opportunities as I aged, for they didn’t mesh with my goal of being a regular mom.

At age 35, I started trying to get pregnant on my own, using donor sperm, only to be foiled by DES (diethylstilbestrol)-related infertility. However, I did have success on my seventh cycle of intrauterine insemination.

After having my son Patrick at age 36, I am a mom, however I never let go of my desire to have a second biological child. So as I turned 37, 38 and 39, I felt increasingly tense. As I neared 40, I felt downright panic. And as I turned 41 one year ago, with one unsuccessful in vitro fertilization (IVF) cycle under my belt, with the egg retrieval of my second IVF cycle only days away, I felt as if every day that I aged reduced my chances. Because every day did.

Today I am 42, and I have a second biological child, my son Luke, who is 3½ months old. I finally feel as if my family is complete, so today is the first birthday in probably 12 years in which I am not obsessed with my DES-induced infertility and/or my biological clock. I am truly content.

So today I spent my day snuggling with my boys, first curled up in bed this morning, where Patrick, age 5, suggested that because it’s my birthday, we should buy some vanilla ice cream, which happens to be his favorite food. Then this afternoon, my husband came home from work early, and we watched a movie, with my motivated husband working out, while I, not so motivated, lounged in a recliner with Patrick and Luke lying on top of me.

I’m a thinker, so I reveled in these hours, appreciating all I have been blessed with and loving that my birthday is no longer cause for biological-clock concern.

Happy Birthday to me. Happy Birthday to me.

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.

Personally, I think his survival rate is higher, because I was given steroid injections to advance his development 6 ½ weeks ago, when my pre-term bleeding began—and he’s big. And based on the gymnastics moves he’s performing in my belly, seemingly 24 hours a day, he’s feisty, a fighter.

I have been cursed in the fertility department, struggling with embryo implantation and suffering early pregnancy losses, due to my in utero exposure to diethylstilbestrol (DES), which led to my underdeveloped, one-third-normal-size T-shaped uterus. And due to my DES deformities, my pregnancies are high-risk.

But my one prior successful pregnancy gives me comfort: When I was pregnant with my 5-year-old son, my complication was premature dilation due to incompetent cervix, which led to hospitalization, steroid injections and bed rest starting in my 27th week of pregnancy. After all that, my son was born on his due date, a rarity that occurs in only 5% of pregnancies, according to my pregnancy books, and he weighed a whopping 9 pounds 7 ounces.

My son did have to stay in neonatal intensive care (NICU) for the first five days of his life because he’d aspirated meconium (his first bowel movement, in utero), but his size and corresponding strength helped him overcome being born in acute respiratory distress.

The nurses told me that he was the biggest baby they’d ever had in NICU. And while there were strict rules not to look at the other NICU babies, the day my son was being released, the dad of a 4-pound twin, who also was being released that day, walked over and admitted, “I looked at your baby last night.” He continued, “That’s what a baby’s supposed to look like.”

If the little man inside of me is anything like his older brother, he will overcome whatever is thrown at him from this point on, because he’s also had the benefit of the steroids, and he’s also big for his gestational age.

So, today, for the first time in my seven months of pregnancy, I’m permitting myself to feel confident that, between now and my due date of April 23, my husband and I will be bringing our healthy, huge baby boy home.

I know there are no guarantees. Even at full-term, a 100% infant survival rate doesn’t exist.

But for today I’m allowing myself the luxury of feeling like my dream of having another biological child will come true. I’m still realistic. I’m still scared. But I’ve hit a milestone so significant that the tears in my eyes right now are not sad ones, but ones of hope and happiness.

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.

Tonight, I’m going to vent about “fat talk.”  

First, I have to admit that my family’s comfort with “fat talk” has been generated by me—by my jokes about my extreme weight gain.  Because I am self-deprecating, my family members assume I am comfortable with them being me-deprecating.  And, while I usually am, laughing along with the teasing, I hit my limit in the past few days.

