DID YOU KNOW?
1 in 8 couples struggle to build a family and 7.3 million American women experience difficulty in conceiving.
Infertility does not discriminate based on race, religion, sexuality or economic status. You never know how badly you want something until you are told that it may not be possible.
It is up to all of us to transform how others view infertility. One that will help educate and provide resolution to the millions of Americans impacted. Be part of a movement that wants to remove barriers that stand in the way of building families during National Infertility Awareness Week.
For those of you who are visiting my blog for the first time or for those of you who just read the title of this post and thought you’d stop by to read, I am glad you did. Now that my story has been public for over a year now, I thought it would be a great time to share it during this week.
My Journey Through Infertility
I have a long story of how I got here… I’m 42-years-old and conceiving a child has been a long road for my husband and I. This is something I have only shared with a small group of people. But, I recently joined a group on Facebook and I told my story there. A young lady was so touched by my story; she asked me why I was so embarrassed to share. She said I could educate other people and possibly be an ear for them. I really don’t know why I have been so embarrassed; it’s something so many men and women are dealing with.
Some background history on me, I have been with my husband since 1996. At the time, we both agreed that we were not interested in having kids too early, so we planned to wait several years. Then, once we considered it… we had some large speed bumps in our way because I started to have crazy bleeding spells. In 2005, I was bleeding so heavily. We didn’t know why. I was ignoring it, thinking I just had a heavy menstrual cycle. Finally, in December 2005, the bleeding got so bad that I was rushed to the hospital for uterine hemorrhaging. The Doctor who saw me in the emergency room said I had a tumor, a grapefruit-sized fibroid tumor, on my uterus and that I needed a hysterectomy right away. This took me by surprise. I was shocked. I immediately thought, there is no way I can lose my uterus; I haven’t even tried to have a child yet. I quickly went around for some “other” medical opinions. I found two other OB/GYN doctors and they both came to the same conclusion – That I needed my uterus removed. I could not deal with this. I cried to the last OB doctor. He suggested that I see a well-known specialist, who was based out of Loma Linda University Medical Center in California. There, he was head of the Center for Fertility. My OB doctor suggested that whatever the specialist were to say, that I should listen to it. So, I got my referral to see this specialist (Dr. James Patton). Dr. Patton was the only one who said he could save my uterus. I was ecstatic and beyond relieved! How amazing that this specialist was so confident he could remove my tumor and save my uterus! So, in less than two months from my trip to the ER in December, Dr. Patton scheduled me for surgery. On February 22, 2006 he performed an abdominal myomectomy, the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before. He had some difficulties. He ended up having to do a complete uterine reconstruction because my tumor had grown through my uterus. The recovery from this surgery was tough. I had to have help the first two weeks. I couldn’t do much of anything. Any movement with my body was severe pain. Even trying to vacuum my home was a nightmare of pain. Think about everything you do with your core muscles and when you are sore from doing to many sit-ups on your worst day. Now multiple this pain by a thousand and it probably still doesn’t compare to what I felt! I thought up to this point I tolerated pain well. Thankfully though, it was a successful operation.
At my six-month follow-up (August 2006), Dr. Patton gave us the “go-ahead” to try for children. But, sadly, no luck. I had regular visits with my doctor and he knew that we weren’t having any success at getting pregnant. Since he was a fertility specialist, he decided to run some tests on me. By the grace of God, nothing came back medically prohibiting me from conceiving, and nothing came back “wrong” with my husband… So, we were stumped! They categorized us as the “unexplained infertility”. For anyone who knows me, they know that this is not the kind of answer I can live with. I am a control-freak and this was something completely out of my control. I asked myself, What did I do to deserve this? I asked myself over and over. I am a woman of Faith and I did not understand why God didn’t want me to have a child. Well, at least that’s how I saw it.
Anxiety, Stress, and Depression set in. However, I was still determined.
So, we decided to try fertility meds and see if that would help us conceive. Over the course of a year, we used the medication during my cycles. But, again, no luck, whatsoever. Then, we decided to get a little more advanced into fertility treatments and try to do Intrauterine Inseminations (IUI’s). For those who do not know what an IUI is:
Medical definition of IUI: “A form of assisted conception. During IUI, your doctor will place washed, prepared sperm into your uterus (womb) and near to your egg at your time of ovulation. This procedure is often combined with fertility drugs to increase your chances of conceiving.”
