The tiny feat of milestones

June 12th, 11:00 p.m., John feels the baby kick for the first time.

June 13th, John gives me his first p17 shot! yeah, I no longer have to give it to myself!

June 14th, I reach my 19th week of pregnancy, after this week I will be half way done and enter into a whole new phase of pregnancy I haven't experienced yet! 


I have reached a landmark every week in my pregnancy since the moment I found out I conceived. It's just so surreal to look back at all the tough things I have overcome to get to this point. The strict monitoring that I'm so used to will finally end and we will be into the "normal" pregnancy risks and complications after this Fridays appointment. I have had OB appointments every other week since week 10 to check my cervical length trans-vaginally and make sure everything is staying put. So far everything has been picture perfect. At 16 weeks I started taking 17-hydroxyprogesterone shots weekly to prevent preterm labor. Even though I do not have a history of it, they want to be safe then sorry. The physician approved to let me do the shots myself. This week, I was having a horrible time giving it to myself, as it has to be given in the buttocks. John is deathly afraid of needles, but somehow got the strength to inject me. I'm so thankful that he's able to administer it now, as the bigger I get, the more impossible the task. After my 20 week anatomy check and last cervical check, I'll feel a considerable weight will have been lifted. We're now in territory we've never seen before, and I'm not afraid of new challenges!

At 19 weeks in 2012 is when I found out I was going to deliver Mia early. We made it to 20 weeks, and then she was born and left this world. It's hard to imagine that next month, had she lived, I would have a 2 year old daughter running around! The one thing that I long for the most is to hear her voice. I think about it frequently. I have come to terms that nothing in this life is truly ours, even our children. They are borrowed miracles which we have the pleasure of nurturing here on earth. But alas, everything must be given back, everything has it's season. Mia has taught me about living in every moment. I know the value of days, hours, minutes and seconds. She taught me how to consciously chose my friends and relationships to the highest caliber, because my days are numbered, just like hers were, so I chose to be HAPPY while I'm still here. She also made me realize that I want to spend my days learning, growing and loving. I am thankful and humble for each lesson and each blessing I may receive.

Isn't it amazing what two little feet can do when they touch your heart!... 

Against all odds...

This is my sacred space. This blog is something I started to share my experiences. So mostly in this blog, others will read about things that I have went through, in hopes that they can relate or learn from. I feel that learning is something we are never too old for. I feel that when we go through extraordinary things, we should educate and express them to help others. To me it helps reveal who I am as a person, because all of my experiences help shape the person I am. The path is never straight forward like we'd like it to be. There are usually valleys, mountains and many obstacles to over come that we never knew were coming. But I'm ok with that. The older I become, I realize that this is simply LIFE! I never sit in the moment of defeat or doubt and cry out for help, I move on to plan A, B, C, D, E... etc. There is always another option. If you think that your options are expendable, you should think again. Because if you can believe it, I know that you can achieve it. But don't forget, it may not be easy!!!

I recently had a procedure done to fix my incompetent cervix. The one most commonly used is the Transvaginal Cerclage (TVC). It's placed around 13 weeks and is done through the vagina .The cervix is stitched shut near the bottom. You are usually on full bedrest afterwards for the entirety of your pregnancy, and it is about 75-85% effective. When they say effective, the medical world means live birth. They consider live births that are severely preterm with lifelong medical complications success stories. Full term, healthy birth success rate is probably less than the 75%. Since the cerclage is placed low on the cervix, the pressure of the baby will still push down, causing you to dilate and funnel up to the stitch. There's a lot of pressure being placed on the cervix itself. Your water can break at any time and can even tear the cervix where the stitch is placed. To me, this is very risky. But I was willing to lay in bed for months on end if need be. I consulted last month with the high risk doctors at U of M and they wanted to do the "wait and watch" approach, measure my cervix to see if there were any changes and then possibly perform a TVC if they felt it needed. In my heart I knew there had to be other options. So we did more research and found the answer we were looking for. 


