Today wasn't about me, but about a new friend in the NICU. I had lunch with Petra from New York, whose son Isaac is on the CPAP and overcoming some initial difficulty possibly brought on by gestational diabetes. He is 34 weeks, but having some issues associated with more preterm babies possibly due to some belated development. I loaned her my The Premature Baby Book copy my brother loaned me by Dr. Sears, but more importantly gave her hours of advice and as much information as possible. I shared a lot of my brother and sister-in-law's hard won wisdoms and NICU tales with her, and I know it must have helped her a lot too like it did me. I hope it wasn't too overwhelming because it took me a month to learn everything I shared. Later that night I also helped walk her over to Dr. Patel's and pow-wow with her surrogate and sort out some confusion with the breast milk provisions, which fortunately got resolved.
We talked over a super yummy but pricey lunch at Madhaban Resort where they are staying. I knew it was nice over there, but had no idea. The place is like Shangri-La and is a true paradise..and I don't just say that because it stands in stark contrast to Anand. I shot a few pics of a pretty water feature in one of the bazillion gardens they have there, and a gigantic hand carved wooden statue.
I did two more bottle feeds today, one for each baby. Only some slight desats into the 70's that I could see coming on before they happened. I doubted my instincts on giving Vivek a break when I saw one coming on and he was slowing down on the bottle despite my encouragement and mimicing the turns and taps the nurses do to help finish a feed. But then Sandia told me it was okay and she was doing that very thing for Tara across from me. I need to work on my burping skills, and Vivek urped all down my arm right after I thought I was done with the burps.
Both babies hiccup a lot after eating, which I know comes with the territory for babies and will ease up with age. I love every little noise they make, but I find hiccups particularly cute.
The cardiologist came tonite that comes every 2 mos, but did not examine my babies. I asked Dr. Kothiala about it and said sonography can confirm but she sees no need to because clinically there is no indication that my babies have anything wrong with their hearts, or any holes in them. I decided to be satisfied with that.
Tara was hamming it up for the camera today instead of Vivek, and with a little patience I got my first shot of her smiling with her eyes open.
I think one of the things she is smiling about is explained in the below photos:
I went nuts with the camera this morning at bathtime. They are so alert and make so many faces and work the camera. They nurses were so great about it even though I was in the way. Vivek doesn't seem to enjoy any part of bath time and protests as loudly as his little lungs let him. His tiny frown is so heartbreaking. Tara on the other hand dislikes the wiping down part of the bath and squeaks in protest, but when the rubbing them down in oil part comes she settles right down and seems to enjoy it. So without further ado.... For some reason the pics stretch out a tad.
Miss Tara's bathtime:
Miss Tara post-bath:
Mister Vivek's bathtime: (You can tell he is less of a fan)
Mister Vivek post-bath:
Tara has a noisy new nieghbor. The NICU was at 7 but a set of twins and a singleton arrived so we are back at 10. Not a whole lot else exciting today after bathtime. I bought a steam sterilizer at Seven Eleven and was overcharged, but had no choice since my small one I brought (Baby Bullet Turbo Steamer) busted after the first use and Suvarna told me they do not want me boiling stuff for 10 min to sterilize it. So now I'm handwashing and then just steaming. I plan on taking pics to show her my sterilizing procedure so she'll believe me because she is so cautious. I appreciate how protective and careful she is, but no way am I bringing 18 pieces to sterilize every few hours when I still haven't gotten one piece back from 2 days ago.
I resolved my account with Dr. Patel today after further discussion with Hitesh. By some miracle I caught him with Dr. Patel and her assistant all in his office. It was about what I expected and planned for, which was $2000 extra to the surrogate for the 25% twin fee, plus a $1000 procedural charge (see below). I did debate the $2000 emergency delivery charge, because if there is no emergency delivery it is supposed to be 50% refunded. Even though it was delivered early and was an emergency in a sense, it was still natural childbirth and not Cesaerean section so they agreed to take off the $1000.
Some things I learned to help out other folks out there:
1. If you have twins they generally do a cervical circlage procedure, and that is a $1000 charge. We were not informed about this but fortunately I planned for a bit of wiggle room in the budget.
2. We had just over $2000 in hospital stay fees for when she was admitted for the fetal reduction procedures since all 5 embryos implanted. We had to do reduction twice since one embryo didn't respond the first time. We were not informed about this, but I think it evened out because I'm recalling the fee schedule may have some hospital charges from when they are normally admitted before delivery but ours never had a chance to be. You may want to doublecheck about hospital fees anytime your surrogate is admitted or has a procedure.
Other practical information for readers coming to Anand: There are English channels here. I'm not sure if they are the same at every hotel, but at the Rama Residency here is my list...which may not be comprehensive.
Chan 45: Movies Now--almost all blockbuster movies
Chan 46: AXN- a mix of shows including several game shows
Chan 51: Star Movies
Chan 60: ZStudio-sometimes movies, sometimes TV shows...including some Comedy Channel shows
Chan 70: Mix of TV shows
Chan 73: Mix of TV shows, including Dexter and the Simpsons.! Indians also seem to love Austrailian competition cooking shows aired constantly on this channel.
Chan 77: Movies
That is at least 7 English channels!!! Netflix and Hulu Plus are not allowed in India due to some crud about streaming rights. Count your blessings folks. I am mostly sick of the same commercials I could recite in Hindi even though I'm not entirely sure what they are about. Usually cell phones. It is all about how cool your cell phone is here. I also find it humorous that many English shows are subtitled in English for some reason. But the funny part is that the person says "shit" but the subtitle says "crap." They JUST said it, so why bother changing the subtitle???
I did end the day on a sad note. As I left the NICU tonight my way was blocked by a tuk-tuk, which was not normal because mainly you see only motorcycles try to go through the narrow passageway by the stairwell entrance. I noticed a lot of men crowded around it. As I squeezed by on the side you can't exit from I saw what was going on.
There was a young woman crying looking very distressed, holding onto an elderly man who was halfway in the seat but slumped over and unconscious and she was trying to hold him halfway up. I knew it was serious the instant I saw it. Everyone was just standing around watching, looking far too calm for what the situation appeared to be to me. However CPR is hardly something that is really known well in this part of the world. I have pretty extensive medical knowledge and training for a layperson, and my instinct wanted me to go through the steps I talk people through at work almost every day at 911. The patient was in the worst possible position for his airway, and showed no signs of obvious death from what I could see. They had a wheelchair but none of the men was moving a muscle to lift the man in it and take him to the elevator into the ICU.
