Update

My mom went and had a really long conversation with the OB, and got the true picture of what happened in the last few days. The situation (and getting the details we did not have) was reassuring: her bp was down, and she has been sent home with beta-blocker pills.

The reason I was stressed out yesterday was I had NO idea what was going on: I did not know if her BP had stabilized, I did not know if her infection had cleared, or even what sort of infection she had. Even if she has no access to decent care where she is now, she is atleast stable, and has promised to come back in time for her weekly appointment next week.

We now have to set a date for induction. Unfortunately, we cannot wait for long because her home environment is not the sort of place you want to be in, in the event of any emergency; I've driven there; getting vehicles in and out is a nightmare, it is far away from the hospital, and the local medical care is definitely un-vetted  and far from ideal (it is the local clinic in a seriously poor neighborhood). So we will have to pick a date for stuff to happen at or close after 37 weeks, which is the 9th.

I'll be so very glad when this is over, hopefully, with a healthy baby in my arms. This is when knowing the gender would have been a little useful in making a decision. Have you guys heard about the "wimpy white boy syndrome?" This is a term that may be somewhat hurtful if bandied about in the NICU; don't know who is the insensitive genius who came up with it. Basically, it has arisen from the fact that, in general, girls mature faster than boys, and the maturation in utero also depends on race. White male babies are the slowest to develop and hit all the landmarks (lung maturation and various reflexes, including the suck-swallow-breathe one). My baby is half-white, and if it is a boy, the odds of him needing those last 2-3 weeks more is higher, give the race-specific data. I have NO idea what the influence of his Indian genes would be: Asian, black, and white babies have been studied, but not south-east Asian. Irrespective of race, it is a girl, we could, in theory, breathe a little easier about inducing close after the 37-week-point. But bleh, this is India, so I can't bloody find out.

Sigh. But still, overall, I can breathe again. Yesterday was rough.

In need of sedation

I found out, mostly because I had an intuition that something was off, that J discharged herself against medical advice, and has gone home. Nobody even bothered informing me of this: I found out because I asked.

I don't know her medical condition and what was done in the past 4 days when she was in the hospital. Right now, I have to wonder if the baby would be safer out of her than in her, but we have to wait to talk to the OB to figure that out.

I have to take really deep breaths and pray that everything will be okay.

More on the realities of surrogacy in India

Part of this post is prompted by the the commenter in the previous post; her first comment was rather judgmental, but allowable. The second one was fairly rabid in tone, and talking about how a blood pressure value of 150/90 is not preeclampsia (no, of course it is not), and how the situation could have been managed while not uprooting J from her home environment, and finally ending with a rant on the utter uselessness of vitamin D, and how I was inflicting this utterly pointless thing on her.

Now, since I am slowly starting to attract the trolls, here are some ground rules for this blog: comments of that tone, with such a content will just be deleted, and you will never be allowed to comment again. You can say whatever you want anywhere else on the internet, and if you can find somebody to listen to you, good for you, but here, you get no talktime. You are, of course, welcome to spend a long, long time composing a new vitriolic comment. I will then delete it as soon as I spot it, and you would have wasted all that time. If the situation ever gets truly annoying, I will turn on comment moderation to save myself a headache, and then nobody can ever see your words of wisdom  for even a short while.

But overall, this annoying episode, and Katrina's very thoughtful comment highlighted that it would be useful to talk a little bit more about this situation.

I can't even begin to sum up what a minefield surrogacy in India is. All the doctors involved have expressed upon me a 1000 times that these surrogates are not like surrogates in the west, and how they should be handled differently. How they should be handled is the billion dollar question, and trying to come up with the most optimal way to do it is a very complex topic. I think I'll spend a good part of my book trying to thrash it all out, and atleast outline how some of the current practices should change, and how that change is sometimes stifled by various issues.

