PCOS and Endo and Clomid, OH MY

If I hear “I am pregnant!” from one more person I swear!!! How many of you have that thought? I want to be happy for my friends and family and really I am, however it doesn’t stop the hurt and the envy. It is a loss. Now, I am grieving another loss. Let me start from the beginning…

My whole life I have struggled with “lady” issues. I had been on birth control since I was in 8th grade to help regulate my body, and for the most part it worked. When I got married in 2006, I decided to stop taking birth control and just four months after marriage I got pregnant! I am lucky to have a beautiful seven year old daughter.

When she was just a few weeks old I was rushed to the hospital with severe pain. I actually passed out in a store from the pain. They thought I had a blood infection from giving birth. They treated me with IV medications and sent me home after a week of being in the hospital. This was the beginning of my many issues. When my daughter was two years old we decided to REALLY try for baby number two.

I had not been on birth control since before my first pregnancy so I was a little worried when I didn’t get pregnant as easily as the first time. I started tracking my temperature, taking ovulation tests, etc… This lasted about six months. Then I had my first D&C. After that I was given clomid, the first of many medications I would try. I took it for over six cycles with no results. I then had my first laparoscopy. This is when I was diagnosed with Polycystic Ovarian Syndrome (PCOS). I had many cysts removed from my ovaries, endometriosis removed, as well as other things that are not important.

The diagnosis of PCOS opened my eyes to many things and all of my past health issues started to make more sense. Many women that suffer infertility suffer from PCOS. (As a side note, if you suffer from PCOS, I highly recommend finding a support group. It is an endocrine disorder that leads to many other health issues.) So, after seeing a fertility specialist and spending more money than we had, and having another three surgeries it came to an end. Not only did the medications, hormones, and surgeries not help; in the end I ended up having a hysterectomy. So at the age of 31 I sit here currently healing physically from the surgery I had just three weeks ago. Mentally, it is still a long road.

While I truly am thankful for my miracle little girl, I still have a hole where another child should be. I always wanted to give my husband a son to follow in his wrestler footsteps. I wanted to give my daughter a sibling, my sister is my best friend and I couldn’t imagine life without her. It is not easy. I feel as if I am grieving the loss of someone, but it is someone I only knew. The worse feeling ever is the loss of hope. That loss of hope is what I am dealing with on a daily basis.

I do have a bit of advice to share. If you have a friend suffering from infertility after having a child don’t say “At least you have one.” This doesn’t help. The loss is still real and having this said to them, even when the intent is to be kind, is not at all helpful or consoling. I know I am lucky to have my daughter, but I also know my pain is real.

I want to finish with this thought. As women we need to stop judging each other and comparing our situations, but come together to support each other. I pray that you all find peace and hope in your situation.

-Jayme Iannarelli

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Science Friday: Miscarriage and heart disease connection

Pregnancy loss, cardiovascular disease connected by new study

July 16, 2014

The Annals of Family Medicine published an article detailing research showing that women with a history of pregnancy loss are at higher risk for cardiovascular disease later in adulthood than other women, work completed by physicians in the Center for Primary Care and Prevention (CPCP) at Memorial Hospital of Rhode Island.
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The article “Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative” stems from the analysis of data from the maternity experiences of a sample of 77,701 women, according to Donna Parker, ScD, director for community health and research with the CPCP. Of those, 30.3 percent reported a history of miscarriage, 2.2 percent a history of stillbirth, and 2.2 percent a history of both.

“We found that the adjusted odds for coronary heart disease in women who had one or more stillbirths was 1.27 (95 percent confidence interval (CI), which is a measure of reliability, 1.07-1.51) compared with women who had no stillbirths,” Dr. Parker says. “For women with a history of one miscarriage, the odds ratio was 1.19 (95 percent CI, 1.08-1.32). For women with a history of two or more miscarriages, the odds ratio was 1.18 (95 percent CI, 1.04-1.34) compared with no miscarriage.”

The researchers found no significant association of ischemic stroke and pregnancy loss, she adds. The association between pregnancy loss and coronary heart disease appeared to be independent of hypertension, body mass index, waist-to-hip ratio and white blood cell count.

“These findings contribute to the growing body of evidence that the metabolic, hormonal and hemostatic pathway alterations that are associated with a pregnancy loss may contribute to the development of coronary heart disease in adulthood,” Dr. Parker continues.

