Sunday, December 22, 2013

Fast Forward....1 yr later

I didn't want to be like all the other blogs that once they got home and got into the swing of things they never updated, but as soon as Tara came home the reality is there is a reason they all stop. Life is so busy, and you have to live it and its hard to find time to write about it. A lot has changed. They are both doing very well, and once again we ALMOST spent another Christmas in the hospital. Until two days ago I had spent an entire month living with Tara in the hospital and only leaving for work. Insurance agreed to pay for a specialty rehab hospital that has one of the best and only feeding therapy specific programs in the country!

My two decades of shoulder dislocation from trying to punch my brother in the face when I was 14 caught up with me, and so my inevitable surgery could not be postponed any longer. When my kids are older, when I have sick leave built up and qualify for FMLA again, etc. But ultimately despite not being able to pick them up and needing so much help and such a intensely painful recovery, it was a blessing because the month she was in the rehab hospital I was on a 40hr work restriction so the frequent overtime mandates at my job did not affect me being there with for the majority of her stay.

Getting Tara off of the feeding pump and eating only by mouth is a long process, but in 1-2 years I'm sure we'll get there thanks to the techniques they have taught us and feeding therapy twice a week. Her tube feeds only occur during naptime and nighttime and she is free to roam. I have created a feeding pump trolley I hope to patent and sell. Big metal IV poles getting knocked over into tiny heads and limiting my little busy body from crawling around were just not acceptable. Carrying the "mini" backpack that is not so mini on a 17lb toddler with a pump and 350ml of formula is not exactly feasible, so hopefully this year I can offer it for sale to help others in our situation as well.

Tara is happy and healthy with a working vocabulary. Mama, uh-oh, baby, bubbles, hi, bye bye, all done, no, wow, yeah, papa (grandpa), and she said her brother's name once! She is still behind in her gross and fine motor but weekly therapy is helping her along. She has a goofy little crawl where she hikes one leg up in front of her, but we are working on that too. Her lungs have improved so much she only gets one inhaler twice per day. She did have two hospitalizations for viral infections, the first for 5 days. The second she had pneumonia in 1 lobe of her right lung and she was only in the hospital overnight with steriods and NO OXYGEN! The lungs grow dramatically the first year and overcome their lack of development in prematurity to an amazing degree. While her motor skills need some work, she is smart as a whip. It took me a while to realize that she was pretending to fall asleep during therapy to get out of it, and when she rounded the corner and the therapist was out of sight it was party time! She even would announce "All done!" at the beginning to attempt to cut it short, but alas she is learning she can't outsmart us despite her best efforts.

Vivek is walking, though he likes to drop to the ground and crawl still pretty often. Talking is not his interest right now and he sounds like the Tasmanian Devil from my childhood cartoons, so we may begin trying to baby sign. He and his sister are buddies and play together constantly, and he only occasionally pulls her awesome pigtails. As of a week ago he now has a full set of teeth. It was very rough teething so much with his low preemie pain tolerance, but ultimately a blessing now because I can sit the kid down with a steak and let him chow down while we focus on feeding Tara through the specific behavior modification method.

The one thing that truly broke my heart last Christmas wasn't the hospitals or not being home with both was that I never got my picture with Santa. I don't even know why it was the one thing that really got to me. So this year I used my one 6 hour pass from the hospital to take the kids for a holiday photo session. They turned out great, and when I rounded the corner at the mall and saw the fat man I nearly burst into tears on the spot. And while things are never perfect and there are still so many uncertainties in the future, I love my babies more than life itself and no matter what happens I still wake up everyday feeling like the luckiest mother in the world. Happy Holidays to everyone out there in the blogoverse, and to those suffering from infertility my heart aches with you and I wish you all the hope  that someday your family will be complete. Never give up!

Wednesday, February 13, 2013

The First Three Weeks as a "Stay at Home" Mom

If  any preemie Mom out there postulates the brilliant idea of setting two doctor/specialist/follow up appointments a day for two weeks to "get them out of the way" I urge you to read and follow the below instructions to the letter:

1. Go into the bathroom and look into the mirror. Gaze deep into your own eyes and silence your mind.

2. Slap yourself as hard as you can.


4. Repeat as necessary until you cancel over half of the appointments.

I would offer as a general rule: Any goals you have planned on any given day, if you accomplish anywhere near to half of them...consider your day a roaring success!

It's not to say the last three weeks were without many highlights, and pictures speak louder than words so I'll share a few of the bounty  I've taken amidst the chaos.

The beginning. The peaceful image I pictured stay at home Mom-dom to be.

Reality sets in. The unecessary wardrobe changes to accomodate the piles of cute clothes and picture sessions to make up for lost time are great. The 2-3 episodes of 30-45 minute inoconsolable crying sessions per day due to severe gas pain from G-tube continuous feeds with little ability of vent are...not so much.