The other kind of cerclage is called a  Transabdominal Cerclage (TAC). It's placed through your abdominal cavity and is so much more effective.  A c-section incision is made and a band (made of merselene) is placed tight and high on the cervix. It can support up to 100 lbs! The procedure can be placed pre-pregnancy or during pregnancy (but only up to 10 weeks or so) . The band is permanent and can be used for future pregnancies. You can only deliver via C-section after it's placed. It totally solves your incompetent cervix, no bed rest is needed and you can resume a normal pregnancy and have the chance to deliver a full term baby! There are only a few doctors in the United States that do this procedure. They are highly skilled and saved thousands of babies lives! This was the route I decided to go. We were lucky enough to live close enough to one of the most recommended ones in the world, Dr. Arthur Haney, at the University of Chicago Medicine. Women from all over the world come to have their TAC placed by him. We consulted with him on the phone for well over an hour, he explained any little detail we could have ever thought of, and a week later we traveled to Chicago. I had my procedure on 4/11/14. 

I was not nervous the night before my surgery, I don't over think things. I couldn't eat 10 hours before hand (surgery was scheduled for 1:30 pm the next day) but I made sure to order room service for 2:30 am so I could get one last meal in. The University of Chicago Medicine Center for Care and Discovery is an amazing building. It feels like you are going into an airport or some kind of space ship, it's really state of the art and just over a year old. I felt I was in the best care possible when I was there. The entire staff that would be in the OR with me came in and introduced themselves, what their role would be and made sure I was comfortable.I was wheeled back into the OR with no nerves whatsoever. They started to give me general anesthesia and the next thing I remember I was waking up and heading to recovery. The procedure took about 2 hours. They were rather surprised that I was coherent so fast. They asked how my pain level was, and it was ok for the moment, they said it was just the anesthesia that hadn't wore off yet because I would soon feel pain and to not be tough, just use the medicine. I was given a pain pump and I could push the button every 8 minutes and have Dilaudid injected straight in my blood stream. I was in the recovery room for a long time, as it was a shift change and they had to get my room ready. I did not have any nausea, vomiting, or any other adverse reactions. I just wanted to get to my room and sleep and get something in my stomach. 

I had one of the best rooms you can get there. It has a city view as well as a view of Lake Michigan, pictures don't do it justice and the windows are tinted. It was nice for my hubby. He was able to stay in the room with me the two nights I stayed which was wonderful.

That night I did get a bite to eat. I did not get into my room until 8:00 p.m. I had a catheter also which are always uncomfortable to me. I lived off the pain pump and was in and out of states of rest. I actually didn't get a wink of real sleep that night, as the catheter was not draining correctly and was causing me pain and I kept waking up trying to roll to my side to see if i could get it to drain better. My throat hurt so BAD! When you have general anesthesia, they intubate you (put a tube down your trachea to maintain an open airway) and that really messed with my throat. It felt as if someone had shoved something down there (which they had!) and irritated everything. 

The next morning was rough. They came in, took the catheter out, stopped the pain pump and you are encouraged to try to get up and walk. Since this is not a normal Csection. They actually go into your abdominal cavity, move your muscles, bowels, bladder and uterus around, you basically feel like you've been cut in half! They give you Percocet as needed, but the next day was rough. Dr. Haney said I should recover well and quickly since I am fit, and have no fat. But, the next day I just felt like a big old baby! My hubby brought me flowers when he went out searching for breakfast and that brightened my spirits for a second. 

I eagerly waited for my ultrasound. They finally came for me, and Dr. Haney met up with us when we went in. The ultrasound tech showed him the TAC and he was pleased with what he saw. He talked to me with how the procedure had went and that he had never had someone with such tight abdominal muscles! (I could tell, because they feel pretty bruised!!) He explained that my cervix would stay long and I could have it looked at every two weeks with my OB/GYN so I could have reassurance things were staying put. He's an amazing man. Truely, I've never met a doctor like him before and I'm so glad that this was all possible. We were all laughing because Dr. Haney personally escorted us to Pre-Op and after the ultrasound, he personally escorted me back up to my room (and this hospital is huge). He said that was the most expensive escorts I'll ever have in my life. I mean, really, he felt like a father I've always wanted!