First, about medication compliance: from the start, her bloodwork has not tallied with the doses she said she was taking. I didn't want to not believe her, but if two sachets of 60,000 IU have not increased your blood levels at all, then something is off. She could be absorbing it very poorly, or she could be lying, or she could have been throwing up what she took. None of these possibilities could be dismissed, and to this day, I do not know what to believe. After I kicked up a fuss after the first few months, the Vitamin D she was taking started to be reflected in her blood levels. I have not checked in several months, and this drop has shocked the crap out of me. Again, cannot tell what the issue is, whether it is lying, poor absorption, vomiting after the dose, or very much increased needs.

Also, surrogates in India would have a very different take on say, prenatal vitamins and nutrition than a surrogate in the west. Such a person would be self-informed, and would understand what was going on. Because surrogates in India are mostly uneducated, they may not also take these things seriously. Also, nobody bothers explaining anything to them. They just say "here, take this pill or this injection." I've spent a lot of time just talking to J explaining what each thing does, and it is my duty to convey that information, even if she pays me no attention or does not understand. I've also tried to give her similar health advice about her own kids. Completely goes over her head, and if she ever takes my advice, I'd be shocked. Still, I cannot help myself. 

Here is some background on the housing situation. J lives in a sort of housing called a chawl. Her bathroom is outside her apartment, which means she has to get up in the middle of night and leave her house to go use the facilities, which is insanely difficult when your pregnancy progresses to this point. It is also getting hot here, and sometimes, without air conditioning in the noonday sun, you feel like you would get heatstroke. Imagine dealing with this when you are nearly 9 months along. Keeping all this in mind and how exhausted she is, I offered her the only comfortable option I could offer: hospitalization. She wanted to get admitted to the hospital after April 2nd, because she was also feeling run down/exhausted. When she showed up with a steadily increasing BP on March 26th, it was the OB's decision to hospitalize her, and I was definitely on board with that because I am really afraid about the medical facilities she has access to right next to her house (an extremely poor neighborhood), where her care would be coordinated by the handler. 

If you went with other agencies, you could have more options. Many surrogate agencies/doctors offer housing/more hands-on care. People can move in in the start, or in the last few weeks in case of a special situation (such as this one). My RE offers nothing other than the handler to manage the whole shebang. Dr Patel at the Akansha Clinic in Gujarat offers a home of sorts, where surrogates live for 9 months. The Mumbai-based agency Surrogacy India (SI)  has a few apartments where surrogates can be housed, and there is a nursing home in the same building, with an ambulance on the premises. While these options offer many benefits, what I do not like about these situations is that the surrogate is separated from her family. While there many be some advantages in separating her from her husband in some (e.g., if the husband becomes positive for an STD, or is deadbeat spouse (very much common in this socio-economic group), I would definitely feel a great deal of guilt if I separated her from her children for this really long period.  If I ever do this again, I'd want a situation where the surrogate could move in with her kids, and I'd be more than willing to spend the extra money to make this happen.

An alternate, viable option is to have your surrogate live at home with the family  (close to the agency's housing), and, if there is any sort of emergency that requires separation from her husband (SI told me the story of a husband who became positive for syphilis during the pregnancy) or for greater medical supervision, move into the agency's housing for maybe the last few weeks.In that way, she would be much closer to her family and see them on a daily basis, etc.  However, in my unique situation, I have no options other than the hospital.

Anyway, I just spoke to J. Apparently, she received IV antibiotics for an infection last night. I have no idea what is going on; going to go to the hospital to try to figure things out.

Admitted!!

Two days ago was J's 35-week appointment. The handler, who was supposed to ensure that J's appointment was kept, was herself unable to come there this week, and J wanted to cancel. I put my foot down and and badgered her into showing up. Had I not been on the scene playing policewoman,  J would have skipped this week, and that knowledge frightens me a little.

It frightens me because when she showed up, her blood pressure was 150/90 and she was admitted on the spot. I'm SO glad she is in the hospital now, where she will be monitored regularly for blood pressure and proteinurea. She is also on medication (alpha dopa) to bring the BP down. It turns out this was the story in the last pregnancy too: things were fine until around this point, and then her BP started rising, and she spent the last two weeks in the hospital.