Hee was surrounded by about a dozen men who were trying to take control of the situation by doing absolutely nothing but spectating while someone slowly walked upstairs to get a doctor to come down from Dr. Kothiala's hospital. As a foreign woman, I knew there was no way I could jump in there and take charge of the situation without resistance. Plus, I didn't know the full story of what happened that could signify obvious death, nor a way to find out. I also had no CPR mask and the chance of a transmittable disease is far more likely here. So instead I stood over by the wall a few yards away and waited, hoping a doctor arrived soon.
After a minute a doctor came down and put his stethoscope to the man's chest, then I saw him pull it away and shake his head no. Very sad. I left to give them their privacy. I wonder if he was that woman's father. I wonder why he arrived in a tuk tuk instead of the ambulance that arrives there several times a day. I wonder if he was already dead when they got him in the tuk tuk, or if he was unconscious and she had help getting him in it. I wonder how you call for an ambulance when there is no emergency number here, or if you can't pay they won't pick you up. I wonder how many people die because there is nobody who can give medical instructions over the phone. So very sad. I walked away and said a small prayer for her, but also grateful I live in a country with the infrastructure to support emergency services.
A fitful sleep and a massive migraine meant I only visited my babies twice today. However I did kangaroo care each time and it was almost an hour with each baby each time.
A couple of quick notes of things I've forgotten to mention. I have not resolved my account with Dr. Patel, but I was impressed that was only because they find discussion of money on my first days here distasteful. I agree...better things to focus on immediately and they are not trying to rush me.
Dr Hitesh did escort me in briefly to see Dr. Patel. She was busy as always so just a quick hello and thank you.
I have not yet met our surrogate but she is pumping for us at the hostpial nearby, so I should meet her soon.
Almost all the clothes and hats in the NICU are pink. I don't know if that color carries the same gender connotation here. So if you are wondering why my son is in pink, that's why. I have preemie clothes that he is still too small for, and they mostly don't use clothing aside from hats for better accessability and so that they can evaluate skin tone etc.
It is almost all twins right now. My babies next door neighbor's are Lakshmi's twin boy and girl, and across are another set whose parent's I haven't met. I the adjoining room are a set of boys and I've met the mother from South Africa. They brought in a singleton yesterday born full term but having a little more problems breathing than mine currently are at almost 29 weeks gestation.
I've read the premature baby book, and it says until a few weeks from now they will develop a sucking reflex and be able to coordinate sucking ,swallowing and breathing so that they can feed by an actual bottle and not from a gavage orogastric tube. Well...my babies must not have read the book because they have been making sucking motions since I got here and are feeding orally by a plastic syringe, and the nurse took two of my bottles yesterday to test out on them possibly today!
Quick post because I'm exhausted after my trip to Big Bazaar and ready for bed.
Well I humbly requested belly pictures of our surrogate, and I got them!!! It gave me a huge jolt of excitement, and it made things feel very real. It is what I needed. I'm like a kid at Christmas and can't sleep! The pics included her face, but for her confidentiality I cut them out for this blog.
The pic seems to have stretched wide a bit somehow when I saved it. Overall she looks very healthy. It seems that the women there never smile for pictures, but that may be a cultural thing having to do with appearing demure. We are only at 26 weeks, so I can't imagine how much bigger she'll be full term! I feel so much more connected to her now after seeing her, and my thoughts turn more to her health and welfare as this has made her existence more concrete to me.
I attended a different La Leche League meeting yesterday, and they were very supportive and I liked it much better than the first one. I'm still not in full agreement on LLL perspective on some issues, but it was a good place for support and information. When I'm no longer working evenings starting Sept, I will switch to the evening meetings and will probably find more working women who I can identify with more than the stay at home gals. I feel more educated on mastitis, and have decided I need to fork over the money to rent a hospital pump because it truly is much more efficient and well worth the money. It will hopefully pay for itself by us not having to buy formula hardly at all. There was some intense discussion on how a woman slipping out her nips in public without a cover is normal and natural and should be accepted without discomfort and staring. I get it, but can't see myself being a breastfeeding crusader that is going to whip them out no matter who is watching. Plus, I have to do both at once and that makes being discreet a lot more difficult. I wish LLL had a list of places to rent breast pumps and a price list from having called around, so that everyone didn't have to do all their own research. I also wish they had a list of places to buy nursing bras. However I think I found two of the best places thanks to some dedicated time Googling.
The invitations for the baby shower are out, and this morning I will transfer money to India for them to host a baby shower for Manju. The text of Dr. Patel's email is as below:
I want to ask you if you would like to do a baby shower ceremony over here. We do it at the surrogate house in the 7th months.
The whole event costs about 125 USD.
This is done according to Hindu ritual, where in a priest performs the ceremony & prays for the safe baby delivery for mother & child both. The inmates of Surrogate house will have a nice lunch & Manju & other surrogates receive gifts. This whole can be done in total 125 USD if you agree to it let me know.
I did add a polite P.S. to the bottom of my response letting them know that "inmate" was not the best term to use, because it gives Americans the wrong idea. I don't want people criticizing Dr. Patel with the false assumption that the surrogates are like prisoners and have no freedom, because I know that is not the case.
I shouldn't complain. I should be happy. I should be in an ever upswinging arc of excitement. But the truth is I'm exhausted from working so much and waiting so long. I'm impatient, I know. It is so hard and painful to be infertile and childless. Though not anwhere close by any stretch of the imagination, it is also hard to wait and be so far away from your babies too. It just feels like these babies exist only in my imagination (at least on this side of the planet), and I keep wanting something to reassure me this is really happening. Maybe the baby shower will snap me out of it in early August. If that doesn't hopefully when I begin pumping to try to start up my milk supply August 15th then I'll have my head back in the game. Pumping 8 times a day will make it very real, very fast I would imagine.
