Late Termination

1.
I punched the 5 digit number into the phone and waited for someone to answer… “Hi, this is the gyne resident, you paged?”

“Yes.  The induction is here. Can you please come and write orders and get things started?”
I wasn’t aware of any induction, nor was I in the right frame of mind to initiate an induction.  Where I live, “late terminations” by induction of labour can be performed for lethal or life threatening fetal anomalies up to 24 weeks.

I went to the ward where the patient waited for me.  She was likely not expecting the person about to initiate her induction to be just as pregnant as herself.  Her chart was clear – her due date only 2 days before mine.  Her unborn baby the same size as mine… moving and kicking and full of life, just the same as the one inside of me.  The only difference: my baby had a normal heart, and normal kidneys, and a normal bowel.  Hers did not.

I went into the room to find her laying still on the bed.  I hoped my scrubs were loose enough to disguise my swollen belly, even though I knew it wasn’t likely.  I explained to her the procedure – how I was going to giver her some medication that would make her cervix soft, and that I would put a small balloon inside her cervix to help it open up.  Essentially I would be inducing her labour, and then she would give birth to a pre-viable fetus that would not survive.  My baby in.  Her baby out.

I sat on the cold, metal stool between her trembling, spread out legs.  I placed the speculum and opened to find her swollen, closed cervix.  “You might feel some cramping now,” I said as I slid the catheter into the opening.  I began filling the balloon.  She winced.  Bright blood started to trickle from the end of the catheter.  I slid the speculum out and placed the medication in its place.  “We’re done.”
I felt my own baby kick me from the inside.

2.
It was 5pm and my night shift was just getting started with handover.  “The woman in room 6, she’s  an indiction for cardiac anomalies.”  I cringed.  It had been less than a week since the last induction.  I didn’t think I could handle another one so close.  “The patient and her partner are not coping well, just so you know.”
This time the baby was already gone – the family had chosen an intracardiac injection prior to induction.  This time her due date was the same as mine.

I decided not to meet the patient – unless there was a medical issue that needed attending, there was no need for me to go in.  I hoped that it would be a slow process and that I could get through the night without being called to see her or her stillborn baby over the next 14 hours.  It almost came to be.
But 30 minute before the end of my shift the nurse called me: “I’m really sorry, but her foley came out and Dr. X called and wants you to break her water.”  It would have been “inconsiderate” for me to leave that task for the person coming on after me.  So I went.

Again, I was too conscious of my own pregnant belly – of my own live, healthy baby who is perfect and who is still alive.  I pulled the scrub gown I was wearing backwards around and over my swollen-ness.  I introduced myself with trepidatious confidence and then sat at the end of her bed.  I proceeded to do what I do so often for women in labour with babies that they are going to bring home with them.  I felt her cervix and stretched it open.  With elegant ease I slid the hook up against my fingers until it reached the tough, premature membranes.  I felt sick at the thought of my hand being so close to a dead baby, the same size as mine.  I almost said that I wasn’t able to reach, even though I could.

I tore the membranes apart and watched as the clear, straw coloured fluid poured from her body.  Suddenly my fingers felt vast space and openness.  I felt my heart skip a beat as I was unable to tell if her cervix fell from my grip and I was feeling her vagina fill with fluid, or if her cervix was suddenly wide open and at any moment I would catch her baby with my fingers and deliver it right at that moment.  The water seemed to gush forever and my hand was paralyzed in place.  I feared that I would feel the delicate touch of her baby’s hands or feet or head and I wanted that moment to be over.  When I could no longer handle the thought of delivering a stillborn baby the same age as mine, I pulled my hand out and tried hard to stand without fainting.

It was the end of my shift.  I went home to sleep.  I woke up hours later and decided that I was done doing late terminations as long as I am still pregnant.

Advertisements

New Year, New Challenges

I have been meaning to sit down since the beginning of the month to blog about my goals for 2016.  However, I have been feeling the constraints of time, exhaustion, and just plain uncertainty about the goals I want to set for this year.  Last year felt like it had a completely different “flavour” than this year: I was hugely focussed on fitness, being healthy, expanding my social circle, taking time for myself, and basically becoming better integrated into my new life in my new surroundings.