Of course, being on bed rest for three weeks has minimized my sense of humor, while maximizing my size.  My bra size is now a 38E—an E, for God’s sake—up from its normal 34C.  And, the frightening thing is that, sitting atop my massive pregnant belly, my breasts actually look petite.

I am so happy to be pregnant at 41, elderly in the reproductive sense—as in literally reproductively elderly, as my diagnosis is “Elderly Multigravida with Antepartum Condition or Complication.” 

I am so happy to be pregnant considering my “antepartum complication or condition,” which is my uterine abnormality, the result of my mother unknowingly taking the synthetic estrogen diethylstilbestrol (DES) for nausea when she was pregnant with me.

But, while I feel so blessed to be pregnant, it’s not easy to live with the significant, body-altering side effects of the medications necessary for my two in vitro fertilization (IVF) cycles, one of which is weight gain.  Nor is it easy to live with the fact that the initial IVF weight gain is then topped with the necessary pounds of pregnancy.

But, because of the loss of one of my twins in September, I added unnecessary pounds through emotional eating in my attempt to cope with the death of my son, whose tiny body was still inside me.  I added unnecessary pounds as I hoped that my body would absorb him, rather than abort him, so that my other son would be saved. 

So, I have gained well beyond the recommended amount of pregnancy weight.  I’m not only pregnant, but also fat.  I know it.  My family knows it.  But, I don’t want to hear “fat talk” anymore.

My nearly 5-year-old son is the main perpetrator.  Sunday night, while we were lying in bed talking before he went to sleep, he asked if would put my arm around him.  I did.  After 30 seconds, he grunted and said, “Can you move your arm?  It’s too heavy.  I think it weighs 188 pounds.”

Monday, out of the blue, he said, “Mama, you’re a big, fat ninja.”

I know why he called me big and fat, so I asked, “Why do you think I’m a ninja?”

“Because you’re fat,” he giggled.

To me, fat would be the least likely adjective to use with ninja, but, then again, I’m not 4.

Yesterday, at bedtime, he started singing, “You’re a fat ninja.  You’re a fat ninja.”

Today, he announced that we were going to play “dinosaurs vs. people.” 

“Who gets to be the dinosaur?” I asked, because he has a remote-controlled dinosaur robot that can kick the asses of any of his toy people.

“You do,” he said.  “Because he’s fat.”

“Nice,” I responded sarcastically, knowing full well that he thought I should have the fat dinosaur because I’m fat.  “Fat dinosaur should be matched with fat Mama” makes complete sense in his young mind.

Hearing my tone, he tried to recover.  “Well, his tail is skinny.”

So, tonight, when he once again complained about the intolerable weight of my arm around him, I decided to have “the talk”— as in “the talk about fat talk.”

I started by asking him how he’d feel if people called him fat. 

He said, “If I was fat, and people called me fat, I would punch them in the face.”

“Do you want me to punch you in the face?” I teased.

He giggled.

I explained, “I know I’m fat.  But, after the baby is born, I will lose the weight.  And, until then, it sometimes hurts my feelings when you call me fat.  I know it’s true, but sometimes it hurts my feelings to be told the truth every day.”

“I’m sorry.”

“Sweetie, it’s OK.  You didn’t know it hurt my feelings.  But, now that you do, can you please not call me fat anymore?”

“OK.”

We’ll see how tomorrow goes…

My weight was 193.7, so I’d gained only two pounds in two weeks, even though I’d been on bed rest for nine of those days.  My blood pressure was 110/62, which the nurse proclaimed “good.”   Another nurse checked my baby’s fetal heart tones, and his heart rate was consistently around 148, which is normal.

When Dr. E came in, she said she was happy to see me outside of the hospital and that I look great.  She measured the length of my ever-expanding uterus, saying it’s perfect for my son’s gestational age.  But, she recommended against a trans-vaginal ultrasound or vaginal exam—to check the position of my low-lying placenta and the condition of my cervix—because either could re-start my placental bleeding.

