Episode 53 SN: Surprised by Preeclampsia: Jess’s Story

Today’s guest did not anticipate that pregnancy would offer a totally smooth ride to parenthood, but the ride she did encounter included a number of experiences that were nowhere near her radar. Managing a lot of challenging conditions like preeclampsia, and post partum anxiety had significant effects on her: first it encouraged her to reimagine what her family would look like and to find contentment in this family even though it wasn’t what she originally pictured; it made her really engage in caring for herself, to focus on both her mental and physical health; and lastly, this experience made her feel grateful for the life she has now.

Find Jess’s podcast, Only You Podcast

Patent Ductus Arteriosus

https://www.mayoclinic.org/diseases-conditions/patent-ductus-arteriosus/symptoms-causes/syc-20376145#:~:text=Patent%20ductus%20arteriosus%20(PDA)%20is,called%20a%20patent%20ductus%20arteriosus.

Audio Transcript:

Paulette: Hi welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist and a writer and the mother of two girls.

Today’s guest did not anticipate that pregnancy would offer a totally smooth ride to parenthood, but the ride she did encounter included a number of experiences that were nowhere near her radar. Managing a lot of challenging conditions like preeclampsia, and post partum anxiety had significant effects on her: first it encouraged her to reimagine what her family would look like and to find contentment in this family even though it wasn’t what she originally pictured; it made her really engage in caring for herself, to focus on both her mental and physical health; and lastly, this experience made her feel grateful for the life she has now

Let’s get to her inspiring story.

P: HI thanks so much for coming on the show. Can you tell us your name and where you’re from?

 

Jessica: Absolutely. My name is Jessica Meyer. I’m from the Seattle area. And I host only you a one and done podcast with my husband. Cool. Wow.

 

P: So I’m gonna get to ask it sounds like you have one child. 

 

J: I sure do. 

 

P: So before you had this child, I imagine you had some idea about what pregnancy would be like. What did you think it would be like?

 

J: I thought I would be anxious during pregnancy. I definitely was aware of that. I’ve struggled with anxiety my whole life, but I also kind of had this sense of confidence. Like, this is what my body’s supposed to do. I’m going to be able to roll with it. You know, whatever comes my way. I had this intuition. I think somewhere that it was not going to be the easiest pregnancy.

 

P: Okay, that seems much more attuned to how complicated the process really is.than most of us are on the entrance, but I’m interested to hear so did you get pregnant easily?

 

J: That part was easy. So I am one of five children. And my mom has always told me that it’s like for our family getting pregnant is usually the easy part. And also for my mom, her deliveries were really fast. So I only tried for a week, and I was pregnant. 

 

P: Oh, wow. 

 

J: Yeah, I got off birth control and I was pregnant one week later.

 

P: Was that exciting or were you like, Oh, my God, I I’m not ready.

 

J: I was so mad at my mom because she told me it would take a little while she told me it would take after birth control that it would take about six months. That was her advice. She was like, it’s easy to get pregnant. But if you’ve been on birth control, sometimes it takes your body a little bit of time to like, you know, catch up and so give yourself three to six months after birth control and it should happen pretty easily for you. But it happened immediately for me and so I was like, You lied to me. You told me I had three to six months. And now let’s just here just like that. 

 

P: Yeah, that does sound like pregnancy on demand, which makes for wafer thin adjustment period. So you find out with a home kit is that how you found out?

 

J: Yep. My husband knew before I did. I was particularly moody and emotional, a different part of our lives. We were also closing a business that we used to own. So I was sort of in the process of cleaning up the retail store and saying goodbye to this really important chapter in my life. So I was really emotional anyway. And I remember one morning before one of the last days or no it was the very last day of my business being open. I was crying. And my husband was making me an apology breakfast for for nothing right. But he didn’t have bacon and so he went to the store to get some bacon and he came home with a pregnancy test. He was like, just in case, you know, he knew that we had been trying and he was like, You seem a little different. And I know it’s the last day of your store. But why don’t we take that too and I was just like, flippant, you know, whatever. I’m so sure. I’ll take it fine. And wouldn’t you know it? It was positive. So 

 

P: wow, 

 

J: we found that out on the last day of this other chapter. It was really beautiful.

 

P: There’s a story book element that timing. As you’re closing the doors on the store, you’re opening them onto this new adventure. So take us through your pregnancy. How was it the beginning? What did you have morning sickness or anything like that?

 

J: Yeah, I was a waitress at the time. So I had left that business and I started waitressing because we knew that I was probably going to want to stay at home with the baby so I just wanted the job for the in between times. And I was very sick in the first trimester. I remember potatoes would make me really really nauseous and I worked in a restaurant that had a lot of French fries. And just the smell of that would make me so sick. But it was I didn’t actually like throw up that much. It was more just a general feeling of queasiness all the time.

 

P: Yeah. And did that go away after the first trimester? 

 

J: it sure did

 

P: Good. Okay, good. And then and then how was the pregnancy after that?

 

J: Well, it was at the 20 week scan that we found out that my daughter was small. She was you know, in a low percentile, I think about the 20th percentile at that time. And we also found out a couple other things. I had marginal chord insertion, which meant that the umbilical cord was sort of right at the end of the placenta, and that can cause growth restriction as well. And then we found out that her kidneys were not developing quite right. And that’s an issue that my nephew had struggled with as well and he kind of just grew out of it. So that 20 week scan, for me was very confirming for a lot of the anxieties that I had kind of struggled with. I remember at the very beginning of my pregnancy and pretty much throughout the whole thing I was glued to this website that tells you how likely you are to miscarry that day. It’s a percentage, and it goes down every day as you get further along into your pregnancy and I was terrified of losing this baby at that time. I didn’t know I’d be one and done. But I still don’t know it was my first pregnancy and I already an anxious person. So I just felt fear and so when we had that 20 week scan it was like see you were right all alone to be scared.

 

P: well that sounds regrettably eventful. That’s a lot going on.

 

J: It was it. It scared me. 

 

P: Let’s go slow for one second here. You’re sitting down but you don’t look giant like somebody

 

J: I’m very small. 

 

P: So somebody has to be in the 20th percentile like why not? Your baby?

 

J: Totally. Yes. I’m, I’m five to and like, you know, 120 pounds or something before pregnancy. So the doctors were like, Yeah, you’re small. My whole family is small. We’re all you know, petite women. My husband is like six five or six something I don’t know. So it could go either way with our daughter. But they weren’t so worried about the small aspect, but it was that plus the marginal court insertion that had them a little bit worried because they needed to be able to keep an eye on the blood flow. 

 

P: Yeah. 

 

J: And to make sure that she was actually getting everything she needed and not to spoil the story, but she wasn’t

 

P: and the kidneys. Is that a genetic issue since you said your cousin have as well or

 

J: it may be genetic. It’s also just a common issue for babies just in general and it’s almost always something they grow out of. It’s just one of those things we had to keep an eye on as she it was like, I don’t even remember anymore. Whatever her kidneys were connecting to that connection was too thin. I’m sure there are folks out there who know more about it. But luckily that didn’t end up being one of her long term health issues going forward. 

 

P: Good. And so what do they do after this? Can to kind of keep an eye on you?

 

J: They just did more ultrasound so I think we did an ultrasound after that every month. And I think that was pretty much it. I was with maternal fetal medicine instead of a midwife at that point. They were just watching us really closely watching my weight watching the baby’s growth and she went from the 20th percentile at 20 weeks to like the 10th or maybe the fifth by 30 weeks. So she was definitely growing very slowly and not in line with her own curve. You know, so if she were at the 20th and stayed at the 20th that wouldn’t have been an issue but they could see her kind of getting smaller and smaller. 

 

P: Well, that sounds stressful. How are you between ultrasounds?

 

J: I was a wreck. Oh my gosh, trying to eat as much as I could. And I remember feeling really guilty. Because I am such a small frame. I wasn’t. I felt like I was putting a lot. I felt like I was putting on a lot of like water weight. You know, I felt very swollen. But I wasn’t really gaining that much and I just felt like I blamed myself. All the time, because it must be me because I remember when I was sharing with my husband’s mom one time how anxious I was. She said Don’t even worry about it. The baby’s going to be fine on our side of the family. We’ve never had any trouble with newborns. They’ve always been perfect. And those words were just ringing in my head like okay, so you’re saying if anything goes wrong, and it’s 100% me, it’s not your side of the family. I hear that. I’m going to take that in. That’s all I could hear but she was trying to comfort me. 

 

P: also Pregnancy is a weird state have 100% responsibility and no control. 

 

J: totally right. Yeah. 

 

P: So it is hard not to feel responsible for something going on inside you. Yeah, but you really obviously you didn’t put the umbilical cord where was 

 

J: I did not. Not intentionally,

 

P:  that there’s not you know unless you’re not like, you know, smoking or you know, drinking too much alcohol like there are limits to what you can really do. 

 

J: Right. 

 

P: But I’m sympathetic. We’ve been into trouble during my pregnancy that required a lot of extra monitoring. I’ve never been a smoker, the anxiety of the waiting between those scans. definitely piqued my interest in becoming one. This is like a terrible…

 

J: Yes, completely.

 

P: It’s very hard not to feel like you’re personally being evaluated in those scans. And it’s hard to separate out, you know, the distinction between what my body is doing and what I’m doing. 

