On episode 63, Tara is half English and half American. She doesn’t feel a strong tie to either of those countries because she was born in Dubai, the United Arab Emirates. She grew up mostly in Hong Kong, and her parents still live there part-time. She’s lived in ten countries. Her chosen home now is New York City where she’s been for over a decade. During the recording of the show, Tara was in the Bahamas where her parents live during the winter.
Thinking about having children happened decades ago for Tara. In her 30’s Tara calls herself a typical city woman who focused on her career, dated a lot, but no one serious. She ended a five-year relationship at 30, and the question of children was ever present for her. She wasn’t sure if she wanted children, but the idea of freezing her eggs was a way to put off decision for a while. She had this conceptual idea that 35 was the magic cut-off to be able to have children. At 32, they retrieved 30 eggs and ended up freezing 28 eggs. Freezing her eggs took the weight off of her mind, so she could stop obsessing about it. Tara took her 40th birthday to reflect on her life. This was quite different from the reflection at the age of 30. If she wanted to have a child, she wanted to decide that soon. She wanted the decision to be a conscious one and didn’t want it to be made for her through her own inaction. If the decision was to not to children, she would thoughtfully make that decision and go on with her life. She sat down with herself and decided to go for it.
Her AMH levels were very high at the age of 40. That, combined with the number of eggs that were retrieved at 32, the doctor thought she would have another successful egg retrieval. If they did an egg retrieval, she could keep her eggs frozen from her retrieval at 32. If she wanted to have a second child, she’d have more eggs to be able to do that with. If they could get her a baby without having to touch those frozen eggs, she could keep them as a continued option for the future. She decided to proceed with a second egg retrieval and went straight to IVF. They got about 26 eggs with this egg retrieval. Tara thinks they didn’t start with IUI simply with the nature of her insurance coverage that allowed her to go directly IVF rather than IUI. They knew IVF had a much higher probability outcome, especially knowing what they know now with the chromosome abnormalities.
Selecting the donor was a lot of fun. It felt like a combination of online dating meets Ikea catalog shopping. There is so much information. She knew way more about the donor than she would ever know about a person she was dating. It showed his extensive medical history on both sides of his family going back to his grandparents. They both had genetic screening to check for anything that might not be compatible, including being a carrier of a disease. She had his GPA, he wrote an essay, and there’s 20 minutes of an audio recording. The information overwhelmed her. She wasn’t sure how to navigate all the information. There are three big national cryo banks in the US. One is called Fairfax, another is called California Cryo and another is called the Seattle Cryo Bank. Tara signed up with both Fairfax and California Cryo. They had a larger number of donors to select from, but the numbers were still smaller than she expected. Each of them had between three and four hundred donors in their system. She started with a quantitative screening: skin color, hair color, eye color, and height. She chose qualities similar to herself with the idea that the baby will look more like her. She started with a height of six foot tall, but there wasn’t many in the database, so she shortened it to five foot ten, applied the physical characteristics and got about 20 donors. Then Tara went through the 20 donors in much more detail on a spreadsheet she created. She was able short-list eight donors, and then shared the list with her family for their input. She made it very clear they could give their input, but they had not veto or decision-making power. She found it to be very helpful. In the end, it was the audio recording that was the final tip on narrowing it down to the top three. It was just hearing someone’s voice for Tara. She believes you can feel an affinity for someone based on how their voice sounds. A few donors were eliminated by just the sound of their voice. She wanted to feel positive about whoever she chose. It was also about how they answered the question: Why did you choose to be a sperm donor? She really liked the answer of the donor she ended up choosing. She thought it was so refreshingly honest. He said, “I would be lying if I didn’t say money was a factor. I needed some cash… it felt like a real win/win. I could help someone and help himself at the same time, so why not.” He was about 20 years old when he was paid for his donation. The other answer she really liked from this donor was that he selected to be a known anonymous donor, meaning her child had the ability to find out his identity at some future date if she chose to. She found most donors are completely anonymous. Tara found him appealing because his answer indicated a degree of empathy. He put himself in the child’s shoes and would want to know who his genetic father was. He continued that it doesn’t seem fair to deprive the child of that knowledge. She really liked that she will be able to tell her baby she believes they would really like her genetic father, and she thinks he’s a good person. Being good isn’t something that is heritable, but she hopes her baby is a kind person because Tara will teach her to be a kind person through her upbringing. Tara heard a lot of answers that felt disingenuous. Tara really appreciated his honesty, so she chose him.
