Lindsay’s Story: Postpartum Blood Clot and Pulmonary Embolism

by | Jan 18, 2022 | Uncategorized

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Lindsay's Story: Postpartum Blood Clot and Pulmonary Embolism

A Normal Pregnancy & Delivery
My husband Michael and I learned I was pregnant with our second baby in the spring of 2020, due February of 2021. This being our second time around, we knew what to expect and I felt pretty prepared for what was to come. With my first pregnancy, I had 7 months of morning sickness and a PUPPs rash. Otherwise, it was a healthy pregnancy. My second pregnancy went even smoother without the rash and less morning sickness.

Like my first pregnancy, my second went past my due date. We scheduled the induction for a Thursday morning. I was ready to meet my baby boy and was anxious about the weather, which had been threatening snow all week. We checked into the hospital with high spirits. Little did I know, induced labor would be rougher than I ever could have imagined. Compared to my last delivery in which we ended up not needing to induce, induction was a nightmare. I was in labor a total of 24 hours and 12 of them were unrelenting contractions about a minute apart the whole time. My epidural was hardly putting a dent in my pain. The most the nurse could do for me was a shot of morphine to allow me 1 hour of semi-painless sleep. Michael did an amazing job of breathing through the contractions with me. I found myself relying heavily on him to breathe with me.

 Finally, our doctor came in and told me he was ready for me to push. Luckily I did not have to push for long. Michael started the timer on his phone and by the time 5 minutes were up, my baby boy was in our doctor’s hands. I had the privilege of cutting the cord and then spent the next hour holding him, skin to skin. It was Friday morning – 24 hours after starting induction

From there, things were normal. A nurse helped me into a wheelchair and wheeled me to our recovery room. I remember laughing and cracking jokes with her along the way. On Saturday, we decided we wanted to discharge a day early to avoid coming home in an upcoming snowstorm. Had we waited any longer to induce, there was a possibility of me going into labor during that storm. 

 

Coming Home

Coming home was extremely emotional. No one could meet the baby for the first time in the hospital due to strict COVID guidelines. Our older son who was 3 at the time was home with my in-laws, anxiously awaiting to meet his new baby brother. My father-in-law helped me into the house across an icy driveway with Michael behind us with the baby. I sat on the couch and watched as my two sons met each other for the first time. I sobbed the entire time, so happy to see my family as a whole.

Unexpected Pain

Sunday was my 31st birthday. My family came over with dinner and we had a low-key night eating and enjoying each other’s company. After they went home I went to bed early Sunday night.

I woke up in the early hours Monday morning with nausea and abdominal cramping. It felt like something had a tight squeezing grip on my guts. The pain was unlike what I experienced in my previous postpartum recovery. I was taking an iron supplement for anemia per doctor’s orders and thought it must have both been agitating my stomach. I pushed it out of my head, attributing it to the many changes my body was experiencing.

Things got worse later that day when my nausea led me to vomit. Alarmed, I called my OBGYN and spoke with a nurse. She also agreed it must be Tylenol and my iron supplement causing my stomach upset. I decided to skip them that night to see if I felt any better.

Tuesday was much the same. I decided to try and sleep it off another day and to call my OBGYN again on Wednesday. Wednesday morning I vomited again. I called my OBGYN and the nurse still thought it was the iron supplement even though I had stopped taking it. She said it could take a few days for my stomach to settle. By Thursday morning I began to experience a low-grade fever. My appetite was also non-existent now and the thought of eating anything made me gag. I was lethargic and could not get off my couch. I called my OBGYN a 3rd time. Upon hearing about my fever, they advised me to go to the Emergency Room. We left our toddler with my parents and our newborn in the care of my husband’s mother and sister. Michael drove me to the hospital.


Back in the Hospital

We arrived around 6:30 PM on Thursday. Michael was not permitted into the E.R. with me due to COVID-19 restrictions. Both of us were reluctant to separate. I went into the waiting room alone. He spent hours in the hospital parking lot, leaving only to get a drive-thru dinner, hoping to take me home soon. Finally, around 7:30 PM it was my turn for triage. I described my symptoms and they immediately prepared an E.R. bed for me. They triaged me as high-priority.

The first thing they did after hooking me up to IVs was order an ultrasound. The initial concern was that there may still be a piece of the placenta in my uterus that was causing an infection. They performed an ultrasound on my uterus around 9 PM. Over an hour later results of my uterus showed there was no infection there. The E.R. doctor considered a possible gallbladder attack due to more pain when she pressed on that area. She wasn’t sure though and she told me that she hoped to have answers from a second abdominal ultrasound. If it came to it they may need to perform a CT scan or surgery.

I wasn’t allowed to eat. I was starving and nauseous at the same time which is one of the worst feelings ever. The hunger agitated my nausea even more and I threw up in the ER, one of the nurses getting me a sick bag in time.

Before midnight the ultrasound tech arrived and performed the 2nd ultrasound. Yet another hour or more passed before the doctor came in to discuss the results.

“I believe you may have a blood clot, so we are going to send you in for a CT scan to get a better look at things.”

The words didn’t quite register with me when she first said “blood clot”. I knew little to nothing about them and wasn’t as concerned as I should have been. By around 3:45 AM I went to my CT scan. On the way there, my CT tech explained to me which area of the body they would be scanning.

“They believe the blood clot is in a vein called the ‘Inferior Vena Cava’. It’s one of the largest veins in your abdomen. It collects deoxygenated blood from your lower extremities. This vein is about the diameter of a garden hose.”

 

The Diagnosis

So far during this process, I was mentally numb. I was going through the motions and placing all trust in my doctors. The CT scan results came back around 5 AM. My doctor entered the room and I called Michael on speakerphone. There was a massive blood clot (Deep Vein Thrombosis or DVT) sitting in my Inferior Vena Cava (or IVC). Clots were in my renal and gonadal veins. They collect blood from the kidneys and reproductive organs. If left untreated the clot would break free and travel through my heart and lungs. This results in death in 25% of cases.

The following moments were surreal. 3 nurses came into my room as well as the ultrasound tech again. I was immediately started on an IV drip for Heparin, a blood thinner. While on Heparin, I would need blood draws every 6 hours to make sure my numbers were correct. At 5:30 AM they performed an EKG while the ultrasound tech scanned my legs for more clots. In most cases, clots of this nature originate there. The on-call OB-GYN also came down to my E.R. room to meet with me.

As the ultrasound tech was scanning my legs, the OBGYN started making small talk with me. My emotional strength finally buckled when we started talking about my newborn. I was missing his first week and that notion weighed heavy on me. I spent the rest of the morning in a constant state of tears. The hardest part of this was that I was completely alone thanks to COVID restrictions. All I wanted was to be home, enjoying those beautiful first days with my baby. I couldn’t be more grateful to my nurses during this ordeal. I was alone and they were as kind and loving to me as my own family would have been. I am forever thankful to those beautiful souls who stood by me.

As I was being prepared to move from the ER to my hospital room, my ER nurse told me I was finally allowed to eat. They administered anti-nausea medication. She raided the pantry for some juice boxes and graham crackers. She also gave me a box of tissues for the endless stream of tears.

Friday at 7 AM I was finally settled in my hospital room. It was my baby’s exact 1 week birthday, and I cried some more. Heartbroken by the fact that I would not be there with him for this small milestone day. To make matters worse, my hospital room was identical to the recovery room we were in after delivery. We were all so happy in that room a week ago, and now I was back in what felt like the same room under sadder circumstances. The doctor who delivered my baby came in to visit me and make sure I was doing okay. He was sorry that this was happening to me and made himself available to me if I needed anything else.

I was so stressed and anxious. Usually, my resting heart rate is in the low 50 BPMs, but after being admitted it stayed at a steady 60 BPM. When Michael was finally able to come to my hospital room to visit me. I hugged him tight and cried into his shoulder. I had only seen him the night before, but it felt like we were apart for days. 30 minutes into his visit, one of the nurses needed to come in and check on me. She had noticed my heart rate dropped from 60BPMs to 50BPMs and she wanted to make sure I wasn’t having a medical issue. I told her no, I was relaxing now that my best friend was finally here. He reassured me that the doctors knew what they were doing. I would survive this thanks to their treatment plan. He remained calm and confident and did an excellent job of hiding his emotions from me. That in and of itself was what helped me settle. It sounds like a cliche, but I truly believe love is one of the best medicines, and this proved it.

Later, I went in for another CT scan around 1:30 PM. This was to check and see if any part of the clot had broken free and traveled to my lungs. The results came back and confirmed a small piece of the clot did travel there, yet I experienced no symptoms. A clot in the lung is called a Pulmonary Embolism (or PE) and it is a leading cause of death in pregnant and postpartum women.

My hematologist explained my diagnosis to me. My blood clots were “provoked” meaning something triggered them. In my case, it was the delivery of my baby. What I experienced was unusual for someone in my circumstances. Blood clots are usually brought on by certain conditions. Pregnant and postpartum women are at the highest risk. Beyond that, there are other risk factors as well: surgery, hormonal birth control, pregnancy after 35, COVID vaccines and illness complications, obesity, smoking, C-Sections, family history, and gene mutations are all known to be associated with blood clots. C-Section deliveries have the highest likelihood of causing a blood clot, and even then they are uncommon, occurring 1 in every 1000 women or a 0.1% chance.

On paper, I was at the lowest risk for a blood clot. I met none of the criteria except a recent vaginal delivery. Of all the people this could have happened to, I was the last person anyone would have expected. Blood clots of this nature are rarely discovered where mine was. In most cases, they are in the legs or lungs. We have no way of knowing where my clot began. There were no clots found in my legs.

