This blog is brand new and hardly used, and I think the time is right for me to start using it. Sometimes perhaps I will talk about weddings and other special events, and sometimes perhaps I will just talk about life. Feather West is about celebrating a beautiful life and exploring what that means for myself and for my clients. For now this blog isn't linked through to from my Feather West website, but perhaps at some point I will put it out there in that capacity. So if you've been sent this link, or stumbled across it, I hope you enjoy.
Right now in my life I have a beautiful 4 month old daughter. Therefore, this post is 100% unrelated to weddings, aside from the fact that one condition of me saying yes to my now-husband's marriage proposal was that we would try to have kids. This post is about my life from July 12, 2014 when I found out that I was pregnant, to February 6, 2015 when we welcomed her into the world.
This post is long and detailed. It's probably written more for me than it is for you, but some things in life just need to be written down in order to digest them. I started writing it as the events of my pregnancy unfolded and as I was sending email updates to my parents, otherwise I never would have been able to keep straight what was going on, and probably because it felt therapeutic to write it all out too. If you are a friend who wonders what my pregnancy and birth story is, well friends, here it is. If you have stumbled across this page because you yourself are pregnant and have found yourself in the midst of some of the challenges that we went through, I hope that my words will give you perspective on what you're going through and I wish for you the happiest of outcomes as we were fortunate enough to be granted. If you are looking for the short version here it is:
At 7 weeks/1 day I found out at I was pregnant - Saturday, July 12, 2014. Based on my googling of due dates based on last menstrual cycles, this baby was due February 27th, 2015. O.M.G. My husband was out on a long bike ride when I took the pee test. My period has always been very irregular, but I waited until one day longer than my longest period ever to take the pee test, maybe I wasn't sure how I felt about all of this! I had no idea how to tell him, and ended up telling him that evening when he suggested we go out to sushi for dinner, and I was all awkward - oh um, yeah, about that....I'm pregnant. He was totally shocked, since we'd been casually trying for a year and a half at that point with no success (reference totally irregular periods on my part) and were getting to the point of saying maybe we should get serious about this and talk to my doctor about how to be more deliberate in our attempts before we move on to discussing possible fertility challenges. I believe his exact words were something along the lines of, 'I didn't know it was actually possible for me to have kids!' I will insert for context here that he was 44 at the time, and I was 34. I will remember the details of this day for a long time because I also had an appointment that afternoon to visit some friends to consult on the possibility of them adding a roof deck and/or additional floor to their house. These friends I knew were trying to get pregnant themselves and I already knew they were having some struggles in that department. I had already thought about how challenging it might be to share the news of my pregnancy with them when the time was right - but little did I know that they were also already pregnant and due 5 weeks before me! Early pregnancy is such a weird thing - no one saying anything to even close friends - so there we were, both pregnant, both possibly feeling weird about it (I can say I was!), and saying nothing. At least I can look back on it with humour.
I called my doctor on Monday morning, July 14. The receptionist simply said that they would call me back, and I would come see the doctor at 10 weeks. That's it? So I just trust that the pee test is right??? I guess so...
That Thursday my parents arrived for a visit, July 17. We told them the good news that evening when I had only a very (very very) small glass of wine. My mom later told me that she hopes I wasn't offended by her reaction of total shock because she was 100% NOT expecting that news from us. I told her she did a good job of hiding her shock, and she DID do a very good job of showing her genuine excitement.
I never got that return phone call from my doctor. Waiting patiently, Monday, August 4th, at 10 weeks/3 days I called my doctor again. They seemed shocked that I was calling and had been lost in their notes, and I immediately had an appointment to come in in two days.
Wednesday, August 6th at 10weeks/5 days I saw my doctor. She felt around, said all looked fine, gave me some prenatal vitamin samples to start taking and sent me on my way with a referral for an ultrasound to be done Thursday or Friday of that same week. I left there still in shock that there was no blood test or anything, that somehow a pee test from Walgreens was right and a doctor could literally feel with her hands the changes in my body to confirm I was pregnant. Mind. Blown. I had lots of blood drawn, as well as a special blood draw to see if my hypothyroidism was being affected by the pregnancy. (A few days later i found out it had, which was expected, and my medication was increased). All other blood tests returned normal (or at least I assume so, they said no news is good news.) It turns out there was some confusion, and the earliest I could have the ultrasound done based on my due date was the following Wednesday. I confirmed with my OB that this was OK, and it was booked.
Wednesday, August 13th, at 11 weeks/5 days I went in for my first ultrasound and first prenatal screening blood draw. I was terrified going into this, afraid that perhaps the baby was dead, having had no confirmation of any sort that it was alive. Indeed though, there it was, alive. Greatly relieved I actually felt excited, which had not been the case very much at all yet. I would get results from the blood test by mail in 5-7 days. I almost considered telling people over the weekend since we were then past the "magical" 12 week mark. Something inside me decided not to, and I did not.
The first bad news came in the form of a phone call on Monday, August 18th (12 weeks/3days) - the call was from a genetic counselor stating that my blood tests indicated a 1:22 chance of the baby having Downs Syndrome. It also indicated a very low PAPP-A reading (mine was 0.1, normal is 1.0) and a slightly elevated hCG reading. We were asked to come in, together, to meet with a genetic counselor the following day to determine next steps. For those of you who also are going to need to google WTF these words mean, here you go:
- PAPP-A is Pappalysin-1, also known as pregnancy-associated plasma protein A. Low plasma level of this protein has been suggested as a biochemical marker for pregnancies with aneuploid fetuses (fetuses with an abnormal number of chromosomes). Low levels may alternatively predict issues with the placenta, resulting in adverse complications such as intrauterine growth restriction, preeclampsia, placental abruption, premature birth, or fetal death. (ref. Wikipedia)
- hCG is the hormone 'human chorionic gonadotropin' which is produced during pregnancy. It is made by cells that form the placenta, which nourishes the egg after it has been fertilized and becomes attached to the uterine wall. (ref. American Pregnancy Association)
Tuesday, August 19th (12 weeks/4 days) we met with Brette, our genetic counselor. She explained the readings and our options. After the appointment I had the Verifi test done (an NIPT - non invasive prenatal test - it was yet another blood draw) and we settled in to wait for the results.
