Briefly, all's well

I had the last appointment of the ultrasound day yesterday - 4pm - as I had a meeting in another city (not the one we live in and not the one the hospital was in) in the morning, and fortunately a nice colleague was getting the train with me back from the meeting and distracted me from worrying, and we were early enough that I could start drinking my large quantities of liquid once I got off the train, and didn't have to walk too far with a full bladder.

They even saw me on time (slightly early, actually) and the radiographer was very pleasant (though she didn't say "oh, I'm sorry" when I told her I didn't know where I was in my cycle because of the miscarriage). But she was able to tell me my uterus looked nice and "juicy" (packing the tampons for the weekend, then), and my ovaries were both the right size (though one was sitting on top of the uterus "like a hat") and then on the condom-covered one (not had that before - the gel wasn't too bad, do they sell it for, er, personal purposes do you think?) she could see that there were lots of little follicles on the right gearing up to argue over whose turn it is, and one big empty one on the left.

All in order, no cysts whatsoever. As everyone goes home about 4.30, the waiting room across the corridor where I normally go was empty but the receptionist suggested I go and see if the nurses (as in, walking down to the nurses' station without an escort) could track down any test results that were ready. The usual nurse was with a patient but I was willing to wait a little while (I'm reading Blood, Sweat and Tea, which is this blog's book), and they were all lovely and polite and left her a message and made sure they came out to the waiting room to reassure me they'd left her a message, and then to tell me she couldn't find any notes so I could ring the consultant's secretary another day. So I will - at my local hospital they aren't allowed to give you results over the phone but can read you the consultant's letter (!) once it's dictated - and the secretary is very nice, so I think I'll try next week for the hormone tests (LH vs FSH - but I doubt it's going to be any big revelation) and in a couple of weeks for the genetic tests. My theory is once I tell them I'm in the RPL clinic they feel sorry for me and let me do things other patients (the heavily pregnant ones that smoke outside the doors next to the sign marked NO SMOKING, or the ones with a newborn ditto) aren't allowed to do.

Now off to a large Landmark Trust property with 6 friends for the weekend; family are joining us for lunch on Sunday, and on Monday I will be Officially Old. No restaurants are open on Monday so we're going to see Casablanca at the local art house cinema and then to a country house restaurant on Tuesday (although I have to be at work early that day as I'm starting running a new study. Syntactic priming, if you're interested. Bad timing), and Mr. Spouse has a not-very-surprising surprise dinner (I had to tell him who to invite) planned locally for the Saturday. Never let it be said I do things by halves.

PGS versus PGD

These two tend to get confused. PGS is supposed to check for aneuploidies but the latest evidence is that it does not decrease the rate of miscarriage. PGD is for a specific condition (in our case, possibly for balanced translocation) and there is some evidence that it does. I am sorely tempted to push for IVF whatever the outcome of our genetic tests but this little piece of research hopefully will help me keep my head.

Ovarian scan on Thursday. I know so little about this that I wasn't sure if it's vaginal, or not - Google wasn't my friend, so I rang the consultant's secretary, who nicely put me through to the US department, who told me it was "probably both" and I should turn up with a full bladder. Since the hour before will be spent getting there, by train and bus and a little walking, that's going to be fun.

Perhaps the brain is functioning again

Although I'm tired today (partly because of odd dreams), I am actually enjoying a less-than-trashy novel the last couple of days, and felt quite accomplished at work today when I understood what was going on with my complicated spreadsheet (don't leave things for three years, is today's lesson).

I was right, you know - always nice to be vindicated - about the friends who have been trying for just over a year. They finally got the GP to make an appointment (she's sent them away after 6 months - my friend is 37, I wish she'd told me, I would have sent her back to bully the GP). Chatting with her last night and my work friend who is now thinking of Guatemala instead of China (her husband is "too old") felt good. I shared with my friend today how I feel I either shock people ("is it actually possible to have that many miscarriages? weird or what?") or make them think we are mad ("surely they would have stopped trying by now") when I tell people, and how there are some people I probably won't tell, but she doesn't react either way. Both of them asked if we'd get NHS funding for any potential IVF but I strongly suspect it's not available for PGD even if it were available at my age*. And PGD doubles the cost.

Anyway - my dreams - first one, I dreamt I'd gone for my ovarian scan (next week) and had found out I was still pregnant. I woke up feeling happy, and realised it was a dream. Second one, I dreamt I'd gone for the scan and had found out I had an ectopic. I woke up terrified and it took me longer to come down from that. Then I dreamt I had gone back to the town I lived in in East Africa and had left loads of stuff there which they wanted me to sort out, including for some reason some old spectacles someone had given me to take out to give to people, which of course I hadn't been able to do, not having any optometry training (people do have the strangest ideas about what is useable in developing countries - or at least, what is easily distributable and the best ways to distribute it. Oxfam, folks. They know what they're doing). Don't think that one was pregnancy related.

*Just looked up on our NHS trust's website - they have a contract with a hospital to do their IVF, as there's none in the area, but it's one that doesn't do PGD.

Not funny

It is really far too soon for me, but my body has decided this cycle is in its second half and has presented me with all the post-ovulation symptoms – extremely sore boobs, especially when I take my bra off at night, some mild cramps and (sorry) a fair bit of discharge. It does seem as if these have started even earlier than they normally would in a cycle, with a few twinges returning about 10 days after I started bleeding, but I wonder if this is one reason why some people get that post-miscarriage fertility surge – they still have a bit of progesterone hanging around from the pregnancy. No fertility for me, though, as that would require having had that sex thing at the right time that really, if you’ve just miscarried, you don’t feel like.

I had another low day yesterday (unfortunately if I want to sing in the concert, I really do need to go to choir – but yesterday was my last 9am fully animated lecture) so that doesn’t help either. A new choir member turns out to live round the corner from us and have a baby who is the same age the first (first what? baby? pregnancy? dunno) would have been.

So, would anyone who is pregnant and doesn’t feel it like some of these symptoms? I’m happy to offload them.

Incidentally if you are in that group and I’m normally a commenter on your blog (this applies to at least a couple of people – Thalia, Inhospitable) then I am still reading, gingerly, and still cheering you on but not really able to comment at this time. For some reason I don’t seem to find it quite so hard to read baby blogs (though there’s one I’m thinking of deleting from my Bloglines as it’s pretty smug) or even later pregnancy blogs (though in person these people are also hard to cope with), but with someone who’s just ahead of me it’s harder. I guess later pregnancy and birth are just fantasies – late first trimester is somewhere I thought I had reached safely, but really never did.

I'm not dead yet

Another week, another plan. I at least survived this week, with only one major meltdown, which not surprisingly was after my Very Long Day (I'm an academic, bear with me on this one) which started with leaving the house at 8.15 (yes, I know, and Mr. Spouse catches the 7.14 every morning, I don't know I'm born) in order to find a parking space to give a 9.00 lecture (to about 300 students - you try being animated at that time in the morning - and if I'm boring they all snore) followed by a regular day's work and a 2 hour class of 10-ish (depending on how many turn up) from 3-5 (you actually have to be MORE animated in those but you can at least give them things to do while you drink your tea) followed by, some weeks, a couple more hours work, but this week by going home, stupidly doing another test (negative of course - tiredness is now officially not hormone-induced) and then heading back for choir practice till 9.30-ish, then getting home after having to give a friend a lift and therefore hold it together in the car, followed, as I say, by meltdown.

So, we say thankyou for Mr. Spouse, who says he feels guilty that he isn't as sad as me. I told him if he was pleased or relieved I'd thump him, but he is allowed not to feel as sad as me.

Tonight, to take our minds off the fact that we should be at our preparation course, we're having a night away at a "restaurant with rooms". We like that kind of thing.

This week, we are trying to work full time, do a bit more exercise (gentle running, cycling to work) and be more assiduous on the food diary, as well as read up on (and, harder, persuade Mr. Spouse to read up on) PGD. This from the couple that said "no IVF, thanks".

We heard this week from some friends who confessed they were seeking assistance to conceive, and I'm wondering (counting on my fingers) whether another couple we know should be going to the doctor's now, or whether to gently nudge them to do so (and if so, how - last time I talked to her, she was very complacent, and it's been a year since she told me they'd started trying - we're seeing them in a few weeks so perhaps there will be a Happy Announcement).

Gotta dash - should have packed half an hour ago!

The plan is...

• Today
• to rest - I was planning to go for a very short run, but energy levels are at zero, since I seem to need 10 hours sleep a night at the moment and only got 9 last night
• This week:
• to rest more, and to go back to work but only going in for the hours I absolutely have to.
• to do a little exercise (yoga, walking)
• to start keeping my food diary again, but only at a keeping-my-weight-the-same level.
• to knit, read trashy novels, and watch trashy TV (Stitch 'n' Bitch is what you want, perceval. If you want to make any of the projects go to a shop and ask them what you could use instead of the yarn in the book. You probably know continental knitting if you have ever learned)
• to order some stuff for the garden

• After that:
• Dunno.