This year, however, feels much different.  I feel like I am in constant battle with myself over my life decisions and choices.  I have been questioning whether or not I am in the right field of my career; I am struggling with maintaining an adequate work-life balance; I have a new baby on the way and I am both excited yet scared about what this will mean for my family… this list goes on. With all of these thoughts and challenges swirling around in my mind, it is hard for me to focus in on specific goals that would help to “make me a better me.”  Not only that, but I am finding it difficult to set realistic and measurable goals in the midst of all this mental turmoil: After all, a goal of “figure out what I want out of life” is not a helpful, measurable, or realistic goal.

As a result of this year’s “different flavour,” I am going to use a different format for setting out my goals.  Last year I set 11 goals and organized them according to categories like Health, Personal, Family, Misc.  Goals that were successful for me last year included: running a half marathon, meeting new friends, engaging in other fitness activities aside from running, reading 12 books in the year, and making more meaningful time for my husband and kids. Those are all goals that I would like to strive for again, maybe with slight modifications.  This year I will have a completely difference scheme: First, I will have some overall year long goals, and then I will have some goals organized as pre- and post- baby goals.  I hope to revisit goals every month to check on in their progress and to modify them as needed.  At he post-baby mark, I will reassess all the goals to see how I am doing.

Have Realistic Expectations

Goals:

  1. Complete unfinished tasks:
    1. Baby birth record cross-stitches:  I started making E’s birth record cross stitch back when I was still pregnant with him (yes, 4 years ago).
      image

      Little E’s Birth Record

      For various reasons, it keeps falling onto the back burner and it has always been a source of guilt for me.  A had his done before he was born, and it was twice as big and much more intricate.  While this is no time for excuses, I will say that I was not in medical school when I was pregnant with A, nor did I have a busy toddler running around and competing with my time.  This year’s goal is to complete E’s cross stitch birth record (hopefully before Baby Girl arrives) and also make one for Baby Girl.  Goal Deadline: End of my maternity leave (still TBD but likely before the end of 2016).

    2. Decluttering: I started reading the book “The Life Changing Magic of Tidying Up.”
      image

      Started but never finished

      I love the idea behind it, and I did manage to declutter my closet sometime back in the summer.  It made me feel great and I only wished I had more time to concentrate on decluttering.  I am going to make it my goal to do more decluttering.  The biggest challenge is that you need to set aside a significant amount of time to get this done.  I will have to do it in stages, but with being off call in a few weeks and then a maternity leave, hopefully I will have a little more time to dedicate to decluttering my home. I realize this is somewhat of an “unmeasurable goal,” but I will do my best.  Goal Deadline: Ongoing.

    3. Anxiety Management: Another “project” I started in 2015 and never completed was my Mindfulness and Anxiety Workbook.
      image

      Another project to finish

      I did find the exercises in this book to be beneficial and I would like to continue working on them.  I have noticed my anxiety levels starting to creep up again and I want to get ahold of them while they are still manageable.  I am only about 1/3 of the way through the book.  Ideally I would like to finish it before baby arrives, but I feel that is quite unrealistic.  Goal Deadline: December 31, 2016.

  2. Self Care and Fitness:
    1. Meditation: I love my meditating app, Headspace.  When I was actually taking time to use it regularly, I found that I did feel more calm and less overwhelmed.  I don’t know if it was meditation alone that did this, but there have been proven benefits to mindfulness and meditation, so I am going to make it a goal this year to meditate regularly.  I only have 6 more call shifts before I am officially off call.
      image

      I need to finish this series of meditations

      Until then (middle of February), My goal is to meditate every day that I am not on call.  Once I am no longer on call, I will make it my goal to meditate every day.  These are 15 minute sessions, so there is no excuse for me not taking 15 min a day to dedicate to myself.  I believe this will be a challenging goal for me because since the beginning of January, I have used the app twice.  Goal Deadline: Ongoing.