As my husband and I had previously had the Counsyl test done over a year ago (at the time it was a spit test that tests to see if you are a carrier of a large number of genetic diseases), there was less concern about other genetic issues popping up. It was known that I carry genes that can cause two severe and often fatal diseases - Bardet Biedl Syndrome, and Pompe Disease. However both parents must carry these genes for a baby to have these diseases, so once my husband tested clear (for all diseases - lucky man), we felt that we were out of the woods on that, and knew all this before even trying to get pregnant.
Unfortunately a big mistake was made when my Counsyl test was being analyzed, and the checkbox was not checked to test for Fragile X Syndrome, another severe disease. Due to the discovery of this - which likely never would have been discovered had we not been sent to see a genetic counselor - I had blood drawn for a newer version of the Counsyl 1.0 test again (it is now a blood test instead of a spit test) and we settled in to wait for those results as well.
We were also told that we would need to have an extra ultrasound at 28 weeks, followed by weekly ultrasounds after that to chart the baby's growth due to the low PAPP-A result. We were told that women with low PAPP-A readings have a 1/10 chance of that reading indicating that the placenta will fail before the 40 week mark, and our baby would be delivered anytime after 28 weeks if/once they discovered that the placenta was failing. So, add to the other stresses we were under, we now had the news that I had a 1/10 chance of having a premature baby.
Waiting is horrible. You wait and wait and have to decide what you will do pending the results. We decided that we would terminate the pregnancy should our child have Downs Syndrome or Fragile X Syndrome. No one else knew we were pregnant except for my parents. I tried to distract myself by doing things I normally like, like going for a run. Running basically turning into me slowing to a walk and ultimately sitting down crying somewhere along the trail. So, I counted the days and the hours in each day and just kept waiting.
In the midst of my waiting, it was discovered that my insurance would not cover the cost of the prenatal vitamins that I had selected from the samples my OB gave me. Friday, August 22 (13 weeks) I swung into my doctor's office to get as many more samples as they would give me until this was sorted out. It took forever, but I finally got my prenatal vitamins sorted out and delivered monthly via an online pharmacy for only $25 a month. Pain in the ass, but at least a distraction?
Monday, August 25th, at 13 weeks/3 days, one day shy of a week after we had the Verifi and Counsyl 1.0 tests performed - I received a phone call while at a job site. Through the sound of saws and drills in the background (remember, I'm an architect) I got the good news that the Verifi test results were back and we tested negative for Downs Syndrome (aka t-21 - as well as negative for t-18, t-13 which we hadn't anticipated being problematic anyways based on the initial prenatal blood screening). What a giant relief. After waiting 6 days this news came at the perfect time. I had my annual work review that afternoon and whether to tell them that I was pregnant or not was weighing heavy on me, knowing that there was a real possibility of terminating the pregnancy. The news came on the first day of my husband's business trip (to Tiburon. We live in San Francisco, so I am still laughing about how weird that was.) - so I was glad to be able to rest easier while he was "out of town."
It was stressful and scary, but telling my bosses that I was pregnant turned out to be not bad at all. They were very supportive and I felt relieved.
As a result of the negative Downs Syndrome result (had it been positive we would have terminated and therefore not continued testing) my husband was asked to come in to have his blood drawn to conduct a Counsyl 2.0 test, which he did as soon as he was back from his business trip. This test would be a further analysis of his blood to be even closer to 100% sure that he did not carry genes for the two genetic diseases that I carry. We knew that the chance of this coming back positive was very very very low, but I wanted all the extra assurance we could get.
But, we still had to keep waiting for the Counsyl 1.0 results for me to test for Fragile X Syndrome to be returned. My husband went in for his Counsyl 2.0 blood draw on Thursday, August 28th (13 weeks/7 days) - and asked while he was there about my results. It turns out they were in but hadn't called me yet! Wonderful news, I was negative for Fragile X Syndrome.
We were relieved and my husband was ready to tell people. I was not however knowing that we still had his Counsyl 2.0 hurdle to clear, but under his urging I told 2 friends that weekend when the opportunity did present itself. My husband told family and friends as well - I was just over 14 weeks.
Tuesday, September 2 (14 weeks/4 days) I had my routine monthly OB visit. All looked well and I got to hear the baby's heart on the doppler. This was wonderful and a relief.
At long last, on Tuesday, September 9th I got the phone call that my husband's Counsyl 2.0 test came back clear. At 15 weeks/4 days we could finally breathe total relief. We were back on track. All looked good. Those collective 3 weeks of waiting had been torturous. I wish that on no one. Finally, we were happy - and having a baby! I still had a daily fear that the baby had died, but tried hard to not think about it. I think this is pretty normal. I came close to buying a home doppler (it was in my Amazon shopping cart daily), but my fear of too much junk in the house allowed me to overcome that desire (barely).
The following weekend, at 16 weeks/2 days on Sunday, September 16th we started telling people en masse at a friend's farewell party, it was public. Relief and happiness!
My husband's birthday was Monday, September 29th. The day before - Sunday, September 28th (18 weeks/2 days) - was the first time I felt the baby kick with my hand on my stomach, and for sure knew it was a kick. I could stop worrying if the baby was alive...I could feel it - before this there were flutters in my stomach (like a fish flipping on a table out of water as someone once described it to me) but this was the real turning point!
Tuesday, September 30th (18 weeks/4 days) I had my 3rd standard OB visit. All was still fine. I heard the heartbeat again, always relieving.
The following weekend we went to Toronto for my husband's cousin's wedding. When we returned, Monday morning, October 6 (19 weeks/3 days) we had our 2nd standard ultrasound and 2nd trimester screening blood draw. The baby was alive and kicking - estimated to weigh 10 ounces, with 10 fingers and 10 toes. All on track. For our 3 weeks of awful waiting on test results, we got to enjoy just under 4 weeks of joy. Then we talked to the doctor following the ultrasound - there were two concerns...