I'm sure this says something about me, or something

I'm typing this while drinking a small sherry. Fino, of course, not sweet.

The hospital visit went OK. I was actually grateful they decided not to scan me - there didn't seem much point, the doctor said (yes, an actual doctor - OK, I saw a doctor last time for the research test but before that it was a nurse). And she really seemed to be taking seriously the fact that we have problems getting pregnant as well as staying pregnant. Previously the gynae at the local hospital seemed to only consider the fertility problems, and the nurse at the RPL clinic seemed to assume we’d get pregnant again quickly. But it was still really, really hard, and not helped by the fact that I didn’t sleep that well last night.

One big question we had was whether there was any way to increase the frequency of getting pregnant; if we have, as I’m assuming, approximately a 50% chance of keeping each pregnancy, which doesn’t really decrease if there’s no known reason for losing them, then two pregnancies in 18 months is desperate (that’s about our average) but two pregnancies in six months would be hard, but at least quicker. No, she said, short of IVF, not really. Clomid is only if you can’t ovulate at all. IUI I know has about a 10% success rate per cycle which is about what we’re on anyway. IVF, as I think I’ve already said, seems like an expensive way to get where we are anyway.

They don't do scans at 5 weeks, as you can't see anything one way or the other. They will see people and do blood tests, but since they couldn't decide to do an ERPC any earlier than I'd be likely to miscarry spontaneously, they can't really do any tissue analysis either. All the blood test would be is watching it happen, as she put it, not preventing it or finding out any extra information.

However she looked at all the results and wasn’t happy with the hormone tests – she asked if I’d had an ovarian scan, which I haven’t. She’s wondering about PCOS. I think she’s wondering in a “well, everything else has been investigated mega thoroughly, but these hormone tests weren’t done by me and there’s been no scan” rather than in a “look at this large hairy woman with 2 periods a year, my word” type way, since although I had mild blood sugar issues when I was 2 ½ stone heavier, I am, as you have worked out, now 2 ½ stone lighter (middle of “overweight” – 5ft 3 and size 12-14), have clockwork periods and am the waxing lady’s dream; she just does waxing Reiki, I think, with me. Though the latter has probably got a lot to do with my Celtic/Germanic/Nordic/splash-of-maybe-Native-American heritage.

So I have an ovarian scan* in 3 weeks’ time which should, based on the last miscarriage, be about the equivalent of CD 27. However, I sneakily did another test (which I promised Mr Spouse I wouldn't) when I got back from the hospital and the hormone levels are still not zero (though the digital bit confirmed what we already knew, the stick had a faint second line again). So it may be another two weeks from now before I ovulate again. But I believe cysts are there a lot of the time, perhaps someone else can help me out here.

She also asked (thank you! Finally!) whether anyone had done any genetic tests on Mr. Spouse. I have asked about this the last two visits, I said. He comes from a family with a lot of only children, I said. Oh, dear, she said. So they poked him about 50 times with a needle and finally got some blood out and after the geneticists have grown it very very slowly in their lab we (probably both of us again; obviously they are doing chromosome tests on me too) will be back in the clinic in early April. Which I guess is about the right length of time for us to get our heads back into decision-making gear, since they are very much not in that gear at the moment.

I am aware this all sounds very rational and together. I don’t feel rational or together but the facts are easier to report than the actual state of my head. I get the feeling work is worried I may go AWOL again on them at short notice; I’m not sure I want to tell anyone other than immediate friends what’s up so they may just have to carry on worrying. Bad luck, work. I did chat on the phone to S who has had the China adoption issues due to the age of her husband; they are thinking about Guatemala instead, and she made me cry by saying “you will have a child, you will be a mother some day, don’t give up hope.”

I’ve finished the sherry now and am just trying to work out if some Green and Black’s will make me feel sick, or cheer me up, and what to veg out in front of on the telly tonight while I try and finish Mr. Spouse’s cuddly, but subtly male charcoal coloured, jumper. One advantage of miscarriages – lots of time to knit.

*Yes, I've had a lap and dye which revealed no problems with my uterus, plus I've had a couple of regular scans - just no ovarian scan - apparently you can't see much of the ovaries, especially if you aren't really looking, during the lap and dye.

Sofa bound

30 hours of heavy bleeding and about 12 of lighter bleeding later, 5 episodes of Gilmore Girls and 4 of Judging Amy, I still feel tired (though heavy bleeding will do that to you), but there are no more cramps and the boobs are significantly less sore. I am slightly wondering if there is a little "tissue" left but I am pretty sure the hormone levels are back to zero.

I've told work I'll probably work from home on Thursday but be off till then. I feel like a bit of a fraud as physically I am not too bad - the bleeding was a bit less protracted this time - but there is no way I can stand up in front of a lecture theatre full of students without breaking down, especially if I do the planned class on prenatal brain development. This year's cohort are just going to have to remain ignorant on that count.

PS to Thalia: yes, I am under the care of the RPL clinic, but as they can't find anything wrong with me this care is repeated scans starting at 6 weeks - which is too late if you miscarry at 5+2. Don't know if this will change in any subsequent pregnancy, or if they have any other answers - we at least have a few questions - and the appointment on Friday is at the consultant's clinic, which means we'll see him, or one of his entourage, and get to ask those questions.

No change

Still bleeding, still red and clotty but also very mucous, still crampy. Basically very similar to the last one, apart from the mucus (I have now, I think, got the adjective and the noun right).

In answer to the comment that said I sound very calm - well, I suppose the panic has given way to the sadness already. I've alerted work, and just feel like I've bedded myself in for a few days of couch-dwelling, the old routine has kicked in. I have no idea where we go from here. I think it's too early to say. I don't know if we will feel up to the prep course - I thought we might, but now neither I nor Mr. Spouse are sure. I thought having another miscarriage would strengthen my resolve to adopt, but we were more optimistic about this one, and perhaps that's why I feel more cheated out of a biological child, or perhaps it's just the immediacy of it. Likewise I thought going through the hell again would make me think "give me contraceptives and give me them NOW" but I'm not sure of that either.

I do know that it makes me more convinced there is something actually wrong, not just bad luck, the pattern is too similar for each of them. And it also makes me less hopeful that they can do anything for us - if the only treatment is TLC and multiple scans, and we can't even make it to the hospital, and the only way to test for chromosomal abnormalities is to test the tissue in the lab, and we can't get that there either, then there's not much to be done.

You will forgive me for being a little despondent at this point, I know.

Prescient?

I woke at 6 a.m. to red blood and cramps. The blood, up to now (6 hours later) has continued but not been very heavy, mainly mucous-y and without clots (this confuses me, as if the mucous is from my cervix, then presumably my cervix is open, in which case why not more blood, and clots?), and the cramps, which intensified over a couple of hours to the point where I wished for ibuprofen (and took paracetemol) have also eased off, and although they did, it now just feels a little sore, and only a little like a period. So far neither the total blood nor the rate of flow are enough to be sure this is the end, so unless it gets heavier I'm in for a couple of days on the sofa counting total number of towels used, I suppose. If I was clever I could check my cervix but I'm not, and it's awkward to find anyway.

Will ring the hospital (but not the agency, I don't think) in the morning. Not sure if they'll want us to go in earlier or just wait till Friday. I don't think I'll be going into work for another couple of days. Fortunately I put a damage-limitation approach to work in operation for the first few weeks of term, as they are, as it turns out, the busiest of the year for me, so I've been refusing everything extraneous anyway.

Slight decrease in panic

Mr. Spouse talked me down somewhat (and I think also now understands more than he did, or wants to, about pee sticks). And having a lie down because I felt completely wiped helped, too, I think. As did (sorry) examining the colour, or lack thereof, of said pee. I'll do another test on Monday morning before ringing the agency, but I do feel a bit better and we did go out for the curry.

We do, however, need to ask to be moved to the next course. If I miscarry after the next few days, but before the course (which starts the 2nd), I will not feel up to it in time. If we went when I was still pregnant, but we did then go ahead with adoption a) I would feel bad not telling them and b) they would, not unnaturally, feel cautious about trusting us when they found out. Which they would. What with medicals. And it is pretty important for your social worker to trust you. And they run at least 3 courses a year, and we should be able to start the home study before the course if the course isn't for a while. And even if they said we could do it anyway, then two days of the course clash with potential 7 or 8 week scans. And the only reason I won't have one of those scans is if I spontaneously miscarry before then, and am feeling awful and lying on the sofa. After which I will want to feel sorry for myself for a while, and not bare my soul to a social worker.

So as you can see we need to postpone the course... But thank you so much for your comments - that is what is so nice about blogging.

Panic panic

For some reason - and I really cannot put my finger on it - I am feeling less pregnant. My breasts still hurt, I still want to pee a lot, I am still getting the occasional, non-painful cramp, and I am still tired. Perhaps I'm just a bit less tired or the cramps are a bit less frequent but I did have some fairly stewed tea this afternoon and the cramps had already been easing off for a few days.

