I’m Sorry You Don’t Have A Sibling

Dear Thomas

Yesterday was your second birthday, and amongst the many wonderful parts of the day was seeing the joy you got from opening presents, discovering their contents and then exploring each one fully. The way you play has become so creative and imaginative in the last couple of months, and your new toys fueled your fire perfectly. A second magical moment was watching you share it all with your cousin, who is just a few weeks beyond two years older than you. Seeing the two of you play together with cars, with the “big bus”, your trains and your new shopping till warmed my heart.

But it also broke it a little too.

You see Thomas, the gift that I’d really hoped to give you hasn’t arrived, and won’t be here any time soon. Mummy and Daddy have been working on trying to get it for your for a long time now, but it turns out that this is more difficult than securing a Christmas must-have or snapping up a bargain in the sales.

What I most wish, with all my heart, that I could have given you (or at least had well on the way) for your second birthday is a sibling of your very own. A playmate. A partner-in-crime. And most of all, a family that will hopefully go on with you in to your old age.

When you’re older, reading this back, possibly with a sibling by your side, you’ll probably be rolling your eyes and telling your old mum not to be so soft. That you didn’t care at two years old. Hopefully that you’re quite happy with how everything turned out. But writing this, the day after your second birthday, we’re not in that happy place yet and, rightly or wrongly, I want to capture exactly how it feels, and to let you know just how much we wanted a brother or sister for you.

People dismiss it all the time. They tell me to be grateful for you. That not having a second child is nothing like as bad as not having a first child. But the person they’re not thinking about when they make these comments is you, Thomas. Of course I’m grateful to have you in our lives and I can barely remember you not being here. Not having you would be unthinkable. I love you endlessly, more than I’ve so far found the words to properly express. But unlike wanting a first child, which is often borne of slightly selfish motivations, having a second child is as much about what is right for the first child as it is for the parents. We don’t just have the two of us to think of any longer; now we’re a team of three.

I know you have the potential to be a great big brother. Of course, you’ll have your share of tantrums, frustrations and jealousy, and I know having two small children will be incredibly hard work. But you’re so outgoing and sociable, loving the company of and interaction with other children of all ages, that I’m sure having your very own little brother or sister, to bring home and be with you everyday, will be a source of enormous joy. You love to fix things, to “help” and to entertain, which will all be fantastic qualities in an older brother. It feels like you were born to be a big brother, to take care or someone younger and help them learn their way.

I have to hide my tears from you when you ask about “a baby” or utter the word “brother”. I think these are things you’ve learned about at nursery, and you don’t really understand. You certainly don’t mention them to upset me, but I’d much rather I could turn those moments into a conversation about the new baby in Mummy’s tummy, on it’s way to join our family. Instead, I pretend I haven’t heard or can’t understand as I divert the subject to something else.

I know these conversations will only get harder in the coming months, as you begin to notice your little friends having siblings and start genuinely asking for one of your own. I’m hoping with all my might that by a miracle of nature or the wonder of medical science, we can bring you that sibling before your third birthday. I hope that you won’t hold it against me if it takes longer, or if the age gap means that your baby brother or sister takes a long time to reach a point where you can actually play together and enjoy the same games. I want you to know that we wanted you to be close in age to increase the chances of you becoming proper buddies. Perhaps it will happen anyway. Perhaps it was never meant to be.

Most of all though, whatever happens, I just hope you’re not lonely.

I love you – every last bit of you. And that won’t change whether you do or don’t get a brother or sister.

Mummy xx

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On the Flip Side…

A couple of days on, I’m concerned that my last post may have come across as unnecessarily negative or self indulgent, and that perhaps it requires some balance.

For starters, I’m acutely aware of how many alternative scenarios I could be facing that are infinitely worse than anything I’ve ever experienced or am facing now. It may be a big deal to me in this moment, but in the grand scheme of things, it’s a minor blip.