Women with a history of miscarriage or a single stillbirth should be closely monitored and receive early intervention from their primary care physician so risk factors such as diabetes, hypertension, cholesterol, obesity, smoking and diet can be closely monitored and controlled.

Journal Reference:

D. R. Parker, B. Lu, M. Sands-Lincoln, C. H. Kroenke, C. C. Lee, M. O’Sullivan, H. L. Park, N. Parikh, R. S. Schenken, C. B. Eaton. Risk of Cardiovascular Disease Among Postmenopausal Women with Prior Pregnancy Loss: The Women’s Health Initiative. The Annals of Family Medicine, 2014; 12 (4): 302 DOI: 10.1370/afm.1668

Were we being punished?

It wasn’t fair.

Why THEM and not ME? Why was it so EASY for other people?

Were we being punished?

These were my primary thoughts for the four years that my husband and I struggled with infertility. I’d known since being diagnosed in 2009 with PCOS, a hormonal disorder, that conception could be a long journey for us. I went off my birth control in 2010, and then we stopped using condoms and started tracking Jan 2011. 6 months later, and no positive. I asked my GYN about it at my yearly, and she recommended a hormone panel, given my known issues of PCOS, and endometriosis that was removed in my early 20’s.

The panel came back clear; accept for one vial that didn’t have enough blood to test, so I had to return to be redrawn. They also recommended my husband submit a sample for testing. On the day of my re-draw, everything went fine, aside from the front of my chart which displayed a large orange sticky note with “SEE ME” on it one of the nurse’s handwriting.

So after having my turn as the human pin cushion, I went back and had a seat across from the nurse. She laid out a piece of paper in front of me with the results of my husband’s semen sample. I scanned it, quickly seeing that something was very, very wrong.

You know in Charlie Brown, when the teacher talks, it’s always this weird noise that no one can understand? Well, that’s kind of what hearing you’ll never have a child with your spouse is like. Everything got very far away and very fuzzy. I remember the nurse putting her hand on my shoulder and I thanked her, checked out, and walked back outside. I made it to my car, where I very promptly lost it.

I kicked my tires a few times, got in the car, bashed the steering wheel, turned up the radio, and screamed. Long, and loud, and full of a pain that I have no words for. It felt very much what I imagine drowning to be like. I was caught in a sea of something, and I could not find the shore.

What followed was a year of deep mourning, and even deeper bitterness. I wish I could say that I handled it like a champ, but that would be a very big lie. I made my bitterness into a blanket, and burrito’ed myself in it. I was not a happy person. I put on a hell of a good show, but there were more tears that year then I care think about. Every joyful friend that got pregnant was like a slap in the face. I hated myself for it. I was happy for them…I was.

But I was also, deeply and profoundly, jealous.

I gave me on God in that year, and have yet to fully find a way back to Him. Was I being punished? What had I done wrong? I was a good person. I didn’t deserve this. My husband didn’t deserve this. He didn’t speak of our loss often, the child we would never have. We both struggled hugely with mourning the IDEA of a child. How do you grieve for something that never was? We’d never have a child that had his eyes, or nose, or laugh, or my hair, or chin, or toes.

What I did know was that someday, we would be parents.

Adoption was our first hope, but that was quickly sidetracked by the frankly massive price tag: on the low end, $15,000. On the high, $35,000. Top it off with the fact that no adoption is guaranteed. The biological mother has the right to change her mind. So we decided to look more into our options for me to carry a child.

In November 2012, we saw a reproductive endocrinologist. He gave me a list of procedures I would need to have done to see if I was even able to carry a pregnancy. He also wanted to send us for a second opinion to see an urologist who specialized in male infertility. We did all this, and found I was going to be able to at least attempt to carry a pregnancy, but my husband could not father a child without extreme medical intervention, including a genome workup, itself running in the tens of thousands of dollars.

So, in May 2013, we decided to try three rounds of inner uterine insemination (IUI) with donor sperm. We carefully selected a donor who matched physical and personality traits of my husband. I clearly remember asking Adam, “Are you sure you’d be ok with me carrying someone else’s child?” His answer: “But it wouldn’t be. It’s my child. Biology is just a set of DNA.”