So, stupidly, I came home this afternoon after 2 pots of tea and only 1 visit to the loo and did another digital test. Not pregnant. The stick itself still has a second line which is only slightly more faint than the one from last weekend but not surprisingly, I am panicking. If I am going to bleed, I want to do it before Monday as we said we'd call the agency and cancel the preparation course then if I was still pregnant.

We were going to go out for a curry with friends tonight and Mr. Spouse is trying to persuade me to go but I'm not sure; however I am doing as instructed and having a lie down (which I do need) and reading a book and seeing how I feel. Currently that alternates between resigned and panicky.

To answer a few questions...

No news, as they say... I'm now further along than no. 2 and the state of the boobage as well as my furnace- like nighttime temperature suggest the end, at least, is not about to come due to plummeting progesterone. I'm currently sitting on the bus on my way home to lie under the duvet - didn't sleep well last night, and one of the secretaries told me I was looking really unwell this morning.

When I had an empty sac on a 10 week ultrasound with no 1, they offered to whip it out straight away - which I guess is why I think the same could happen this time. If they saw no sac, probably they would, but I don't know - I'd rather take the bag and be prepared, I think.

Still not meaning to get at perceval, but although I do know the management of RPL is very different to regular, even post-infertility, pregnancy, I really don't want to think or talk about anything after 6 weeks right now. Even that feels presumptuous.

Hollow laugh...

Sorry, perceval, nothing personal but that was the sound of me responding to the idea that I'd be able to wait until 9 weeks for a scan. Fortunately the nice nurse and, I think, NHS guidelines for RPL (or at least the clinic's best practice) agree with me and I'm booked in for next Friday morning. Mr. Spouse can thankfully take the morning off to come in with me and I asked about bringing an overnight bag in case of surgery and she said, somewhat mysteriously, "we'll come to some arrangement". Since it's an hour and a half away, I think I'll take a bag just in case, as if they are sure it's ended at that point (it will be 6 weeks) I'd rather have an ERPC there than have it at the hospital here a few days later, where I wouldn't be sure they'd collect any tissue properly.

No other news, the nurse said to give her a call if I start bleeding, but still nothing, though knicker-watch of course continues unabated, and I am intermittently scared by cramps, though they are small. I actually feel a little nauseous already when I’m hungry, and tired (though that could be caffeine withdrawal – having had 2 cycles off I had overdosed a bit, especially over Christmas. Oops.) and I think that so far at least it’s not going to be immediately falling HcG levels that signal the end of this pregnancy. I will probably do a reassurance test at the weekend if I make it that far, though I don’t know if I could see if the lines were stronger than the Sunday night one as the lines on the actual stick were pretty dark.

AAAAAARRRGGHHH!

That was Mr. Spouse's response when I showed him the (digital, done in the evening, no doubt there whatsoever, definitely positive) test just now. He agreed that if it ends within a week, like last time, we will probably be OK to go to the adoption course, and I also suggested I might consider using contraception if we do that and are in the middle of the adoption approval process - as it will take about 6 months, and we do now have more confidence in the getting pregnant process. I am not sure this will be what happens, though, as I am fairly sure my hormone levels are higher than they were this time in the last one, in which I had a negative test and full-on bleeding at 5w. I will ring the nurse at the RPL clinic in the morning. I'm not sure if they'll do blood tests this week, or wait till next to do a scan.

We are feeling quite down however as the news from my friend who is going to be 40 four days before me, has 2 under-5s, and stomach cancer, is not good. What do you write in someone's card if you are not sure they'll even get to their birthday, let alone see another one?

Nothing to see...

No bleeding, just a little, not too scary, cramping, but I'm still only a day late. Haven't plucked up courage to tell Mr. Spouse. If I bleed before Monday I'm not sure if I will, or maybe tell him it was late and I thought the test was positive, and that I'm sad but not too sad, which I think I will be. If I don't but the Monday test is negative I think I'll tell him anyway, plus ring the hospital to see what they say. I am of course on full-on knicker watch but managed to sleep quite well last night.

This morning our information pack from Adoption UK arrived, with our first official (not cast-off, out of date) copy of Children Who Wait, arrived. It did make me feel positive about adopting - there were a few children in there I could see parenting, though they wouldn't be for us I don't think, as either they are too old (as in, I could see us parenting children like that who'd been with us for a while) or we wouldn't get chosen for them because of their ethnicity. I always particularly look for children who are half British and half some-East-African-origin, obviously, and there was one in here, but the social worker blurb asked for a family who could "reflect" rather than "reflect or promote" their ethnic origins. Which is fair enough, but some of the cases just show how unrealistic some placing social workers can be; either really complex ethnicities where they will be lucky to find even one family in the UK with that mix, or children who have fathers of different ethnicities and they think they'll find a mixed race family to adopt white children, or children who are mixed race but don't look it, and ditto. Obviously it is not good to pretend that mixed-race children are white, but people tend to assume children have the ethnicity that they appear to have.

I have been bad, but I will be confessing

I hope you think my badness is justified. I have had a sore shoulder for a few days now and, although I broke the shoulder about 10 years ago so it is occasionally sore, I had a nagging “ectopic” going round in the back of my mind as it wasn’t quite my regular pain. My period is probably due this evening, maybe tomorrow, so this morning I sneaked a Clearblue test and got a faint positive. Not light-of-a-thousand-suns faint, but fainter than the control line. I was actually thinking of heading straight for A&E but as I had to go to the GP anyway I looked pathetic at the nurse and she squeezed me in with a different GP to my regular one (who, er, said we should wait this month after a booster jab on CD2. I ask you – CD2?? With something that isn’t actually contraindicated in pregnancy?).

I’m trying really, really hard to steel myself for this being a chemical (and I will try my damndest to count it chemical if it’s less than about 4w4d). So please, no congratulations. I didn’t want to test this early, and I actually didn’t think I had any regular Clearblue left – I thought I’d stocked up on digital for that exact reason. If I have a late period and don’t know I’m pregnant, I needn’t tell Mr. Spouse I am (I’ll tell him it’s late, but I don’t need to tell him any symptoms). And if I only have digital tests in the house there’s no point in doing one early as they are pretty insensitive. Similarly if I just have a late period I don’t need to tell the adoption agency.

Anyway the plan is to panic a lot over the weekend, possibly presenting this episode to Mr. Spouse as another “trying to be positive” test (that’s what no. 2 was like and we were a little sad but coped fine when I bled at 4w5d) or possibly not telling him at all till Monday if I haven’t bled before then. Then (not sure I can look beyond 4w3d at this point, let alone to the adoption preparation course early next month) I’d have to ring the hospital and get booked in for a scan. If I haven’t bled before the scan, I think that would be the time to ring the agency. It’s a bit of an emotional risk, I think, rather than a medical one – could I cope with going to the preparation course if I’m only 2 weeks past a miscarriage? Judging by my last one, I’ll be really keen to move on, and I probably will be able to.

And the GP? Apparently I’d be in full-on cramping agony if I’d been having shoulder pain for a few days as my abdomen would be full of blood. So at least, so far, I can rule that out.

Adoption reading, books aimed at parents, relatives and childcare workers - first installment

I'm not sure how frequent these will be but there is far too much so far to put in one post so I may do a few over the next few days or weeks. Apologies for the totally idiosyncratic writing style and theoretical stance - these are notes for me, which I guess I'll share verbally with the social worker, but I thought some people might be interested. At least I'm trying to use APA format!

Mercer, J. (2006). Understanding attachment: parenting, child care, and emotional development: Praeger Publishers.
Review [originally written for the discussion forum at Adoption UK website]: This is written by a respected academic and although it is primarily intended, I think, to be of use to parents who are wondering about childcare issues and, especially, divorce, it is really readable, with only a little jargon, and it has a lot of information which will be highly relevant to adoptive parents (I imagine, not being one myself!).

All of the work on attachment that she talks about is very well researched, and has been confirmed in a number of studies. She also talks about some "misuse" of the term "attachment". In particular, she talks about some of the more extreme therapies (I know that some people have come across these, I don't want to tread on anyone's toes by slagging them off, but I do know that some can be actively dangerous), and also tries to disentangle "bonding" (the parent's feeling for the child) from "attachment" (the child's feeling for the caregivers).

I know that reading this will give some people a slightly different picture of attachment than they have read in more popular "therapy" books but I do think that what she writes is based on actual research rather than speculation, and she uses the most accepted definition of attachment.

The other thing that is helpful about the book is it really goes into detail about the different ages and stages of attachment, and how it works for adults. I know that my students, and friends who are parents and ask me for advice, are always keen to know when children go through different stages - it is so easy to think that what will work for a child aged 1 will also work aged 4 - and to expect that a child should be able to do one thing when in fact they have not gone through the previous stage.