 

J: Sure,

I think honestly, during pregnancy was the beginning of a long journey that I had with hyper vigilance. So during pregnancy, I was extremely by the book, you know, I was checking every single thing before I ate it. I wasn’t taking any medications that weren’t on the list even you’re drinking tea right now and it reminds me I was checking tea. What tea can I have? What do you can take out, you know, things that most pregnant women I think don’t worry too much about. I was hyper focused on the safety of my baby. And that was before I even knew about some of her health issues. So the whole time I was trying to take control of the situation that I had very little control over

 

P: let me ask you this. Were you were you physically healthy before you got pregnant?

 

J: Yeah. Oh, yeah. I’ve always been pretty healthy. I mean, even now, I haven’t ever had any health issues, which was why my pregnancy being the way it was, I think came as such a shock.

 

P: Yeah, that is super hard. You know, once you dig into the details, like the chemistry and all that a pregnancy is a miracle that anyone’s born ever. Like, it’s so so many things have to go right in just the right way. that it’s it’s a tricky thing to nail totally. So anyway, we’re in your story. We’re we’re getting ultrasounds were 30 weeks and what happens then?

 

J: So I think we were at the 35 week scan, or maybe it was right before the 36 week scan can we go in it’s just a regular growth scan. And the night before I was a wreck. I remember I was crying my eyes out with fear of what was going to happen at that next scan. And again, I think that’s going back to some of this like, anxiety, but also some intuition. Like I was really feeling like something was wrong. And it had been, I think, I think I was at a month between scans. So the last one was 30 and this one was 34. Somewhere around there. 

 

P: Yeah. 

 

J: And I was just feeling so scared. So I was there anything

 

P: was anything physical going on. Like did you feel pain or no nothing. You just had a sense

 

J: and she was kicking like my kick counts for good. I just want to correct myself. It was 36 weeks. I had the last one at 32 This one was 36. So when we were getting ready to go the morning for we would do our appointments before my husband had to go to work. So he was in his work uniform. He had his lunch all packed. We had our coffees, but I had my go bag ready pretty early on, just in case. And we drove separately to the doctor’s appointment like we always did. And they took my blood pressure. And it was crazy high. And so they were like that can’t be right. And I remember my eyes were swollen my whole face. was swollen, but I thought it was just because I was crying so much the night before. And so they took it again and it was extremely high. And then they didn’t tell me it was high. They did the scan, and she had dropped below the fifth percentile. So she was like somewhere in the second I think. And I remember the maternal fetal medicine doctor came in and with like, tears in her eyes almost, she was like just so sorry. You need to go to the hospital. You’re not going to be able to leave without your baby. We think you have preeclampsia. You gotta go 

 

and I was just like, what you know this was not an outcome I had prepared myself for preeclampsia. 

 

P: did you know what preeclampsia was?

 

J: I did from my you know, feverish research throughout the pregnancy of all things birth you know, I listened to a lot of birth podcasts. And I read a lot of birth books. And so to me preeclampsia was almost like a death sentence. I was really scared because I had heard a lot of really terrible outcomes. So she seemed scared. And that made me feel scared. 

 

P: Yeah, yeah. Yeah. 

 

J: And she basically said for the safety of you and your baby, that you got to go. And so I remember they put you in a wheelchair, wheeled me over the hospital. It was just like, This is crazy. Pierce called out of work. It’s like I think I’m gonna be on paternity leave now I got a you know, so I was already you know, I had already taken leave, I think for my job that so they wheeled me over, took my blood pressure again. I think at that point, like normal is 120 over 80 And I believe it was to 220 over 120

 

P: Oh my god. It was Yeah. Oh my I think the cutoff for preeclampsia is 140 over 90. 

 

J: Yeah, it was very it was like scary high and so they put me on, I don’t know some kind of medication right away They put me on a high dose of low beta low almost right away and that actually I continue to take for a long time. And I remember one of the first things they did when I got into my emergency triage room was they gave me a shot in my back for pennies. Like a steroid shot for her lung development. 

 

P: Yeah, 

 

J: is there like this is happening now. We need to get this baby ready so that she can survive. It’s just, I mean, those kinds of words being thrown around pregnant mother where she had probably stopped growing somewhere between those two scans. So not only was I having a 36 weaker, but it was a 36 weaker who was probably the size of like 32 weaker.

 

P: So but she was still kicking for that. Those weeks right between 32 and 36.

 

J: Kicking. Yeah, yes. Okay. Yeah, she was still moving really great. So when I would do my kick counts and stuff that was all good. She seemed, you know, she seemed pretty strong to me. Yeah. And, you know, she, they were checking her so they put a monitor on my belly pretty quickly as well. And that was kind of the beginning. of my birth story, right then, you know, kind of suddenly on a random Monday morning at 36 weeks.

 

P: And so are they saying it’s gonna be a C section or are they saying you can try to like did you have had you have imagined what the birth would look like?

 

J: Yeah, I had a doula who unfortunately was out of town because we were away before my due date. And they told me that they were going to try to induce because they, they wanted to avoid a C section. I don’t remember why. Something about losing Blood, I want to say they wanted to do it naturally, at all costs. That was the birth plan. So they were going to bring me in and have me stay in a room and induce me. And because I didn’t have my my midwife or like my actual doctor there. They were changing care plans a lot. So it was like, Alright, we’re gonna get you in a room now. And start inducing you or we’re gonna send you home and have you come back Friday and induce you no if you go home. You probably won’t be okay. And so they were kind of changing up my care plan a lot because the way Badal did lower my blood pressure. 

 

P: Oh, good. 

 

J: So that that worked pretty quickly on me. It was a very high dose but it didn’t have too bad of side effects or anything. And it was just funny because I felt fine. Like I felt swollen but yeah, I blood pressure. It doesn’t really feel like anything for me. At least I didn’t have the tunnel vision that they talked about or the headache. 

 

P: Yeah, 

 

J: I wasn’t really getting any of those. So it was just kind of a real surprise for me that I was even sick. And I remember them saying, honey, you’re really really sick. And just being like, how I feel fine.

 

P: That is kind of a weird disconnect. Right? 

 

J: Yeah. 

 

P: So how did the How did the induction you know?

 

J: That’s okay. So they ended up giving me a room and I spent about five days being induced. So I was there a long time. 

 

P: Oh my God. 

 

J: They had such a hard time stabilizing my blood pressure, like the labetalol would work one day the next day, it would not be working anymore. So they try a different dosage and they tried it intravenously. And then Penny is like her heart rate would go down with too much medication. So that was on Monday. I think the Pitocin didn’t even start until Wednesday, because they were still just like trying to get me stabilized. And the Pitocin and the magnesium I think happened on the same day. 

 

P: So are you in the hospital feeling anxious? Do you feel like I am where I need to be and we’ll sort this out.

 

J: It was kind of a blur at a certain point. Like the first couple days I was really glad to be there and I was really against them. sending me home. Like I do not want to do this at home like my anxiety is going to be out of control if you just have me sit there and monitor my blood pressure. Because you know, all throughout the night and day I had this monitor on my belly for a penny and then I had a cuff and I think every hour the cuff would go off. And then I could hear Penny’s monitor every moment. And so I was just like in full on hyper vigilance mode. 

 

P: Yeah. 

 

J: And like my mom was there my husband and like, luckily, this was pre COVID. So I could have, you know, a couple people there with me, but I just I wanted to stay in the hospital at all costs. And they weren’t going to send me home anyway. I don’t think so. The first couple days. I was definitely feeling like part of the care team. You know, I was really trying to make sure whatever medication I was on wasn’t affecting her and trying to manage my dosages and stuff. And then once they put me on the magnesium on Wednesday, I was kind of I was kind of useless to the world. There were a lot of side effects for the magnesium. I was very shaky. 

 

P: Yeah, 

 

J: like almost tremors they put me on. They put me on some drug at some point that they told me it would be like a glass of wine. And it was not like a glass of wine. It was like a bottle of wine for me. My husband always teases me and says that I asked the doctor I kept calling him man. I was like hey man. How are you? Like what? He said, I just seemed like I was my old self. But like way before being a mom like I was at a party.

 

P:  I feel like that’s the way to do it. That sounds right.

 

J: I wasn’t worried about anything for that amount of time but I was still very shaky and so the cervadil and the Pitocin. I think those both started really working on Thursday. And then I was about four centimeters dilated on Thursday. And there was a point where they felt like, although the induction medications were working, they were actually putting too much strain on Penny. So every time I would have a contraction, her heart rate would go down. So they started talking about a C section at that point. They were like this induction is actually going to be too much on her. If we keep trying to go this route. She might not make it. You might not make it. So we were talking about a C section and I was really pushing for that. I was like I do not care about natural birth versus a C section. Whatever is safest like, please just take me down there. I want to be done like I want to be safe. But they were really adamant on doing it naturally. So we kept laboring, things kept moving. And then finally very early Friday morning she was born.

 

P: Wow. So have you slept at all of these five days. I feel like….

 

J: no

 

P:  I feel like the blood pressure cuff alone would wake you up every hour. 

 

J: Certainly not more than an hour at a time. No. Wow. I I was in a fog. I hardly remember. My husband was kind of updating our family in a group chat. I remember watching movies. We watched Shrek at one point I think it was sort of like a dream state.

 

P: Can you can you push when you have magnesium?

 

J: I did. I guess 

 

P: Wow. 

 

J: can I say something kind of gross. 

 

P: Yeah. 

 

J: Is that okay on a podcast like? So I’m very stubborn. And I remember when they finally took me into the birth room, so I had been laboring in a labor room and then they are going to take me into the birth room where they had a NICU team at the ready. And they had like a warming table. It was a huge room. I think this was the room they take women who are having a high risk labor so there’s like 10 people in there. Yeah. And it felt like a spaceship. I was so out of my mind. And for some reason on TV, there was a space show. So I felt like I was giving birth like on a spaceship. And they were like okay, they gave me the epidural. 

