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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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 Infertility Journey (1.11): The Neighborly Infertility Waiting Room

As soon as my ovaries shrank back to their normal size (after a failed IVF cycle, sabotaged by ovarian hyperstimulation); my hormone levels normalized; and I had my period, I was immediately ready to start another cycle of IVF. I was going to make this work. I was not going to be discouraged. I was going to get pregnant.Pregnant Woman holding her hands in a heart shape on her baby bu

I was fertile…incredibly fertile…confirmed by a tiny drop of medication overstimulating my ovaries.  I didn’t need a break. I needed a baby. And, so, we started over again. This time I was required to have more frequent ultrasounds and more frequent blood draws (oh, so convenient for my work schedule). The medication doses were titrated to push the ovaries to make follicles but not to hyperstimulate. We were on the right track. But…

Once, again, I hyperstimulated. It was not as intense this time. I was able to continue the cycle, but unfortunately because we were using such small doses of medication I ended up with a lot of very small follicles that didn’t have eggs at the right stage of maturity. I only had a few follicles that looked promising. Would these few follicles be enough? I held onto hope.

During this cycle, a somewhat random and awkward series of events transpired. As I made my way into the clinic one morning, I noticed a familiar face. Not just a vaguely familiar face, but the face of my next door neighbor. She sat alone, looking down at either her phone or a book, or anything just to avoid eye contact. I knew that she had seen me. How could she not, with only a glass wall to separate us on entry, and one other person sitting in the waiting room?Three patients sitting in doctor's waiting room

For several months now I had observed that everyone always looked up when someone entered the waiting room. Maybe they look out of curiosity. Maybe it was an instinctive reaction to the sound of the door opening. Maybe they thought the nurse was about to call their name, or maybe it was a glance longing for connection-the connection of seeing someone else struggling with the same grief that infertility brings. In this silent community of women, all were pained by similar emotions yet distanced from one another by shame or a desire for privacy. But, behind each heart filled with pain was also a yearning for understanding and support.

As I sat down, I tried to make eye contact. Instead of feeling like my privacy was being invaded, I was excited to find comradery. I wanted to know my neighbor’s story. I wanted to tell her mine. I eased myself into the seat, sore from my distended pelvis. I wondered if she was in the middle of a cycle. As my mind was racing through possible scenarios, she briefly glanced my direction. I tried to catch her eye and smile. This time she did see me, but instead of saying hello and exchanging pleasantries, she simply gave me a hasty, half-hearted smile and quickly looked back down. Each morning after was the same.Outdoor profile portrait of a beautiful thoughtful Chinese Asian

I didn’t judge her. How could I? Just months before I had been shrinking behind the vending machine hoping that no one that I knew would see me. How could I expect her to behave differently. She hadn’t invited me into this private part of her life. She didn’t want me to know her struggle. She deserved the right to her privacy, to her reaction, to her annoyance at my presence. I understood. She was dealing with her infertility struggle in the way that worked for her. Who was I to pressure her to talk or to share?

Over the next several months we saw each other frequently. Our exchanges were limited to a quick glance and a brief smile. By now our husbands were accompanying us to our appointments whenever they could. My neighbor’s husband would smile and greet me comfortably, as though we were both in our front yards watering flowers. Our husbands worked out in the same gym and would run into each other on occasion. Somehow they were easily and openly able to talk about our simultaneous infertility journeys and failed IVF cycles.

Young woman doctor in cap and face mask in surgery room interiorAs coincidence would have it, we both ended up having our egg retrivals on the same Saturday morning. So, just the four of us sitting in the fish bowl waiting room at 6 am, eager, worried, and more than a little tired. Would we both come out of this round pregnant? Would only one of us have success? How many eggs would each of us get today? How many embryos? So many questions…so many what if’s. I wasn’t sure what to say. Besides, my mind was more than a little hazy from the sedating medication I had taken before arriving to the hospital. This clinic expected you to be tough. A benzo by mouth and some IV narcotics were all they gave for egg retrievals. Looking back, I’m a little jealous of my friends who had full anesthesia at other clinics! I’m pretty sure I’d be okay with never knowing what an egg retrieval feels like!