We purchased three vials in June 2013, waited for my July cycle, and then began to test for the hormone surge that would signal ovulation, and the start of our first of three attempts. Together with my husband holding my hand, I went through the first cycle of IUI in early August, 2013.

We had to wait 14 days from the procedure to take a test. On that Saturday morning, I lay awake, trying to not throw up, a ball of nervous energy. At 5 am, I woke Adam up. It was time. I took the test, placed it on the bathroom counter, set the timer to 3 mins, and returned to bed.

Longest. Three. Minutes. Ever.

The whole time, I was babbling about how it was going to be negative, I didn’t feel any different, we were used to disappointment, so we should this be different? When the buzzer went off, I balked. I didn’t want to go look at the test. I didn’t want to not be pregnant again.

We went into the bathroom and together looked at the test. I’d bought a digital test, wanting no uncertainty. There, bright on the screen, no two words, but one:

PREGNANT.

I wish I could say I had a dream pregnancy and post partum recovery, but I didn’t. What I can tell you, is that after four years of grief, and pain, and loss, a complicated pregnancy, preterm labor scare, a month long hospital stay due to severe preeclampsia, and a c-section…

We became parents at 12:20 pm on March 28, 2014 to a stunning baby girl. Lily is perfection, and very worth the long wait.

–Emily

Science Friday: Which is better after miscarriage? Surgery or waiting?

In May 2014, the effectiveness and safety of expectant (waiting) management vs. surgical management of first trimester miscarriage were compared.

In surgical intervention, a dilation and curettage (D&C) is performed to evacuate the tissue from the uterus–most commonly in the case of a missed miscarriage (fetus with no heart activity) or incomplete miscarriage (part of tissue stays in body). The most common side effect of a D&C is infection.

Waiting it out, or expectant management, is a common surgical alternative that results in complete evacuation in 79% of cases. It is easy, effective, safe and cost-effective from a medical standpoint.

In the study, 217 women with missed miscarriage and incomplete miscarriage in their first trimester participated. They were randomly assigned to surgical or expectant management. The groups were demographically and conditionally equivalent. Women in the surgical management group underwent a D&C. Women in expectant management group were advised to use acetaminophen tablets to relieve pain.

81.4% of patients undergoing expectant management were successful with loss of uterine contents within 4 weeks. 18.6% had to have surgical uterine evacuation because products still remained in the uterus.

95.7% of women in the surgical group had successful D&Cs.  5.2% had emergency surgical uterine evacuation. 4.3% had second curettage due to incomplete evacuation in first procedure.

The average duration of bleeding was 11 days in expectant group and 7 days in surgical group. The average duration of pain was 8.1 days in the expectant group and 5.5 days in the surgical group. These differences were both statistically significant.

Both methods had the same complication rate, however, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively).

So what does this mean? First of all, talk to your doctor about the pros and cons of expectant vs surgical management of miscarriage. It could be that your personal health situation points to one method over the other. You must also think about, and share, your personal feelings with your doctor. Some women want to eliminate the physical evidence of a miscarriage as soon as possible, and some are content waiting for the physical evidence to evacuate naturally.

Either way, this small study indicated that expectant management (waiting) is safe and effective, but that surgical management is ultimately more successful.

Want to read the paper? See below or go to http://www.ncbi.nlm.nih.gov/pubmed/24240972.

Expectant versus surgical management of first-trimester miscarriage: A randomised controlled study.

Al-Ma’ani W1, Solomayer EF, Hammadeh M.

INTRODUCTION:

The aim of this study is to compare the efficacy and safety of expectant management with surgical management of first-trimester miscarriage.

METHODS:

This randomised prospective study was conducted in the Gynaecology Department at University of Saarland Hospital, Germany between February 2011 and April 2012. A total of 234 women were recruited following diagnosis of the first-trimester incomplete or missed miscarriage and randomised into two groups: 109 women were randomised to expectant management (group I), and 125 women to surgical management (groupII). All women were examined clinically and sonographically during the follow-up appointments at weekly intervals for up to 4 weeks as appropriate. The outcome measures were: efficacy, short-term complications and duration of vaginal bleeding and pain.