- The baby was not in a position to see enough of the heart to complete the standard analysis - we would need to come back in 10 days to have another ultrasound taken.
- The placenta was completely covering my cervix - a condition called a complete placenta previa. If this did not resolve throughout the pregnancy I would need to have a scheduled c-section. Of course, since my head kept switching to worst case scenarios I envisioned what would happen if I lived somewhere without the kind of healthcare we have here today - if I didn't know I had this condition and tried to birth vaginally I would likely have bled to death and have killed the baby too. I was asked to come back at 28 weeks to review again. I was already scheduled to come back at 28 weeks due to my PAPP-A readings, so this was just another thing to pile on to the list of concerns that grew and shrank, and had just grown again.
I called my OB that afternoon to understand what this complete placenta previa meant. This is when i got the really bad news - it meant no exercise except gentle yoga, walking, and swimming. It also meant no travel - which would likely span Thanksgiving and Christmas (and both of our families live airplane rides away). Sadness. Lots of sadness. Basically it meant a huge (albeit temporary) lifestyle change.
Ten days later - Thursday, October 16th (20 weeks/7 days) we returned for our follow up ultrasound. Two results came of this...
- The placenta had moved! I did NOT have any placenta previa (complete or partial)! The doctor said that I must have been having a contraction (which you have throughout pregnancy without feeling) during the previous ultrasound, which due to the uterus not being stretched out yet with a large (ie birthing sized) baby meant that it had contracted so much that it pulled the placenta in front of the cervix (temporarily). So thankfully my travel and exercise restrictions were lifted much sooner than expected! Had I not had to come back for this followup ultrasound I wouldn't have gotten this good new for another 7+ weeks!
- The other result however was that they felt there was one part of the heart that was not showing as normal, and they wanted me to have a fetal echocardiogram done to look at this in more detail. Sad face. They would schedule it for me.
The next day I still had not heard back with an appointment time for the fetal echocardiogram so I called to schedule myself. The earliest they had available was the following Wednesday - but my husband had meetings that prevented us from scheduling it until that Friday. We felt it was important for us to both be there to hear whatever news would be handed to us.
Friday, October 24th (22 weeks) we went in for the fetal echocardiogram. It was a long exam and the doctor discussed the results directly after. The findings were this...
- There was a small hole between the two lower chambers of the heart - called a ventricular septal defect (VSD for short).
- The pulmonary artery (that sends deoxygenated blood from the heart to the lungs) was measuring the same diameter as some other important artery (which one I didn't catch - too much information all at once!), but it is supposed to measure larger.
- One of the fetal blood vessels (the ductus arteriosus, which in all babies closes up after birth - it is used for transporting deoxygenated blood from the heart via the pulmonary artery to the placenta) is measuring small.
The doctor said she felt that #3 is not a concern, since it closes up after birth anyways and the baby is tracking normal in development otherwise. #1 and #2 however are traits that are indicative of a heart disorder called Tetralogy of Fallot. We had to go back in another month when the baby's heart is larger to have another look so she can determine for sure if she thinks the baby has this heart disorder. However, she said that she feels it is MORE likely that these are small abnormalities unrelated to Tetralogy of Fallot - #2 potentially will be a nonissue, #1 has a good chance of closing up before birth, or within the first year after birth on its own. #1 may require surgery at some point if it didn't close up. If when we come back in a month she determines that the abnormalities are indicating Tetralogy of Fallot, this would require open heart surgery within the baby's first year after birth. Additionally she said that there is a genetic syndrome (DiGeorge Syndrome) which is often associated with Tetralogy of Fallot, and that if we wanted to do an amnio procedure to test for that we could go ahead and do that anytime. This was so much information and so scary that my husband actually passed out while she was discussing it. This was all getting to be a bit much. Pregnancy is supposed to be a happy time, of which my experience so far, it had not been at all.
I called our genetic counselor to discuss that afternoon. She explained that if we wanted to do the amnio procedure to discover or rule out DiGeorge Syndrome (and any other syndrome that the Verifi and Counsyl tests hadn't for some reason caught) we would need to do it ASAP, because the legal cut off date for termination of a pregnancy in California is 24 weeks - I was running out of time to be able to make a decision if we got results which indicated one of these syndromes which we personally felt not up to the challenge of raising a child with. And by ASAP she meant Monday or Tuesday - remember, this is all happening on a Friday afternoon. ASAP. I said I would discuss with my husband and call her right back.
I followed up with a call to my OB because I had a regular appointment scheduled with her for the following Monday and I needed to know what to do. She was out of the office for the day, I was told a nurse would call me back. I guess I said all the right key words, because within a few minutes I had a phone call from my OB herself. She said 100% do the amnio. No reason not to. Yes, there is a 1:500 chance of miscarriage, but "knowledge is power" and she has only experienced 1 patient losing a baby due to an amnio in her career, so she feels the risk is even lower than 1:500. In addition she noted that due to my previously very high risk (1:22) for Downs Syndrome, even though we tested negative on the Verifi test which has a 90%+ accuracy rate - this would give us 100% confirmation - we hoped.
I called my husband, we agreed to do it ASAP. I called the genetic counselor back, and had the amnio scheduled for Monday morning.
Monday, October 27th, at 22 weeks/3 days I had the amnio done. We would be getting both the direct array/chromosome analysis and the micro array analysis. We declined the FISH analysis which only tests for Downs Syndrome (t-21), t-18, and t-13 - the genetic counselor noted that if we did the FISH (whose results come back in 48 hours - how nice would that be!) we would risk having the rest of the results take an additional 2 days, because they would likely not run them concurrently. The t-21, t-18, and t-13 results would come as part of the direct array (as well as the DiGeorge Syndrome result). All went well, I took the rest of the day off work. No issues, just some itching around the needle prick in the following days. Results take 7-8 business days to come back. We settled in for another wait.
