STRUGGLING TO HAVE A BABY

Ever since I was young (quite literally, since I had my first period) I’ve wanted to be a mom. It has always felt like the one thing I was meant to do with my life. I was always so careful to use birth control and prevent any unplanned surprises, thinking that it would only take one time to conceive a baby. Turns out, that’s not how it worked out for my husband and I. After a full year of trying (with LH strips, the Ava bracelet, studying my cycle…all the things), we really started to think our time would never come. Who was I supposed to be, if I wasn’t meant to be a mom? We did at home fertility testing that didn’t provide any answers. With further researching, we figured that if the first suggested medical treatment would be an IUI, we may as well try something similar at home first. We used the Mosie syringe system and finally conceived after 13 long, hard months. 

MISCARRIAGE

As soon as we were pregnant, I immediately started researching miscarriages. I had no logical reason why. I felt like I needed to prepare myself. I would have thoughts that I would never meet my baby and could picture calling out of work for a miscarriage but couldn’t picture going on maternity leave. I was so unbelievably anxious. I had gone off of my SSRI for baseline anxiety and depression when we started trying to conceive and at this point the midwives essentially told me I was going back on it. I’m thankful that they did; I think it laid the groundwork for surviving what was to come. The anxiety didn’t ease up. I was anxious enough that they scheduled an early ultrasound for me. I remember a day about two weeks before the ultrasound where I went to the bathroom and immediately thought “something just changed”. I brushed it off as a part of my incessant anxiety. We went in for our ultrasound at 8w4d and found out that our baby had died at 6w6d and that I was having a missed miscarriage. Intuition is a crazy thing. Somehow this still rocked me to my core. We were thankful to have guidance in choosing management options and when we were told we could try to conceive after our first period following the miscarriage. Somehow, the stars aligned, and we conceived our daughter in the cycle after our first period with the Mosie syringe system again. 

PREGNANCY COMPLICATIONS

As a pregnancy after loss, I had anxiety every day and a constant fear of losing another baby. I thought after a clear anatomy scan, I could finally take a deep breath. I was so excited for our 20-week ultrasound for exactly that reason. Instead, we found out our daughter had a single umbilical artery. We had a consult with Maternal Fetal Medicine and went through extensive genetic testing to ensure this wasn’t a small sign of a larger problem. We were thankfully cleared and made a plan for intermittent growth scans to monitor for any signs of intrauterine growth restriction. Maternal Fetal Medicine encouraged me to plan to deliver no later than 40 weeks to prevent the risk of complications, so we went ahead and scheduled an induction at 39w6d. I was optimistic this would be the last complication, until I was diagnosed with gestational diabetes. I was again lucky to have diet-controlled diabetes and not require insulin. I struggled with everything that came up during pregnancy. After our struggle conceiving and miscarriage, it felt like the universe was trying to tell me I wasn’t meant to be a mom. It took a lot of time and work to get through the fact that this wasn’t a sign, just speed bumps on the road to becoming a mom. 

INDUCTION/HOSPITAL ADMISSION

We were scheduled for induction at 39w6d, on June 17th, 2021. We were told to wait for a call from the hospital to be told when to come in. I was so anxious waiting for that call, I just didn’t want to be responsible for noticing when my baby died. It sounds morbid but that was truthfully my fear and my persistent thought. We called in at noon when we hadn’t heard anything. They were so overwhelmed with patients they had that they said there was no way I would be coming in, but offered a non-stress test to check on my baby later that afternoon. I was so upset. My husband and I went for a walk to waste time before the non-stress test. We had multiple non-stress tests before and knew what to expect, so we were happy to at least hear our baby and know she was okay. About five minutes into my non-stress test, numerous staff members came running into the room and had me change positions a few times. Turns out that my daughter had a large deceleration and earned us admission right then. We were on continuous monitoring and waited for there to be enough staff to start our induction. My daughter continued having intermittent decelerations even without beginning induction and I was consented for a c-section overnight that night. They finally started my induction with Cervadil around 6:00 in the morning. The decelerations slowed down throughout the day and weren’t as severe or as long. The Cervadil, unfortunately, didn’t do enough to ripen my cervix for Pitocin. As the decelerations had improved, they decided to utilize Misoprostol throughout the night. The decelerations picked up again but not enough to indicate obvious distress, until the morning. I woke up at 7:00 in the morning to about 14 staff members in my room speaking loudly and moving me around, instructing me eventually to get on all fours and then they lost the tracing on the fetal monitor. Thankfully, the loss of tracing was simply from all the movement and my nurse was able to find it again. This was such a terrifying way to wake up and honestly is not a feeling I’ll ever forget. After everything had settled down, I asked my nurse if I could talk to my midwife team about the risks vs. benefits of continuing with induction versus moving to c-section. The midwives came in and pushed me really hard to continue with induction, despite my concerns. They mentioned a contraction stress test, where they give me some Pitocin to have actual contractions and see how the baby tolerates it, but didn’t think it was necessary. They were using words like “elective” to describe having a c-section which, with a first baby, I didn’t want to choose when maybe it wasn’t the best option. I asked them to involve the OB team, who recommended the contraction stress test as a decision maker. They started the Pitocin, I started to have one contraction I could barely feel, and my daughter went into a huge, prolonged deceleration. They immediately said I needed to go to emergent c-section and we were in the OR in no time. I was so thankful my baby was going to be here safely before anything bad could happen to her. We finally made it to the finish line, it felt like. 