    2. Regular Exercise (Post-Baby): Baby Girl is due to arrive in the middle of May.  It is my goal to get back into a regular walking/running routine within 1 week of delivering baby.  This means that I will start walking regularly (at least 3x/week) either outside or on the treadmill until my body is sufficiently recovered to start jogging and running again. Goal Deadline: Must start once Baby Girl is 1 week old.
    3. Run a 10K race before the winter: Originally, I thought I would want to try and run the 5K or 10K race in the mountains that is associated with the half-marathon that I ran last year at the end of May.  I realized however, that this is likely very unrealistic.  Even if I was sufficiently recovered from pregnancy and child birth to run any meaningful distance, would I really want to drive 4 hours to the mountains with a newborn baby and the other members of my family for this goal?  It seemed like setting that goal would just add more stress to my life.  Instead, there is another Mountain race that I participated in a few years ago that takes place in September.  While I would like to hopefully be prepared to run a 10K sooner than 4 months post-partum, my official 10K running goal will be to run this mountain race in September with a time of 1:00hour or less. Goal Deadline: September 2016.
    4. Nutrition/Post-Partum Weight Loss: With baby #1, I did a horrible job of losing weight post-partum (despite breastfeeding for 14 months). With baby #2 I did an amazing job of losing the weight and was down below my pre-pregnancy weight within 6 months.  This time I am hoping to lose weight like I did with baby #2.  M hope is to do this with a combination of breastfeeding, regular exercise (see above goals), and nutritional awareness.  Last time I joined Weight Watchers.  Perhaps I will do this again.  Goal Deadline: Initiate within 1 week of Baby Girl’s arrival, then ongoing.
    5. TaeKwonDo: This activity was something I really enjoyed doing in 2015.
      image

      2015 Taekwondo Success

      I have taken a break from it now with the pregnancy and it is my goal to get back into in once Baby Girl is here.  Since starting in January of 2015 until I started my Hiatus in December, I completed 6 belt levels!  It was also a great activity to share with my kids, who are now both doing TKD.  I will be starting up again at the “blue stripe” level when I return.  I don’t yet know if we are going to continue TKD through the summer months or not, but it is my goal to resume TKD and attain 2 more belt levels before the end of the year.  Goal Deadline: Red Stripe Belt by Dec 31, 2016.

  3. Personal Goals:
    1. Quality Family/Kid Time: I am making it a priority to spend more meaningful time with my kids and my husband.  Not only does this mean “finding” more time to spend with them, but it also means being more present in my time with them.  The biggest challenge to this is the existence of my cell phone.  I have already tried (with great difficulty) to not use my cell phone while I am with my kids.  This will be an ongoing challenge.  I also want to make sure I am setting aside time to “do” more activities with them instead of just watching movies with them or “supervising” their play.  Ideas for this goal will be a work in progress and will hopefully get easier once the weather is nicer and once I am more able bodied after this baby vacates my uterus! Goal Deadline: Ongoing.
    2. Find Meaning and Balance in my Work Life.  How’s that for the most vague and uncertain goal of 2016?  I anticipate that this year will involve a lot of soul searching and questioning myself about my career choices and how they affect my family life.  I can say with confidence that I am not happy right now.  I need to get off of this treadmill of putting up with the unhappiness and find solutions.  If a solution is changing career paths, then I need to come to terms with that decision and just make it.  If the solution is making changes in my current career situation, then I need to put aside the roadblocks I have set for myself (like length of my maternity leave, for example) and allow myself to be satisfied with that decision.  I don’t really know how to measure this goal, but I do know that something in this realm needs to change.  Goal Deadline: Ongoing
    3. Blogging: I love blogging and I find it to be extremely enjoyable and therapeutic.  I have really let blogging fall to the wayside and I need to stop doing that.  This year I will make it a goal to blog at least twice a week. Goal Deadline: Blog (at least) twice a week, all year.

If you made it to the end of this blog post, thanks for being so attentive to my long winded goals!  Wish me luck in my endeavor to accomplish these goals.

Reflections for a New Year

 Many of these types of inspirational pictures and messages have been floating around on my Facebook feed over the past few days. Given that I’ve been in a rather introspective mindset and contemplating changes in my life, they have really been hitting a chord for me. I know that I’ve been rather absent from the blogosphere lately and I think that has actually been a bad thing. This is a great place for me to come and let out my thoughts, fears, questions, and frustrations. While I’ve been very busy with work and home, I feel like the winter blues have been making me lazy and unmotivated to blog. The truth is,  though, I really miss it and I think my mental health is suffering because of it.  I really need o work harder on making blogging a priority – not because I want to promote my blog or anything, but because I know it contributes to my mental sanity. 