Yet despite the difficulty of straddling the line between Mom and Nurse, I think I handle it pretty well and find moments of joy amidst the regimented schedule of care and tasks and rapidly increasing number of doctor appointments.  I never feel bitter or deprived of "how it should have been..." We go for our first jaunt in the jogging stroller as the weather is improving, because I am determined that no feeding pump or oxygen tank should make a baby or her mother a prisoner under house arrest. They love the fresh air and her R.A.D. does not react to it! We bought this house for the lake and miles of jogging trails around it after all...
We have a few visits from friends and family.
Agemate Armaan and his wonderful mother Preeti
(Vinnie's cousin) come visit and we bond over
babies now that our individual NICU journeys are
finally over.

Aunt Jan, a lifelong asthmatic herself, helps with one of four daily breathing treatments.

Cousin Amber and her beautiful daughter Naomi with Tara

Cousin Amber, Naomi, and Vivek

Vivek playing with my bestie Erika

It becomes rapidly apparent that my son is a huge flirt. And to make matters worse, when he occasionally gets a glance at the TV when I'm not careful, he is typically trying to get a view of a pretty girl it seems. I'm already worried...
Thankfully we have a great system going now that involves me going to bed early and Daddy staying up later. There is a changing of the guard around 2am and we both wind up getting enough sleep. They sleep through the night, though we have to do a breathing treatement and a feeding bag change, and wake him up for at least one bottle as we have upped his calories and are trying to get more chub on him. She has the G-tube advantage though, so they actually dropped her calories since she is getting so pudgy!
We find occasional nap time is in order....
...especially when on rare occasions our "sleep throught the night system" fails. Thank you again, early teething fairy!

But every morning at 8:00 there is a flurry of activity with Tara's medical needs and Vivek's hungry tummy and piles of diapers and mixing fresh formula in different concentrations for each baby.

Mornings start much earlier than that most of the time because I usually have a Dr. appointment at 9:00am and have to rush to get everything done and packed and get babies loaded up!

Thank God they love car rides and sleep through them. I've gotten packing these babies up down to a science. The stroller all packed up is a monstrosity that defies description, and barely fits in elevators.
But the view on a foggy morning on the greenbelt that surrounds our house as I load up the car with all the gear always gives me a moment of peace.


Meanwhile the babies are noticing each other more and more. They are still too young to interact much. Vivek is in a hair grabbing stage, but fortunately I made it to the playmat just in time so the sibling relationship is still intact.

They are both teething early. Apparently they don't like to do anything in the expected time frame. Teething sucks, especially when your mouth is too small for teething rings and you don't have the coordination to hold one up to it anyway. We are coming up to a month of bad teething symptoms and still no teeth. We had four days were Vivek fought against his bottle, and it took five people to finally get one down him after 9 hours and me nearing panic. Turns out I handle all her problems well, but when my boy throws me for a loop I fall apart. Apparently one baby with health issues is all I can handle, but thank God for family support!

They constantly nom on their hands now, and one of these days I think Vik may get his entire fist in there. He has also discovered his hand and loves to stare at it, but only his left one. I'm waiting for him to figure out that there is one on the other side. He has now learned to place his hand gently on the bottle instead of forcefully grabbing it and knocking it out of his mouth then angrily screaming at me like it is my fault. And unfortunately she has also gotten defter at being grabby and handsy, in the sense that she can now play with and push away the mask and tube during her breathing treatments!

Tara is all about sucking on her index finger constantly, and lost interest in the pacifier. She likes to wring her little hands together. Lately she is all about lifting up her dress with one hand and sucking on the finger of the other. My usual view of her as she sleeps pictured below:

Unfortunately things fell apart during Vivek's days of bottle refusal, and suddenly Miss Tara has develped a bad oral aversion out of nowhere. I don't know if she has just figured out that it is work and the G-tube is easier, or if her finger now satisfies her craving to suck. That has me more frustrated than anything, so now we have total bottle refusal and upping feeds in a few weeks will now involve a therapy team and feeding clinic. Sigh. I'm a little down about that development, because she aced her swallow study (as shown below) and her feeding clinic eval by the speech therapist was glowing, even though she was having a bad RAD day and was pretty tachypneic. She was cleared to use no thickener and up feeds as soon as her G-tube feeds are weaned down to bolus in the coming weeks. We have started that process, but it came a little too late so here's hoping she learns to love the bottle again soon! The speech therapist comes on Monday, and until then we are trying to remove all negative associations and "play" with the bottle and nipple.

Miss Tara had 7 professionals gathered around waiting on her, but she had some gas and they started to call it off. A few toots later we were back on and everyone rushed around to re-prepare the test. It is rather funny to see so many folks all waiting on the whim of a baby!
I manage a mini-photo session on one of the few days we had only one appointement.

"Oh...hey there other baby!" Have you been here all this time?"

They can both sit up now with a little more support, so they are able to get some time in the Bumbos now, though she gets tired sooner. Tummy time is still a battle, despite trying every iota of advice from friends and all the developmental specialists who have finally had a chance to assess them both. Getting 25 minutes a day is so hard when she would rather socialize than exercise and 30 sec-2 min increments are all we can manage before she hits meltdown mode.