DELIVERY

I went to the OR, got my spinal, and was prepped for section. I made sure to tell everyone who would listen that I wanted the drape to be dropped when she was being born. That was all I wanted from delivery, to see that my baby girl actually came from me. Unfortunately, anesthesia was busy and the drape was only dropped on my husband’s side. I wasn’t able to see my daughter be born. They took her over to the NICU team who was present as it was an emergent c-section. They invited my husband to go meet our daughter while the NICU team was still tending to her. It turns out, she required deep suctioning as she aspirated a significant amount of my blood and she needed CPAP support to recover from the aspiration. Thankfully she was finally cleared and brought over to me as I was almost done being closed up. I started feeling nauseous and got some anti-nausea medication. My IV stopped working right as they were pushing the medication in, but they said it was fine as the case was over. We were wheeling back to the room and I was holding my baby but something was very wrong. The corners of my vision were turning black. I knew something terrible was about to happen and I told my husband to take the baby. I felt myself get so exhausted, my eyes closed, and I couldn’t open them again. My blood pressure was low and continuing to drop. I was given IM epinephrine to make sure I could make it back to the OR where I could get IV access and further intervention. The charge nurse was pushing my bed through the hallway, said “oh sh*t”, and started running. As we came into the OR, I heard her start yelling that my blood pressure was 40/20 and asking who was going to put a line in. The anesthesia team went to work putting a large central line in my neck, an arterial line in my wrist to monitor my blood pressure, and giving me more IM epinephrine. My blood pressure stabilized and I became minimally responsive (an improvement from entirely unresponsive). I went for a CT scan and finally came back to my room with my husband and my baby hours after delivery. They put her on me for skin to skin and I still couldn’t open my eyes. I kept telling my husband to make sure she didn’t fall. I slowly became more awake and more interactive, but was not awake enough to hold her. I was moved to the step-down unit for the night, away from my baby, before even really getting to know her. The nurses on the step-down unit worked hard all night to get my lines out and get me back to my baby in the morning. Wheeling back in to my room on the birthing pavilion at 6:00 the next morning is a feeling I can’t even explain. It was like coming home, even though it clearly wasn’t home. But it was the room my husband and baby were in. That’s what made it feel like home. 

PROLONGED ADMISSION

I was in the hospital for longer than anticipated. Our daughter was born on Saturday and we didn’t get to go home until the following Wednesday night. I had a blood clot from the line in my neck that was occlusive and required anticoagulation. They came in to my room and told me to choose a medication with daily monitoring that would allow me to breastfeed or a medication with no monitoring that would not. With the separation from my baby at birth and the whole first night, not having any education on the pump or how to use it, and struggling to deal with still being in the hospital, it felt like daily monitoring would break me and I couldn’t breastfeed anyways. I was so exhausted again on Tuesday that I couldn’t hold my baby. After some iron and a couple of blood transfusions, I finally felt well enough to leave on Wednesday. After some convincing and a two-day post-discharge follow up appointment being scheduled, my team agreed to let me go home. 

CONTINUED COMPLICATIONS

I continued bleeding for weeks, but was on blood thinners and didn’t think anything of it. The week of my six-week postpartum visit, I started passing large clots (again) and soaking through a pad in an hour. I called the on-call OB who told me that because I was an ICU nurse, I should know when I need to come in and to just go to my scheduled appointment. I called the office the next day and got my appointment moved up. When I saw the OB in the office and told her what was happening, I was so incredibly thankful that she took me seriously. She got me in for ultrasound during my appointment time which showed some sort of collection in my uterus. We made a plan for a D&C the next day after 24 hours off of my blood thinners. They surprised me when they came in my pre-op room to consent me for general anesthesia. I understood the fear of decompensation but was again blindsided. The D&C made me feel better immediately. My bleeding stopped two days later and I had so much energy. They found retained placenta which was likely the source of a number of my problems. I went through some severe PPD/PPA at about three months postpartum. I asked for help and required additional medications to stop myself from thinking that my baby would be better off without me. Thankfully, my PCP listened and found the exact medication for me. 

WHAT THIS MEANS FOR THE FUTURE

They still aren’t sure what happened to me. The best guess is peripartum hemorrhage (during delivery) with formation of a large uterine hematoma while I was decompensating complicated by sudden cardiovascular collapse. The DVT was considered provoked and hopefully won’t occur again. We found the medication that worked well for my PPD/PPA so if it happens again, I’ll know exactly what to ask for for help. My daughter had a single umbilical artery, a short umbilical cord, and an exposed loop of vasculature. The exposed loop of vasculature is likely why she couldn’t tolerate even a single contraction without having her blood supply cut off. Maternal Fetal Medicine plans to do a detailed scan looking closely at the umbilical cord of our next baby when the time comes to ensure we do the best we can to prepare for complications. I am planning on having scheduled c-sections for future deliveries. I think the fact that my baby would have died if I had gone into labor on my own has terrified me enough to not want to risk it with any future pregnancies. The Maternal Fetal Medicine team is ecstatic about that decision, to say the least, and told me I likely wouldn’t have even been offered a VBAC. Theoretically, all of these complications were flukes and shouldn’t happen again. Theoretically.

BIO

My name is Addison and I’m 27 years old. I work full-time as an ICU nurse. I’ve been a loud advocate for miscarriage support since experiencing it and am trying to do the same with my traumatic birth. I struggled to label it traumatic as I received excellent care and, as a nurse, it feels wrong to dismiss the care I received by calling it a traumatic experience. Over time I’ve come to realize that being separated from my baby, missing the golden hour everyone talks about, missing her first vaccines, and not having my one wish for my delivery met truly did make this a traumatic experience for me. My daughter is almost 7 months old now and my husband and I are hoping to expand our family again in a few months. We are working closely with Maternal Fetal Medicine to ensure it is safe, but we don’t want to allow this experience to change our initial plans for a  large family with children close in age.