We first attempted an IUI in 2008. We were really excited because our first round resulted in me having 4 eggs and my husband having 220 million sperm! It was almost nerve wrecking because the thought of 4 babies just overwhelmed me… But, we were too excited to even pay attention to those numbers. We just knew we wanted a baby. Unfortunately, though this cycle was unsuccessful. Our attempts on the IUI cycles went on and off over the next 19 months. You cannot do cycles back-to-back because when you over stimulate your ovaries, large cysts tend to form. I did get new cysts on my ovaries and they got to the size of golf balls! We attempted 8 more cycles. All failed. Dr. Patton decided he wanted to perform another surgery to check me for adhesions from my previous two surgeries. He said there was a chance this was hiccupping the IUI’s for us. So, another surgery in September 2009. Ultimately, he had to clip a few things inside that he thought might be an obstruction to me getting pregnant. So, yet again… more scar tissue to add to my poor uterus.
This was really my lowest point. I was so unhappy; I didn’t know where to turn. Since I had only shared with a select few people, it didn’t help me. I had no one to talk to. Those people I shared with did not suffer from any sort of infertility, so they could never relate. In fact, some people asked me really insulting and ignorant questions related to my infertility. That is when I shut down. My husband did not understand why I didn’t want to talk about it. I tried to explain to him that, as a woman, I felt embarrassed. My thoughts were always, How can I be a woman if I cannot conceive a child as God had intended? So, at this point, I finally decided to give up everything and just turn to God. For those of you who are believers, you have heard the phrase, “Give it to God.” Well, I did. However, it was a constant obstacle that the enemy decided to put in my way. The enemy was so happy to see me so discouraged and steering away from God. So, I constantly had to tell myself, It’s in God’s hands, not mine.
Most are familiar with the saying, “When it rains, it pours.” Well, that’s exactly how it felt. To add to my frustration, my insurance did not cover fertility treatments, which are very costly.
At this point, we only had one other option. My doctor said he wanted to try In Vitro Fertilization (IVF), but it would cost us $20,000. I didn’t have that kind of money. For those who do not know what IVF is:
Medical definition of IVF: “Is a reproductive technology, in which an egg is removed from a woman, joined with a sperm cell from a man, inside of a test tube (in vitro). The cells fuse to form a single cell called a zygote, which then starts dividing, becoming an embryo.”
So here we are in January 2010. I just happen to talk with another Air Force member who was telling me she was going to the Infertility Clinic at the Naval Medical Center in San Diego. She was going there because they were helping her do a reversal of her tubal ligation she had gotten 10 years earlier. I got curious and asked her how she was able to be seen at that facility being so far from it. Since we were stationed at March AFB in Riverside, both of us had Tricare Prime Remote. She said she got a referral from a Military Treatment Facility (MTF) and got put on their waiting list. Apparently there are four military hospitals in the United States that have infertility clinics.
I started to make some phone calls. The San Diego clinic would not take a referral from my Primary Care doctor because they were civilian providers. Since I had no MTF on my base I called Edwards AFB. I was able to get assistance from a very nice lady and she sent the referral for me to be put on the waiting list at the Naval Medical Center’s Infertility Clinic. I was told it was a two year wait. But the price of IVF using a MTF was the way to go. The IVF cost was covered since it was a MTF except the cost of the embryologist. The Embryologist was contracted out and it was going to cost us about $5,000. Part of the IVF process was also the egg retrieval. So if you had a lot of eggs you could also freeze the extras (at a monthly rate) through the company the Embryologist worked for.
The waiting game began. Of course we continued to try to conceive on our own, but still no success.