Her fine motor and expressiveness is slightly behind, but is all explainable from her hospitalization and not a developmental defecit from her prematurity. I was told that it is more like she is starting at month 1 from the date of hospital release, so not to worry. She qualifies for ECI (Early Childhood Intervention State services), but he tested at or above age level in all areas and doesn't even qualify for the program!  We are relieved and optimistic about the future. But Miss Tara is so interested in people and not toys and  isn't the natural wiggle worm that he is, so getting her to participate in her exercises is a little tougher and involves different tactics. She is finally rolling to her side, and he can roll from tummy to back!

They finally went to their first pediatrician appointment together with both Mommy and Daddy present, because before that it has always been just one of the twins. I had done one surgeon follow up with her and Vivek by myself, and vowed never again to go to the doctor with both babies without a 2nd person if I could avoid it. They both had waiting room meltdowns. I got many looks of pity and lots of help from strangers! I thought surely with both parents at the pediatrician appointment we were good to go. I'll admit I was a little judgy when I saw that my brother and sister-in-law brought their nanny to the pediatrician with their twins. Now I am just pissed that I didn't think of it first and don't have a nanny to bring! All is well until the Doc comes in and they then both start screaming and messing up diapers the entire 30 minutes we are trying to communicate vital medical information and juggle paperwork. But before the screamfest I did get a cute pic and video of them showing off their super-toned baby physiques!

Meanwhile I am pulling myself back together now that the appointments have finally slowed down. Many of them at the tail end were for Vivek to re-test his vision and hearing to satisfy my pediatrician, since that was all done in India where the records leave a lot to be desired. The bulk of the appointments from now one will be once a week for him. He has been recommended to get a helmet to correct his head shape. Unfortunately due to his position in the womb as a twin, his prematurity, his positioning due to reflux (unable to be flat on his back with head able to go side to side), and getting held less since she is home and requires so much care and attention due to her medical was unavoidable. I still manage to feel guilty despite the reassurances from the great folks at Cranial Technologies. But seeing nothing but twins in the waiting room though did help drive the point home that there was nothing I could have done to prevent it. I still find his mishapen head adorable in the pics they sent me from the headscan and cranial evaluation. He has moderate brachycephaly and plagiocephaly and it should be entirely correctable in 2-3 months of wearing the helmet. I have some cute plans on how to decorate it!

I am trying to take better care of myself now that the appointments have slowed down, and taking small steps to move forward in my career soon. Hopefully more on that front soon. Meanwhile Daddy is working overtime every week for over a month, so I'm usually by myself. I've realized the only way I'll get pics with the babies is if I take more "selfies" so here is one.
It is a whole lot easier to take photos of adorable babies when most days I've turned into a no-makeup, sweatpant-wearing stereotype. I'm starting my P90X again and daily food tracking on my Livestrong Daily Plate app, and if it stops raining we'll go out in the jogging stroller more. Mommy needs to take better care of herself! should probably take a shower. Soon!
In other news, the final medical bills for Miss Tara finally came in. I take everything bad I ever said about United Healthcare back. (For the most part!) Our portion of the hospital bill was $13.32, out of a total of over one and a quarter million for two months in the NICU!!! We pay a larger portion of the bill to the neonatologists group, but that still barely totals  over $3500. The last bill to come in was for the AMR  ambulance transport, but it stated that insurance didn't cover it. Since the AMR rep called me twice about billing issues and sounded like a nincompoop beforehand, I anticipated there would be a problem. After an hour on the phone to my insurance company and AMR we determined they used an incorrect billing code.  Turns out they deny "maternity benefits" when you code a 3 month old baby as a pregnant woman! That is being resubmitted as we speak. I also got a call from a collections agent about the ER bill, which I was still waiting on. turns out the jerks had our address wrong and made no other attempt to contact us despite having our info to call us or our insurance company. i did lose my temper on that phone call so that got fixed pronto! So by the time she is 1 year old if you total up the cost of surrogacy and India NICU care and all the specialists she now sees, with the portion paid by our insurance she will surely be the $2 million dollar baby! Below you can see what $1,265,822.12 in American healthcare looks like, and I think you'll agree she is worth every penny!!!
The last thing I'd like to share is that I'm very angry and very relieved to learn about the "decompression tube."  I had been told with a G-tube by other experienced preemie parents online to vent, vent, vent! But with continous feeds that is hard to do. Before her NICU discharge I had been concerned about their haphazard education on how to do G-tube care. They thought it was odd that I asked if they had a checklist or lesson plan to go over with me to make sure we covered everything. They were unfamiliar with the BARDs ince it was the first one they had seen. I was given a big booklet of generic information not specific to the BARD. During a late night call to home health nursing about the problem, I was told how to use a giant syringe in a cumbersome procedure to pull out everything from her tummy, remove the air, and put it back in. Doing that every few hours and constantly sterilizing the syringe was not very workable, and seemed to upset her more. Instead I just pulled the plug end often and popped it back in, hoping the "pfffft" of air I heard would offer some relief. But the gas pains continued.  I had talked to multiple doctors and nurses about the gas problems she is having daily over the past two months. What I had not been told by anyone was that there is a one way valve in the BARD button and there is a special decompression tube designed to vent the tummy. It turns out we already had one in the sealed BARD replacement kit we were given in case it somehow came out and we had to go to the hospital for an emergency repair. After talking to all the doctors and nurses abou the problem, it was the developmental specialist at that insisted that even if it wasn't a Mic-Key button there is probably a one way valve and there should be some kind of decompression tube provided.  Thank you!!!!  The first time I tried it I was shocked at how much air came shooting out! No wonder she was in pain!!! Here is hoping that instead of multiple daily screaming fits with no way to comfort her, this will be more of what we see in the future!