Thank you Pam and Josey for your inputs. Yes, absolutely, waiting till 39 weeks and beyond will ensure that your baby's first few weeks are more comfortable/easy. I don't think I'll have that choice now. As of now, J cannot wait to get this done. She asked me if she could deliver at 36 weeks. The answer was a firm hell no.I told her that if things are fine medically, there is no way anything is happening before the 37-week point. I also told her that the OB would decide when things would happen.

To make matters a bit more strained, J wants to attend a wedding on April 15th: her sisters. I was flabbergasted: Even if she gives birth on, say, the 12th, I fail to see how she could be up to speed three days later. I'm not going to say, wheee....lets induce on the 9th, which is the 37-week point. All in all, I'm butting out of this and leaving it to the doctor. It is going to be a rather uneasy balance to strike, I think.

I had another jolt when we redid her Vitamin D test...I've been giving her a sachet of 60,000 IU every 2-3 weeks, and around like 6-month time point, her levels were a rather comfortable 23 ng/ml. This week, it was 11 ng/ml!! (just as a note, if you get below 10 ng/ml, you fall into very unhealthy territory).

If she has indeed been taking her sachets as she told me she was, it clearly shows that babies are little vitamin D leeches/vacuums, apparently. I know the mother's vitamin D requirements go up strongly in pregnancy, and it is logical it would go up even more in the third trimester when the growth really picks up, but to this extent?!?

The baby apparently has been growing well. There was an ultrasound done yesterday, and I got the information secondhand through J, and it hence may be inaccurate:  it seems rather high for 35 weeks, especially given that this has been a smallish baby all this while: 2.8 kgs (over 6 pounds!). This was a different operator/machine though.

All in all....getting into the final stretch. Gotta pack that bag now. Monday is my last day of work. Hoping to spend whatever little time I have working on that proposal for the book on Surrogacy in India.. It is also time to launch my new blog. And write a few pending blogposts for this one. And prepare for a baby!!!! So very unbelievable.

Driving myself batty

I'm having a teeny tiny freak out. FOR NO GOOD REASON.

Everything is okay. J's blood pressure was 130/75 yesterday, so in the normal range. She is getting it checked out every two days.

The baby, as mentioned in the last post, is fine. After I put up the last post, another mom who used my donor told me that her baby was in the 95th percentile for height too. Awwww. As one of my friends puts it, the most random things are turning me into mush. The thought of my baby being similar to one of its (many) half siblings in any way makes me just melt. And I don't even have pregnancy hormones to blame!

Going a little off topic on a rant here, but India's decision to ban sex determination is one of most useless of its many useless decisions. I recently found out PGD is banned too, unless you have a genetic disorder, and can prove you have a "valid reason." Since I have only recurrent miscarriage, I would not qualify.

I wanted to talk about the futility of outlawing sex determination and the unbelievably ugly realities surrounding this situation in this country. I had it all typed out, and then I deleted it. I can't have that in the same post as this (see below!).

Moving to better, happier topics: my doctor switched the 4D mode on for a little bit at the last ultrasound, and I saw his/her little face!!  What is driving me batty is I want to discover my child. For example: This is going to be a biracial child: I spent a looong time wondering (googling) what colored eyes he or she would have. It is going to be utterly up in the air. Most likely, it would be brown, but then I may be surprised because I have people with hazel eyes and green eyes in my extended family. After brown, hazel probably comes in second, with respect to probability. All the rest should be way lower.

And some days, like today, I feel like I have no patience left. Recent studies have shown that babies born at 39 weeks onwards do best, and do slightly better than the ones born at 37 week in many aspects. These findings are prompting people to change the definition of "term" to 39 weeks.

Nonetheless, in India, the average point of delivery for surrogates with singletons is 37 weeks. If you are a surrogate carrying twins, it is before 35 weeks, I think.

I feel like I am hanging on by my fingernails till the 37-week point, and honestly, I should be pushing them all (J who is anxious to deliver, and my docs who will probably give the green light at around 37 weeks) to wait 2 weeks longer. And yet, I absolutely do not want to do that. I need to be disciplined enough to try to do the right thing when the time comes.