And at the end of the measuring of the TAC and cervix, I finally got to see the entire reason for this, the reason why I'm willing to go through so much suffering, pain, and any obstacle I need to....

Introducing the incredible little life that is growing inside of me. John and I have conceived all on our own. I know that my baby has a fighting chance of entering this world healthy, because I have done all that I physically can to protect Baby Pak, and that is all any parent can do for their child. 

I'm at home, recovering, and it's hard. Every day gets a tiny bit better. The worst pain I have had was the first 3 days after surgery. My body was so pumped full of air, I thought my stomach was going to explode and I've never been in that much pain in my entire life. Another thing, I would advise getting a TAC pre-pregnancy if possible. The incision is a bit smaller as well. I am at the end of my 1st trimester, but still not feeling so hot and it's complicated recovering from major surgery and being sick from pregnancy. Also, I would advise against the narcotics unless you're GI track can handle it. It makes things a lot worse for me with an already slow digestion because of pregnancy. I stopped taking them the day I got home. I rather suffer with pain from surgery, then the pain of bloating and not being able to eat when you are starving!

If you have any other questions regarding Transabdominal Cerclage (TAC) please feel free to comment below. I am so thankful for Dr. Haney, what a blessing he is! 

In Remembrance of Mia

This morning I feel compelled to share the eulogy for my daughters Memorial service. These words have comforted me so much in the early days of her death. The first time I went into Mia's memory box and read this, my heart hurt so bad. But today, as I read the words my heart is filled with thankfulness and warm remembrance for a child that has forever changed my life. I share this not for sympathy, but for hope that this may also soothe the heart of another parent who has lost a child. 

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Our journey to a family (Part 2)

After I lost my daughter, I felt as though I had lost a of piece of myself. Imagine every hope, dream and aspiration you have being extinguished and there is NOTHING you could ever do to get it back. We had spent the spring and early summer preparing our house for this child that I was suppose to bring home. All the home improvement projects had been finished and the spare room was converted into a nursery. Now, as I walked up to the doorstep of our house, I felt loneliness, an empty feeling and I did not feel comfortable at home. We decided to take a week and travel. I had the idea to take one of the toys we bought for Mia and take it with us. We would vacation as though we were all together and take pictures at monuments and places we would have taken her. It felt like a great way to cherish her memory. I was told to take it easy after the delivery, I had a 6 week maternity leave but I needed to run from the pain I was feeling. I needed to see the world and realize that life must push on, it must press forward. I needed these moments to reflect and embrace the things that her birth and death taught me. 

Summer turned to fall and the pain in my heart was still strong. I gained about 10 pregnancy pounds and I decided I should be focused on my health. I started on an all organic and  mostly vegetarian diet. My husband joined me. The holidays came and went. 2013 started. We decided that we WANTED to be parents. Mia could never be replaced, but we wanted to try for another child. On January 29th I found out I was pregnant. I called the high risk OB doctors at University of Michigan and made an appointment to be seen in two weeks. I never made it to that appointment. On February 17th, I went to the emergency room because I was bleeding. I was transferred to another hospital and told I was having a miscarriage. Really? Was something wrong with me? My family physician reassured me that this was just a fluke. She too had experienced a miscarriage and stated she got pregnant the following month. I had nothing to worry about. I decided to make a appointment with the doctors at the University again to get consolation on my recent loss.

April came and we were at our in-laws to celebrate our birthdays (me and the husbands are 3 days apart from each other) and to my surprise I got ANOTHER positive pregnancy test the day BEFORE my University appointment. We went the next day to the appointment and told the physician we were pregnant.  All of our high risk scans and ultrasounds were scheduled. The entire timeline of this pregnancy was drawn out and I left feeling hopeful. This time, we were going to make it to 12 weeks so we could get that cerclage, and I would then be on bed rest for the remainder of the pregnancy. And then, it happened. I had another miscarriage at 6 weeks. It was all so much to take in. Why had I never heard of such things happening to other people? Why was this happening to me? What in the hell was going on?