The "schedule" Dr. Patel has emailed to other client's as well as what other client's have told me say that week 23-24 you get another report. Today is the last day of week 24. I wonder if since we got an unscheduled report 4 weeks ago, does that mean we don't get one now? The report just says they are doing fine when we get it along with a bunch of medical info that is meaningless to me even though I can decipher the report down to the fine details. And no news is good news. I know this. As soon as I get a report I'll just want another one anyway. So how come everytime someone asks me how the babies are doing and I have nothing to report other than my assumption that all is well because I haven't heard anything, I feel this urge to stifle back a tear from the corner of my eye. I guess all it is is that I just miss the two babies I've never met. I hope to have dinner next week with a local gal who had a baby by Dr. Patel, and maybe she can tell me if it was just as hard waiting for her as it is for me...because I don't know anyone who can relate to exactly what I'm going through.
So today in the hope to brighten my mood I went to the Newcomers Tea to welcome the newest members of the Mother's of Multiples Club. It was very nice, and I took notes on how to make my home family friendly but not look like a daycare center. It was babies, babies everywhere. I'm trying to take the advice to enjoy it while I can, but I'm really just jealous. Let's go already! Over eight years without children, so let's get this show on the road. They ask if I'm ready. I am, but of course I'm not really. There is a lot left to do on the house. Besides, however many ways you may feel ready, there have to be a hundred ways you don't know what to expect in how it will change your life. I know that. Have I mentioned I'm impatient?
At the tea party there was an entire room to the right of the door that became a parking lot for all the double strollers, but they spilled out into the hallway and living area too. I took a picture because it got me tickled!
So just this past week Dr. Patel and the Akanksha clinic celebrated the 500th baby born through surrogacy! Technically it was twins, so they are at 501. Video below. Wish I could understand the language!
The clinic wanting to share their happiness held a small ceremony which was joined by not only the recently born twins but also many other surrogate mothers and their families on Friday afternoon.
Doctors at the clinic say that childless couples from around 29 countries including India, USA, UK, and Pakistan turn to Anand seeking help of surrogate mothers to give birth to their babies. According to them, babies born through In-Vitro Fertilisation (IVF) have shown a ratio of 253 boys and 247 girls at the clinic.
“It is a good feeling. After a long struggle and controversies we have been able to spread happiness to 500 childless homes,” said Dr Nayna Patel, who is considered to be one of the pioneers in IVF surrogacy.
I found a few more articles today, but they are poorly written and full of misinformation and logical fallacies so I'm not posting links because I don't want to contribute to fear and ignorance. Heavy on the slippery slope arguements and short on actual facts or research. People make a lot of statements and they are not backed up, and from what I can tell they are based on fears or isolated cases rather than reality. It just reminds me that modern day journalism lacks the ethics or integrity to put out well written factual articles, and I feel sorry for people who read the garbage they write and can't tell the difference.
We got an update today! I think the only reason we got it earlier than the predicted schedule of 23-24 weeks is because I sent Dr. Patel an email asking for a signed copy of our surrogacy agreement and to verify if our package of sarees and pictures and thank you letter to Manju was recieved. So excited, and today happens to be our eight year anniversary. I showed my husband the blog and he loved it!
So we are at 21 weeks along, though I say that because we are 20 weeks and 2 days, so that to me means in the beginning of week 21 right? Who the heck knows. I've seen all sorts of online calculators but I enter the same info and they give me different calculations on due dates and such, and with twins they are full term at week 37 anyway. I'm not really sure what week begins or ends a trimester because apparently there are 3 different ways to calculate it, though around 27 week mark seems about right:
by Development:
This uses actual developmental stages to divide up a pregnancy. From LMP to 12 weeks the embryo develops all the major organs and becomes a fetus. From 12 weeks to 27 weeks the fetus continues developing and reaches viability. From 27 weeks on the fetus finishes development and prepares for delivery. Here the second trimester begins at 12w 0d and the third at 27w 0d.
by Gestation:
With this method you take the 40 weeks of gestation and divide into three equal stages. Here the second trimester begins at 13w 3d and the third at 26w 6d.
by Conception:
This method is where you take the 38 weeks of post conception development, divide by three, into the three equal trimesters. Here the second trimester begins at 14w 5d and the third at 27w 3d. What is the length of the first, second and third trimesters?
The length of the trimesters is often a source of confusion. The word trimester means 'three months'. Three periods of three months each, gives pregnancy a beginning, a middle and an end period.
These periods match the developmental stages to divide up a pregnancy.
Beginning: From LMP (last menstrual period) to 12 weeks the embryo develops all the major organs, becomes a fetus, and the placenta takes over control.
Middle: From 12 weeks to 27 weeks the fetus continues developing and reaches viability.
End: From 27 weeks on the fetus finishes development and prepares for delivery.
As a side note, 28 weeks seems to be the magic number where a baby has a very high chance of survival with little to no chance of developmental delays. My brother's twins were born at 28 1/2 weeks and they are both fantastic with no problems, though it did take another full 3 months in the NICU before they could go home.
So when you get these scans from Dr. Patel, what are you supposed to do with them? Other than trying to figure out what part of the baby you are looking at, of course... I am not sure on most of them what I'm seeing if it isn't the head, and lately they seem to get even blurrier and harder to tell instead of easy like the first ones were. Maybe they are doing more close ups. Dunno, but this latest scan is the first time we have gotten shots that appear to the be fancier 3D Doppler kind. It says on the report "2D Echo" so that is probably what refers to these two shots. Check them out! The 2nd one I don't have much of an issue telling what I'm looking at on the left side, but the 1st one I have no idea what is in front of my the baby on the right. Is that the other baby's feet or something?:
I'm not going to pay out of pocket for a local radiologist to look them over when Dr. Shah (Anand radiologist on report) and Dr. Patel already have and say everything is fine. That would be going overboard. Okay, okay...so I did have my Dad call in a favor and forward the last two to a radiologist friend just to see if he could determine gender. He isn't sure cause they are scanned in with big fax stripes and so blurry by the time we get them by email, but he agrees we may have at least one girl. But I can scarcely see the A or B mark on each pic that tells you which pic is for which baby, so unless you have a double gender shot with both babies in it (highly unlikely) or see a boy and a girl clearly, you won't know which twin you are looking at in each photo and could think you have two boys when you are looking at the same boy for example. Plus they don't tend to take shots from the right angle since they aren't really trying to detect gender. I don't honestly care because I just want them healthy, but it would make packing clothes so much easier because gender neutral stuff is harder than I thought to find. I can tell you that when you see a split screen pic with two images in it that it seems to be of the same baby every time.