Checking in: 33 weeks

We had the weekly ultrasound a few days ago, and things looked good: this is one seriously long baby, the femur length is at the 95th percentile! Weight-wise, this baby is sort of small (20th percentile) when compared to the US growth charts, but he/she is bang in the middle in the Indian population charts. So yep, everything looked good there.

Went to Hiranandani Hospital. Chatting with a bunch of surrogates made me realize one thing: Indian surrogates (in Mumbai anyway) don't seem to get epidurals, even if their labor is long and painful. I asked the handler like 4 times...nobody gets epidurals? She was like, nope. Just FYI, if I were going through a delivery at the same hospital, I would definitely get the choice of an epidural. They are common here for all the "regular"  upper middle class moms. When I told my mother about the surrogates not getting an epidural for the pregnancy in which the cost of an epidural is a mere drop in the bucket compared to the other expenses, she just sadly shook her head.

If J goes through labor, I'm going to make sure she gets one if the labor is protracted. However, around 75% of all surrogate deliveries are C-sections. J asked me wistfully if she could get a C-section because the last time had been so rough. I was like...but you suffer AFTER the procedure, instead of during. And she was like, well, yes, that is true.

From my end, I definitely don't want a C-section; what I want is for J's water to break naturally after she is safely ensconced in the hospital, so she does not have to go through the more painful induced labor process. I highly doubt that fate would cooperate like that.

After a 2-hour wait for me (a 4-hour wait for the various surrogates gathered), the doctor saw us.  Her BP was on the high end: 130/84. Gotta start monitoring that.

Slightly nervous now.

Thinking ahead (on vaccination strategies)

Today marks 32 weeks. Rather unbelievable. I've started buying stuff, which freaks me out quite a bit. I have to make a significant purchase/decision soon: the mattress. The options for cribs in India don't seem so bad. The options for mattresses suck. They are all made of PVC foam or are "antibacterial,"which is just a fancy sales gimmick, but is actually far from ideal. And pillows. OMG, does the Indian baby market abound in these. I shudder to think who would buy, for example, this product. Despite the rather appalling lack of consumer awareness, surprisingly, the incidence of crib death is lower in India than that in many other countries.

So I'm going to have to buy my mattress from the US, or get it made myself (you can get gaddi makers to do it, and could could source cotton materials yourself). For multiple reasons, I would rather go with option #1; right now, I'm thinking Naturepedic. If anybody has any thoughts/ideas on this subject (also on making your own mattress; I'd love to, but I have little know-how), I would love to hear them.

A few days ago, I told a really close friend of mine, who had a baby 6 months ago, that I was going to be having a baby soon. She was my roommate when I first started trying over 3 years ago, and was incredibly supportive then. Her reaction when I told her now blew me away: she offered to express and freeze breast milk for me! I'm not going to turn this incredible gift down. If I get even a few days worth of partial feeds, it would make me feel so much better. She is such an amazing friend.

Finally, we come down to a controversial topic: Vaccination. As an immunologist, I was initially appalled at how early vaccinations start in the US. Then I compared the Indian schedule to the American schedule, and I realized that the American one is actually a tad better in comparison. In the US, only the HepB vaccine is given at birth; here 3 vaccines: HepB, BCG, and the Polio vaccine is given at birth. All three are for diseases a newborn is unlikely to catch in today's day and age, especially if you come from a situation where the baby will be kept mostly isolated after birth, which would cut down the TB risk. I am sure these were designed keeping the poorer section of the populace in mind, but none of these is anything my baby is at risk for.

Indian rules aside, overall, vaccine policy in the world is rather flawed, although everybody who attacks vaccines seems to be making the wrong argument. I spent a good part of my career studying the cells that the vaccines are directed towards, so every time somebody told me about a a bunch of vaccines that would be given when the baby was 6 weeks old,  I would get a headache, because the immune system of young infants is not yet ready to optimally respond to a vaccine, because it is still developing. If you give a 6-8-week old baby a bunch of vaccines, it will not result in optimal protection; very far from it actually, it could mildly hamper the immune response towards the targets. Additionally, if the immune response is not optimal (which is very likely if 6 vaccines are given together at 2 months of age), your child may be protected for the next few months, but despite boosting, may not efficiently develop long lived protective immunity in the form of memory B cells, which is supposed to be the goal of a vaccine. All this is covered very well in this Nature Reviews Immunology article; I would urge the doctors (especially any pediatricians) visiting this page to read this.