I decided it was time to get an appointment with a reproductive endocrinologist (fertility doctor). I wanted to subject myself to every test they had to try to figure out if something was wrong with me or John. Recurrent miscarriages are not necessarily normal and I didn't want to keep this pattern going. The physical and emotional toll it takes it very complex and exhausting. I'd had enough. All the tests came back normal, except one. They tested my blood for a gene mutation called Prothrombin G20210A. Prothrombin is a protein that helps clot your blood. My genetic code causes me to have TOO much prothrombin, making my blood more likely to clot. I am heterozygous, which means I only have the gene from one parent. This mutation is found in only 2% of the Caucasian population and uncommon for African American, about 0.5%. I later had my mom tested and and found out she carries the mutation. This was what was likely causing my miscarriages. I was put on a 81mg baby aspirin daily, and told that I would need Lovenox shots when I became pregnant next time. 

I received the blood clotting information in May. John and I went away for Labor Day weekend for a music festival , one of the first normal activities we had done since the new year. I felt like now I had some missing pieces of the puzzle, and I should allow myself to breath! I had spent the last year with so much heartache, sacrifice and uncertainty. My brother was getting married in June and I just wanted to enjoy each moment. I wanted to have the summer to relax and not have to think about anything pregnancy or baby related. We had a wonderful, gorgeous summer filled with family, friends, sun and TONS of water. I let go of the anchor that was on my heart, and plunged it deep down in the waters of life. I missed my daughter, but I knew I had to let her go or I could not truly LIVE. I decided to honor her with the way I lived my life. I wanted her to be proud of me. I knew I had an angel watching over me. I felt like I could finally exhale, the tightness on my heart lessened just a bit. I smile when I realize what a blessing she has been in my life.

 

Me and John as my brothers wedding

September came and we consulted with our fertility doctor again. We got back on the baby making wagon! Back into the perplexity and stress! The doctor said that we were healthy and he did not see any problem with us conceiving on our own. We inquired about IUI (intrauterine insemination). He was fine with letting us proceed with this procedure. The first cycle we did with Femara and natural baby making technique (lol!). We did not get pregnant that cycle. The second cycle in October I took the Femara and we did IUI that time, again, negative. For the third and fourth (November and December) we decided to switch up the meds to see if we'd have better results. I had ultrasounds on day 3-5 of my cycle to make sure everything looked good with my follicles and ovaries. Once I was cleared, I started injecting myself daily for 5 consecutive days with a medication called Gonal-F, which is a follicle stimulating hormone (FSH). I then had to have another ultrasound to see how many eggs I had produced and to see if they were near maturity. After the doctor reviewed it, he would decide when I need to trigger (inject) myself with a drug called Ovidrel which causes ovulation and also matures the follicles (it has HCG in it, the same hormone you produce when your pregnant). We then drove down to Grand Rapids to have the IUI performed. John had to produce sperm, which was washed in their lab, where it would leave the highest quality swimmers to be injected directly into the uterus. After each procedure, I had to take prometrium (progesterone) in the mornings and evenings for two weeks. At the end of two weeks, you get a blood HcG test to see if you are pregnant. If not, the process starts all over again! 

 Me in a hotel room the night before November IUI, exhausted!

The view from our hotel room

September, October, November, December 2013 all failed cycles, one natural with medication and the other three with medication and IUI's. The progesterone was making me moody. I was constantly at the doctor being poked and prodded. All the traveling we did, since we live 2 hours away from the fertility clinic was starting to take it's toll. The medications were just starting to make me feel really out of sorts and my pain level would sky rocket every time I was off the hormones. 

We've decided to take a break from the medications. I really believe that my body can get pregnant on it's own it did last year, twice. In retrospect, I suppose we just wanted to increase our chances of getting that positive test. I've learned so much through this process, I've never lost my hope. Sometimes you just need to sit back on the sidelines and observe what is happening around you. Always remember to listen to that little voice deep inside that is telling you something is not quite right, because most of the time that gut feeling is right. I feel like I need to take the control back. No doctor or nurse knows me better then I know myself. And one day, my destiny, whatever it may be, will be fulfilled. The creator knows the desires of my heart. And I am content with that.