When I was pregnant with my son, now nearly 5, a doctor in my previous high-risk pregnancy practice found, at my 27-week appointment, that I was dilated—the curse of having a T-shaped uterus as a result of my exposure to diethylstilbestrol (DES) when I was in utero.  She immediately put me in a wheelchair and had a nurse push me over to the hospital, where I stayed for 48 hours, the time necessary to not only receive the steroid injections that advanced my son’s development, in case he was born pre-term, but also to monitor my dilation.  When my cervix didn’t dilate further, I was released and directed to spend my days at home on bed rest.

Yesterday, the first day of my 27^th week of pregnancy, I was feeling nervous, because of my history, about whether my cervix is still long and closed, as it was at last check.  But, then I realized that, whether my cervix is thinning, dilating or funneling isn’t relevant at this point.  I’ve already received the two steroid injections to advance this baby boy’s brain, heart, lungs and stomach, and I’m already on bed rest.  Everything that would be done, if my cervix were becoming “incompetent,” is already covered.  Therefore, it’s not worth risking an exam that could irritate my placenta.

My next appointment is in two weeks, unless I have complications in the interim.  Dr. E told me to stay on bed rest, saying that, if I still haven’t bled by this next appointment, she may be able to lift some of my restrictions.

Today, it’s been 10 days since my initial bleed, 10 days of bed rest.  My baby boy is still inside of me, where he belongs, and he’s had 10 additional days to grow, to gain weight and strength.  Dr. O, the doctor who released me from the hospital last Sunday, said it’s rare for placental bleeding to necessitate pre-term delivery.  So, I will hold on to that thought, as I struggle to keep the bed-rest blues at bay.

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.

When I was trying to get pregnant six years ago, my reproductive endocrinologist performed a hysterosalpingogram, which revealed that I had a T-shaped uterus.  The result of exposure to diethylstilbestrol (DES) that my mother took while pregnant with me, my uterus was underdeveloped, one-third normal size.  Further, my doctor explained that, while a normal cervix, the bottom portion of the uterus, is about 3 cm in length, mine was 6 cm.

My extra-long cervix didn’t serve me well during my pregnancy with my son, who is now almost 5.  I was dilated at 27 weeks of pregnancy, hospitalized and given steroids to advance my son’s development in case he was born pre-term, and then put on bed rest.  At 31 weeks, I was further dilated, my cervix was funneling, meaning thinning out from the inside, and I was having contractions, so I was hospitalized again.  After 13 weeks of restrictions, I gave birth to my son on his due date, thank God, which gave me confidence that I could accomplish the same with a subsequent pregnancy.

My son, all 9 pounds 7 ounces of him, stretched out my uterus a bit while he was in utero.  When my new reproductive endocrinologist performed a hysterosonogram last spring, prior to my first in vitro fertilization (IVF) cycle, he described my uterus as arcuate.  Bottom line:  It’s still deformed, but now slightly less so.  This gave me further confidence that, if I could get pregnant again, I could carry my baby to term.

I did get pregnant with twins during my second IVF attempt, losing one in my eighth week of pregnancy, but this time I have an unanticipated problem: placenta previa, meaning the placenta is completely covering my cervix, which can cause hemorrhaging and/or pre-term delivery. 

As I near the 27-week point in this pregnancy, I have become more and more anxious about the combination of incompetent cervix and placenta previa.  Before yesterday’s appointment, I was consumed with fear about the repercussions of my cervix failing me once again, but this time having the placenta on top of it.

At my 16-week appointment, the ultrasound technician said my cervix was 5 cm long and closed.  At my 21-week appointment, my doctor said it was 4 cm and closed.  And, because of placenta previa, he told me to get extra rest, not lift anything and not have intercourse.

My husband and I have not been intimate, but getting extra rest and not lifting anything has been nearly impossible.  So, with almost four weeks between my 21-week appointment and yesterday’s, I was worried that my cervix had become dangerously short, as it had when I was pregnant with my son.  And, with little supporting the placenta from below, I worried I could hemorrhage, forcing either my son to be born way too early or me to be hospitalized for an extended period of time in order to prevent pre-term delivery.  My friend Jessica just told me that one of her close friends had to be hospitalized for two months because of placenta previa.  With a workaholic husband and a 4-year-old, I need to be home…

During my trans-vaginal ultrasound yesterday, the technician said that my cervix is at least 6 cm long—and that she’s being conservative.  She said she was having trouble fitting in all on the ultrasound screen to be able to measure it. 