Friday, October 31 (23 weeks) I had my (rescheduled) standard monthly appointment with my OB. We discussed what would happen on both sides of the results we were waiting on. If things go well I come back in 4 weeks where we discuss hospital visits, birthing classes and all that jazz. I also would do a glucose test and another thyroid test. If things go poorly there are several doctors who specialize in late pregnancy termination in San Francisco and will be able to accommodate us before the end of next week when we are no longer legally allowed to make that choice in California. She said she has a candle in her kitchen that she lights every day for the patient she is thinking about the most - she said she is lighting it for me this weekend. Fingers patiently crossed.
Monday, November 3 (23weeks/3 days) I got the call from our genetic counselor. My OB's kitchen candle worked - we tested normal for the microarray - which means we are cleared for DiGeorge Syndrome! We should also have shown up an indication of Down Syndrome in this test if present - but the direct array/chromosome analysis will give us 100% confirmation. She suspects those results will be in later today or this evening. Big huge sigh of relief. Almost there.
Tuesday, November 4 (23weeks/4 days) I got the follow up call from our genetic counselor - we tested normal! One more box checked. Now we just wait the 2.5 weeks to get more information about the heart defects. But, as of Thursday termination would no longer be an option (without leaving California and heading to Oregon) - but all this should put us in the clear as far as health concerns that are significant enough to warrant termination. Tetrology of Fallot, if the baby does indeed have this condition, can be corrected with surgery at birth with minimal lifetime effects and limitations. While still scary, I feel like we are really on the way to having a healthy baby in February (or before, we still have that low PAPP-A reading in the back of my head).
Wow, a whole 2.5 weeks without an appointment, and able to feel happy about this pregnancy! We took the plunge and ordered a bassinet and stand as well as the tiny mattress and linens for it. The first of our baby purchases. We also settled on a crib (IKEA FTW), though we don't need to order that anytime soon. Carseat and stroller research is well underway.
Friday, November 21 (26weeks) we went in for the second fetal echocardiogram. This time the news was different. First, no, it is definitely not Tetralogy of Fallot - so that is good news. However, the hole between the two lower chambers (the ventricular septal defect) is still there - but it appears to be very very small and she anticipates that it will close up on it's own - though it would be checked after birth to confirm so and an operation would be done at 6mo-1year if it didn't close up naturally during that time. Also reasonably good news. But, the "new" concern is that the one of two fetal blood vessels (which remember in all babies close up after birth - the ductus arteriousus) which she had previously noted was measuring small, is now noticeably considered "tortuous" - meaning that it takes a more circuitous path than normal, which means that the blood has a more difficult time getting through it. The good news is that as long as the baby is OK with it during gestation, this closes up within the first 24-48 hours after birth - so it in and of itself is a non issue. The effect however is threefold...
- The walls of one of the lower heart chambers (the chamber that the blood is exiting as it enters the pulmonary artery en route to the ductus arteriosus, can become thickened because of the backlog of blood in the chamber due to the slower flow out - she said that this is noticeable now to a small degree, but not to be concerned about really - more so it is an indicator of the other two following concerns which could develop.
- The second effect is that the walls of the aorta where the ductus arteriosus connects to it can become thickened (called coarctation of the aorta), which means that after the ductus arteriosus closes up after birth, the normal human heart blood flow path through the aorta can be decreased, which can be OK, but if decreased too much can be an issue that requires repair. She cannot see a thickening here yet, but will check again in 6 more weeks to review. If she determines at that time that it is indeed thickened here the options are two-fold:
- If it is mild, the child would be followed throughout life by a cardiologist to see if they are experiencing any negative effects from this. If they were they may require surgery at some point, likely if there is an issue it will be immediately obvious and surgery would happen in the first 6mo to 1 year of life. Otherwise it is something people can live with without impact throughout their life. Surgery is considered a complete fix for the issue and people lead healthy active lives following it.
- If it is severe, I would be switched to a different OB doctor and deliver at UCSF (where we've been going for these appointments) instead of CPMC where I currently planned to deliver with my current OB. This is so that the baby can immediately after birth be put on an IV of a medication that prevents the ductus arteriosus from closing up. While keeping the ductus arteriosus open via the IV medication, during the baby's first week of life they would perform surgery to repair the coarctation of the aorta. The baby would then be taken off the IV medication so that the ductus arteriosus can take its usual 24-48 hour process of closing up, and the baby would be "cured" of this ailment. They would be followed throughout life by a cardiologist, but it is anticipated there would be no other complications throughout life. My delivery hospital would be changed because UCSF and Stanford are the only hospitals in the area that can perform this procedure at birth. While I like my OB, this change doesn't really bother me, as UCSF is actually closer to our house than CPMC and a very well respected (obviously) hospital.
- The third effect is that because of the difficulty of blood getting through the ductus arteriosus, more blood than should is flowing into the lungs (normally very very little blood goes to the lung in utero) which can impact the baby's lung development. They cannot tell anything more about this yet since the lungs are not used in utero - this is something that has to be checked after birth and dealt with at that time if there are any issues detected.
So, wow. I guess we'll find out more in 6 more weeks and go from there.
Monday, December 1 (27weeks/3 days) I had my marathon morning at CPMC - I went in first for my glucose test, which entails drinking a bottle of flat soda-like drink, then sitting in the waiting room for an hour (I did a lot of reading), then getting my blood drawn. This is a totally normal pregnancy test that everyone gets. To bring some humour to the number of additional test I've had to endure during this pregnancy, my OB told me that if I failed this test and was diagnosed with gestational diabetes that something was very very wrong - apparently based on my ethnicity and height/weight/activity level it would have been extremely unlikely for me to develop gestational diabetes. Fortunately she was right and I passed this test no problem. They also drew blood to recheck my thyroid levels (I ended up with yet another bump in my medication, mostly related to weight gain). I of course left the lab hopeful that all that comes back normal, but I wouldn't know that it did for a few days. Then I grabbed a late breakfast (you couldn't eat before the glucose test), moved my car so I wouldn't get a parking ticket, and went back in for my OB appointment. Nothing to note there, I usually don't really feel like I learn anything at the OB appointments since I have been having all of these other specialized appointments in between. She did say that she is surprised at the baby's small size (at the last ultrasound the baby measured at the 23rd percentile) given my husband and my birth weights - both of which were quite average (me at 7lb12oz, he at 6lb13oz) - so now I'm just feeling more pressure about next Monday's 28 week ultrasound / growth scan. I hope the week goes by quickly.
