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.

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.

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 10^th percentile from the 40^th. 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,

Our Infertility Journey (1.2): Another Bump in an Already Bumpy Road

After a thrilling day working in the dermatology clinic looking at skin cancer and warts, I checked my phone for missed messages. A text from Dave simply said, “Call me when you get a chance.” So, being the loving wife that I was, I gave him a call…5 hours after he had sent the text! Dave’s phone went straight to voicemail, but I didn’t have to wait long to find out where he was. My phone rang. It was the Emergency Room.

Dave quickly calmed my panicked state of mind by letting me know that he wasn’t dying, but he then sheepishly informed me that he had seriously injured himself that morning. No, not to worry, he didn’t damage his male parts (Although, that would make this story even more intriguing). No, he had ruptured his pectoralis major tendon, the tendon that attaches your chest muscle to your arm. He had been doing declined bench presses in the gym during a quick break from rounding on patients in the morning. In the middle of his set, something popped, electricity tore through his arm, and his weights came crashing down. Sadly, the tear was so complete that he was able to diagnose himself by simply feeling that the muscle was no longer attached. He now had a case of “saggy boob syndrome.”

You may wonder why this had any impact on our fertility or why I should even include this in the story. Well, now our primary medical focus was no longer on infertility but on his shoulder. After a stat MRI confirming his injury, Dave was scheduled for surgery to reattached the muscle to the bone with bone anchors. It was a grueling recovery. He was in an immobilizing arm splint for six weeks and was only allowed to lift something as light as paper and pencil for three months. The recovery included hours of physical therapy and hours waiting in the ortho office. Because his dominant arm had been damaged, he was unable to do most things for himself for quite a few weeks (I even remember changing the tire on my car while he watched.)

Needless to say, trying to make a baby is a little tricky when you aren’t supposed to move your upper body… at all…and you are in a fun arm contraption that starts to have a lovely aroma after just a few days. So, baby making efforts were pushed to the back burner. Months later, with his arm finally on the mend, Dave decided he was ready for surgery number 2…his varicocele. After all that he had been through, this surgery now seemed minor. The operation went smoothly, but we had to wait another three months before we could repeat the semenalysis. We held onto the hope that Dave’s sperm counts would top the charts. But, instead of chart topping numbers, the count was at an all-time low.

I felt defeated. Our chances of getting pregnant on our own were now next to none. It was my turn to become the infertility patient, and the thought turned my stomach. The fear of the unknown crept over me. Would I ever be a mother? What would it take, and how much was I willing to give?

From The Mom in Me, MD

 

 

Our Preemie Journey: Delivery Day…8 Weeks Early!

My mind was fuzzy, my vision blurry, and my body on fire from the magnesium! I felt like I was going to burst like a water balloon from even the tiniest poke. I could barely move my fingers due to the swelling, and I was scared. I was terrified for my unborn child and for myself. Preeclampsia had taken over. It didn’t care that I was just shy of 32 weeks pregnant. It didn’t care about what I had already gone through just to get pregnant! It was mocking my plans for a perfect delivery. I asked myself, “Who attacks a mother and her innocent unborn child? How could a disease be so sadistic…so ruthless?”

I waited for Dave to arrive for what seemed like hours. I was alone, alone with my unborn baby…uncertain of what was going to happen next…uncertain if my child would survive…uncertain if my body would fail me…uncertain of what the future held. A sense of relief washed over me when Dave walked into my hospital room. He hadn’t realized the severity of the situation until he saw me. I was barely recognizable from even the night before. Dave had raced from work, stopping at the house to take the dog out and to throw some overnight clothes together. Little did he realize that our overnight bag would need to get us through the next nine weeks.

The next several hours were filled with ultrasounds from Maternal Fetal Medicine, discussions with the neonatologist (NICU doctor), and constant blood pressure checks and rechecks. I was reassured that 32-week old babies can do very well. They can still have major complications including bleeding in the brain, respiratory distress syndrome, vision problems, and much more; but according to my Ob/Gyn, making it to 32 weeks was a great accomplishment. It didn’t feel like an accomplishment. It felt like a failure. My body was failing my baby and me. Once again, my best efforts could do nothing to change the situation.

