The Final Word On Induction

It's very difficult to plan a trip when you could potentially be called to leave at a moment's notice and you have no idea how long you'll have to stay. We're supposed to fly out to Minnesota early Monday morning, but Jimmi and I have been trying to pack in advance in case Aria decides to make a surprise escape a few days early, which wouldn't give us much time to think about what we'll need to take with us. Of course, if she is still nestled comfortably inside Lyndsay until our planned departure, we'll have to be prepared for at least a week's stay in the midwest, if not longer. 

This sucks.

I'm a planner, in case you haven't noticed. I don't do well with playing things by ear or waiting on details. I need to know exactly how, what, why and where my life is headed at all times. Don't get me wrong. I love surprises if they happen spontaneously and I don't have time to think too much about them. But, given room to ponder, I turn into a complete basket case.

That's pretty much where I am now.

I won't rehash all the specifics for the millionth time because I know most of you have been keeping up with my blog but, for those who may have missed a few entries, here's the Cliff's Notes version:

Lyndsay is due May 18th. Jimmi has to leave for a three week tour no later than May 21st. We're flying to Minnesota on May 12th. Lyndsay's original doctor was deployed a few weeks ago and another one took over. We've asked the new doctor if Lyndsay would be approved for induction sometime between May 13th and 15th to make sure Jimmi will be present at the baby's birth. While I was waiting for an answer, Lyndsay was bounced around a bit while scheduling her next appointment, and finally settled on a midwife to care for the remainder of her pregnancy. Knowing midwives are usually adamantly against induction for any reason other than medical necessity, I decided to send an e-mail, pleading our case, hoping for a miracle.

The response I received from the midwife on Monday gave me a small glimmer of hope, as we weren't immediately turned down:

Hi Suzanne,

I just wanted to let you know that I have received your email and, yes, I have been updated on your situation from both Dr. H and the other midwife Lyndsay saw. As with any patient, we always want to make the best clinical decisions. Let me look more carefully at Lyndsay's chart, etc. before I go any further. Just please know that I am here and aware! :-)

I will be in touch soon.

J

J's reply had a calming effect that quickly loosened the tension that had been plaguing my shoulders for two weeks. She gets it, I thought to myself. I know she'll help us. She has to help us. I found myself feeling much more relaxed over the last two days, as I almost patiently awaited J's final answer, hoping it would come before Lyndsay's 39 week appointment on Friday. And, tonight, at 8:00 PM, the suspense ended as I read these words:

Hi Suzanne!

I can share some updates with you. Please know that even if I am the midwife caring for Lyndsay for the remainder of her pregnancy, she is still considered a "physician" patient. (Side Note: I'm SO glad she cleared that up for me. It was another major cause of stress as I really wanted a doctor in charge, in case of any emergencies.) Given this, I have spoken with several key players in our department regarding your situation. Two of which are physicians who will be working in the timespan of your requested induction dates. We all have reservations about inducing Lyndsay. We do appreciate your situation and empathize. However, per our policy, (our hospital) does not offer induction of labor without medical indication. We wait until 41-41.3 weeks to optimize our chances for spontaneous labor. 

I know this process has been frustrating for you, and I apologize for the change in clinic providers here at the end of the pregnancy. Please know that we have Lyndsay's and your baby's BEST interests at heart.

I look forward to our visit on Friday.

J

And, just like that, my balloon was burst into a million tiny pieces.

It's over. There's no one left to ask. I've hit every possible angle and they've all turned into dead ends. Yes, we can hope Lyndsay goes into labor on her own, before her due date but, based on her last pregnancies, which were just over 40 and 41 weeks, that's not a likely outcome. Chances are, I'll be sitting in Minnesota for a few weeks, missing my boys and waiting for Aria, all by myself.

Complete Loss of Control

It's hard to explain how difficult the last nine months have been for me. I've tried not to delve too deeply into the recesses of my mind to pull out the ugly thoughts I've had. I'm not sure if I'm avoiding the truth for my readers' benefit or my own. Maybe I don't want to think about my true feelings because they're just too hard to deal with right now. But I can't hold back anymore. 

