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.

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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.

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Our Infertility Journey (1.20): Could It Really Be Good News?????!!!!!!

We were scheduled for our fourth embryo transfer, and this time my primary infertility specialist made sure that she would be present to do the procedure. She agreed that given all of our complications it made sense that she be the one to perform the procedure. This time went so much more smoothly (the way it was supposed to go). After only a minute, two perfect embryos were in my uterus.Golden Egg

I decided to stay on my back with my legs up for a while. (30 min. to be exact.) I didn’t care if there wasn’t any medical evidence for this, I needed to do something different. I needed this to work. I went home and propped my legs up again. Then we waited once more. I was somewhat pessimistic. I didn’t know if this would work. I wanted it to, but it hadn’t yet. And, after 5 cycles of IVF (the first once being cancelled due to hyperstimulation and the others never resulting in a pregnancy) I doubted that things would ever work for us. In the midst of my doubt, I still held onto a thread of hope. This cycle had been as close to ideal as we would probably ever get…great embryos and a great transfer. Two weeks of waiting felt like an eternity.Biological clock ticking - woman holding clock in front of stoma

A few days before the pregnancy test I began to feel crampy. I was heartbroken. How is it possible that it hadn’t worked again!  The day I went in for my blood work, I told the nurse that I was sure that I wasn’t pregnant. I felt like I had after each cycle…crampy. I hadn’t started bleeding yet, but I was sure it was only a matter of time. I waited for the typical call from the nurse. I was at work and had been talking with my coworker who was waiting for an adoption opportunity. Just minutes before she had received the news that a baby boy was going to be born within the next couple of days, and he could be hers! She was ecstatic! I was so happy for her. She left the room to see a patient and in the meantime, my call came.couple, pregnancy and love concept - close up of woman and man h

I saw that it was my infertility nurse, and my heart leapt and then sank all at the same time. I knew that I wasn’t pregnant. I didn’t even need her to confirm it. I answered the call just as my coworker walked back into our office. “Hello”, I said. “Emma, its Libby.” “Emma, you’re PREGNANT!” What! What! No, that couldn’t be right! How could I be pregnant. I was crampy. I didn’t feel pregnant. They must have been looking at someone else’s results. “No, Emma, we double checked. These are your results. You are pregnant. Congratulations!”

I was in shock. I was through the roof! Oh, my goodness. You have got to be kidding me! It finally worked!! I was pregnant. I could get pregnant! It was all worth it. I wanted to jump up and down, but I didn’t dare for fear it would expel the precious embryos. But, how good were my levels? I knew that this mattered. Was I really pregnant or just a little? No, I was really pregnant. My hcg numbers were high. They were prefect. I would have to have them repeated in 2 days just to make sure that they were doubling, but I was definitely pregnant.Baby Fetus Newborn Over Isolated White Background. New Born Chil

My coworker knew immediately when she saw my face. We were both going to be having new babies! I immediately tried to call Dave. He needed to be my first call. Voicemail. I paged him but didn’t get an answer. I knew that he should be the first one to know, but if I couldn’t reach him, I couldn’t keep it to myself after everything I had been through. I quickly dialed my parents. My mom was thrilled! We were all cautiously optimistic. We knew that a positive pregnancy didn’t necessarily mean we would be having a baby. We still had a lot of hurdles to get through, and the pregnancy rates were always much higher that the delivery rates for IVF. Although I was cautiously optimistic, I was also full of hope. I couldn’t wait to make it past 12 weeks. I just needed to get to the safe zone,  and then, 2012 would be my year of motherhood!

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An Update on Our Current Pregnancy Situation (Jan 2015)…unfortunately, labs don’t lie

I know I’ve been posting a lot lately about our struggles with primary infertility (trying to finish out the story for everyone). However, as most of you know, we are currently undergoing infertility treatments in an effort to make baby #2. Christmas Eve I found out that I was pregnant after a frozen IVF cycle. But, after several ultrasounds and repeat labs, I’m sad to say that we are having a miscarriage. Our little one decided not to stick around.