Because our baby’s lungs hadn’t gotten the chance to fully develop, I was stabbed with the first of two steroid shots to speed up the process. A plan had been put in place. We were going to wait for my 24-hour urine protein to come back, and we were going to try to get both steroid shots in before delivery (these had to be spaced out by 24 hours).

I was a little nervous about a C-section, but I was willing to do whatever it took to keep my baby safe. Because my blood pressure was so incredibly high, an attempt at a vaginal delivery was out of the question. Starting an induction would be too hard on the baby and on my already stressed body.

The minute that my 24-hour urine protein results arrived the conservative timetable was thrown out the window. I was loaded into a wheelchair and told that the C-section was happening NOW! My urine protein was the highest that my Ob/Gyn had ever seen. The baby was starting to have some dips in her heart rate, and we couldn’t wait any longer. Delivery was the only “cure” for preeclampsia. My leg was stabbed too early with the second steroid shot in a last ditch effort to give our baby’s lungs every chance to mature. The magnesium and blood pressure medications continued to run into my veins, in an attempt to prevent me from having a seizure or stroke.

As the nurse wheeled me down the hallway, I pleaded desperately with God. He had answered my heart’s longing for a child. I had watched my belly grow with awe, wonder and gratitude. This baby was my answered prayer. He had to protect her! If not, then why had he given her to me in the first place? I loved this little being that I had never met more than my mind could comprehend. He couldn’t take her from me now…not after we had made it this far.

The spinal was more unpleasant than I had imagined. For some reason the idea of a huge needle poking into the nerve track in my back freaked me out more than just a little. I wasn’t worried about having my belly cut open with a scalpel, but a giant needle wasn’t my idea of fun. I hunched, I hugged the pillow, and I hunched some more. After three attempts, the needle was finally in the correct position. I was transferred to the operating table, and prepped for surgery. I had assisted in numerous emergency C-sections during residency. I had reassured many panicked mothers that everything would be “just fine”. Now I was the panicked mother, and I found that my own advice fell flat.

My C-section!

The C-section felt like an eternity. Just as they were pulling the baby out of my belly, my blood pressure dropped precipitously from the anesthesia, and I began to vomit. I vaguely remember the attending physician showing my baby to me before she was whisked to the resuscitation table. Her skin was dusky. She wasn’t crying! Was she breathing? I couldn’t see. What was happening? And, then I heard her. I heard her first cry. It was a small cry, but it was fierce. She was a fighter. She was in the lightweight division at 3 pounds 2 ounces, but she was a fighter!

Ayla in the Delivery Room being Resuscitated

Before I could catch another glimpse of my precious baby, she was rushed to the Neonatal Intensive Care Unit with her daddy close behind. I felt physically sick, helpless, and alone. I was her mother, but I had yet to hold my baby. I wanted to be at her side, but I could barely keep my eyes open. I wanted Dave at my side, but I knew that he needed to be with our baby. My mind was heavy, clouded by painkillers, anesthetics, and magnesium. As the last stitch was placed in my belly, I drifted off. When I awoke to a soaring blood pressure and splitting headache, I realized that I was in a fight for my life. Preeclampsia was still my master, and it wasn’t finished with me yet. Delivery had only made it more determined to destroy me, but I was a fighter too!

From The Mom in Me, MD

Our Preemie Journey: The Beginning

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.

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 10^th percentile from the 40^th. 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

Sex at its Worst

The worst sex is baby-making sex. It starts off romantic, even inspired, but it quickly loses its charm. Some lucky couples may be exempt from my assessment. For example, the “oops couple” may have been having the time of their life only to find out that they are unexpectedly pregnant. Or, the “let’s stop the pill for one day and see what happens couple” may really enjoy the added benefit of being off of a medication that has a tendency to stifle orgasms and intense sex drive. For most of us, baby-making sex is timed, routine, get it done sex. It is layered with the stress of, “Will I ever get pregnant?” It may start off fun because the thought of making a baby together is beyond incredible, but when months start to pass and periods keep coming, the giddy gitters are replaced with a nervous question, “Will it ever happen?”