Shocked, I asked if four weeks of no intercourse, minimal lifting, and minimal extra rest could have resulted in my cervix returning to its original length, and she said yes.  But, when I met with Dr. M afterwards, he said that it’s likely been 6 cm all along—and, that, the two prior ultrasound technicians, not expecting a super-long cervix, just hadn’t caught all of it on-screen when they were taking measurements.

He called my cervix “world-record-length” and said the doctors in the practice want patients to have a cervical length of at least 2 cm, while 2.5 cm is considered ideal.  He said to have a cervical length of 6 cm at this stage of a pregnancy—25 weeks—in his view eliminates any concern about pre-term delivery.  He also said that my placenta previa looks a little bit better, so the placenta could move up in the next 15 weeks, enabling me to have a vaginal delivery after all.

Oh, and I only gained 2.3 pounds in the past four weeks, which I blame entirely on the snow boots I was wearing during my weigh-in.

With such good news yesterday, I’m feeling extraordinarily Zen for the first time in months…

My weight gain is so extreme, so early in my pregnancy, because of several factors:

1.  I’m not an active exerciser, but I am an active person.  But, once my husband and I decided to try to have another child, being active wasn’t an option.  Because of my diethylstilbestrol (DES)-induced uterine abnormality, blood flow to my uterus is compromised, resulting in too-thin-for-successful-embryo-implantation lining.  With infertility medications lengthening my cycle, my uterine lining gets a little bit thicker; however, that minimal progress would be negatively affected by exercise, which would stimulate blood flow toward the body parts being impacted—the heart, the lungs, the muscles—and away from the uterus.  Bottom line:  I haven’t overexerted myself in 10 months.

2.  In vitro fertilization (IVF) medications—hormones, hormones, hormones—make women gain weight.  For the majority of four months, from late-May through September, I underwent two IVF cycles, the second of which resulted in a twin pregnancy that required an additional protocol of daily injections of progesterone oil to try to save both babies.  Regardless, I lost Baby B in my eighth week.

3.  I’m an emotional eater, and I coped with Baby B’s loss by overeating.

4.  I’m a former anorexic/bulimic who, psychologically, has to give myself complete freedom with food while pregnant.  I have now accepted that I will forever have body-image problems, regardless of my investments in therapy and reading every eating-disorder book published.   When I was 13, a family member said my calves looked “thick.”  When I was 15, another family member repeatedly told me I had the body of a 50-year-old woman.  I had several boyfriends, from high school on, suggest that I “just needed to lose weight in my thighs.”  But, while I recognize that I will never escape the early damage to my physical self-image, I have gotten strong enough to not respond to my negative thoughts.  So, I eat when I’m hungry.  And, if I overeat, I no longer take laxatives to get rid of the food.  Obviously, being pregnant is the ultimate mind-fuck for an eating-disordered and body-image-disordered person, but, when I was pregnant with my son, I ate what I wanted, when I wanted, for the nine months—getting up to 209.  And, I’m proud of that.  And, as of last Friday, at 21 weeks of pregnancy, I weighed in at 189.3, and, for me, that’s emotionally healthy.  But, physically, it’s taking its toll.

Now at 22 weeks of pregnancy, I’m sure I’ve hit and surpassed 190, but I don’t weigh myself at home—yet-another personal triumph.  And, hauling around 40+ pounds of weight has to be burning ample calories, I rationalize.

For me, having a healthy pregnancy and healthy baby overrides all else.  So, regardless of my body-image problems, I eat.  And, I don’t exercise.  And, as of last Friday, I don’t lift anything or have intercourse because of my placenta previa. 

