When Pregnancy Swelling Becomes Something More…

 

After years of trying to get pregnant, our dream finally came true. God had finally answered our heart wrenching prayers for a baby. Getting pregnant had been the hard part-being pregnant was a breeze in comparison. That is, until everything went wrong.

Because we had conceived with the help of IVF, I was already a paranoid pregnant lady. Even though I followed all of the recommendations, I still feared a miscarriage, a physical deformity, or a genetic anomaly. I had thought of most potential complications, and every little ting or pain alarmed my fragile state of mind. Knowing too much as a physician didn’t help. I reminded myself that it was normal to be overly concerned considering all that we had been through. It wasn’t like getting pregnant was a walk in the park for us. All forces of nature had conspired against us for years. Now that we had finally gotten a positive pregnancy test, I was a little leery that it was too good to be true. But, as months passed and our baby continued to be a perfect patient, the hypochondriac in me started to lessen. I resolved that I was going to have a happy and healthy baby.Love and new life concept. A woman's hands forming a heart symbo

Around 26 weeks of pregnancy, I suffered the worst headache of my life. My husband and I had recently moved states, and I had just established care with a new OB/GYN. I didn’t want to be the annoying patient who called about every little complaint, but when loads of Tylenol and sleep just didn’t cut it, I began to worry. Knowing that headaches can be linked with pregnancy induced hypertension and preeclampsia, I quickly checked my blood pressure. It was normal, but the pain in my head was not. With tears streaming down my cheeks, I asked my husband to call the doctor.

The physician on call recommended that I come into the hospital for blood work, to monitor the baby, and to get me something stronger for the headache. I couldn’t have agreed more. Thankfully, my blood pressure and blood work were fine, the baby was active, and the Percocet took the edge off.

After that episode, pregnancy life returned to normal. My follow-up blood pressures were fine. I hadn’t had another headache, and my only real complaint was the swelling in my feet. By swelling, I mean absolutely NO shoes fit my feet. I questioned, joked, and complained about my elephant feet, but I just assumed that it was part of the beauty of getting pregnant.

Since we had just moved to a new state without any family nearby, I knew that I needed to establish a support system before the baby arrived. This gave me the bright idea to join a Mom’s group while still only 32 weeks pregnant-I like to think outside of the box sometimes! I loved my “Real Mom’s” group from the moment that I met them. They applauded my assertiveness in joining the group while pregnant and welcomed me wholeheartedly. They didn’t, however, welcome my swollen feet! Instead, they insisted that I prop them up and have someone take a look at them. I reassured them all that I had a doctor’s appointment later that day, and that I didn’t have preeclampsia. It was simply swelling from pregnancy. I had noticed just the night before, however, that my glasses seemed a little tighter on my face, and my rings were even tighter than usual. I voiced my concern to my husband but then brushed it off as paranoia.

Fetus 7 Month In The Womb. Visible Head And Arms

At my 32-week prenatal visit, my blood pressure checked out fine. The Ob/GYN examined my belly and listen to the baby’s heartbeat. After measuring my belly, she recommended that we get a quick ultrasound of the baby since I hadn’t grown much since the last visit.

I waddled off to ultrasound, my feet aching with each step. The ultrasound confirmed that my baby’s growth had decreased to the 10th percentile from the 40th. Something was making her very unhappy inside of me. When I returned to the exam room, my doctor asked for a urine sample (which being pregnant I was easily able to give.) She reexamined my feet and decided to confirm my “normal” blood pressure. On recheck, my pressure wasn’t just a little high; it was stroke worthy! My urine dip screamed protein. And, when my doctor asked if I had been seeing any floaters, I dumbly responded that I had been having a weird, spotty kind of dizziness for months, but it seemed to be positional. Duh! Floaters! Wow, sometimes being a physician really doesn’t prepare you to be a good patient.

Within minutes I was loaded into a wheel chair and whisked to the OB floor for overnight observation. I voiced my concern that my mom was coming from Michigan to pick me up and take me back for a wedding shower. My Ob politely but firmly replied, “Emma, you aren’t going anywhere. First we have to make sure that you and the baby are safe.” By the time I made it to the OB floor, my blood pressure was sky-high, my head was pounding, and I was starting to get very scared. The nurse poked and re-poked me to start the IVs for the blood pressure medications and the dreaded magnesium. In what seemed like minutes, I had developed sudden and severe onset preeclampsia.

