Natural Family Planning Awareness Week

When I was 23 or 24 years old and single, I went to a new gynecologist for an annual exam. She asked me the standard questions to get my history, and when she asked about my sexual activity I told her I was abstinent. She said, "Good for you. There is too much out there to catch."

Cleanliness was only the secondary reason for my abstinence.

The hierarchy was:
1) My deeply-held belief in the sacred nature of sexual union, and the fact that I did not yet have a husband;
2) My unwillingness to catch something that might stick around forever and/or compromise my future fertility; and
3) My unwillingness to bring a baby into the world without the proven benefit of a married mother and father.

We went on with the appointment and discussed some issues I had, specifically that my cycles were irregular and extremely painful. She didn't seem to be overly concerned, but she ordered some blood work and sent me to a radiology center to have a pelvic ultrasound. My results, it was reported, were normal.

In the following year or so, I met my now-husband and we got engaged. At my next appointment with the same gynecologist, again for an annual exam, I answered the sexual activity question in the same manner, and then later she noticed my engagement ring. She congratulated me and then said, "When you're married, what do you intend to do about birth control?" I said, "We're not using birth control, but instead we're going to learn NFP. We're practicing Catholics."

And she laughed.

She laughed in my face and said, "With your irregular cycles, that is not going to work for you."

Then she saw my stony face. She shrugged and told me she'd see me six weeks or so after the wedding to confirm my pregnancy. As if it were a threat.

I went home and Googled "pro-life ob/gyn Northern Virginia" and found out that Tepeyac Family Center, one of the largest pro-life practices in the country, was less than five miles from my fiancé's condo, which we would be sharing after our wedding. Even though I had just had an annual exam, I made an appointment.

The receptionist told me, "We are a pro-life practice and do not prescribe birth control, nor do we perform sterilizations." I said, "That's why I called."

I had lost all confidence in my old gynecologist. When she laughed in the face of my deeply-held religious convictions, I realized she wasn't to be trusted about anything else, either. I had my doubts about the results of my tests the previous year and wanted them to be run again.

Lo and behold, when the blood tests were run again, this time by a doctor who cared about the actual mechanisms by which fertility functions, the results were clear: I had polycystic ovary syndrome (PCOS). As I had suspected, my irregularity and pain were not normal, but were symptoms of an underlying pathology. The original gynecologist, in her astounding ignorance about the actual mechanisms at work in her chosen specialty, had seen the same severely out-of-whack hormone numbers and decided they were irrelevant.

The non-birth-control-pill medication protocol for PCOS turned out to be effective enough at sloooooowly bringing my hormones back in line without flipping the switch on my fertility to OFF; unfortunately I couldn't tolerate the medicine and had to stop taking it.

Soon enough I was married. My new husband and I learned the Creighton Method of NFP with the help of a retired OB/Gyn (the simpler Sympto-Thermal method is less effective when pathology exists). I took waaaaay too many negative pregnancy tests when my charts were unclear -- or more likely: my charts were clear but I didn't want to believe it. I endured all the delightful side-effects from fertility medications, especially as the doses were slowly increased to levels that made the pharmacist do a double-take. Between the Creighton lessons, the wasted pregnancy tests and the fertility medication my insurance refused to cover, it cost us a small fortune, all told.

I cried to my mother about the injustice of growing up in a large, endlessly and effortlessly fertile family and not being able to conceive, when I had been so careful to avoid compromising myself. I cried whenever I so much as thought about abortion -- what a personal insult it was to know women were throwing away something I wanted so badly! I tried to smile and make jokes when everyone I had ever known in high school and college, who knew about my commitment to my virginity, asked me constantly whether I was pregnant yet.

After three years or so, still not pregnant, I insisted on laparoscopic surgery to investigate the possibility that I also had endometriosis. On December 1, 2011, I had the surgery, which did indeed reveal (and remediate) endometriosis. I kept using Clomid. And in February 2012, I discovered I was at long last pregnant.

It never would have happened without NFP.