RESULTS:

Of 234 eligible women, 17 were lost to follow-up, and the remaining 217 women were analysed. The baseline characteristics were similar in both groups. The total success rate at 4 weeks was lower for expectant than for surgical management (81.4 vs 95.7 %; P = 0.0029). The type of miscarriage was a significant factor affecting the success rate. For missed miscarriage, the success rates for expectant versus surgical management were 75 and 93.8 %, respectively. For women with incomplete miscarriage, the rates were 90.5 and 98 %. No differences were found in the number of emergency curettages between the two study groups. The duration of bleeding was significantly more in the expectant than the surgical management (mean 11 vs 7 days; P < 0.0001). The duration of pain was also more in the expectant than the surgical group (mean 8.1 vs 5.5 days; P < 0.0001). The total complication rates were similar in both groups (expectant 5.9 % vs surgical group 6.1 %; P = 0.2479). However, the pelvic infection was significantly lower in the expectant than the surgical group (1.9 vs 3.5 %, respectively; P = 0.0146).

CONCLUSION:

Expectant management of clinically stable women with first-trimester miscarriage is safe and effective and avoids the need for surgery and the subsequent risk of anaesthesia in about 81.4 % of cases, and has lower pelvic infection rate than surgical curettage. However, surgical management is more successful, and with a shorter duration of bleeding and pain. Therefore, the patient’s preference should be considered in the counselling process.

Fragile. Seeking Forgiveness After Miscarriage

At two weeks we knew there was life. At nine weeks we knew there were two. At twelve weeks we knew something was wrong. At thirteen weeks, after a drive to Los Angeles for a long needle through my abdomen and meetings with specialists, there was hope. At almost sixteen weeks we knew it was too late. At what was supposed to be four months into our pregnancy I was sedated and emptied, and once again alone in my body.

Three. That’s how many babies we’ve conceived and lost in one year. My new therapist offered to call them embryos if it would make me feel better, but it wouldn’t. Embryos are what they would be if they were not intended, not loved, not cared and dreamed for. These were our babies and always will be. I consider myself a mom of four, even though three of them never made it past the second trimester. But I can’t say that. When people ask me how many children I have the answer is, of course, one. One perfect 6-year-old daughter. And when other women who I know have had miscarriages and stillborns and infant losses are asked how many children they have, of course the answer is the number of living. But we all know the truth in our hearts.

I didn’t name them. I probably would have if they’d made it to 20 weeks. For some inexplicable reason, that’s the point where it made sense to me. Maybe because we were hoping to make it to 20 weeks, when fetal intervention surgery may have been an option to save at least one. But the mass growing in the chest of Baby A causing pressure on her developing heart and lungs grew too rapidly. With a shared placenta her sister couldn’t handle the change in blood pressure, so within hours of each other we lost them both, much sooner than even our doctors expected. The routine visit showed not the squirmy twins I’d loved watching only two weeks prior, with beautiful profiles and feet that were kicking each other like I’d hoped they would do for years to come, but instead lifeless little bodies with still hearts. I felt my own heart stop for a moment with them, forever  just “the twins,” our Baby A and Baby B.

Only weeks ago yet forever ago I was assembling hidden inspiration boards on Pinterest that I intended to make public as soon as we were confident enough to make our happy announcement. Clothes, registry items, products and advice we’d need in the coming months and years was being curated as I lay in bed or on the couch or on the bathroom floor, my body too tired and sore to do much else. I’d finally broken down and purchased a few maternity basics as there was no hope in buttoning any of my regular size jeans, and I often wondered if I would ever be able to again given my age and the multiple pregnancy.  Projects and trips had been cancelled, put on hold, or sped up to accommodate both the official due date and a more realistic expected one, and real estate in two different states was analyzed in the hopes of making some very big decisions quickly. I went to sleep at night with my hands on my belly trying to feel those first few flutters expected at any moment, and I woke every morning wondering how much they’d grown while I’d slept. Now I place my hand on my soft abdomen and miss them so much it’s hard to get out of bed.

The last miscarriage was hard, this time was harder. Is harder. It will take longer to bounce back into the land of the living and although physically there is no permanent damage, emotionally that is not the case.  I am still getting promotional emails for formula and cord blood registries and car seats. Alerts pop up on my phone telling me that my baby is now the size of an onion and what nutrients I should make sure to be getting this week. I delete the apps and unsubscribe from the mailing lists but more keep coming. My body is late getting the message as well, ready to nurse infants that aren’t here. There suddenly seem to be more babies around than ever before. And so many twins. And everyone I see seems to be pregnant. I resent the once forbidden wine, sushi and unpasteurized cheese that I’m now able to have after months of craving them.