Friday, January 25, 2013

A Fond Farewell

To my co-workers at Plano 911:
I vowed to myself and everyone around me all night long that I wouldn’t send “the final email.” I lied. Whether it be the gift basket and nummy food or the outpouring of support, I find myself surrendering to sentimentality.

While I’m sad to be leaving Plano 911, it couldn’t be for two better reasons. I want to extend a huge thank you to everyone who has helped me and worked alongside me these 12 years, though many have moved on as well in that time.  I’m so proud of what we all accomplish as a team on the floor and on staff, and will leave with many fond memories. I hope to someday work on a team as capable, dedicated, and innovative as Samantha Baumgartner and Sheila Powell again. I’m proud to have worked with so many amazing people, who labor in obscurity in a basement and no one they serve will ever really see or appreciate the sheer difficulty of what they do.  We are very tough on ourselves and regimented and push hard to be better. And I’ve seen enough of other agencies by now to realize that even if we aren’t perfect, it makes us among the best in the country at what we do.

Working at Plano 911 has made me a stronger and smarter person in so many ways, through experience and training you just can’t get in any other profession and even at any other agency. I am a lot tougher of a gal than the nervous young woman that started here in 2001. I am a better person.

I’m not sure if many other workplaces would have given me the encouragement and understanding Plano PSC has. I thank everyone for that support. I’d like in particular to thank Susan Carr, who helped make it possible to take the opportunity back in September of 2011 and has offered continual support along the way. Had I not worked here, I don’t know if I would have endured the trials that these past 5 months as well as I have.

But something I do know is that my daughter would not be alive if I hadn’t worked here.

The day I gave her CPR will be forever in my mind. It was like I was outside of myself watching,  calmer than I think would be possible in that situation for anyone who hasn’t been on the other end of a 911 call for so many years. I knew her breathing was agonal the second I saw and heard it. I’d been watching her breathing religiously for  months, and there was very obviously no air moving. That meant I had to act because there were minutes left, and the paramedics would be there too late if I didn’t do something. I knew that because her 20 second apnea alarm had never gone off that there was still oxygen in her blood and so I started with compressions first. I remember thinking how she seemed so much like one of those plastic dolls I’ve practiced on over the years, just as limp but heavier.

I told my mother to call 911 and put it on speaker, double verifying my address and phone number then stating “baby not breathing” and answering the EMD questions in order and telling the poor Carrollton Calltaker to go to card 9 and protocol A. I was careful to speak slowly and clearly despite the urgency of the situation. She was a little stupefied, but she recovered well and coached me through the rest and converted me over to ventilations and compressions.  I was grateful she was there for me, and promised myself if we made it through this I would thank her personally and introduce her to my daughter.

I made sure her head was tilted back, covered her mouth and nose with my mouth, and blew the two puffs of air in and saw her chest rise and deflate. I made sure I didn’t waste time switching back and forth between compressions and ventilations.  I made sure to press down far enough and come all the way up between pumps. I told the Calltaker to use the compressions monitor, but I was already singing the “Staying Alive” song in my head so I already knew I was going fast enough.

I knew even in the moment I was doing everything right, but I also knew that in 12 years I’ve never had a documented life save that we know of because CPR so often is not enough. I remember having the “it’s not working!” reaction I used to teach about in ETC class, then consciously realize I was having it and continued CPR telling myself “this is helping her even if I don’t see a response.” But the truth is as much as I didn’t want it to be, I really thought it was the end. But 5-7 minutes later the paramedics arrived and laid her on the bed and told me she had a pulse of 120. Then I thought there was a chance after all.  The first few hours it looked grim, but then the most talented doctor I’ve ever met threw a hail Mary treatment at her and it began to work. For the week after that, she clung to life on a ventilator in one of the best NICU’s in the country and they could have lost her at any moment. But now three months later she is alive and recovered. Within a year the health problems from her prematurity that led up to that awful day should resolve completely. And the Calltaker that took that call has no idea that she even lived, and went on to the next phone call. Just like Georjon did a few minutes ago, and Jenn S. may have saved a guy a little while before that. All in just one regular night at Plano 911. There is a whole other end to that story that they’ll never know, so we all just move on and will never realize the true impact we have each had on so many lives.

The one time I have a known life save…it’s my own daughter. It’s like every 911 call I’ve ever taken was a rehearsal for the most important and terrifying moment of my life. The paramedics played a critical role, as did the responding officers and of course all the hospital staff. But 911 is the true first responder that all the rest of them depend on.

