Yes It Was Bad…But It Could Have Been Worse

I’m back. Well, for now at least. It’s been some time since I last wrote on here. My last post was a pregnancy announcement. I wrote that post back in April. Between then and now, things have been hectic to say the least. So I think it may be time to do a few updates. Be forewarned, as it has been some time since I’ve written (and since this was an overly eventful pregnancy) this will be a long one. Please bear with me.

First and foremost, the pregnancy. My wife and I were looking at a due date of July 20th or 21st. Instead, due to complications, my wife was induced on July 7th and delivered on July 8th. I am very happy to say that our newest family member, baby Michelle, is doing well. But she didn’t come without giving us a scare. My wife also had a hard time with this pregnancy. There are several risk factors that contributed to the issues we had, such as advanced maternal age (my wife is 42), gestational diabetes (my wife has PCOS and is insulin-resistant as a result) and the fact that this is baby number 5 (pregnancy number 9) for us. These are just a few factors that were not in our favor. So let’s go back to when the problem started and I can go over a few of the warning signs that were missed.

This has been a very tough pregnancy for my wife. In fact, according to her, it was the toughest. She has had more back pain than in any other pregnancy. She has had unbelievable bad swelling, especially in her feet and face. Those things started fairly early on and only got progressively worse as time went on. In June, during one of the non-stress tests that she was doing twice a week, my daughter’s heart rate went too high and stayed there. During these tests, the monitor will show a baby’s movement and the elevated heart rate that goes along with it. The baby moves and the heart rate goes up. When the baby stops, the heart rate is supposed to go down. My daughter’s heart rate went up to over 180 beats per minute which is very high and it remained there for several minutes. It was a bit concerning, but since it eventually went down, nothing was done and the red flags that were raised were folded and put away. Around this time, my wife had a violent sneeze at home, after which she thought she might have cracked a rib on her right side. It hurt badly for the duration of the pregnancy. Every time she would sneeze or breathe deeply, her rib area on her right side would hurt her a lot.

During one of my wife’s weekly doctor visits, she had some fairly high blood pressure readings. This was rather concerning and the doctor told my wife that she wasn’t in any trouble yet, but that “something was brewing.” To me, that’s a scary thing to hear from your doctor when you are nearing the end of a high-risk pregnancy. We have a home blood pressure monitor and we checked it several times daily over the weekend. It remained high. When my wife went in to have her next non-stress test and blood pressure check on the following Tuesday, July 6th, her doctor said it was too risky to go any further. So, we were sent from the clinic we were in over to the hospital to be induced. My wife was just about 37 weeks along. It was early, but close enough to full-term that the risks of delivering were less than if we waited and her blood pressure got even worse. The fear was this: pre-eclampsia.

Pre-eclampsia is what women get prior to getting eclampsia, hence the name. Pre-eclampsia can lead to seizures, strokes or coma. Eclampsia is what it is called when the seizures start. Quite often, when women get pre-eclampsia or when they are on their way to getting it, the cure is delivery of the baby. That is why we were being induced so early. It was to keep both my wife and my daughter safe and not let them get into a life-threatening situation. And so we went to the hospital. Once there, my wife was again hooked up to the monitors to watch the baby’s heart rate. It spiked again. This time it went well over 200 beats per minute. That’s way too high. The doctors got very concerned. they called the specialists up at Dartmouth-Hitchcock Medical Center here in New Hampshire. Not only is it the best hospital in the state, it is in the top 100 in the country out of more than 6,000. To us, that meant it was serious. The hospital we were at always seemed like a very good hospital to us. They wanted us to have more specialized care. They said to pack up and drive up there (an hour away) so that their pediatric cardiology team could be on hand for the delivery. It was scary but it felt like the right move. So we packed up and left after 10pm and after my wife had already been given two doses of induction medication. We arrived at the new hospital just before midnight.

After we arrived, the doctors and nurses told us that they had decided to put the induction on pause for the night and would just be monitoring both my wife and the baby. They said they’d start the induction the following morning. We tried to relax but thoughts of the worst kept popping up. Having lost four pregnancies previously, including one around five months along, we were justifiably scared. Morning came and went. Still no induction. Afternoon also made an appearance and passed without incident. As we approached evening, we were starting to wonder if we had been forgotten. We had the occasional nurse pop in and tell us that the hospital was just unusually busy with other more urgent pregnancy patients. C-sections were happening all around us and so we were forced to sit and wait. It was torture. Eventually, the induction process began again late that night and we were slowly moving forward again. By morning, my wife had her water broken by a doctor and was having regular contractions. Once she had reached full dilation, she was ready to push. From the start of her pushes, timed to each strong contraction, to the time my daughter came out was only about 13 minutes. It was fast, and that was a good thing, because that’s when we were faced with more terrifying events.