The wait seemed forever. But we got a phone call in December of 2010. It was the Clinic calling me to wish us a Merry Christmas and tell us that they had a few people drop off the waiting list and that they would be calling us by April in the new year. We were so excited! I still remember the day my cell phone rang. It was February10, 2011. It was the San Diego clinic calling to tell us that it was our time. We had to go through a few preliminary appointments as new patients (exams, bloodwork etc.), but we were ready. We had one minor setback in May 2010 when they performed the Saline Infusion Sonogram. That’s the sonogram where they check your uterus’s content and make sure there are no deformities or foreign objects in the way for the upcoming embryo to implant on. There was something on my lining showing, so they doctor scheduled an out-patient surgery called a Hysteroscopy. These are performed for woman with endometriosis and those getting ready to attempt an IVF cycle (if needed). Well in my case going under anesthesia was a waste of time as they found nothing inside that was obstructing anything. As this delayed starting my IVF cycle another month. Only to add additional scar tissue to my uterus. But in the long run it was better to be safe.
Our IVF cycle officially started in June 2010. The medications to start were harsher than I was expecting. Hormones were crazy! They did my ovary stimulation and we ended up getting 11 mature eggs, but only 7 actually fertilized with my husband’s sperm. So, we decided to freeze 6 of the embryos and implant only 1 for the IVF procedure. Our fresh embryo transfer was on July 25, 2011. And, on August 9th… I got my first big fat positive pregnancy blood test! We were in shock! I had taken over a hundred home pregnancy tests up to this point and never once did I see a positive. Couldn’t believe it was that easy… Our doctor tried explaining that, “IUI’s are timing…,” and our timing was always off. He continued that if we would just let him do IVF he could pretty much guaranteed it would work… AND, IT DID! Of course, I didn’t think I would be that old, I was 38-years-old when we conceived our son Justis… And, I know 38 isn’t that old… but, it felt it for me! Especially when this control freak didn’t plan it that way.
My Miracle Baby, Justis
Now, to my birth story. I know this is a long story, but I had to bring you all up to speed to understand all that we have gone through. I’m going to skip the majority of the pregnancy, up until week 32. (Side note: I went in at 28 weeks and they gave me a shot to stop contractions that day).
My OB had always categorized me as a high risk pregnancy and the plan was to go in at 39 weeks for a planned C-section because of my previous surgery (abdominal myomectomy from my fibroid tumor). I wasn’t able to have a vaginal birth. Well, my doctor decided to take me out of work at 32 weeks and 2 days… I was sorta in shock and felt like a wussy, but I knew that I needed to take it easy—she said modified bed rest. Then, what do you know, I’m trying to relax and I keep feeling contractions and lots of pain. I ignored it for 2 days and was thinking it was Braxton Hicks. So then the third day, I went to Target, thinking that walking around outside of the house would make me feel better. Something wasn’t right though, so I called my hubby and went home. I was timing my contractions and I got to 4-5 minutes apart and decided to call the doctor. She was like, “WTH Marcy, get in here!” So, we drove to the hospital, grabbing my overnight bag.
They got me hooked up to all the monitors and immediately asking, “Can you feel these contractions?” I was like, “Ummm, yeah, but I thought they were the practice Braxton Hicks.” The nurse was like, “OMG! You are so lucky you came in!” My cervix was only dilated 1-2 cm… so, nothing too much, but my OB showed up and said Justis was coming this weekend. So, it’s now Tuesday, I was officially 32 weeks and 6 days, and she said we needed to get steroid injections to help Justis’s lung development because she was afraid he was coming. She said I needed to get to 33 weeks for her to feel any peace about him coming early. Contractions weren’t stopping, so I was getting injections to stop them. Then, after so many injections they switched to a pill every 6 hours. They admitted me so we could be ready for Justis and said once we got past the 36-hour window of the steroid injections to fully take effect and work that they would then be ready for him. So, it was to hold me off, which was a good thing because I wasn’t ready at all! Scared and nervous. The NICU team was in there to brief my hubby and I on what would happen with him coming at 33 weeks. Yet again… the enemy was at work! But, we were ready; we had to be.
After the 36 hours and a few more ultrasounds, they also realized that I had 2 large kidney stones that were contributing to my pain. But, nothing I could do about those until after the baby was here. On the other hand, one of the ultrasounds showed my uterus and where my old scar tissue was from my two prior surgeries… it was stretching. Stretching too thin. So, immediately my OB said I wasn’t going anywhere. She said hospital bed rest until he came. She said they were no longer worried about Justis coming early… they were worried about me and my uterus rupturing. Thinking it could be catastrophic for me if it was to rupture and I wasn’t in the hospital, so I tried to listen and be a good girl. Again, control freak’s nightmare.