The loss of control is eating me alive.

Control? Yeah, I lost that about three years ago when my body, which I'd always cared for, started to give out on me. For about six months the only control I had was whether I'd sleep on the couch or in my bed after a long day of chemotherapy. I also had control over which wig I wanted to wear to my own wedding. Other than that, the doctors made all the decisions and I just followed their lead like a sick puppy. 

Once we beat the cancer into submission I thought I'd be able to take charge of my life again. Jimmi and I decided to find a gestational carrier and transfer our embryos into her functioning uterus so we could have a baby of our own. I had no idea that something so exciting could make me feel so useless; so completely out of control.

We found Lyndsay last May and our journey progressed quickly. I brushed aside my tinges of jealousy that I was no longer able to grow a human life inside my body and needed to find a "complete" woman to do that for me. The feelings of inadequecy grew daily as the news of her positive pregnancy test was revealed. I should be the one telling Jimmi I'm carrying his baby, I thought to myself. It wasn't supposed to be like this! But I knew we were lucky that we found Lyndsay and that we even had this option so I tried to force the feelings out. 

Lyndsay's doctor kept us informed of every detail of her pregnancy, making us feel like we were actually a part of it. He Skyped all of the appointments we couldn't fly to Minnesota to attend and he responded very quickly to any e-mails I sent. It was really the best situation we could've hoped for. 

But, as things progressed, my mind took a left turn to Crazy Town. The thought of someone else feeling my baby's first kicks pulled at my heartstrings and when I spoke to Jimmi about it his indifference worried me. I quickly realized that, since he's never been through a pregnancy with anyone, he couldn't possibly understand how much he was missing. I figured that might be a good thing. Maybe then he wouldn't be angry at me for not being capable of performing a "real" woman's job. Maybe he wouldn't resent me for forcing him to miss the nights of cuddling my swollen belly as gentle kicks responded to his soft words. But then I realized it was much worse. 

Jimmi felt completely disconnected from our baby.

Maybe I was wrong, I thought when we were about 18 weeks along. So I asked him, "Do you know how many weeks pregnant we are?" He shrugged nonchalantly and responded, "I dunno. Thirteen?" The disappointment painted my face as I shot back, "We're eighteen weeks." There wasn't a hint of remorse when he asked, "What? Is it such a big deal that I didn't know?" I couldn't believe he asked me that. "Yes, it's a big deal! It's our baby!" He shrugged again and said, "I don't know why you're getting so upset about this." Anger took over and I questioned, "If I were pregnant would you know how many weeks?" He answered without hesitation, "Probably. But that's different." I was shaking, "How is it different? She's still our baby!" He shrugged for the third time before I answered for him, "You don't feel any connection to this baby, do you?" His face was almost cold as he said, "Not really. But I'm sure I will later."

That conversation has stuck with me for months. Because I had cancer, I can't have babies. Because I can't have babies, we found someone who can. Because someone else is having our baby, Jimmi feels no attachment to her. Because Jimmi feels no attachment to her, I feel guilty for not being able to have babies. But that's out of my control. Nothing I can do about it. 

Don't get me wrong, here. I have no doubt that Jimmi will be an amazing dad once he lays eyes on his little girl for the first time but, until then, he's on the outside, looking in. The situation isn't real. He's a thousand miles away from all of it so it's not really happening. He'll just snap into fatherhood once the baby is born. Or maybe he'll have to leave for his tour before she decides to make her appearance and he'll have to wait until she's three weeks old before he even meets her. That should make bonding easier. Did you catch my sarcasm there?

Ah, the tour. Another thing that's out of my control. Of all the days in all the months of the year, his band was scheduled to leave for a tour on our due date, May 18th. An understanding manager offered to cancel the first few shows but Jimmi absolutely needs to leave on May 21st to catch up to the band for a gig on May 22nd. 