And, I thank God that I have a husband who doesn’t trigger any of my “issues”:  He is attracted to me, regardless of my size.   When the doctor told us last Friday that we couldn’t have intercourse, my husband said to me:  “He might as well have told me I can’t eat…”  God, I love him.

• Lots of extra rest
• No lifting
• No intercourse

I know that my uterine abnormality, initially a T-shaped uterus now stretched by my previous full-term pregnancy into a slightly larger arcuate uterus, is the reason I battled infertility. 

I know that my uterine abnormality and a prior surgery to remove precancerous cells from my cervix are the causes of my cervical incompetence during pregnancy. 

I know diethylstilbestrol (DES), the useless synthetic estrogen given to my mother when she was pregnant with me, is the reason my uterus never fully formed—and is therefore deformed. 

I know the sexually transmitted Human Papilloma Virus (HPV) is the reason I had precancerous cervical tissue, hence the reason part of my cervix is missing in action.

But, I had no idea why I am currently experiencing placenta previa, yet another complication in my already high-risk pregnancy.  Being an information junkie, I’ve looked it up.

You and Your Baby: Pregnancy by Dr. Laura Riley, OB/GYN (Meredith Books, 2006), the book given to me by my high-risk pregnancy practice, states that placenta previa “happens in about 1 in 200 pregnancies.  You’re more at risk if you’re older, if you’ve had several babies, if you’ve had a prior birth by cesarean, or if you smoke cigarettes.” 

What to Expect When You’re Expecting by Heidi Murkoff, Arlene Eisenberg and Sandee Hathaway, B.S.N (Workman Publishing, 2002) gives the following explanation for placenta previa in its “When There’s a Problem” chapter:

“The risk of having placenta previa is higher in women who have scarring of the uterine wall from cesareans, uterine surgery, or D & Cs following miscarriage.  The need for greater placental surface area due to an increased need for oxygen or nutrients on behalf of the fetus (because of smoking, living at a high altitude, or carrying more than one fetus) may also increase the risk of placenta previa.

In Your Pregnancy Week by Week by Dr. Glade B. Curtis, OB/GYN, and Judith Schuler, M.S. (Da Capo Press, 2004), the authors state the following:

“Placenta previa also occurs more frequently among smokers.  The rate of occurrence increases by 25% in moderate smokers and 90% in heavy smokers.”

and

“This problem is not common; it happens about once in every 170 pregnancies. …  The cause of placenta previa is not completely understood.  Risk factors for an increased chance of placenta previa include previous Cesarean delivery, many previous pregnancies and increased maternal age.”

Older?  Increased maternal age?  Yes.  Advanced maternal age starts at 35, and I’m 41.

Several babies?  No.  I’ve had only one.

Many previous pregnancies?  Yes, but except for my pregnancy with my 4-year-old son and my currrent pregnancy, I’ve only had a prior pregnancy last until the 6^th week.

Birth by cesarean?  None.

Scarring of the uterine wall from cesareans, uterine surgery, or D & Cs following miscarriage?  I’ve had none of these three procedures.

Smoker?  I’ve never smoked cigarettes.

Living at a high altitude?  Nope.  I live in a Chicago suburb.

Carrying more than one fetus?  I was carrying twin boys, one of whom passed away during the 8^th week of pregnancy, then was absorbed by my body, making him a “vanishing twin.”  His gestational sac was at the top of my uterus, with my surviving baby’s at the bottom.

So, based on these three pregnancy books, I can conclude that I am one of .005% of pregnant women to have placenta previa because of my age and/or because I was originally carrying twins. 

Of course, I wonder if my DES-induced uterine abnormality is also a cause.  My uterus is one-third normal size, so it contains less surface area for implantation as it is.  Then, during my second attempt at in vitro fertilization (IVF), I became miraculously pregnant with not one, but two, embryos, both of whom had to fight to implant, with one going high and one going low.

The fact that I am one of .001% of women to have a congenital uterine abnormality has to be a factor…  How could it not be? 

I am so sick of the havoc and horrors DES continues to wreak on my life—and the life of yet-another of my unborn children.