 

P: Yeah, 

 

J: there was nothing. That was fine. I was like that was fine compared to all the other things you guys have been doing to me. And they were going to do a catheter because after you have the epidural, you know, you kind of need to do a catheter. And I was like, I’m not doing that. I’m not gonna get a catheter because I didn’t want them to have to take it out later. After all the drugs had worn off 

 

P: where’s fun bottle wine girl.

 

J; Those drugs had worn off. She would have been fine with it. This was like hungover so fun bottle of wine girl was no more and now it was hungover shaky magnesium girl. Yeah, and she was refusing a catheter. So they were like, I don’t think this is your choice. You have to go pee right now like we can tell your bladder is full and you don’t have any control. of your body. And I was like yes, I do. If you put a bedpan under me I’m gonna go pee right now.  They’’re like that’s not possible. And I was like yes if this so they put it under me and I did. I totally went pee right there. And I don’t know if the epidural totally like took because I felt a lot of labor in my back. So I guess maybe it like, halfway worked because I had total control of my bladder as well. 

 

P: Yeah. 

 

J: Which was I mean, it wasn’t super painful. It worked where it needed to work. Yeah, but I just I remember that because it was a good example of me just being so stubborn and of all the things like catheters don’t hurt that bad when you take them out. It’s not fun. But I was about to give birth and I wouldn’t let them just so stupid. 

 

P: gotta’ plant the flag somewhere

 

J: that’s where I draw the line. So the actual birth it was hard. I pushed for probably an hour and a half. Because I was so exhausted, like my body was tired and magnesium made me very out of it and I hadn’t slept. So I was just having a really hard time mustering up the strength to push so it took quite a bit of time for me to deliver her. And she was born at 1:44am on the Friday.

 

P: Wow. Oh my god, what a long labor. 

 

J: Really long 

 

P: Yeah. And what was her state when she was born?



J: So she was about four pounds. 11 ounces.

 

P: Well done.

 

J: Thank you. Not so bad. Yeah. She passed the Apgar tests greatly. So that was all good. She was cold. So she didn’t need to be in the warming table. They let her do skin to skin with me. She lashed right away. And then she did skin to skin with her dad under the warming thing or I mean like, I remember I had him wear a button up so he could do skin to skin with her, but it was like a wool button. So he was just sweating. It was way too hot. But they kind of stitched me up I had a couple of tears and yeah, she was tiny. But she was mighty. 

 

P: That’s awesome. And did she stay in the NICU for long?

 

J: So they didn’t put her in the NICU. She was just rooming with us she had like mid level jaundice. So they were just having us nurse her a lot. And unfortunately, I think our care team maybe dropped the ball. I think she probably should have gotten in the NICU. And I think she should have been observed more closely. Because they sent us home the next day that I think maybe it was the Sunday. Yeah. So we spent Saturday there and I think they sent us home on Sunday morning.

 

P: Wait, this this is too fast for me to send you home. 

 

J: I agree. 

 

P: wait,  your blood pressure is fine. Now

 

J: my blood pressure had stabilized but I was on the beta low. Okay. So I remember they were discharging us and she was doing the carseat test, which is what they do for infants under five pounds to make sure that they can like sit in a car seat. Yeah, when she passed him. And I remember being like to the doctor, hey, do you want to test my blood pressure again before I go? And he was like, No, you’re probably fine. Like they had completely stopped taking care of me. And they were just focused on her. And she seemed to be doing fine and they tested her jaundice just the one time and it was medium. So they’re like just put her in the light and feed her. Like okay, so we got home on the Sunday and she was getting yellower or and yellower and I hadn’t been able to get an appointment to get her seen for her first ever doctor’s appointment. until Tuesday. So Monday came around and it’s like she wasn’t eating very well. And they hadn’t given me any information on like supplementing with formula. I remember calling and being like, can I give her formula because I don’t know if she’s getting anything like I don’t have that much milk coming out right now. I think it’s just colostrum. They’re like hers. Her belly is the size of a nut. You know, she doesn’t need very much. I was like But she has jaundice. So we ended up getting an earlier appointment with a pediatrician. And she opened up her diaper or I did and there were crystals in the diaper because she was so dehydrated. 

 

P: Yikes. 

 

J: And she was like so she’s really dehydrated and she’s really yellow. So we’re going to need her jaundice. You know, we’re gonna have to check her jaundice. So what we’re going to do is I’m going to get you a room in the children’s hospital, so you can just go ahead and go straight there and you’ll get right into a room

 

we were like what? We have to go back to the hospital. And as it turned out her jaundice levels were like, off the charts. And she had to be she my little one day or two day old baby had to get an IV of fluids because she was so dehydrated. And that that was really hard, you know, high jaundice levels and dehydration that can that can kill an infant, you know, and I just feel like my care team really dropped the ball with us. So we ended up actually being at the children’s hospital for a few weeks, because while we were there, they found some other issues and she had a heart murmur. And it turned out she had a PDA.

 

P: Okay, according to the Mayo Clinic, a PDA is a heart condition. It stands for patent ductus arteriosus and it involves an opening between two major blood vessels that lead from the heart. This opening is supposed to exist in the fetus, and at birth is supposed to close for a baby that’s born at term. Whether it becomes a significant issue or not depends on how big it is. If it’s big, it can allow poorly oxygenated blood to travel in the wrong direction. And can weaken the heart muscle and cause all kinds of complications.

 

 J: for babies that are preemies that haven’t developed all the way it doesn’t close completely. And it’s supposed to just close over time but because she stopped cooking, it never did. So you can just hear this big murmur this big opening in her heart. And so we had to, they had to decide if they want to try to close it with a surgery or if they’re going to do a couple other things. They decided to just let it close over time. And as of today, she’s 19 months old, it still is not closed completely. It went from really big to really really microscopically small. So we’re gonna check back when she’s two to see if it closes. But she was having some issues. Like with her breathing, she was having some issues with her heart and then her jaundice was you know she had all of these different problems that probably should have been caught and taken care of in the hospital. And she should have been in the NICU getting 24 hour care, but they just kind of sent us home.

 

P: Yeah, that seems like a weird decision. Also, I guess when you told me it was going to close on its own and I wasn’t thinking of a two year timeline. Is that what you were imagining?

 

J: Most of them don’t take that long. So usually when they say it’s going to close on their own, it’s like before the three month appointment or so. 

 

P: Yeah, yeah. 

 

J: But sometimes it does take longer, just depends on the kiddo and how big it was to begin with. There’s other ways that they can do it like when it’s really big and not getting smaller for really tiny infants. I think of them like Tylenol, or ibuprofen or something like there’s there’s non invasive ways for them to fix it. But if she does end up needing a surgery, it’s pretty not easy, but it’s not even open heart. It’s just like a catheter that goes under her chest and into her heart and it just kind of like this little tiny filler where that hole is so it’s kind of you know, almost 100% success rate, but they’re not, they’re not really important. Yeah, no, no, it’s not something that’s going to follow her throughout her life. Like a lot of people who have that condition never even know about it until they’re in their 50s or 60s and they have their first heart attack. And their doctor is like, oh, when you were a baby. This part never grew in. And it’s a lot harder to do this surgery or this procedure when you’re an adult than it is when you’re a baby which is why they find it. They’d like to nip it in the bud.

 

P: Now talk to me about you How are you feeling in the fourth trimester and what’s going on with preeclampsia? And does that all work out?

 

J: wouldn’t you know it, I was still super sick. I remember when I was in the children’s hospital I felt pretty bad. And I don’t think I was taking any medication anymore. I think they just let it all come out of my system because traditionally they say the number one way to cure preeclampsia is to have a baby. I did that. And sort of I think just assumed it would solve itself. So my mom had encouraged me to get one of those at home blood pressure. cuffs at one point but we were in children’s hospital so I wasn’t going to leave her for even one second. I was having some really bad postpartum anxiety and depression and seeing her in the lights, the biliruben lights that was very traumatizing for me. So I couldn’t leave her I just couldn’t step away even for a second. And so I think it wasn’t until like a week later that I finally got out and got my blood pressure checked and it was super, super high. 

 

So I called my midwife or my doctor and they’re like, Yeah, you have to go to the emergency room. I had to leave my infant, go to the emergency room with my mom. And they were trying to decide if they were going to admit me, put me back on a magnesium drip because they were like you have postpartum preeclampsia. 

 

P: Yeah, 

 

J: you’re still a risk for a stroke or a seizure. We can’t like just let you walk around like this. 

 

P: Yeah, 

 

J: but I didn’t even notice and I think even if I was having symptoms, I wouldn’t have done anything because I just wanted to be with her. Like my my mom’s sense was too strong. I couldn’t take care of myself. But it was actually my mom. You know, convinced me so I have my baby but I’m still her baby. You know. So that was kind of a special moment for me that my mom was so involved in making sure that I was getting taken care of as well. So they ended up not admitting me I remember I was crying asking them begging them. Please don’t make me stay here. I need to get back to my baby. She’s in the hospital. And they just put me on more labetalol and I think one other medication and had me monitor it again every day on my own and it actually took three months for it to stabilize.

 

P: Yeah, that’s how it goes sometimes, right? 

 

J: Yeah. 

 

P: And how’s everyone now?