It would be nice to tie a bow around fertility and say that most of us have it. Realistically, one in eight couples struggles with infertility according to The National Survey of Family Growth from the Centers for Disease Control. That indicates that if more than eight of you are reading this, at least one of you is struggling with or will struggle with infertility. Not to rain on the stork’s parade, but this is something that women should be aware of so that they aren’t blindsided in their journey toward motherhood.

Knowing that you may struggle with infertility may be hard to acknowledge, but it may push you to seek help a little more quickly. Many women have embraced the career path, pushing back their nesting days into their thirties. In our culture this is more the norm than the exception, myself included. Although the typical rule of thumb is to try for at least a year before worrying about infertility, this doesn’t apply to those of us with ticking fertility clocks. Those of us desiring to enter the motherhood arena past the fertility prime of our twenties should be aware that the timetable is quite different. Women in their mid-thirties should actually consult an infertility specialist after only six months of unsuccessfully trying to make a baby the old-fashioned way based on current recommendations.

Although this may seem like a very short time to let nature take its course, the infertility workup path can be quite protracted. Many infertility clinics are booking out several months down the road. Completing a full infertility workup takes at least a month for all of the blood work, testing, follow up appointments, and decision making on how to proceed. So, if you haven’t gotten pregnant in six months, you most likely won’t even start infertility treatments for several months more. And, who is to say how many infertility treatments you will need before you actually get pregnant? Going into baby making in your thirties or forties with this knowledge may improve your chances of getting pregnant by encouraging you to be more proactive in investigating your fertility status sooner.

On a side note, some of you may be offended that I mention your twenties as your prime fertility years. Don’t start chewing me out. Biology and genetics are the ones running the show. I’m only stating the facts. Besides, it’s not like I’m in my twenties either. It is a confirmed fact that our ovaries have fewer and fewer healthy eggs with each passing year. Acknowledge it. Accept it. Embrace the fact that you are no longer in your twenties!

In addition to seeking an infertility evaluation sooner, knowing that one in eight couples struggles with infertility may also make you feel just a little bit less broken. People who are getting pregnant share the news. This is why it may seem like you are the only one not getting pregnant. People who are infertile often keep it to themselves. Infertility is a heavy word. It is weighted with shame, embarrassment, and feelings of inadequacy, despair, and desperation. Even the most optimistic couple can’t help but feel a little defeated when faced with this diagnosis. The possibility that parenthood may never be in their future can be world shattering. Knowing that you aren’t an anomaly can soften the blow…just a little bit. And, in the midst of an infertility diagnosis, any softening helps immensely.

In addition to knowing you aren’t alone with your infertile status, being aware that infertility is common (6.7 million women in the United States alone struggle with infertility according to the Centers for Disease Control) may nudge you to find a support system sooner than you would have. When my husband and I realized that making a baby the natural way was most likely unattainable for us, I struggled with the reality that I was an infertility patient. I went to most of my appointments alone, and even though I was in a waiting room filled with other women struggling with similar experiences, an uneasy silence filled the space between us. This silence was laced with pain, fear, and cautious hope. Why we didn’t reach out to each other always confused me. I assume that we wanted to respect each other’s privacy. We didn’t want to overstep the invisible barriers that each of us had build around us. Looking back, I would do things differently. I would risk a little more. I would trade in my pride for the support that these women could have offered. Maybe they didn’t need me (doubtful), but I needed the support that they could have offered. I now realize that enormous support exists for those of us carrying a diagnosis of infertility including online support groups such as Resolve, community support groups, and wow, probably one of our eight friends who is in a similar predicament. If we would be willing to share our story with others, they may just be willing to share their story with us.

If you find that baby making sex isn’t your forte either, embrace the fact that you can throw your birth control pills down the toilet for good! Sex can be entirely recreational and for passion and love’s sake alone. And, although the infertility journey may be the most difficult one that you take, starting the process sooner may increase your chances of success. You are not alone in this journey. Reach out early, and the stamina and strength you garner from other women’s stories may surprise you. Nothing is more powerful than women empowering other women in their journey toward motherhood.

From The Mom in Me, MD