During my hospital stay, I remained on nausea medication so that I could continue to eat. My doctors told me that nausea and fever were my body’s way of telling me that something was wrong. Everything would subside in a few weeks as the blood clot resolved.

Discharge

After 2 days in the hospital, my doctors told me I was ready for discharge. This notion scared me, as I felt safe and protected from my own body when I was in their care. They would know before I did if something was wrong and could address it right away. I liked being on the heart monitor for that reason. They would be the first to know if my heart stopped. I was afraid that my blood clot would continue to break apart and travel again. I voiced this concern to my hematologist. She jokingly assured me “Well, not to sound morbid but the clot already ‘got’ you. It can’t hurt you now.” She was referring to the PE.

Before we left we would be taught how to administer blood thinners via an injection. If I wanted to continue breastfeeding, I would have to receive my blood thinners this way. At the last minute, I decided that I would prefer to take an oral blood thinner. Injecting myself twice a day with the likelihood of needing Michael’s help felt like too much to deal with. I had already been through enough and did not want to add to it.

Being unable to breastfeed was upsetting. I wanted to do it right this time since I struggled so much the first time around. I knew I could do better this time. This was one of the first of many sacrifices I would have to make from this blood clot.

When I got home, I remember sitting on the couch with my boys, together again at last. We watched “Finding Nemo” and I cried during the credits. I was thankful that I was alive to do something as simple and routine as watching a movie with my children. The music in the credits made me want to dance with my sons and I was so glad I would be around to dance with them in the future. From dancing in our living room to dancing with them even on their wedding days, I wanted to be around for all of it. This close shave with death made me appreciate being able to do those things even more.

Life after a Blood Clot

Today, 11 months later, I am healthy but I will be high-risk for blood clots for the rest of my life. I take an oral anticoagulant, or blood thinner. My Hematologist decided I will take them indefinitely due to the severity and unusualness of my circumstances. Blood thinners stop the formation of future clots so that the body can resolve existing clots on its own. They do not actually “thin” blood consistency. They are not “clot busters”. Side effects of blood thinners are minimal, causing more frequent bruising, bleeding longer if I am cut, and heavier periods. I need to be aware of the possibility of internal bleeding and brain bleeds in the event of serious trauma like falls or car accidents. Special steps must be taken prior to undergoing certain medical procedures. Any future pregnancies will be high-risk pregnancies. I will have to switch to injectable blood thinners if I ever get pregnant again. I am unable to take Ibuprofen or other NSAIDs as they interfere with my blood thinners. Otherwise, I live a normal life.

In some cases, blood clots may never go away and form into scar tissue. Instead, the body will form a new vein to go around the blockage. On the anniversary of my clot, I have scheduled an ultrasound to verify if this is the case with my clot.

I have spent a lot of time over the last year trying to wrap my head around this experience. Many people, including health care professionals, say that it is a miracle that I am here today. Those early days were terrifying. I was afraid of being alone. Afraid of falling asleep for fear that I would not wake up. My doctor assured me that my clot would not travel now that I was being treated, but the fear still weighed heavy on me. The thought always sits in the back of my mind. I wonder if going through induction had led to my experience as well. My hematologist has assured me that it is unlikely, yet that thought still hovers over me.

I have tried to dedicate some of my social media presence to blood clot awareness. Pregnant and postpartum women are in the highest risk group for blood clots yet it’s not talked about as much as it should be. I recall it being an afterthought in some of my pregnancy appointments. I would love to see that change in the coming years. If nothing else, I would at least want my story heard in the hopes that it helps someone else. 

900,000 people in the U.S. each year are diagnosed with blood clots. Up to 100,000 people die from a blood clot in the U.S. each year. I urge anyone who thinks they or someone they know is at high risk of blood clots to explore the many resources available. I recommend starting with Stop the Clot – https://www.stoptheclot.org/.


About me

My name is Lindsay. I live in a small town about 45 minutes outside of Philly with my husband Michael of 5 years, our 2 sons Lucas (4 years) and Logan (11 months), and our dog Panda. I work full time as an Underwriter. I have recently gotten back into horseback riding after taking 2 years off during my pregnancy and blood clot recovery. I enjoy going camping and down the shore. I’ve recently found a love for gardening & houseplants. I am also an avid reader and have challenged myself to read 24 books in 2022. I take every moment I can and take my sons on adventures and excursions – seeing them smile makes me smile.

 

The Birth Trauma Mama

The Birth Trauma Mama

Samantha’s Story: Two traumatic C-Sections, Uterine Rupture, & My Favorite Green Sweater

by | Jan 10, 2022 | Uncategorized

It’s Supposed to Be the Best Day?

My favorite green sweater is sitting, hung up in the front of my closet. It is the sweater that I wore when I went to the hospital the day I went into labor with my second daughter. Now, it is also the sweater that I wore when I went to the hospital to have a baby and almost didn’t come back home. I haven’t been able to wear it since so it just sits there, hung up. When I think about what happened on that day, I have a hard time remembering it all. I have a constant tugging or need to try and make sense of it or understand it. Sometimes I go through our family group chat, looking at the timestamps on the messages my husband sent when he would give an update because I know he was sending whatever the nurse told him as soon as he could. I look over my lab information because I was being monitored so closely I can see all my levels and results going up and down. I can see when things got really bad. I go through my husband’s photos of our baby girl because I don’t have any of the first 10 hours of her life. I wasn’t there for it. I have to read her medical notes to get a real picture of what she went through because I still don’t think I’ve processed it all. A lot of people say that the day your children are born is the best day of your life, or it’s supposed to be. I’m still trying to figure out why I don’t have that feeling and how to be okay with that.

Baby Girl Number One

When my first daughter was born back in 2018, I felt like my body failed me. My pregnancy went well and I was referred to the low-risk clinic. At around 36 weeks I started measuring big so at 37 weeks they sent me for an ultrasound and my baby girl was rather large!  In order to get things moving along so that she wouldn’t get too much bigger, my doctor did a cervical sweep and a few days later, my water broke. I had taken prenatal classes, read all the books and I knew that I wanted to try my best to have the least amount of interventions possible, while also being open to whatever I needed to do. When we arrived at the hospital, the doctors advised me that since labor didn’t start and my water had broken, the best course of action was to induce me. Induction led to needing an epidural, the epidural led to not being able to move around, not being able to move around led to my baby girl deciding “Eff this- I’m not ready to come out!” and her turning “sunny side up” right when I was about to start pushing. They had to call an OB in to assess the situation and I could tell things were not going to go as I had hoped. She got me to push (though looking back I think she knew it wouldn’t do anything and just wanted to let me try-which I am so grateful for), and I PUSHED. I have never tried so hard for something ever! My baby girl didn’t budge an inch and with each push, her heart rate was going all over the place. The OB said we needed to go for a C-Section. I was so upset. I am such a planner and I tried so hard my whole pregnancy to just go with the flow-the only thing I didn’t want was a C-Section. So off we went. Down the elevator, my husband in some scrubs, me just pissed off, terrified and upset.

On the way down to the OR I felt like I was outside of my body watching what was happening. I was so afraid when I found out we had to go for a C-Section that I think I just shut down. Once we were in the room I remember feeling cold and hearing music playing. My husband appeared by my side and things felt like they happened TO us. I didn’t even know they had started. I just felt this immense pressure relief and there she was, above the curtain. They showed her to me and then took her over to the NICU team to be assessed. She wasn’t crying yet and she was a little sleepy. Then, a few minutes later she was good to go and they laid her on my chest. I couldn’t feel her and I was shaking uncontrollably from all the meds. I couldn’t really hold her yet because my body was so numb. That was so hard. I really wanted that moment of meeting her to be so special and it was a mess. I was so out of it I barely remember. I look at pictures and I can sort of recall what happened, I just remember feeling so angry that I wasn’t able to have that “moment” that we all think we should be having. No skin to skin. No latching right away. No picture of the three of us in the bed, smiling. 

We had to stay longer at the hospital which was not great. She wasn’t eating properly and her blood sugars were off so we had to give her formula on a schedule which was hard. I wanted to try to nurse her and it just wouldn’t work. We came home and I can’t even explain the shock to the system. I was so sick from all the pain meds and different things I had been given that I kept throwing up. I even went back to the hospital because I couldn’t figure out what was wrong. They assured me it was just from all the meds and it would pass. I remember crying on the couch telling my husband that I didn’t think I could ever do this again and I was sorry. He told me that if we just had one baby then that was okay. I felt terrible. She felt like a stranger. It was like someone gave us a random baby and we just had to bring it home. I cried a lot and over the next few weeks, things got a lot better. I healed, she started to latch and we got to know each other. We figured it all out and she and I became best pals. After a couple of years, my husband and I decided we were ready to try and have another baby. 

Baby Girl Number Two

When I got pregnant with my second daughter, I was referred to the high-risk clinic because of my previous C-Section. I was lucky enough to have the same OB who delivered my first baby as well as her colleague who were both wonderful. They were so supportive as I was really hoping to have a VBAC (vaginal birth after cesarean). I didn’t want the same thing to happen with this pregnancy as my first and I really wanted to do what I could to help this labor and delivery be more on my terms. They assured me that I waited long enough between pregnancies and that a VBAC was an option. They told me that if I was measuring on track, went into labor on my own, and before my due date that I was a great candidate for a VBAC. So at 37 weeks, we had an ultrasound and the baby was measuring perfectly. Step one: check. A couple of weeks later on a Thursday I began to have contractions and went into labor on my own, before my due date. Step two and three: check. 