Without NFP, I would probably have wasted years on the Pill, convinced that I didn't want to be pregnant yet anyway. Without all that meticulous, excruciating charting, I never would have discovered that I was borderline anovulatory. I would not have been able to point to charted proof that the Clomid was working and I was now regularly ovulating but still not conceiving, thus sending me on the search for a further answer. I would not have been able to get pregnant almost immediately once the barrier of endometriosis was removed because my charts told me exactly what to do.

Most people writing about NFP awareness are writing about how it helped them space their pregnancies, or how they don't use it to space pregnancies but like knowing that they could, or how they support it but hate it personally. Everyone writing about NFP awareness mentions how good it was for their marriage.

Those aren't my experiences.

Infertility is a huge burden and it can be extremely hard on a marriage. The senses of inadequacy and helplessness, the depression that accompanies the arrival of every period, the feeling that sex has lost all fun and spontaneity: these things are real and they are heavy. Because our marriage was basically born into the crucible of infertility, we never had the chance to consider the benefit of using natural methods to space pregnancies.

This is the cross that God gave my husband and I to bear. We struggled to remind ourselves that faith in God includes having faith in His timing. We got a baby when He said it was time; we had to learn patience and forbearance and selflessness. I'm still learning to have patience and forbearance and be selfless.

But here's the reality of the situation: whether you feel burdened by your fertility because you have eight kids under the age of 11, or whether you are suffering because you just want a baby, natural family planning is a gift. Doctors who care about how your body is actually working or not working are a gift. My children are a gift. 

And thanks be to God for those gifts.

Infertility Awareness Week

Soooo... I've never gone into much detail in this space on my struggles with infertility. I have (finally!) been blessed with two gorgeous children, and hopefully there will be more, but they were years in arriving. So buckle up, here comes all the nitty-gritty.

Michael and I were married in October of 2008. A couple of days after we got back from our honeymoon, I realized my period was overdue and we went to CVS to buy a pregnancy test.

{I'm not going to go into details about the fight we had in the car about my husband's reaction to finding out I might be pregnant already. ;)}

It was the first of many, many negative tests.

My period arrived a few days later, typically keeping to no kind of schedule, and we went on with our lives. We had been married for two weeks and we were relieved that we could get used to being married before having to make such a major adjustment -- Michael especially.

It was probably seven or eight months later that I had reason to take my next pregnancy test, which was again negative. At this point I started to wonder if something was wrong; we had made absolutely no effort to avoid pregnancy -- and I knew Michael was ready now, as I had caught him eying up strollers -- and I come from a long line of endlessly, effortlessly fertile women.

I was between gynecologists. When I had last been, just prior to getting married, my doctor had asked me what I intended to "do about birth control." I told her that we were practicing Catholics and would be learning NFP. She laughed in my face and told me that with my irregular periods, "there's no way that's going to work for you." I immediately resolved never to return, but I hadn't yet found a new one. It was almost time for my yearly exam anyway, but I didn't know how to go about finding a doctor who would not laugh in the face of my deeply-held religious convictions. On a whim, I Googled "pro-life OB/GYNs" and stumbled on Tepeyac Family Center.

{I have since discovered the American Association of Pro-Life Obstetricians and Gynecologists, which is a great resource for finding out if there's a pro-life doctor in your area.}

Founded by Dr. John Bruchalski, Tepeyac is named for the hill on which the apparition of Our Lady of Guadalupe appeared to St. Juan Diego. It is an entirely pro-life practice, and I immediately called for an appointment. I was unable to get an appointment with Dr. Bruchalski, who's a very busy man, so I took one with another doctor in the practice, Dr. Cvetkovich. {I mostly see Dr. Bruchalski now; he's a wonderful man. A third doctor in the practice, Dr. Pereira, happened to be on call and delivered both my babies.}

After my first appointment, I had a raft of blood tests done and was diagnosed with polycystic ovary syndrome (PCOS). This is when I started to get mad. The previous doctor (you know, the laugh-in-your-face secular nightmare) had done the same blood tests for PCOS (but her office had neglected to call me with the results) and had sent me for a pelvic ultrasound, which uncovered no ovarian cysts. Dr. Cvetkovich told me that the actual ovarian cysts need not exist for PCOS to exist; my bloodwork made it clear.