From The Mom in Me, MD

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Our Infertility Journey (1.9): Keeping My Head Down and My Hopes Up

Armed with my vials, needles, syringes, and injection pen, I was ready to get started. I prided myself on being tough; and in truth, since I don’t have an abnormally intense fear of needles or blood, the shots were not that bad. After the first self-administered shot, poking myself four times a day became part of a “normal” routine. Yes, it hurt, but I figured if my diabetic patients could give themselves as many shots as they did for a lifetime, I could do this for a few weeks.Abdomen Subcutaneous Insulin Syringe Pen Injection Vaccination

I start off using ice to numb the injection area, but eventually that was just a nuisance. I usually talked to myself out loud just to prepare myself before the poke. It was a quick pep talk reminding myself that, “You can do this! It will be over in two seconds. etc. etc.” A quick poke and burn, and then another poke and burn and I was done. When my stomach started to feel a little like a pin cushion I tried rotating spots; but even so, I bruised with each one. I didn’t mind. I was going to make a baby!

My schedule was dictated by the shots. I had to get a cooler to put them in just in case I wasn’t home when I needed to administer them. I did have Dave try to give me a shot early on just to see if it would make the experience better. Definitely not! Somehow, having control over hurting yourself makes it less painful.

Three patients sitting in doctor's waiting roomNow came the tricky part-trying to work my schedule at work around the IVF clinic schedule. The IVF clinic didn’t offer appointments. It was first come first serve starting at 7:30 or 8 in the morning depending on the doctor. They had instructed me that some women, in an effort to get to work on-time, would get to the waiting room as early as 6 am to sign in. That sounded insane to me. Why wouldn’t they just offer appointments. How inconvenient! You would never know when you would be seen with this set up. I had my own patients to see twenty-five minutes down the road! How was I going to come in for daily ultrasounds and blood draws without knowing my timing? The answer…show up to the waiting room before anyone else. So, that is what I did.

I raced through the parking lot each morning as fast as my feet could carry me.  If I saw the familiar face of another infertility patient I picked up my pace. I needed to get my name in first. I had other people depending on me. I couldn’t change my patient schedule everyday. It wasn’t fair to my patients and their needs.

We usually all ended up on the same elevator ride up to the third floor of the hospital. No one made eye contact. We all knew where we were going and why, but somehow talking about it just seemed like a violation of our privacy. The real though was who was going to get off of the elevator first to put their name at the top of the list. We all had jobs. We all had places to be. No one wanted to seem rude, but everyone jockeyed for position.Outdoor profile portrait of a beautiful thoughtful Chinese Asian

Often the lights were off in the waiting room. The heat had been turned up to an ungodly temperature, and the only people passing in the halls were surgery residents-many of whom knew me. I would quickly sneak to the coveted position in the room-the seat next to the vending machine in the corner. Here I was somewhat safe and out of sight.

We worked on an unspoken honor system. When the nurse finally arrived to take attendance she would start by asking who got there first, second, third etc. Each infertility patient would chime in with their name when their position was called. It was all about who walked through the waiting room door first. No one ever tried to steal a spot. The rush through the door might have been somewhat hostile, but once seated…everyone knew their position in line.

This waiting room should have been filled with comradery, with moral support, and ultimately with friendship. Unfortunately, our emotions were too raw. We each sat with our heads down, our hearts heavy, and our minds consumed with INFERTILITY. We were cautiously optimistic. We held onto hope. We held onto our fairytale dream of a happy ending. If only we had been brave enough to hold onto each other as well…it might have made the journey just a little easier.elegant girl with umbrella sitting on antique chair in the mount

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

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

Sex at its Worst

Distressed Couple Finding Out Results Of A Pregnancy Test

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

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