That night I tucked my other daughter into bed and sang her a song, gave my dad a hug since my parents were staying over to be with my oldest, and around midnight, my husband and I went to the hospital. Around 7:00 AM after a long night of labor, walking around, pain, crying, we were given our room, an amazing nurse who was going to be with us for the day and I asked for an epidural. We were able to get a couple of hours of sleep and everything was going great. I felt so much better this time about everything. Around 11:00 AM I was fully dilated and getting ready to push. We were waiting for the OB who was on that day to come and break my water. She was busy with another pregnancy so we just waited. That was when I started to feel a bit uneasy. The timing of all of this was so similar to my first labor and delivery. The nurse asked me when the last time I ate was and I knew that was to prepare for a C-Section. I figured I was just overthinking it because I was nervous and tried to stay positive. Right before the OB could get to us, my little girl decided she didn’t want to wait and my water broke on its own. Then things started to spiral out of control. 

The OB, Dr. K, who was on the unit that day came in and we started to push. She was amazing. So supportive and really kept me in the loop with everything she was doing and what was happening. While I was pushing I remember feeling that this was totally different from my first labor when I tried to push. This time I felt ready. I could tell that my baby was ready too. I was so sure this would work. Dr. K did a check and I knew from her reaction something wasn’t right. She explained that the baby was in the wrong position, sunny side up, again. The difference this time was that she was far enough down that Dr. K  said there was still a good chance I could push her out if I wanted to try. So I did. With everything I had. I was so close. So, so close. Then everything started happening very fast. The baby’s heart rate dropped. Not like my first pregnancy, this time it was quick and sudden. She was in distress. I remember all the lights on in the room and a lot of staff around. Dr. K looked at me and told me that we needed to move quickly and if I wanted, I could try pushing one more time.

I still don’t know how or why I did this, it was like my mouth said it before my brain could think. I just told her to forget it, let’s go for the C-Section. After that, things shifted and there was a feeling of urgency in the room. When we were heading down to the OR I asked the doctor to please let me see her when she was born. I told her with my first they just took her and I really felt like I missed something. She reassured me and things got started. When we got downstairs I was introduced to the anesthesiologist- it was the same anesthesiologist, Dr. M, that I had with my first. I told her I remembered her from last time and was relieved to see her again. In what felt like a minute they were testing whether or not I could feel things. I still could. It didn’t hurt or anything -I could just tell they were working. Both doctors told me that I needed to be sure because if I could feel pain, they were going to knock me out. I was okay. This wasn’t the same as with my first C-Section. They needed to start and they needed to start right away. My husband appeared at some point and my baby girl was born. Things were happening so fast that they were only able to give me a glimpse of her as she was rushed over to the NICU team. All I saw was her fuzzy little head fly by me on my right and then blue scrubs surrounded her. I told my husband to go over and check on her.

The Trauma Continues

The doctor was closing me up and noticed I just kept bleeding. She had to open things back up and that was when she discovered that I had a uterine rupture. When I was going to all my prenatal appointments and talking about a VBAC I was told that the chances of this happening were 1 in 200. When I talked with her afterward she explained that not only did I have a uterine rupture, it happened on the back of my uterus right where the uterine artery was which was why I was losing so much blood. She told me it was “like a faucet” and that when she discovered the tear she grabbed onto it to stop the bleeding. She held on and paged for her partner, another OB, to come and help. She held on, waiting, not letting go for 11 minutes. The other doctor drove there in 11 minutes and rushed in to help. During the next few hours, a lot happened and I am so grateful that I was able to communicate with my doctors. Dr. K told me she might have to remove an ovary and tube and was going to try and save the uterus. Then as she was working and they discovered where the tear was and she explained that she would be able to leave the ovaries and tubes, she was going to have to remove the uterus. I said it was okay and that she could do whatever she needed to do.

At this point, the anesthesiologist, with the help of her respiratory therapist, had been monitoring me so carefully. I had so many IVs and so many people constantly checking numbers. I had been awake this whole time because I kept thinking it was almost over and I didn’t want to miss seeing my baby as soon as I could. I lost three and a half liters of blood and needed two blood transfusions, they had a third one ready just in case. When they were almost done and closing up, they had to go back in and check because their sponge count was off. I had been awake and in the OR for four hours now and I was just so tired and things were starting to get really uncomfortable. I could feel things. I kept asking the nurses and the other doctors if they were almost done because I didn’t know how much longer I could do it. The OB and the anesthesiologist both suggested that they put me under and let me rest while they finished up. They assured me it would be okay and two hours later I woke up in recovery.

I got to see my husband and get an update on our baby, who was still in the NICU. She was okay. She was on the CPAP machine and being monitored closely. She had fluid in her lungs (from all the blood) and needed some help clearing it out. In the pictures we have, I can see she had a little feeding tube and a lot of other things monitoring her. They are hard to look at. My husband had been getting some updates throughout because I kept asking our amazing nurse to keep him informed and he was keeping our family in the loop as best he could. We called our parents to tell them we were okay and just hugged each other for a while.

The anesthesiologist, Dr. M, came to see me and told me that she was on the fence about sending me to the ICU. She told me that I was very sick and that they would be better at monitoring me there. I was so afraid because this was happening in the height of the pandemic and the last place I wanted to be was in the ICU. We waited in recovery for a couple of hours and my labs came back better. I was getting better. I have no idea how or why. I just was and we were able to go back to our room. On the way there they took us to the NICU so I could finally meet our little girl. I was finally able to hold her and see her after over 10 hours.

She had to stay in the NICU for two nights and was discharged. I had to have a lot of tests, an iron infusion and somehow was also discharged. I was in shock that after all that I could just go home. During the two days at the hospital, all of my doctors came to visit me and check in. Two of them came in on their day off just to see if I was okay and to answer any questions. Dr. K told me that she met up with my prenatal OB and they went for a long walk to talk about what happened and to debrief. My husband and I began to realize that what happened was not normal or something any of them had really dealt with. The weight of what happened was finally sinking in. 

Not once during the whole ordeal did I feel unsafe or like I was in danger. The entire medical team made sure they were calm and kept me informed. I knew there were moments of urgency and I knew that something bad had happened, I just always felt like they had it under control. When talking to them all after, my husband and I realized things were not as calm as they made it seem and it could have been a lot worse. That is when the guilt set it. What was I thinking? How selfish was I for trying to have VBAC? I put my life and my baby’s life at risk all for a stupid “feeling” I thought I needed? What about my husband and my amazing toddler at home? How could I? Our families were so worried because I couldn’t just schedule a C-Section? I also felt so terrible about not being able to be there for my baby. All the NICU nurses and doctors were taking great care of her and my husband was with her, I just felt like I should have been there. I felt just sick about it all. Like it was all my fault.

When I spoke to my doctor about this after she told me that I did everything right. I was a perfect candidate for a VBAC and that what happened was so rare that it would have been impossible to predict. She told me that if the baby’s heart rate had not dropped she was sure I would have been able to push her out. She also said some sort of mother’s intuition kicked in for both of us that day because if I had not gone for the C-Section when I did, the situation could have been much worse.

Healing

We came home and I cried and hugged my other little girl with all my might. Our new baby rocked her first week home and even gained weight. Since then we have had a lot of checkups and a lot of healing. The first few weeks home I struggled with being left alone and I really had a hard time. I couldn’t send or post pictures announcing the birth because I was just so shocked by it all I couldn’t just pretend things were fine. A lot of people kept saying things like “Well, you are all okay and that’s what matters” or “Well, you weren’t planning to have any more kids, so it’s okay that you had a hysterectomy”. I know that people are trying to help. It doesn’t make me feel any better about it all. I get nervous when I talk to people who don’t know the whole story and hold my breath, waiting for them to ask me about the birth or if we are having any more kids. I don’t know how to answer them. I was able to read through our daughter’s medical notes from her delivery and it is hard to do. For the first 10 minutes of her life, she was in real distress. It’s heartbreaking to read. I’ve been working through all of it in therapy and am so lucky to have a strong support system of friends and family around me. These last few months both my daughter and I have had so many checkups and follow-ups. We are so lucky to have such an amazing medical team looking after us. 

I know that mentally, I still have some healing to do and I am working on that. Each step in this process is part of that healing and sharing this story is something that I am hopeful will help others feel less alone. Most days, I can sit and enjoy watching my girls play or my husband making them dinner and not even think about what happened. I also know that when I do think about it or it’s still upsetting, that is okay too. I know that I am lucky and I love our girls and my husband so much. Slowly, as a family, we are trying to move forward, and hopefully, one day, I will wear my favorite sweater again.

A Bit About Me

Hi! I’m Sam! I am a Drama teacher from Canada! I like playing sports, theatre, and snacks. Thanks for listening and reading my story :). 

Ebony’s Story: Severe Preeclampsia, HELLP, Micro Preemie, and Trauma Turned Advocacy

Ebony’s Story: Severe Preeclampsia, HELLP, Micro Preemie, and Trauma Turned Advocacy

by | Nov 28, 2021 | Uncategorized

My name is Ebony Ford, and at 26 weeks pregnant, I was diagnosed with severe preeclampsia & HELLP syndrome. 

