AUGUST 10, 2016
The following is an account of my journey to where I am today: 6 months pregnant with my first child and turning 40 in a week. It might be a total overshare and I have some uncertainty around sharing this much personal information in my blog, but what I have realized over the past few years is that everyone has a unique journey to parenthood (or to the decision to not enter into parenthood). I have always been very open about my experiences and found it to be rewarding because most people I’ve spoken to also have a story to tell, can identify with certain challenges or know some bit of information that has been helpful to collect along the way. I share this today in hopes that it might help others to feel a sense of community in our collective paths to family, whatever that might look like for each of us.
The photo above was my Facebook celebratory pregnancy announcement from several weeks ago. As most social posts are, it shows an exuberant and blissful account of the perfection of that moment; my perfection of a wonderful partner, quaint little home, cartoonishly adorable puppy and healthy baby ultrasound. What it doesn’t share is the many years of wondering if this would ever happen to me. The worries, the various little health blips along the way and the close monitoring of the ticking clock. It doesn’t show the challenges associated with being of ‘advanced maternal age’ and the way we take things week by week, without any assumptions or promises. It’s not a sad story or anything particularly astonishing or out of the ordinary. Rather it’s one of meandering pathways, overcoming both common and uncommon challenges, and a bit of luck. And most of all, one of hope, joy and blessings.
The Days of Less-Advanced Maternal Age
I was never one of those girls who was counting down the days or years until I could begin popping out children. Quite honestly, I was more the opposite. Surprised by many of my peers birthing multiple children in their early 20’s after college, I ran the other way. After all, this wasn’t our mothers’ generation, I thought, and to me the glass ceiling appeared with shards of glass indicating endless years of possibility and I wanted to spend my energy moving towards it. I threw myself into my career and goals for seeing the world, living in big cities and having a thriving social life. I skipped out on as many baby showers as possible (apologies to my friends but I was terrible at ‘What’s in Mommy’s Purse Scavenger Hunt’ anyway!) and I’m certain my eyes glazed over a bit when any Mommy friends tried to share with me what their new day to day lives were like. It was like they were speaking a new language that I didn’t want to learn.
In my thirties it was much of the same really. A few notable differences were that it became slightly more challenging to find single girlfriends as I watched former sidekicks find their matches, head down the aisle and trade in my lifestyle for the seemingly black hole of new parenthood. In addition, both of my little sisters started having children during this time. Still, I was happy to remain a very proud ‘Aunt Sara’ instead of ‘Mom’ at this point.
I remember a girlfriend of mine once relaying to me how her gynecologist started advising her to be aware that as she approached 35, she should really keep her fertility in mind as it would become more fleeting. I reacted with a sense of defiance at that point. ‘They can’t dictate when we become Moms’, I said, ‘we have plenty of choices, lots of time and lots of things to do first!’
I asked my doctor about freezing my eggs in my early 30s. She said it’s an option, but expensive, not covered by insurance and, at the time, had a 25% success rate, and probably less with eggs of someone my age. ‘Am I better off to spend my time and money online dating then?’, I asked. She laughed and replied, ‘Yes.’
At 33, after a routine gynecology check-up, followed by an ultrasound, I was told I had a cyst the size of a baseball on my ovary. It was most likely benign, but it would have to come out. I had just moved to San Francisco weeks earlier and hardly knew anyone, so my Mom flew out and took me to the surgery. I signed away my left ovary pre-surgery, should they not find a way to remove the cyst without taking it as well, and went under. Fortunately, when I awoke, they told me they had removed the cyst and left my ovary in tact! That would come in quite handy in future years. The cyst turned out to be a benign dermoid cyst, or what many lovingly refer to as a “twin”, although medically it is not believed to be signs of an actual twin. These cysts are known to contain things such as teeth, cartilage and other human characteristics. Mine was filled with hair. Just hair. I’m not kidding. I have a color photograph to prove it, but I won’t frighten any sensitive readers by posting it here.
My surgeon sent me off with the color photograph instructing me to share it with a doctor if and when I was ever ready to try to get pregnant down the road. Apparently her concern was scar tissue in my fallopian tubes from a childhood appendectomy. Fabulous, I thought, another complication to add to my advancing age.