I called my mom to let her know the change of events. Knowing nothing about preeclampsia, she asked, “Emma, is this serious?” That’s when I broke down sobbing. Yes, it was serious. I was getting sicker by the minute, and I knew that my baby needed to be delivered soon…TOO SOON.

For more about preeclampsia head to The Preeclampsia Foundation or March of Dimes. Both have their annual walks all across the country in May and June. Sign up to raise awareness and support women who have had pregnancy complications, and help prevent complications for others.

From,

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Can a Pregnant Mom Trust Modern Medicine?

Pregnant Woman Belly. Pregnancy Concept

The beauty of medicine is that it can fix most things. No, it’s not perfect, but modern medicine saves countless lives. In addition to saving lives, it dramatically improves the quality of the lives we live. Without modern medicine, my 18 month-old daughter and I would not be here today. After sailing through 32 weeks of a healthy pregnancy, I developed sudden and severe onset preeclampsia. I’m a high achiever, so my body decided it needed to start setting records. My blood pressure soared to stroke high levels. The protein in my urine topped the charts at 12 grams (5 grams is considered severe preeclampsia), and I gained over thirty pounds of fluid, becoming the Michelin man overnight. A simple tap on my arm or leg would send my limbs flying into the air. My nervous system and reflexes were in overdrive. The pounding headache, spotty vision, and abdominal discomfort were icing on the cake.Pregnant woman sitting on sofa looking at her unborn baby's ultr

Overnight, I became one sick mamma to a 3 lb. 2 oz preemie. As soon as my daughter was cut from my belly, she required urgent resuscitation. A tiny tube was placed in her airway, and she was whisked away to the neonatal intensive care unit. It took me two days to even make it up to the NICU to see her. Even then, I was hooked up to IVs, countless medications and could only manage to hold her for a few minutes. Although the textbook answer to treating preeclampsia is to deliver the baby, for some women this doesn’t solve the problem immediately. My blood pressure continued to top the charts, my reflexes remained in hyperactive mode, my mind was very confused, and I was pretty sure I had, or was going to have a stroke. My concerned OB/GYN consulted a cardiologist to manage my unimproved condition. She was amazing. She listened, investigated, and made the necessary changes (mega doses of several blood pressure medications), which eventually helped normalize my blood pressure. But, even she didn’t have all of the answers. It wasn’t until three weeks after I delivered that I was able to cancel home nursing and stop my blood pressure medications.Close up of doctor writing on a medical chart with patient lying

Through this experience I started asking questions about why this was happening. What was the physiology behind this crazy multisystem condition affecting my nervous system, cardiovascular system, kidneys, liver, and reproductive system? What caused preeclampsia? What could I do to prevent it in the future? What was my chance of having it happen again? Why couldn’t we prevent it or at least treat it more effectively? I didn’t like any of the answers that I was hearing or reading. They were all just theories, nothing concrete. This condition, which landed me in the hospital for eight days, forced me to have an emergency c-section at thirty-two weeks, placed my tiny baby in the NICU for nine weeks, and which put me at risk for having high blood pressure and a stroke later in life was still not understood.Care For A Sick Child In The Pediatric Icu

One out of every twelve pregnant women will develop preeclampsia according to data from the Preeclampsia Foundation. One in twelve! I don’t like those odds. How is it possible for a condition that is so common and potentially life threatening to mom and baby to continue to mystify us? We have mapped the human genome. We have eradicated small pox. We can identify breast cancer at its earliest stages, ensuring early treatment and amazing survival rates. Why haven’t we identified the true cause of preeclampsia and developed earlier and more efficient and effective screening tests for this condition? If prevention and earlier identification are not yet possible, then why haven’t we developed more effective treatments that will allow for a continued healthy pregnancy?

I have a fifty percent chance of developing preeclampsia again and at an earlier gestation in future pregnancies. I’m not a fan of my chances. I did everything right during my pregnancy. For goodness sake, I was the crazy lady who gave up all caffeine even though it probably wasn’t necessary. I didn’t drink a single soda, and I verified that every item entering my mouth was pasteurized. I was a paranoid pregnant mama! And, although following all of the recommendations probably prevented me from having other complications, it didn’t protect me from preeclampsia.