This job is like no other. What we do is important and changes and saves lives. It is  interesting and scary and fun and exciting and boring and annoying all at the same time. PD and NCIC and FD and Calltaking are all valuable and challenging in their own way. But I’m only going to leave you one bit of advice.

Nothing we do is more life critical than being an Emergency Medical Dispatcher. So even if you don’t always like that part of your job, keep your skills up and be a damn good one.

I hope to never be a stranger.

Wednesday, January 23, 2013

Pros and Cons and Myths about Surrogacy in India

So this afternoon I get a call from CBS News, who are working on a news story about surrogacy in India. As expected, they are fishing for stuff that could go wrong, though I guess if they didn't it wouldn't be a news story. So they went surfing the net and sure enough they found folks like me, though with everything that went wrong I still consider us a case gone right. 

I worry because I have seen so many poorly researched news stories that sensationalize a few well known problem situations or clinics without telling the whole story and being balanced. Recent isolated cases of DNA tests not matching the intended parents are indeed very concerning, but still isolated and could conceivably happen in other countries as well. Some other "gone wrong" cases have more to do with a couple going to a clinic without making sure they were established and well reputed, or not being careful about legal conflicts (and the laws of the home country were the problem instead of India to my recollection). I don't think rare and extreme examples should be the basis of a decision like this. You can find a horror story about any potential infertility solution, so take them with a grain of salt and use reasonable precautions. Nothing is guaranteed, especially when it comes to infertility.

While India could use some better regulation on surrogacy, I hope they never become over-regulated to the point places like England are where it becomes nigh on impossible to do surrogacy. See:  I find that the biggest roadblock to surrogacy is not only the cost, but the lack of legal recognition that it is a legitimate path to parenthood in so called "developed" countries. India was our land of opportunity partly because the regulations were not overbearing.

There are plenty of pros and cons to any solution to infertility, and surrogacy in India surely as any has a unique set. I hope that my blog and online presence has helped to educate others in their decisions. But the bottom line: I would do it all over again and recommend it to others. But you must DO YOUR RESEARCH and prepare yourself. Above all find a reputable clinic. Clinics and surrogates have been deceptive and taken advantage in many countries, and regulation can't always keep you safe. Be prepared for what could go wrong. But also be prepared to finally have your dream come true and become a parent 9 months later! (Our in our case 6 months!) I will try to give a brief summary, insomuch as someone like me can ever be brief!

1. The baby: You could finally become a parent! Finally having a child outweighs all the other pros by a mile, but you can't let it cloud your decision so that you don't do proper research and preparation or examine other reasonable/affordable alternatives for your unique situation.
2. The cost: A lot closer to $30K than the $100K+ you would pay in America. It takes 2.5 tries on average before successful implantation, so the cost for attempts is something to take into consideration.
3. The chances of success: If you are looking into surrogacy in India, you have likely looked at and tried other options but they have either failed, have low odds of success, or have cons that you are uncomfortable with. A proven gestational carrier combined with modern fertility medicine and the best prenatal care give you odds of success that other options may not have offered you. You could have equal chances of success for surrogacy elsewhere, so likely you are looking to India for the cost.
4. The betterment of many lives: The impact you will have on the surrogate and her family is beyond measure. The surrogate, her children, and her children's children will live a totally different life than they would have otherwise, with a home and education and life lifted out of poverty. Our clinic offered financial counseling and set up a trust in the surrogate's name to help them make sure to manage their windfall well for long term benefit.
5. Having the full experience: As a general pro to surrogacy anywhere, you get to to participate in a pregnancy, though in a limited sense when it is in India.  A big reason I chose surrogacy was that you get a child from their first day of life and experience infancy and all stages of development. Low cost adoption of older or challenged children, fostering to adopt where you can lose the child, or international adoption of an older infant or toddler were the only affordable options for us. While we intend to do that someday, each had an understandable downside with a process and paperwork that in my perception is a lot more intensive than surrogacy in India. If you can be a genetic donor, then you can also have the experience of a child that you are related to. It is not selfish to want that, anymore than it is selfish to want a healthy newborn that is lower risk for medical, developmental, and attachment problems.
6. Return on investment: While you can have failed attempts, you will be out a lot less money than you could potentially be from a failed adoption from what I understand. From my research I've seen more horror stories about failed adoptions and tremendous emotional pain and  loss of investment than I was comfortable with. I know an adoptive mother whose birth mother changed her mind in the several day waiting period after birth, and devastating does not even begin to describe it. An Indian surrogate not only does not want the baby, but they bear no relation or right to it. As long as your home country's regulations are also on board and you do the proper contract through a reputed clinic, this is YOUR child and it cannot be taken away from you.
7. Prenatal care: In India they will most likely choose to stay at communal surrogate housing, and you can choose that as a condition for your surrogate, though it could limit your selection. Some folks look at pics and see a room of cots and make negative judgements, but they have clearly never been to India. Trust me...a surrogate house is Shangri-la compared to other alternatives or where they have been living. Healthy food is prepared and educational classes are offered. There is air conditioning and on site medical care and close prenatal monitoring. They don't have to work and clean and endure the strain of caring for their own children during the pregnancy, though their families can visit frequently. These surrogates are not only happy about how their life and their family's lives are changing for the better and their comfortable accommodations, but many of them say the lifelong friendships they formed with other surrogates are the best part and lead them to do it again.
8. You have a greater chance of having twins. It's risky, but it is also AWESOME! This is a pro for surrogacy in general, and not exclusive to India.