Our journey to a family (Part 1)

Some women are born with this innate biological urge to get married, buy a house and start a family, PRONTO! I've never been THAT woman. I've always been career minded and had a sense of adventure, I guess I'd never really considered having children. Even after marriage with my husband, the years flew by and one day I figured we'd better have "the talk" to make sure we were both on the same page. We both agreed that we liked our 
independence and ability to chose what we wanted to do within a moments notice. The "if it happens it happens" approach was for us. We were content on spoiling our niece and nephew, but we knew parenting was a 100% commitment and definitely not like babysitting.

And then, after 9 years together, on a trip to Chicago on St. Patrick's Day 2012, we conceived a child. I remember looking at the positive pregnancy test with disbelief as I showed my husband. I felt stupefied and the look on my face matched. John on the other hand looked as if he had just won the lottery. He immediately went on the internet to calculate our due date. December 13th was our EDD. We'd have the scariest, coolest and best Christmas present ever! 

My pregnancy was not easy. The month before I had been diagnosed with Fibromyalgia and was just starting to feel a little relief from the medication I was on after years of agony. I had to stop taking it, as it was a Class C drug and not approved while pregnant. As my body quickly started changing, on came the morning sickness. I'm talking about 24/7 gut wrenching nausea. I could not cook in my house for several months. Everything made me ill. I craved food that I NEVER ate. My mouth watered like a hyena. I was miserable. The only thing that kept me going was, well, that I had to!! I kept praying vigilantly that my symptoms would ease up by the 3rd month like everyone was suggesting it would. By the 4th month I started to see the light. The sickness lightened up a bit where I could function. I could barely wait to know what the sex of my baby was. I worked at the hospital, and at 17 weeks I had my friend in Ultrasound give me a scan to see if she could tell early what I was having. "Unless it has a really tiny penis, you're having a girl" she told me. Hearing this news both scared and shocked me. I had pictured a boy the entire time. A GIRL!? Someone that is going to look up to me in every way!? (terrifying!!) I was happy, regardless. I was having a child and it was starting to get very real. 

After sharing the news with my hubby, in our excitement, we went to buy our first outfits for her. As much as I wanted to buy every cute outfit I saw, I restrained myself JUST in case the scan was incorrect and we were having a male! I knew it could be a possibility. I bought a breast pump and a co-sleeper. I started putting together a nursery.  One day while sitting on the porch eating Italian ice, I asked John what he thought of the name Mia. He liked it. Our daughters name was chosen. 

In my 19th week, one evening before going to bed I used the rest room. When I wiped and saw the tiniest tint of pink on the tissue. I was not alarmed. My body was going through so many changes, I figured it was one of them. Just to a make sure, I called my OB/GYN the next morning. The nurse told me to come on in, that I most likely had a urinary tract infection. Me and my husband came into the office, I gave a urine sample. They could not see any trace of an infection, so they wanted me to wait for a physical exam. I was on the table and and the nurse examined me, and then left the room. She came back in with the physician. "I'm so sorry, but your membranes are protruding and you are going to have to go directly to the hospital. You're going to have the baby, I'm sorry there is nothing we can do". What? How did this happen, what do you mean? I started crying and my world shattered. How could all the plans and hopes and dreams I had for my daughter end like this? 

We left the doctors office and went straight to Labor and Delivery where I was admitted. I was scared. Nurses came in and checked me periodically. They kept telling what to expect, that the baby may just come suddenly without warning. I was not having any contractions or any other sign of pre-term labor, so I did not understand how this could be the end of everything. I did know that at 19 weeks, Mia's lungs were not developed enough for her to be able to survive. Every nightmare I had ever imagined was child's play in comparison to this scenario. My family came to visit, they prayed, gave me their support and encouraged me to be strong. 

After two days in the hospital, I still had not delivered my daughter. Her vital signs and mine were steady. My husband started researching, he wanted to know if they could perform a rescue cerclage. A cervical cerclage is a procedure where they close the cervix with a stitch. The doctors listened and said before they would consider such a thing they needed to know that the baby was healthy. They thought my body was rejecting her because of a chromosomal  defect or an infection. They drew blood work which took 2 days to get back from the Mayo Clinic. She looked perfect. I waited another day to have an amniocentesis, and had to wait to another day to have that read. Everything came back normal. They decided they would attempt to do this risky procedure. It's not typically done when the amniotic membranes are bulging PAST the cervix, that's why it's called a "rescue". They were going to try to use a foley catheter to gently push the membranes back up where they needed to be so they could do the stitch. 