As has become the norm for me during the deliveries of my children, I was assigned the task of holding up one of my wife’s legs. A nurse held the other. They didn’t actually need my help. It’s just the hospital’s way of allowing the partner of the woman in labor to see the baby come into the world while also being able to say, “Hey, I helped too!” when people tell the woman how strong and amazing they are. From that vantage point, I was able to watch my daughter’s hair peek out a bit. Then the head came fully out. And then I watched in horror as the doctor removed not one, but two loops of umbilical cord from around my daughter’s neck. They pulled her out quickly after that. They clamped off the umbilical cord, I cut it and they quickly whisked her off to the other side of the room to warm her a bit and get her breathing. These loops, also known as nuchal cords, can cause brain damage or even stillbirth, depending on the tightness of the cords around the neck. Luckily for my daughter, these loops were not so tight that they couldn’t be removed from her neck quickly. We actually went through this before with my second oldest son, Caleb. He had just one loop of umbilical cord around his neck, but wasn’t breathing when he was born and was rather purple. The panicked nurse at the time, saying loudly, “Is he breathing at all?” wasn’t helpful. But he is just fine and nearly seven years old now. With this delivery of my daughter, the double loops were not the end of the umbilical cord experience. She was also found to have what is known as a “true knot.” This is when the cord is tied in an actual knot from a baby moving around in the womb. This only added to our fears.

As if we were not already freaking out over having our daughter come out with two loops of umbilical cord around her neck, we now had the revelation of a true knot to fill our minds with dread. On one hand, it helped to explain the spikes in her heart rate leading up to her delivery. It seemed to make sense to all of the doctors that this knot, when pulled tighter during fetal movement, caused her heart to have distress and beat rapidly. Theses knots are rather rare, only occurring in between .3 and 2% of all births. It also happens more frequently in boys than girls which made our case even more rare. About 10% of all true knot instances end in fetal death. Finding out that there was a knot, and having our daughter survive, was reassuring. But, on the other hand, there was still worry to be had over the long term effects of being deprived oxygen and nutrients due to a knot in the umbilical cord (likely there for over a month in the womb) as well as it being wrapped twice around her neck. As we watched our newborn daughter sleep in her hospital bassinet, we turned to the internet for guidance. Bad idea. Reading about things like hypoxic-ischemic encephalopathy is terrifying. This is brain damage as a result of things like having a true knot or the mother having pre-eclampsia. We had both. Babies with HIE can develop things like epilepsy, cerebral palsy, learning disabilities or even death, often before their second birthday. This was excruciating, not knowing. The doctors, after observing her for a day or so, eased our fears a little by telling us that by 24 hours, we would have started to see signs of brain trauma related to cord issues. There were none noted. I was not completely convinced we were out of the woods, but I was able to put it out of my mind just a bit.

We spent several days in the hospital, filled with worry. Not only about my daughter, but about my wife as well. The day following the birth of my daughter, my wife was wheeled into the operating room to have a scheduled tubal ligation. What used to be referred to as “having one’s tubes tied” is actually the removal of the fallopian tubes. She had what is known as a Bilateral Salpingectomy This is when both fallopian tubes are completely removed. This complete removal, according to the surgeon, not only causes sterilization (nearly 100% effective) but also lowers the risk of developing ovarian cancer by about 40%. It seemed like a win-win to us. She went in for surgery and came back in just over an hour. That’s when the next cause for concern hit us. Her blood pressure was up again. This time dangerously high. A normal blood pressure reading is typically between 90-120 over 60-80. Hers was about 185/100. It was evident to the doctors that she was one of the unlucky patients to develop full-blown pre-eclampsia postpartum. It’s not unheard of but still doesn’t happen that frequently. It happens in about 5% of women.