 

J: Oh, good. I’m good. I mean, I checked it for a long time, I think up to the six month mark. And then now whenever I go to the doctor and it’s been completely normal since Penny is growing amazingly well. She like skyrocketed in growth because I ended up pumping for the most part at the Children’s Hospital. They had me kind of 24/7 hooked up to have planned and so they could measure her feeds because they we had this big chart up on the wall and we would write down exactly how many milliliters she would take. You know it was like that my and then we would supplement with formula or donated breast milk as needed. So for the first few months of her life, I was nursing concurrently with pumping and doing measured feeds. And so between the first and third month she like bumped right back up to a decent percentile. You know she’s still not huge, but she was back up to like that 20th percentile range good of like, not even one. 

 

P: Yeah, 

 

J: but between birth and that first doctor’s appointment. She went from four pounds 11 ounces to just four pounds even. So she lost 11 ounces just the first day of being alive. She was really having failure to thrive, basically And the pediatrician who sort of sent us to the Children’s Hospital the first time is still our pediatrician now and every time she sees Penny, she’s like, I cannot believe this is the same baby as that stick of butter you brought it as she was the size and the color of a stick of butter.

 

P: That seems like a triumph. Right? That’s that’s a great endorsement of all parenting. Yes, I’m working on another episode of the show that includes the story of a woman who experienced preeclampsia in ways that are different from yours. And I’m putting together that story. I talked to a maternal fetal medicine doctor who specializes in preeclampsia research. And she said we need to get away from using the word cure because there’s no quote unquote cure. Preeclampsia has this extended reach and that even after delivery, both the mother and the baby from the preeclamptic pregnancy are at higher risk for cardiovascular disease going forward. In her lab at University of Chicago they’re working on biomarkers to help identify preeclampsia much earlier. Oh, she said preeclampsia comes with all these kind of vague symptoms like swelling, or you might have a headache really have a little hypertension, but there’s no protein in the urine and so it doesn’t get caught. And so her lab has figured out the ratio of these two chemicals that a preeclamptic pregnancy produces if you look at the ratio and so they can predict, you know, a month beforehand, kind of which path that you will go on because some people have hypertension and it doesn’t develop into anything. 

 

J: Sure. 

 

P: So talk to us a little bit then about your ongoing care of yourself or like what you’re doing

 

J: so I think preeclampsia basically what led to us being one and done. First and foremost. Yeah. It took me about a week from having, you know, been past that experience to say I’m not doing that again. Yeah, and talking to doctors because we’re in the hospital setting and saying Is this likely to happen again? And I’m saying well, yeah, if you’ve had it once, it’s not unlikely that you’ll have it again. It’s not 100% Guaranteed right? And then talking to my primary care doctor after having postpartum preeclampsia. They told me that because I’m like, so predisposed to hypertension, and then it kind of stuck around for so long that he would think it actually is more likely for me to have it a second time. I’m 29. Now so if I were to get pregnant again, I would be a little bit older. And for me, from what I can tell from my care team, it feels like a 5050 split, whether it would happen again in my second pregnancy. So that was my first decision. We were gonna have several kids and we decided to cut it short at one. 

 

And aside from that, I’m just a lot more involved in my care, you know, I go to my doctor’s appointment, I do yearly physicals, I try to stay active, all these kinds of things. I actually just found out that I have like permanent damage to my eyes. My optic nerve was damaged somewhere in my pregnancy. It’s possible that it was that time of very, very high blood pressure that did damage my optic nerve, but it puts me more at risk for Glaucoma. So that’s like another thing.

 

P: Can you do you feel any symptom of that now or no?

 

J: Well, I just got new glasses, but I went to the doctor just to get a routine eye exam because my vision had changed a lot pre pregnancy to now about 19 months later. And that’s normal, right? When you have a baby your vision changes, but it had gotten substantially worse. And I had this new optic nerve issue. So that’s something I have to do yearly eye exams and eventually I might have to do some glaucoma risk care. So there’s like these eyedrops that you can take to make sure there’s not too much pressure on your eyes. It’s actually very treatable if you catch it early, which luckily I seem to have done.

 

P: So Pregnancy is a stress test, obviously on everyone’s bodies, and that’s one thing it is hard to, I think, carry the burden of a potentially chronic condition. At the same time. It feels like you’re getting in at a time where maybe you can affect that trajectory. 

 

J: Yeah, 

 

P: so. That’s kind of you know, if there’s any good news to be had in this

 

 J: I feel like you know, my husband and I met and we pretty quickly got married, like within a year and a half of our first date. We are married and how to house like we moved very quickly. And we had already known each other a long time so his sister is my best friend. 

 

P: oh lovely

 

J: So we knew each other but like our first date, I should say not really when we met anyway. It just all moved so fast. And sometimes I wonder like wonder what made me want to move so quickly. And I wonder if somewhere deep inside like I wanted to do my pregnancy as early as possible before I was any older, because maybe my intuition was telling me like this isn’t going to be super easy on your body. And I don’t know. I just wonder if the universe helped me out with that or something. Because 

 

P: Yeah, no kidding. 

 

J: I kind of got out lucky all things considered. And so Penny,

 

P: totally, totally. I’m curious here. We’ll say this. If you could give advice to your younger self, what do you think you’d tell her?

 

J: I don’t think I would change anything. I wouldn’t have wanted to have a baby any earlier. That’s for sure. Yeah, just like emotionally and maturity wise. Yeah. Right. So I think I would be pretty proud of my younger self for everything that she did to get me here and get me to a place where I can be a good mom and and survive this really difficult pregnancy.

 

P: It is amazing, right? I’m sure you look at Penny as she grows every day and think I can’t believe it.

 

J: Yeah, I absolutely do. She’s my lucky penny. That’s what I call her.

 

P: That’s awesome. So how old is she now? She’s she’s not too yet.

 

J: No, she’s 19 months old.

 

P: So we’re her tricks. What does she like to do?

 

Unknown Speaker  13:40  

Oh, she’s got a big personality. She’s really funny. She likes to make people laugh a lot. So she’s like our little comedian. If she does something that makes you laugh once she will like do it a lot to try to keep getting a rise out of you 

 

P: super cute. 

 

J: She likes to copy what you’re doing so like today, or yesterday we were doing like a Baba Baba bad and then she would do it back to us. Yeah, like she’s very musical. And I don’t know, I think she’s going to be somewhere in the entertainment world because she just like she likes to be the star of the show. And being an only child is only going to add

 

P: I was gonna say to the stage already. Yes. Nice to know, totally carved her path is awesome, Jessica. Thanks. So much for coming on the show and sharing your story. It’s an important one to share and one that I think is totally hopeful.

 

J: Oh, good. Yeah. Thank you so much for inviting me and if there are any parents out there who are struggling with the decision to relive anything that they went through with their birth experience, I would just like to say to them, you know, your mental health is really important. And your physical health is really important. And if that means your family has to look different than you thought it would, that’s okay. And you can give yourself a little bit of grace for that.

 

P: Yeah, that’s a great ending message. Thank You 

 

J; Absolutely

 

 



 

Episode 35 SN: Vagonominal: A vaginal delivery and a cesarean visit the same birth: Kristy

Today we are lucky to get to talk to a midwife who shares her experience of a twin pregnancy. The process of getting pregnant and giving birth did not look at all as she had planned–and she had a lot of real information on which to base her prediction. Although she didn’t have the specific birth she originally envisioned, she successfully carried twins to term, and gained personal experience with more styles of delivery in one pregnancy than most mothers of twins–she delivered one twin vaginally and the other through cesarean section–which she described as a vaginominal, thus the title.  Now she can bring her hard won knowledge to her midwifery work.

Relationship between sleep and birth outcomes

https://academic.oup.com/sleep/article/43/12/zsaa110/5851407?login=true

https://pubmed.ncbi.nlm.nih.gov/29103944/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836666/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824023/

Preeclampsia

https://academic.oup.com/jn/article/133/5/1684S/4558569

https://www.uptodate.com/contents/preeclampsia-clinical-features-and-diagnosis

Maternity leave laws in US

https://worldpopulationreview.com/state-rankings/paid-maternity-leave-by-state

https://www.bls.gov/opub/ted/2017/establishments-with-fewer-than-50-workers-employed-60-percent-of-construction-workers-in-march-2016.htm

https://www.patriotsoftware.com/blog/payroll/states-with-paid-family-leave/

Audio Transcript

Paulette: Hi, Welcome to War Stories from the Womb. I’m your host, Paulette Kamenecka. I’m an economist and a writer, and the mother of two girls. My kids are in their late teens, and talking with todays guest, who has kids of the same vintage, its really interesting to acknowledge how much has changed in the world of pregnancy between the time we had our kids and now. And that comparison is made possible by the fact that today’s guest is a midwife.

The process of getting pregnant and giving birth did not look at all as she had planned–and she had a lot of real information on which to base her prediction. Although she didn’t have the specific birth she originally envisioned, she successfully carried twins to term, and gained personal experience with more styles of delivery in one pregnancy than most mothers of twins–she delivered one twin vaginally and the other through cesarean section–which she described as a vaginominal, thus the title.  Now she can bring her hard won knowledge to her midwifery work.

Let’s get to her inspiring story.

P: Hi, thanks so much for coming on the show. Can you introduce yourself and tell us where you’re from?

 

Kristy: I’m Kristy Culp-Leonard and I’m from California. 

 

P: Cool. Thanks for coming on the show Kristy. One thing I should bring up before we really get into it is that you are a midwife, which is super cool. So But before we talk about your kids, why don’t you tell us how you came to midwifery?