I’ve spent my entire life refusing to be someone who says “It’s not fair”, because, frankly, that is only stating the obvious. Life is intrinsically unfair.

Perhaps the most difficult part for me is the lack of control. I’m used to working to get what I want and holding no one accountable but myself if I don’t get to where I want to go. And whilst I’ve made changes to my lifestyle and devoted hours to monitoring and recording my “fertile signs”, doing everything in my power to optimise our chances of successful conception, ultimately there is only so much that I can do. At the end of the day, much of it is out of my hands and comes down to chance, or to good old-fashioned luck. It’s hard for me to get my head around that.

I feel sometimes like my body is saying “no” to me, which is not something I find easy to accept. As someone who has met a lot of narrow minded prejudice in my life, I’ve learned always to be clear with people that they shouldn’t tell me not to do something that I really want to do. Not to tell me “no” based on their own assumptions of what they could, or would, do if they were me or in my position. The greater the barriers people raise, the higher I will jump, or the further I will go, to get around them. I  generally set a limit on my limitations rather than letting my limitations set a limit on what I can achieve. I can assure you that without this attitude I wouldn’t be where I am now, doing the job that I do, living, and having lived, the life that I do.

But none of this works when then problem lies in the way that your body works. Or doesn’t. I can’t go any further or work any harder, and my passivity is translating in to negativity.

On the flip side, at least I’m used to things not really working how they should. I’m used to unexpected twists to the journey and I’m used to getting bad news about my health. Even a commonplace broken leg for me had to be complicated by the simultaneous rupture of my achilles tendon which led to three surgeries and a total of more than six months in plaster. I never do things by halves, and perhaps my biggest mistake is allowing myself to be surprised that this isn’t going smoothly.

The positive side of all of this is that I’m built to cope. If I can’t direct my strength and determination into actually making it happen myself, at least I can direct it into re-setting my expectations and coping with the journey.

And not giving up.

Flowers on the piano

Broken

I’ve been a bit quiet lately, both online and off. It’s not for a lack of things to write about or share. It’s not even as simple as a lack of time, although things have been exceptionally busy. It’s more down to a lack of motivation and a slide in to reversed philosophy of not doing today what can be put off until tomorrow. That, and every time my thoughts turn to my blog, or to other parenting blogs – and hence Twitter too – with so many sibling tales and happy pregnancy announcements throughout, they can’t help but turn to the baby we keep failing to conceive.

I never meant for this blog to turn in to a “trying to conceive” blog. And I certainly never dreamed it would become an infertility blog. When I first wrote about trying for a second child back in February, we’d already been trying for a number of months and I made the decision to share because I wanted to touch on the subject of the extra stresses that are associated with the experience when you have diabetes. I honestly thought at that time that we wouldn’t have too much longer to wait, so it seemed like the best time to cover the topic.

But here we are, eight months down the line, no nearer to having another child but with the newly acquired diagnosis of “secondary infertility”. The cause, if any, is as yet unknown. And I’m starting to really feel the strain. Even Ian’s attitude of calm, relaxed patience is starting to falter. Time and again he’s been the one to remind me that it’s “normal” for this to take up to a year. But just this week he has conceded that though this statistic is often bandied about, we know very few people who have waited that long and then suddenly conceived without fertility treatment. In fact, we know far more people who have experienced accidental surprises, or fallen pregnant on their first try.

Somewhere along the line this has stopped being about a desire for a nice tight age gap – although the number of Phil & Ted’s pushchairs at the local park is still a stark reminder of what we now won’t have. But these days it’s about desperation to complete the family I aspire to, whilst slowly losing hope that it will happen at all. I feel as though I’m surrounded by pregnancies, or families with more than one child. I know it’s partly because I’m focused on it, but it’s hard to do anything else when you want something so badly. It’s hard not to wonder why it seems to be working out for everyone around me.

I’ve tried to be positive about this. I’ve tried standing the typical questions on their head and asking not, “why us?” but instead, “why NOT us?”