My mid 30’s came with a growing realization that, while the professional world may be my oyster, I was indeed up against mother nature when it came to any hope of one day giving birth to a child. I remember fighting an occasional cloud of panic when I thought about the fact that I wasn’t even getting beyond a first or second date in my love life, much less being even somewhat close to finding a partner to become a father to a potential child. I would often do the math of how long it would take to date before marriage, get engaged, plan a wedding, get situated, try to conceive, etc. Add those years to my current age plus the inevitable months and months it was taking to even find an eligible candidate and my mind was off to the races. I had many a conversation with friends in the same boat. What were we supposed to do? Quit our jobs and position ourselves in the pathway to every eligible bachelor who might be passing by? It felt like most of them were looking for women of less advanced maternal age anyway.
During this time, another routine gynecology visit led me to several ultrasounds, followed by an MRI, which ultimately told me that my uterus was malformed in some way. Essentially, as it had fused together at birth, one of the sides didn’t form correctly and the doctors believed I had a “rudimentary horn” on the right side, which basically means the right side probably didn’t work. Not something they recommend surgery for, but something that would potentially affect fertility. The next step was a hysteropingogram or “ink test”, which shoots a dye up through your cervix to see where it travels. It tells you if your fallopian tubes are open and/or attached to the ovaries. My doctor recommended I hold off on this test (as it can be quite uncomfortable) until I was ready to try to conceive.
So off I went, back into the world of late 30’s singledom, now armed with the knowledge that fertility was even more of a potential challenge than anticipated.
First Comes Love
Given my tendency to err on the side of anxiety in most situations, I realized I needed to find a way to let go of all of this worry about the future and whether or not I would meet someone in time to give birth (if that was even an option for me). I needed a paradigm shift. I needed to let go of the outcome. To do this, I focused on regaining “control” by realizing that I had options. One does not just become a parent through giving birth. I started to open my eyes to other paths to parenthood. First, I loved the idea of adoption (and still do!) and what an amazing opportunity it is for both parent and child. I also saw many of my friends dating men with children from previous relationships, something I hadn’t been sure I wanted to explore up until this point. One of my best friends met her husband online and he had 4 kids, to whom she is now a mother figure. After meeting them all at her wedding and seeing how wonderful they were, I realized this is something I was open to. And then there was the option to not become a parent. Without a vision as to who my partner might eventually be, that was viable too. Think of all of the freedom I would have to continue to explore the world and grow my career.
And there you have it. I had options. I was back in charge. I was not living my life based on a countdown clock in a state of desperation and panic. I decided to do something totally crazy – and just enjoy myself. Enjoy dating, meeting people, and my life as it currently was. This was not some sort of staging area for “the real thing”. This was life- and a pretty damn good one, at that. I focused on living a healthy lifestyle (with the exception of my affection for wine country, of course) and taking things more day by day. Letting things unfold.
It was in this mindset that I met Max. Again, a longer story for another time, but he was my person. I knew it almost immediately. So, of course, I blurted out over dinner on our second date a rambling account of the fact that I had a weird uterus and possibly blocked fallopian tubes and may not be able to have children, in case that was a deal breaker for him. Super sexy date chat. But he didn’t even blink. He breezed right through it in his calming manner, by simply saying it wasn’t important to him how he became a father, whether it was through children he and his partner had naturally or through adoption. He had a particular passion for adoption after feeling blessed with having wonderful parents himself and then traveling around the world with the military and seeing less fortunate scenarios. Boom. That was it for me. Now I knew I wanted to be a Mom. With someone like this as the father of my child. (Or really with this guy in particular as the father, but luckily I didn’t go as far as to share this on that date. I had already overshared sufficiently for one evening.)
Fast forward and Max and I became more serious. Due to circumstances and timing, we did things out of the traditional order. First came a 3-day first date, then 8 months apart while he was deployed overseas, then we moved in together, then bought a house together in Florida and moved cross country. And, at some point, we confirmed our desire to have children together and, with time not exactly on our side, started trying to conceive. Then came engagement. Then came pregnancy. And soon will come marriage. It’s not necessarily how I planned it in my head as a young girl, but I wouldn’t do any of it differently.