 

K: Oh, wow. Well, that’s a long journey ago. I’ve been a certified nurse midwife since 2002. I was my in my early years in college, I did public health work in Latin America, and was very much interested in Spanish speaking culture and then found myself to also be interested in public health and working with families and decided to go on to nursing school with the idea was going to be a nurse practitioner and work with women and families, and then learned about becoming a certified nurse midwife and being able to really care for women through their lifespan and work with them. Through labor and birth and empowerment and post birth. So that’s how I ended up being a certified nurse midwife.

 

P: That’s very cool. Where are you in Latin America, what countries.

 

K: I have an in Paraguay twice. Costa Rica. And Mexico twice. 

 

P: I assume you’re fluent in Spanish. I’m totally jealous. Oh my god. That’s very cool. Did you become a nurse midwife before you had kids? 

 

K: I’d graduated from the University of San Francisco with my bachelor’s in nursing. moved to Houston Texas. Wow get work experience knowing that I wanted to be a nurse midwife. So my app the time fiance but now husband, we just packed up and moved there and and I worked is an OB nurse in labor and delivery are about five years before I went to midwifery school at University of Texas in Galveston.

 

P: Okay, so you’re a midwife first. So how do you step into pregnancy? Many of us who you know we’re just civilians, we walk into pregnancy with this very idealized view of what it’s going to look like. But I wonder how people in the know might approach it.

 

K: so we were very plans. husband went to law school, some work experience. I was getting my graduate degree in midwifery getting all of our degrees out of the way. Kind of like a lot of Silicon Valley couples these days. 

 

P: Yeah, 

 

K: and work experience and then decided on having a family also decided to go back and get a master’s degree which kind of threw a wrench in it all. But that’s, that’s okay. I was a professional as an as a certified nurse midwife at the time, and then we encountered some trouble getting pregnant and had to seek out some assistance there. So that kind of threw us for a loop because I had at the time done a lot of internships in birthing centers and home birth and just really had this dream of a beautiful waterbirth with my colleague in her birthing center, and all of a sudden those dreams came to a halt because we had to work on getting pregnant, not the most traditional way at home. So but we were pregnant with our first try through assistance. Twins. 

 

P: Wow. I remember when I was pregnant, and we got that first ultrasound, and they’re like, I see a heartbeat and I was like checking CVC and other one was keep looking around there. So that to me feels like a feels like a lottery win. When were you excited for twins?

 

K: I was not my husband was super stoked. He was like, oh two for the price of one. I immediately as a midwife, and having previously worked as a high risk OB nurse. I was stressed, worried about premature birth. Worried about being laid up at home in bed all the time during pregnancy. I was not excited at all. In fact, it probably wasn’t really embracing it until about halfway through the pregnancy.

 

P: So this is a difference between knowledge and no knowledge, which is you and me because I would have no idea what the risks are. So I like your husband will be like oh my god, this is so great. We only have to do this once. 

 

K: Right? And I was not feeling that and you kind of at the beginning of pregnancy in general. You don’t feel that great or most people don’t feel that great with morning sickness and just feeling really tired. I think with twins, you have a much higher risk of morning sickness. So just knowing that in my mind, I kind of went full force with all of the natural remedies like taking vitamin B and trying all of the other natural remedies like ginger and just making myself eat a snack every two hours regardless of how I felt. So I think that kind of stuff was really important at first I was also extremely worried about the future, looking all the way forward to school days with twins and parenting twins. And is it right to have them in the same class or not? And so I’ve all of a sudden had to like start reading general lay persons literature about parenting twins and trying to not look at it from a clinical perspective.

 

P: yeah, yeah, You’re right that it does obviously bring up 100 different challenges for parenting that you may not have. It just does having twins mean you can’t do the waterbirth 

 

K: correct

 

P: okay, so you also do that? 

 

K: Yeah. Oh, yes. During our pregnancy, we went to a cloth diapering class at my friend’s birthing center. And it was it was the first time my husband had ever been there. But I had been there to seeing as a student nurse midwife, and assisting in birth, I said, Hey, let me show you this place and we walked around and he was like, Oh, my gosh, this is seems so awesome. Why can’t we have the babies here? And I was just like, Oh, you just like crushed my dreams.

 

P: Yeah I’m on a slower learning curve with your husband there. It was. It would have taken me going as well to be like, Oh, this idea. So how was the pregnancy?

 

K: Actually my pregnancy went pretty well. Probably around 12 weeks of pregnancy. I let most of my co workers know. I was pregnant and they were super kind and took me off of night calls. So I didn’t have to do night call in the hospital.

 

P: So it occurs to me that very few professions would be so understanding about pregnancy in terms of what your schedule was like, is there are they just being kind or is there clinical evidence to suggest you need to sleep or you shouldn’t have interrupted sleep or anything like that?

 

K; that’s a Good point. I think that we know being mindful and having less stress is really important for pregnancy. And however, there’s not a lot of great supports in the workplace for that. We experienced this with all kinds of professions I do when I’m caring for patients. And they happen to have the night shift whether they’re working at Home Depot stocking housekeeper for a hotel or a nurse in the hospital. Yeah, and there’s really not much as a professional that I that we can do except for just saying, you know, it’s really important to manage your life when you’re not at work. Make sure you’re getting adequate sleep for me because I’m a nurse midwife. We work in the office so we have daytime work hours as well as nighttime work hours, and you swap back and forth a lot. So I think if there was another person in my practice that had a singleton pregnancy, the group might not have been so supportive. But knowing that this was twins and I think some people knew that it was challenging for us to get pregnant. They were supportive 

 

P: kudos, to practice for doing the right thing.

 

P: so I was impressed by the nurse midwives in Kristy’s practice before I did a lot of research but it turns out that researchers think there is a relationship between sleep and birth outcomes. There’s some studies in both humans and racks that suggest as you might expect, that sleep deprivation is associated with worse outcomes for mother and baby. It’s associated with higher rates of gestational diabetes in the mother, which is probably not super surprising. Since there’s a bunch of research about how sleep deprivation interferes with glucose metabolism in people who aren’t pregnant. But in pregnancy, this problem can be shared with the fetus and affect this development. One study found a higher rate of preterm births. Another found that sleep deprivation of the mothers was related to higher BMI. And higher risk for overweight or obesity in girl babies, but not boys. It’s nice to see a practice treating one of its own in a way that is consistent with good birth outcomes. Now we just need the rest of the workforce to follow suit and think more carefully about how pregnant women are treated since it fell in love who’s affected it’s also the baby which translates into public health.

 

K: I was still working a solid 40 to 50 hours a week. Yeah, it’s the removal of night call was extremely supportive and helpful. Yeah.

 

P: That’s awesome. So, so 12 weeks you tell everyone and you’re doing pretty well. And then for twin pregnancies, does it start imagining and starts to feel harder to carry the pregnancy just kind of physically earlier than it does for a single family? Is that your experience? 

 

K: Yes. When I was 12 weeks pregnant, my tummy was probably more like 18 to 20 weeks sighs maybe still you can hide it and scrubs. 

 

P: Yeah, 

 

K: at work. Well, yeah. And then around 30 weeks, I looked like I was gonna deliver. Yeah, it’s just extra heavy weight and little ones growing in there.

 

P: Are there any recommendations for twin pregnancies like different levels of vitamins or something else you’re supposed to do?

 

K: Yeah, I did do some early reading in the pregnancy and what I was basing it off of was like a twin mom book that I had read about vitamins and protein being really important to try to prevent preeclampsia in pregnancy.

 

P: One thing that’s interesting about talking to Kristy is that she’s in the medical field so likely in touch with the most up to date information. And in the last 20 years since she’s had kids, information, ideas about preeclampsia have changed. So for example, around the time when her kids were born, doctors used to say that preeclampsia resolves with the delivery of the baby in the placenta. And now doctors think that preeclampsia is not a condition cured. By delivery. And long term women who experienced preeclampsia are an increased risk for heart and kidney issues. Researchers used to think that protein intake might be related to the incidence of preeclampsia, as well as calcium, sodium, iron and folate. But now more extensive studies suggest that we can’t link protein or these specific micronutrients to the development of preeclampsia. So medical community has known about preeclampsia for something like 2000 years, but we still don’t know what causes it. Having said that, you can’t really go wrong by pursuing a healthy diet. The only trick there is defining healthy

 

P: are you at higher risk with twins? 

 

K: Yes. 

 

P: Okay. 

 

K: higher for gestational diabetes, preeclampsia. And so I just really managed my nutrition really well. And made sure my body was nurses like those cupcakes. Eating those I was like, I’m not doing it. I because I don’t have a lot of space, right? 

 

P: Yeah, yeah. 

 

K: So it has to be pure value if I was eating it.

 

P: That’s an impressive thing to follow. Because it takes a lot of willpower and you’re already tired with my first pregnancy. I was really careful about eating what I imagined in Olympian would eat. And with my second one, I was nauseous the whole time and only ate hotdogs and I’m a vegetarian. So it’s disgusting and under no circumstance should anyone consume that many hotdogs but I just I couldn’t I couldn’t hold anything else down so I’m impressed that you that you kind of traveled the straight and narrow….that’s a hard thing to do.

 

K: Well, interesting thing is, this was back so they were born in 2004. Yeah, so it was near the end of my pregnancy. I think I remember reading an article about professional article about mere mercury and fish and really the types of fish we should be limiting during pregnancy. Like all of that information started coming out. Yeah. One of the things was albacore tuna. Oh, my main sources of protein during my entire pregnancy was albacore tuna. So I stopped eating the albacore tuna probably about and went to chunk light tuna, probably only about a month before they were born. That was really science.

 

P: Totally, totally it you know, you’re you’re doing your best and you’re you’re better than Mrs. Hot dog. So that’s a we’ll take a week yet. So how far do you get to your in your pregnancy?