Lyndsay's doctor, who was deployed two weeks ago, had mentioned the possibility of inducing labor at 39 weeks because of our extenuating circumstances. At that time I e-mailed the new doctor to ask her about that option and she told me the entire OB team would have to make that decision the week we hoped to induce, but it wasn't a normal practice to induce for scheduling. The helplessness and desperation grew as I spoke to the original doctor in Kuwait, who seemed to have changed his original tune about the matter as well. Back and forth we went without any decision being made. Thoughts of Jimmi missing the birth of his daughter caused panic attack after panic attack as I realized the first minutes of bonding with his baby were quickly slipping away and there was nothing I could do to change anything. If he's feeling a disconnect now, missing the birth would only widen the gap.

I called the director of the surrogacy agency who informed me that her carriers are induced 90% of the time to make sure the parents can be present at the birth. She seemed surprised by the policies at Lyndsay's hospital but neither of us could change them. In the meantime I spoke to Lyndsay about her feelings on induction and she told me she'd prefer to go into labor naturally. Yes, I absolutely agreed with her. But if the doctors decided that induction would be safe for everyone, I want to do whatever it takes to make sure Jimmi isn't MIA when his baby enters the world.

I've been losing my mind over this entire situation for weeks now. Lyndsay and I finally came to an agreement that was acceptable to everyone and, during our appointment last week, the doctor admitted that, if she recommends it, the rest of the OB team would probably be on board with inducing just a few days early. I started breathing a little bit easier.

Until Wednesday.

We had our almost 38 week checkup scheduled for 2:00 PM that day. I waited anxiously by the computer with my Skype screen ready to go. An email from Lyndsay at 1:50 announced the last-minute cancellation with a new appointment scheduled for Friday, this morning. "Is it with Dr. H?" I asked. "No. They put me in with a midwife." That seemed odd, I thought. We've only seen doctors up until this point but I knew they were squeezing her in this week and the midwife was probably the only one available. 

The appointment was quick and Aria is a healthy, full-term little pumpkin. "Do you have any questions?" asked the midwife over the phone after allowing me to listen to my baby's heartbeat. I wanted to ask about induction again but I didn't feel like repeating the entire story for the zillionth time. Besides, we still have another week before they'll need to evaluate Lyndsay for our timeframe and this woman wouldn't be the one making the decision anyway. "Nope. I don't think so." 

A few minutes later Lyndsay texted me to tell me our next appointment was scheduled for the 9th at 8:15 AM. "With Dr. H?" I asked, referring to the doctor who had taken over for our deployed one. "No. A different one." I had to calm myself before my head exploded. Another doctor? Yes, I understand it's difficult to fit all the weekly, end-of-pregnancy appointments into one doctor's schedule. I get that it's not Lyndsay or Dr. H's fault. But now I need to contact this new doctor to explain the situation to him so he can be prepared to evaluate Lyndsay for induction next week. Ever hear the expression "Too many cooks in the kitchen?" Is Dr. H still in charge? Is the new doctor my go-to-man? Who can I speak to about my baby? 

I decided to send an e-mail to Dr. H:

Dear Dr. H,

I wanted to send you an e-mail to touch base about our baby and what's been going on here over the last few weeks. Now that we're down to the wire it seems things are starting to fall apart and I'm getting even more nervous than I've been to begin with. Imagine how difficult it is to trust another person, who started out as a complete stranger, to carry your baby for you because you can't do it yourself. Imagine that person is 1000 miles away and your husband isn't able to experience the joy and excitement of a pregnancy. Imagine everything is going as smoothly as possible until the last month when you start being bumped from one doctor to the next and you have no idea who to turn to with questions or concerns about your own baby because, technically, Lyndsay is the patient so, even as the baby's mother, I don't feel that I matter in the equation. Dr. C had been Skyping our appointments, which made things slightly easier. There was a miscommunication when you met Lyndsay last week so we were forced to use speakerphone. I understood that. I had emailed you earlier this week to make sure you could bring a computer the the appointment on Weds but I never heard back. The appointment ended up being canceled anyway and I had to listen over the phone again today with a midwife who was, again, a stranger. It's just not the same feeling of connection.