So what does all of it mean beyond the pictures? I just go to the very bottom and look for the sentences first, since it is easiest to understand and seems to sum it all up. I'll put what I've been able to decipher from Googling, but I'm just a layperson and NOT a doctor or radiologist so I could be very wrong. I know a bunch about physiology and anatomy from taking two college courses for fun on the subject and getting my Emergency Medical Technician in 1995, but that hardly makes me an expert so take everything below with a grain of salt. I assume if there is a real problem Dr. Patel would email you and tell you. It says stuff like:
DCDA twin pregnancy-Dichorionic/diamniotic twins. It means they are fraternal and don't share an amniotic sac. This is good because there is no risk of twin-to-twin transfusion syndrome. If it was monochorionic (MA) they would be identical twins. The chorionic part is actually referring to the placenta, and sharing a placenta means the syndrome above is a possibility. Identical twins are the only kind that can share an amniotic sac, and there is a high survival rate but there is an added risk of cord entanglement or compression.
Variable presentation. That seems to simply mean the baby moves around and doesn't stay stuck in one spot. From what I understand, that is a good thing.
Posterior high placenta. That means the placenta is in the back of the uterus. This is good, and I think where Dr. Patel tries to get the embryos to implant on purpose since both of our twins implanted there. A low lying placenta is the only place I know that is definitely bad, but I'm not sure what medical term that would be. That means there is a chance of "placenta previa" and the baby will have to be born by C section. Google it. So when you see "no previa" on a report that is a good thing.
Fetal growth 7 AF normal. Sounds good to me. I think AF is amniotic fluid. Not sure what the 7 is for. I found AFI charts online to show normal fluid levels, but I can't interpret it that in depth and it is probably different in twins.
Fetal heart normal. Awesome!
Low resistance flow in both uterine artery--PIH least likely. PIH means Pregnancy Induced Hypertension, so least likely is a good thing. That means low resistance flow in the uterine arteries are a good thing too.
No fetal malformation. Definitely good.
No growth discordance. This is good. It means one is not growing significantly faster than the other.
EFW-Estimated fetal weight. Ours is in grams, but it shows the conversion to lbs too.
Note* In the measurements section there appears to be a column for "last" measurements to measure growth. Ours is always the same number as the most current measurements on every report, so I think he doesn't re-enter old data in the new reports for whatever reason. So don't freak out and think your baby hasn't grown.
LMP-Last Menstrual Period: This is a way of calculating the gestational age.
GA-Gestational age: This column is next to all the measurements from the fetal biometry section I describe below. You want this to be close to
EDD-Estimated date of delivery. I think in the first column it is calculating it based on the LMP and the other based on GA, which makes sense because I've seen that there are several ways of calculating due date and these are two ways. This never seems to change more than a day or two for us and reflects the 40 week date. With twins 37 weeks is full term though, and delivery can depend on other factors and 35 weeks is frequent with Dr. Patel and twins.
HR-Heart rate. It starts off in the very early weeks the same as the mother's, then by week 9 rises to 175 BPM (beats per minute). In the middle of the pregnancy it is often 120-180 BPM.
NT-Nuchal Translucency. Ours says normal at the very bottom, which is good. See more about this below.
NB visible. I think this means nasal bone. I take it that it should be visible, so woo hoo! This was right next to "nasal triangle normal" so that makes sense.
Fetal biometry is basically the section where they take various measurements of your baby in order to determine the fetal growth is normal. On some scans they have done a side by side comparison in a separate section to establish any growth discordancy. This linke shows charts of what is normal percentiles if you want to totally obsess about it: http://www.centrus.com.br/DiplomaFMF/SeriesFMF/18-23-weeks/appendix-03/normal_fetal_biometry/appendix-03.htm Abbreviations from this section as follows:
BPD - biparietal diameter: Transverse diameter of the head between the protuberances of the two parietal bones of the skull
OFD- occipito-frontal diameter: The diameter of the fetal head from the external occipital protuberance to the most prominent point of the frontal bone in the midline.
HC-head circumference.
AC-abdominal circumference
FL-Femur length (thigh bone)
HUM-I think this is humerus length, but not sure.
The names Hadlock, Jeanty, Hansmann are all referring to which growth table the doctor is using on that particular measurement on the scanner.
Fetal cranium: This section is all about measurements of the head, including the left ventricle, the cisterna magna (CM), and cerebellum (CEREB).
Ratio section: These have the previous mesurements in a ratio format. It takes these ratios and compares them to a normal growth chart, and the percentages on the right show you what is normal for how many weeks along your baby is. You want it to be somewhere in that percentage range.
2d Echo section: ASC AO stands for ascending aorta and MPA diam stands for main pulmonary artery. These kinds of scans I think are designed to check for good blood flow on major arteries, so that makes sense because it doesn't get more major than these two arteries in the human body. This section also has measurements on the uterine artery flow, which admittedly is way too hard to interpret. But the summary section at the last page will say what it did on ours hopefully that I referred to above, which tells you all is okay. We had another report that had similar abbreviations and a section for "Ductous Venousus," (DV) which appears to be an important fetal vein that shunts approximately half of the blood flow of the umbilical vein directly to the inferior vena cava.
PI Pulsatility index
RI Resistance index, Pourcelot’s index
S/D ratio Systolic/diastolic ratio
Vmax Velocity maximum (same as PSV and MPSV)
MDV Minimum diastolic velocity
PPI Peak to peak pulsatility index
PSV Peak systolic velocity (same as MPSV and Vmax)
MPSV Maximum peak systolic velocity (same as PSV and Vmax)
TAMV Time averaged maximum velocity (same as TAMX and TAPV)
TAMX Time averaged maximum velocity (same as TAMV and TAPV)
TAPV Time averaged peak velocity (same as TAMV and TAMX)
When you get the first trimester screening report around week 11-14, it is written in mostly plain English. A few points for interpretation:
Cord-3 vessels is what you want and is normal. 2 can still result in a live birth but poses more risks.