Now, the new plan had shifted to ‘Let’s get him out at 36 weeks if Marcy can make it that long’. But, no way was I to go past that, said the high risk doctors. So, we waited. Contractions continued everyday, but were monitored with meds. Days and nights were slow for the next 3 weeks. I hadn’t prepared for this. My husband was really great about caring for me; cooking me dinner and bringing it to the hospital. So… not too much excitement over the next 3 weeks… But then, it was here! Week 36 had arrived and it was the morning of my C-section! Nervous… excited… anxious… to meet my angel! I was really nervous for my C-section because all I could think about was my abdominal myomectomy and the pain I endured.
On March 19, 2012, I was prepped for surgery, waiting for the anesthesiologist team to do the spinal block for the C-section. They had a little trouble doing the spinal block, but after the fourth attempt, they got it! And, here we go… not too long into the surgery and we hear my OB say, “OMG, he’s huge!” LOL! Needless to say, we weren’t planning on a big baby at 36 weeks, but he was a plump 7 lbs. 3 oz. They held him up for us to see and then all I could hear was, “Give him to us,” and the NICU team immediately took him out of the room. The rest of the time in there was getting put back together. The wait for updates from NICU was all that went through my mind. They let my hubby leave the operating room and go to Justis. He came back and explained to me the Justis was having a hard time breathing. I had so much fear at this point. A new mother, my newborn baby and I couldn’t do a thing to help him. I was helpless. So, they immediately put him on a CPAP (a machine that keeps air pressure going into his nose). They wouldn’t let me see him, except through a window on my way to recovery. They did let my hubby in there to take some pictures and hold his hand, but right away he was hooked up to IV’s and put on antibiotics. I had to wait until they moved me into my room and my body wasn’t numb anymore to go see him in the NICU. By the time I had gotten in to see him, he looked awful. I was crying so hard because I didn’t know what was going on. Thankfully, my hubby is a Firefighter/Medic, so he understood a lot of what they were saying. Justis’s chest was filling up with air because his lung collapsed (pneumothorax). They were really concerned for him. By day three, the NICU’s lead doctor came into my room at 1 a.m. and woke me up to tell me that Justis’s lung had collapsed completely and they needed to insert a chest tube and they wanted me to know because he was critical. My hubby had just left to take a break, so I immediately called him to come back. I was freaking out! God gave us a miracle, but the enemy was back trying to claim it.
So, they inserted a chest tube, but we soon found out that it was input too far. The doctor said it had immediately relieved some of the air pressure, but now it was filling the lung with blood and fluid. This was a nightmare! More time went by of me just watching my son look helpless. This baby was a fighter though. They finally teased that I could hold him, but it was nearing a shift change… they said to come back after shift change to do Kangaroo Care (skin to skin) with him. I was excited, but we had to wait two long hours! When we got back at 8 P.M., since they’re closed from 6-8 P.M. every night for shift changes, we came back to yet another horrifying surprise. He was now intubated! What the heck??? He was fine when we left… no phone calls, no nothing! Apparently, his chest tube went bad and they couldn’t restore his breathing. So, he had to be intubated. For those of you that don’t know what that is:
“Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.”
By this point, I was such a wreck. He had feeding tubes, tracheal tubes, IV’s… it was not a site for a mother, especially a first-time mother, to see without overwhelming fear. Thankfully, I continued to pray over my son and ask the Lord to keep my fear away. I had prayed so hard for my son that I knew I could only put my faith in God!
As we were in fear, anger started to rise, too. We were upset that no one had called us during or soon after this happened. Rest assured, the physician on shift apologized that no one called us… they needed to make a split-second decision and because of the shift change they got side tracked and didn’t notify us… Skipping over a few more days, my little fighter was taken off the tubes and finally breathing on his own. Yes! His oxygen levels were still sporadic, but he was doing much better. Success!