My stress level is now through the roof.

Lyndsay has her 39 week check on Friday, May 9th, with Dr. A. I don't know him and neither does she. I can't e-mail him to bring a computer. He doesn't know our situation, aside from what he'll read in a file. He has no idea that I really need someone to evaluate Lyndsay that day for possible induction the following week. Through our surrogacy agency, Lyndsay and I now have an agreement about induction, so the ball is in the doctors' courts. My husband and I are flying out on the 12th. Our due date is the 18th. As I mentioned to you, Jimmi will be going on tour for 3 weeks and missing his daughter's birth would be devastating for all of us. If we're approved for induction, I would hope it could happen between the 13th and the 15th, to give him time to bond before he goes. I would really like Dr. A to consider our dilemma next Friday so we might be able to have some sort of a plan in place. I understand it's not the clinic's policy to induce based on scheduling, but I'm only asking for 3-5 days early in an extenuating circumstance. 

Lyndsay, Jimmi and I are all on the same page about induction, as long as it doesn't seem like it'll harm her or the baby but, since she's not the one dealing with the feeling of just wanting to be the mom already, she won't blatantly ask for it like I will. But, without actually being there, it's hard to make my points to each different doctor over the phone. I'm asking for your help in this matter. Actually, I'm begging. Please help me feel like I'm a part of what's going on with my baby. Will you speak to Dr. A about evaluating her for induction at her appointment next week? I hate that I keep badgering you with this, but I have nowhere else to turn.

Thank you,

Suzanne

As soon as the e-mail shot off into cyberspace another one popped up in my inbox from Lyndsay:

 

"My appointment on Friday is now with a colleague of the lady I saw today and she will see me until the end. I asked the doctor today if she could finish out with us and she is only there Monday for 4 hours then gone the whole next week. So she talked to this other doctor and she said she would take us and finish out with us! So that would be very nice." 

While the thought of another doctor change made me crazy, I agreed it would be nice to know we would now have the same one for whatever is left of the pregnancy. But I was confused by the wording of her email. "Is she a midwife or a doctor?" I asked. "She's a midwife." And then the palpitations began. I don't know much about midwives but, from my understanding, they are all about the woman's body doing its job on its own, without help from outside forces. In simple terms…Induction won't be an option unless it's medically necessary. I asked Lyndsay if that was the case and she told me the midwives follow the same policy as the doctors at the clinic. Being that I've never actually seen one, I'll have to take her word for it. 

I am now left with no other options. There's no one left to speak to. I have no idea who is in charge. There's no way to make sure Jimmi will be present for Aria's birth. I can't tell my boys how long I'll be away from them. I have no answers to give the hotel or car rental or airline about my checkout or return dates. 

This control freak has officially lost all control.

Dodgeball

Picture it. I'm ten years old, in gym class, dreading the next 30 minutes of my life. The game we all played - the one that has since been banned from elementary schools around the country - is about to begin. I'm standing on the shellacked wood floor, crouched in ready position, as the biggest and meanest kid in the class grabs hold of the bouncy, red, rubber ball. He looks around evilly, quickly takes aim and hurls the round, air-filled weapon in my direction. I jump out of the way, just in time but, before I can take a breath, the ball whips back at my head from behind. "Watch out!" calls an ally, as I turn and duck before the flying sphere knocks me to the floor. But it's not over yet. Each time I dodge one bullet another comes in, faster than the next, until, finally, the gym teacher blows the whistle signaling an end to the torture.

Where's the teacher to blow the whistle now?