At this point, we still weren't necessarily trying to get pregnant. I started taking metformin, the non-birth-control-pill protocol for PCOS, in hopes of getting my hormones under control. Unfortunately, I was completely unable to tolerate it. It was months before I was ready to admit it; nausea is a known side-effect, but it typically subsides as your body adjusts. Mine never did. I slept with a mixing bowl next to the bed in case of vomit the entire time I was on the stuff. Dr. Cvetkovich prescribed me the name-brand version, which tends to be better tolerated. When I filled it, it was $90 for a 30-day supply so I thought, "This stuff had better be a magic bullet," but if anything I felt sicker. Dr. Cvetkovich took me off of metformin. She also referred me to a doctor who would give us private instruction in the Creighton Method for NFP. {We hadn't yet learned a method because I wasn't getting pregnant and it didn't really occur to me to get that ball rolling; Dr. Cvetkovich wanted me to have charts so we could find out if I was anovulatory.}

My charts showed that I probably wasn't completely anovulatory, but that during each cycle my body was trying two and three times to ovulate before it happened.

A healthy chart usually looks something like this:

We have a period, then a handful of infertile days, followed by a week or so of fertile days, a peak day, three post-peak days, followed by another (usually consistent from one month to the next) number of infertile days. And then another period, or a pregnancy.

And mine looked more like this:

Imagine that first line starts with a menstrual period. Then we have a bunch of infertile days, dotted with the occasional maybe-fertile day, and two-to-three peak days, after which the period does not come but instead another bunch of fertile days and a peak day. Eventually a period.

At this point I had been married for more than a year, and we were starting to move from the if-we-get-pregnant-it's-fine stage to the let's-get-this-show-on-the-road stage. Since my hormones were not fixed, I began taking fertility drugs.

I took cycle after cycle of fertility drugs, but I did not get pregnant. My charts got more uniform, but I did not get pregnant. I had horrible hot flashes and routinely woke up in a puddle of my own sweat, but I did not get pregnant. I prayed and cried, but I did not get pregnant. My friends had baby after accidental next baby, but I did not get pregnant. I took a dozen premature pregnancy tests and then got annoyed with myself for effectively peeing on $8 each time, but I did not get pregnant.

I was so sad all the time. I wouldn't say that I was ever mad at God, but I did ask Him a bunch of times what the deal was. I had maintained my virginity for my husband. I had never taken birth control pills or otherwise messed with my fertility. I had done everything "right," so why the heck could I not get pregnant?

Eventually, I marched into an appointment with Dr. Cvetkovich and pretty much demanded a laparoscopy. I was 99% sure I had endometriosis on top of my PCOS. There's no test for endometriosis except laparoscopic surgery. On December 1, 2011, I underwent a (thankfully outpatient) laparoscopic procedure, which uncovered and addressed the endometriosis that I was right that I had.

In mid-February of 2012, I finally, finally, finally took a pregnancy test that showed that wonderful little plus sign. Me, plus a baby on board. Thanks be to God. It felt like a million years, but I gave birth to my firstborn a week before our fourth wedding anniversary.

I know it takes a lot longer for some, and those people have my utmost sympathy. If you're still struggling, know you have my daily prayers. It's a terrible burden.

When we started thinking about a second baby, it only took two cycles of fertility drugs before I conceived again. I think God knew I didn't have another protracted battle in me again just then! I found out I was pregnant again with my little man a year ago today, and gave birth to him just after Christmas 2014.

Questions? Leave 'em in the comments and I'll get right back to you!

Infertility, and some further information

I just wanted to share this article on chastity.com, which is a great overview on the infertility struggles that many couples face, and which Catholic couples in particular face in view of the Church's total prohibition on assisted-reproductive technologies (ART).