 Moving away from the efficacy of multiple vaccines given at two months of age, vaccines given at birth are even worse, and are most likely utterly useless, for multiple reasons. One important one is that they will most likely be neutralized by the antibodies that the mother passes to the baby in the last trimester. For example, most mothers have strong immunity against Hepatitis B, and their antibodies, which protect the baby for about 20-30 days, will most likely neutralize the vaccine that is given at birth. So why bloody bother giving the vaccine at this point?

Another downside is that the vaccines themselves are a terrible jolt to the system. There is  no concrete evidence to indicate that the vaccines cause autism or have any long term side effects, but still, to err on the side of caution and also to ensure that they work in the way they were intended to work, I would rather wait till my baby was older (atleast 3-4 months) before I started vaccinating, and then go for a very staggered schedule, with longer intervals (3 months maybe) between boostings.

Yet, I understand the dilemma faced by both parents and medical officials: what if you cannot isolate your baby, and you have to travel with them, or send them to daycare regularly from an early age? If you are a parent with a micropreemie, the situation would also have to be handled differently. 

But, when it comes to full-term/close-to-term babies who can stay home and relatively isolated for the first few months of life, there is a better way available to do things.  Yet, the truth that doctors will not tell you (possibly because they do not understand it themselves; the only ones who would would be the immunologists who have an in-depth understanding of B/T cell biology) is that that very early vaccinations produce crappy/inefficient immune responses, and the longer you wait to vaccinate, and give fewer vaccines at one time, the better the immune response and the efficiency of the vaccination. Keeping the last point in mind, there is one alternative vaccination protocol from Dr. Robert Sears that has been doing the rounds; It is popular, as well as controversial. My opinion is that some aspects of this protocol (giving only two vaccines at a time in the first year of life) may produce better results than the regular protocol. It would be interesting to study antibody titres in babies subjected to the two schedules. Maybe that would put an end to all the bickering and the uncertainty. However, I am not too enamored of the dragging out of the vaccinations in the Sears protocol after the first year of life; somebody mentioned that even the most well meaning of parents could just lose track of the vaccinations if they are being dragged out, and that seems like a fair point. After babies are no longer classified as "infants," their tolerance and their immune robustness is closer to that of an adult, and the kid gloves (ha ha) could come off partially at this point. This is especially so after 2 years of life, when they start responding well even to polysaccharide vaccines. But this is an incredibly complex area, and my simplified take does not even begin to touch on some of the other issues (for example, is it better to get chickenpox as a kid, or be vaccinated against it).

In my own case, if I can manage relative isolation (no daycare/travel for the baby, and as little contact with the outside world for the first few months of life as possible), then I'm going to delay the start of vaccinations for as long as I possibly can (maybe up to 4 months). Ideally, I would have loved to start vaccinations only after the baby crosses a year of age, but unfortunately, we cannot live in a bubble for that long. There are additionally multiple ways to ensure that your baby's fledgling immune system is as optimized as possible, but that is a topic for another post.

An epiphany

After reading many, many neuroscience studies (she has to edit them), a really good friend of mine told me she thinks she may have ADD (attention deficit disorder). She gave me a long list of symptoms, which made me go like, huh, I have a few of these issues myself: I zone out/am completely oblivious about the things that do not interest me, have a hyperfocus and a startling attention for detail for the things that do, and have major procrastination issues. Do I have ADD?? Probably not, given all the things on the list that I have to answer no to. But then again, to play the devil's advocate, maybe I do have a very mild form. One of the things I did not know how to answer: Do you have problems starting/finishing projects? I start/finish projects at work just fine (I managed to get myself a PhD, and that is the mother of all projects). But I am rather lazy outside of work. I don't do art. I don't volunteer. I don't cook/bake. I started vocal lessons and I abandoned them. Basically, I need to feel passionately about something to really work at it. Outside of work, the only place I have ever applied myself is in this area.