On a similar note, I have been reflecting on some goals for the new year. Last year on the old blog, I set 11 goals for myself over the year. I met most of them by half way through the year, and a few of them fell to the wayside. In July, right before I closed down the old blog and started anew, I revised and reset some goals but with the blogging fiasco, I never kept up with them. I really want to start some new goals for 2016 here on this blog, much like I did last year. I have been reflecting on  some reasonable goals given that I’m struggling with decisions surrounding my career, I am 4.5 months pregnant, and I feel like I am starting from “zero” most days.  I’m hoping that by the end of this weekend I will have delineated some reasonable goals and will have posted them here for accountability. 

In the meanime, in will make a shot-term “pseudo goal” to get back into the blogging world.   
    
 

Ready For Christmas

December has been a whirlwind month. I feel bad for not blogging in almost a whole month. However, it’s been tough keeping my head up over the past few weeks. Today we are on our way out of town in preparation for Christmas. It is going to be another crazy 5 days, but at least I’m off work and spending time with my family. I’m hoping to get a few more blog posts in over the next few days. But here is a quick summary of the last few weeks:
I had a week of vacation where I managed to get a significant amount of baking and reading done. Hopefully in the next few days I will get a chance to post about my reading adventures. I managed to read 3 books in December, thanks to my week of vacation, which means I accomplished my goal of reading 12 books in 2015!
I went back to work and, again, struggled with the challenge of feeling like I’m not quite in the right place in life. Work is so busy, demanding, and tiring, and it makes me really question if I’m doing the right things with my life. 
Pregnancy has continued to be exhausting. I am almost 20 weeks pregnant now, which means that I am getting bigger, gaining more weight, and feeling more uncomfortable. The first few days back after my vacation I was feeling a lot of cramping and that was stressful. Thankfully it was only that – no bleeding, no contractions, no broken water. I think that the worst part of my job these days is seeing all the bad and unfortunate pregnancy outcomes. This week alone I think I dealt with at least 4 or 5 peri-viable (22-23 week) broken waters or deliveries. It’s been hard to see that happening. 
After all those difficult outcomes at work, the worst thing an anxious, pregnant mom of two boys could do is plan an anatomy ultrasound for the morning that her Christmas Vacation starts. After a tense hour of having a stranger smear gel over my swollen belly and take hundreds of pictures of my unborn baby without saying a single word, it turnes out that everything looks okay! Normal anatomy (including heart, spine, and palate), high anterior placenta, long, closed cervix… And, it’s a Girl! 

 

Feeling Overwhelmed

I am sad to report that over the weekend I just felt too tired and overwhelmed to finish the Nano Poblano challenge.  It makes me a little sad to think that I was so close and didn’t do it. But even now, it’s taken a lot of time for me to feel anything like a normal person and get back to blogging. I think this feeling started about half way through November, but I had been pre-scheduling so many of my posts that it didn’t matter. Some of you may have noticed, though, that I haven’t been around reading and commenting like I normally do. 

I just feeling very… Overwhelmed. Very tired. Very misunderstood. Very alone. 

I do remember this being the lowest point of my year last year, so I hope this is just a phase and that it will get better. In the meantime, I feel like I am losing the ability to cope well. Thankfully, today is my last day of work for the next 12 days. I am off to an out-of-town conference tomorrow for the weekend, and then on vacation until Dec 15. Hopefully in that time I will be able to recover some of my mental and emotional reserve.

I need some words of wisdom and encouragement, please! 

  Something To Treasure

“If you are not happy, you had better stop worrying about it and see what treasures you can pluck from your own brand of unhappiness.”
~Robertson Davies

I had a difficult week at work.  I was tired from waking up early every day, putting in long hours at a mentally challenging job.  I had some patient cases that challenged me beyond my limits and made me feel like I’m not smart enough to be doing what I’m doing.  And worse, I felt like I will never be smart enough or capable enough to do this job I’ve picked for myself.  Saturday was no better, when I still had to get out of bed, put on my blue scrubs, and cart myself to work and do it all over again for another day.

The day started out with a difficult case: a woman who was sick and only getting worse.  The baby inside of her also showing signs of not thriving well.  The decision was made to deliver her baby and we wheeled her into the operating room.  A 27 week baby that looked more like a 24 week baby that was difficult to deliver… a lifeless baby that I handed to the nurse… a baby that needed CPR before being intubated and whisked away to the NICU.  And the a tattered uterus to put back together.

IMG_6458I left the OR feeling more tired and deflated.  The feeling of the baby’s brittle bones between my fingers and his heavy doll-like head bobbing in my hands was etched in my mind.  I walked back into the delivery room waiting for the next disaster but instead found a large bouquet of flowers on the desk… and it was for me.  A rare and unbelievable gift from my husband – something to keep me going for the day.  The card simply said, “Have a great day, Beautiful.”