Becoming a Unicorn
But I digress. After a few months of unsuccessfully trying to conceive, I visited my new ob-gyn in Florida to see what we were going to have to do. She sent me to a fertility doctor for the dreaded ink test. And I survived. The ink flowed easily through the left fallopian tube (thank God for the aforementioned salvaged left ovary) and, as expected based on previous tests, the ink went through the right side and just out into my body, without connection to the tube. Good news was that one side worked and that was enough to potentially conceive.
Back to the ob-gyn to follow up on next steps, as she requested. I brought her the color photograph from my previous surgery and had my San Francisco records sent to her weeks prior. After waiting for over an hour, she finally met with me only to tell me things I didn’t want to hear: She couldn’t help me from here, I needed to go back to the fertility doc (something she should have told me before I waited for 3 weeks for her next opening), she lost my San Francisco records and, according to her glance at my photograph, she would venture to guess that I actually had 2 uteruses and it was likely that carrying my own child would be too risky and she recommended I research using a surrogate.
I recount this inconsequential visit only to share that it was a day I won’t forget. What I heard her say is “you will never give birth to a child”. And regardless of how I felt in my earlier years or any uncertainty I ever had around motherhood, I felt like someone had knocked the breath right out of me and taken away something I had possibly always taken for granted would just happen for me some day. I felt a sense of loss that I had never experienced in the same way. Max was in Germany for work that week, so I remember driving home and just crying off and on all day. And some the next day. And grieving for the loss of something I hadn’t known I wanted so strongly.
But essentially that doctor was speculating and probably shouldn’t have at that stage. Because several days later I went to the fertility doctor and showed him my photograph. He took one look at it and said, ‘Oh you have a unicorneate uterus, that’s okay it’s likely you can still get pregnant and have a healthy baby with this condition since we know one tube is working.’ He explained that this basically meant I was born with half a uterus, or one side of the uterus. (My sister calls me a “unicorn”.) He completed an ultrasound and told me that my “half uterus” was actually of a decent size which was even better news for carrying a child.
As I was trying to take all of this in and revive the recently deceased dream of having a child naturally, he rattled off various fertility treatments he wanted me to try. But I told him I needed to think about it all and left.
An online search led me to realize that there was not much information on the unicorneate uterus condition. It is extremely rare and only 1 in 4000 women have it. The risks for having a baby included pre-term labor, higher percentage of miscarriage and breach birth (many women with this condition are required to have a c-section). Okay, this was doable. So Max and I kept trying to conceive. We decided we wanted to try on our own for a little while longer, without pills and hormones and expensive treatments that we really couldn’t afford at the moment. We were going to focus on enjoying living our day to day lives so we didn’t let any unnecessary stress further affect our results.
Positive. And Negative.
It took about a year, but in January, my body felt different one day. Sure enough, an early pregnancy test came out positive. I couldn’t believe it and stared at the stick for what felt like an hour. I told Max and we cautiously celebrated that afternoon. I went to the doctor to get a blood test to confirm, as we were heading out on a 10-day vacation to NYC and London the next day. The following day, when we landed in NYC, the doctor called and said the test was positive but my progesterone levels were low. And I needed to take another blood test within a couple of days to track the HcG (pregnancy hormone) levels and see if it was a viable pregnancy. In the subzero temps, we trekked our way to a Quest lab in Chinatown a few days later and took another blood test. Then we got on a plane to London. When we arrived the next day, we had to pass the time until 6pm when I was able to call the nurse for the results. “Oh Sara, it’s bad news. Your HcG levels are low, which basically means you’re miscarrying.” Punch in the gut. Wind knocked out of me. I just curled up in Max’s arms and cried. I realize that this pregnancy was just a blip and not even close to the heartache so many encounter with loss later in the process, but for me it was the loss of the hope that it might have worked after a year of trying. And the thought of starting again. Max said, “Let’s be really sad for 24 hours and then try to start moving forward.” So I cried myself to sleep and then woke up and started my holiday in London, miscarrying along the way. Max and I lit a candle in Westminster Abbey for that sweet spirit we never got to meet. I will never forget that.