1. Culture shock: If you haven't traveled, been to a third world country, and aren't familiar with Indian culture you are in for a shock. But if you open up your mind and prepare yourself it can be an amazing trip and a wonderfully life changing experience. I married into an Indian family and had spent a month there 8 years before we tried surrogacy so it was a lot easier for me and I knew what to expect. If you are borderline OCD and like everything antiseptically clean and hate crowds and traffic, India may not be for you. In my personal opinion things are much cleaner than they appear, but Westerners are used to everything being new and bright and shiny.
2. Communication: The language barrier, cultural differences, and time zone will pose definite challenges. As someone who has suffered from the pain of infertility, you are likely to have some control freakishness going on so the lack of clear communication will be hard to handle but can be well worth the frustration when the baby is finally in your arms.
3. Emotional connection: There will not be much of one, either with the surrogate or your baby. You are having a baby by email, and it may not feel like this is actually happening until there is a screaming infant being handed to you. You may connect with the surrogate, but since you don't have ether lifestyle or language in common it isn't likely. You will have the baby in common, and that is enough. It is primarily a business arrangement, and there is really nothing wrong with that. It's great if you can have a local surrogate in your home country and ya'll become besties and can share in every moment of the pregnancy, but it's not somehow morally wrong if that isn't your reality.
4. Medical standards: They do a great job at Indian NICU's. Don't get me wrong. But having experienced both I can confidently say that they cannot compete with American medical care, even if it is simply because of the available technology and not the doctor's skill level. Availability of experienced specialists is more limited. You have to hope you won't wind up in this boat, but you can do everything right and it can't always be prevented. They may be able to treat the symptoms pretty well but not give a solid diagnosis, and advanced therapies may not be available.  I've felt guilty that my daughter needed more medical care and expertise than was available, but the fact is my guilt is misguided because I would have done surrogacy in America if I could have afforded it and I've done everything in my power to give her the best care I can possibly provide.
5. Baby born premature or with medical problems: This can happen anywhere, even if you have a well screened egg or sperm donor and your surrogate does everything right and has no complications. But since this baby is in another country where you don't live, you could be in for a long and expensive ride. Your insurance may not cover out of country care or put up a fight about coverage, even though it is far less expensive there. You might have to live in India for many months, or wait to join your baby until they are discharged from the NICU. You may have to medivac your child out. (Check out the Rasta Less Traveled blog for what this can be like). This part of the journey did indeed suck, but we made it through to the other side and have two beautiful babies and have our happily ever after.
6. Death of the surrogate: Though not a risk exclusive to India it bears mentioning. I only know of this happening once, and it couldn't have been prevented or anticipated. It was an educated risk the surrogate or any woman takes on in a pregnancy, so your clinic should offer life insurance. In the case I know of the family was paid several times what she would have earned, and the baby did survive.
7. Surrogate risking their reputation: Education and scientific understanding is lacking in India, so many folks can't understand how surrogacy works without infidelity or genetic links to the offspring to the surrogate. This is one reason why surrogates travel from smaller villages and often choose to isolate themselves in communal surrogate housing, though often it is for the comfort and camaraderie. They just tell people it was for a job opportunity, which is very common and an easily believable ruse .An Indian woman takes on this risk, though they do it in part because they understand far better than most women in the world the pain and stigma of infertility because of how it is viewed in their culture. Our clinic helped local women at lower costs, and helped fake a pregnancy so the family will never judge the woman for not being able to bear a child.
8. You have a greater chance of having twins. It's awesome, but it is also risky no matter where you do surrogacy. You may have to do a reduction procedure if more than two implant. You stand a greater chance of loss of the pregnancy or one twin, complications, or prematurity. It will be more expensive to have twins in any country, but if done in India while you live elsewhere you could find yourself paying for double the extended NICU and exit fees like we did.
9. You won't know gender: It's annoying because gender neutral clothing is a myth in my experience. But if you really care about this so much then you probably shouldn't be having a child in the first place.