I think it’s probably selfish to believe that we’re somehow more deserving of an easy ride than any other couple and I know just how lucky we are to have one fantastic child. But yet I can’t help but think that I’ve already dealt with enough crap and, in particular, enough of my body’s failings. Whilst no one else may deserve to be in this position either, I think I’m justified in wishing for a break.

My entire medical history, not mention life story, is too long and too boring to share here. Besides, I don’t care for the medical one-upmanship that abounds across the internet – there is no competition or prize for the longest list of bodily ailments. I prefer to focus on living well despite limitations. But here are some of the important facts of the matter: Diabetes pre-dates my earliest memories. I literally do not know what it feels like to live with a body in full working order, to not be reliant on an external supply of an essential substance that most people barely even know about, never mind take for granted. Then, following a run in with meningitis as a teenager, I’ve dealt with a life altering diagnosis which severely limited my freedoms and opportunities at precisely the time of my life I should have been seizing them. Instead, I was seizing in an entirely different way. To this day I live with brain circuitry that is dependent on medication for its proper function. And whereas many people couldn’t tell you where their pituitary gland is located, I’m intimately familiar with each of the hormones it produces and what can happen when their function goes haywire too.

I live with a broken body. Bloody hell, I live well – a good life – with a broken body. But I think it’s understandable that just sometimes I wish my body would do what it is supposed to do, without the need for medical assistance, without any hiccups. I’d like for things to simply work.

I’m not normally one for reading horoscopes (I mean, come on, can those little paragraphs really each be so applicable to one twelfth of the population?) But at the hairdressers earlier, the page in the back of a magazine caught my eye. Under my own sign, it included the statement “eventually life runs out of ways to torture us”.

Today, feeling down as I do, I couldn’t help but wonder when that time might come for me.

Why I Believe Fertility Support for Women With Diabetes Needs a Rethink

Like a lot of women with diabetes, I spend a lot of time ensuring that people see that it doesn’t have to interfere with life and that there aren’t very many things that I can’t do. We don’t want or need special treatment in most ordinary circumstances in life. That said, it certainly complicates life at times, and many things need a little more thought and planning. Pregnancy is an obvious example. Women with diabetes can, and frequently do, have happy healthy pregnancies with happy healthy babies at the end. But it does take a lot more planning and effort to achieve than for many women without diabetes.

Pregnancy prep, for a diabetic, begins many months before “trying to conceive”. Current available evidence suggests that the risk complications is reduced if blood glucose control is at optimal pregnancy levels for some months prior to conception. Most experts seem to recommend a minimum of three months of good control. And this has benefits for the mother-to-be too, as very rapidly tightening control after learning about an (unplanned) pregnancy is associated with a greater risk of worsening any pre-existing eye complications, or bringing new ones on, as well as a much greater risk of hypoglycaemic unawareness and severe low blood sugars – potentially dangerous for both mum and baby.

Pregnancy standard of control achieved for the requisite time, you get the green light to start “trying” in the normal way in the hope that a positive pregnancy test will soon follow. Except, obviously, sometimes it doesn’t. In the presence of good control and regular cycles, there is nothing to suggest that this might be related to diabetes. But all the while that tight control needs to be maintained.

Unless you live with it, it’s impossible to truly understand what that means, but here is a small flavour: Testing blood sugars frequently (up to ten times per day) day-in, day-out. Counting every carb that passes your lips and calculating the corresponding insulin dose. Restricting dietary choices in pursuits of better post-meal blood glucose levels. Aggressively correcting high blood sugars whilst trying to avoid too many lows. Dealing as best as possible with the hormonal ups and downs of each cycle and their effects on your carefully calculated control. And doing that over and over as each month your period arrives and your pregnancy hopes fade.

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Trying to conceive can be trying for everyone, but trying to conceive with diabetes is a double whammy of struggle.