In a world where I count on modern medicine to fix most things, I have decided that modern medicine has failed to meet my expectations. Yes, it definitely saved my life and my daughter’s, but not all women are as fortunate as I was. Globally, preeclampsia is listed as one of the leading causes of mother and infant morbidity and mortality (illness and death). Worldwide, the United Nations reports that more than 500,000 women die each year due to pregnancy related causes. In the United States alone, preeclampsia causes 18% of maternal deaths. In short, preeclampsia is a killer.

As with any horrific and life threatening disease, the way to beat it is to study it. Research and clinical studies require interest, money, mental power (the scientists), and patients willing to participate. In most cases, it takes years before the results of clinical trials can be used in every day medicine. With only a short window left for my childbearing years, I’m hoping that new preventions and treatments will be available quickly. In the meantime, I’m doing my best to raise awareness and money, educate other women, and save the lives of women and their future babies (myself included). Join me by putting on your tennis shoes for the Promise Walk for Preeclampsia in your area. Or, take a look at the Preeclampsia Foundation or the March of Dimes for other ways to get involved. Push modern medicine to meet our expectations as women, mothers, and future mothers.

Both March Of Dimes and the Preeclampsia Foundation have their annual walks in May! Head to either of their websites to sign up and get involved.

From,

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Our Infertility Journey (1.1): Who’s to “Blame”

A man and a woman on a pierCrumpled up in a ball on the sofa, I stared at the television with heavy eyes. I was exhausted, but I had that strange high that sleep deprivation brings. Although I had been up for 36 hours, my adrenaline high had yet to fully fade. I had delivered several babies, coded a patient in the intensive care unit, and admitted over 20 patients overnight. I could never go right to bed when I made it home. My body longed for sleep, but my mind wanted just a few minutes to unwind. My usual routine on post-call days was to hit the sofa for an hour of mindless TV before trudging up to bed.

Lately I had been following the reality television show, Giuliana & Bill. On this particular post-call day, the show revealed that G&B’s only option for having their own child was to pursue In Vitro Fertilization. My heart sank for them, and then I thought of myself. What if that was our only option? What if we really couldn’t get pregnant on our own after all? I tried to shake the fear. I dismissed it as emotional irrationality from exhaustion. But, the next morning after a good night’s sleep, that same sickening feeling lingered in my stomach. What if?

My husband is an eternal optimist. I love him to death, but sometimes he doesn’t just see the glass half full, he believes that it’s overflowing! When he started to question if something was wrong with our ability to conceive, I knew that the sick feeling in my stomach was more than just paranoia. It was time to get some answers.Three Hands Pointing

Dave had been diagnosed with a varicocele in college. Many men have these harmless dilatations in the blood vessels in their groin, and they are usually nothing to worry about. In general, they don’t lead to infertility if they are small, but larger varicoceles can potentially heat up the testicle, leading to damaged sperm. Countless hours of standing in the operating room with gravity as his enemy had caused Dave’s varicocele to become rather large and uncomfortable. Because this was the most obvious issue contributing to our baby making struggles, he decided it was time to get it reevaluated. Part of this evaluation included a semen evaluation.

This was Dave’s first journey into the uncomfortable world of infertility. Our medical center had one small room for sperm collection (aka male masturbation station). The idea just seemed dirty, but it guaranteed the most accurate specimen. After uncomfortably waiting his turn for the room and accomplishing his mission, Dave transported his own sample to the lab where his swimmers were scrutinized for quantity, quality, and movement. Now we waited.

I remember Dave’s voice of concern laced with optimism when he called me with the results. His genetic components were great, his sperm movement was great, but…his count was incredibly low. I tried to sound positive, masking my dismay. I didn’t want him to feel worse than I knew he already did, but the sickening feeling in my stomach was so strong that it made me want to throw up. Something was wrong! Although my mind was racing in a million different directions, I managed to ask, “So, what now?”unhappy heterosexual couple

The plan was to repeat the count just to make sure that it wasn’t a lab error. When the repeat number was worse than the first, I was devastated but optimistic at the same time. Varicoceles could be surgically corrected! And, the urologist told us that we could still get pregnant on our own; It would just be more difficult. We decided that surgery was worth a try, and we didn’t want to waste any time. But, before we could schedule the operation, I received a call from the emergency room that changed everything!