I was happy to know we could try again right away, since the pregnancy was lost so early on. Of course, following a miscarriage, it’s challenging to track your cycle because the body is all out of whack. Which is why I couldn’t have been more surprised to take a pregnancy test 2 months later and find another positive response! As you can imagine, all guards were up and I allowed very little hope and excitement to trickle in. I texted Max and made a doctor’s appointment. I went through the same series of blood tests, prayed and waited for results.
And this time was different. “Sara, your numbers look great!” the same nurse said when she called with my results. I could hardly believe it. I went in a couple of weeks later for my first early ultrasound. And there it was. A tiny blob. Our baby. Both Max and I felt emotional, but were also trying to temper that with the reality that we had a long road ahead of us.
Elderly at 40
And so began the journey that we find ourselves on today. Since that first early pregnancy visit, I have had an ultrasound at least every other week for 5 months. I am considered high risk because of my age and my unicorneate uterus. So I see an OB once a month and high risk consultants every 2 weeks. I graduated from the fertility guys after 13 weeks. Since becoming pregnant in March, I’ve seen 9 doctors (they rotate OB and high risk docs each visit.) Each one of them, in their own way, has given me the “advanced maternal age” spiel. The first OB even let me in on a fun secret- on my medical records, I am classified as “Elderly” in the maternity world. Probably something I didn’t ever need to know. I’ve listened to list after list of things I’m at higher risk for because I’m giving birth at 40.
And then there’s the genetic testing. It’s optional. But, at my age, I am at a higher risk for a baby with Down Syndrome and other chromosomal abnormalities, so after 35 they highly recommend these tests. But, then in the next breath they tell me that, again- at my age- there are a significant number of false positives with these tests. Tricky. After much discussion, Max and I went for it and did the first trimester screening. All came back normal. Then, the next month, a new OB shows up and says those tests are only about 90% accurate and he strongly recommends we do further testing, called a Cell-Free DNA test, which is a blood test and less intrusive than the dreaded amniocentesis needle-in-the-belly test. I pushed back, saying we felt quite comfortable with the screening we had already gone with, had mentally moved on from this topic and weren’t interested in further testing. He responded with something to the effect of, “But you are a dinosaur. Freaks like you having babies beyond 35 don’t have a choice.” Okay, so he didn’t really say that, but that’s what I heard. When he left the room, I started crying, just tired of feeling ancient in this world and like I was being punished for not trying to conceive sooner in life. But we decided to do the test and it came back completely normal and I feel nothing but absolutely blessed.
This rollercoaster of emotions continues and will continue through to the end. My cervix is measured every 2 weeks to ensure it’s not shortening and I am not going into pre-term labor due to my “adorable uterus” as Max lovingly refers to it. So far so good. We have chosen to take this pregnancy week by week. We celebrate each one, regardless of what fruit the baby has grown to represent. We allow ourselves to feel the excitement when we have a good appointment, or reach a significant milestone. Every time we see that little profile, face or feet in the ultrasound we feel overwhelmingly in awe. That’s our little miracle in there, waiting to meet us. And we are not parents-to-be. We are already this baby’s parents. No matter what happens, nobody can ever take that away from us. And it’s already the greatest honor I have ever experienced.
Things That Help
Again, I’m not sharing this story to claim that I am particularly unique or special in my experiences, in fact I am sure many of them are more common than not. And I have no regrets about my choices along the way, only gratitude for where they’ve led me to today. But I do know that sharing creates community and makes us feel like we are not on an island when we make tough life choices, experience obstacles to our dreams and battle biology, societal expectations and uncertainty.