Fahlberg, V. (1994). Child's Journey Through Placement: Brit. Agencies for Adoption & Fostering.
Interesting and quite informative – probably really aimed at social workers but in language that can be understood by parents. Gives parents a good idea of the processes children and social workers go through in coming to the decision to place a child for adoption, and some of the things they (should) take into consideration. It appears to be a fairly introductory text for social workers, but some of the things I have read elsewhere suggest that even the basics are sometimes ignored. It also has easy-to-read and fairly accurate sections on child development (strong on social development, not surprisingly, but with some other aspects covered).

Sunderland, M. (2006). Science of parenting: practical guidance on sleep, crying, play, and building emotional well-being for life. New York: Dorling Kindersley.
Very long on speculation and extrapolation and, sadly, short on science. The book tries to give biological explanation for each and every behaviour but unfortunately we do not know that much about how neural activity even correlates with (let alone drives) children’s behaviour. Fails to acknowledge the possibility that children can, for example, learn how to behave themselves in situations when they would naturally find it hard, but instead expects parents to adapt everything to the child’s supposedly “inevitable” stage of development. This means the book is rather disappointing for parents of children with difficulties as the implication is that therapy and behaviour modification can’t work, either. Some of the supposed links between brain and behaviour are rather unfounded (there is no evidence children who are left to cry for moderate lengths of time end up with neurological damage, as she implies) or in fact current evidence actually contradicts them (she labours the point that children’s frontal lobes are underdeveloped – so they can’t be expected to do anything involving higher thought – when in fact we know they can do some things that require frontal lobe functions from at least the age of about 18 months -2 years).

Is it worse...

to flirt with someone when your spouse is there or when their spouse is present? Or both?

This has nothing to do with fertility or adoption but it's not something I want to blog about on my other blog. We went to a great, but quite small, New Year's party, with a fancy dress theme, where we knew four of the people there and there were 6 others we didn't know, three single men (that we already knew one of), one single woman (who we already knew) and the rest couples. Everyone else already knew each other and to some extent it felt like those parties that you go to when you are single and you feel you need to make an effort and schmooze everyone in the room – I haven’t been to one of those in a while.

One guy, however, seemed to want to flirt with all the women. I may be imagining it, but he particularly seemed to want to flirt with me. But his (very attractive and sexily dressed, in a fun kind of way – this was fancy dress remember) wife was also there. As was my (rather under the weather due to a cold and not his usual dryly humorous self) husband. Comments, rather than touching, though he was the only person I’m not married to to try to kiss me at midnight, and he dived in first. I noticed he was doing it to L, our single female friend, to some extent too, but I still felt a bit targeted. Perhaps just because he hadn’t met me before.

In other news, you can catch me in January’s Redbook (US) – a very small, and probably completely misreported (I’ve received it but not read it very closely) segment in the Parenting section.

Why is it...

that I come over all emotional when I hear or sing Christmas carols?

It was pretty much a foregone conclusion that I'd be in floods (well, a slight leak, to be honest) when we went to St. Paul's this afternoon, and a very small girl did a completely perfect reading, much better than a couple of the adults. She can't have been more than about 8 - she had to stand on a box.

I know that some of my feelings at Christmas are related to infertility, the same with choirs - I can't help hoping that I have children who love singing as much as I do, but I know that even children genetically related to us both would not automatically be musical, since Mr. Spouse is not particularly so. I also know that any girls we had could miss out since the best choirs are still all-boys - and I know part of my emotion is the regret that I missed out myself.

But Christmas is also so much about birth - and I have to remind myself to skip ahead to other parts of the story, where we are adopted as children of God, who are equal with birth children. And also that Joseph, crucial in Christ's lineage, was his adoptive father.

Somewhere, tonight, a child is born. Maybe to us.

I was going to ask if you missed me...

… but DD’s comment showed you have. How lovely to have such a devoted readership.

I had a really good trip; it was very worthwhile (I have to keep saying that so people won’t think I was skiving), and an extremely lovely part of the world. I hadn't been to SE Asia before, but in some ways the island I went to was very similar to the area of East Africa where I used to live. I hope I didn't bore people in saying so. In fact, my student's project team were probably more interested in hearing about the similarities than she was, as they are all Muslim and were interested in cultural things. The food was fabulous too (have been Googling restaurants in London where we are over Christmas).

It was also a pretty good way to spend the 2WW - not that I had any hopes for this month, but what with jet-lag and probably a very tired uterus after last month, my period was 2 days late, which really didn't freak me out in the slightest. Busyness and travel are good for me. The only bad thing was Mr. Spouse couldn't come too, but the flights over Christmas were prohibitively expensive, and we also feel we shouldn’t abandon his mother for her first Christmas on her own.

I think I am feeling more like we are likely to adopt and less like we are likely to get (and stay) pregnant with each month – this makes the adoption thing more real, but also more scary. I only spent about half a day being sad and emotional this month, I was reading a book on immigration to Britain on the plane and people’s stories were making me come over all weepy – though to be fair, anyone who doesn’t come over all weepy at the story of the Kindertransport has a heart of stone, I tell you.

So now we need to ring the agency in January and make sure they have found us a social worker to start our home study – I am looking forward to it, in a strange kind of way. I know people say it’s intrusive, but I think we are both the kind of people who don’t mind talking about ourselves, to a certain extent. It’s the bit after adoption that scares me. But we are also feeling sad for our friends, who I’ve mentioned before, who had just done their preparation course for adoption from China – except that he is about the same age as Mr. Spouse i.e. over 50 – and they have no idea what is going to happen now, except it looks like they won’t be able to now. After all they’ve been through – much longer than us, with no pregnancies – this must be devastating. There are very few other countries with arrangements with the UK so I don’t know what they are thinking now.

There’s confidence for you…

An internet friend of mine who’s been trying to get pregnant for very slightly longer than us, who is about 10 years younger but otherwise whose path pretty much mirrors ours (one miscarriage about two months after mine, at 14 weeks, one suspected miscarriage about 4 or 5 months after that, a variety of investigations which revealed nothing much except possible low ovarian reserve, but that wasn’t certain) has just announced she’s pregnant.

At 3 weeks 5 days. 9 DPO. Including her due date – and the fact that she thinks it’s actually 4 days later due to ovulating late.

OK, so I announced my last pregnancy on here at 4w3d. But not on any of the message boards I read. And I didn’t even calculate my due date – and I now deliberately don’t know it. I will allow myself to feel sad on the anniversary of finding out I was pregnant the first time, as I think it’s around then.

In our world, the last cycle is over – phew – a uterine biopsy is, well, OUCH. And DOUBLE OUCH. Followed by lots of spotting and a thankfully early period, which at least put an end to the spotting. I bought a Mooncup. I have been putting this off for ages as I thought you had to buy different ones dependent on whether you’ve had a vaginal delivery or not, but it also depends on age which affects your pelvic floor muscles. I have to say that I probably could have used the girls’ version as I do Pilates and yoga and, erm, lets just say have a busy night-time life, certainly much busier than I did before I was 30. But no matter. It is so far no more uncomfortable than a tampon (I know it’s there but it doesn’t hurt) and it is quite convenient to know it can stay there for a much longer period of time.

We took in our CRB forms this week and as far as we know it all went well, but I may have to have US clearance forms, and I had a panic when someone mentioned references from all the jobs, voluntary or otherwise, that have been with children – that would be starting with volunteering at the university playgroup when I was 19 – does it even still exist? But apparently a selection will do, so I am to make a list of the organisations that I can remember.

Reading continues, for me at least (Mr. Spouse is not such a good reader – and is also feeling a little reluctant at the moment – but I think he’ll manage to process a few selected books in the end). I’ve finished reading (or, at least, skimming) three books by Caroline Archer, which seem OK; one thing that strikes me is that they use behavioural techniques while being rather scathing about them, and trying very hard to come from a hugely psychodynamic perspective. They explain interactions in terms of psychodynamics (the one I’m reading at the moment, by Vera Fahlberg, even goes on about Freud and the Oedipal phase – I didn’t realise anyone even put that in books any more) but then suggest largely behavioural interventions for the difficulties children have – introducing things gradually, in safe and anxiety-free environments, is a staple of e.g. behavioural therapy for phobias. The other thing that slightly bugs me is that none of the interventions have in any way been proven in any kind of research trial. I’ll read on.

I’m off on my exotic trip on Tuesday – not, I have to say, as excited as I could be – the journey there will take 48 hours including a nearly-24h stopover, and Mr. Spouse can’t come. I’ll be back just before Christmas so behave yourselves while I’m gone.

Sorry to leave you hanging on there!

Blogger does not like very long posts, and I had been sitting on three quarters of a post for a few days, so thought I’d just put it up.