From The Mom in Me, MD

Our Preemie Journey: The Beginning

Pregnant Woman holding her hands in a heart shape on her baby bu

After years of trying to get pregnant, our dream finally came true. God had finally answered our heart wrenching prayers for a baby. Getting pregnant had been the hard part-being pregnant was a breeze in comparison. That is, until everything went wrong.

Because we had conceived with the help of IVF, I was already a paranoid pregnant lady. Even though I followed all of the recommendations, I still feared a miscarriage, a physical deformity, or a genetic anomaly. I had thought of most potential complications, and every little ting or pain alarmed my fragile state of mind. Knowing too much as a physician didn’t help. I reminded myself that it was normal to be overly concerned considering all that we had been through. It wasn’t like getting pregnant was a walk in the park for us. All forces of nature had conspired against us for years. Now that we had finally gotten a positive pregnancy test, I was a little leery that it was too good to be true. But, as months passed and our baby continued to be a perfect patient, the hypochondriac in me started to lessen. I resolved that I was going to have a happy and healthy baby.

Around 26 weeks of pregnancy, I suffered the worst headache of my life. My husband and I had recently moved states, and I had just established care with a new OB/GYN. I didn’t want to be the annoying patient who called about every little complaint, but when loads of Tylenol and sleep just didn’t cut it, I began to worry. Knowing that headaches can be linked with pregnancy induced hypertension and preeclampsia, I quickly checked my blood pressure. It was normal, but the pain in my head was not. With tears streaming down my cheeks, I asked my husband to call the doctor.

The physician on call recommended that I come into the hospital for blood work, to monitor the baby, and to get me something stronger for the headache. I couldn’t have agreed more. Thankfully, my blood pressure and blood work were fine, the baby was active, and the Percocet took the edge off.

After that episode, pregnancy life returned to normal. My follow-up blood pressures were fine. I hadn’t had another headache, and my only real complaint was the swelling in my feet. By swelling, I mean absolutely NO shoes fit my feet. I questioned, joked, and complained about my elephant feet, but I just assumed that it was part of the beauty of getting pregnant.

Since we had just moved to a new state without any family nearby, I knew that I needed to establish a support system before the baby arrived. This gave me the bright idea to join a Mom’s group while still only 32 weeks pregnant-I like to think outside of the box sometimes! I loved my “Real Mom’s” group from the moment that I met them. They applauded my assertiveness in joining the group while pregnant and welcomed me wholeheartedly. They didn’t, however, welcome my swollen feet! Instead, they insisted that I prop them up and have someone take a look at them. I reassured them all that I had a doctor’s appointment later that day, and that I didn’t have preeclampsia. It was simply swelling from pregnancy. I had noticed just the night before, however, that my glasses seemed a little tighter on my face, and my rings were even tighter than usual. I voiced my concern to my husband but then brushed it off as paranoia.

Fetus 7 Month In The Womb. Visible Head And Arms

At my 32-week prenatal visit, my blood pressure checked out fine. The Ob/GYN examined my belly and listen to the baby’s heartbeat. After measuring my belly, she recommended that we get a quick ultrasound of the baby since I hadn’t grown much since the last visit.

I waddled off to ultrasound, my feet aching with each step. The ultrasound confirmed that my baby’s growth had decreased to the 10th percentile from the 40th. Something was making her very unhappy inside of me. When I returned to the exam room, my doctor asked for a urine sample (which being pregnant I was easily able to give.) She reexamined my feet and decided to confirm my “normal” blood pressure. On recheck, my pressure wasn’t just a little high; it was stroke worthy! My urine dip screamed protein. And, when my doctor asked if I had been seeing any floaters, I dumbly responded that I had been having a weird, spotty kind of dizziness for months, but it seemed to be positional. Duh! Floaters! Wow, sometimes being a physician really doesn’t prepare you to be a good patient.

Within minutes I was loaded into a wheel chair and whisked to the OB floor for overnight observation. I voiced my concern that my mom was coming from Michigan to pick me up and take me back for a wedding shower. My Ob politely but firmly replied, “Emma, you aren’t going anywhere. First we have to make sure that you and the baby are safe.” By the time I made it to the OB floor, my blood pressure was sky-high, my head was pounding, and I was starting to get very scared. The nurse poked and re-poked me to start the IVs for the blood pressure medications and the dreaded magnesium. In what seemed like minutes, I had developed sudden and severe onset preeclampsia.