This morning, I woke up with a startling surety: I want to write a book on surrogacy in India. I never thought I would write anything other than scientific manuscripts, and this would be one heck of a project. After the birth, I had planned to write an in depth blogpost about what I have learnt, how you need to protect yourself when you get into this, and what needs to change for the betterment of the surrogates themselves, but what I have to say is so much more than what can go into a few blog entries.

Plus, if I really wanted to help people figure out the best way to proceed here, I would have to do so much more research, and the only way to work up to that level of commitment is to, well, commit myself to something big.

I think I am fairly well poised to be the person that provides a good accounting of this topic: I've gone through this firsthand, while living here, and the information you glean while going through this process is astounding. I've actually been to the hospital appointments and seen what happens. I have a clear idea about the financial side of things, and BOY, let me tell you, that stuff needs airing. The social aspects need airing. Surrogacy in India needs to be made more transparent, and change (through legislation) needs to happen, on many, many levels. I'd like to help that along, in whatever small way I can.

How DOES one go about this? I decided I would not do this half-assed. I would try to find an agent and a publisher, and then proceed. The first step involves putting together a book proposal. Then, I can go agent hunting. Ulp.

I hope this is a project that is not a one-day/month wonder for me, and will end up making a bloody strong case for me *not* having ADD. 

Checking in: 29 weeks

Random things in bullet points:

• My OB did get back to me after I finished my last post, saying that the surrogate DID need to be given the anti-D shot. Her assistant had not put that on the report. I then had to get the prescription ordered and get the surrogate to Dr. Bhansal who agreed to give the shot, and I reluctantly decided to get the ultrasound done too, because we were going there anyway. As I was on my way there (with slight trepidation in my silly heart as I was going alone for the first time to an ultrasound), my mom called and told me she had missed her flight and could make it there anyway. YAY. Thank you Universe.

•  I got proof that fetal biometry readings should be taken with a giant pinch of salt: Remember a while ago that I was mildly nervous that the head circumference (HC) was in the 12th percentile? This time, it was around the 50th percentile, while abdominal circumference (AC), which was around the 50th percentile the last time around, had now fallen to the 7th percentile. The only thing that has been consistent is the femur length, which is around the 80th percentile in each scan. So yeah, fetal biometry, not seeming hot, really.

• I also met a lawyer to take care of the legal stuff for getting the baby back to the States. Her first question was, where did you do your IVF treatment? She asked me this because there are apparently some doctors in Delhi who have put other people's embryos in a surrogate, and the poor parents have a bone jarring shock after birth when the DNA test revealed that the baby was not theirs. If you are a foreign national who planned to return to your home country with your baby, things get impossible, and there are families in limbo and babies in limbo because of this. Horrifying. She did tell me that she had handled some surrogacy cases coming out of the Malpani clinic, and they had been ethical and did not pull such horrifying cons. It is unbelievable that there would be doctors out there who would do stuff like this.

• The baby is just past 29 weeks now, and should hopefully approaching 3 pounds soon. Still so utterly tiny. Nearly every day, I google fetal survival and fetal weight and go over information I should be able to recite in my sleep by now. Previously, 28 weeks was my safety mark. Now, it is 34 weeks, where the only issue a baby may have may be an initial inability to suckle. It is also getting more real now: I've been my own person my entire life. It is terrifying and exciting that I may be getting a little person who will take over completely. 

• I told my aunt (who I am pretty close to) the news. The last time I told a family member I was trying this, their reaction was so ugly that I was badly burned and decided not to tell anybody in the family till the baby was here. In contrast, my aunt's reaction was wonderful. She just kept repeating that she was happy for me that I am getting a child of my own, but so sad that I had gone through 3 miscarriages and such a difficult journey by myself, and that she was just so glad that my parents had been there for me and had known all along. It was a lovely, lovely response, and I am so lucky to have her in my life.  