If you’re under 35, like other women in the UK, women with diabetes are expected to endure 12 months of this roller coaster of trying and waiting until basic fertility investigations are carried out on the NHS. By this stage the obsession over blood sugars has already been going for at least 15 solid months. You then spend month 13 of “trying to conceive” getting blood tests done on appropriate days. And possibly month 14 having these repeated in the hope of a different result. Then you might wait anything between six and eighteen weeks to be seen by a fertility specialist (unless you opt to pay privately, of course). All of which adds up to over 18 months of super tight diabetes control. Two pregnancies worth, before you’re even pregnant.

It’s easy for outsiders to dismiss, to tell you to take a break and that it won’t hurt. Even my GP suggested to me that I stop trying quite so hard to keep my control so good, and if I did happen to fall pregnant I could quickly “sort things out” then. It’s easy to say if you won’t be the one unable to move on should that pregnancy end in miscarriage, forever wondering if those weeks of slacking were the cause. It’s also easy to say when you don’t understand that “sorting it out” isn’t always as easy as it sounds. Because where blood sugars are concerned, stability breeds stability and chaos breeds, well, chaos. Keeping on the level is hard work, but comparatively easier than creating good control out of a mess.

I’m well aware, as someone who wants to minimise the impact of diabetes on my life and health, that we should all be striving for tight control for our own sakes, not just our unborn children. But there is a difference in the level of control required long term to reduce the risks of complications and the extra level required to really minimise the risks to a growing baby. The difference is that just two weeks of terrible control in a forty week pregnancy is a relatively long term. Two weeks in the three decades of diabetes behind me and the many, many years still stretching ahead of me is comparatively tiny. I can slip up for a few weeks, slack off and only test a few times each day. I can take a break between CGM sensors if I so choose and I can be lazy and let my pump infusion site run on for four days because I don’t feel like changing it. In the grand scheme of things it won’t make much difference, unless you throw a potential pregnancy in to the mix. A baby is the biggest motivation for good control ever. But it’s also the biggest fear factor.

I can’t say it often enough that people with diabetes on the whole don’t want to be treated any differently than those without. For the most part there is no need. But sometimes it’s essential. Our pregnancies aren’t managed in the same way as pregnancies which aren’t complicated by diabetes, and I don’t believe that the assessment of our fertility should be either.

I wouldn’t for a moment suggest that women with diabetes should somehow jump the queue for fertility treatment and I fully understand and support the general need to wait a while before testing fertility, as most often all that is required is time. But for some people all that time will turn out to be a waste, because pregnancy could never have been achieved without some form of intervention. That is sad, and hard enough to bear for any couple. But for a woman with diabetes who has driven herself to burnout in all the months of obsessive control, it’s even harder.

The basic fertility tests offered to women who’ve been trying for a year are relatively inexpensive in health service terms and I believe that they should be offered sooner to women in this position. Even if it’s just reassurance that all the effort is worth while because there is nothing obvious going on and pregnancy is as likely as for every other couple. If the news is less good, then at least it’s possible to make informed decisions about diabetes management moving forwards. Because what is the comparative cost to the health service of managing pregnancies in women who have tired of all the hard of work of diabetes and burned out long before the successful conclusion of a pregnancy? These women are at increased risk of miscarriage, need even closer monitoring in pregnancy, have increased risk of needing a caesarean delivery, and increased risk of birth defects or still birth.

Obviously this is something about which I’m very biased, impatient as I am to have another child and as burned out as I am by controlling diabetes right now. I know that every women who is trying and failing to conceive is desperate for answers and wants them as soon as possible. What I’m trying to illustrate is how dealing with an all-consuming chronic medical condition makes this process harder. I’m constantly baffled by how we are left to struggle yet the moment the second line appears on a pregnancy test, there couldn’t be more help on offer.

I could certainly have done with a bit more support on this journey. It’s amazing how much better I’m beginning to feel now that we’re finally getting it.