Monday December 8 (28 weeks/3 days) we went in for the 28 week ultrasound / growth scan. Finally - genuine good news! The baby had a growth spurt, and was measured at 2lb8oz, which is in the 41st percentile - so much more "average" than the 23rd percentile we measured at previously. This is good news on the realm of concerns related to the original low PAPP-A reading. I would come back in another month to check again with another ultrasound - and do nonstress tests starting that day and every week following to be sure nothing alarming popped up, but the doctor there suspected that the low PAPP-A was not affecting me, which was great news - since had the baby's weight dropped below the 10th percentile they would have considered delivering me as early as this week - which was a stressful thought always lurking in the back of my head up until that day. Even if things started to drop when I went back in a month (January 5th), I would be at 32weeks/3 days - so somehow that felt like a less stressful "early" time to delivery - though obviously I would prefer to just hang in there all 37-40+ weeks! January would be a busy month, but for now, just one more OB check in appointment before we left for Christmas vacation for 2 weeks - and then a slew of appointments once we return.
Friday, December 19th (30 weeks) I went in for my final OB appointment of 2014. Uneventful. Got lots of paperwork to read about signing up for hospital tours, birthing classes, disability leave pay, and pediatricians. I would have to dig into all that after the holidays. We were off on vacation tomorrow to visit family in Ohio and Ontario...and arrive back to San Francisco the Saturday before my next (Monday, January 5th) appointment. We took care of signing up for the hospital tour and birthing class while we were out of town. I still needed to take care of my disability leave paperwork and find a pediatrician.
Monday, January 5th (32 weeks/3 days) we went in for the next ultrasound / growth scan, as well as the first of what would be weekly nonstress tests. The ultrasound was fine, the baby had grown to be 3lbs12oz - we were told it is on the low-but-still-ok side, in the 27th percentile. I was booked for another growth scan ultrasound in 4 more weeks to check in again. Then I did the nonstress test, which was uneventful as well. In layman's terms, they strap two monitors to you and have you lie there reading magazines for 20+ minutes as they monitor the baby's heart rate and monitor if you have any contractions. They look for the heartrate to spike 15+ bpm during activity and they want to see a certain number of movements/activities with appropriate heartrate spikes before they let you go. At that first appointment I wasn't sure what the contractions monitor did as I didn't have any while I was there - I did learn that that is the same sensor they use during labor, which I had sort of heard of, but honestly didn't know much about (I guess this is why you take birthing classes!). I would come in and do that test every Monday morning from now until I had the baby - if they detect that the baby isn't having a big enough heartrate spike during activity, or not enough activity at all then they would send me back in for another ultrasound - otherwise, it's just maintenance. They also check your blood pressure to be sure that is tracking normal as well.
Tuesday, January 6th (32 weeks/4 days) I went in for my routine OB appointment. Nothing unusual here - every few times I go in there's something new though. Today was the pee on a stick test which you do every appointment (I still actually had no idea what this tests for - so I finally asked - I was told it tests for protein in your urine which is an indicator of pre-eclampsia), followed by taking my blood pressure and weight per usual. There was also listening to the baby's heartbeat, and then measuring the size of my belly. The new thing today was a vaginal exam - like your typical pap smear, but I learned much more painful when you're pregnant - to be totally honest I'm not sure what that tests for and I didn't bother to ask. Then I had to get a third trimester Tdap vaccine. All seems well and usual, back again in two weeks.
Next up, weekly nonstress test, Monday, January 12th (33 weeks/3 days). The baby was transverse breech which is bummer news, hopefully the baby keeps swimming around and goes back heads down so we don't have that to deal with on top of everything else! Otherwise, readings were fine, so back in a week.
Tuesday, January 13th (33 weeks/4 days) we went to CPMC for their hospital tour. It's starting to seem real!
Friday, January 16th (34 weeks) we went in for our third fetal echocardiogram. The news this time was the best yet. First, the VSD is getting smaller (as the heart gets larger around it) so they are feeling very optimistic that it may close up before birth or within the first few years of life and will not require treatment. We will take the baby in for an echocardiogram within their first month of life to assess again and go from there. Also the tortuous ductus arteriosus seems to still be present, however she is not seeing evidence of coarctation of the aeorta so she feels that this is likely not having an impact on our baby. She (a new doctor as our other doctor was now off on maternity leaver herself) did express concern that due to its 'tortuous' nature, it might not close up on its own after birth, but if that happens we will deal with it from there. We were cleared to deliver at CPMC as planned which is great. Also, in good news, the baby was back heads down today!
Monday, January 19th (34 weeks/3 days) I went in for my weekly nonstress test. Baby was still heads down, though the spine was on the other side, so still moving around in there. I had been feeling non stop movement since Friday, which I guess is more common when the baby is heads down. Readings were fine, back in another week.
Wednesday, January 21st (34weeks/5 days) I had my biweekly OB appointment. Nothing to note, all looks good. She did note that per the nonstress test reports she's getting, that my levels of amniotic fluid are on the higher end of normal (I'm at 19cm, normal tops out out 24cm) - so I may be feeling some discomfort from that, but nothing to be concerned about unless the levels start to change.
Monday, January 26th (35 weeks/3days) is the weekly nonstress test again. It was uneventful, good baby movements and heartbeat and baby is heads down. Last week I thought maybe I felt and saw a contraction while hooked up, but this week I'm fairly certain I felt and saw a few. They are still very random and weak, which sounds about right. Will see what next week holds.
