Posts Tagged ‘Acute Fatty Liver of Pregnancy’

I think it’s because things feel like they’ve settled down here that I’ve been having thoughts of wanting another baby. We feel more grounded as a family: we have an awesome babysitter who comes 6 hours/week so I can go to the studio, we’re more financially secure, Wifey’s work schedule is more manageable, and A. gets more wonderful every day.


For me, it’s not necessarily a logical thing to want another baby; it feels more biological, or hormonal. Or something. I’m having baby urges again. It’s hard though, because the exuberance of the urges is tempered by the thought that I can’t get pregnant again (because I might have the same complications as last time, my liver could shut down and I could die).

Last night I had a dream that I had just found out I was pregnant. I was giddy with joy, but then I would remember the warnings of the liver doctor, then happy again, back and forth. I was walking down a street in a foreign country (Spain?), and there were women singing on the side of the street. I was wondering excitedly, “I wonder if it’s a boy or a girl?” And just as my mind formed the word “girl,” my favorite girl name came as the next word in the women’s song. I was sure it was a sign that I was having a girl, this would be my S.  I was light with joy.

I’ve had an ache in my heart all day, because this won’t ever happen. It seemed so real; it is not that crazy a thing: to already have a beautiful child and then to get to have another. I won’t ever be pregnant again.  It was such a beautiful dream. It felt so natural. I felt so at home with the feeling of having a baby girl growing inside me.

I’m haunted with the thought that maybe there’s some way I could get pregnant again and stay healthy. Maybe my complications in my pregnancy with A. originated with the placenta, as opposed to originating with my body. The doctors acknowledge that this is a possibility, but maintain that there is no way to know. It could have been the placenta, and I could be fine next time. Or it could be that my liver shuts down when I’m pregnant. If I were to get pregnant again and my liver started shutting down, it could be at 27 weeks, or 34 weeks, or 16 weeks, or 23 weeks. The baby would have to come out and most likely struggle in the NICU for months, and be at risk for many many complications we were so fortunate to have dodged with A.  I would hopefully survive and hopefully my liver would recover after 3 months of steroids.

I’m totally on board with the logic that it is not worth these risks.

Wifey would probably do splendidly pregnant, and yes, we are lucky that there is another uterus among us. She has never had the subconscious/conscious/bodily urges to be pregnant. She’s also not sure she wants another child. Which is totally reasonable. She’s (I admit, rightfully) terrified of increasing the chaos in our life. She agrees that it would be doable, it’s just that our resources are thin. Our place is just barely big enough for the three of us, our income just barely enough, our time with each other and for ourselves is already stretched thin.  It’s the logical thing to enjoy the settled feelings we’re experiencing now with our little family, rather than throw it into upheaval and invite more unknowables.

I still often feel like I can’t believe I was really pregnant. We had a pregnant friend over last night who is having a great pregnancy, and she looks perfectly healthy and totally wonderful. I guess even if I never looked like that, I was still pregnant. Our pregnancy was terrifying most of the time, but I was still pregnant. I was swollen and not beautiful, but I was still pregnant.

August 2007, didn’t even know I was pregnant yet:


Just a few weeks pregnant, already nauseous and zonked.


13 weeks:


15 weeks:


17 weeks


20 weeks, Christmas


21 weeks, January 2008


25 weeks


26 weeks


27 weeks


27 weeks 3 days: February 9th 200827weeks

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We got the results of my final follow-up Liver Function Test, and the liver specialist has proclaimed my liver NORMAL!!!!!!!!!!  Yipppppeeeeeeeeeeeeeeee!  Now we are 100%, rather than 90%, sure that my disease was limited to pregnancy and is OVER!  and I am HEALTHY!   How boundlessly grateful am I.



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I feel really nervous sitting down to write this. I want to write it all out so that I can anchor myself in the present as I plan A.’s first birthday.

This is the first time I saw my son, standing.


I was totally drugged on magnesium for the first day and a half after A.’s birth (to prevent seizures as my liver was recovering).  He was born on a Saturday night, and I didn’t realize I had had a baby until Monday.  Am I a mother?  Do I have a son? The first time I let myself think those thoughts, I was washed with a joy uncertain. It would rise up like a question, I would hold it a minute, then let it go before I got too hopeful.