And therein are my treasures: A loving husband, who might not always seem to “get me,” but he loves me nonetheless.  Two healthy children who will never know the difficulties of the baby I had just delivered.  Another growing child inside of me – one that I came by rather easily.  A job that I love, despite how much it exhausts me.  And, all the opportunity and ability that anyone in the world could wish for.

 

Happiness Is…

“Now and then it’s good to pause in our pursuit of happiness and just be happy.”

~Guillaume Apollinaire

From The Old Blog, November 9, 2014:

Happiness encompasses so many different things: It can have different meanings for different people, and we all measure our level of happiness against varying standards.  I like to think that my happiness is multifactorial and that there isn’t just one thing that ultimately defines whether or not I’m happy.  With so many different pursuits happening simultaneously, it is often difficult to know (or define) a moment when you have achieved “complete happiness” in life.

 

In last year’s blog post I wrote about a recollection of  a happy moment with a friend.  It was a moment that I had forgotten about, likely because I have tried to stop thinking about this friend.  As I read through the post and thought about how I was going to write this post, I though that there was no way that I could describe as happy of a moment that I’ve had in the last year.  I haven’t come close to making as good, meaningful friendships in this new life that I am living.  I am overworked and spread thin by my job.  And, I hardly have enough time to spend with my family.

But, then I stopped thinking about all these “big” things and thought about all the smaller moments, like the other day when I woke up post call, sat on the couch with my kids and cuddled with them to watch a movie.  I had one of them on either side of me, one arm around each of them, and their heads resting on my chest.  I was happy.  It was a relaxing, non-stressful, special, and enjoyable moment for the three of us.  In that moment, I was happy.  It’s so easy to forget about those small moments of happiness when we are always fixated on the bigger things in like that we believe are supposed to make us happy.

When I pause to think about more of those small moments of happiness, I find that they are times that are easily overlooked and sometimes missed.  Another great example is from a few months back when I got my first positive pregnancy test result: I felt a fleeting surge of excitement and there was a smile on my face that couldn’t be stolen away from me.  It only lasted for a few minutes before all my fears, anxieties, and irrational thoughts broke into my mind.  Regardless, in that moment… I was happy.

Last year’s discussion of this quotation involved an important memory of an old friend, and that memory is no longer something that makes me happy.  This year I’ve really come to realize that the little moments that cause me to pause and feel true happiness are smaller, everyday instances that mostly involve my family and kids.  Despite the differences between this year and last, the end of last year’s post still stands true:

It is those moments of real, true happiness that remind us that life is wonderful.  If we worry too much or we try to hard, it is easy to miss those little moments.  But we live for those.  We work for those.  And, those are the moments that remind us to keep moving forward.

This Winter is Better Than The Last

“If we had no winter, the spring would not be so pleasant.”

~Anne Bradstreet

From The Old Blog, November 4, 2014:

An observation that I make every fall is that people are always complaining how cold the weather is becoming.  I am guilty of this as well.  However, I quickly remind myself that if we had these same temperatures in March or April, we would be over the moon with excitement and some of us would already be breaking out the capri pants and sandals.  While I am not “crazy” enough to still wear sandals in this chilly fall weather, the different perspectives based on the time of the seasons are not lost on me.

The seasonal metaphor is quite amenable to the normal ups and downs of life.  After reading my post from last year, I realize that I am not nearly as low or as cold as I was at this point last year.  I am however, feeling lower than I have at other points in this year.  I can tell you why though: I am tired and exhausted from my work schedule, and I’m not at all happy with my work-life balance.  I find it stressful that I don’t have control over these aspects of my life right now.  I am tired and exhausted from being pregnant and some days I still wonder why I thought this was a good idea.  I’m hoping when the spring comes (conveniently when this baby is due, as well), I will have the right answer to this question.

As a sufferer of Seasonal Affective Disorder, it should come as no surprise that the winter months are harder for me than the spring and summer.  However, it is definitely these lows that make the highs better.  I am relieved to realize that (at least so far), this winter is not nearly as cold and drought filled as last winter, and that makes me feel so much better!  I wonder if it’s a coincidence that they are predicting a milder winter for this part of the world this year, too…

It Looks Like A Baby

The appointment was at 8. I showed up 10 minutes early with the hopes they’d get me done early and I could get back to the OR on time. Actually, the real reason I was early… My bladder was already full and I wanted to pee! 