Thursday, January 29th (35 weeks/6 days) we met with the first of the two pediatricians we were able to get in with (who knew getting a pediatrician in San Francisco was so difficult?!) - Dr Goldstein of SF Bay Pediatrics. It was brief and she was nice, I had no idea what questions to ask - so we will go meet the next pediatrician in a few weeks and maybe the choice will be obvious. We were also supposed to attend the CPMC Childbirth Class today, but it was cancelled. This is a total bummer since the next class isn't until February 15th! We have access to the online class now instead, but I really wanted to drag my husband to the in person class since I know he's not going to make time to do the online class.
Saturday, January 31st (36weeks/1day) we did a maternity photo shoot. I wasn't planning to do one, but in these last few weeks I found a great opportunity to collaborate with a photographer friend (Olivia Smartt) and a florist friend (Lily Goff) and decided to go for it - and it was so so so much fun!
Monday, February 2nd (36weeks/3 days) - It's now due date month! I started the morning with my usual weekly nonstress test and all went well, good movements etc. I followed that appointment up with another growth ultrasound - the baby has slowed down in growth but is hanging in there at the 17th percentile and weighing in at 5lb 7oz today, so the doctor felt like things looked good enough for me to not come back for another growth scan. She said the head is measuring narrow, and that that is probably driving the low percentile. She also said that she can no longer detect the VSD - which is not to say that it is not there anymore, we will still have it checked after birth, but it is to say that is is getting smaller, so that is all great news! Feeling good after today! I started to feel like I was maybe getting a cold throughout the afternoon though - and by the evening knew I wasn't feeling well. I went to bed after some comfort food of mac and cheese and woke up in the middle of the night with a horrible sore throat. Being quite pregnant and sick sucks.
Tuesday Feb 3rd (36weeks/4days) I stayed home from work because I was still feeling lousy (though at least the sore throat went away) but I did go in for my weekly OB appointment. First the good news - I am a "loose 1cm dilated" so my body is in the know that this baby is going to be ready to come in the next few weeks. Then the bad news, my blood pressure was high - they checked it three times to be sure. This was concerning since yesterday at my nonstress test it was totally normal. They also thought my weight was high (12lb gain in 2 weeks!) - but turns out that was user error - it was only 2lbs, phew. Thanks a lot nurse! My OB had me do blood and urine tests down in the lab which they got results of in 2hrs and had me call back to discuss. When I talked with my OB after those results came back she said that it leads her to believe what she was concerned about is true, which is that I have developed pre-eclampsia. I was sent home with a container that looked like a brown orange juice jug to do a 24hr urine collection test which would confirm if I did indeed have pre-eclampsia. Though the lab told me to start the test the following morning my doctor had me start right away so that we would get results sooner. So now I'm peeing in a jug for 24hrs and have to return that to the lab tomorrow for review. I've also been told to go to the ER if I get headaches, face or hand swelling, or vision blurriness. I also have to come in Friday for another blood pressure check. She said if it gets too high, and pending the results of this pee test she will likely have me come in and be induced early - ie, have that baby this weekend. Holy cow. Scary, it's kind of getting real...and soon... The rest of the day pretty much sucked, I DID have a headache, but I had that all day due to being sick and also had body aches.
Wednesday, February 4th (36weeks/5days) I'm peeing in a jug all day and then had to run it over to the lab after my last pee of the 24hr test (5:13pm) and before the time the lab closes (6pm). Fun times. I was back at work today even though I still felt sick, a little less achey but the runny/stuffy nose is developing. Totally sucks but I'm so low on vacation hours and totally all out of sick hours, so here I am - peeing in a jug at work. Awesome. I made it to the lab in time and just waiting until Friday for results.
Thursday, February 5th (36weeks/6days) I stayed home from work again. I still had a lingering cold, and I decided I just couldn't be bothered to go into the office and try to be productive for the day. Instead I spent the day trying to sleep it off, and in between naps did some productive things like doing the online childbirth prep class, washing all of the clothes/linens/etc that we had bought for the baby, and packing my hospital bags. All day I felt like I had been getting small back aches like I get during my period - it was basically just annoying and I attributed it to this cold that I had. If you've had a baby at this point you are probably saying, of course you were going into labor!!! How did you not know?!?! Well, I did not know. I had 100% no idea. While we were eating dinner however it felt like this back pain that came in waves was getting a little more noticeable and mentioned it to my husband. He was not concerned and said he's sure it was because I was sick, and that I should go to bed early and just try to sleep this cold off. By the time we finished dinner however the back pains were becoming certainly more noticeable and rhythmic, I decided to start timing them with the contractions app that I had downloaded. I also recalled an email exchange that I had had with a friend earlier in the week when we were discussing the fact that I may have pre-eclampsia - she advised me that if there is ever an appointment in the coming days/weeks where I thought that there is a chance that I will be kept and admitted to the hospital to be induced, that I should be sure to go to that appointment with a stomach full of food and freshly showered! So I decided that after dinner I would be taking a shower - and continuing to time these contractions(?). By the time I got out of the shower things have moved from noticeable to borderline painful. While my husband was still advocating for me getting to bed and resting this off, we both agreed it would be prudent to call the 24 hour hotline at my OBs office to discuss with the on call nurse.
I made the call and the nurse advised me that this did in fact sound like I was going into labor. Per my contraction timing app these were lasting 30 seconds each and spaced consistently 2 minutes apart. However, all of this was happening at 9pm, and since I was still not full term (which is 37 weeks) - I was shy of being full term by about 3 hours at this point - that medically she had to advise me to try to slow and stop the contractions because I was technically in preterm labor, which meant going to the bathroom and emptying my bladder, taking some tylenol, and going to bed to rest. If the contractions did not slow or stop, if I experienced any vaginal bleeding, or if my water broke, I was to call her right back and she would call in to the hospital to alert them that I would be coming in ASAP.
I was certainly slightly panicked at this point. I in no way was expecting to be in labor this evening - at worst case I had been prepping myself for the possibility of being induced the next day or over the weekend pending the results of my blood pressure and 24 hour urine test. I did step one of her directions, which was to go use the bathroom. At that point I realized that I had in fact started having vaginal bleeding. I called her right back, at this point having to kneel on the floor in the middle of our conversation when a contraction happened. Things were starting to move really fast. We were told to head to the hospital immediately. Holy crap. I gathered the hospital bags which I had packed just hours before, and my husband let our two dogs out in the yard to pee and tried to tidy up the house just enough so that they wouldn't destroy anything for the next few hours (or more?) while we were gone. Off we went to the hospital.