The first thing the doctors did after diagnosing her with postpartum pre-eclampsia was to get her on an IV of Magnesium Sulfate. This is given in severe cases of pre-eclampsia in order to prevent seizures and strokes. If a patient has seizures, it has moved beyond the pre-eclampsia stage and into eclampsia. Both stages are potentially life-threatening. She remained on the Magnesium Sulfate IV for the next 24 hours. During this time, her blood pressure remained dangerously high, but was slowly moving lower and lower. She was given anti-hypertension medication to go home with in order to lower and eventually stabilize her blood pressure. We were told that this condition could take days, weeks or even months to resolve. As of right now, we are two weeks past her diagnosis of postpartum pre-eclampsia. Her blood pressure is now ranging from completely normal to only slightly elevated. She is not considered high-risk any more, though she’ll remain on her medication until she is consistently getting normal readings.

Here’s what was extra scary about my wife’s condition. She wasn’t having symptoms during delivery or prior to having her operation the following day. A lot of doctors wanted her to wait six weeks after delivery to have her sterilization done. The surgeon she had do it felt like there was enough of a safe window to do it right away, before the uterus shrank down too far and the full six weeks would need to pass in order to have it done. At this point, the doctors and nurses felt that our daughter was healthy enough to go home. The only thing keeping us at the hospital was my wife having her surgery. If she had symptoms prior to surgery, they would have cancelled it and started her on treatment right away. She was doing fine before she went in though. It was not until afterwards that she started to have problems. Had we not been able to have that procedure, we might have gone home without knowing my wife was getting very sick. We might have been here wondering why my wife wasn’t feeling so great. It could have been bad if we didn’t know the symptoms to look out for. We didn’t know that the swelling she had all along was caused by pre-eclampsia creeping up on us. We didn’t know that her elevated blood pressure was going to be an issue postpartum. And remember the rib pain I mentioned earlier? It turns out that her sneeze had nothing to do with it. It was a violent sneeze, but it wouldn’t have hurt so bad if her liver (also in that area) wasn’t also being affected by the impending pre-eclamptic episode. In the hospital, her right side pain continued. Headaches followed. Then, her vision began to get a bit fuzzy and she started seeing spots floating around the room. It was terrifying to me and brought me to tears several times, despite my wife assuring me that she’d be fine.

Once my wife was well enough to come home, we were able to focus on our daughter. She left the hospital with jaundice which is quite common in pre-term babies and quite common with all of my kids. She also dropped a bit of weight, which is perfectly normal. But over the next week, she dropped a bit more than we would have liked. The doctors weren’t too concerned and just said she needed more calories. We wanted my wife to be able to breastfeed exclusively due to the health benefits of it. But, as we had to do with our last two children, we had to supplement with some formula. She was born at 37 weeks at 6lbs, 15 ounces. At her last doctor’s visit, she was down to 6lbs, 5 ounces. After some supplementing and some better feeding techniques, she is almost back to her birthweight. She was 6lbs, 11 ounces yesterday when a visiting nurse came to our house. She’s definitely on the right track now.

My wife seems to be back to her normal self. Her swelling has finally gone away and it’s now painfully obvious that we missed some warning signs. Swelling of the hands and face are normal in any pregnancy. The levels to which she swelled were not normal. We just didn’t know it. The doctors were cautious, but weren’t overly concerned. Luckily the doctor that decided to send us off to be induced did so when she did. She potentially saved two lives. Her name is Nicole, the same as my other daughter. My older daughter was named after this doctor as she helped us through both loss and through difficult pregnancies. She will always be a special person in our lives. My newest daughter is named Michelle. We picked that name out when we found out via ultrasound that we were having another girl. Another doctor who helped us in the past was named Michelle. That doctor delivered two of my other children. Little did we know that one of our nurses, as well as the doctor who delivered our newest princess this time around, would also share that name. Although I know it was nothing more than a coincidence, it was fitting nonetheless.

So that’s my story…and it’s not over yet. It is a story still unfolding, but it seems the worst is behind us. We have our precious little girl safe and sound at home with us and my wife is recovering nicely. We know that this will be our last. It is a little sad, but we know we are wise to cap our family at 5 children. A family of seven is quite complete and, knowing the risks involved at our age and with our history, we know when to say when. We are whole and we are healthy. That’s all that matters. The journey to get here was fraught with peril and it was scary. But we emerged in a good place.

Thanks to all of you who have been so supportive and patient as I try to get back to sharing here regularly. It’s been tough. Finding the time to do anything on zero sleep is difficult, especially writing. Gathering my thoughts has been a challenge lately. I will work to get to where I want to be…and where I need to be. I will do my best to return to the WordPress community where I belong. Until then, here are a few photos…