Over the last three years I've had so many balls thrown at my head I'm surprised I can still see straight. But, each time, I manage to lunge out of the way and continue playing the game without anyone screaming, "You're out!" I sometimes feel there's a higher power who loves my writing and hates when I have nothing to blog about. "Hmmm, things are too calm in Suzanne's world," he says. "Let's give her triplets! Now let's take two of the babies away. How about some inexplicable pain in her pelvis that makes the doctors think her cancer is back? I know! Let's make her dog choke then send him to the hospital with pneumonia. Better yet, we can give Jimmi a random staph infection, knee surgery and two serious drug reactions, all in a matter of one month!" But, apparently, that being hasn't had enough fun with me. Now, in what should be the last three weeks of our pregnancy, I'm sitting on eggshells, waiting to see if Jimmi is going to miss the birth of our baby.

Yes, you read that correctly. After everything we've been through and as far as we've come to get to this point, Jimmi may not be in the delivery room to watch Aria take her first breath or hear her first cry or cut the cord that will symbolize her disconnection from Lyndsay and entrance into our arms forever.

I don't even know where to begin with my explanation.

I'm not sure exactly when we first heard the news that shot a pang of excitement with a side of devastation through my body. I believe it was back in December, though. Jimmi got the call that his band had secured a spot performing at Rocklahoma, a three-day long rock n roll festival in Oklahoma that, not only have we always wanted to attend, but he's always wanted to play. So, what could possibly be bad about that? Other than the dates…

If you still haven't caught on, let me help you.

Our baby is due on May 18th. Ok, so, that's not so bad, right? It might not be if Lyndsay didn't have a history of giving birth at least a week late each time. I chose not to worry too much about the situation until it was absolutely necessary.

I'm pretty sure I'm allowed to freak out now.

Jimmi's band was confirmed for a 4:20 PM time slot on May 25th, which, as far as I was concerned, was the best possible day of all the bad choices. After all, it was the furthest day from our due date, allowing the best chance for delivery sometime before showtime. There had been some talk of a short tour from New York City to Oklahoma and back, but nothing had been booked and we thought it was safe to assume all dates before the big show on the 25th were open. That made me feel tiny bit better. At least Jimmi would be able to fly out to Minnesota with me on May 12th to wait impatiently for Aria to make her appearance and, if worse came to worse, he could just fly right from the hospital to Oklahoma the night before the show and meet the band there.  I booked our flights last Monday and a huge weight was lifted. One less thing to worry about.

That's when the big, red, rubber ball came flying at my head again.

In a casual conversation with Jimmi's band's manager, I learned that three shows, the first on May 20th, had been booked on the way out to Oklahoma and four had been booked on the way back. A tentative return date of May 30th was mentioned, with Jimmi leaving again on May 31st, his birthday, for a three-day tour with his other band. "But we're leaving for Minnesota on the 12th" I typed through my hyperventilation. "They also have a show in NYC on the 17th," he replied.

No. No, that can't happen!

"But our baby is due on the 18th!" I typed frantically.

I called Jimmi in hysterics. "You're gonna miss her birth!" I cried. "You can't be in New York the night before our due date!" Jimmi gave me a virtual slap in the face and I calmed down just enough to explain exactly what I was taking about. "Relax!" he soothed. "It'll all work out!" I didn't believe him. "How?" I asked. "How is it gonna work out?"

He couldn't answer me.

I ran through all the scenarios in my head and none of them had the ending I was hoping for. Chances are Lyndsay will not go into labor before May 18th. If she goes any later than the 16th, Jimmi won't be in Minnesota anymore. Sure, we could attempt to fly him out from wherever he may be, but let's be realistic. He'd never make it in time. I took out a calendar and just stared at the month of May for awhile. If we were home, the show on the 17th would be local so it wouldn't matter much. Everything from the 18th through the 30th was blocked out for the Rocklahoma tour, which includes both travel and performance days. Then a quick overnight at home sends him back out to Arkansas on the 31st with a return on June 2nd. No matter how it works out, Jimmi will miss the first precious weeks of his first, and probably only, child's life. As much as that sucks, I decided I could deal with all of it as long as he makes it to her birth and can spend a day or two with her before he heads out. Then I remembered what Dr. C had told me on more than one occasion.

"Because of your unique situation, we could think about inducing at around thirty-nine weeks to help you with planning."