When we arrived at the hospital they were expecting us and we were immediately checked into OB triage and given a room. I was examined and declared at 3cm dilated, so I was going to be admitted. O.M.G. We are having a baby?!?! Holy crap. Since we hadn't gotten around to filling out the birth plan paperwork the nurses asked two basic questions...
- Who is your pediatrician?
- What are your pain mangement preferences?
Well, #1 had me and my husband looking back and forth at each other - we had only met with one pediatrician! We had an appointment to meet with the second one that coming Wednesday - so, well, I guess our doctor is Dr. Goldstein, she seemed nice enough, right? Then #2, to which I indicated I intended to go without medication as long as I felt possible. The OB doctor on call came in a few minutes later to discuss things with me and she noted that while she respects my preference not to use pain medication, and felt that given my current ability to manage the pain at the 3cm I was at she felt that I would be able to pain manage this myself if I so chose, however, she would like me to be put on an epidural - that I was welcome to delay when it was administered up to a certain point - but she said that she would like me put on one before my labor advanced too far. Her exact words then were something to the effect of: "Due to your history of having a (albeit resolved) placenta previa, and the vaginal bleeding that you are experiencing, I am not sure what your delivery will be like. I feel that there is the possibility that it will require some intervention that you will not be able to pain manage yourself." At the time this sounded like code for something I didn't need to / want to know about, and I trusted her expertise. However, mentally, once I knew I would be getting an epidural at some point, my desire to continue to pain manage the increasingly painful contractions on my own came to a halt.
This was all happening at approximately 10pm. I was walked upstairs to the delivery room and I requested to be put in line for getting an epidural. To prep for this the nurses had to put a hep-lock into my arm (also called a saline lock, this is an intravenous catheter that is threaded into your vein, flushed with saline, and then capped off for later use. This way you are not hooked up to an IV pole, but the nurses have easy access in case you need something injected into your vein later.) which is how they would initially administer pain medication that would enable me to keep still for the full 15 minutes it takes to administer the epidural, and it would be there in the event I needed anything else via IV during labor/delivery/post delivery. To do this you have to stay still so that they can find your vein and get the needle in - which is NOT easy when you only have 1-1/2 minutes between contractions which at this point were so painful I was kneeling on the floor with my face pressed into the bed during each one. So they did their best to get the needle in between each contraction but they failed terribly. I ended up with 4 different nurses trying, and 4 different failed punctures in my arm. Finally the nurses gave up trying to put it into my forearm and let the anesthesiologist put it in the back of my hand. Now that I've experienced having it in the back of my hand I can say that the forearm would have been a million times better (as the nurses were trying to tell me). With this large piece installed on the back of your hand you can't really use that hand for anything, including pushing yourself up / repositioning yourself in the bed, holding your baby, etc. But whatever, I was getting pissed at the nurses for this taking so long (I have small veins and giving blood has always been a challenge, so I can't really fault them) so, when the anesthesiologist finally got there to give me the epidural at 2am I didn't really care where it went anymore. Fortunately that process went very smoothly, and my husband who usually passes out in the presence of blood or needles managed to keep it together and stay conscious through all of this (though he did admit to turning away and not watching most of it). The effect of the IV pain medication was slow but helpful, and the effect of the epidural was nearly immediate. It took quite awhile for the epidural to take full effect of numbing my legs, but the numbing of the uterus was immediate and a great relief. I was somewhere between 5-7cm dilated when it went in, and had only been in active labor and at the hospital for 4 hours. Things were moving very fast, and for this reason my contractions were more painful and more frequent that I had been prepared for. I also continued to experience significant bleeding, soaking through sheet after sheet on the bed and losing a significant amount of blood all at once when I stood up prior to receiving the epidural. My husband and the nurses were noticeably concerned by the volume of blood, and the doctor was called in several times to consult, but she assured us all that this was fine as long as the baby and I were continuously being monitored. From 2am-3:30am or so we settled in to wait though really time flew by - I was continuing to progress, and through my pain was dramatically reduced with the epidural, I was experiencing some painful (this probably isn't the right word considering what things could have felt like) leg cramps in my right leg. For some reason the epidural was numbing my left side but causing me cramps in my right leg similar to sciatic pain. The nurses did what they could to take the edge off this, but it mostly amounted to me being turned from my left to right side every 10 minutes or so, which was a 3 person procedure once my legs were mostly numb.
Around 3:30am when I was being examined my water broke and flooded the table and floor with very red liquid. My husband almost lost it at this point, but held it together and the doctor assured him that this was still OK, mostly water, just colored with some of the blood that I was losing. I think it is probably a good thing that although I felt it break I could not see it from the position I was lying in the bed. At this point she announced that I was fully dilated at 10cm. The nurses prepped me to settle in to wait for the right time to start pushing, and my husband pulled out the tiny chair-bed they offer dads and curled up to catch some sleep. Discussion had ensued about what the timing of this all might be - the nurses indicating to my husband that chances are I wouldn't start pushing until around 6am - he had considered going home quickly to feed and let out the dogs, but decided to get some sleep first and stay with me.
At around 3:45am the beeping from the monitors that were hooked up to me that were charting the baby's heart rate suddenly slowed down dramatically - I knew just enough to feel concerned, but not enough to really know what was happening. All of a sudden the nurses sprang into action and an oxygen mask was put on my face. The doctor arrived and announced that we were having this baby right now and it was time to get ready to push. My husband was looking around confused from the chair-bed he had literally just laid down in, and worked his was to my side. The doctor explained in a calm but quick voice how I was going to push and then the nurses would tell me when I was having the start of a contraction and to push. It was all very surreal - it began literally 30 seconds later and I was pushing maybe 4 times tops - I couldn't feel anything except pressure, so it is honestly quite amazing that I (or anyone else who has birthed a baby with an epidural) does the right thing since you can't feel what you are doing at all! After a few pushes the doctor narrated that she was performing an episiotomy because we did not have time to allow me to tear naturally, and, fun fact, that I have a very short perineum (distance between my vaginal opening and anus) and would likely tear all the way through without the episiotomy. I'm glad I didn't have time for this little bit of info to sink in at the time!