My story is to be continued. And hopefully it leads me to a happy ending with a healthy baby. But as I continue to take things day by day, here are the top 3 things that have helped me so far:
1) Identify Your “Lucky Charms”: A dear friend who recently had her first baby at my age after some challenging experiences along the way, gave me the most beautiful gift by sharing this bit of advice with me as I was beginning to try to get pregnant. She said to find something constant to look at or call upon, that gives you hope and encouragement to carry on, no matter what the circumstances are. A lucky charm, if you will. Hers was a star outside her window that was there each and every night. As she looked up at it, she felt a sense of calm and reassurance that everything would work out somehow. I’ve identified 3 different charms along the way. The first was my little rescue pup, Charlie. He has a spot on his right side that looks like a big heart. When I first saw it, I knew he was our puppy and every time I look at that heart I know my family will be filled with love, no matter how it is created. I also call upon the spirit of our sweet baby angel that we never got to meet. For some reason, it feels like a feminine energy, so I picture a little tinkerbell type angel buzzing around as I need her. She’s part of the family too. And finally, the spirit of my friend Mary Ann, who left us in December, is such a constant comfort for me. I picture her right next to me, holding my hand, as I wait for every ultra sound and every test result, saying in her sweet way “You’ve got this, girl”. This little “team” has helped me to find a strength and peace I needed to create a healthy environment for this baby.
2) Find The Other Unicorns: Now that I know I am a unicorn, I have so much more clarity on my situation. But it can feel lonely when you are dealing with something that makes you feel out of the ordinary. So I have found it helpful to seek out the other unicorns. For me, with a lack of published information on my unicorneate uterine condition, I really wanted to connect with someone else who had dealt with this. It just so happened that my sister’s friend has a friend who also has this condition and has 2 healthy children. Apparently she was very open to communicating with me, so one day I sent an email to a stranger that basically said, ‘So I hear we have similar uteruses, want to chat?’. The email that came back to me was filled with more helpful information and advice than anything I’ve heard from all 9 doctors I’ve seen put together. She also pointed me to a private Facebook group dedicated to women with my condition. I found my people! I felt so much better just to know there were others out there.
Another 'unicorn' community I seek out is other women who are having their first babies in their late 30’s and beyond. I never tire of hearing their stories, their insights and sharing experiences. I’ve been lucky to have several friends in this group and they have been my mentors along the way. I hope to be able to serve others in the same way.
3) Watch The Movie: One of my doctors told me at one point, when I had done all of the blood tests, genetic screening and info gathering I could at that stage, that all I needed to do now was to “sit back and watch the movie”. In other words, just go out into the world and be pregnant. Let my baby grow, enjoy becoming a mother and let go of the outcomes. Of course, do the things I can control, such as healthy diet, exercise and plenty of rest. But by letting go a little, we release that tension and anxiety that can lead to unwanted physical issues. Finding calm, trusting the process and focusing on living in the moment is one of the best gifts we can give our bodies, regardless of what we are going through.
What I love most about the insights I have discovered, is the concept that family is not always what we expected it to be and it doesn't always appear when we expected it to. It is constantly evolving, changing and growing along the way. I love how different it has looked for me in different seasons. The traditional parents and siblings model growing up has evolved to include my friends I’ve collected through my various phases and places in life, so many becoming pure family to me. And now it grows to include Max and his family. And Charlie the puppy. And our little baby. And who knows what else beyond that. These are my people.
I am continuously inspired by other family stories and drawn to the details of how they unfold. There are the friends who have or are currently going through fertility treatments, soldiering through to make their dreams come true. And the friends who started their families early and have this amazing wisdom they’ve acquired as their little people have transformed into bigger ones. And my cousin and her husband’s journey to the adoption of their amazing son. And friends who have become parents through marriage. And friends who have opted out of parenthood for themselves and have magical networks of love through their roles as Aunt or Uncle, or their bond with their partners, pets and friends. And Max’s journey as an only child that has led him to find his wonderful brothers and sisters through his experiences in the Navy. And the new friends we met recently who are in the process of adopting multiple siblings who are young teens. And the friends who have recently experienced deep loss in their journey to parenthood, but who are incredibly and impossibly resilient and inspirational in the way they rebuild strength and honor their loss and role as parents.
It’s all beautiful to me. There are no rules. There is no need to put life on a mental hold as we wait for some predetermined vision of family to appear down the road. Our family is made up of our people. The ones we have right now. The people who hold our hands as we journey to what’s next. They may not look the same as the family pictures we drew in school when we were kids. But they are even better. Because they are messy. And real. And imperfectly perfect. And they teach us and sustain us and love us. They give us purpose, perspective and foundation. And they are ours.
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