I hadn't taken that option into consideration until that moment but, right then, it seemed as if the miracle answer was staring me in the eyes. I grabbed the calendar again and scanned down to the 39-week mark. May 11th. Mother's Day. While that would be a perfect present for me, I wanted to be home, in New Jersey, to celebrate with my boys. Since we already booked a flight out to Minnesota on the 12th, the 13th or 14th seemed like the best options for induction, as Jimmi would not only make it to the birth but, all being well, he'd be able to fly back home with us and spend a day or two before journeying out. But I had one more person to convince that my idea was best for everyone.

I e-mailed Lyndsay and desperately pleaded our case. Her response had some obvious concerns about what's best for her and Aria's health but she decided, if the doctor was on board with safely inducing labor, she would be, too. Well, since the Dr. C had already mentioned induction more than once, it should be a no brainer, right?

Wrong.

In case you've forgotten, Dr. C, our OB since the 9th week of pregnancy, after our triplets reduced themselves to a singleton, was deployed to Kuwait last week. We were left in the hands of Dr. H, chief resident, who none of us had even met yet; unless you count the quick e-mail I sent introducing myself that wasn't answered for a full week. But, really, if Dr. C told us 39 weeks would be acceptable, why would Dr. H disagree?

I typed a very detailed and emotional note to Dr. H explaining our situation, trying to keep the desperation out of my writing. I told her about Jimmi's recent illness that forced him to cancel more than a month's worth of gigs. I told her how difficult it's been for me, knowing Jimmi wasn't able to experience this pregnancy. I almost begged her to assure us that Jimmi would be present for his baby's arrival. I figured, as a woman, she'd understand. She wouldn't deny us this experience. She couldn't!

"Hi Suzanne!"

Her reply began.

"Thanks for your e-mail. I certainly do understand the uniqueness of your situation. The decision to proceed with induction will need to be reviewed by the maternal fetal medicine team and the OB team on that week. I will certainly advocate of your behalf, but will not be able to be the final decision maker.

Thanks for understanding and have a great weekend!"

Thanks for understanding? Have a great weekend? Seriously? So, basically, what I just learned is that, if we want to induce on the 13th or 14th, we'll need to wait until the 12th and have two different teams, who don't know anything about us, review our case? Does she realize we're only talking about four or five days before our due date at 40 weeks? Does she understand that women are technically considered "full-term" at 38 weeks pregnant? I don't get it. I convinced the doctor to induce me when I was pregnant with Justin because I knew he was getting too big. The doctor didn't think he was too large but, after a bit of begging, he agreed. The kid popped out of my 5 ft. 2 in. frame at 8 lbs 11 oz. Can you imagine if the doctor hadn't agreed? OUCH! It's not like I'm asking for anything I haven't been through myself. And, since this is Lyndsay's fourth pregnancy, her body should know how to open up and shoot my kid right outta there. She just might need a little help getting started.

Unsatisfied with my non-answer that didn't bring me any closer to a solution, I decided to e-mail Dr. C in Kuwait. He told me he would be reachable if I had any questions and I shouldn't hesitate to write. I just figured, since he's higher up on the totem pole, maybe he could let Dr. H know that it was his idea to induce at 39 weeks in the first place.

I waited a week for a reply that contradicted his early suggestions. Dr. C backed Dr. H's statements about waiting until the week we're hoping to induce to make any decisions. Apparently it'll all depend on Lyndsay's cervix and whether or not it's started to dilate and efface on its own. If it has, we can probably help speed it up. If not, we'll need to wait…up to ten days past her due date.

WHAT!?

I don't understand! Why did he even bother bringing up induction at every appointment for the last four months? Why had he never mentioned the contingencies before now, when we actually NEED to get our baby out by a certain date? Based on her past history, Lyndsay's body likes to keep babies very cozy, with no sign of anything going on until she's actually in labor. That doesn't bode well for our plan.

And that's that. If I had to make a bet I'd say Jimmi will probably miss Aria's birth. It's devastating to even think that way but the odds are not in our favor. I'm just hoping for a miracle.