“Did you drink your water?” The receptionist asked. 

“Yes, I sure did!”

She eyed my large coffee cup suspiciously, “you drank water?” She asked tersely. 

“Yes.  Water.”

I sat back in the waiting room and waited. 8:10 – my gosh, I have to pee! 8:15 -I can’t wait anymore, I should ask them is I can half pee while I wait.  8:20 – they call my name, finally. 

She starts the scan and, of course, my bladder is too full: “please use the washroom and pee until you are comfortable.”  What does that mean?  Is it ever comfortable to pee only half way?

She took the pictures, and by gosh, it looks like a baby!  Arms, legs, everything!  Even a little heart beating at 154!  

This is just too real now!

  

Maternal Instinct

This morning, after I finished working my call shift, I had my first appointment with my new obstetrician.  I was a little nervous, even though I picked her from all the obstetricians I know in this city because she is one of my favourites.  I also knew exactly what to expect from the appointment, seeing as how this is my third pregnancy and this is my area of specialty.  Regardless, I was nervous.  I have been working fairly closely with this woman over the past few months with her supervising me in my delivery and cesarean-section skills.  I enjoy her casual attitude, her skill, and her friendly demeanour.  This appointment, though, was about to introduce a new dimension.

The appointment itself went well and there was nothing too unexpected.  However, I was caught off guard by how strongly I found comfort in feeling like this woman was “taking care” of me in some way.  It took me most of the day to place this familiar feeling – but I realized that it was the same feeling I had when I first met my new family doctor just over a year ago, and most pronounced when I engaged in the patient-obstetrician relationship that started with my old friend and mentor, Kay, many years ago.

Part of coming to this realization occurred after I woke up from my daytime sleep and reflected on the dream I had in my pregnant and post-call state.  I had a vivid dream about the obstetrician that I saw this morning.  Like most dreams, I only remember bits and pieces, but the parts I do remember were sufficient enough to point towards an underlying theme.

For some reason, this doctor was staying with me, in my house, for a certain amount of time.  Perhaps it was because her house was being renovated or something like that – she was displaced for some reason.  During this stay at my house, she was very attentive to me and how I was feeling; she took time to talk to me about “stuff.”  I don’t remember any of the details of what was said, I just remember feeling like it was important that she listened to me.  She was very affectionate towards me in a maternal way, making me feel like I was, again, being cared for, looked after, and important to her.  At one point in the dream, I remember my own mother appearing and then feeling confused about why she was there and what her purpose was at that moment in the encounter.

That’s pretty much all I remember.  Initially I woke up from this dream feeling a strange sense of belonging and satisfaction.  However, that feeling quickly gave way to feelings of sadness, loneliness, and hopelessness.  All those feelings arose as I realized that everything I felt in the dream was not real and were only projections of feelings that I want or need but am not able to acquire – at least not in the places I am looking.  It was at this point that I remembered having similar feelings of wanting to be cared for by other female (and physician) people in my life.

This is not a new feeling or phenomenon for me (let me find a post from the early days of The Old Blog to prove it).  It was a while back in my counselling when I discovered that these feelings originate from the lack of maternal care and influence from my own mother.  I have been seeking to have this role fulfilled from other women for almost my entire life – at least since I was 12 or 13.  I am surprised, however, to discover that after knowing for so long where these emotions come from, and having spent many years working on them and realizing that I need to look inside myself to find a solution to these difficult emotions, that I would still so easily fall into the old, familiar, yet unsatisfying pattern of seeking comfort in places (and people) where it can’t be found.

In addition to feeling sad, hopeless, and confused about the re-emergence of these emotions, I am feeling angry at myself for falling back into this harmful pattern of searching for maternal love and acceptance where it can never be found.  Obviously this is something that I need to spend more time working to resolve.  Perhaps the resurgence of this Maternal issue is something that I am meant to deal with throughout this pregnancy.  Perhaps it is also part of the reason why I am feeling so uncertain and uneasy about my decision to have another baby.  Maybe all of these emotions are tied together somehow: the desire to seek out maternal care, the prominence of these emotions in pregnancy, and my somewhat confusing desire to expand in my role as a mother.