The Nuchal translucency test is the portion of the ultrasound which tells you an estimated risk of certain genetic disorders. It screens for Down syndrome (trisomy 21, meaning an extra copy of chromosome 21) and other disorders that are caused by extra copies of chromosomes (trisomy 13, trisomy 18), as well as congenital heart defects. Fetuses who have an extra chromosome may have more fluid at the base of their necks — a spot known as the nuchal fold — and this can make their necks larger. This fluid can be measured on a sonogram during weeks 11 to 14 when the base of the neck is still transparent. I think the results are easy to understand and self explanatory. Here is a screenshot of that portion on our report.
I found online this list of abbreviations for ultrasound reports, so if your reports have different stuff than mine maybe this will help:
ABO - May be seen in reference to blood test to check what your blood group is
AC - Abdominal circumference
AF - Artificial feed i.e. bottle fed
AFP - Alpha fetal protein (test offered at 16weeks to assess risk of problems with babe such as Downs syndrome)
ANC - Ante natal clinic
APH - Ante partum haemorrhage. Bleed whilst pregnant
BF - Breast fed
BO - Bowels opened
BNO - Bowels not opened
BPD - Bi parietal diameter. One side of the head to the other (ear to ear direction)
BP - blood pressure
Br - Breech
CEPH - Cephalic (head), in regards to presentation means head down
CRL - Crown to rump length i.e. Top of head to baby.s bum
C/S - Caesarian section
CTG - Cardio toco graph. The machine that they use on delivery suite to measure contractions and baby.s heart rate over a period of time Cx - Cervix = d - Usually in relation to fundal height (uterus size) means is right for dates
EBM - Expressed breast milk
EDD - Estimated date of delivery ELSCS - Emergency lower segment caesarean section Eng - Engaged EPU - Early pregnancy unit FAU - Fetal assessment unit FBC - Full blood count FBS - Fetal blood sample OR fasting blood sugar FL - Femoral length (thigh bone) FMF - Fetal movements felt FHHR - fetal heart heard regularly (sometimes seen as FHH)
GTT - Glucose tolerance test
G2 P1 - Gravida 2 (2nd pregnancy) Para 1 (1 child living) GA - General anaesthetic Hb - Haemoglobin i.e. Iron levels HC - Head circumference IM - Intra muscular IUGR - Intra uterine growth retardation i.e. Small baby for dates IV - Intra venous (going into vein) IVI - Intra venous infusion i.e. a drip LA - Local anaesthetic LMP - Last menstrual period LOA - Left occiput anterior i.e. the back of baby.s head is to the front left side of your abdomen (where you want it to be) LOP - Left occiput posterior i.e. back of baby.s head is to the back left side of your abdomen (where you don.t want it to be really) LUSCS - lower uterine segment caesarean section (sometimes seen without the U ) Mec - Meconium (babies early poo) Multip - Has 1 or more living child MSSU - mid stream specimen of urine NAD - Nothing abnormal detected N/Eng - Not engaged NNU - Neonatal unit
NICU - Neonatal intensive care unit
NPU - Not passed urine OC - Oral contraception OP - Occiput posterior OA - Occiput anterior Palp - Palpable i.e. what can be felt PIH - Pregnancy induced hypertension (high bp) PMH - Past medical history PPH - Post partum haemorrhage. Bleed after baby is born PR - Via rectum PU - Passed urine PV - Via vagina Primip - First pregnancy Reg - Registrar
Rh - Rhesus
SCBU - Special care baby unit SHO - Senior house officer SPD - symphisis pubis dysfunction i.e. loosening of cartilage at front of pubic bone (v. rough definition)
TOS - Trial of scar
Tr - Transverse ie Lying sideways U&E - Blood test checking urea and electrolyte levels USS - ultrasound scan VBAC - Vaginal birth after a caesarean section +ve - Positive -ve - Negative
VE - Vaginal examination
Vx - Vertex, used in relation to presenting part/position. Means head down.
So in my anxiety during this 7-8 week gap between baby updates, I desperately search for other blogs of folks who've done surrogacy in India. I find plenty, but most are from the Surrogacy Centre in Delhi. Only two used my clinic, and don't go into the ridiculous level of detail that I would like them to because I'm obsessed and it's all I can think about.
Along the way during my Googling, I find that a woman named Adrienne Arieff has written a book called "The Sacred Thread." She had twins and used Dr. Patel AND wrote an entire book about it.
When Adrienne Arieff and her husband Alex learned they were unable to have children, they considered, like millions of American couples, the traditional options. And then they chose what many would consider the most unlikely and unexpected path: surrogacy. In India. The Sacred Thread, Adrienne Arieff’s compelling, insightful, and informative chronicle of her journey into the heart of India to become a mother. With the help of an inspiring Indian doctor, an Indian surrogate named Vaina, a loving husband, some skeptical friends, and a cast of surprising and hospitable Indian friends, Adrienne experiences her own unique path to motherhood. Along the way she discovers the challenges and promises of the growing global phenomenon of foreign surrogacy— what it is and what it means, both for Indian families and for the American couples who seek them out. After three pregnancies, three miscarriages, and dozens of tests and disappointing diagnoses, Adrienne and Alex realized they must seek an alternative route to their happily ever after. Adrienne’s doctor advises that she consider a possibility as far from her mind as motherhood once had been: surrogacy. After Alex reads in the New York Times of the Akanksha Clinic in Anand, India, where a Dr. Patel works to bring together two women from disparate cultures to help each other, the couple immerses themselves in research surrounding a phenomenon they’d never heard of: foreign gestational surrogacy. Several months, hundreds of research hours, and thousands of dollars later, Adrienne boards a plane for Mumbai. There, in the 107 degree heat of Indian summer, she meet Dr. Patel, undergoes IVF treatments, and forms a deep bond with 26 year old Vaina, a surrogate mother who would eventually give birth to Adrienne’s children. Whereas most women like Adrienne return home after the fertilization, Adrienne was unable to stay away. Placing her life and business on hold, Adrienne packs up and moves to Anand for the duration of her surrogate’s pregnancy, immersing herself in the culture and traditions of India, and shaping a lasting friendship with her surrogate, Vaina. As Adrienne and Vahina share their stories with each other, aided by the visionary Dr Patel, they witness first-hand the challenge and promise of international surrogacy. The stories of these two women—an American woman and an Indian woman—are intertwined, creating a surprising and heartwarming narrative that results in the birth of twin daughters, Emma and India, but also gives birth to a transformative and mutually beneficial relationship between Adrienne and her surrogate Vaina. The Sacred Thread offers a unique and revelatory look at the landscape and culture of India through the lens of an American couple searching for family, an Indian family searching for a future, and a doctor offering a chance for both to find what they seek. A timely, challenging, informative, and heartwarming story, The Sacred Thread offers one woman’s perspective on a trend that illuminates our global interconnectedness. Above all, it is the story of a unique friendship between two women from two entirely different worlds, who, with the help of a committed physician, are able to reach out to each other and cooperatively change one another’s lives, through their physical and spiritual gifts to each other.