To continue the story: A lived with me for about six months, during which time he started school and learned a lot of appropriate skills. He started to refer to me as his mother. this is not such a big deal as it may sound – most African children have more than one adult woman they will call or refer to as Mama – it is sometimes necessary to ask people whether the person they are talking about is their birth mother/father and it’s not considered at all an insulting question. He would tell people when we were out that I was his mother – when he was living with me this seemed appropriate – and people would ask us this. This may seem a completely ignorant and mad question, but you have to bear in mind that it is very common in the region to see a white (albino) child both of whose parents are black, and for all they knew there was a similar genetic error which could make it happen the other way round. A became affectionate – but appropriately so – towards me, and seemed to enjoy living with us (my housekeeper and me).

He was also a little terror. It is very likely that he was sexually abused, possibly by the boys who were living across the road. The pattern in the region seems to be for older boys to “educate” younger boys by either forcing them to have sex, or to watch them. Anyway, he had inappropriate knowledge and, according to a colleague, tried to kiss her very forcefully. After I left, there was a rumour he had tried, or even managed, to rape a girl in his school. He could also be violent and oppositional – he was never violent or sexual to me but could be very oppositional, tended to run away (I had to chase him round town in the car a couple of times).

When A was a small child, his mother died, as I have said. His father was a refugee from Mozambique, and had no family locally. He had worked as night watchman for a family who, I believe, were from the UK, and A had lived with them when he was small. He spoke pretty good English for a child from his area (normally it is limited to Howareyouteacher) and gravitated towards wazungu (white people). The British family had wanted to adopt him but his father had understood this would mean not seeing him again and had said no. The only person left to care for him was his alcoholic father. We think he was enrolled in school aged 7 – we are not sure if there are some relatives of his mother locally – and things seem to have gone OK for a little while, until he ran away – aged 10, at most – and his father didn’t look for him.

Parenting was hard, and I don’t know how I would have coped with life as a single “parent” if it had not been for my housekeeper. Not only did she do lots of practical things round the house (but teaching A to do the things that were appropriate for his age), but she also babysat when I was away (he bit her), and gave me advice on how she would have expected her brothers and sisters to behave at that age. She was very longsuffering and I was, I hope, appropriately grateful.

The end of this stage of the story comes when I had to move back home and find somewhere else for him to live. His father this time wanted me to adopt him and take him home. I didn’t even know where I was going (as it turned out, I spent the next six months constantly moving) and if I would be allowed to do this, I did do some half-hearted investigating but it was never really going to be an option. I needed to find him a family locally.

Fostering and adoption are just not common at all in the region – people do not care for children that are not kin – so this was hard. He went to stay with a pastor and his family for a weekend and they said they couldn’t cope with him. I was in floods of tears coming home from their house – one of those count-on-the-fingers-of-my-hands floods that only come a few times in your life. Finally a very good woman who worked for the project, who was a friend of mine, said she’d take him in. My job was being taken over by a friend of mine, who continued to employ her, and I knew I could send something for his support through him, so I was very relieved. In fact not everyone on the project liked her (the other colleague I mentioned above, in particular, didn’t) but that didn’t really matter. At least he had somewhere to live.

There is more to come, I just don’t know when!

Instant parent

I don't think I've blogged about this already, but stop me if I have.

Stirrup Queens blogged about "finding a baby on the doorstep"; well, this almost happened to me. As in, it wasn't a baby, it was a ten-year-old boy.

When I lived in East Africa, lots of the neighbourhood kids used to come round and play on my sizeable balcony and watch my video and when there was food, they would eat. A group of older teenagers moved into a house opposite and one of the kids that was hanging around at mealtimes was A, who was 10. Turned out he was living with them, doing odd jobs, he had been living on the street, and I found out he wasn't enrolled in school, and asked around - my housekeeper suggested we needed to find out if he had parents before doing anything about this. So we put the word out on the bush telegraph and his dad turned up.

A's father was alcoholic and his mother had died when he was a young child. His father was more than happy for us to feed and clothe him so long as he didn't have to. So he moved in to the spare room. When he came he had only one set of clothes, no underwear, no toothbrush or comb, no school clothes, I think he may have had some flipflops but no proper shoes. Lest you think "well, he's a small African child", most of the children in my town had all those things, and their mothers would have been ashamed to let them out of the house in the state he was in. He didn't know how to wash his own clothes, and the other children laughed at him when they found this out, because they had all been doing theirs since they were small.

There is a lot more to this story, which I may tell you at one point, but at the time I remember thinking "well, I didn't think my first experience of parenting would be a stroppy 10-year-old boy". I was only just old enough to be his mother, realistically, but I was at least an adult. I have also had a lot of people comment "oh, how good of you that was" but really, was I going to chuck him back on the streets? What else could I do?

Of course when I want cycles like clockwork...

I'm going to go to the big hospital again next week to have the uterine biopsy (just thinking about it makes me wince) for the clinical trial - I was supposed to ring up on getting a positive OPK. This should have been on Wednesday (CD15 - and I had started my period very early in the morning this month so I was pretty confident). I bought (from Ebay) some very fancy OPKs just to be sure (usually I use hijacked fertility meter sticks). No little smiley face. Nothing on Thursday either. Am I using them wrong? I thought. Maybe they are too clever for me. But finally on Friday they did their stuff. Which (annoyingly, and I am telling you lot because you will appreciate - Mr. Spouse attempted to nod off when I told him) means that I will be going to Exotic Climes on next months' CD 12, which doesn't really give us much of a chance - and we've had to use condoms* this month.

I have two other blogs; one of them is my diary from when I was 11, and is at theyeariturnedeleven.blogspot.com - I have been finding out where all the people I was at primary school with have got to, and it is very good for me - so many of them are not in a relationship, don't have kids, have been divorced... with one happy marriage, I actually feel pretty lucky.

*that little noise you hear is us collectively whimpering.

I think I’m going to have to dripfeed this…

because adoption is even slower than infertility. Life is measured in two-month segments, as far as I can tell, rather than two-week. But oddly it feels more like we can get on with our lives together.

OK, so I never finished the tale of the interview with the agency director, but it’s long enough ago that I will need to check I don’t repeat myself. She sounded pretty positive but trying to be realistic – we would have a good chance of being approved, I think, although obviously they can’t promise anything at this stage, she really endeared herself to Mr. Spouse by refusing to believe he is 51. But if it was between us and a younger couple, then a child’s social workers might well go for the younger couple. However, I believe that in a lot of cases only one couple is considered for a child or children.

One suggestion she made is that we might suit a pair of siblings with a large-ish age gap (e.g. a six year old and a one year old). She was very understanding of the “need to parent”, especially to parent young children and babies, which she says placing social workers often don’t understand, but not to make the mistake of taking an older sibling just so we could have a baby. I have to say I would be up for this if the older sibling was uncomplicated – but that is unlikely – though I heard about a child who had been in a loving foster home for four YEARS before an adoption placement so it is not completely impossible.

I also mentioned the possibility of mixed-race children. I’m not sure she really thinks that dark-skinned bi-racial children would be possible (we, on the other hand, don’t particularly see a problem – especially if they have heritage in a country we could take them to) but she said there are sometimes children who are mixed-race but appear fairly white, or sibling pairs with different fathers where one is mixed-race, and adopters who are dark in appearance won’t take such children, but again placing social workers tend to be rather unrealistic about such children. So that is another option.

So, we have found our referees (three friends – not family – plus one of the vicars at our rather over-staffed church) – they don’t show what the referees write to us, but the referees themselves are free to show us, which we have told them, and they have all said they’ll show us what we wrote. I’ve also been getting books out of the library, and vetting them for Mr. Spouse, who prefers to read newspapers. I have a feeling I might have to bite my tongue when the social workers recommend some of them, as there’s a lot of pseudoscience, poorly explained ideas, and unfounded therapies.

Chances are...

we will not be getting pregnant on our own, given these calculations, which don’t even take into account my previous miscarriages as a risk factor. I suppose I could restart the clock at the last, surgically assisted, pregnancy, and estimate about a 25% chance of pregnancy (6 months trying rather than a year) with a 40%-ish chance of keeping it making maybe 10% chance of one live birth in the next 4 years.

We were discussing this today after our adoption meeting where the SW was probing about how far we felt we’d gone with having a biological child, what we felt about using contraception, etc. I said I felt that we were being told we had a really low chance, and there was no treatment they could give, by the gynaes, and also (if she was any good at reading between the lines) that once we were matched, or had a newly placed child, that like with a birth child we would use contraception as we would want a gap between the arrival of children as any parents would. I do not honestly feel I could say we’d use contraception now (though Mr. Spouse and I are not quite on the same page on this one, as he is now very keen to Get On With It and afraid another miscarriage would set us back for too long, I am a glutton for punishment and feel I could cope with maybe one more…)

Of course the whole interview this morning was not about this. There was a lot more (including, inevitably, Madonna, but I brought my own twist onto this, I thought, with my observation – a major problem I have about overseas adoptions – that they would not be able to have any kind of developmental assessment to get an idea of any difficulties little David might have). Still processing. Output from program may or may not appear here in the next few days.