She continued by stating (all in a very calm voice despite the fact that things were moving very fast) that she could feel that the umbilical cord was wrapped around the baby's neck, and that she would be using vacuum extraction to get the baby out right now. I heard my husband make an audible gasp and tighten his grip on my hand. And then, within seconds, at 4am exactly, this bloody red tiny little baby was out in the world!
A few snips and the umbilical cord was removed, and this tiny baby was rushed across the room where the NICU staff was on hand to check her out. Since the baby was no longer technically a preemie (she made it to full term by a whole 4 hours!), once they were able to do their basic exam the NICU staff deemed her healthy and she was released back into the care of the nurses. They asked my husband several times if he would like to cut the last of the umbilical cord off which he declined several times until they finally got the hint that he was not in the least bit interested. Back over on my side of the room I was still in disbelief that all of this had just happened. I pushed a few more times to expel the placenta and began experiencing the after effects of all those hormones flying around after delivery, which for me were the 'labor shakes' - uncontrollable shaking of my hands and arms. I was assured that this was totally normal and to not try to fight it, that it would only make it worse. I was stitched up from the episiotomy and as this was happening a nurse called from across the room asking if we had named her. OMG! In all this drama I hadn't even asked if I had just given birth to a girl or a boy and the doctor hadn't told me!!! Because we had to take the Verifi test back at 12 weeks, which in addition to testing for genetic diseases can also determine the baby's sex, my husband had known since then that we were having a baby girl - he had shared this information only with my mom, my brother, and my sister-in-law - no one else knew! I had chosen not to find out, and he had kept his promise and no one had told me. So hoorray! It's a girl! After a few minutes of examination and cleaning up she was brought over to me and placed on my chest. What a surreal experience to have this tiny new baby lie on your chest and root around and begin to nurse with no prompting or effort on your part, simply incredible. We were able to bask in new parenthood now - how incredible after all we had been through. A tiny little lady, only 4lbs11oz, 18.5" long, was ours.
Now that things had calmed down and after we had been able to hold her for a little while she was taken back by the nurses to do some things like the antibiotic eye ointment, the initial Hepatitis B vaccination, and her first bath. My husband was finally realizing how shaken by this whole experience he was and was brought some juice because it looked like he might pass out. I was also brought some juice to start getting rehydrated. That didn't work out so well for me, and a few seconds later I asked if any of the medication I was on should make me nauseous - the nurses said no, and yet all of a sudden I was throwing up. Good times. Fortunately all this happened quickly and passed, and I was left there with my still nonstop shaking hands to wait to for us all to be transitioned to the recovery room. The nurses did their best to get rid of the blood and vomit I was now covered in, but at this point, let's be honest, I didn't really care.
Maybe around 5am or so we were rolled down the hall to our recovery room. Despite the hospital and our own preference to room-in with her, our new daughter would be staying in the nursery for awhile for supplemental formula feeding and observation due to her being deemed hypoglycemic (low blood sugar). I was frankly totally OK with this since I was completely exhausted and happy to just roll over and fall asleep for a few hours. My husband headed home to take a nap himself, care for the dogs and do other important things, like go buy a carseat (oops).
A few hours later in the morning when my OB came in to work she stopped by my room. She opened by saying "Well, that's one way to have a baby!" Yes, ma'am, yes it is. This is when I found out that the delivery experience I had just had was due to a placental abruption (remember that being on the list of possibilities back when I tested low for PAPP-A?). I started by experiencing a partial placental abruption which means that the placenta had begun to pull away from the uterus, this is what triggered me to go into an accelerated labor and experience vaginal bleeding. I was very very lucky that I had reached 10cm and was fully dilated before the placenta fully abrupted (pulled completely away from the uterus) - which is what happened when the baby's heart rate dropped and she had to be delivered immediately. It is apparently fairly rare for a pregnancy experiencing a placental abruption to be delivered vaginally, this condition usually results in an emergency c-section. I now know that the doctor who delivered our daughter knew what was going on the entire time but chose not to share it with me (which I am 100% fine with) and her words concerning the epidural when I was checked in were related to her knowing that there was a very real possibility of me requiring an emergency c-section (which obviously is not something you pain manage yourself!).
What happened over the next few days and weeks is for another story. I will end by saying the following to bring closure to those last few concerns that were raised for us during the course of the pregnancy...
- Our little girl's blood sugar was brought within normal ranges over the next day.
- Her in-hospital pediatric exam determined that she did not appear to have a VSD or coarctation of the aeorta, the ductus arteriosus closed up normally, and her lungs had developed normally. We did have a follow up appointment when she was few weeks old with the pediatric cardiologist at UCSF and they confirmed these findings. Though there were a few new very minor concerns with her heart, they assured us these defects were very minor and they anticipate being able to give us a 100% clean bill of heart health at her next appointment when she is 6 months old. If for some reasons this evolves into something else, I guess that will be another story to share at another time.
- I found out later at my 6 week follow up appointment that it had been determined that I did not ever actually have pre-eclampsia - it is unknown what caused my blood pressure to spike those last few days, but likely related in some way to me being about to delivery the baby early.
And that is how we welcomed our little princess into this world! I hope this long long story will someday help and bring perspective to someone else who is desperately googling around as they try to cope with some of the issues we faced - and I hope for them that they are blessed with a healthy little baby in the end as well. I spent a lot of time googling the various conditions and diseases we were faced with, and reading stories by real people, no matter their outcome, was always more impactful than reading medical websites which really just scare you to pieces. To my friends and family who made it through this whole story, our little lady has an extra hug for you next time she sees you. ;)