Although, she believes creating the embryos is where her age played a role in the numbers. Out of the 26 eggs that were retrieved, not all of them fertilized. She remembers maybe 21 were fertilized and 14 made it to day 5 blastocysts. Tara sent the 14 blastocysts for chromosome testing. It’s a big consideration for her and it was likely quite a few of them would be abnormal. It was not covered by her insurance and they charged the number tested. She felt really optimistic up until this point. She remembers getting the call that out of the 14 tested, only two were normal and the other 12 were not compatible with life. She was proud to have two, but it was also a shock to lose 12. It made her feel a lot less sure of the process. She had only two chances. She questioned if she should do an egg retrieval again or go to the embryo transfer stage because they wanted her to have three embryos. She wasn’t sure what do you, so she called her brother who is great with statistics. She told him, she had a success rate of about 60-70% with a normal embryo when transferred. If she has two tries at this, what is her probability of success? She remembers her brother telling her she has about an 80-90% chance success with the two and about 99% with three embryos. She liked that probability and wanted to move forward with the two embryos. She really didn’t want to go through another egg retrieval. Before the transfer, she had to choose between the two embryos and she did find out she had one male and one female embryo. She asked her doctor which one they would choose if she didn’t because the grades were the same. They told her the lab tech would choose. Tara wanted to be the one to decide which one to transfer. As a single mother, she decided the gender she had the most familiarity with, so if she only ended up with one child, she’d have the best chance at sharing her experience. She chose the female to be transferred. Tara says the transfer was so easy. She expected it to be more than it really was. It was hard waiting two weeks and not to test. She managed to hold off from testing and kept herself busy. She took a pregnancy test the night before she went in for the blood work. She wanted to be prepared in case the test came back negative and didn’t wanted to be surprised. She was shocked when it was positive. She couldn’t believe it and wondered what was next. Her HGC levels were exactly what they wanted to see.
She had a great pregnancy. For the first nine weeks, the hardest part was the belching, and it was constant. She would be on a work call and have to excuse herself because of an upset stomach. She continued the progesterone oil shots for the first nine weeks. She did many of her shots, but she also thinks a least ten different friends and family helped, too. Her best friend from the lady that does her eyelash extensions did the injections for her. She had one last shot as her brother came to visit. He had the honors of injecting her with her last shot. She and her brother went to Coney Island and she couldn’t ride on some of the rides, which was disappointing to her. She assessed the risks and went on the easy rides. They went on one ride that was a spinning ride which she didn’t enjoy. That was the last ride she went on. This is an example of how she looked at pregnancy and the ‘rules’. Tara is a researcher. She called Expecting Better by Emily Oster her bible during her pregnancy. She didn’t want to know what she could and couldn’t do, but she wanted to know why, and what were the exact risks involved. She loves the data driven approach that the author had and that informed many of her decisions and choices.
The handoff from fertility to obstetrician was non-existent, and she felt absolutely abandoned. She had her final appointment with her fertility doctor at about six weeks which was the heartbeat scan. Her doctor basically said to her job was done, she was pregnant, good luck and told her to go make an appointment with an obstetrician. Tara wasn’t sure what to do. It shocked her that there wasn’t a better transition between providers. It caught her off-guard. She scrambled to start researching doctors and get recommendations. At 7 weeks she started reaching doctors, but they would tell her she could be seen in a few months. She had her fertility care at NYU, so she stayed with them for simplicity. She called NYU and asked who could see her first. They said the first appointment would be at 11 weeks. Being four weeks away, it really worried her. She got connected with a virtual women’s healthcare located in Dallas for a virtual appointment with an obstetrician. A week later being all the call, she remembers the obstetrician and explaining her situation and asking what she should do. The doctor made her feel so calm. The doctor helped explain to her that she was so used to being a fertility patient and going in all the time. She went on to explain that many women aren’t even seen until 10 or 11 weeks. That’s very normal to be seen at that point for your first prenatal visit. Just hearing that was so reassuring to her. She also said if she was feeling really anxious about it, to ask her fertility doctor if they’ll see her just one more time. Tara called her fertility clinic, and they agreed to do a 9-week ultrasound. Everything was fine.