I think that reading this book will keep me busy for another week while I wait for an update and keep me calm. Who am I kidding? I read it in about 6 hours between midnight and 9am the next morning and go to work dog tired the next day.
There are a few things I disagree with or had a different perspective on, but partly I think I went into this with a better understanding of Indian culture and had some more adjusted expectations. But I'm so glad I read it and it eased my mind and gave me the sense that I know what is happening with my babies on the other side of the world. I went from anxiety to being in a much more relaxed state after reading it, which is the most important thing I can say to anyone expecting through Dr. Patel who thinks about buying it. If you are thinking about using Dr. Patel then this is a great book to read to get you more prepared in the emotional/culture shock sense, especially if you have never been to India. The only thing that prepares you for the finer details is just reading the Dr. Patel surrogacy blog as well as this blog and any other links I've mentioned. We all have to do our own research. I truly appreciate the time and effort she put into this book, and her style of writing does bring you into the story with her. I did laugh out loud several times. But most of all as she sees her twins being born and brings them home healthy, I let the hope that will happen to us in 3 1/2 months finally take roost in my brain and settle in.
Things I learned and random thoughts on the book below:
* I love her descriptions of the town, how it has grown because of Dr. Patel's business, and the impact it has had there. These are things I was too self absorbed and nauseated to look around and notice while I was there.
*She describes the outlook and percieved perspective of the surrogates well, and they do vary widely. Some surrogates have very personal career related goals for the money, others dedicate it to their children or community, but many do let their husbands utilize the money as they see fit. I didn't know that Dr. Patel counsels them about how to best handle their new windfall of money to help build a better future for themselves and their family, and operates a trust at the clinic and makes sure the money is issued to the surrogate herself. The book did remind me of the roles of men and women in this culture that I do take for granted at times because I am such an independent woman and used to gender equality and "love marriage." It helps to hear more about the life of a woman in a small village with an arranged marriage, and what can be see as exploitation can also be seen as placing trust in her husband and his role and decisions in the family. It is very different, but as much as I am for the equality of women it isn't necessarily different in a bad way. It made me think. It reminded me of one of my favorite books "The Spirit Catches You and You Fall Down" by Anne Fadiman, that helps you look beyond what you know and see that what the West judges about the East can often be hasty and misinformed.
*Her experience getting bitch slapped by a cashier at the Ahmedabad embassy after she bawls her out for raising a fee and having inconvenient hours and making unreasonable demands is an important reminder. Unless you are getting completely swindled, if someone in an official capacity says jump you say "How high?" When it comes to getting your babies home, play by the rules even if they seem to change them every 5 minutes. You have no power here. My mother always said you catch more bees with honey than with vinegar. No where is this more true than India.
*Don't email Dr. Patel incessantly with long emails full of questions and demands, and try to understand when the communication is slow, incomplete, or non-existent. I learned that 5-8 new clients arrive every week, and the NICU has a few new babies every week. She also runs an OB/GYN clinic for local women, which I had suspected because of all the locals in the waiting area, but this book confirms. She is crazy busy. She is a force of nature with so many balls in the air juggling, that your anxiety and control issues about your growing baby or your questions about whether you choose her clinic must barely register. She has bigger things to worry about with the influx of people to her daily, like caring for the surrogates and patients and babies right in front of her. She has a lot of life and death in her hands and is also a mother and wife who is a community leader changing the lives of so many. She would rather help as many women and families as possible of those who always find their way to her in high numbers, and I think that is admirable. There is another path where I could see them focusing on building the business and marketing to Westerners and making the appearance and communication the priority. Somehow I think if that happened this clinic would not be the passionate force that it is, and things that matter most would get delegated. I like that Dr. Patel tries to do so much, because it is what tells me about this clinic's ethics and integrity and heart behind it are in the right place. Seeing what kind woman Dr. Patel is makes me trust I came to the right place. I'm frankly amazed that she manages to be as hands on as she is. But in the end, she puts priority on the things that matter despite so many demands for her time. I could learn something from her about that. Though I really would like to know if my package with my contract arrived with gifts and a letter for my surrogate, but like the rest I will have to wait for a response or not get one. But this book reminded me to keep my requests for information in perspective. I wish I could find a way to help as many people in such a profound way as she has, but for now I'll just hope that this blog helps just one person. From my posts on an infertility forum two women have sought me out and are now going to Dr. Patel's clinic for an attempt, one after talking to me on the phone for an hour about my experience. Woo hoo!
* I knew the surrogates were well cared for, but I didn't know how much. They have a cook that makes balanced meals for them. There is a nurse on site that takes care of them, and ensures they each take their pre-natal vitamins. They have a sonogram machine there it sounds like, or have easy access to because it is close to the clinic. They get checkups weekly. They offer more classes than just English classes, and many of the women study books and take it very seriously. Religion is a big part of India, but also a big part of the surrogate's lives with many ceremonies and blessings occurring with Dr. Patel's participation. They have a strict schedule for the surrogates that includes plenty of naps, especially at the hottest parts of the day. The family may visit the surrogate more often and freely than I thought previously.