I think the order of the process is rather different between different agencies, but they sounded like they would be happy to find us a social worker for January, and a place on their February preparation course which, miracle of miracles, does not clash with any of my work commitments. We now have to forewarn our referees…

Metablog

A post about blogging...

I very rudely wrote far too much identifying information about one of the very nice women I spoke to on the phone about their adoptions, and as you may have seen I edited that post. People do not like to be identifiable, but adoptive parents especially do not like that, for extremely good reasons. When I started this blog I really wanted it to be a diary, somewhere to spill my thoughts. I don't have huge numbers of readers like Julie or even Thalia, and I don't mind - the occasional bit of feedback is good.

I do post as I say on a couple of forums that have adoption-related discussion and I had put my link on one of them (this one also has fertility stuff, so it seemed particularly relevant) in my profile, but I've decided to take that down. I'm not sure if this is sufficient to return this to the "personal diary, shared with a few" mode - I know I'm on a few blogrolls, but usually they are miles long so it's not like I get a lot of hits from those.

Anyway although this has not been of the scale that others' "outings" have been, the current hoo-ha with Thalia, together with a separate incident in which another adoption blog talked about something I'd been chatting in a PM with another board user about, which made me link them up as the same person, has given me a wake-up call. If you have any suggestions or other warnings, now is the time to make them. I don't want to stop writing, and I want to be informative, but I don't want to be indiscreet or give away too much information about myself, anyone else, or the UK adoption process. I'm going to find and delete the only information (a comment made by me, I think) that enables people to identify me by name, too.

Some good, some not so good

So the news is partly good – we have our first interview with the agency director on Friday – I’m feeling quite calm about it, probably because I suspect they will ask us the same type of thing the social worker from the first agency asked on the phone the other day. Even Mr Spouse seems quite calm.

I heard from a very dear friend who lives in the US and has one son through IVF that she is a) almost certainly coming back to live in the UK and b) expecting FET twins. She was very sweet and said if I didn’t want to mention it she’d understand totally.

We have told quite a few friends about our plans to adopt and they have invariably been very positive - in fact, it has given us some ideas about who might make a good referee (we have to have three each, I believe) based on their comments (although some of them seem to be a little unrealistic about us!) So we thought we should probably tell my mum in case someone else told her, as we were visiting over the weekend. The good news is she says she isn’t going to tell anyone else – though she wasn’t supposed to tell anyone about my first pregnancy, and did…

She was incredibly negative about the whole idea. First of all, she thinks that no children who are not genetically related to us will be any good, to be honest. I have to say this is something I’ve struggled with but we are going to have to get over it. There are nice, pleasant, even bright people in this world who aren’t related to us. Such as my husband, for example. And being highly intellectual is not a guarantee of being pleasant or happy.

I'm not really sure what she thinks our options are - whether she thinks we are doing this instead of getting pregnant. I am not sure I really want to ask, but I know she is not in favour of IVF, so I don’t know quite what she thinks we should do. Wait another two years and hope we actually manage to keep a pregnancy, and if we don’t, then what? Does she think we’re refusing treatment for miscarriage, or that we’ve decided not to get pregnant because we don’t want to have any more miscarriages? I have a feeling even if "old-fashioned" adoptions where young, bright girls gave up their babies voluntarily at birth were still possible she'd probably be against the idea.

But she also seems very set on the idea that adopted children are bound to be extremely disturbed, no matter how good their foster homes, or how little they remember of their birth parents, or how young they are. I have tried to explain that we are consulted at every stage about what types of difficulties we would be able to cope with. We are, I hope, going into this with our eyes open. I also pointed out to her that if you have birth children you have no guarantees - I used the example of autism - she says there's no way we’d have autistic children because we are both normal and outgoing – of course my godmother's family who have a grandchild with Asperger's because they are weird.

As you can imagine I’m not very happy about this! - it's all very well to say "oh, she'll love them when they come along" because I'm not entirely sure she will. As far as I can work out, her opinion is that no-one in her family should have a child with a difficulty or disability, and if you do, you've brought it on yourself - she is really, really negative about the distant family member (my age) with Down Syndrome, despite the fact that she's a happy and loved individual - she says "oh, they didn't have the choice in those days".

I think I’ve been thrown by this partly because of the positive reaction of most of our friends – I assumed she’d be the same – she loves our nieces and can’t wait to see them (although she also can’t wait to say goodbye sometimes!)…

Edited: after Thalia's comment - I don't know which book you've read, but as part of my research is in this area, and there's a lot of recent data suggesting input/environment is MUCH more important than previously thought, and I keep telling my mother this (and have always done so) I can't help feeling like banging her head against the wall and saying "Have I taught you NOTHING?". But strict nativism makes much more sexy copy.

A tale of two phone calls (plus a third to come, and several

Last week -phone call to a friend of a friend who lives in the next (vast, rural) county north of us, who has a little boy, aged four, been with them a year, adopted through their Local Authority. As only two women who have never met but have an important subject in common can, we talked for an hour and still had a lot to say. Their adoption procedure sounded boring and long-winded (it might be slightly better with non-LA agency because of how most of the voluntary agencies structure theirs) but ultimately well-run and they are very happy with their little boy. They both work in health/social care fields and had been through fertility treatments and said "no more". Their little boy sounds intelligent, sensitive, and advanced ("Mummy, do octopuses have teeth? How do they clean them under the ocean?"). I asked if they felt the social workers had matched them well to him and they said they felt it had been taken into account that they would be the kind of family to suit a bright and articulate child.

Yesterday - after a bit of trouble arranging it (her husband thinks everyone on the Internet is weird - well, can you blame him) - phone call to a nice woman who posts on two internet fora I frequent (one full of babydust I'm afraid, but very UK-oriented, one full of scary people with children with severe mental health problems, but also helpful in a practical sense). She lives about the same distance from us but slightly nearer Big City. Again, as only two women ..... we talked for an hour and still had a lot to say. They had been through a voluntary agency quite some time ago and their older child was placed with them, and then they had done concurrent placement and had a baby placed with them. Although far more children placed though concurrent placement stay with their adoptive parents, I get the impression from a few different people that social workers minimise this risk, and in their case the child was returned to the birth parents. Another poster on one of these boards whose child stayed with them, I think, said they felt torn between wanting the birth parents to set themselves straight, and wanting them not to, so the baby could stay with them. I'm also not sure whether concurrent placements that result in the child returning to their birth parents will include ongoing involvement in the child's life - most regular foster carers can do this, unless there's something specifically to prevent it. They then adopted their little girl through a LA they don't live in, but who was also quite young (about 12 or 18 months I think). Both children again sound delightful, allowing for the fact that the boy is a teenager! I also asked if the social workers had matched them well to their children, in her opinion - yes, they are always being told the kids look like them.

I am not quite sure if a) the two women understood my question about matching rather differently or b) they have very different priorities in matching and the social workers took this into account or c) they have very different priorities in matching and by chance the social workers got it right. I do know that of all the children I have seen on social work websites/magazines the pair that has stood out most for me was a pair of African descent who were noted to be advanced for their age. I'm pretty sure Mr Spouse would not be up for this particular pair but I guess what this tells me is I don't mind if people don't tell me the children look like us... I know they think about this when allocating donor sperm or eggs, but at this point I suppose what I'm trying to say is it would be a luxury, rather than a necessity.

So I've now got Wednesday afternoon down as my afternoon to ring the first agency - the one that does concurrent placement. Despite the lengthy contact sessions and the risk of the child going back to birth parents, I feel this is a good way to go. I don't think the risk of placement breakdown is any greater than with a regular adoption - although it might be differently upsetting to have a child returned to their birth parents rather than leave because we could no longer handle them or they put other children at risk. It remains to be seen whether our geographical distance from the contact centre can be put aside since our travelling time is no longer than many other much closer families (it's only 10 minutes longer than the woman I spoke to, for example).

Voicemails - mainly to the miscarriage nurse, again, I'm afraid. I finally got the information sheet from the clinical trial but I still want to find out about what happens if my prolactin levels are still too high, can we be tested for the balanced translocation (very rare I know, and probably only in my mind because of Julia, but also I have these niggling doubts about the very high number of only children in Mr Spouse's family), and my acupuncturist keeps on at me to find out if the progesterone cream is OK to use. She thinks not (it could stop the progesterone receptors working, she thinks, and I never specifically asked the nurse, and feel that (though it would be much easier) I cannot lie to my acupuncturist...

[Edited because I had put up some information I shouldn't have]

I am married to a very lovely man

Yesterday I found out one of my colleagues is pregnant. This is quite an achievement as there are only twelve female members of staff in the department - two have school-aged kids "and that's enough", three are in their fifties or sixties, three have publicly declared they aren't up for commitment/of that sort (one single and complains to me about clingy men, one relishes her boyfriend being away at sea for four months at a time, and one happily coupled but childless), and one is also infertile. Which leaves J. Who has the office opposite mine. And who lives on my street. Closer to town. I have to walk past her office on the way to the photocopier and her house on the way to anywhere.