 

K: Well, that’s an interesting situation. They were born 39 weeks and four days. Wow. That’s 2004 Oh, so about I think it was about a year or two after that recommendation from maternal fetal medicine was that twins should be delivered by 38 weeks of pregnancy because of risks of the placenta, just aging and maturing a little bit faster and maybe not functioning as well. At the end of pregnancy, also risks of hypertension in the mom.

 

P; So did you make it to that late date intact? Is there any obvious cost to you for going longer?

 

K: But I worked all the way until 39 weeks? Oh, wow. I was living in Texas. We don’t have state disability there. So I had to work. And I actually I probably had preeclampsia in retrospect. And they were most likely some pretty solid signs of it starting around 37 weeks.

 

P: What so what happened that what happened that wasn’t caught by her practice?

 

K: well, I think there was this feeling of oh, she’s gonna be fine. When she lays down her blood pressure goes down. So a couple things we look at when there’s preeclampsia and pregnancy is maternal blood pressure. If it’s elevated, then that signs of at least hypertension, high blood pressure and pregnancy and then if there’s protein in your urine that’s a latter sign of eclampsia as well. So I had intermittently small amounts of protein in my urine, but when I would lay down my blood pressure wasn’t really elevated at all. So 

 

P: are the guidelines for the blood pressure positional 

 

K: not really like your body shouldn’t be shooting high blood pressures, intermittently like that? 

 

P: Yeah. 

 

K: I’m currently speaking about hypertension from my current knowledge and what the guidelines are currently. Yeah, this is back in 2004. 

 

P: Yeah, 

 

K: we weren’t as strict okay about hypertension in pregnancy. So I would go into the office and be checked and then I would take a couple breaths and my blood pressure would be fine. And then I would go home and I feel fine, no headache or anything like that. And then at 39 weeks, in a couple of days, I had an office appointment. And my blood pressure was sustaining of pretty high, pretty high numbers. In that practice. I was sent home to rest with a plan to be induced the next day, when a bed opened up. If I had at that time if I had seen a person in my practice with those blood pressures. He would have said Beeline it to the hospital right now. But I was in a different practice slightly different guidelines at that time. So I said, okay, I’m fine to go home because I’m in my heart. I didn’t want to be induced. But clinically, I knew it was right to be induced.

 

P: Well, that sounds like a tricky thing. And advances in medicine take a really long time. This doesn’t seem all that long, right? It’s like 17 years. Right? So it’s interesting how much we have learned about pregnancy in the since well, I have a 2004 birth also. So since those kids yeah, I feel like a lot has changed. 

 

K: I’m going to rewind a little bit. So just share one of the things about twin pregnancies, 

 

P: yeah. 

 

K: And route of delivery though. So it’s in twin pregnancies. We have to be concerned about the two babies and the position that they are in the womb. So ideally, you have babies in the womb that are both head down. And we checked out at the end of pregnancy and if a person’s desiring a vaginal birth, and we move forward with plans for vaginal birth twins are both head down. 

 

So in my pregnancy at around 28 weeks, first baby twin A is head down but Baby B was Baby B had prior to that then head down or vertex so he continues to be breach breach breach, and I started going bonkers thinking I’m not having a cesarean birth and talked to my OB was in support with my midwife and I said I know you have a lot of experience with a breech extraction. And we need to have an honest discussion about this because I really want to have a breech extraction with Baby B. And he kind of was not giving me like an absolute solid answer on that. Well Kristy, we’re just gonna kind of roll with it and see how it goes. And let’s just seeing it that baby turns. I start getting stressed about this and start at around 

 

P: thats  a stressful answer. 

 

K: right? I think it’s yeah, it probably didn’t help that my husband is an attorney either. So we have a midwife patient and houses an attorney and honestly, so I enlisted some support of local pregnancy natural support people in Houston. First I went to my acupuncturist said we got to do something to help this baby turns her head down and they’re like, no, what we’ve got we we do have tricks for that, but not when there’s a twin pregnancy. You can do some acupuncture to help with relaxation. Oh, I did that. Then there’s a doula massage therapist in Houston at the time, who was known for pregnancy massage and helping open up the lower back and the mostly the lower back of, of the pregnant woman at her hips. In her massage techniques, and frequently breech babies would turn to head down. So I started seeing her like two to three times a week, around probably around 35 weeks of pregnancy. It wasn’t cheap. It was well worth it. Initially, I knew there was an OB physician in Houston. That’s known for his technique at doing vaginal breech births, which now is more of a lost art, especially for the first time mom and I had actually like looked into going to him to transfer care. It was like 37 weeks of pregnancy. 

 

P: Yeah, 

 

K: really late. 

 

P: Yeah. 

 

K: So if I did transfer care to him, though, it was going to be extremely tricky. It was going to definitely be induced labor because of his call schedule and where he worked. It was going to be a lot more medicalized than I was really desiring so I decided to stick with my team. I was super nervous about being in the hospital, even though I work in a hospital and literally went on two tours of the labor and delivery unit with my midwife. I was just like, oh, I have to see where I’m going to be. I have to see the operating room. I know I’m going to give birth in there so I’ve got to got to feel comfortable here. So fast forward to about that 39 week visit where my blood pressure is going up. We do an ultrasound and lo and behold, Baby B is head down as well. 

 

P: Oh, Wow, 

 

K: so I’ve got two babies that are heads down. And at this point, I was like, Okay, this is great. I’m totally on board with being induced. I know I have high blood pressure. This is a bummer but I can do this.

 

P: Is it riskier to be induced? What if you have high blood pressure?

 

K: not necessarily, I mean, it’s risky to stay pregnant, 

 

P: okay. 

 

K: Depends on how high your blood pressure how high the person’s blood pressure is, and if we can control it, so sometimes there’s people depending on where they are in their pregnancy in the way the baby’s laying that do need a cesarean birth as a  result of their high blood pressure, okay? 

 

P: but You’re not that person. So, now I’m imagining your bag is packed and you go in for your induction.

 

K: Well, my bag is packed. And I go home and I from the office and I sleep right? And then we call the next morning. We’re ready. Like when should we go in and they’re like, You know what, we were really busy all night. We don’t have a bed. So, 

 

P: wow. 

 

K: So eventually that evening, have a bed for me. And so we go in to be induced 

 

P: and how did that go? 

 

K: We get there and one of the midwives from the group, probably I would say the people always have personality clicks, right. And so she’s like one of my favorite midwives in the group. She was on call that night. So she comes in and she checks my cervix. And I was thinking I was like, you know, maybe a half a centimeter dilated or one because my physician the day before checks me and she looks at me with all honesty and she said you know, Kristy, I think doctor was really generous. Yesterday, your cervix is rock solid. 

 

P: Oh 

 

K: hard and you are not dilated. So I’m just gonna start this induction

 

P: so you’re starting from ground zero 

 

K: there is what I’m starting from ground zero and we started with Pitocin and my IV from ground zero.

 

P: Well, that doesn’t sound comfortable already.

 

K: Really, but here’s the thing. Things that happens when a woman has preeclampsia and I’ll be honest, I don’t truly understand the physiology of this but a true a person with true preeclampsia many times once their body is into labor, they just go and their bodies like we know we have to cure this by delivering the baby in my case babies and placenta so also as pretty. I feel like I’m fortunate my mom has really good birthing genes. She’s just kind of like that person that accepted labor contractions and just went with it and had a baby in a normal ish amount of time. So I just kept thinking about my mom during the labor and go and thinking like I’ve I’ve got my mom’s genes on my side, I can do this. My husband and I did have a doula with us. It was someone that I had worked with in the community, so I knew her do her techniques. I felt super comfortable with her. 

 

So she was there for our labor. The beginning of the labor, we started with Pitocin it was a little rough. I had a newish nurse caring for me. So this was the hard part. Because remember, I had been a nurse before I was a midwife I have ideas and how a nurse should be 

 

P: Yeah, yeah. 

 

K: And I don’t think we were a good personality fit. That’s okay, but one of the things for me was don’t offer me pain medicine. I’m very much aware of what the options are. I’ll let you know if I want it. And the first couple hours all of a sudden into labor I just had some excruciating pain in like, of my lower quadrants on my abdomen and it would not let up at all.  In retrospect I think it was probably one of the babies like just elbowing me and was just like, This is what I’ve got to do to come out so deal But The team was pretty like worry about my level of pain, because it wasn’t related to contractions. It was like this severe shooting pain and rare but we’re always concerned what if there’s a spontaneous uterine rupture like it’s thin and it ruptures or something we’re more concerned about that of course and someone that’s having a vaginal birth after cesarean but the twins do create an over distended uterus, so we turned off the Pitocin for a while. And the nurse of course offered me pain medicine. 

 

And I was like, we’re not going there. My doula will be in in just a moment. And I think like at that point, I was probably only like, one and a half centimeter dilated or maybe even one. Like I knew this was gonna be a long night and a long next day, and I’m sure everyone in the background was like just shaking their head and rolling their eyes at the midwife laying in the bed in room, whatever. But my Doula Nadia came and when she was there, I just felt like super confident and comfortable. And something just changed. And I said, let’s start that Pitocin backup. Come on, like we’re not going to sit here all day. 

 

P; Yeah, 

 

K: or really. It was at night. And I think we started the Pitocin backup around midnight. And things just truly picked up at that point in they did not have any option for like cordless monitoring or anything like that and the bathroom was across the room from the fetal monitoring.