I called my mom to let her know the change of events. Knowing nothing about preeclampsia, she asked, “Emma, is this serious?” That’s when I broke down sobbing. Yes, it was serious. I was getting sicker by the minute, and I knew that my baby needed to be delivered soon…TOO SOON.

From The Mom In Me, MD

destigmatizing infertility in a baby booming culture

Beautiful young woman with pregnancy test. In bathroom.

In my previous blog I alluded to the fact that the inability to get pregnant is laced with stigma and shame. People put autism puzzle stickers and breast cancer survivor stickers on their cars, but I have yet to see an “Infertile Couple” awareness sticker. Is the diagnosis of infertility any less of a diagnosis? Insurance companies lead us to believe this by their lack of coverage for medically necessary infertility services (a blog for another day).  Although infertility may not be life threatening like breast cancer, it is a painful and limiting condition that profoundly impacts many lives.

I assume that the stigma of infertility in part stems from the fact that SEX is broken. Who wants to admit that their sex doesn’t “work”? And, although Sarah Jessica Parker may have normalized talking about explicit sex over the dinner table, many of us don’t want to share the intimacies of our relationship with friends, let alone strangers. In my mind, one of the beauties of intimacy is that it is something shared just between my husband and me. And, although I don’t shy away from joking about sex with friends now and then, I don’t make it a habit to share what I do in private. Talking with girl friends about periods, child-birth, and boobs is no big deal. But, infertility doesn’t naturally or comfortably fall into that “normal” girl talk.

Our culture is inundated with sexuality, but the idealized kind filled with Victoria’s Secret Angels, Tatum Channing physiques, and Ryan Gosling charm (okay, and physique!) Infertility is poor performing sexuality. Who wants to talk about that? Not men, and not most women. No, men hate bringing up (sorry for my choice of words here) their struggles with erectile dysfunction. Most aren’t even able to verbalize their complaint. Instead, they just point at their crotch and stutter, “I can’t, umm,” followed by a fill in the blank. And, in the past 15 years I have only had one woman come to me concerned over her lack of orgasmic ability.

Thus, infertility falls into the hush, hush sensitive topic category. It is sensitive, but the shame and stigma associated with it prevent women and men struggling with infertility from getting the resources and support that they need. Breast cancer used to have a similar stigma associated with it. Women should not openly talk about their breasts! How improper! Yes, it was cancer, but the “unmentionable” kind. Thankfully, the shame that used to accompany the diagnosis of breast cancer has been diminished due to proactive campaigns encouraging and empowering us to embrace our womanhood, “feel our boobies,” and kick cancer in the butt. This change in culture has led to life saving advancements in breast cancer research and treatments.

Can a similar cultural revolution transform how infertility is viewed? Yes, but only if people are willing to step outside of their comfort zones. If thirty year olds still refer to their genitalia as their “junk,” how are we going to have a real conversation about infertility. Using real words and talking about real life problems is a good starting place. Acknowledging that the human body often fails us, and that infertility is one of these physical and biologic failures that is out of our control, lessens the stigma, even if slightly. Normalizing the idea that infertility is incredibly common may also empower men and women to open up more readily about their struggle toward parenthood. The more that people talk about this culturally uncomfortable issue, the less uncomfortable it will become.

Reducing the stigma of infertility will positively and powerfully impact the infertility world. Infertile couples will have a larger support system if more people are willing to share their stories. This in turn will lead to increased social networks and social capital. With increased unity focused on the cause of infertility, more money will be raised for research, leading to improved infertility treatment options. Additionally, awareness campaigns may lead to political activism, forcing insurance companies to take infertility seriously and cover necessary treatments. Imagine a world where people have increased fertility because of improved infertility treatments and insurance coverage! If population control is your thing, then this may not excite you. But, for those of us hoping to add to the human race, this thought is utopia!