More glimpses of the realities of surrogacy in India

J goes to Hiranandani hospital for her routine OB-GYN checkups. I went with her for her very first checkup, and it was an intensely disconcerting experience. There are about maybe 12 surrogates gathering and waiting for anywhere between 1-3 hours. The OB-GYN's assistant shows up, and starts seeing this procession of women. They get a doppler check and their blood pressure and weight read, all while the next 3 patients are queuing up on the other side of the curtain while the first patient is in the bed. My mom likened it to the situation in the poorest, most strapped municipal hospitals, where she worked briefly as an intern

After that first painful experience where I waited over 3 hours for a 15-min cursory check complete with an ancient-looking doppler, I never went again, and instead only go with J to the wonderful, detailed ultrasounds that are run at the Mediscan testing center by the very capable Dr. Bhansal.

This past Wednesday marked 28 weeks, and J went for her checkup at Hiranandani. I contemplated going, but I decided to just trust the system and sent her off with all the reports and expected her to get both the Rhogam shot and much discussed mandatory steroid shot. Too many times where I decide to just trust the system here, it has turned out to be a Bad Idea. But that is a topic for another post.

I talked to J after the appointment and find that no injections were given. I then try to find out what happened. If you go to an agency like Surrogacy India, they have this system where all the reports are scanned and uploaded and are available online for the parents immediately. Here, with the Malpani Clinic, there is no such centralization. I've spent 3 days waiting to find out what exactly was done at that visit. The surrogate handler claims that she gave the report to the receptionist at the clinic, who then claims to have emailed it to me. No such email was received. The handler claims she reminded the receptionist of it again one day later, and that she apparently mailed me. No mail was received. I've asked the doctor what was happening, and have received no word. I am SO very glad that I have to deal with this system only for another 10 or so weeks.

But here is the deal: they don't give the steroid injection at the hospital, they only write the prescription for it, and expect that some local nurse or some local doctor will give it. In the case of the Malpani clinic, the person who gives the shots is no trained nurse, but the handler herself.  A little background on the handler: This is a woman who has gone through surrogacy herself, comes from the same socio-economic class as the surrogate, and is partially literate, but at best studied till high school. In general, these are not people who are professional and impartial: they may not above lying for the surrogate (remember the story I posted about the handler who helped a 42 year old surrogate propagate a lie that she was 28?). 

In this case, the handler will give the shot at her home.I have to pray that the she is atleast trained in sterile techniques. I asked my RE about this, but as with most situations, I got resounding silence.

Here is the other thing: J told me that Dr. Malpani thinks that the Rhogam shot at 28 weeks is not necessary. He has not bothered communicating this directly with me, and nor has the OB-Gyn.

The person who did seem to think it necessary is Dr. Bhansal. She is a fetal metal specialist who works with high-risk pregnancies. She is also the go-to person for detecting fetal anemia, and is also the go-to person to give transfusions in the situations where it does develop. I'll have to talk to her about the necessity of this again. I totally hear you guys about the many places that do not give this prophylactically at 28 weeks. The one reason why I'd be more concerned here is because this is a surrogacy, and J may not be as prompt as required if something goes wrong (if she falls, etc).

But, in happier news, we have crossed the 28-week mark. This is the point after which the complication rate falls considerably. I was supposed to go in for an ultrasound tomorrow, but my mother will not be in town. A while ago, my friend M told me to always take my mother with me to the ultrasounds, because she is my lucky charm. I take that advice very seriously: she has come for every appointment, and I'm far too chicken to go in without her now. The next ultrasound should happen in the middle of next week.  

Also, I want to celebrate the surprise (to me anyway, I had NO idea) pregnancies of 2 bloggers who are very close to my heart, who have stopped actively blogging. I think it is rather cool that two such very wise women who I thought were actually quite similar (in their outlook on things and their utter sensibility)  are so synchronized with their pregnancies; they both just crossed 24 weeks. Adele and Arohanui, so very happy for the both of you!