 

But I felt the best sitting on the toilets. So I had every like side effects like nausea, vomiting, and and I was like, Well, I’m gonna I’m gonna go to bathroom. I need to go to the bathroom. And I just kept getting off the monitor and going to the bathroom. And I begged my midwife please can we just like let me take five minutes shower. Like because I was trying so much just be in the shower because I knew that water is like what we call an agua dural. So water is super helpful for support but I couldn’t be in there. Because they had to monitor the high risk pregnancy. And keep in mind I had high blood pressure too. My midwife had to come in and give me a little lecture on how it was really important to be on the monitor. So we went back to the bedside, and I was on the monitor and then the nurse kept fiddling around with the monitors on my tummy which drove me crazy because the night before I got into so I broke out with a rash called pups, which is an itchy rash all over it was all over my lower abdomen and thighs. 

 

And so I was extremely sensitive to fetal monitors. I was just getting annoyed with them adjusting them the whole time. So my bag of water had broken and my husband was super stoked and excited things are moving along. And Nadia and I just looked at each other and we’re like, we’re not gonna make a big deal out of this out the bag of water breaking and we just kind of just kept laboring because we felt like the more the nurse wasn’t in the room, the better it was for my mental state and progress, which absolutely was true. They should have changed I should have asked for a different nurse or they should have changed us or something.  Bad personality fit but that’s okay. 

 

At Some point my husband goes outside to get ice and water and he’s just so excited and he tells the nurses all we think her bag of water broke about an hour ago.

 

P: Oops.

 

K: Exactly. So Nadia and I when we heard that, that he did that we were just shaking our heads because we knew we were like doing this on the down low or not telling anyone because we knew the babies were fine like listening to their heartbeat. And we knew that they had central monitoring outside of our room and they could see their heartbeat tracings. So it was fine. So the nurse comes in, you know, we get scolded, how come you didn’t tell me? Because everything’s fine. That’s why we didn’t tell you I literally I had to calm her down. I said because everything’s fine. That’s why we didn’t tell you. And then she, she looks through the pads and she’s like, there’s Meconium in the amniotic fluid. I said yes, there is. It’s like meconium but everything is fine. So there’s nothing we’re going to change about this. We’re just going to keep supporting my labor. I mean, I’m having to labor support my nurse, literally so as much as possible that we could get her keep her out of the room. It was great. 

 

At that point I said you know what, I’m I’m done with you pressing around on my tummy. Can we just put scalp clip on baby as head because it’s hard for you to monitor and I can’t I can’t handle you touching me all the time. And so we agreed to that. I was four to five centimeters already. I was probably like, at three in the morning. Literally. We started Pitocin around midnight, and that was probably around three or four in the morning. 

 

P: That seems fast. 

 

K: oh Yes. It was. And I was really like, don’t really want to be in my mind. I was like, I don’t want to be checks because in my mind I was thinking oh my word. I’m only going to be one centimeter and it’s going to be so depressing. I don’t want to know that I’m one centimeter but I’m bracing myself mentally. I can do this if I’m one centimeter right. And then she’s like, you’re like four to five. Okay, that’s pretty impressive. We put the scalp electrode on the baby and then probably about an hour and a half later I’m still standing at the bedside standing getting on my hands and knees just moaning with each contraction and just taking one at a time. No pain medicine at all. And then probably about an hour and a half later. Started like showing signs of transition shaking. Things were just getting really intense. 

 

I think we had to check on one of the babies or something at that point. Or it could have been a time when Titi was telling me I needed to stay on the monitor again because I was sitting on the toilet a little too often. And so she checked me and I was already seven to eight centimeters. 

 

P: Oh Wow. 

 

K: It was really intense. Pretty sure she left the room and went and called the doc because he was probably at home I’m assuming to say hey, you’re not going to believe this or midwife twin patient is almost complete. And so about an hour, hour and a half after being seven centimeters I was fully dilated. 

 

P: Wow. 

 

K: Yeah. 10 centimeters and bearing down spontaneously. 

 

P: Wow. 

 

K: Yeah. Kind of how my mom’s? I think labor went like smooth that way. Like literally like I really only had like six hour labor though. 

 

P: Wow. So is the delivery smooth now that we’ve gotten complete,

 

K: right? So my doctor, he comes in and he’s just like trying to you know, talk to me and I’m just having contractions back to back. And I’m on my hands and knees and I just keep looking at him going.  This is so hard. This is the hardest work I’ve ever done. This is so hard. That was my mantra. I never said like, I can’t do this. How much longer nothing like that. I just kept acknowledging how challenging the situation was my doula and I didn’t really want to start pushing in the operating room. We really were hoping to like do some of the pushing in our delivery room but with twin deliveries, you need to go to the operating room for the just in case 

 

P: Yeah, 

 

K: there was a scenario and my midwife told me, Oh, Kristy, you’re doing great. You’re not going to push that long. Which I will never say that to a patient because that was the longest hour in my life. So we go to the operating room, and unfortunately in the operating room, you’re laying on a table meant for surgery. It was much different than my my ability to be free standing or on my hands and knees and moving around and squatting. And I was just laying there and with my over distended tummy it was plopping over to one side or the other was very challenging to get my pushing efforts together. There’s probably about like 10 or 15 people in the operating room, which I didn’t really feel or notice, because I think I was used to that. 

 

P: Yeah, 

 

K: but my husband was like, Oh my gosh, what’s going on here? So we just working on pushing a lot of like the nurses had to do a lot of coaching. Eventually, they pulled in this nurse who I had actually worked with when I was a labor and delivery nurse before I was a midwife, and I really admired her and thought she was a great nurse. She just got in my face and was really screaming at me like come on, you can do this. You’ve got this that’s exactly how to do it. And that is truly what got me to help birth my baby. Some people really want to have a calm pushing experience. But I needed somebody to be in my face, coached me through this to give me the feedback. 

 

Additionally, I was like, Wait a minute. It was just running around in here and nobody’s helping me hold my tummy. I was lucky enough. They let my Doula go in. And I think that’s really because possibly my persistence and me being a midwife, and they knew that we had this really good teamwork bond going on. 

 

P: Yeah. 

 

K: And they also they they knew this doula really well. And so usually you can only bring one person into the OR with you but husband and doula both gotta go. And Nadia knew her place and she sat there and she just like worked with me and helps me.  She helped hold my tummy in place. And then I was like, Don’t you know, have a mirror in here so I can see what I’m doing. They got that mirror in there and the nurse was super helpful was coaching me then we had baby A.  so Baby A was born and was handed to the pediatric team I barely got to see are our babies were our their genders were surprised. So that was exciting. 

 

P: that is exciting

 

K: it was a little girl. And I totally didn’t believe my husband when he announced it. That was one of the like the the most important thing I had a birth plan. The most important thing to me on it was nobody announced the gender of our children let my husband look and say it’s everything out like if I got an epidural or something like that, I’d be okay with it. That was the most important thing. So he told me and I was like you got to be like, I don’t believe this. I said, Okay. And then I just remember looking up at him and going, Oh, my God, I got to do this again for the next one. So at that point, there’s in a twin delivery there’s a lot of poking and prodding and everything into the vagina and feeling the cervix and breaking the bag of water and think, you know, ultrasound on your tummy to check the position of baby B and that was that was pretty stressful. So we confirmed Baby B was head down. they broke the bag of water which Ideally,

bring the baby’s head down to the cervix and then you just push the baby out. That’s not what happened in my case. 

 

So my cervix moved back to be about eight centimeters dilated 

 

P: No, 

 

K: yes. But I didn’t know that. And baby’s heart rate started having these huge dips, which I was not aware of because part of me trying to be mindful and in the moment of labor and birth was I absolutely didn’t follow. I didn’t look at the fetal monitoring or anything like that. I was not interpreting anything that was going on. I just said, You know what, I’m just going to take care of each contraction at a time, push the babies out. You’re my clinical people. Trust that you’re monitoring the monitors. Right? 

 

P: Yeah, 

 

K: It’s not my job. My job is to go through labor. Not a midwife today. Oh, I didn’t know his heart rate was doing all these changes. Everyone in the room starts to get a little worried. Doc was in there and you could see the look on his face like oh, he’s like, listen, we have to have a true discussion here. Baby B’s having a lot of decelerations on the monitor. This doesn’t look good. I’d really like to deliver baby soon. But we can go through a few more contractions and see how it is a baby will tolerate it. So we go through a few more contractions and at this point, they turn the volume up on the monitor so everyone knows what’s going on. And then I hear it and I can just hear the dunk. Which is a very slow rate, right? Oh, yeah. And I was just like, Oh no, this isn’t good. I practically sat up on the operating table and I was like, I give you permissions. Put a vacuum or forceps on baby B right now. Let’s just do it and he looks at me and says, You know what? I can’t do it. You’re only eight centimeters.

 

P: Are you surprised by that? Is it normal for the cervix to close? Well, there’s another baby in there.

 

K: I mean, it could but it’s not that like usually in all of my experience. Between deliveries. You break the bag of water. The baby mom bears down the cervix stays dilated. 

 

P: Yeah, 

 

K: you have the next baby. There’s usually like a, like a 10 minute difference in their age or something like that. 

 

P: Yeah. 

 

K: No. And so we try a bunch of position changes to alleviate heart rate changes, and that didn’t work. So I decided that I needed a cesarean birth for the Cesarean birth though I remember I don’t have any pain medicine. 

 

P: Oh, yeah. 

 

K: So I just started to mentally prepare myself that I was going to have to have general anesthesia be put to sleep 

 

P: because that’s faster acting than a seat get an epidural. Right?