Is Suffering Quantifiable?

It’s a common point for philosophical debate: The idea that there will always be someone worse off, and consequently, the idea that we shouldn’t moan about the circumstances which life deals us. Leaving aside the slight element of schadenfreude in this sentiment, it’s not something that I’ve ever been able to fully reconcile in my head.

I believe in positive thinking, I really do. I think that whilst we don’t have the power to control certain things that happen to us, we do have at least some degree of control over how we respond to those things. And life is very much what you make it. No matter what life throws at us, it’s worth taking the time to look for, and celebrate, the positives. A consistently negative attitude makes no one happy, least of all yourself. But that doesn’t mean there is no room at all for negative feelings in life. And it definitely doesn’t mean that your right to feel negatively about something should be graded against what other people are going through.

Yet, there have been times when people have told me that “at least diabetes isn’t cancer”. That “at least epilepsy isn’t cancer”. During one of my moments of feeling utterly overwhelmed with managing diabetes during a pregnancy, I was told by a “friend” that I couldn’t possibly moan, because so many people would give so much to be in my position, expecting a baby.

And now I’m in that position myself – desperate to conceive but for whatever reason struggling to do so – I’m being regularly told that I haven’t actually been trying that long compared to many other people, or had to go through the years of fertility treatment that others have endured and reminded that “at least you already have one child”, and so, consequently, I shouldn’t moan.

These kind of statements are imbued with the assumption that I hadn’t realised these things, or that I am ungrateful for the very many blessings with which I find myself, and this frustrates me beyond belief. Of course I’m well aware of all the many awful things that happen in people’s lives and the world at large. I’m well aware that for some people, the dream of a family never becomes a reality. But just because such difficulties exist for others, simply because there is terrible suffering to be found, does that instantly negate my own feelings of sadness and frustration, or make me any less entitled to feel what I feel about them?

I don’t believe that it is necessary to measure every situation against someone else’s, when the situation at hand represents a unique challenge to the person concerned. Just because something passes like water off a duck’s back for you doesn’t automatically mean that it will for everyone, and each person has different priorities, hopes and dreams. Each person’s experience of life is so different that I simply can’t believe my feelings about the individual hand life has dealt me can be quantified against anyone else’s feelings surrounding theirs.

To be completely honest, I think the only benchmark for how something makes you feel is yourself. Everything is relative, after all.

Why Trying to Conceive Again May be Harder Than the First Time

Here’s something that may surprise you: the biggest challenge of conceiving a second child isn’t necessarily finding the time to have enough sex. Unless your first child is very young, or not yet sleeping through the night (in which case a second child may well not be on the cards anyway) it’s almost always possible to carve out time for sex, even if it means sacrificing ten minutes of sleep, or squeezing in a quickie between the baby’s bedtime and cooking your dinner. If you want a baby, you can make the time. No, a lot of the challenges of conceiving a second child are more subtle, and mostly emotional rather than physical or practical.

So here is my run down of some the top reasons why trying to conceive again may be more challenging than it was the first time.

The age gap pressure.

Let’s get the obvious out of the way first. I’ve written about it so many times now that I know I’m getting boring. It simply doesn’t exist when you are trying for your first child. Of course I know that there is a lot of impatience – I’m sure that most women who have decided they really want a baby are probably like me and really want a baby *NOW*. But the sense of urgency will be all but cleanly wiped from your memory once you actually have that baby in your arms, because it’s true that they are totally worth waiting for. With your second child, however, there will be a constant reminder of the time it took to conceive them in the form of the age difference to their sibling.

The enquiries from strangers.

“When are you going to have another then?”

“So you’ll be having another one soon then?”