Now, I did think I was doing OK. I found out about the pregnancy (I think she must be about 5 months, but a clever dresser) during a day-long meeting where she was sitting opposite me, and I was OK - bored, but OK. Then when I got home I fell apart. Why does it still hurt? Why was I OK last time I got my period, but not on hearing that this very nice woman is pregnant? Will it still hurt if we have children but they are adopted?

Anyway unfortunately Mr Spouse had gone to see his mum after work and it's a long journey so by the time he spoke to me and realised how awful I was feeling he couldn't get home for a couple of hours. I moped in front of the telly with some soup and some cake and then had a hug when he got home. Today he left before I got up as usual and I'd said I was going to work from home - or possibly even call in sick, but in fact I had a lie in and felt much better so I went in late. And even managed not to have an extra coffee, which normally I need to perk me up when I'm feeling crap. So I got home and found...

a card saying there were flowers for me next door. He had sent me a bunch fo flowers! Isn't he sweet? He says it's in the appendix to the Husband Contract.

I'll let her off

The nurse rang me this morning at 8.30 - she said she'd been covering for other people most of last week - which I suppose rings true as the consultant's secretary wouldn't necessarily know that.

Anyway all the clotting tests are fine but my prolactin was elevated. Apparently this can be due to stress but she'd like to repeat it. She says it isn't related to the miscarriages but they'd like to repeat it. I don't think they would have taken this one before - a quick Google reveals that elevated prolactin can prevent ovulation, but since we know I'm ovulating nicely (had a decent progesterone level in that round of tests on day 24 or so I think, too), that's not the issue. The RCOG guidelines say that evidence linking hyperprolactinaemia with miscarriage is "equivocal". But if it's elevated again I'll ask if it can be treated, I think.

However they don't think there's a clear reason for the miscarriages so they are going to send me a letter about the NK cell trial - but given how slow the wheels of NHS bureaucracy grind, that is unlikely to be this month - apparently the research registrar is only just back from holiday today anyway.

So, I thought that we'd be taking the month off this month but it seems not... which brings up a whole load of adoption-related stuff.. perhaps for another post.

But I'll leave you with what the nurse at the GPs said to me while I was having my smear (why can't they hold the smear stick in one hand while they do the speculum with the other? why do they have to walk off and leave you in pain?). "So, do you have any children already? (no) Oh, did you just start trying quite late (yes, we only got married two years ago- was she going to tell me off for putting it off?)?"

OK, given that she only has my last 4 years' notes, or less, and I only told her the most recent referral to the gynae was for infertility (that part WAS her business), how does she know I didn't have ovarian cancer in my twenties, say??

*(&)$*£@&$)(*

I have spent most of this week, it seems, on the phone to the nurse at the clinic. I've left multiple messages, called before 9am, after 5pm, at lunch time, and called the consultant's secretary who assured me the nurse would be in this afternoon - I must have called five times this afternoon, but still no luck.


So still no results. I know she's getting my messages because she called me herself early on Tuesday to say she only had half of them and the rest would be available on Wednesday. But she hasn't called me back since.

OK, seriously, what AM I?

I don't have my results from the nurse yet - this is the week they should be available, but she called early Tuesday morning to say one set would not be available till today, and I didn't get a call-back today after leaving a message, so I will try again tomorrow. If you've been following (and if not, do try to keep up at the back! honestly!), if they are all negative I can go on the NK cell trial, which involves calling Dr Q on CD1. Which is today...

So, another cycle, another wasted test. It's now 2 years since we started trying to get pregnant. If I calculate it rationally, that's a maximum of 26 cycles (28 days each) but of those I was pregnant for, say, 3, having a break for 2, on medically enforced abstinence for 1 and out of the country for the crucial week of another one. So that's 19 cycles and probably 3 measurable pregnancies. So I would imagine your average infertile would laugh me court of court if I claimed to be infertile too. Even if there were only 2, that's 1 every 9 months. But I don't feel very fertile.

Again, I don't feel as if I've had so many pregnancies and so many miscarriages - not compared to some people - some of whom seem to get pregnant really easily, perhaps that'[s how they fit in so many miscarriages? Or am I just misperceiving the time because time in my world goes slowly, but only reading their blogs it seems to go quickly in their world.

There does seem to be a dichotomy between difficulty getting pregnant and difficulty staying pregnant - I guess I do have both, but it's hard to tell how severe either one is - which will turn out to be the dominant one - will I never get pregnant again? or will I have more miscarriages? or will I be lucky?

If only I knew...

It only goes to show, you never can tell

... as someone (Chuck Berry?) sang.

I recently made the online acquaintance of someone who seemed to be in a somewhat similar position to me - worked in a similar field, was married to someone quite a bit older than her, similar age to me, was unable to get pregnant (in her case because of health issues) so was considering adoption (in her case from China). We had emailed a few times and I was going to call her (I had her mobile number) but was away on holiday so somehow never got to it. She then posted on the forum where I knew her from saying her husband had been in a serious car accident and was in hospital, in intensive care, and texted me asking to post that he was going to need more surgery. Shortly following this she posted that he had died.

This upset me, not surprisingly. However, a few hours after this it was posted that she had in fact been an impostor, and had also had several other (and I have to say, much more extreme) personas in the past, so had been removed from the site with immediate effect. Now I'm not sure what to feel. I know that some of the things she told me and/or posted were very similar to my own situation, and were not written after I had shared my circumstances, so it wasn't particularly a case of her singling me out - but it still feels personal. We've had a death in the family, a friend's father has died, a friend my age has inoperable cancer, and to be told that a husband of a friend who is very, very similar to my husband/marriage in salient ways had died was just TOO close to the bone - I was in bits.

I don't know if this (what appears to be a case of Munchausen by Internet) has ever happened in Infertile World, but it seems as if it could easily happen. And it makes you question your grasp of reality.

I did ask Mr Spouse if he was real, but he declined to answer, on the grounds that he'd have to kill me if he told me. We had been watching Spooks...

When can we...

go on holiday? ring up the adoption agency? book my work trip to Tropical Climes (Asia this time)?

As Thalia just blogged, if you think there is a possibility you might be pregnant/have just had a scan/be just about to have a scan/have just miscarried/be just about to miscarry, then it is hard to plan ahead, especially for major things.

After the last miscarriage, at 5 weeks, just as we were supposed to be going away for the weekend for our anniverasary, and I was supposed to be giving a talk for work also several hours away (the same place, though), I am really scared of travelling while pregnant. But I also know that, if we did have another very early miscarriage, then I'd probably be fine with travelling after a couple of weeks - after the first miscarriage, I went to East Africa and was glad to get away. But I'm also not going to anywhere disease-ridden (especially malarial) while pregnant - and this is totally contrary to my normal inclinations, which are that lots of people get pregnant and give birth just fine and live in such places, and I have access to better medical care than most of them. I'm not planning a home birth in a developing country, don't panic, but I've always been a bit dismissive of nervous Nellies. Now I am one.

So my mind is full of scenarios like: will I tell the student whose fieldwork I'm going to supervise the real reason if I decide to cancel? Would I only tell her if I'm pregnant, but not if I miscarry close to the trip? Would I go if I was 15 weeks (I think that's just about possible)? She knows I've been sick on and off. So perhaps "I'm sick again" would do. But if I was at work, and cancelled 4 weeks before the trip, would that wash? Would my GP even write me a note for the insurance (probably, as it is a malarial area)?

And then, what about the adoption? Mr Spouse has agreed that we will try our luck with the concurrent planning people - no idea if either his or my age, or our distance from their centre, will be an insurmountable obstacle - but they should tell us definitely no, or that we have permission to apply, pretty much immediately. So the plan is to make that initial enquiry towards the end of October, leaving either them or the other agency two months to get the criminal records checks out of the way before starting the proper application early next year. But do we do the traditional "I'm not pregnant AGAIN since I just got my period so I will cut my losses and ring them now" or is that a bit too predicatable? Again, do I wait till my next cycle (not for 3 weeks) to book my Asia flight so I know more clearly the possible options (the 15 weeks pregnant will have been ruled out then, you see).

I really hate this ruling my life by my cycles, and I know I'm doing it to myself. I guess if you have treatment in the equation you just have fewer options for any one date - but you know further in advance which ones might lead to a pregnancy. I know the real answer is "book now, see what happens, don't let anything else be ruled by your cycles", but it's hard.

I really, really should know better...

than to ever tell parents anything about child development. You see, I only do this for a living - I don't have any actual in-house children, just a lot of theoretical and practical knowledge. But of course that doesn't count for anything.