W. and I had no knowledge of preemies and their ability to turn into healthy kids, so we were terrified and in shock. It would have helped immensely if I had already been connected to this blogging community.

There were so many weird, fucked-up feelings coursing through me, especially the first few days.  I read about these feelings in support books, but I was certain that mine were worse.  There was:  Fear of my baby, fear of looking at my baby, fear of loving my baby and getting attached to him, fear of dying and not being able to raise my baby. Disbelief that I had given birth. Feeling like I was cheating, somehow, if I said I gave birth, because I didn’t, really; rather, I had to have a crazy emergency surgery because I was very sick because my body failed pregnancy and instead got me and my baby very sick. I was actually embarrassed. I had to call and cancel a hair appointment for February 14th, and I was embarrassed. Embarrassed that I had failed, as though my pregnancy and now childbirth were a sham.  Had I really even been pregnant? Even that seemed doubtful at this point. Resentful that this was my baby’s birth. Resentful that the name we picked out for our healthy beautiful baby was going to be given to this baby. (How terrible is that? That is the worst one.) Mad at myself for all the fucked-up thoughts. Mad at myself for failing my baby. Mad at my body for not doing what it was supposed to do. Worried that he would die. Worried that he would have permanent health problems. Worried that I would die. Worried that I would have permanent health problems.  Disappointed that there would be no beautiful pictures of me and my baby just after birth, with me looking tired and blessed and him looking new and whole. Instead there would be incubators and wires, and me all swollen and sick. Guilty that I wasn’t what he needed now, for his third trimester. I couldn’t give him what he needed to live. I had failed, and the job was passed to the professionals, who would do it right. Guilty.  I know he needed my milk and that I succeeded in giving it to him. But at the time, I didn’t believe he really needed it, because I had failed him on all counts. I thought the nurses were just telling me it was liquid gold to make me feel better. Sometimes, I couldn’t imagine that there was any way this was all going to be OK– that he would be OK– and I would long for my life before I got pregnant.  Guilty. Guilty for not believing in him from the very beginning. Guilty for not landing on my feet and hitting the ground running. For not launching myself into motion right away and determinedly seeing him as a fighter and myself as his tireless cheerleader. He was a helpless thing that I failed. And what was I? Really, I didn’t know.  I was his visitor that would try not to accidentally hurt him while taking his temperature and changing his diaper.


I would see the equipment, the nurses, the specialists, and be stunned, thinking: wow. you really have hope for this little being.  your hope is more beautiful than mine. mine is desperate, doubtful. yours is certain and steady and generous. mine is selfish and wounded.  yours is the hope that he needs right now. you are what he needs right now.  why am i not the one he needs right now?  how can i be the one he needs right now?  am i doing this right?  is this hurting him?  why are his alarms going off?  is this normal?

Much of the time in the NICU, I was keenly aware that I wasn’t supposed to be seeing him yet; he wasn’t supposed to be born yet. Looking at him in his isolette, I often felt like I was looking at an ultrasound. I was seeing my baby, but I was taking a peek at him through a barrier that felt 2 feet thick; I was catching him off guard, disrupting him.

From the very beginning, we were told that there would be good days and bad days; that we’d be on a rollercoaster for three months. That things might get very scary. We were very fortunate that things never did get very scary. There were definitely days that were harder or easier or more distressing or assuring, but there was no day among the 99 days where anyone was truly concerned about his progress. Yet the neonatologists, nurses, respiratory therapists, physical therapists, nurse practitioners, lactation consultants, social workers, other parents, and March of Dimes ladies were constantly reminding us that things could get bad any minute now. We were on the edge of our seats for three months, always waiting for the other shoe to drop. There were echoes of other people’s shoes dropping all around us. Two babies died in our nursery.

All of this, and I still knew—I have to admit that I always knew– very deep down, that he was going to be OK. I looked at him, raw and red, and saw a perfectly formed baby. Did I really make him?  Look! He has toes and legs and hair and hands!  He is perfect!  Just very little is all.


He is holding W’s wedding ring in that picture.

I was excited to blurt his name, his full name, to anyone who would listen. I was certain it was the best name in the whole world.  I drew hearts on all the February 9ths on all our calendars, like a 12 year old with a crush. I sent an email out to all of our friends and family, with the subject heading: our little bird.