From The Mom in Me, MD

Where Modern Medicine has Failed the Pregnant Mom

Pregnant Woman Belly. Pregnancy Concept

The beauty of medicine is that it can fix most things. No, it’s not perfect, but modern medicine saves countless lives. In addition to saving lives, it dramatically improves the quality of the lives we live. Without modern medicine, my 18 month-old daughter and I would not be here today. After sailing through 32 weeks of a healthy pregnancy, I developed sudden and severe onset preeclampsia. I’m a high achiever, so my body decided it needed to start setting records. My blood pressure soared to stroke high levels. The protein in my urine topped the charts at 12 grams (5 grams is considered severe preeclampsia), and I gained over thirty pounds of fluid, becoming the Michelin man overnight. A simple tap on my arm or leg would send my limbs flying into the air. My nervous system and reflexes were in overdrive. The pounding headache, spotty vision, and abdominal discomfort were icing on the cake.

Overnight, I became one sick mamma to a 3 lb. 2 oz preemie. As soon as my daughter was cut from my belly, she required urgent resuscitation. A tiny tube was placed in her airway, and she was whisked away to the neonatal intensive care unit. It took me two days to even make it up to the NICU to see her. Even then, I was hooked up to IVs, countless medications and could only manage to hold her for a few minutes. Although the textbook answer to treating preeclampsia is to deliver the baby, for some women this doesn’t solve the problem immediately. My blood pressure continued to top the charts, my reflexes remained in hyperactive mode, my mind was very confused, and I was pretty sure I had, or was going to have a stroke. My concerned OB/GYN consulted a cardiologist to manage my unimproved condition. She was amazing. She listened, investigated, and made the necessary changes (mega doses of several blood pressure medications), which eventually helped normalize my blood pressure. But, even she didn’t have all of the answers. It wasn’t until three weeks after I delivered that I was able to cancel home nursing and stop my blood pressure medications.

Through this experience I started asking questions about why this was happening. What was the physiology behind this crazy multisystem condition affecting my nervous system, cardiovascular system, kidneys, liver, and reproductive system? What caused preeclampsia? What could I do to prevent it in the future? What was my chance of having it happen again? Why couldn’t we prevent it or at least treat it more effectively? I didn’t like any of the answers that I was hearing or reading. They were all just theories, nothing concrete. This condition, which landed me in the hospital for eight days, forced me to have an emergency c-section at thirty-two weeks, placed my tiny baby in the NICU for nine weeks, and which put me at risk for having high blood pressure and a stroke later in life was still not understood.

One out of every twelve pregnant women will develop preeclampsia according to data from the Preeclampsia Foundation. One in twelve! I don’t like those odds. How is it possible for a condition that is so common and potentially life threatening to mom and baby to continue to mystify us? We have mapped the human genome. We have eradicated small pox. We can identify breast cancer at its earliest stages, ensuring early treatment and amazing survival rates. Why haven’t we identified the true cause of preeclampsia and developed earlier and more efficient and effective screening tests for this condition? If prevention and earlier identification are not yet possible, then why haven’t we developed more effective treatments that will allow for a continued healthy pregnancy?

I have a fifty percent chance of developing preeclampsia again and at an earlier gestation in future pregnancies. I’m not a fan of my chances. I did everything right during my pregnancy. For goodness sake, I was the crazy lady who gave up all caffeine even though it probably wasn’t necessary. I didn’t drink a single soda, and I verified that every item entering my mouth was pasteurized. I was a paranoid pregnant mama! And, although following all of the recommendations probably prevented me from having other complications, it didn’t protect me from preeclampsia.

In a world where I count on modern medicine to fix most things, I have decided that modern medicine has failed to meet my expectations. Yes, it definitely saved my life and my daughter’s, but not all women are as fortunate as I was. Globally, preeclampsia is listed as one of the leading causes of mother and infant morbidity and mortality (illness and death). Worldwide, the United Nations reports that more than 500,000 women die each year due to pregnancy related causes. In the United States alone, preeclampsia causes 18% of maternal deaths. In short, preeclampsia is a killer.

As with any horrific and life threatening disease, the way to beat it is to study it. Research and clinical studies require interest, money, mental power (the scientists), and patients willing to participate. In most cases, it takes years before the results of clinical trials can be used in every day medicine. With only a short window left for my childbearing years, I’m hoping that new preventions and treatments will be available quickly. In the meantime, I’m doing my best to raise awareness and money, educate other women, and save the lives of women and their future babies (myself included). Join me by putting on your tennis shoes for the Promise Walk for Preeclampsia in your area. Or, take a look at the Preeclampsia Foundation or the March of Dimes for other ways to get involved. Push modern medicine to meet our expectations as women, mothers, and future mothers.

From The Mom in Me, MD