I'm also tired and sad - my very sweet but quite elderly and, latterly, fairly sick father-in-law died on Tuesday. I think Mr Spouse saw it coming more than I did, in fact - he's much more of a realist than me.

We spent the Bank Holiday weekend at a festival - we've been going, separately and together, on and off, since 1983 (when I was a little teenager, and he would have been my youth leader!). Being the kind of place where people of like mind and marriagable years get together, there are a lot of couples and babies. I was pretty apprehensive about going - we didn't go last year, as I should have been about 38 weeks pregnant, and we would have stayed away, so didn't want to wander around going "oh, we shouldn't be here". But although there were lots of babies, children, and bumps, I remembered all those years of watching couples, and how happy I am now with Mr Spouse - and tried to trust that we'll be going with our children, one day.

Not too shabby

Well, it took me an hour and a bit to get there, and about 2 hours to get back (the first hour of which was sitting in traffic in a rainstorm), but it was a fairly satistfying visit. The nice nurse is very nice, and very sensitive - you couldn't really do her job and not be sensitive. She asked me if it was OK to talk about the miscarriages - I suppose you need to be prepared to talk about them to go along to an appointment like that, but it does tend to bring it all back. She also asked if we had "any little ones at home" and said if we had another miscarriage they'd do some analysis on "the little one" which made me cringe a little but apart from that, full points. She didn't say "oh, perhaps the second one wasn't a pregnancy" which I had feared.

I asked all my questions apart, I think, from the one about implantation - I am pretty sure I am right about the cramps, since they only started after the first miscarriage (and we were only trying to get pregnant for 3 months before the first pregnancy), and don't happen every month. I don't think our problem is getting the sperm to the egg.

So the story is:

Multiple clotting factor tests, including all the ones that were done before and then some, and lupus etc. - she distracted me while taking the entire arm's worth of blood from my useless vein (I must have been a junkie in a former life) by telling me about the house she is buying where the previous owner was proud of not having hoovered in 17 years. If any are positive they will recommend either aspirin or aspirin plus low molecular weight heparin once I get pregnant. She said she saw where the nice gynae was coming from suggesting I take it anyway, they don't really suggest it but she didn't sound like it could do any harm. They won't do the genetic clotting tests again.

There may be a spina bifida issue. My brother and father have club feet (spina bifida can cause this, or you can have it alone) and there was a question of a cousin with a dimple in her spine. She wants me to take 5mg folate if I get pregnant - she said no need to do it before. I think I may get a prescription just in case, as finding out I was pregnant on holiday, for example, would be needlessly nervewracking. This also counteracts the hyperhomocysteinaemia (MTHFR) so that would be sorted too if I have it.

If all the tests come back negative then they will ask me if I want to be entered into the NKC trial. Since the tests are due back just as my next (but one) period starts (in a month's time) I might be able to get the biopsy done for that in September or October. So it is not all that shabby - she even apologised that they weren't recruiting this month because of too many lab staff being on holiday. So they are only recruiting people who clearly have idiopathic recurrent miscarriage. It being a clinical trial and all. I think they do also recruit from elsewhere in the country, again with a diagnosis of IRM.

I think it is at that stage that they would do a uterine ultrasound too. I'm not entirely clear what they see when they do the laparoscopy, but I would have thought they'd see anything obvious - so I'm not massively worried about that.

They don't do progesterone supplementation - if you have oligomenorrhea they give HcG - but I'm too regular for that.

So, if I see those two blue lines I'm to ring immediately (do not pass go, do not ring Mr Spouse - OK, I think I can ring him!) and they will follow me up. I could, I think, have similar follow up in my local hospital - in fact, it turns out the nice gynae used to work in the Liverpool hospital, as a research registrar - but I think I might use it as an excuse to take more than the odd day off work. I am even thinking of asking if I can go part time for a while (most it can be is 2 months, right?) if (when! when!) I get pregnant again. It does seem as if supportive care is actually the best - and extremly succesfull - intervention for IRM.

I actually feel like there is a way forward - and I have also started to feel more positive about adoption. I don't feel the same urge to get and stay pregnant, though it would be nice. I think that our plan C* (apply officially to adoption agency 6 months after last miscarriage i.e. in November) could still work out, as it is highly likely all my tests will be over by then, and I don't really think IUI is that crucial for us any more.

Things that made me well up yesterday: Seeing an undergraduate student come in with her TWO count them TWO little girls who were both accidents and who mean she's taken 4 years so far to do two years of her degree. Seeing the "baby wall" at the RPL clinic and not believing I'm ever going to have a baby picture to put up there. And then hearing that my father-in-law, in his 80s, is in hospital with pneumonia. The vicar decided he needed to go to hospital, having called round to see them. Mr Spouse (who was also tearful, not surprisingly) is worried he won't come home, because he doesn't think he can. We also worry about my mother-in-law, who is a similar age but more hale and hearty, but who does not tend to go out on her own, as she lacks confidence, so is at great risk of getting very isolated.

*A having been "get pregnant quickly" and B being "OK, we forgot to mention the part about staying pregnant, so let's get pregnant again and keep it this time."

A few links...

This is the Royal College of Obsetricians and Gynaecologists review of care for recurrent miscarriage.

This is very depressing for those of us with older husbands. I sent the link to Mr Spouse but he hasn't commented yet.

This is the four-drug combo study. I think I'd be more impressed if I knew what kind of clinical care the untreated women got - as frequent ultrasound and attendance at an early pregnancy clinic also seem to reduce the recurrence of miscarriage.

and finally this (absolutely, positively not work-friendly) has to be my best search term ever (and a mad search engine, too). No idea what page I'm on as I didn't dare go that far.

Note to self part, er, I don't know

I've got my appointment at the recurrent miscarriage clinic next week so this is a (to be updated) list of questions I want to ask:

Clotting factors: which tests will they do? Check they are doing the MTHFR as they couldn't do that locally.

Chromosomal factors: when will they test Mr Spouse for the balanced translocation? Can he have the blood taken locally?

Elderly reproductive system factors: is it worth me getting my FSH done again (the gynae said not, since it was only taken in January - I imagine she's right - perhaps next year)? What about an antral follicle scan - would this show a decreased ovarian reserve and would that be affecting the miscarriage?

Immune factors: are they still doing this trial of steroids? Does this require a biopsy? On a) day 21? b) a barrier contraception cycle? This will be yes to a) but no to b).

What about this new study of four-drug therapy for recurrent miscarriage? I realise it was a study with no placebo group but would they approve me trying the treatment? If no, would it do any harm to try aspirin (the gynae said it wouldn't)? Progesterone? (I have actually ordered some progesterone cream, partly because - of course - I hope it will help us conceive, but also because I have heard it's good for premenstrual cramps, which continue to plague me some months).

Which aspects of the therapy (steroids, aspirin, folate and progesterone) could I start at day 14 of my cycle, given our difficulties conceiving? If she says "none", would it be worth going onto the higher dose of folate anyway?

If I have another miscarriage, and it's not too fast, is it worth my having and ERPC to try and test any tissue? Would they be able to keep the tissue locally or would I have to go down there?

Oh, and about those cramps - is it possible they are conception cycles, with attempted implantation?

I'm hoping this is going to be an interactive post - if anyone can think of any questions I should ask, I'll add them in.

Notes from the notes:
I have looked into Foresight, but I think we are doing, or have done, everything anyway (vitamins - though there's no evidence anything except folate helps; stopping smoking - neither of us ever did; testing for STDs - got that sorted; heavy metals in hair - erm...)

Agnus castus - I understood that was for short luteal phases, which I don't have. But I'm prepared to be corrected.

The progesterone cream arrived today (about 6 dpo) and is very, er, creamy.

On holiday

You see a lovely part of the world, and fall in love with it. You dearly, dearly wish to live there, yet circumstances prevent this. However, there is nothing to stop you from visiting as often as you can. Each time, you are charmed again, you do see there are some disadvantages but perhaps you are a little blind to them since it is, after all, a holiday. Parting is, of course, sweet sorrow. You book another trip the moment you get home, and once again you sigh and wish you could live there.

One comment recently asked me if it was hard for me to work with children, since we haven't yet managed to have any of our own. Mr Spouse was also asking me why I like volunteering with the Brownies (and why I suggested he might do some volunteer work with children, too), wondering whether I don't find it hard to have to give them back.

In other, not great, news, my work colleague who was going to go for her free IVF round on the NHS has had to cancel. I don't quite understand the protocol, but she says she went for an antral follicle scan (is that right?) at the start of her cycle (do they scan before starting? other people tell me they only scan after stimulation) and they found 3 follicles whereas they were hoping for 15? or is it 15 each side? Her FSH was also quite high - they've never found any problems before. She says she was (understandably) very sad at first but now they have resolved to go ahead with adoption from China. We are going to start a two-woman campain for equality of adoption leave with maternity leave (they recently updated the T&C at work and made maternity leave the same across job grades, but didn't update the adoption leave, which was previously inferior anyway).