He was furry. Especially his shoulders.  We could touch him gently by “containing” him, putting our cupped hands around his head and feet.  He would calm when we did this. It was a few weeks before I could hold him. I felt like his mother when I held him.



Cheech and Chong taught us how to pump. It was funny, but also like Hell.  Two night nurses showed up around 11:30pm the day after his birth. One spoke Chinese primarily, the other spoke Spanish primarily. “Hello Susanna! Do you have pain?! How are you?!  Now, you pump!”  Are you kidding me? Now? I’m only a few hours off the magnesium and totally wiped out. And, Really? You think I’ll even make milk? How could my body possibly make milk? They smiled with relentless cheer and bickered about how best to wash the pump parts, reprimanding Wifey, “No! You wash three times hot water, one time cold water! No soap!”  Then the other would tell us the opposite. “Use Ivory soap only!  You soak 20 minutes!” Then the next day the lactation consultant told us something completely different.

It sucked being in the postpartum unit, where I could hear healthy babies crying in the rooms next door with their mothers.

I was discharged on February 14th. Two days later, my C-Section incision opened. And I was also feeling some of the same abdominal discomfort that I had felt the few days before he had to be delivered; maybe liver issues?  Back to my OB. To be sure the liver issue had resolved itself (as it usually does with HELLP Syndrome), she did bloodwork. My LFT (Liver Function Test) was still very high. (It is supposed to be 0-40 and mine was in the 400’s). I was readmitted to the hospital, and stayed for another frightening week. No one knew what was wrong with me. Sometimes HELLP shows up/sticks around after delivery. Since delivery of the baby is the only cure for HELLP, what do you do if the baby is already delivered? Obviously, you die. Or, remain heavily medicated. But no one was telling me that.  They were just running lots of tests, doing labs twice a day. There was the possibility that it wasn’t HELLP after all, so I was visited by a different doom-speaking specialist every day, and each would order a nerve-wracking ultrasound of a different body part, usually to be performed at some ungodly hour of the day. There were perinatologists, gastroenterologists, wound care specialists, and all the OB’s in my OB’s practice.  I behaved bizarrely stoic through all of this, even cracking jokes with all of the medical staff working on me, and I’m usually not really that funny. I took pictures of them doing wound care on the 1.5″ deep, 5″ wide gash in my abdomen. Really, I was scared, mainly at night. W. stayed with me every night, sleeping on a cot. I would usually wake her in the night and ask her to climb into my hospital bed so that I could feel her breathing and relax enough to sleep. I was very afraid that I would die of this strange disease.

A week after delivery, my LFT was still climbing, not lowering. After ruling out several more possible causes, the OB’s and perinatologists gave up and handed me over to the liver specialist.  He was fatherly, with thick Scottish sweaters. He assured me I would not die, and put me on a hefty dose of prednisone, and the LFT started going down, slowly. I was discharged, and we’d have to wait and see what my liver did on prednisone over the course of a few months. More diagnostic possibilities were weeded out, including three different forms of autoimmune hepatitis, which is what the liver specialist thought I had. This would have meant being on steroids the rest of my life. Each of these tests took forever, and it was weeks before we had answers. Hepatitis E was also ruled out, but first I was called (as in, personally, on the phone, for 45 minute interviews) by the (suddenly concerned!) federal and state government health departments to see how I might have contracted Hepatitis E without having left North America in the last 6 months. Oh yes, I felt special.  Only one case per year is reported in North America, and it is more common in India and some other developing countries. The most rare of all of these possibilities was the very last one, the one the liver specialist took forever to admit that I had. Variant Acute Fatty Liver of Pregnancy, which one in 15,000 women get. It is usually diagnosed after death, and otherwise can only be diagnosed by biopsy or, the preferred and  less-invasive method, process of elimination. The OB’s still refer to it as HELLP, because Acute Fatty Liver of Pregnancy and HELLP are on the same spectrum of liver shut-down. It’s like you have preeclampsia on one end and then HELLP and then Fatty Liver.  A person recovers from Fatty Liver of Pregnancy, once the LFT is managed, usually–hopefully– without the help of steroids beyond a few months. I was going to be fine. But I was told that I would die if I tried to have another baby. I was finally weaned off the prednisone on May 7th, A.’s due date.  (Ironic, isn’t it?) I had to go back this week, actually, for my 6 month follow up blood draw to check my LFT, to make sure it is still down. I’ll find out in a week. It was hard being back there, like visiting an old nightmare.