Two things the article fails to mention, from my perspective as a Catholic who struggled with infertility and finally achieved pregnancy (and then a second!):

1. The Creighton Method (NaPRO Technology) was a godsend. My husband and I took private lessons with a pro-life doctor who specializes in reproductive issues, and it took weeks to learn how to properly chart using this method, but it was worth it. The article specifies the Creighton Method as useful for Catholic couples, but what the article never mentions is that this type of charting can reveal issues such as the wife being anovulatory, meaning she doesn't ovulate (or, in my case, didn't ovulate regularly). In this case, it is entirely permissible for a faithful Catholic to use drugs which induce ovulation, such as Clomid. 
2. The other thing is that the article discusses the necessity of masturbation as the only means of obtaining sperm for technologies such as intrauterine insemination or in vitro fertilization. This isn't strictly true (which still does not make these procedures permissible). Catholic ethicists have okayed the use of non-lubricated, non-spermicided, punctured condoms for use in diagnosing male fertility issues. Such a condom can assist in the collection of a sample for testing purposes by collecting a high-quality sample during an act of marital love without acting as a barrier to conception due to the puncture and lack of spermicide. 

If you're struggling with infertility, know that millions of women feel your pain. Our daughter's nightly prayers include a line just for you (and everyone knows that baby prayers count triple!), and I hope you find peace. 

God bless.

On nursing and failing to nurse.

I just finished reading about Haley's recent experience with downshifting her nursing schedule with her 14-month old, and it made me think about my breastfeeding experience with my now-21-month old and what I'm hoping for with #2, due in December.

I had a serious problem with low supply with #1. I have various hormonal issues which caused me to be infertile for years, and so I was dismayed but I wasn't very surprised when, four days after giving birth, my milk still hadn't come in. I was more surprised by the lack of support from the pro-breastfeeding community, some of which insists (with a stunning lack of compassion) that there is no such thing as an inadequate supply of breast milk. "Don't supplement," they insist, "Because if you do, you'll cause nipple confusion and tell your body it doesn't need to make milk."

Okay, well, four days into her life, my daughter was bright yellow. Bright. Yellow. Her bilirubin levels were rising and rising and it was all because she wasn't pooping. She wasn't pooping because she wasn't eating. She wasn't eating because I had no milk and the very unhelpful lactation consultant insisted that I not feed her formula.

Her pediatrician, who had initially encouraged me to "just keep at it" and not supplement, changed his tune. "She's going to have to go back into the hospital if we can't get these numbers down. Give her some formula."

If I hadn't been a brand-new, clueless, impressionable mom, whose own mom lives a couple of hundred miles away, I would have done that already. If it happens again with #2, everyone can give whatever advice they want and I am going to feed my child.

My poor baby sucked down two ounces of formula in about three seconds flat. She was so hungry, you guys. They told me to only give her 10 ccs at a time but it was empty, all 60-ish ccs, before I could stop her. I'm glad I didn't stop her because she was SO HUNGRY. She fell asleep within seconds, after four days of crying all the time, and an hour later pooped out so much meconium it overwhelmed her little newborn diaper. She pinked right up.

I continued to nurse her. I spent all my time doing something to do with nursing. I would nurse her, then give her a bottle since she hadn't gotten much from me, then when she fell asleep, finally satisfied, I would pump with the hospital-grade torture machine I had rented, collecting about a half-ounce total, and then I would wash the pump supplies, and then sit down for what felt like four seconds, and then she'd wake up hungry again and we'd start over. Meanwhile I was drinking gallons of water, plus that absolutely foul concoction called Mother's Milk tea, and eating oatmeal and doing every other folk remedy to increase milk supply that anyone's ever heard of.

The machine of my nightmares.

It was beyond miserable. Eventually I got to a place where I was able to satisfy her with exclusively breast milk during the day, and only had to give her a bottle of formula at night because I didn't have enough to get any length of sleep out of her by the end of the day. From the time she was a month old until I had to go back to work when she was three months, she was in this way (almost) exclusively breastfed. I never felt letdown once. I have a vague idea what that means, and I know it never happened to me. I never got engorged with milk.