Please read my previous posts to see the many misconceptions about surrogacy in India.  and  
A couple of things I'd like to re-emphasize.
1. Indian surrogates are being exploited: Why is it assumed that they won't understand what they are doing but an American surrogate will? Do you have to have money in order to make a responsible decision for yourself? You don't have to be educated to be smart, and the tough lives these women have lived make me seem ignorant in comparison. They are perfectly capable adults who are counseled and aware of what they are doing, and selective reduction if necessary is done to ensure the health of the surrogate.  They have all been pregnant before, so that understanding of what it entails is a given.  Yes...being poor sucks in many ways. But it doesn't automatically make you less of a human being or less capable of making good decisions for yourself. And it doesn't mean that two women reaching across the world to help each other are engaging in exploitation just because one of them lives by what the other defines as poverty. Why is it that if you do it in America it is okay, but if you do it in a poorer country it is exploitation?
2. Isn’t there a risk of wealthy Americans ‘outsourcing’ pregnancy and birth to the third world to avoid stretch marks?”
Fears like this are extrapolated using a logical fallacy call the slippery slope. The pundits latch on to this one because sensationalism sells. It’s like saying that by allowing gays to legally marry pretty soon we’ll wind up allowing people to marry their dogs or inanimate objects. Sigh. Anyone who has been through the process could never imagine someone doing this as an “easy solution” because it is anything but. Having been through it, I cannot fathom any way where someone foolish enough to try this could even get through a beginning phase of the process.  It would be far costlier, but much easier to abuse surrogacy in the U.S. than to go overseas in my personal opinion.

Thursday, January 17, 2013

New India Surrogacy Regulations Article

I simply cannot understand why so many countries do not recognize surrogacy as a legitimate way to become a parent. Even gestational surrogacy where there is a clear genetic donor! I feel so bad for folks in Austrailia, and don't get me started on the backwards regulations in England! At least America it is more possible, but prohibitively expensive. It is hard enough to be infertile, but to live in a country where they create barriers to non-traditional pathways to parenthood must be infuriating!

India cuts off commercial surrogacy to many Australians

Nance Haxton reported this story on Tuesday, January 15, 2013 08:12:00
TONY EASTLEY: Changes to commercial surrogacy arrangements in India, introduced just before Christmas, have cut off one of the more popular avenues for Australians wanting to become surrogate parents.

While going overseas for commercial surrogacy is illegal in Queensland, New South Wales and the ACT, hundreds of Australians still fly to India every year to become parents.

However, the Indian government has now issued a directive that only couples who have been married for more than two years can enter into commercial surrogacy arrangements, and only if it is legal in their home country.

Nance Haxton reports.

NANCE HAXTON: Queensland lawyer Stephen Page is a surrogacy specialist who has represented many Australian surrogate parents. He says the policy changes in India have already had a huge impact.

STEPHEN PAGE: Essentially, if you want to go to India in future for surrogacy, you've got to be married for a minimum of two years - gay marriage is excluded - and surrogacy must be legal back home.

And the only place where commercial surrogacy can occur in Australia is the Northern Territory. So unless you're in a heterosexual, married relationship for two years and you're living in the Northern Territory, you can forget about going to India.

NANCE HAXTON: So there was effectively a loophole before this where many Australians were able to go to India to engage in commercial surrogacy arrangements.

STEPHEN PAGE: Anyone could undertake it in India, anyone. So... and the majority of people from Australia who went weren't married. So they were either living in a de facto relationship or they're in a same sex relationship or they were singles.

I believe instead of about 200 children a year being born to Australian intended parents a year, it will be down to five or 10.

NANCE HAXTON: He says the rule change won't stop Australians entering into commercial surrogacy arrangements overseas. They will simply look elsewhere.

STEPHEN PAGE: See the strange thing is, it's outlawed at the state level but at the federal level it's not. At the federal level, you can go overseas and all that you need to establish is that the child is yours and then the child is entitled to Australian citizenship.

NANCE HAXTON: Surrogacy Australia president Sam Everingham says many Australians with incomplete commercial surrogacy deals in India are now in limbo. He says it would be far preferable for Australia to regulate commercial surrogacy at home.

SAM EVERINGHAM: It's become a legal headache for many courts in Australia dealing with the unintended consequences of surrogacy. And I think you know if we had arrangements in Australia where commercial arrangements were possible, it would make it much easier for the kids that are born, as well as the parents.

NANCE HAXTON: What about for people who have ethical concerns about exchanging money for children in that way?

SAM EVERINGHAM: Look, I think there's a lot to be said for keeping these arrangements all happening in the same country. You avoid issues like accusations of exploitation of families from less well off backgrounds, and it's been clear from systems in place in US states like California and Minnesota that commercial systems can operate very well, with really positive outcomes for the children, the surrogates and the intending parents.

So I think we need to look really closely at that as a wider community. I mean, despite the laws we've had against surrogacy, a lot of families go overseas and ignore those laws. So I think it will be a much better outcome if we could get those sorts of arrangements and much better access to surrogates in Australia.

I mean, even if it's not commercial, even if it's just surrogates being able to advertise that they're willing to carry in Australia it would be a start.

TONY EASTLEY: The president of Surrogacy Australia, Sam Everingham, speaking there with Nance Haxton.


As I said in my last post, sometimes it takes 50 photos to get one good one...especially when they are together and you have double the lack of cooperation. Some of my favorite photos wind up being the outtakes sometimes. 

It was almost perfect but Vivek photobombs this one
It almost looks like they did this on purpose together
I like to call this her "stank face"
All drama, all the time
Tired of picture taking
Sneezy the elf
Vivek is not impressed
Smooshy the elf
Sleepy the elf
"Whatchu talkin' bout Willis?"
This is just wierd. He doesn't even look like that.



And they lived happily ever after...most of the time.