There’s this Bonnie Prince Billy song called “No Bad News” on the album The Letting Go that goes:

hey little bird
hey little bird
thank you for not
letting go of me
when I let go of you.

That’s the song I sang to A. over and over as I held him on my chest.


He was so light. We kept him covered with blankets that had been warmed for him. Gradually, we did “skin to skin” for an hour every day. I brought my own bathrobe, and would wait with butterflies in my stomach for the nurse to tell me he was stable enough to be held that day.




Alarms were always going off, for him and the five other babies in his nursery.

Fortunately, we only live 10 miles from the hospital A. was at. I wasn’t one of those mothers who stayed at the NICU for fourteen hours a day. (more guilt).  Wifey and I would go for about five hours per day, either together or alone at two different times. The last few weeks I would stay longer, but earlier on we couldn’t really go more. I was still sick, and W. was trying to take care of me and go to work, and keep our bills paid, our food stocked, our dog happy, etc.

I was a cheeseburger-eating zombie for three months. Stoic, if I’m feeling generous, but mainly depressed and single-minded. The prednisone was doing weird stuff to my mood. I would walk through the halls of the hospital feeling like I was in a bubble, somehow floating through the real world without being a part of it. The bubble effect was even greater outside the hospital.  I was actually glad to have to pump every 3 hours because it gave me something productive to focus on. I felt lost and confused and dim witted. Somehow the time passed. I ate lots of cake in the hospital cafeteria. My parents visited a lot; my mom went with me to my scary doctors appointments. We would both eat cake. I think I was taking refuge in the cafeteria, because it seemed like the greatest place at the time.  I had three doctors appointments each week for a while: wound care, OB, liver specialist. Doctor, pump, NICU, cafeteria, sleep, repeat.  I guess we only renewed our monthly parking pass 3 times, but it felt like 10.








Often A. would sleep through our visit, often he would fuss in discomfort. On those days I would leave deflated. Other days he would engage and interact with me and it felt like the moon in my hands, we would have conversations staring at each other. There were good days practicing breast feeding and bottle feeding and scary days where he choked badly. Once he stopped breathing — choking while breastfeeding — and I had to shout out for the nurse. I think that incident had some lasting traumatic effects, because for months afterwards I would break out in a sweat with anxiety every time I nursed him.

There were three blood transfusions, no surgeries, 8 days on the ventilator, many weeks on CPAP, then vapotherm, then nasal cannula. He stayed in the ISCU for three weeks after he was off oxygen because he was having a hard time eating via nipple. He did better with breastfeeding than with the bottle (an uncommon occurrence), but still not well enough to get a full feeding, eight feedings per day. Each day in the ISCU seemed so long. I started getting more demanding with the nurses, quizzing them at the beginning of their shifts. I was starting to believe that I could take better care of him than they.  We would get hopeful that he would be coming home, then have to wait. May came, and with it his due date, my birthday, and Mothers Day, all passed. Everyone kept saying, “It’ll be at least two more weeks.” Then on May 15th he yanked out his own feeding tube and they didn’t put it back in. On May 16th they said he was coming home tomorrow. I don’t think it was until that day that we let ourselves totally believe he was really ours, that we would get to keep him. That we could really be this lucky.


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I. Examining The Pregnant Body


I look at this picture and still can’t believe that’s my belly. The third trimester must be when pregnant women get to really “feel” pregnant and get used to their new identity. I wouldn’t know, because I didn’t have a third trimester.

I had always thought I would make a great pregnant woman; in fact, various friends through the years have said so, too.  Maybe it has to do with body type?  If your body looks like the Venus of Willendorf are you assumed to be as fertile as a Midwestern field?



And perhaps the Olive Oyls of the world are thought to be less reproductive?


In my own personal experience, the opposite seems to be true. I know several Olives that made babies with no problem at all, whereas my Venusy body didn’t adapt well.


II. Bleeding

I had bleeding throughout the first trimester, which was scary every single time. Having had a miscarriage, of course I feared each drop of blood was my baby dying.  After ultrasounds and exams, the cause of bleeding remained unknown. Also, I was nauseous and exhausted for 16 weeks.