When I went back to work and she went to daycare, despite my best efforts I had hardly any frozen milk for her. This is when my amazing sister-in-law came to my rescue. She had a baby five weeks and one day after my daughter was born and while I was bemoaning my undersupply, she was dealing with the opposite. She had so much milk that she couldn't nurse without pumping first because her daughter would gag and choke on her letdown. She had so much frozen milk they couldn't fit anything else in their freezer. So every time I went to Pennsylvania to visit, I would come home with a cooler stuffed with frozen breast milk, and so my daughter was able to go to daycare every day with breast milk instead of formula. At first it felt a little weird, feeding my daughter someone else's breast milk, but I was so grateful -- my sister-in-law eats a healthy diet and lives a healthy lifestyle, and I don't care whose breast milk it is, it's got to be better for a baby than formula. (And I'm not knocking formula; that stuff saved our lives. But you know what I mean.)

While Keira was at daycare, I was pumping four-to-five times a day, and getting diddly-squat for my efforts. I could and did pump for twenty minutes a side and collect less than an ounce. Total. When she came home and nursed, she seemed to get something, but pumping just didn't work for me. I propped a picture of her in front of me, hoping for some oxytocin stimulation from the sight of her, and nothing worked. I would nurse her in the morning before I took her to daycare, in the early evening when she got home, and during any night wakings.

I held her off of solid foods for as long as I could, even though she was so interested in watching Mommy and Daddy eat. My mom told me she hadn't given any of her seven children a single bite until they were at least nine months old because they didn't need it. I, again, was young and impressionable and stupid and tried to hold off for that long too but only made it to seven months, at which time she took to eating like an old pro and refused nothing (except mashed peas, which begs the question: can you blame her?). At this time, she self-weaned. She had given up the evening nursing in favor of food, and I basically dried up immediately.

Please ignore my voice in the background. "Num nummers," indeed. Good grief.

So, obviously, what I'm hoping and praying for with #2 is: none of the above. I pray I have enough milk to feed him or her but not so much that it's squirting from my eyeballs like my poor sister-in-law. I pray I have an aggressive eater with a strong latch and enough patience to wait it out. I pray I have enough confidence to do what's best for my baby without listening to medical professionals who haven't been listening to me. I pray I have the humility to ask God for the wisdom to know what's best for my baby and not make any rash decisions borne of frustration (I'm asking Him now, but I'm going to have to remember to ask Him then, too).

St. Giles, patron saint of breast feeding, ora pro nobis.

Miracle!

You guys. I have had a miracle.

On Wednesday, Michael and I went to my OB/Gyn for my eight-week ultrasound. We got a good look at our little bean, heard his or her wonderful, 164 bpm heartbeat and got a due date of December 29. Merry Christmas, baby!

God is so good.

Afterwards, I had that whole long "you're pregnant, tell us everything about everyone you've ever met" conversation with one of the doctors. I had only seen this doctor once or twice before during my last pregnancy, but I had liked him. He started off by asking me if I had any concerns, and I told him about how useless I've been with the hyperemesis gravidarum. He asked me what I've tried, and I said, basically, "Everything. Zofran made me feel worse; Phenergan I thought helped me last time but it's definitely not helping now except that it makes me sleepy and while I'm asleep I'm not throwing up but I just don't have time for two naps a day; gingersnaps/candy/ale makes me feel better for about 0.5 nanoseconds but then it comes back up like fire, Doctor, I am not even kidding; etc., etc., whine whine whine."

He asked me if I had ever tried vitamin B-6. I said no, and honestly I probably said it like, "Um, really, vitamins is your big solution? This nausea laughs in the face of cancer-patient-grade anti-emetics and you think a vitamin supplement is going to help? Don't waste my time, dude." Because I was about to barf and being about to barf makes me mean(er).

He was so patient with me, y'all.

He explained that it's a good first place to start, and that for some patients vitamin B-6 in combination with doxylamine succinate, the active ingredient in Unisom, is a nausea cure for them. Plus, obviously, it's not the same as blitzing the baby with all these weird chemicals (because B-6 is a vitamin found in nature, obviously, and doxylamine succinate is safe in pregnancy) so let's start there.