I received spinal anesthesia and was prepped for the surgery. The doctors attempted the surgery, but they stopped after their failed attempt. The catheter method was not working and they did not want to rupture the sac. We had come so far, I wanted it to work with every breath of my life. The only option I was given was to go home and on bed rest and see if I could reach viability, which is 24 weeks. That night John started to read medical articles and learned of a method of where they drained amniotic fluid and then attempted to use the catheter to push the sac back. The next morning we found a group of physicians who were experts at this type of procedure at the University of Michigan.  We asked our consulting doctor if we could be referred to them and she transferred orders to have me admitted. 

My husband ran home and got our Jeep Sahara 4 door, blew up an air mattress and made me a bed in the back. I had been on bed rest for 7 days so far, and I needed to be lying down with my hips and legs elevated at all cost. He went and bought a portable urinal and a step stool so I could get into the back of our lifted Jeep. Off we went for our 4 hour drive all the while hoping and praying I would not deliver Mia while we were traveling without any medical attention. We stopped off on a two-track for one awkward and scary bathroom break, but she held on, this girl was tough like her mother!

We made it to the hospital, where they examined me. The admitting doctor said she needed to talk about the plan of approach they wanted to use with her colleagues. I was admitted. The next day I was visited by the physician who would be performing the procedure. He talked to me about the technique they would be using (exactly what the hubby had looked up!) and told me I needed to be on antibiotics for 24 hours before they would attempt it. 

I kept my faith, I rested and stayed positive, I had hope. My in-laws came to visit me. They took John to dinner. He hadn't had a non-hospital meal in 10 days. I told him I would be fine by myself, to go and get some fresh air. As I laid there with just me and my daughter I rolled on my side and looked out the window as the white fluffy clouds rolled by. It was our first time together just her and I. I told her how much I loved her, how much she meant to me, how much she was loved as tears streamed down my face. It was a moment I'll never forget. 

And then that evening, my water broke. I was in denial, not wanting it to be true, pretending like it could be something else. The nurse came in and confirmed the truth. I would not be able to have the surgery. But I was still willing to fight. We had read that the baby could live without the amniotic fluid, but it was a high risk to the mother. I was now 20 weeks along. I knew that she needed the fluid for her lungs to develop, but I wanted to hold on to her as long as I could. The doctors told me I could, but if I started to develop a fever, they would have to induce me, as my health and life would then be in jeopardy. I held on for an hour, and then my body got hot and I got a cold sweat. My body was being infected. The next time my vitals were taken, they told me that my temperature had spiked and I would have to deliver her. 

After 24 hours of contractions I delivered my Angel. 

Mia Lee Pak was born on July 27th, 2012 at 10:12 p.m. She passed away at 10:45 p.m. She weighted 10.7 oz and measured 9.75 inches. 

I left the hospital with a diagnosis of incompetent cervix. With any future children I would be a high risk pregnancy and advised to have a cerclage at 12 weeks to prevent future loses. 

We coordinated with a nearby funeral home in Ann Arbor and the hospital to have her body released to us and we would deliver her directly to our local funeral home. I was wheeled out of the hospital in a wheel chair with my tiny baby wrapped in blankets. The 4 hour drive home we took turns driving and holding her. We both wanted the opportunity to go over every aspect of her, to have it burned in our memories. To marvel at how much she looked like both of us. At times it was heart breaking and at other moments it just felt like we had a sleeping baby that we were going to bring home to cherish. The hardest moment was arriving at the funeral home and leaving Mia, a piece of me, a piece of my husband, made by our LOVE. 

I am so grateful for the time I got to spend with my daughter. I see her in the morning sun, I see her in the wind that blows gently on the trees on a warm summer night. I see her in every beautiful thing I lay eyes on upon this earth. I am blessed to be her mother.

This is part 1 of our journey to a family.. stay tuned for part 2..