Thank you all for your kind words, prayers, and support along this journey. As I watch my beta-hcg levels fall it’s a little surreal and incredibly sad. Seeing an empty uterus on ultrasound confirmed the diagnosis and cemented the fact that our infertility journey is not yet over. When we received the news that we were pregnant it seemed too good to be true (and it was). No more stimulation cycles, no more needle pokes, no more financial planning for fertility! We were going to have another baby! Sadly, that’s not the case, at least not yet. So, I’m pulling myself up by my Hunter boot straps and gearing up for what’s to come. With two more frozen embryos left, our IVF journey continues. Maybe this next cycle will be the end of our infertility road? If not…ovarian stimulation and fresh IVF here we come!

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Our Infertility Journey (1.16): When Hope Outweighs Despair

I was starting to despair, but I had not yet lost hope. Despair is a terrible thing. It’s that sick feeling in your stomach that slowly creeps in. It makes you want to curl up in a ball and ignore the outside world. It makes you feel that your problem is the only and most important in the world. It definitely causes you to become self-focused. Holding onto hope was my only hope. I couldn’t despair. I had to trust that this would work. If I was negative about it what good would it do? Somehow the power of positive thinking was going to make a difference. I begged God. I cried. I pleaded. I told him that I was angry that he would do this to me. I had followed what I felt was a calling to go into medicine. I had dedicated my life to helping other people. Why wasn’t he helping me now? My anger turned into remorse. I apologized for anything and everything that I had ever done wrong. Was he holding out on me because of some unconfessed sin? I didn’t know, but I wanted to clear up anything that could possibly influence his response to my desperate cries for help.Anxious woman thinking in her bed next to her sleeping partner

I had to wait several weeks before starting the frozen cycle. All during this time I had been trying to act normal at work. Only a few people there knew what was going on. I didn’t want to make my private business public to the whole office (ironic since I’m now sharing it with the world). I didn’t want them to ask me how things went or to look at me with pity. I wanted to see my patients and then go home.

In primary care you get to know your patients fairly well. I sat down and started to ask my patient how she was feeling? I knew that she was pregnant. It hadn’t been planned, and she wasn’t all that happy about it. I had actually been the one to diagnose her pregnancy several months before. I then asked her how the baby was doing. She gave me a strange look, then glanced toward her young daughter who was playing in the room. She then whispered to me that she wasn’t pregnant anymore. Oh, I said, “I’m so sorry. What happened?” I assumed that she had a miscarriage. It didn’t even occur to me that she would have ended the pregnancy. All I wanted was to be pregnant, so the thought of giving that up was far from my considerations.Baby Holding Mans Finger

She responded in a whisper that she had an abortion. Now was not good timing to have a baby. Regardless of my position on pro-choice vs. pro-life (I’m not here to get into a debate. I am just sharing from my infertile perspective), in that moment, I felt like someone had punched me in the stomach. The only thought that kept going through my head was that, “I would have taken your baby. I would have loved your infant. If only you knew what a precious gift you had. I would give anything for that.” I swallowed my stomach, forcing it to go back to its normal position, and I responded without missing a beat. My face did not show my sorrow or my surprise, instead, just as medicine teaches us, it showed no signs of judgement. I simply said, “Oh, are you happy about that decision, and how are you feeling since the abortion?” I became objective because medicine mandates objectivity. As a physician I was forced to be objective and non-judgemental, but as a desperate woman wanting to become a mother…I grieved.

The beautiful thing about the frozen cycles was that I didn’t have to do a stimulation cycle. This meant that I only had to do a portion of the shots, and I had to take steroids. Unfortunately, the protocol for frozen cycles was that the progesterone had to be given as shots…Not the small needles, but the intramuscular shots in the butt twice daily. Usually, the spouse was the one to give these shots because it was a little hard to reach the correct spot on yourself. Besides, the needles were like torture devices. No one in their right mind would want to see that going into themselves. I surely didn’t. They had to be spaced out by 12 hours, one in the morning and one in the evening. The problem was Dave’s schedule. As a surgery resident, he was getting up at 4:30 in the morning in order to leave by 5 on certain days. I am not a morning person to begin with. Just imagine being awakened just so that you can bend over and have someone drive a needle (two by four) into your butt cheek.