She went to her first appointment with the OB, but she thought it was awful. Awful enough that she then had to go back into NYU to the main coordinator and told her to make a note on her file that she should never be seen by that doctor again. The doctor was so cold and condescending. She didn’t listen. There were things that were in in her file and discussed that were obvious she didn’t read first. For example, the doctor wanted to do genetic testing because of her age, but she already had the embryos tested. The doctor agreed. The doctor also got really snippy with Tara about her multivitamins. She was taking a prenatal but also taking a whole host of other vitamins. Tara thought the prenatal was something you had to take in addition to other vitamins. Tara was taking actually, more than she needed, but none of it was harmful. The doctor was just so mean about it. She really made her feel stupid. Tara was in the NYU system up until eight months pregnant and then she saw a different doctor every visit which was not good. At no point did she feel that she had anyone that was truly caring for her. She felt pretty alone in that process. In fact, the most care that she felt she received was when she was on holiday in France for a couple of months over the summer holiday. It was during her 20 week scan. She had scheduled to have it done with a doctor in France, and they were amazing. It felt really personal. In France, it was a very small clinic in a very small town. The clinic was in the countryside, the doctor did the scan, and her mom was in the room with her. He spent half an hour with her showing her everything about the baby. It was really nice. Quite a stark contrast. It cost her almost nothing, too. It was $100 out of pocket.
At 25 weeks, Tara had a work trip to London and was already not feeling well. She had some kind of sinus issues that had developed into bronchitis. She saw a specialist in London who said she had bronchitis and gave her an antibiotic, called Amoxicillin. She was worried about taking anything during pregnancy. She was told it’s the one they will typically prescribe if you’re pregnant. She got antibiotics and felt a lot better. About three days later, she was feeling well enough to go back into the office. At the end of the day, she was feeling quite hot. She went back to the place she was staying and took her temperature. It was quite high. She took a Covid test and it was positive. She started to panic a little, mostly because of the fever. She called NYU to ask what she should be doing to get well, but she couldn’t get anyone to take her call. NYU’s system let her down again. A friend came over, she ran her a cold bath and still the next morning, her fever still had not gone down. She decided to go to the ER in London, and they were wonderful. They saw her very quickly, got her hooked up to an IV and monitored her for 24 hours. The fever went down, but it took another two weeks to really be better. She went back to where she was staying in London and quarantined. The bronchitis made her ill for a month.
At nine months pregnant Tara moved. Her priorities were to find a doula, baby nurse, and then a place to live. She was in a WhatsApp group with other women that were due around the same time she was. They were doing things that Tara had no time to do yet. She just wasn’t in the same place. Tara found out she could do a whole lot in the final couple of weeks and Amazon is great! She signed up for a hypnobirthing course. She bought the book, as well which she got more from the book than she did from the class. Tara says she’s right in the middle between having a totally drug-free natural childbirth to a planned C-section. She didn’t want a home birth. She was very open to having pain management, but also intrigued by what she could do on her own and whether she could manage it. She definitely did not want to have an epidural because she didn’t want to give birth on her back. She wanted the freedom of movement, but also wanted to be at a place a epidural was an option if need be. She is also very aware of her body. She teaches yoga in her spare time. She did a lot of Pilates during her pregnancy, which was amazing. She signed up for the hypnobirthing course to find out what was happening during labor. She learned the most from that class. Hypnobirthing was about visualizing your breathe, and how you control your movement with your breath.
They wanted to induce Tara at 39 weeks. She was feeling great, was very mobile, didn’t have much weight gain, and she could move easily. The baby was doing well, also. She told them that she did not want to be induced. There was some data that suggests some worsening of outcomes specifically for her age group. She wanted her baby to come out when she was ready. The policy at NYU is that you must be induced ten days after your due date. Her doula was very helpful by reminding her they cannot force her to be induced. This was her choice. Her body. She didn’t have to show up at the appointment. It empowered her. Tara did schedule an induction eight days passed her due date. A couple of days ahead of that, she had a membrane sweep. It is one way to get labor started and is considered a fairly mild form of induction. After the membrane sweep, she got up to get dressed to see her mucus plug laying on the table. That was a pretty good indicator that things were starting to move. She started to feel some different things in her body. She did not go into labor ahead of her induction, but she did feel that her body was getting ready. She felt much more comfortable going in for the scheduled induction because she thought she was close to being ready.
