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.