They tell you how they grow up so fast. They truly do. I look at my two new favorite pictures below and see how much their faces have changed and are full of personality.
Is it just me, or in some photos does it look like he has a 5 O'clock shadow?
I look at the pic taken of (almost) all the grandkids at Christmas and realize how grown up the rest of them are now.  It makes me feel old!

We have truly adjusted to life with twins at this point, despite all the complications. Even our dog Ralph has adjusted. He has laid claim to a broken baby swing seat, but otherwise knows his place.
"The dumpster. I think not! It's mine. You can't have it back."
I told my husband that in so many ways I can't wait to see them grow up and walk and talk to us. But then I want a switch that for just a few minutes would turn them back into tiny 6lb babies every now and then. As it is Tara is now 11lbs and Vivek is almost 12lbs. They now fit perfectly into 3 mos size clothes just like their corrected age, but I'm sure it will become snug on him soon.  

Today for a big change I took my son in for a doctor's appointment instead of my daughter. He had to visit the urologist for his circumcision consultation. I was wracked with guilt because we had postponed it due to our daughter's hospitalization, not knowing that when he reached 10 lbs they would no longer do the "ring" and instead it would be an inpatient or possibly outpatient procedure requiring anesthesia. But the urologist told me that since he has a slightly curved situation going on down there it would have had to be done at 8 1/2 months as an outpatient procedure anyway to correct that at the same time. So once again my Mommy guilt is alleviated. Turns out only 1 out of 150 boys has it, so my son apparently wanted to be a medical rarity as well.

I must say it is weird filling out the piles of medical paperwork as the parent/guardian. I have to remember to fill it out for the patient instead of myself and be sure to put single instead of married. Some things strike me as very funny because they are so small, such as marital and veteran status. Medical history gives me some chuckles too. Symptoms: Vomiting. Check. Uncontrolled bowel movements. Check. Frequent urination. Check. Difficulty speaking. Check.

Vivek and Tara both smile like sunshine all the time now, and she has finally started cooing more. We are working on tummy time progress and charting it everyday now to make sure we are more consistent. If the plagiocephaly continues to improve by us forcing their position with rolled up burp cloths, then hopefully no one will need a lovely foam helmet made for them when our pediatrician assesses them at their next appointment in two weeks. The incredible pulmonologist spent an entire hour discussing her case with me in great detail, even calling my husband and sending a detailed summary of our discussion and conclusions to our pediatrician who raved about his thoroughness! Thank you Dr. Sah from Pediatric Pulmonology and Sleep Specialists! In the end we have decided not to change anything regarding the diuretic/24cal/sodium chloride to keep her lungs dry, but can add lactolose to help with her constipation that has her screaming for 30-45 minutes at 10:30am every day. You could set your watch to it. 
Sleepy little angel...for now.

"I like Dadoo. He's funny! But why does Dadima keep calling me Conner?"
As a funny side note, I saw a posting on a Yahoo Group for Indian surrogacy the other day asking about the pros and cons of doing surrogacy in India. I was too busy to reply at the time, but planned on writing something later to mention my blog so they could hear our crazy tale. Funnily enough, before I could someone else replied and named my blog as an example of "what could go wrong" to help them consider the con side of it. Ha! I'm glad my blog exists to help folks out there consider everything that could go wrong so that they are prepared for what can happen, but I hope it doesn't discourage anyone completely because we would still do it all over again.  My advice: Think about what you will do if you have twins. Think about what you will do if they are premature and have to have an extended NICU stay. Think about what you would do if they had to be medi-vaced out to your home country. And to my gay and single friends out there, research the impact of the newer regulations India is putting out there as well as your home country's most current rules to be sure what risks you are taking on so that your children won't be without a country or without a recognized parent.

And while our situation was tougher than most, it could have been tougher with even more severe medical problems like our wonderful Bernadette and her family have had to deal with. But the true worst case scenarios to me would be failed attempts, loss of the pregnancy, surrogate health being affected, and worst of all stillbirth or infant death. But the fact is these same things can happen anywhere you do surrogacy and you can't control them beyond taking reasonable precautions. So as long as you find a reputable clinic (Ex: Akanksha/Dr. Patel, SCI, Rotunda)  I say go for it. But if you can afford alternatives in the US or a more developed country for goodness sakes do it there! The reason I say that is because the NICU care in India cannot compete with the U.S. at the highest level of care in more complex medical situations, and that is the only reason that would have mattered to me in the end if I had any other choice.

A lot of things are uncertain about the future, particularly when and where I'll be working full time again. But amazingly I'm not worried about it and am able to adapt and be flexible about whatever happens next. Fortunately there are plenty of opportunities out there for me due to my training and experience, and I've had some response already from some jobs that might work better for our current schedule of medical care for our daughter and our in laws helping out. That is truly a gift that my children have given me, because those that know me will recognize that not being obsessed with how to get a crystal ball is a major step for me.

One thing is for sure, I know I wake up everyday and look at the two of them and still can't believe I finally got my happily ever after!
It took about 50 photos to get this one with both of them looking at the camera and not thrashing into wierd positions.