I get these kind of enquiries all the time. Again, I know it also happens to women before they’ve had their first child, particularly if you get married and/or move in together. People who know you well will start making light-hearted remarks about the patter of tiny feet and even the odd stranger may ask if you’re going to be starting a family. But once you already have a child, it steps up a whole gear. People start telling you that you shouldn’t leave it too long. Or worse, that you can’t possibly only have the one child, as if that is somehow a form of cruelty. This is particularly hard for me in my very public-facing job, where my patients often treat me a very familiar way, because my own style is very friendly, and they think nothing of asking when I’ll next be on maternity leave. I think people partly think these questions are fine to ask of people who already have children because of the assumption that:

You have one baby, so therefore you should be able to have another.

Despite secondary infertility actually being more common than primary infertility, an awful lot of people still don’t know that it happens. Lots can change between conceiving one child and trying to conceive another, not least childbirth itself. Plus we’re all older when we try for our second child than we were when trying for our first. However, people see one child and assume another will be possible.

The assumption of simply being able to have another child comes from within too. Struggling to conceive a second child, particularly if you conceived easily the first time, can be enormously frustrating because it does go against that superficial logic. By contrast, most people are aware of infertility and will often start their journey to try to conceive their first child with at least a seed of possibility in the back of their mind that they may have a problem, or perhaps a strong hope that they won’t be one of the couples who do.

No escape from babies and families.

Since you already have a child, you are fully immersed in the parenting world. Not only do you know exactly what you are missing out on, you’re likely to be surrounded by mum friends, many of whom may be getting pregnant again, and mum strangers who all seem to have more than one child. The school holidays are particularly difficult for this, and I’ll shamefacedly confess to not joining a planned children’s centre activity this week because when I arrived all the other mums were either pregnant, or had one baby in a sling whilst chasing their toddler around. (Perhaps I would have dealt with it better had my period not arrived that morning. Hey-ho.)

When you’re trying to conceive your first child, you will see pregnant women everywhere, and feel like the whole world is having babies, but somehow it’s easier to turn a blind eye when you have plenty of non-baby things to be getting on with, like enjoying trips to the cinema or theatre, and spontaneous afternoons of drinking in the sun in a pub garden.

Feeling torn between sadness at not conceiving, and happiness with the child you have.

And being made to feel guilty by people stating the very obvious “at least you have Thomas”. Well, duh. I dislike the implication that I’m not endlessly grateful for the miracle of this child in my life, but having one child is not the same as having two. And I want my son to have a sibling who will hopefully be there for him in to old age when we are long gone. It was easier to want one child, and wallow in the pity of not being pregnant with wine and chocolate. Now I feel sad, and my mind frequently wanders to thoughts of another child, but I can’t let that affect how I am as a Mummy to the child I already have. Which is hard. I’ll always be over the moon to have Thomas in my life, but if we didn’t have a second child, I’d always feel like we had a little bit missing.

The emotional side of sex.

Time for sex may be a surmountable problem, but there is no denying that the actual act of trying for a baby is different the second time around.Sex is less relaxed when there is a possibility of being interrupted, and there may be a background voice urging you not to make too much noise. It’s definitely easier for it to become a chore, and something that happens solely for procreation purposes, which in itself isn’t helpful to your relationship or you chances of success.

 

I’ll admit that I used to think that people struggling to conceive a subsequent child had it far easier than those trying to conceive their first. I’m guilty of having had the “but you already have a child” thought. But I know now that the desire for more children is just as strong as the desire for a first, and just as valid and important. It is just as innate and uncontrollable. And I’ve also come to see all the extra complicating factors that I’ve listed above. This is, as always, a pretty personal post. I realise that not all of these things will be applicable to every woman, and not every woman will share my desires and viewpoint. But hopefully it may give some food for thought before you ask someone about when they are planning to have another child, or point out the obvious that at least they already have their first child. These kind of questions and statements are, for me, up there with asking if a baby was planned, or unsolicited touching of the bump.

If you’ve not started trying to conceive your next child, I hope this post never becomes applicable to you, and that you find conceiving your second easier than your first. But if not, please feel free to say hello! And any tips, please pass them my way.