I did not run right out and get them, because I honestly didn't think there was any chance they would help. But the next day, on our odyssey from Virginia to the Jersey shore (from whence this story comes to you), we stopped at our favorite place on Earth: Costco in Delaware, home of tax-free shopping. (Can you hear the choir of angels singing? They also sell booze. TAX-FREE BOOZE.) On our way out I wandered to the pharmacy on a whim -- which is a miracle in itself because we had just had Mexican food for lunch and I was seriously feeling nauseated -- and the nicest pharmacist ever helped me. She got me the Vitamin B-6 from behind the pharmacy counter and  even though they didn't carry Unisom she found me the Kirkland generic with the doxylamine active ingredient (and thank the good Lord for my chemistry background or else I would not for the life of me have remembered what to ask for!). When we got back in the car, I popped a vitamin.

Inside of an hour, I felt 80% better than I have in weeks. When I went to bed, I took the generic Unisom and slept like a champion. When I woke up, I was a little queasy because I was hungry, but I was able to face eating in a way that I'm usually not able to and I took more B-6 with breakfast. When Keira was having lunch several hours later and I smelled it without having eaten again myself, my stomach turned over a little but two days ago that would have sent me running to throw up.

I feel human again.

God is so good.

He put the right doctor in front of me at the right time, to push past my resistance -- 100% born of frustration -- and convince me to give this ridiculously-simple-sounding remedy a try. Even if it stops working in a week, I will be so grateful that I got a low-nausea Memorial Day weekend with my family at the shore. I'm sure I'll still hit the occasional wall, where I have to stop chasing a toddler and sit down, but my life until yesterday was all wall.

I even stayed in the house while my mom cooked meatballs today, and that is amazing. When I was pregnant with Keira, Michael was cooking meatloaf and I had to hide upstairs in our bedroom with a rolled towel under the door.

This is a miracle in my life. I am so grateful I could cry.

Sts. Gerard and Gianna Molla, ora pro nobis.

In which I decide to stop making excuses about my lack of bloggery.

The more I think about this, the more I think there's no good reason for keeping it off the blog. I'm currently blogging fairly incognito-ly, which is to say that I don't think anyone I know "in real life" is reading.

I'm 7.2 weeks pregnant (or so... I don't yet have a due date), and thank the good Lord for his blessings. I only had to undergo two rounds of Clomid to conceive this time, and that is a wonderful, miraculous thing. I am overjoyed, truly.

However.

Oh, however.

For the second time in two pregnancies, I am dealing with the scourge that is hyperemesis gravidarum (HG).

You guys. It is the WORST. If you gave me the choice between a) delivering a full-term baby every six weeks for nine months and b) HG, I would unhesitatingly, unblinkingly choose to a) give birth all of those times.

I can only imagine what morning sickness is like. I have only ever had morning-noon-and-night, unrelenting misery, not mere morning sickness. It was in some ways easier with my first pregnancy: my responsibilities were fewer (read: I didn't have a toddler), and thus if need be I could sacrifice whole weekends to just sitting around trying to curb the nausea and vomiting; plus, I had some naïve  hope that it would only last for the first trimester. On the other hand, this time my husband knows what to expect and that is immensely helpful.

He has been a rock star. I mean that with the utmost sincerity. He rearranged his work schedule so he can handle both the morning daycare drop off and the evening pickup, he's been doing all of the baby's baths and most of the meals (picking them up from restaurants, that is, because I could cook but only if they want me to actually vomit in their meals).

I don't know how to even describe the magnitude of the disruption to our lives. But when Mama literally can't do anything without retching, life changes. A lot.

The best part of my day is the time between dinner and Keira's bedtime because I sit on the couch while she runs around being funny and distracting me from the horror show happening in my stomach.

Please say some prayers for me that this time the HG doesn't last every moment of my pregnancy, as it did with Keira. St. Gerard has been getting an earful from me already, but I would appreciate a few more intercessors!