*You don't have to feel guilty if you approach this more as a business arrangement and don't develop a relationship with your surrogate. Dr. Patel says that a bond or relationship not really the point, and I am with her on that one. But other women feel a strong connection and need to bond with their surrogate. They are the exception, of which Adrienne is a huge one. I have never met our 2nd surrogate, but I know that when I do we will share a connection, however brief, that lets her know just how much what she has done for us means to us. My incessant sobbing at the sight of her and unintelligible "thank you's" will fully get that point across I'm sure. I think in the end as long as you find a way to communicate your appreciation beyond just the financial compensation, that is what really matters.
*I'm not sure how long ago she did surrogacy and when she wrote the book. Some things seem different. I think there is a Domino's and not a Pizza Hut, and there was nothing in our contract about providing breastmilk that I read. I think that the Rama Residency has a better rep now than the Laksh Hotel as a meeting place for Dr. Patel's clients. Either way, they are both nices places to stay. I'm note sure if they both existed at the time she was there.
There was a several month wait, and I truly didn't feel all that hopeful. It was truthfully very dark times. If you told me there was literally a dark cloud hanging over me or you got a chill when I walked by I would believe you. If you get disappointed enough you tend to prepare for the worst, and hoping for the best becomes a lot harder. I admittedly did take it very hard when right after we found out it didn't work on our first try that my brother and sister in law were pregnant with twins. Not news I was prepared for at that moment. I wanted to just be happy for them and not jealous, but that is easier said than done when you are at rock bottom. I wasn't happy about anything. People that have faced infertility understand that reaction completely. People who haven't been where I've been may judge and not understand. I know that I was holding it together the best I can under the circumstances.
So it arrives. Our last ditch effort. We get pics of our little embryos below. Aren't they cute? Five of them. I'm disappointed again there are not more left to freeze, but all are implanted. We did four last time and nothing. So maybe five is our lucky number. And yes, no matter how many implant they will reduce down to twins for the safety of the surrogate. I happen to agree with that and have no ethical qualms about it, though I know there are many that do. Dr. Patel will select on her own the least robust embryos to reduce towards the end of the first trimester and inform you when it is done and send scans.
The two week wait. Then the night arrives. Dr. Patel tells us that on February 13th we will get the results. With the time difference that means I'll be up all night until I get the email, since this time I know what actual day the HCG test is on. February 13th arrives. This will either be the best or worst Valentine's Day ever.
Refresh. Refresh. Refresh.
Drink of water. Pace back and forth.
Refresh. Refresh. Refresh.
Oh my God! There it is. An email from Dr. Patel. I open it. It says "Congratulations!" Our surrogate is pregnant.
I don't believe it. My heart is racing. I've answered suicide and crisis and emergency calls for the combined total of two decades. I am not someone who is speechless. I was speechless.
I walk into our bedroom where my husband is and he can already tell from my face that it is good news. I finally managed to stutter out "It...it...it...says...it says....CONGRATULATIONS!!!"
He grabs me and holds me so tightly it hurts a little bit. He only lets me go when I tell him I need to sit down. I feel a little lightheaded. It feels every bit as good as I hoped it would feel. No...it feels even better than that. However good you think it will feel to finally have the hope light up in your soul again after so many years, it will feel every bit as good as you dream it will and then some.
Our dream is alive again.
We call my in-laws. They cry out "Jai Mata Di!" We call my mother. She cries unintelligibly. I call and wake up my best friend who musters as much enthusiasm as you can expect being woken up in the dead of night. It is without a doubt one of the happiest moments of my life.
I go inside my lovely hotel, the Rama Residency. Sure there are nicer and more expensive ones around for those folks that care about amenities and a westernized feel, but this is plenty nice and is within a 1 minute walk to the Akanksha IVF Clinic/Dr. Patel and also to the NICU. Why stay anywhere else when you are going there on a daily basis one or more times? http://www.hotelramaresidency.com/
The hotel is nice and the BEST place to meet other patients of Dr. Patel and pump them for info and stare at their babies with longing. The AC in your room turns on when you insert your key into a device in the wall, so you can't leave it on when you leave.
Rama decorated for Diwali--the biggest Holiday in India
Cafeteria with great daily breakfasts
Our room looked just like this. Seating area at right off camera.
After I check in I don't even bother to get unpacked and I go right across the street to Dr. Patel's clinic. I have no problems getting there thanks to Hammock Guy that posted YouTube videos of how to get from Point A to Point B all over Anand. http://www.youtube.com/user/hammockguy66
He is the super awesome creator of the forum of Dr. Patel's patients where you can find loads of info and some posts from me. Anything I write here I'll try to make additional to that and not repeat to save myself time. http://dr-patel-surrogacy.com.
So I get to the clinic and Dr. Hitesh can see how tired I am and greets me and tells me to go back to the hotel and get some rest, then come back later in the afternoon for my first IVF shot. There are lots of men and rickshaws waiting around the area, and the waiting room is full of folks. They always smile at the foreigners, or maybe just me because I wear a saree and follow the custom to remove my shoes and leave them outside even though they don't expect me to. I sign in up front with my name and contact info, and they write down and give me a patient # that I will use for reference during my trip. They don't seem to be expecting me or know this is my first day, and this alarms me a bit. They immediately direct me to Dr. Hitesh's office outside.
Dr Hitesh's English is great, and I'm used to Indian accents so no problems understanding anything he is telling me. He gives me a map (copy found on blog) of the area and where to eat, and says we can take care of business details later. I follow orders and get some sleep. I find out later I am on their schedule for surrogacy and they are expecting me, but Dr. Patel has that info and Dr. Hitesh and the front desk don't have immediate access to scheduling and so it seems a little more disorganized than it is. Dr. Patel has a lot of people assisting her, medical or otherwise, and I see her pass by in a flurry of activity as I depart to take a long overdue nap.
When I go back in the late afternoon the clinic that was previously a hustle and bustle of activity, it is almost abandoned. Now let me say if you are used to American medical clinics that are perfectly sterile, then India will be a shock for you. Having been there before and finding the USA to be a little overboard with sterile conditions I had no problems whatsoever, save the one occurence on this one day. Even my American physician said that somewhere between the US and India is probably the happy medium on sterile conditions, and the US takes it a little overboard. The equipment is not brand new but everything is clean enough and they take new needles out of the package everytime. The "Vampire" guy that takes your blood doesn't wear gloves. But the man is good...this is all he does. But the only thing that bothered me regarding conditions was on this day, because the sharps container is just a bucket. This late in the day it was overflowing and there were needles on the floor. Remember that I was barefoot, so I tread carefully. But other than that, I felt perfectly safe. I get my first shot in my belly, and that's it. This was my first time doing IVF since we were hoping to use my eggs.