.Money in syringe

The first time I was incredibly nervous. It was about as bad as I thought that it would be. Having your husband inflict pain on you makes you somewhat more of a wimp as well. You have to put on a brave show for someone you don’t know, like a nurse, but you can whine and complain and say what you really feel when it is your husband. I am not one to get light-headed and woozy at the sight of needles, but after the first shot, I had to lay down…immediately (I’ve since gotten a lot tougher:) I thought that I was going to pass out. That sensation did not diminish over time. With each shot I felt more than a little flushed and light-headed. Then my butt began to get pretty sore. I started to have a pretty red spot on each cheek and decided that someone should take a look to make sure nothing was wrong. It turns out, that my husband has a very precise aim. He was giving me the shots in exactly the same spots every single time. You don’t really want this much precision! He was instructed to widen his aim to prevent a site reaction from getting worse.

It hurt to sit, and it hurt to stand. I started to long for the Crinone progesterone gel that turned into a cottage cheese curd-like discharge. It may have been gross and messy, but it certainly didn’t hurt like this. I decided that I could do anything at this point though. I could even give myself the shots; And, well, I had to. Dave was running late one evening (as in I don’t think he left the hospital until the next day.) I was on a strict schedule with my shots, and I wasn’t about to mess things up. I didn’t really have anyone else to ask, and I didn’t want any of my neighbors seeing my assets. My coworker had mentioned that because of her husband’s schedule she also had to give herself the IM shots at times. If she could do this so could I! I loaded the syringe, attached the mile long needle and prepared to self-inflict torture. I had to contort my upper body while looking in the mirror in order to make sure that I was in the right spot and wasn’t going to hit a nerve. After several start and stop attempts, I just decided to get it over with. The funny thing was, it was so much better when I gave it to myself than when Dave did it. It’s like getting your own splinter out. Somehow it just hurts less.

Transfer number three was scheduled. Again my primary infertility specialist was not going to be present for it. Instead it would be the head of the department. I was informed that his technical skills were very good, and we shouldn’t have a problem this time. Well, that was not entirely true (I’m sure his technical skills are fine…but we still had a problem). All three of the embryos survived the thawing process. The plan was to transfer all three because frozen cycles are known to have lower success rates than fresh.The Equipement Of Gynecologist Room

Striped down, knees in the stirrups, ultrasound smashing my belly once again, the transfer started, only to be started and stopped several times. The physician confirmed that my cervical pathway was more than a little tricky. It was winding and somewhat challenging to feed the catheter through. I lay there with my legs in the air panicking. Not again! They had to get the embryos in. The concern was that embryos are very temperamental to their environment. They should either be in the incubator, or they should be in the uterus. Any time out of these environments could compromise their quality and ability to survive. Eventually, the infertility specialist was able to get the catheter in place. The embryos were transferred, and we had three embryos floating around in my uterus. The idea that we could get pregnant with triplets and even as many as six babies put me into a little bit of a whirlwind; But, who were we kidding, we hadn’t been able to get pregnant once yet, so what where the odds that we would get pregnant with three?

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Our Preemie Journey: Holding My Dream Come True for the First Time

I couldn’t do it. I hadn’t been able to get out of bed with my soaring blood pressure, pounding headache, and magnesium clouded confusion. I desperately wanted to hold HER; but, it had been two days, and I had yet to see my baby. Today was the day! I willed my body, forcing my legs to carry me just one step toward the wheel chair. Un-showered, unrecognizably swollen from the preeclampsia, connected to several IV lines and a foley catheter bag…I was far from a picture, perfect new mother. Actually, I was a wreck! I was trying to hold it together, but it was all too much. My body continued to suffer the side effects of preeclampsia, unresponsive to the blood pressure medications being loaded into my veins. I was terrified for myself and my tiny newborn. But, I had to see her! I had to hold her! I had to touch her!Iphone 1634

Iphone 1729Every tiny bump, even the elevator’s gentle thumping felt like foot-high speed bumps. My head bobbed and my body swayed as though I was on a tiny fishing boat weathering rough seas. Although Dave was probably only moving at a turtle speed, I begging him to slow down. The nurse at his side, there to make sure that my blood pressure didn’t jump any higher and that my IV lines were running appropriately, assured me that we would be to the NICU in moments. I reminded myself to take deep breaths. I could make it. I would make it.