During the 2nd week of this, due to stress or only God knows what, I had been in excruciating pain over the weekend and didn’t want to say anything, but I started urinating blood and the pain got to be so severe. Well, come to find out I was passing those kidney stones that I mentioned earlier—but, they were too big and they were getting stuck in my ureter. I spent the day in the ER downstairs, away from my son in the NICU. (I was hurting, but they gave me good drugs!) My hubby was like, “Why didn’t you say anything?” Obviously, I didn’t want to say anything because I didn’t want to leave my newborn miracle, my fighting son in the NICU. I couldn’t stand the thought of being away from him. Call me Crazy! LOL. But, I was able to pass them, they did do some damage, but there was so much relief after they passed. To be honest, the pain from my C-section was a cake walk compared to my kidney stones and my abdominal myomectomy.
After another few days, my angel was finally allowed to come home with us! A terrible few weeks leading up to his birth and then a horrific few weeks in the NICU, but thank you, Lord, for my miracle. Thank you, Lord, for healing my son and letting him come home with us!
If you would like to see my son, Justis’s birth/dedication video, please go to this link on YouTube: https://youtu.be/UU720Q2M5ZM (Click on hyperlink)
Now onto my next miracle…
My Miracle Baby, Jace
After the blessing of Justis, we asked God for another baby. In February 2013, we ended up getting pregnant on our own! Can you believe it? We, too, were in shock that I could be pregnant. Sadly, that ended in a miscarriage right after Valentine ’s Day. Then, again two months after, we got another positive test! Within a few weeks… another miscarriage. We felt the enemy again. So, we waited a few more months to let my body recover and decided we’d give it one more go. We did get pregnant a third time and immediately went to the doctor. She tried to help us save it by using Progesterone. But, after eight weeks, it wasn’t meant to be. Three miscarriages in such a short year. Why?
I returned back to my OB to see what was happening. She found that my fibroid tumor had returned. Sadly, it was bigger than my first one in 2006. So, in May of 2014, I had to have another myomectomy to remove it. As you can imagine, the scar tissue on my uterus was pretty bad at this point. Another disappointing part with this last surgery is that we found out one of my fallopian tubes was now blocked. My OB doctor said it was most likely bumped during one of my surgeries. Not great.
Surprisingly, within 6 months’ post-surgery, she gave us the green light to try again. We were anxious to try on our own; we did have three recent pregnancies, pregnancies that turned into miscarriages, but pregnancies nonetheless. But… nothing. At this point, we had some decisions to make. We really wanted Justis to have a sibling. We knew we still had 5 frozen embryos. So, we decided to try IVF again. Same process, but since I had already used this clinic, I did not have to wait again. All I had to do was call them when I wanted to start. It was super easy.
We decided to thaw one embryo. Picked our good one—the embryo we picked is technically Justis’s fraternal twin. He/she was just frozen this whole time. In the fertility world, this is called a “Snow Baby”. And, voila… we got pregnant again, on the first try, with our second IVF cycle. Lots of nerves still set in… I was pretty scared now because I had just miscarried three times, and in all these years had never conceived on my own. But, God gave us another miracle.
By this time, I am 41-years-old, about to turn 42, this pregnancy had been completely different than with Justis. I was so sick, throwing up so much every day. Sometimes up to 11 times a day. I was so sure it was a girl with how different it felt. But, sure enough… it was another boy. So very grateful for another boy since Justis is a mama’s boy. We were super excited to hear the news of another boy! The plan for our new baby boy was to remove him via C-section at 37 weeks (37 weeks is considered early term). I have way too much scar tissue on my uterus now, from the 5 surgeries I have had, so I was prepared knowing that I could never carry a baby full term to the expected 40 weeks. I accepted that; it was part of our planning, so nothing was a shock to us.
Skipping through most of the pregnancy, I had just gotten to 35 weeks and had to head to the hospital. Very similar to Justis. I was contracting and the contractions were so close together. But, at this point, my OB did not want to stop the contractions. She felt that I was far enough along. Her main concern was that my cervix was still closed. Apparently, I have an irritable uterus from all the scar tissue and my uterus is actually very tiny from my reconstruction. So, she kept me over night in the hospital. After eight hours from arriving, I finally fell asleep and my contractions seemed to lessen. She said if this happens again he needs to come out, because she was still very fearful of a uterine rupture. I was nervous to leave the hospital and go home because we lived 45 miles away. But, for now, we were going to continue to let him cook a little longer, so she sent me home.