She ended up in labor for 26 hours. They started with the Foley balloon method. They put an uninflated balloon into the bottom up through the cervix, and then inflate it. It acts as a weight on the bottom of your cervix that is simulating the baby’s head dropping and can start to get the cervix dilated. It wasn’t painful at all. It was uncomfortable, but not painful. It was the contractions that were painful. She was not prepared for that. She was having contraction storms, where you basically don’t have more than a split second of coming down from the contraction before you go straight into another one. There are no moments to breathe. Just one after another. Her mother and her doula came up to be with her during her labor. At one point she was screaming at the monitor that it wasn’t showing she was having a contraction when she could feel it. She made it eight hours before she asked for an epidural. The anesthesiologist was busy with another patient and took 40 minutes before they got to her. It took a few tries to get the epidural in but got immediate relief. They left her for the night in hopes she could get some sleep and be back in the morning. She had a button to push that released more medication when she needed it. It was a rough night, and she didn’t sleep much. The next morning she asked the nurse for more medication. Tara pushed the button during the night as many times as she could with little relief. The nurse walked over to inspect the pump, and there was an awkward silence followed by a big swallow. The pump was not hooked up. Twenty hours in, her waters broke naturally. She describe it as an amazing movement. They wouldn’t check her cervix after that, and she went through what they thought was transition, the stage of labor when you hit 10 centimeters dilated. It’s a very intense stage where her doula was fairly certain she was going through transition because she threw up. She also felt the sensation of wanting to poo and that also strongly indicates that baby has descended. They wouldn’t check her cervix until 12 hours after her water had broken. They were concerned about introducing any infection at that point, so they wanted to limit any checking. Her and her double concluded the baby has dropped. She kept asking them to check, but they held her to the 12 hours. Her water broke at 6 am, and they did not check her again until 6 pm. She was 10 centimeters at 6pm, and everyone got into position for Tara to push. Because they gave her that epidural so late in the process, she never lost movement in her legs and never lost the ability to be able to hold herself up with her legs. She was on all fours on the bed for a while. The doula did all sorts of great movements for her with her hips. They were moving her around and would squat on the bed to move the baby down. When it came time to push, they really wanted her to labor on her back using their breath counting where they count and on their counting, they make you hold your breath until the count of 10, then push, then breathe and inhale over and over until the baby is born. It’s called purple pushing. It worked, but it wasn’t what she wanted to do or practiced. She had four people around her counting and telling her to hold her breath and push, so she felt like she had no choice. She really didn’t want to be on her back. She wanted to be in a different position. She asked if she could move, but they didn’t want her to do that. She insisted, so they brought this bar over her to hold onto and got into a squatting position for one round of pushing. It was hard to be in that position because of the epidural, so she ended up back on her back. The woman counting was off with her breath. She did not need them counting for her, so she finally yelled, “Stop fucking counting, I can do my own counting!” Honestly, she just wanted the baby out. She looked at her doula and said she didn’t think she could do this. Her doula looked her in the eyes and said, “Tara, you really didn’t want a C-section. You have avoided it to this point. The only way this baby comes out now is through you pushing. You’ve got to get this baby out.” Tara pushed with all her might and they were astonished at the progress and it was kind of reassuring to hear with each push, that they were effective to get the baby out. It was maybe 45 minutes of pushing to the baby was out. She needed a couple of stitches because of a little tearing. Not severe, but some. As they were stitching her, the lack of epidural hit her to the full effect because she could feel the stitches. They got some local anesthetic quick. After that, it was a blur. Within five minutes of her daughter being born, her dad and brother were in the room. Her brother burst into tears.
Her doula was amazing. She made her feel empowered. She very much supported whatever choices she made and if she wanted to go down a path of hypnobirthing and no epidural, she would support either. She was there with her the whole time. She really just helped her understand what was happening. It’s nice to have someone there telling her what the machines mean, what to expect, and what’s going on. When they set up her room, she had a starry night projector and had a playlist going. It was a vibe and the doctors and nurses would come in there and want to stay in her room.
Recovery was really good. She thinks that a lot was due to her having been in pretty good shape up until labor and the Pilates she did. She started the most gentle Pilates back as soon as she could. She couldn’t look down there but could feel the stitches. She got a bidet that attach to the toilet seat. It was nice to have a little bit of warm water without having to wipe anything. She also use a spray bottle, as well. Mentally, she was also pretty good. The hardest part for Tara was breastfeeding. It was a very tough for the first few months, but the first few weeks were the worst. It’s very stressful. She felt a lot of pressure to have the milk is come down. At the same time being in pain down there, it hurts to sit and just when you didn’t think your boobs could get any bigger—they do. She didn’t even want hugs because it was so painful. She had a baby nurse and that helped so much with her sleep. Of course, she was still up during the night, but definitely got more sleep than she would have otherwise. The woman she used was a former pediatric nurse and she taught Tara so much: how to change a diaper and what to look for, how to hold the baby, and was an emotional support for Tara with breastfeeding. All of this was so helpful in Tara’s recovery. With the ability to sleep and not worry about the baby helped her recovery. It was an incredible positive experience.
Resources:
Over 40 Fabulous and Pregnant on Instagram
Expecting Better by Emily Oster
Leave a Reply