III. Down Syndrome?

The second trimester brought one singular fright, which dragged on for many weeks. We opted to have the genetic screening done, because what the heck, it would mean we’d get to see the baby one extra time in an ultrasound. And also, it would allay some worries.  The results were bad.

So, how it works is, various hormone and protein levels are tested in your blood work. When there is a chromosomal abnormality, most often your various hormone and protein levels are higher or lower than normal. The levels are entered into a computer. The computer calculates your risk factor for having a chromosomal abnormality, most commonly Down Syndrome. If the calculated risk is 1 in 250 or greater, you are considered “high risk” for Downs, or a variety of other abnormalities, and are directed to have an amniocentesis. My bloodwork was so off-the-map that our risk factor came out 1 in 3 for Downs, and 1 in 30 for something much worse than Downs that the baby would not survive.

This was very hard and sad and scary. We cried a lot. We met with a somber, kind genetic counselor in the Perinatal wing of the hospital, a wing most people hope they’ll never set foot in. We decided we would keep the baby if it did have Downs. This all happened at this time last year; on Thanksgiving we still didn’t know the outcome. We had to wait weeks to have the amnio, then more waiting after the amnio.

Then finally one morning, our first good call from the doctor: the baby is fine, healthy, no abnormalities. Flooded with relief and joy boundless. Yet we still didn’t know why the bloodwork was so off.


IV. Translocation?

Then a few weeks later, the genetic counselor called again to say that upon further scrutiny, the amnio did reveal a chromosomal abnormality called a  translocation.  So you know, every chromosome has a mate; they are a pair. Well, with a translocation, a piece of one chromosome leaves its mate and joins up with another pair.  There are combinations of triads that mean absolutely nothing because no genetic material is lost in the regrouping, and there are combinations that result in retardation, various health issues, death.trans1

More testing and waiting to see which kind of translocation our baby has: The totally harmless translocation (balanced) on the one hand or the seriously awful, devastating translocation (unbalanced) on the other. This means doing further studies on the amnio, and bloodwork on me.


V. What Are The Odds?

1 in 1,000 people have a translocation of the harmless sort, which is usually genetic.

I am one of them. And now, so is A.

Relieved, we are saved again, but feeling too emotionally exhausted to make a full recovery. How many more shoes are going to drop?  We still don’t know why the bloodwork from the genetic screening was so whacked beyond belief.


V.  Swelling

I looked sick most of my pregnancy. Pallid, pasty, very swollen and tired. The swelling led to bad carpal tunnel in both hands, which was especially bad at night.  I felt like something wasn’t right, but discounted it because who wouldn’t feel that way after having had so many things go wrong? Plus all of my pregnancy books, and my OB, described the swelling, carpal tunnel and fatigue as normal symptoms of pregnancy. So I just thought that for whatever reason, I was simply not the vibrant, glowing pregnant woman I had so badly wanted to be. We don’t have a ton of pictures of me pregnant.

I’m an artist, a painter. During my pregnancy, on the rare day I felt good enough to go to the studio, I was drawing volcanoes, couldn’t get enough of them. At the time, I didn’t know why I was obsessed with these big swollen mountains that look rather serene but could explode at any minute.  ha ha.

Here’s the volcano in the backyard of my fair city.  Actually, I had A in a building just barely off the left side of the picture.



VI. Growth Restricted

Because we still didn’t know why my bloodwork was so incredibly weird, my OB decided to do an extra ultrasound at 28 weeks. She said that sometimes weird hormone and protein levels can indicate a growth problem. I happened to schedule the ultrasound at 27 weeks. So, in we go at 27 weeks, February 5th, for yet another ultrasound where the technician is visibly concerned but not saying anything. There is silence, the rechecking of measurements, waiting while she gets the radiologist. There couldn’t be another thing wrong, right?  No, I’m sure everything’s fine. They just aren’t allowed to say anything. Yeah but she looked weird, concerned. The radiologist comes in and says we need to go immediately to the OB because there is a serious problem with the baby. He is growth restricted because the placenta is not functioning well.

In shock and distress, we make our way to my OB’s clinic. She isn’t there, so we see another doctor in her practice. She says that tomorrow morning my OB will most likely have me admitted to the hospital.

We don’t believe this could really be happening, and so don’t pack a bag.

But it is really happening, and in the morning I am admitted.