Reigning Over It

After 5 years of infertility & 3 losses, my husband & I were elated to find out that we were pregnant again in October of 2017. My pregnancy was uneventful but due to my history, I needed to see a high-risk obstetrician. At 25 weeks, I developed a bit of swelling in my feet and made a note to tell my doctor at my appt. But I arrived at the appointment to find that my doctor had an emergency and I would be seeing a partner. My blood pressure seemed fine so the doctor told me not to worry and to go on the trip we had planned that week. Despite my doctor’s orders, he decided that I didn’t need to do my usual lab work due to the results always being normal. A few days later, my husband & I traveled to Las Vegas and I felt great. But on my second day there I began to experience severe swelling in my extremities, shortness of breath, and lightheadedness. I reached out to my doctor and she advised that I return home immediately and report to Labor & Delivery. I boarded the plane and fell asleep. I woke up as we were landing and realized that my vision was gray, my feet no longer fit into my shoes and I had a very hard time catching my breath. I was wheeled from the plane to the pickup lane and we proceeded to the hospital.

Reigning Through It

When I arrived at Labor & Delivery, I was told that since I wasn’t in labor and my concerns weren’t necessarily “pregnancy-related” that I should go to the emergency room. After 15 minutes, and not having my vitals taken, I was eventually wheeled to the triage area in the ER. The triage nurse put the blood pressure cuff on my arm and when it was done reading her eyes got wide as she asked to put the cuff on my other arm and the machine read 246/154. She explained, while pressing a button on the wall, that she was calling a brain attack (stroke protocols) and things would go really fast from here. And she wasn’t kidding! Staff ran out almost immediately, lifted me onto a gurney and rushed me into the back. Almost immediately the doctors told me they were sure I had preeclampsia or a blood clot in my lung but would wait for my results to come back. Within 30 minutes the doctors told me that they found a ton of protein in my urine indicating preeclampsia and my chest x-ray showed severe pulmonary edema which explained my being out of breath. A doctor from Labor & Delivery came down to explain to me that because I was diagnosed with preeclampsia, they could keep me pregnant until 32 weeks but I would have to stay in the hospital until delivery. I wasn’t thrilled about that but I knew it was what was best for my baby. My husband began to make calls to share with our family what was happening when doctors came back in sharing that they just received my outstanding lab work which indicated that I was in complete kidney and liver failure. They then shared that I had something called HELLP Syndrome and would need to deliver IMMEDIATELY! I began to cry and panic as they worked to get an additional IV in order to push magnesium and additional blood pressure medications. My pregnancy had been totally uneventful up to that point, so to suddenly hear the words, “We have to deliver your baby right now via c-section” was completely unreal to me. How could I have to deliver my baby at just 26 weeks? What would a 26-week-old baby look like? WOULD SHE SURVIVE? These were all the questions that flooded my mind as they rushed me up to labor and delivery.

As my husband called our parents and those closest repeatedly sharing the awful news that we were about to deliver, a neonatal intensive care unit (NICU) doctor appeared and started sharing what we could expect from a baby born at 26 weeks. There was so much chaos in the room as the team of doctors, nurses, respiratory techs and more were preparing me for the c-section so I only remember hearing certain key phrases like respiratory failure, intubation, blindness, cerebral palsy, hearing loss, feeding difficulty and probable brain bleeds all describing what could affect my unborn baby. Before I could ask any questions, the monitors started going off indicating that my blood pressure and heart rate were elevating. One of the nurses put an oxygen mask on my face, encouraged me to take deep breaths and kept telling me to relax. The NICU doctor promised to come talk to me after the c-section and let me know how my baby was doing. While processing all of this, another team of doctors from the ICU came to talk to me about my condition. Because my health was rapidly deteriorating, they felt it was best to put me under general anesthesia for the c-section and then intubate me to allow my lungs to rest. They said that if my lungs and kidneys didn’t respond to delivery ad treatment that I may need to go on life support. But they were sure that wouldn’t be the case. A few moments later I was whisked away to the OR. I remember thinking the entire way to the OR that I may not survive this. It was a feeling of impending doom that I had never experienced and haven’t since. I remember praying aloud (and not caring who heard me) and asking God to please not make my husband a widower and a single father in the same day. And as they lifted me onto the table, I was asked to lay flat and I panicked because I felt like I was drowning. I began to hyperventilate and kept saying “I can’t breathe! I can’t breathe like this!” That was the very last thing I remember…

And She Shall Reign

On March 25, 2018 at 6:53 pm I gave birth to my dream, my fighter, my heartbeat, Reign Victoria. She came into the world crying and alert weighing 1lb 15 oz. And while she was stabilized to be transported to the NICU, doctors attempted to reduce sedation and take me off of the vent. But my condition deteriorated and a chest x-ray showed worsening pulmonary edema. I was given a dialysis port in the OR and then taken to the ICU where I spent the next 26 hours on life support, undergoing dialysis, magnesium transfusions, and was typed for a liver transplant due to my elevating liver enzymes. Simultaneously my daughter experienced a collapsed lung requiring a chest tube and a transfer to the ventilator. After 26 hours my condition began to improve and the sedation was lifted. My blood pressure continued to spike but I was able to be transferred to Labor & Delivery and shortly after meet my daughter for the first time. Though in a lot of pain, feverish from the magnesium and seeing spots, I was determined to sit with my baby girl as long as possible. And for the next 79 days, as she battled jaundice, severe anemia, lung collapses, and bronchopulmonary dysplasia, I faced readmissions for blood pressure, kidney and liver issues. And though she was released home seemingly healthy on day 80, I continued to battle the effects of my traumatic birth mentally, emotionally, and especially physically.

In the months and years to come, prematurity reared its head and dealt us some devastating blows in the form of 4 bouts of RSV, Croup, Bronchopulmonary Dysplasia, hypoxia, severe expressive speech delay, global developmental delays, and pulmonary fibromatosis requiring 3 rounds of radiation and an impending surgery. Our journey birthed a passion for advocacy so I have dedicated my life to mentoring NICU parents and those who are medically fragile. I founded a non-profit organization and diversity inclusion firm called Miracle Mamas that provides guidance to hospitals & organizations seeking to make an impact in the maternal health crisis, provide mentoring and resources to individuals impacted by prematurity, birth injuries, disabilities, and traumatic births to ensure that their physical, developmental, social and emotional needs are exceeded. We host weekly support gatherings on the Clubhouse app for mothers of premature, medically fragile, and disabled children. We are currently hosting a fundraiser to take self-care bags to NICU families as well as dinner to the NICU staff on Thanksgiving Day. Please consider donating to help us make a greater impact by clicking here (hyperlink: https://www.paypal.com/pools/c/8EiqFZiBiV )

Author Bio:

Ebony Ford is a 34-year-old Washington DC native. She is the proud wife of Ryan Vincent Ford, musician and gospel recording artist, and mother to her pride and joy, her daughter Reign Victoria. Ebony received her Bachelor’s Degree in Psychology and Certificate in Pastoral Counseling from Liberty University and is currently pursuing her Master’s degree in Forensic Psychology. She hopes that her education and personal experience will allow her to open her own practice and specialize in near-death experiences, more specifically birth trauma. Her traumatic, near-death birth story and her daughter’s NICU journey birthed a passion for advocacy and mentoring. In February 2021, Ebony founded Miracle Mamas, a support group for mothers of the premature, medically fragile, and disabled that meets on Clubhouse and hosts monthly gatherings. In August of 2021, Ebony founded Miracle Mamas LLC, a diversity and inclusion firm that provides consultations to organizations looking to aid in the maternal health crisis and provides resources to families of the premature, medically fragile, and disabled to ensure that their physical, socio-economic and emotional needs are met. Both Ebony and her daughter also serve as Ambassadors for March of Dimes and find great joy in sharing their story and serving the population most affected by prematurity. They most recently contributed to March of Dimes’ national campaign “It’s Not Fine” and appear in both the commercials, digital ads on various websites and social media as well as the print ads in multiple magazines.

Sarah’s Story: Birth Trauma x2, Preterm Birth, Postpartum Preeclampsia, and Stroke

by | Nov 14, 2021 | Uncategorized

First Pregnancy

Throughout my first pregnancy I was the model patient for my provider, overweight yes, but otherwise without complication, until of course I wasn’t. To this day I wish I had realized what labor and pre-term labor was and I wonder IF only I had gone in sooner.

Food Poisoning?

It all started on a Sunday, July 15, 2018, while my husband worked on the room that would be the nursery. He still had 10 weeks before it needed to be done, although I’d hoped we would be further along in the process- there were still no walls. I had been plagued by nausea and terrible swelling the whole pregnancy, started wearing my husbands shoes at 10 weeks, so when I was nauseous and had a sore back I didn’t think anything of it. I spent the day napping and coloring in bed. My husband got me up for a bike ride with promise of ice cream. Thankfully he ended up with a blister when we were only a quarter of the way into our 12 mile bike ride and we turned back. Getting off my bike I felt a stab of pain in my belly but it went away as quickly as it came so I brushed it off and we drove to go get our custard. I didn’t really stop to think about my discomfort until we were going to bed around 10pm. I tossed and turned for about an hour before deciding it must be our mattress causing my discomfort, back pain. We moved to the other bed and I continued to toss and turn until I felt cramping like I had food poisoning and was going to puke or poop my brains out, which I did for the next two hours pacing through hall between events. Finally at 2 am the pain was unbearable and I had noticed that I lost my mucus plug during my multiple trips to the bathroom (not that I knew what that was at the time) so we called the on-call OB who agreed with my assessment that it didn’t sound like labor but to come in to get checked.

We’re having a baby!