Having never done IVF before I didn't know what to expect, so that made my anxiety level higher than most. Also, my husband was not with me. He speaks some Hindi and so having him there helps, though they mostly speak Gujarati there and Hindi is of little use. I was lonely without him, and Dr. Hitesh commented on how much more I smiled when he arrived. But ultimately here is what it is like:
1. You go in and get a shot almost every day. You get blood taken and trans-vaginal sonogram seen above every few days. It will hurt cause she has to poke towards the ovaries where you are already swollen, but it ain't that bad. There is a curtain in front of that area, but lots of folks coming or going, but all female. This curtained area is directly behind Dr. Patel's desk in her office full of assitants rushing about. The only bills I received in addition to what I was told beforehand was for bloodwork, and it was minimal.
2. Your time with Dr. Patel will be brief and to the point. She will give you updates on how many eggs are growing and such. You can ask questions. However, I recommend letting the doctor be the doctor and not try to control everything, and if you are very experienced with IVF and into all the details that may be challenging for you. Communication here is not what you would expect in the US, but some of that is a cultural difference that I knew to expect. She will make the decisions and inform you after, to include how many eggs she implants.
3. Unless you've never been to India and want to do the tourist/shopping thing, there is not much to do in Anand. All the places to eat and shop are on Dr. Hitesh's map and in the blog link above. I was bored, and so nauseated I barely left the room. It was a little too hot for me to go out in that state in the middle of the day in October, but I ventured out a few times. Thank goodness for wireless internet and TV, with I think 2-3 channels in English that were playing a Schwarzzenager movie marathon unfortunately. I saw True Lies 5 times. I mostly went out to Big Bazaar for foods that didn't make me want to puke. I hated buying westernized food when I love to eat local fare, but I have never been so consistently nauseated and bloated in my life. For this reason I won't comment on the food at Rama Residency, because it may have been much better than it tasted to me at the time. I did drink the milk and eat fruit with peels, but as long as you stay away from the non-bottled water or unheated water you should be fine in my opinion.
Kellogg's & Cadbury are the few recognizable brands you'll see
I did realize that computer where all emails are recieved and responded to is right next to Dr. Patel's desk. There is an assistant on it all the time. I think most emails, of which they recieve TONS from everyone from current clients to prospective ones who want to know every last detail, are answered by an assistant. Sometimes she must copy and paste some FAQ, other times it is personalized. But I realized that the reason my email responses were stilted and brief and sometimes didn't answer all I asked was for this reason. They are VERY busy. It seems they get a lot of folks who want to know about and control every last detail. I am low maintenance in comparison, and if I wasn't I think that alone would drive me nuts.
They do track payments but aren't really demanding or communicative about due dates, so when I asked about the first payment transfer I found out that I did need to get the money transferred. Below is a chart I made of what it costs for those who are curious about doing it themselves. This is only what I came up with and not something they gave me, and doesn't include initial travel costs like airfare and lodging and food, etc. Some stuff I won't be sure on until we actually pick up the babies. I'm told the NICU fees are about $40 per day per baby, and with twins 1.5-2 wks in the NICU is common and she tends to delivery by C-section at 35 weeks. We'll see how true that is come September!
I did get to meet the surrogate, and it was a tad awkward and while Dr. Hitesh was available to translate....I didn't have much to ask beyond basic chit chat. I got a very good vibe off of her and she seemed like a confident and strong young woman who was determined to do this for her family.. Dr. Hitesh offered to take a pic with her so I did. I no longer have it because I deleted it when our attempt did not work. Anyway, she was cute as a button and got married at 15 years old to a farmer, and had been married 10yrs. She looked healthy and was shorter and smaller than me, and had very demure mannerisms. He asked if there was anything I wanted to say to her after I read the very basic profile of her he had handed me. I just said directly to her "Ghano ghano dhanyavad" which means thank you very much in her language. I got choked up when I said it to her, and that was the first time she smiled. I realized that was all I needed to say.
I did meet some couples who were suprised at the surrogate selected for them as they were older or very skinny, however ours was young and very healthy looking. I think the more slender body type is common here. You don't have control over who your surrogate is, but they will be married with at least one child. They will select one whose cycle is synced up with yours or the egg donor's. I trust Dr. Patel and I trust her selection process. I'm sad that it didn't work out with our first surrogate. I haven't met our second surrogate because we used donor eggs and a frozen sample, but I can't wait to meet her. I sent her a package with sarees, photos of us, and a personalized letter of thanks that I had translated into Gujarati below.
We thank you so very much for what you are doing for us.My husband and I are finally so happy!You are making our dreams come true. We know that carrying two babies will be difficult and you are sacrificing much time with your family. Your help in creating our family is giving us the happiness we have hoped for over eight long years of waiting. We hope that the money you receive for this incredible gift will help to make your dreams come true also.
I have not been able to carry a baby for more than a few months before it would die, so I have grieved for so many years. But you have made hope possible again. My husband and I and our entire family pray for you and your family every day. All of our parents are older and in failing health, but now they all have new life because they will get to meet their grandchildren. My husband and I married in 2004, and we have wished for children since then.
In 2003 before my husband and I were married we traveled to New Delhi India so he could introduce me to his family. We did not think then that we would get married, but a wise old man who was dying read our palms on our hands and told us our future. He said that we should be married as soon as possible, and our marriage would be very long and successful. He had never met us and knew things there was no possible way he could know. He told us that one day we would have two children, and then someday adopt a little girl. For so many years I thought he did not speak the truth, but now I know he was sent from God to give us hope...just like you were.
We will give both babies a wonderful home in the United States in the state of Texas. They will always be loved and well taken care of. We have sent you some pictures of us and our family from our wedding. Later when we finish the room for the babies we will send you pictures of our house. Please also accept these gifts of sarees. I hope you like them and wear them, but if you do not wear them I’m sure you can give them to someone who will be able to use them. Even though I am not from India I have always loved and worn sarees, so we hope you will like these.