VII. Admitted


I am put on bedrest so that as much of my energy and bodily resources can go to the baby as possible. He is struggling to get nutrients from a placenta that is just not a good placenta as placentas go. Apparently you can have a healthy baby alongside an unhealthy placenta, even though they were made together in the same Big Bang of conception. We don’t know why exactly the placenta is bad. I am visited by perinatologists and neonatologists who give me warnings about what could lie ahead: extreme premature birth and its host of possible health problems for the baby, including heart problems, breathing problems, brain bleeding, cerebral palsy, hearing impairment, vision impairment, developmental delays, basic survival stuff, etc. I get the steroid shots to help with the baby’s lung development. They say they want to keep the baby inside me as long as my uterus continues to be more hospitable than the outside world. The outside world isn’t a very hospitable place for a 27-weeker, so I hate to think of the dreadful habitat my uterus provided. The doctors are excellent, and it turns out we have unwittingly landed in the best hospital with the best perinatal and neonatal care in the region. Knowing this helps.

The hope is that I will be in the hospital for three months for a full 40 week gestation. The realistic goal is three weeks, for a 30 week gestation. I make it three days. Three days that, aside from the odd jacuzzi dip and cafeteria lasagna, are a constant barrage of tests and frightening midnight ultrasounds.

My blood pressure goes up, protein is found in urine, I develop preeclampsia. My back aches in a new and strange way, like front/back cramping.  Once you get preeclampsia, you have earned twice-daily blood draws to make sure the condition doesn’t turn more serious. It does turn serious quickly and without much ado.

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I wish I had started a while ago, when A was in the hospital. Or even earlier, when my pregnancy started to get all scary.  Or while we were trying to conceive…. I suppose I could keep going back.  Blogging communities are such a unique place for support and story-sharing. A blog writer can be semi-anonymous; that is, anonymous enough to feel free to talk about personal things without taking many risks.

I suppose many, or even most, contemporary American babymakers get a lot of comfort and support from our mainstream contemporary American babymaking culture– the effect of which is so much stronger than I ever thought. I didn’t think I cared about it. It turns out it had infiltrated my subconscious, probably before I could even say “Barbie.” I have deviated from the norm: by being gay, by having a miscarriage, by having a difficult pregnancy, by having a preemie, by nearly dying in childbirth, and by having postpartum depression (along with a host of other postpartum acronyms; ah the bouquet: PPPTSD anyone? How about PPOCD? PPAD?)  As I interact with other moms who had babies around the same time I did, I feel like there stands between us many layers of my otherness. I still enjoy their company, as probably one day my baby will enjoy their babies’. But I am frequently reminded of my differentness, and the different circumstances that got us all our babies. At least I am white (like they all are) and speak English as a first language (as they all do); otherwise, it might be too much to bear. So, maybe by having some virtual/blogging friends who are gay, some who have preemies, some who have dealt with depression or a miscarriage, or difficulty getting pregnant– maybe I’ll have all my bases covered, with the cumulative effect of feeling less strange. That is my hope.

I started reading Alexa’s Flotsam blog first, at the suggestion of a dear friend. As someone who had never read a blog before, I found the similarities between my and Alexa’s stories totally incredible, as though stars had aligned to make this amazing connection. It turns out she has hundreds of readers all over the world who share a similar connection. She is an amazing writer, with the uncanny ability to describe the big and the small in the same paragraph, without either losing any sincerity. I would read her posts with mouth gaping, “Oh my god, that is exactly what A is doing this week!”  And I would read the comments her readers wrote– so caring and encouraging.  I clicked around, and soon came up with several blogs I was interested in enough to check on regularly. I’ve been doing all this online stuff while pumping, so every night I’d see how people were doing.

I started to see a trend among the women whose stories I’d learned:  When it came to babymaking, they didn’t have it easy, one way or another. They didn’t have it normal. Sometimes it seems like the world could be divided into two groups: those who had babymaking easy-peasy, and those that had it world-crashingly difficult. I know that there’s a vast gray area between the two, even amongst the blogs I read. But still, the difference is there.

My sister-in-law didn’t have to miss a single day of work her entire pregnancy, “might have been a little queasy one day,” carried past-term, was in labor for 2 hours, and pushed for 20 minutes.  Whatever.

I’m glad you all are out there. And I’m glad I finally got the gumption to add my story to the mix.

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