We arrived at 2:30am. We were brought up to the L&D triage room to be assessed. The OB was pretty sure I had a kidney stone or bladder infection. They set me up on the monitors, found baby’s heartbeat but had difficulty keeping him on the monitor because he was low. Meanwhile, no contractions were registering and I was in constant pain, not waves. The OB asked to check for pre-term labor “a simple swab test, just to be safe” but he quickly decided that was not what needed to happen and was frankly a bit flustered. After a quick back and forth with the nurse he said “nope I’m just going to measure her” to which I jumped in with “ we already know the baby is measuring big and my mom was fully effaced and 3 cm dilated the last two months with me, so I wouldn’t be surprised if I’m partially dilated”. He looked up and said to me “no you’re fully dilated”. It was 2:55am.

The next thing I knew the tiny triage room was stormed by every L&D nurse free at the time to start IVs, get magnesium and antibiotics (no one checked my allergies), steroid injections, etc. in as fast as possible. All while the doctor looked at me and repeated “Don’t push!”. The NICU nurse arrived quickly with the isolate, but nothing was set up because no one had warned the NICU until they discovered I was fully dilated. Meanwhile, I was made to lay down something I hadn’t done since midnight and that’s when I finally felt the contractions right on top of each other but in distinct waves and the whole while I keep hearing the doctor say “don’t push” to me and “are you ready yet?” to the NICU team. There was a lot of conversation back and forth as the doctor still couldn’t tell when I was having contractions but I focused on not doing the one thing my body so wanted me to do, push.

Finally at 3:45 the NICU team was ready and introduced themselves, the RT was my sister-in-law’s mom Susan, so I said “Hi Susan! It’s Sarah” because that’s the polite thing to do right? With permission to push I did and it was in no way relieving. My water broke mid push and showered the doctor and the triage room floor to ceiling such that the curtain was dripping when we were alone after the delivery. After 3 contractions at 4am we found out we had a son, we hadn’t know the sex before that. I saw part of him for 10 seconds and only really remember the Dr. commenting “easily a 14-pound baby at term” (I still feel guilty for the minor blessings of not delivering such a large boy at term) before he was whisked away and just as quickly as everyone had arrived they were gone. Those, what were likely only minutes, felt like hours as my husband and I sat in shock that we had a son and worrying that he may not survive. I don’t remember this but the worst part for my husband was when the Neonatologist walked in saying “I’m sorry…” something about how it took longer for him to come talk to us than he wanted. 

About 3 hours after he was born I finally got to see my son. He was small and covered in tubes and wires, on a ventilator. Everyone complemented me on how well I handled it all, but then I’m usually the rock and the strong one for everyone else so that’s what came naturally to me. While inside I screamed every time someone congratulated me, I couldn’t understand why we were celebrating my failure and his tentative hold on the world.

First Time Meeting Micah

NICU Stay

We had a relatively short NICU stay, 40 days, but leaving the hospital after 3 days and still never having held him was soul-crushing. Having to induce lactation (I never was very successful), feeling guilty and pressured to provide the only thing he could have initially, and navigating the postpartum period I never learned about because we didn’t get to go to our class and I hadn’t gotten that far in my pregnancy book, was so hard. Seeing him intubated, hearing he had an infection, hearing he had a brain bleed, was frightening, but worse was seeing other babies and feeling guilty that he was doing better than some, while jealous of other moms who got to hold or feed their babies or even go home with them. I’m still sorry for the thoughts I had about the full term mom whose son was large, I was so mad at how she panicked when the alarms were going off because her son was mad and hungry and she wasn’t on time to feed him, meanwhile she was bookended by a mom with a kid on a ventilator and a mom with a kid on an oscillator who knew which alarms to pay attention to by that point. Regardless, even a short NICU stay is traumatic and I know how awful it is to be in a room on the L&D floor hearing other moms with their babies – I’m so sorry to that mom and others, like the pregnant woman in the hall or the friend who didn’t have a NICU baby. I don’t wish my experience on anyone but I did at the time and do wish it never happened to me.

I spent approximately 12 to 16 hours a day (6 am to 10 pm) in the NICU with mine and 5 other babies in our little bay. There were a few nurses in the NICU who supported me and cared not just for the babies in their care but the parents too. One (Craig, dad to 3 NICU grads himself) even pulled my husband aside and told him to keep me away from the NICU even if only for an hour. He saw the writing on the wall that I was headed for a major breakdown.

Coming Home

Coming home was also difficult; not going back to work and staying home 24/7 because he was medically fragile, losing the support of people who had become family during our stay. All the appointments, we had home nurse visits, weight checks, ROP appointments, and more. I even had a county health nurse shame me for not breastfeeding him, meanwhile, I was lucky to produce enough milk for one of his 10 bottles a day. It was overwhelming and lonely. Most people thought that once he was home everything was fine and he was a normal baby. I felt so alone. It took me until he was nearly 6 months old before I started to put the pieces back together and bond with him in a way that was not just focused around fear. Even now, I wonder if I hadn’t been made to feel like the pain was in my head or that I wasn’t really sick in the past, I might have gone to the doctor sooner. But, then I think that if I’d gone sooner they probably would have sent me home and missed the pre-term labor anyway.

Today he is happy and healthy even with lingering respiratory issues and, like any 3 year old, refuses to sleep. Even so, he is and always will be my Mighty Micah.

Second Pregnancy 

Following my experience with Micah I was nervous to have another child because we had no (and still don’t) explanation for why he arrived 10 weeks early.

As an aside, I’ve found writing my story with Ezra more difficult, maybe because it’s fresher, or maybe because it wasn’t his life but my own that was on the line.

We found out we were expecting again when Micah was about one and a half (Thanksgiving 2019). This time I was determined to know as much as I could about what to expect in terms of complications and how we were going to try and get me to term. I never considered that complications might arise during my postpartum period.

I had ultrasounds at 8 and 9 weeks and then every other week from 12 to 24 weeks then weekly starting at 28 weeks. I took weekly progesterone to make my uterus “a happy home” from 16 through 36 weeks. I was at a higher risk (20%) for preeclampsia due to my white coat syndrome (is it surprising that I have anxiety with/around doctors/medicine?) so I had to monitor my BP 2x a day and take baby aspirin. My first appointment with the MFM I had a BP of 120/100 and he nearly put me on BP meds then and there.

COVID

When March 2020 came along I was at 20 weeks and stressed by the constantly changing protocols and not knowing how care would continue if I were to get COVID or just be symptomatic. My appointments couldn’t just go virtual and I was worried that any change in my care plan would result in a second preterm birth.

Because of COVID and the new protocols, I ended up going 25 weeks never seeing my own OB (who did by chance get to deliver Ezra) and not knowing who I would see until I arrived at my appointments. The OB I saw at 21 weeks decided I didn’t need to see an OB until 28 weeks when I would have my glucose challenge, but I was already seeing the MFM doctor at 22, and 24 weeks so I didn’t worry too much about it.

Gestational Diabetes 

At 28 weeks I ended up failing the 1 hour challenge and subsequent 3 hr test. I was officially diagnosed with GDM (increasing my risk for preeclampsia among other things). The next 10 weeks I worked to control my blood glucose with diet and exercise. I had to walk for an hour after every meal to have an acceptable blood glucose while on a low carb high protein diet, hungry ALL the time especially for brownies and ice cream. Regardless, I ended up needing insulin over night and it seemed like every week the dose was increased. Nothing I did made a difference. It was hard when the only thing I could try to control was uncontrollable.

Once I reached viability I started to break down the rest of my pregnancy into little goals to be pregnant just one hour more than I was with my first. Then to reach 32 weeks pregnant and avoid our hospital’s “small baby protocol”. Followed by making it to 35 weeks and avoiding automatic NICU admission at our hospital. Then term at 37 and then to hit 40, something I’d originally thought would be impossible.

Induction: Labor & Delivery

Because of my risk for preeclampsia and the diabetes it was recommended I be induced at 39 weeks. We gave our son every opportunity to come before his eviction date but he wasn’t interested in leaving on his own so I was scheduled to be induced at 39 weeks 5 days. When I was admitted I was 3 cm dilated and he was at -3 station. Induction was delayed a bit so I could get some insulin: I ate before arriving at the hospital since I knew I wouldn’t be eating after.

Even on Pitocin (started at 9am) and with my water artificially broken (at 11am) labor felt like nothing or maybe a period, but my blood pressure and blood sugar were all over the place throughout labor. While I didn’t have to have magnesium they did put seizure pads on the bed rails just to be safe. Around 2 pm I went through transition (food poisoning feeling again for me). And by 4 pm after 3 contractions I delivered Ezra. I got to hold him and neither of us had any complications other than high bili, due to being Coombs positive, for Ezra. It was an answer to prayer that I could hold him after birth, room in with him, and go home with him. The stress of COVID, not knowing if I would suddenly go into labor, and controlling my GDM paled in comparison to getting what I so desired for my time in the hospital.

Postpartum Preeclampsia & Stroke

You’d think my story ends there with a relatively un-traumatic pregnancy, labor, and delivery; however, the discharge instructions are actually important when you go home from the hospital.

Five days postpartum (3 days at home) as I was making breakfast and going up stairs to change Ezra’s diaper I lost vision in my right eye. I’m used to ocular migraines and thought that I must just be having a severe one, because again I’ve been trained to write off every symptom as insignificant or in my head. I went outside to pick some tomatoes and while bent down lost feeling in my right hand and right half of my face. I panicked a bit but didn’t want to do anything about it. Meanwhile, my husband checked for other stroke symptoms and I didn’t have any. I decided to take my blood pressure just because, and it’s was 160/90. High but I wrote it off as me being anxious about the loss of vision and feeling. I still sent an email to my doctor because my husband was worried.