Only another week went by. As I sat at home, I felt that something just wasn’t right. This time, I had some severe abdominal pain that was accompanying my contractions. I would tolerate the contractions, but this pain was something fierce in my abdomen. My OB told me when a uterine rupture was about to happen that you get this severe pain in your abdomen and you will just know that something isn’t right. With that knowledge and fear, I called my husband home from the golf course and told him that we have to go in… something is definitely wrong.
We arrived at the hospital at 2:30 in the afternoon and within just minutes of getting hooked up to the monitors, my OB showed up and said we were ‘going in’. The anesthesiologist came in at 3 P.M. to take me to the operating room. Spinal block was easy this time. And so, the surgery began. Emergency C-sections move fast! I was 36 weeks and 2 days. This big boy Jace came out at 8 lbs. 3oz. He was a whole pound heavier than Justis and both preemies born at the same time. He let out a very loud cry and then the NICU team took him. Because he was early, the NICU team has to be on standby. Well, immediately he was having respiratory issues. My OB yelled to the NICU team that this was almost identical to what happened with Justis and to take it easy and not over do any of the CPAP pressures. So, they gave him a few minutes, but he did need help breathing. They hooked him up to the machines, and honestly, this was like reliving my nightmare from my firstborn son and his NICU stay.
Immediately hooked up to the CPAP, the NICU did a chest x-ray. His chest was filling up with air because part of his lung collapsed (pneumothorax) and they were really concerned for him, too. This was caught early, so his little lung was strong enough to recover on his own, with the help of the CPAP for just a few days.
Then, his levels looked so great that they were able to remove him from the CPAP and he was able to breathe on his own. We were super excited. Unfortunately, the next night we had a huge set back though. Jace stopped breathing in the middle of the night. It’s referred to as Apnea.
Infant Apnea is defined by the American Academy of Pediatrics as “an unexplained episode of cessation of breathing for 20 seconds or longer, or a shorter respiratory pause associated with bradycardia”.
In premature babies, apnea and bradycardia often occur together, along with low blood oxygen levels. First, apnea occurs and the baby will stop breathing. Then, because the baby isn’t breathing, blood oxygen levels will fall. The heart slows down in response to the low blood oxygen levels. Together, apnea and bradycardia are often called “episodes” or “spells”, and a low blood oxygen level is often called a desaturation or “desat.” When babies in the NICU have an episode of apnea or bradycardia, the monitors that record their heart rate and breathing start to alarm. Sometimes, just the sound of the alarm is enough to stimulate the baby to breathe again, and the baby is breathing well before the nurse even has time to respond. Other times, the alarm isn’t enough. Stimulation, through rubbing or patting the baby, will be used. If the baby still does not recover, then the baby will be given breathes with a bag and mask.
So, he continued to have these episodes. Thankfully, the nurses were able to stimulate him each time and he was able to recover from each episode. However, each episode extended his stay an additional 5 days. Every time, it reset the clock. This also happened to Jace as he was breastfeeding. When feeding a premature baby at the breast or bottle, pacing is critical, especially at the beginning of a feeding. I was instructed that if your baby seems to be sucking continuously without pausing to breathe, to pace the feeding by periodically pulling the nipple out of his mouth. Several times, I had to personally stimulate him. It scared me because my little baby was right in my arms, feeding, and he’d stop breathing and desat. It was also frustrating because he really looked like a healthy plump baby. But, if he stopped breathing or destat, we’d much rather have him in the NICU with 24/7 observation.
His hospital stay finally came to an end. In order to be released, he had to pass a car seat test. His test was to sit in his car seat for an hour and a half without any desats. He made it! Finally, we were done and we were able to take our angel home! Daddy brought Justis to the hospital to meet his baby brother and take him home. Our family was finally complete!
If you would like to see my son, Jace’s, birth story/dedication video, please go to this link on YouTube: https://youtu.be/jrjpKsGdcFE (Click on hyperlink).
***This is my very personal story. I hope it blesses those of you out there struggling with infertility. There is hope; there are options. Even when the enemy brings darkness, God will light the way. I am here if you would like to talk and/or share stories. Thank you for letting me share this with.
I leave you all with this: But Jesus looked at them and said to them, “With men, this is impossible, but with God, all things are possible.” Matthew 19:26 (NKJV)
My family is complete.
Written & Published by: Marcy L. Newbern Edited by: Jennifer Covington