I am heartbroken. I am angry. But mostly I am really really sorry. It doesn’t matter how many doctors tell me that it wasn’t my fault, that there was as a one in a million chance of the anomalies, or that neither my body nor our genes caused the problems. In my mind I failed these babies by not giving them the best chances for survival. I don’t know how but somewhere something went wrong and it happened inside of me. I am sorry that my amazingly paternal husband still does not have his own child, one with features and gestures that he and his family can compare to their own. I am sorry that my daughter still does not have a half-sibling like we have now twice promised her she would have, and who instead has a mother who cries all the time.

I am also sorry that when a woman sat next to me at the cafe with her beautiful baby in her arms, I didn’t smile and ask her questions like everyone else did. Instead I turned away and tried to work through the suffocating emotion without making a scene. And I’m sorry that I abruptly stopped and walked the other direction when I saw a couple on the beach with twin toddlers. Sorry that I didn’t attend the PTA meetings, dinners, and trunk shows where I knew someone would be pregnant or showing off their new family addition. Sorry that I couldn’t really go anywhere, worried that the tears would suddenly start streaming down my face and I would have to explain why. Sorry that I couldn’t bring myself to comment on friends’ sonogram images, pictures of their babies in Halloween costumes, or their beautiful new maternity photos. So so very sorry that I can’t share in their joy. But they have friends, family and strangers smiling at them, approaching them, touching their bellies and asking about sleep training and onesies and siblings and strollers. I have a void. Literally a void in my body where new life is supposed to be growing. Figuratively a void in my life that baby showers, kicking, mock-tails, registries and birth classes were supposed to fill right now. In a few months I will feel the void that infant crying, midnight feedings and diaper changes were supposed to fill. But how do I tell them, these happy sleep-deprived people, how bitter I am? I can’t, and I won’t. But the ache is constant. I miss my babies and the dreams I had for them. I miss being exhausted and sick but knowing it was all for a good reason. I miss the anticipation of their arrival in our lives.

I know that I am still living, that my heart is not the one that stopped. I hope to one day forgive my body for these cruel betrayals. I hope to receive forgiveness from the friends and strangers who didn’t get the happy version of me they were expecting, and who didn’t know why. I hope that one day my husband and I either find the strength to try again, or find peace in not taking the chance of more heartbreak. I can’t comprehend either at this point but I am grateful that we do have options, knowing that it could all be much worse and is for so many. If our life consists of only my daughter, our beautiful marriage and supportive family, then it certainly isn’t something to complain about. I know.

I am sorry that in my fragile heart right now, it’s not enough.

Science Friday: Women don’t need to delay getting pregnant after miscarriage, study suggests

Women who conceive within six months of an initial miscarriage have the best chance of having a healthy pregnancy with the lowest complication rates, according to a new study published on the British Medical Journal website.

Lead author, Sohinee Bhattacharya from University of Aberdeen, says that current World Health Organisation (WHO) guidelines recommending that women who experience a miscarriage should wait at least six months before getting pregnant again may need to be reviewed.

Women who experience a miscarriage are not only at an increased risk of a second miscarriage, says the study, but also of complications in a subsequent pregnancy. Around one in five pregnancies ends in miscarriage before 24 weeks.

But the length of time couples should wait before trying again to get pregnant are not consistent, say the authors, with some doctors saying there is no justification for asking women to wait and other bodies, such as the WHO, recommending a wait of at least six months. This study was based on women delivering in Scotland and while the findings are valid for this population, the original WHO guidelines may still be applicable to women in developing countries.

Delaying getting pregnant is particularly problematic in the western world, they add, because “women over 35 are more likely to experience difficulties in conceiving and women aged 40 years have a 30% chance of miscarriage which rises to 50% in those aged 45 years or more … any delay in attempting conception could further decrease their chance of a healthy baby.”

The researchers reviewed the data of over 30,000 women who attended Scottish hospitals between 1981 and 2000. The participants all had a miscarriage in their first pregnancy and subsequently had another pregnancy.

The results show that women who conceived again within six months were less likely to have another miscarriage, termination of pregnancy or ectopic pregnancy compared to women who got pregnant between six and 12 months after their initial miscarriage.