The doctor called later that afternoon and asked me to check my BP, it was 200/90 and 180/90 (I double checked because I didn’t believe the first reading). I was advised to head to urgent care or the emergency room to get checked out. I left fully believing I would be home in a few hours, in time for dinner or at the latest bed time. I went to the hospital and the ER/urgent care was busy so I sat and waited for my turn through triage. I was happy to wait because waiting meant it wasn’t a big deal and I was fine. After about 45 min I got called back and my blood pressure was 220/115. I spent no more than 15 min in the ER before being admitted to L&D. When I got to my room right by the nurses station and next to the triage room I’d delivered my first son in, I got in another bed with seizure pads already on the rails. I guess the long ER wait didn’t correlate to being ok.

I was in denial that I wasn’t going home to my boys so much so that I refused to take my shoes off. I wasn’t able to eat since they were concerned I was dangerously close to full-blown eclampsia. I had 5 min head-to-toe checks for two hours, then once my BP was “under control” at 160/90 it was reduced to every 15 min for 5 hours. The next morning my blood pressure spiked again. It was terrifying knowing I’d already had a TIA/mini-stroke. I was also unable to talk to my family. I didn’t bring a phone charger and my phone died shortly after being admitted.

Thankfully my nurse was amazing and helped store my expressed breast milk so my husband could come pick it up to feed Ezra. When he arrived with Ezra in tow all the nurses looked the other way because they said it was cruel and unusual punishment to keep a newborn from his mother “screw the visitor policy”. My nurse advocated for me to get me out of the hospital as soon as my 24-hr magnesium drip finished, instead of the more extended stay that I’d been told to expect. I was sent home on strict bed rest and BP meds because my BP was still crazy but controlled.

I had a second TIA at home but my blood pressure was in the range it was supposed to be so I stayed home, going to the hospital only added stress and anxiety which didn’t help in the least. I had a lot of follow-ups and wasn’t able to walk around the block until nearly 2 months postpartum without my heart racing and my blood pressure either going through the roof or tanking. On several occasions, I had to call out to my husband as I blacked out. I spent most of my maternity leave asleep on the couch or in bed.

The funny thing is I thought we’d escaped all complications and trauma. While I was incredibly lucky to be admitted to L&D instead of the stroke floor and am lucky to have no lasting effects it was so hard on me and my boys, my husband and Micah especially. While my OB is optimistic that a third pregnancy could have no complications I am terrified by the unknown, and we are worried about the risk to my health. I don’t know what the future holds and am still working through my grief with Micah’s early arrival and our loss of ignorance and ability to just go ahead and start trying to get pregnant/have as many children as we want. I am thankful for my boys but so often wish we hadn’t had to go through any of it and that I could still be blissfully ignorant.

My experience has affected my relationships with friends and family, especially those expecting. I am continuing to work on those relationships and finally admitted to my doctor how not ok I am which was a big first step for me. Not yet ready to do anything more than that but maybe in the near future.

My name is Sarah, I am a boy mom to two beautiful boys Micah (3) and Ezra (1). I work as a geologist in Wisconsin. We love going on adventures especially to the lakeshore and woods.

Heather’s Story: Preterm Labor, NICU Stay, And Complex Grief

by | Nov 7, 2021 | Uncategorized

Pregnancy

So many birth stories start with how easy their pregnancy had been. Mine was not. My first two pregnancies were easy, as were my deliveries.  My first was a spontaneous vaginal delivery at just shy of 39 weeks. My second was a scheduled induction with an easy labor and quick delivery. So I naturally assumed that my third would be just as easy. During my initial prenatal appointment, my brother passed away in a tragic work accident. I had come home from that appointment excited about the future member of our family but that excitement was extinguished as soon as I heard about my brother.  The next few months of my pregnancy were difficult due to normal pregnancy exhaustion on top of the exhaustion that comes with grief. During this time, I was convinced there was something wrong with the baby.  Until we had the results of the genetic testing, I was sure that the baby had Down syndrome. But the test showed that the baby had a very low risk and that it was a boy! 

The pregnancy continued to go pretty normal until around 26 weeks. I started to have intense pain under my ribs on my right side. I called my OB office and they sent me into Labor and Delivery. The on-call OB ran some tests but everything looked ok. She said it was probably baby wedged in my rib cage and that I should have some relief once the baby shifted his position.  By this point, that nagging feeling of something being wrong was back. Due to being advanced maternal age, I was having growth scans every 4 weeks and so far, the baby had looked great. At my 28 week ultrasound, they noticed that baby was measuring large and I had borderline polyhydramnios. The MFM provider was concerned that I may have gestational diabetes but my 1-hour glucose was normal. Over the next few weeks, the pain in my ribs was becoming more and more unbearable.  I was having difficulty walking and breathing and would spend most of my time at home in bed.  At my 32 week ultrasound, I had even more amniotic fluid and the tech noticed an anomaly with the left kidney. The doctor came in and took a look and believed that baby had a horseshoe kidney (which my oldest happens to have). A little over a week later, on 3/22, I woke up feeling off. I took my blood pressure and it was elevated. I also found that I had gained 10lbs in about 3 days and noticed that I wasn’t feeling the baby move as often as I had before. I went to work and at the end of the day called the office to let them know what was going on.  The midwife on call had me come in to be checked. By that time, my blood pressure had returned to normal and my blood work looked ok. Because I was only 33 weeks, I had to stay in triage until the on-call OB evaluated me.  Due to the high amount of amniotic fluid and how swollen I was, he was concerned that preeclampsia was going to develop in the next few weeks. He also explained that the rib pain I was feeling was due to having to use my accessory muscle to breathe and not due to the baby. He wanted me seen in the office twice a week until delivery. I left the hospital concerned about losing my job, not realizing that I wouldn’t be returning to work.

A Chaotic Birth

That night, I was having a hard time getting comfortable in bed. I was up constantly to use the bathroom and couldn’t find a comfortable position in bed. At 2:20 am, I woke up to fluid streaming out of me. I prayed it was just urine but when I jumped out of bed a massive amount of fluid continued to pour out of me. I woke my husband and tried to get dressed quickly, but every time I stood up more fluid would gush. After changing 3 times, I finally threw a towel in my underwear and we left.  The hospital I chose to deliver at was 30 minutes away and during the ride I had started contracting. By the time we arrived, my pants and the two towels I had been sitting on were soaked through with amniotic fluid. My giant belly was completely gone. The midwife and OB were still at the hospital and immediately came in to evaluate baby.  Things got tense as soon as the OB did an ultrasound. I had gone from having way too much amniotic fluid to literally no amniotic fluid.  Baby was also not tolerating contractions, his heart rate would drop drastically during contractions. My OB squatted down next to me and told me, “your baby is alive now, but he won’t be for much longer. If he’s not falling out of your body, I need you in that OR in the next 20 minutes or he’s not going to make it.”  As soon as I consented to the c-section, the room erupted into controlled chaos. The anesthesiologist told me he had one chance to give me a spinal, and if that didn’t work he was going to have to put me under. As they were wheeling me out of the room, I heard a nurse tell my husband that he couldn’t be with me. That was the moment it all became real.  Fortunately, the spinal worked and I was awake for the procedure. My midwife held my hand and the anesthesiologist wiped my tears. Sawyer Matthew made his debut with on 3/23/21 at 4:58 am, at 33 weeks and 3 days gestation. He was quickly brought to another room to be resuscitated and evaluated by the NICU team. A nurse brought him back to the OR for me to see him before they transferred him to the NICU. 

Unexpected Complications

Shortly after I was settled in my room, our nightmare began. We were told that he didn’t have a horseshoe kidney, but instead, they believed there was a large mass on his left kidney. It was determined that he needed to be transferred from the small hospital he was born at to Yale for more imaging and easier access to specialists.  I was able to visit him for a short time before he was transferred. I was finally transferred as well a few hours later and was able to see him again around 9:30 that night after an MRI of his kidney. I was hoping to finally hold my sweet little boy, but his temperature was on the low side. His nurse promised I would get to hold him in the morning and I was brought back to my room. 

When my husband arrived at the hospital the next morning, we immediately went to the NICU to see our baby. He had even more wires attached to his little body and gauze wrapped on his head. Earlier that morning, his nurse had noticed some seizure activity and they immediately started an EEG and attempted to get his seizures under control. They needed to do an MRI, but couldn’t do the test until his seizures were under control. While we waited for them to find the right combination of medications, we met with multiple different specialists. Oncology told us that they couldn’t diagnose his tumor until it was removed. Once a biopsy was done they could determine if chemo would be needed. The next day, we met with a surgeon who was fairly confident that the tumor on the kidney was a benign tumor known as a mesoblastic nephroma. The only way to know for sure was to remove the kidney and tumor for biopsy. But they wanted him to gain weight first and tentatively set the surgery for 4 weeks out.  Nephrology explained that he could have a completely normal life with one kidney but that we would have to do everything we could to protect that kidney. They finally had his seizures under control after about 36 hours and he was scheduled for an MRI. I rushed up to his room to see him before they took him and went back to my room to try to rest. 

At almost midnight, alone in my hospital room, I found out that my sweet little baby had diffuse brain damage, evidence of a hemorrhage, and that his brain was smaller than it should have been. They believed the size was due to a lack of oxygen while in the womb.  I was in shock.  How could we lose my brother and then have a baby with such complex medical concerns, all within a 6 month period?