The NICU was a whole new world. Small rooms filled with even smaller babies. IV’s, feeding tubes, heart rate monitors, ventilators, incubators…all in an effort to save these precious little lives. My wheel chair stopped in front of HER room. It wasn’t the perfect pink room with a white crib and velvet curtains that I had planned but hadn’t had the time to decorate. Instead, it was a hospital room with a tiny incubator, purple walls, heart rate monitors, and a hospital curtain.Iphone 1653Iphone 1764

I barely noticed the room. All that I saw was HER. So tiny…so fragile…so transparent. Again, I was terrified. I didn’t see a beautiful, healthy, chubby baby that I could snuggle and kiss. Instead, what I saw resembled a frail, baby bird that had fallen from its nest. Her skin was translucent, covered in downy hair. Her features were far too fine and underdeveloped, lacking the fullness and health that fat brings. Her skin was wrinkly, and her arms and legs almost looked skeletal from the lack of fat. Some may be appalled to read that I didn’t find her beautiful at first sight. I loved her desperately, but her appearance was shocking…even to me, a physician.Iphone 1693

I was afraid to hold her. Would I break her? Her weight had dropped into the 2 pound range-down a little from her birth weight of 3 pounds 2 ounces. The nurse reassured me that SHE would be fine. It took some time to get her out of the incubator and untangled from all of her iv and monitor lines. Just as she was placed in my arms I began to feel waves of nausea. My blood pressure had jumped, and my medications were making the room spin. I had made it this far. I had to hold her.Iphone 1661IMG_2042Iphone 1703

After only a few moments, with tears streaming down my face I asked for someone to take her from my arms. I had to close my eyes. I had to lay down. My body was my enemy. It was preventing me from being the mother that I longed to be. But, I had seen her. I had held her-even if just for a moment. In that moment, in my sick and terrified state, I was in love with a little life that had been gifted to me. She was tiny, but she was precious…the most priceless gift my arms had ever held.Iphone 1832

From The Mom in Me, MDIphone 1738

Our Preemie Journey: Day 1 of Motherhood

When I awoke, I almost forgot that I was a mother. The discomfort from my c-section and the breast pump forced my mind to acknowledge that I had a baby, but I hadn’t seen her. I hadn’t held her. I hadn’t even named her yet. I knew she existed, but she felt like a distant memory. The magnesium continued to cloud my mind. I was sick. Oh, so sick. I knew that I cared about a little being, but it was hard to think about more than my own failing body. I was flooded by feelings of guilt. Did I truly care about myself more than my baby? Was I really that selfish?

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My precious preemie daughter!

The thought brought tears to my eyes. I wasn’t selfish. I loved my baby more than the knot in my throat would allow me to voice. Preeclampsia was to blame. Preeclampsia was the guilty one. Still, I couldn’t shake the guilt. I wanted to hold my baby for the first time. I needed to hold her, but I couldn’t. Even if I would have been able to move out of bed, I wasn’t allowed to leave the obstetrics floor with my dangerously high blood pressure and my magnesium IV still running. A picture of my fragile, tiny baby was my only glimpse into her world. She terrified me. She was so small. Too small. Scary small. I couldn’t look at her picture without bursting into tears.

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My baby in her incubator under bilirubin lights with feeding tube and supplemental oxygen.

A baby that small needed her mother. She needed to know my love and my presence. She had been a part of me for 32 weeks, and I had been her EVERYTHING! Now she was being cared for by people that she had never met. I envied them. I envied my husband who was able to spend hours cherishing our baby on his chest, skin to skin. The two floors that separated my hospital bed from her incubator might as well have been a continent. My heart longed for her. I was now a mother, but I felt childless, empty, hollow. How could day one of motherhood feel this tragic? I wanted my daughter back. I wanted to give her eight more weeks to grow and develop inside of me. I wanted to rewind and then fast forward to a perfect, full-term delivery! I wanted a day one of motherhood “do over.” I knew I couldn’t get my “do over”, so instead I decided to fight toward my next best option…Day 2 of motherhood with my preemie. Maybe tomorrow I would finally be able to hold my baby.

From The Mom in Me, MD

 

 

 

 

 

 

 

 

 

Our Preemie Journey: Delivery Day…8 Weeks Early!

young pregnant woman sitting on the windowMy 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.Fetus 7 Month In The Womb. Visible Head And Arms

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.

I remember the tugging and pulling during the c-section, and that the spinal was just as unpleasant as patients have described. My blood pressure dropped fairly rapidly at one point, causing me to vomit.

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!

My baby was born at 3 lb. 2 oz. She was whisked away to be resuscitated.

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 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