The women who conceived within six months were also less likely to experience a caesarean section, deliver prematurely or have low birth weight babies. This association wasn’t explained by social and personal factors or by other problems in pregnancy including smoking.

The authors conclude: “our research shows that it is unnecessary for women to delay conception after a miscarriage.” They add that when there are reasons to delay, for example if there are signs of infection, women should be advised about what to do to protect their health.

An accompanying editorial supports the view that women who conceive earlier may have better outcomes and fewer complications and calls for further research into this important area.

Journal Reference:

Eleanor R. Love, Siladitya Bhattacharya, Norman C Smith, Sohinee Bhattacharya. Research Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. BMJ, 2010;341:c3967 DOI: 10.1136/bmj.c3967

BMJ-British Medical Journal. (2010, August 6). Women don’t need to delay getting pregnant after miscarriage, study suggests. ScienceDaily. Retrieved March 12, 2015 from http://www.sciencedaily.com/releases/2010/08/100805204001.htm

I could have a baby, but she could not

Editor’s Note: This piece is reposted with permission from Tammy Moyle over at www.blitheblog.com. This goes out to all of you who struggle every single time a friend announces a pregnancy.

My husband and I met and married pretty quickly. Our first date was January 3rd and we were married by December 12th. So I guess it was no surprise when we found out we were pregnant that March following our wedding; we liked to work quick!

We were making plans to attend our wonderful cousin’s wedding in Northern California and decided we should make a little romantic weekend out of it and spend a few days in Wine Country as well. We were completely surprised when I woke up the day before our trip to a positive + sign on a little white stick. But oh so excited!

I think I was especially excited because it is what I had dreamed of since a little girl! Meeting and marrying Prince Charming. Having a cute little baby with him and becoming the dearest of words: “Mommy.” Our excitement overflowed and so did the planning. I am pretty sure Babies R Us saw me weekly if not more….. Multiple baby showers in the various states I had lived in were planned. A nursery was designed and set up. Name books were underlined, dog eared and highlighted. It was all I could talk about and think about. I breathed baby all day.

When I was about 28 weeks pregnant we visited one of those 3D Ultrasound picture studios. With my bare belly sticking up, and friends and family on Skype, thanks to state-of-the-art technology we were able to see our little boy’s chubby cheeks and tiny fists floating through his watery home in my womb. Of course I cried. Such a beautiful experience!

The next morning, as soon as I hit my office chair, I emailed out to all my friends, family and co-workers the ultrasound pictures of our beautiful baby boy. Immediately emails and texts came rolling back in saying how cute he was and how they couldn’t wait to meet him! And my cup overflowed.

But what I didn’t know was there was a woman I had made cry. I didn’t know she had been trying for 4 years to get pregnant. I didn’t know she had multiple in vitro fertilization attempts that didn’t work. I didn’t know she had 6 miscarriages that she had grieved through in the past few years. I didn’t know that my baby pictures I rejoiced over and emailed to her just broke her heart because I could have a baby but she could not.

Days later I was told of her sad news through a friend. I was asked, per her request, not to mention my pregnancy and baby around her nor to send out any more pictures. And, even though I saw her almost daily, I was to not mention my pregnancy whatsoever. And I am ashamed to say I got angry. Here I was, in the happiest time of my life, and I needed to be quiet. I needed to hold my joy. And I felt cheated. Cheated out of the joy of my pregnancy.

But what I didn’t realize at the time was she felt the same way: she felt cheated out of the joy of being pregnant. She felt robbed of the chance to have life growing in her womb and being called mom. She was heartbroken. And I had just added to her grief.

Years later, I am now pregnant with baby #3. I have been blessed to have had no complications or real issues with any of my pregnancies. And yet I feel overwhelmed most days to have 2 toddlers and a newborn on the way. I get frustrated when I can’t get into the shower because my daughter won’t let me put her down. I get frazzled when I can’t make a meal because my son is screaming every time I walk into the kitchen because he wants to do puzzles NOW. I get emotional because I still never get to sleep through the night.

And yet I know that same woman, whose heart I broke, would ache for these moments. She would give anything to feel this wanted or needed as a mother. She would happily embrace all the child issues I take for granted.

Please head to Tammy’s blog for the rest of this piece.