Discharged Without My Baby

I was discharged the following day. The hospital social worker encouraged me to stay at the Ronald McDonald House across the street from the hospital. But how could I possibly be away from my other children for an undetermined length of time?  The only thing that kept me going was knowing I would be able to see them soon. Later that afternoon we met with a neurologist and was told that he has what is known as HIE. HIE or hypoxic-ischemic encephalopathy, is brain damage due to oxygen deprivation. In Sawyer’s case, it seems like his was due to the kidney tumor. The tumor caused the polyhydramnios, which most likely comprised the umbilical cord function.  The neurologist told us that with this condition, they can’t give us a prognosis until he’s older and missing his milestones.  However, looking at his neuro exam, she said he would most likely have some mild to moderate disability.  At that point, I was finally able to hold my baby for the first time after 4 agonizing days. At that moment, I knew none of it mattered. We would love that boy just as much as our kids at home. 

I was discharged on March 26 but continued to make the hour-long trip to Yale almost every day.  He was quickly weaned from any oxygen support and downgraded to the NICU step-down unit. He still struggled to take full feeds by mouth and relied heavily on the NG tube for nutrition. On 4/20, exactly 4 weeks after he was born, he underwent a radical left nephrectomy. They had warned us that he would be brought back to his room intubated but nothing in the world could have prepared me for that. To see him cry without making a sound still haunts me to this day. It took a few days but he was finally weaned from the respirator. As soon as he was able to, he began taking his bottles like a champ. Less than a week after surgery, his NG tube was removed and on 4/28, after 36 long days, he was discharged home and was finally able to meet his siblings 

Sawyer’s Recovery

Sawyer is now a happy and healthy 4 month old.  So far he’s met all his milestones and is doing even better than we could have imagined. He sees outpatient physical therapy once a week and early intervention comes to our home every two weeks for services. He’s beginning to show early signs of cerebral palsy, but once again we were told we have to “wait and see.”  The past 4 months have been a struggle for me. I’m dealing with PPD, PPA, and PTSD.  Studies have found that up to 60% of mothers develop PTSD from having a baby in the NICU.  Every doctor’s appointment brings on anxiety and heart palpitations. But it’s so much worse when I have to take the baby to Yale for an appointment. Just the smell of the factory I have to pass on my way there starts a domino effect. Racing heart, sweaty palms, intrusive thoughts, and shortness of breath are just a few symptoms I deal with on appointment days. But I’m seeing a wonderful therapist who is teaching me ways to overcome these feelings.

Since having a traumatic birth, I have had an overwhelming feeling that I should be helping other women like me. But as a school nurse, I couldn’t figure out how I would go about that. However, I was recently hired as a Labor and Delivery nurse. I’m hoping that this will be a healing experience for me and that I’ll be able to help mothers who have a negative or traumatic birth experience.  Birth trauma, having a baby in the NICU, and PPD have made me feel so lonely. But I’m not alone. And I hope my story helps another mother realize that she’s not alone too. 

About The Author

My name is Heather. I’m a mom of three. Oliver (7), Nora (3), and Sawyer(4 months). Plus I have an awesome 18 year old stepdaughter named Ashlyn. I am a registered nurse.

Rachael’s Story: Infertility, Loss and Placenta Accreta x2

by | Oct 24, 2021 | Uncategorized

Fertile Beliefs 

Miscarriage. Infertility. Birth Trauma. I knew that these were possibilities when journeying into motherhood. I simply thought they wouldn’t be a part of my story. My fertile beliefs were confirmed when my husband Brad and I became pregnant in the first month of trying. The pregnancy went smoothly, labor and delivery were routine and at 4:29 am on March 2, 2012, I became a mother for the very first time. 

In November of 2013, we knew we were ready for another child. Again, fertility smiled on us, and we became pregnant that first month. Brad and I went to our 12-week OB appointment giddy knowing later that evening we would be surprising family and close friends that Ella was going to be a big sister. Only, the ultrasound revealed our baby had died just days before. Blindsided, I felt I had been pushed into a pit of darkness. The doctors and nurses, my midwife and family, friends and colleagues all kept saying “these things happen”. Why did everyone keep saying that? I knew that these things could happen, I just never thought it would happen to me. 

Secondary Infertility  

I had a D&C to remove the fetus. The loss of my baby had broken my spirit. Whispers of obsession took hold and I began believing if I could get pregnant again it would fix all that had been undone. Month after month of trying. OPK sticks, temperature checks, cervical mucus inspections, and still nothing. I was numb. What should have been joyful achievements now meant so little. I graduated at top of my class in nursing school, I passed my N-Clex, and became an RN. My hopes of becoming a midwife put on hold. My dream was now a trigger. The pressure intensified with each negative pregnancy test. I needed to get pregnant again. I had to get my life back, get me back. 

It didn’t happen. More months passed and I began to panic. Something must be wrong with me. How could a woman get pregnant twice the first month she tried to then have months and months with nothing? It had been nine months since my D&C and Brad agreed we should see a Reproductive Endocrinologist. I wanted answers desperately. We didn’t find any, only more questions as we received the diagnosis of unexplained secondary infertility. In a nutshell, it means your tests are normal but you still aren’t getting pregnant and we don’t know what’s wrong with you so we are gonna put you in this pile of unsure but let’s try stuff and see what happens. I know, awesome right? 

We tried for a few months naturally with guided ovulation at our fertility clinic and nothing. It had been a year since my miscarriage and I was crawling the walls. Living in a perpetual fog, all I could see was my infertility. My daughter was growing right before my eyes, each birthday and milestone was a stab to my heart. Would she ever have a sibling? Will they be so far apart in age they won’t have a connection? I felt immense guilt that I was robbing her of the childhood I had hoped for her. I believed her lonely when in reality she just wanted my love and attention. 

Brad and I spoke with our doctor after Ella’s third birthday and said we were ready to try IVF. My naïve obsession at an all-time high, believing this advanced fertility treatment not only would work but, I’d have twins, make up for lost time and never look back. HA! Jokes on me guys because what I’ve learned the hard way is IVF is a lot of things but it sure as hell isn’t the catch-all fool-proof fix I had believed it to be. In Vitro was expensive, invasive and emotionally draining. We came through having made 19 embryos and thought our prayers had been answered, surely this was it. We transferred two embryos and were pregnant! Finally, we were on our way out of this dark hole of despair! Or so I thought. At our 10-week ultrasound we again experienced the trauma of being told our baby didn’t have a heartbeat. The darkness swallowed me up as I again had another D&C. This time we were able to test the fetal tissue and found that baby had trisomy 21. I had transferred an abnormal embryo simply because my clinic did not do testing for abnormalities. I was heartbroken, but I was angry. I could have avoided losing this baby. My Re told me my favorite line “these things happen” and urged us to try once more. He believed the odds of this happening again were so small, promising all we needed was to transfer one more time and we’d be parents again. We listened against better judgment and I experienced a chemical pregnancy. $50,000 spent and all I had was another miscarriage. I had to leave. I couldn’t “give it the old college try” anymore. 

So Much For Plans 

We packed up our embryos and moved to another clinic. Literally. Our babies on ice in the passenger seat as we made our way to our new RE with one of the best labs in the country. We jumped in with both feet, taking the advice of our new RE we agreed to do an entirely new IVF stim cycle. We ended up with 6 Day-5 embryos for PGS testing. Two weeks later the results were in. We had one normal embryo. We were devastated but I was starting to believe my intuition was right. Perhaps my eggs were shit. Our doctor told us to get away over the holidays. She said we’d get back to it in the new year and make some normal embryos. Brad and I took her advice, we left the bitch, infertility, at home and went away for a couple of nights to Atlantic City of all places. While there we found ourselves again, hell we had sex for fun again. The trip was exactly what we needed. A couple of weeks later a shiver ran down my spine as I realized in a booth at Chick-Fil-A that my period was late. I drove to a CVS and home like a wild woman, peed on a stick and promptly threw it at Brad. We were pregnant. Somehow, we had gotten pregnant spontaneously and I was sure I’d have another miscarriage. Great, now we’d have to endure all this time lost before we could do another IVF cycle. 

Only, that miscarriage never happened. As the weeks passed my severe pregnancy anxiety grew. I believed this baby was destined for miscarriage and when we hit 20 weeks, I feared stillbirth. I didn’t fully believe he’d live until Dean was placed on my chest healthy and crying in September of 2016. Two spontaneous pregnancies, nearly five years apart. Our rainbow after so much rain. Time passed and we never forgot about our one normal embryo. We knew we wanted to see it through and transfer once Dean was a year old. That’s just what we did. To our shock, this FET worked! I was pregnant with our third child and could see the light at the end of the tunnel of my motherhood journey. This baby would complete our family and I couldn’t wait to put the trauma of infertility behind me. 

Birth Trauma 

In August of 2018 I gave birth to Aden. Filled with relief I held him to my chest knowing this chapter of grief was behind us. We began to breastfeed as my midwife prepared for delivery of the placenta. Time passed and it wasn’t detaching. Pushing on my abdomen she tugged at the umbilical cord again and again. I began to groan in pain as I felt rhythmic gushes of blood splash from my vagina. One last yank and the umbilical cord snapped away from the placenta. I looked around at the concerned faces of the medical team. An OB was called. As she examined me she spoke to my midwife of an Accreta. I knew what that meant. My placenta had attached too deeply to my uterus. The OB gave me two options, either they try to manually remove it or do a D&C. I opted for the D&C and was whisked off to the OR for emergency surgery. My legs were placed in stirrups and a mask was placed on my nose and mouth. The edges of my sight blurred as the gas began taking me under. I remember my last thought was I hope I don’t bleed to death. 

I awoke to the beeping of machines with a rock in my throat and the need to vomit. It was dark and I was disoriented. Where was I? What were these tubes? Where was Aden? Brad rushed to my side with a basin. I vomited violently as my head began to pound. Brad had been crying, his eyes red-rimmed circles. He sat on my bed, stroked my hair as he explained I was in the ICU. I had coded in the OR from the amount of blood lost during the operation to remove the Accreta. The hemorrhage was stopped by ablation to my uterine arteries. The procedure saved my uterus. Yet, why did my head pound with a pain I’d never experienced? When could I see Aden? Doctors and nurses brought Aden in an incubator to my room. I couldn’t touch him, hold him, be with him. I cried in the blindsided bewilderment of this moment. I had been so vigilant, careful to ensure that the baby would be safe. I never considered that my life was the one at risk. 

I remained in the ICU for 9 days as they did tests and found I not only had an undiagnosed placenta accreta but an infarcted golf-ball-size pituitary tumor in my brain. The deflated tumor was found after three days of excruciating head pain. Doctors finally suspected something other than the hemorrhage and sure enough there it was. The tumor had exploded but, it remained a deflated sac I needed to watch for years.  

On the tenth day, it was finally time to go home. I left the hospital a shell of myself holding a baby I couldn’t care for with a broken uterus and a severe form of Sheehan’s Syndrome. All I knew is I would be on steroids for the rest of my life and my body could not make breastmilk. At discharge, doctors gave me paperwork for a life alert bracelet because of my adrenal dysfunction. They warned me never should I or could I become pregnant again. My life would certainly be at risk if I did, but with all the scarring from the D&C hemorrhage and ablation, the likelihood I’d get pregnant was less than 1%. When I finally came home, I sat on my bed and cried harder than I had in my life. I was incredibly angry with my birth experience. Heartbroken that this was my reality. I thought Aden was the end of my motherhood trauma not the ushering of another kind. It all felt so unfair. 

Trauma Anniversary

My birth trauma had brought sickness into my life. I simply was no longer well. I had chronic migraines, barely left my bed, and was losing so much weight. On Aden’s first birthday I remember trying on a dress while looking in the mirror. I could see the bones of my clavicle and chest, my eyes sunken, my cheeks deep pockets of grief where happiness once was. I was wasting away. I could barely eat, my head ached as the dizziness gave way to nausea that was unbearable, I couldn’t eat, I never slept. I feared this may be my reality for always. I had been in therapy for years, since my first IVF cycle, but now therapy wasn’t talking of babies and cycling. I choked out suicidal thoughts and the fear I may never be able to mother my children I worked so hard for. My pituitary healed slowly. My need for steroids stopped. My period came back. So why did I feel sicker than I ever had in my life? 

Old Haunts, New Trauma 

Not much changed in the months and years after Aden’s birth until August of 2020. Frail, my 5 foot 8 frame, a mere 106 pounds. Sick and surviving I found myself pregnant. The first emotion I felt was fear. The accreta. I could have another. That shifted at once to how on earth was this possible? I was beyond malnourished, my periods irregular at best. The next was grief. I thought about how this baby likely wouldn’t make it, I didn’t have anything to give. I miscarried while a vibrant version of myself, the odds of this baby holding on as I barely did were dismal. In spite of my infertile beliefs, this baby held on. Week by week I was amazed at his growth. Yes, his! We found we were having another boy. When I found myself 8 weeks pregnant, I began a patient of one of the best hospitals in the world, The Hospital of the University of Pennsylvania. 

I was introduced to a new group of doctors who took my accreta history very seriously. As a high-risk patient, I was seen often for ultrasounds to ensure no accreta was visible. Thank God it wasn’t! I felt well supported and cared for, both my care team and I believing I could deliver vaginally. I found myself an incredible doula, one who understood my unique supportive needs as a birth trauma survivor. I had done all I could to have a successful birth and at 39 weeks it was time to have this baby. 

This would be my third unmedicated birth, it was peaceful and calm until I went to pee. I felt the urge to push and as I waddled back to bed I began the primal howls of delivering baby while standing. The nurse and OB guided me to the bed on my side as I delivered Liam upside down at the bottom of the bed in April of 2021, all 9 pounds 11 ounces of him. He was on my chest breastfeeding as we both got cleaned up. I held my breath as I reached the cusp of what we all had hoped would be a delivered placenta. Placenta’s Out! Whoosh, a big exhale of air as I smiled at Liam. The placenta was out. I didn’t have an accreta. Gush… No. Gush…. I knew. Gush… I told my OB I was bleeding and she immediately took action. The room went from calm to chaos in two minutes. 4 staff members went to 8 then 12. My IVs went from one to two to six. Medications were shot into my thigh, shoved in my rectum, and pushed through IV. Blood was given as in the OR high and fast. My arm turned purple as my lips turned blue. The nurse shouted out my blood pressure again and again. 70/40! Rachael, stay with me. Call a rapid. Twelve people became 30 as I saw Brad rocking Liam in his arms as tears fell from his eyes. I smiled at him to reassure him I’d be ok but, I knew he feared the worst. My doula held my hand, held my hair as I vomited again and again. She stayed with Brad as I was moved down to emergency surgery. The same uterine ablation from years prior was tried again. The doctor screamed directions. I couldn’t open my eyes, unable to move my body but I heard everything. I began to vomit while laying on my back. I feared I’d drown right there in my own bile before a nurse turned my head to the side. “Clean her up for fuck sake, knock her out, let’s go” I awoke to more beeping, coughing uncontrollably. I was in the surgical ICU and they had given me so many blood products I was ballooned with fluid. A CPAP machine was placed on my face to help me breathe. Gush… No. Gush…. Not again. I pulled at the sheets off my bed unable to speak. The nurse looked with alarm on her face. “She’s bleeding again.” Doctors held vigil and debated my options. 

The doctor again put on gloves to her elbows and went digging in my uterus pulling out clots and blood parts as she had hours before when the chaos began. “Take it out” I chanted. “Take it out” They looked at one another and understood. “Rachael, we just want to ensure we’ve done all we could to stop the bleeding. It’s never an easy decision to remove a woman’s reproductive organs” I nodded. I understood. Barely breathing and conscious, I closed my eyes and prayed I’d make it through the night. 

Moments later one of my doctors leaned down to speak to me. I could barely open my eyes but I heard her. “Rachael, we’ve decided on the hysterectomy. We will need to take your uterus, fallopian tubes, and cervix. You’ve been through so much and I know this is a lot to hear. Are you willing to have this total hysterectomy procedure” I spoke with the last strength I had “I’m ready”. With that, emergency transport was in and whisked me back to the OR. Hours later I awoke back in the surgical ICU with a circle of doctors crowded around me. My OB, the doctors from that night, the OR team, my nurse from my delivery. Everyone wanted to see I made it. I was promised if I did well in the next twelve hours I could go to the women’s surgical floor and be reunited with Liam. That was all the motivation I needed. I slept all day and had Liam on my chest and Brad at my side 28 hours after giving birth. It was the most terrifying night of my life. I had lived out a dance with death and I had made it after the music stopped. 

I did have a lesser form of Sheehan syndrome again from the extensive blood loss. Over six liters in total. I haven’t been able to breastfeed Liam. That’s something I’m sure I’ll always grieve. I lost my uterus and the ability to have children, which is something I’m still wrapping my head around. Pathology said it was a very sick organ that needed to come out. It was still holding chunks of placenta from my accreta in 2018 and that of 2021. There is sadness, a void where my uterus once was. It is taking time to adjust to this new normal. It was a traumatic birth. God, was it traumatic and yet, this birth trauma is different than that of 2018. I believe that’s because I was prepared. I knew the possibility of accreta and I did all within my control to have the best outcome for Liam and I. As I look back, it shows. From my care team, to my doula, to my postpartum experiences I am grateful to have advocated and chosen with purpose all I did prior to having my second placenta accreata complication. These choices have created I’ll be it slow but purposeful healing physically and emotionally over the past six months and a mom who is able to love and care for her son. A mom who is no longer full of sickness but, strength. In my gut, I know my uterus needed to be removed. I believe a part of me always knew something wasn’t right since 2018. I’m coming to terms with the finality of it and the lack of choice in my reproduction but, I find as time passes the peace grows.  

My motherhood journey has encompassed twists and turns I never saw coming. Waves of the greatest of joys and the deepest darkness and sorrow that’s knocked me off my feet and forced me to find my way back to me more times than I care to count. It’s also given me four incredible children who I’d walk this same journey again and again if only it led me here. If I can say one thing to another woman on her own walk with motherhood, it is that you aren’t alone. In the all the ways motherhood breaks and makes you, know there is a village of women, like me, who see you, support you and get it. 

BIO

Hey friends! I’m Rachael. A Mom, RN and writer who just had my fourth baby in April of 2021. I love watching Netflix with a Ben and Jerry’s, jumping in bed with a good book, and there’s never been a beach that hasn’t felt like home. I am a fierce advocate for infertility and birth trauma support. I’m passionate about sharing my birth trauma, bringing awareness to placenta accreta so that moms know the risks and that with that comes choices in supportive measures for optimal outcomes for both you and baby! I will keep sharing raw real squares of motherhood on Instagram while finishing my motherhood memoir. Come share in my motherhood journey on Instagram @the.lotus.mama and visit preventaccreta.org for the best of accreta information by the National Accreta Foundation.