 

K: Yeah, I started to get like a little teary eyed and freaked out but I was like, I can’t do that. Because if I’m freaking out, going under, I’m going to be freaking out coming out. Need to just calm down. And I remember the anesthesiologist, just saying in his like lovely think it was a British accent. Listen Kristy just roll over to your side and push your back out and let me see if I think I can get a spinal anesthesia in you really fast. And I was probably the most compliant person ever. 

 

I rolled over. I was laying there for probably like two minutes, maybe three, pushing my back out towards him. Watching the fetal monitor and watching that baby’s heart rate go super low. And then he’s like I got it in control over now. Oh, who’s like the most grateful person ever? Because that is not very common. 

 

P: Yeah, 

 

K: it was literally like three minutes. I rolled over. I looked at the team and I said because you have to have a Foley catheter in your bladder before surgery to keep your bladder empty. And I was like, alright, team, let’s put in that catheter and let’s go then I was kind of a midwife telling them what to do. Then they started the Cesarean birth, and I looked up at my husband and that was really scary. I looked at him knowing what I saw on the fetal monitor and I said this might not be good. It might not come out screaming and crying right away. That’s why we have this neonatal team in here. We’re just gonna like, be calm right now, but this might not be good. And that was sTinker came out. screaming and crying. 

 

P: Awesome. Well done. 

 

K: Yeah, I joke now that it was a vaginal birth. One vagina, one abdominal.

 

P: I feel like you’ve coined a useful phrase here.

 

K: Yeah. I’m like super grateful for the anesthesia team for their skills. Getting that spinal anesthesia in me. I’m super grateful because like, literally that was about three minutes. And they’re under some stress. 

 

P: yeah, Yeah, 

 

K: trying to feel through this and also thinking like, I’m not gonna mess this one up. Yeah. You any wasted three minutes. 

 

P: Yep. Yep. 

 

K: So I’m very grateful for that. Then my husband was like, Oh, we have a boy. So we had a we have a girl and a boy. And I was like, that’s great. Make sure he’s tagged and there there was a nursery and I was like, I need to recover. I’m extremely nauseous and vomiting right now. I can’t enjoy these babies. Send them to the nursery. 

 

P: Yeah, that’s probably smart though,. Right? That that is again, like I think evidence of what real knowledge is helpful for? 

 

K: I think, yes. So for me, I needed to take care of myself so that I could start parenting them better. Yeah, and a couple of hours. I really had to get past the nausea and vomiting because that was horrible. And then I was confident about, you know, the security and the nursery. So going into pregnancy, I thought I was going to have this like singleton waterbirth at my friend’s birthing center, and waddle back to a queen sized bed and have that bonding golden hour after birth with a baby on my chest. But I didn’t I got to see them about two hours after birth. And they were on my chest for months and months after that. 

 

P: Yeah, no, honestly. It Sounds like because you know so much you kind of expected from challenges in your pregnancy and that went pretty well. I mean, that went shockingly well, to make it so late.

 

K: Yeah. I just had to like mostly let go a couple times. I called my Doula one time when I was at work, and I was like, I think I’m having contractions. This is so stressful. I put myself on the monitor and she’s like, Kristy, you gotta take your clinical mind out of this. Go with what how your body’s feeling. I want you to lay down right now and be patient and her support in that sense was super helpful. I wasn’t that person that went home. And listened to the baby’s heartbeats with a Doppler all the time. I have my own Doppler. I could do that. 

 

P: yeah, Yeah, 

 

K: I only did ultrasounds during pregnancy when I needed them. I didn’t I never did them for fun at work. Because I was worried not even to check position. 

 

P: yeah. 

 

K; So I’m, I mean, I’m grateful for my ability to be able to do that. Well, and the support of my Doula friend.

 

P: that seems amazing. Since your kids have been born. Have you seen any other twin births like yours?

 

K: I have not. I don’t think so. Something I’ve been present. Of course, there have been people in our practice that have had vaginal and unnecessary and but most of the time, I have not either somebody chooses to have an elective Cesarean birth for twins, or they have successful vaginal birth times two 

 

P: that is totally interesting. 

 

K: Yeah, one of my best friends who is a labor and delivery nurse, I would have wanted her to be with me if she could have been with me, but she was living in a different state at the time. But she hears my story and she’s sometimes a little bit more on the high risk end and I’m on the low risk end of like, how things go and how we approach and and she’s like, wow, that’s a bummer. Wouldn’t you have just rather just had a cesarean birth to begin with and I was like, No, I got to experience labor and birth 

 

P: yeah, Yeah. 

 

K: And even if I had gotten an epidural, I still would have experienced labor in my mind, but I am happy that I truly experienced a full labor and vaginal birth without an epidural.

 

P: My guess is it’s a boon to your patients. That You have this pretty wide experience in one pregnancy, 

 

K: I could have a better idea of how they feel. 

 

P: Yeah, 

 

K: you know, actually on that note, like it’s, it’s definitely helped me coach people and be genuinely honest with them before having a cesarean birth and what their recovery will look like. Because we talked to people about to cesarean birth, and we’re just really, oh, these are the risks, you know, infection and bleeding and da da da, but we don’t really talk to them much about the sensations, yeah, of recovery. Say a little bit about like, what you might feel during the actual birth, but not all of the recovery, but definitely has helped me change the way I speak to people before Cesarean birth, how their recovery is going to be and also just being supportive with them, even a year after their Cesarean birth if I just meet them for the first time talking to them about the sensations they have, because there’s a lot of things that go on with when your nerves start waking up and the sensations like on your skin level. The tingling and the itching and pulling in the corners of your scar and how weird it is. 

 

P: Yeah, 

 

K: and that’s ignored. 

 

P: Yeah, I mean, that falls into the giant, bottomless postpartum bucket in which wrecks many things are shoved right without examination. How was your postpartum with twins?

 

P: There wasn’t much sleep. I forced myself to take a nap every single day. The whole time. I was on maternity leave, which was only 11 weeks so 

 

P: oh, Wow, good lord.

 

Let’s talk real briefly about maternity leave while we’re on the topic. The US currently ranks 36 Rock Bottom among OECD countries for the carrot provides new parents for maternity leave. Probably everyone listening heard that the attempt to pass a paid leave bill is precarious right now in Congress. current federal law requires 12 weeks of unpaid leave for companies with at least 50 employees. Basically, this leads to about 12% of Americans getting paid leave for 12 weeks. States have passed their own paid leave bills in 2018 and 2019. And these states are basically on the east or west coasts, and they vary in their generosity.

 

K: I was in Texas and I didn’t have a lot of benefits and I guess it was just all I got was my FMLA. That’s it.

 

P: here FMLA is money from the Family Medical Leave Act.

 

K: So it was 11 weeks and the whole time I was on maternity leave for 11 weeks. I made sure I took a nap every single day I was scared to death of getting postpartum depression because I had the blues that was definitely apparent and I probably had some depression but just kind of worked my way through it, keeping my chin up and acknowledging it and taking naps and then once I went back to work, I only went back to work part time which I’m super grateful for my employer, allowing me to change my status. I only worked in the office, so I stopped doing call in the hospital, but every single day I was off. I still took a nap. So we were woken up frequently for a very long time. In fact, our children didn’t really ever sleep through the night until probably about three or four years old. And I nursed 100% A little over a year. 

 

P: Good lord. Wow.  that’s a lot of work…

 

K: I had helped a lot of people with breastfeeding and nursing and the minute they came out of the nursery, I was like alright, we got to nurse these little babies and did send them to the nursery. Again to try to get like a three, three or four hour solid nap in because I was like this was like maybe day two postbirth is one of my midwives from the practice came in to round on me and I got an earful in a lecture from her about how silly it was to send those babies to the nursery. They needed to be with me mammals are never left by their left by their mom, almost pulling their baby cubs every two hours to offer them milk to keep them alive. They need it for survival. I loved Theodora she was also one of my other favorite midwives in the group for background was breastfeeding support and also doula support. The babies had already been latching and stuffing perfectly so I was feeling like pretty overly confident. That’s why I sent him to the nursery but she she must yourself into that nursery brought those two babies back and was like, alright, what is it then you need to nurse them for survival. And honestly with that little pep talk and lecture. I didn’t have any issues with milk supply. I mean, I had to work hard when I got back to work and I was pumping and all of that would pump in my car on the way to work and do crazy things like that, but I never had to purchase formula.

 

P: and Now there have one foot out the door for college right?

 

K: Mm hmm. 

 

P: Amazing. 

 

K: Yep. 

 

P: Thank you so much for sharing your story.

 

K: Thank you

 

P: Thanks so much to Kristy for sharing her story and her insights about pregnancy in general and twin pregnancy, given her professional life as a midwife.  And thank you for listening. We’ll be back soon with another inspiring story.

Episode 11SN Wrestling with Preeclampsia: Audrey

Like many women, today’s guest imagined that having a child would be straightforward–that’s the way she’d always seen it portrayed in the culture around her. And at the start, her expectation and experience lined up well. Getting pregnant wasn’t a challenge and being pregnant, was an exercise in smooth sailing for many months. But then the swelling hit, followed by an episode of fainting, and she and her husband found themselves caught up in the whirlwind of preeclampsia, including some of the more disconcerting features of this condition. She is fortunate to have excellent medical care and now both she and her baby seem to be enjoying toddlerhood. Listen to her story of overcoming.

Cover Art provided by Stephanie Davern from Mamapaints on Etsy

Preeclampsia research

https://journals.physiology.org/doi/full/10.1152/physiolgenomics.00017.2018

Blood pressure and preeclampsia

https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745#:~:text=Blood%20pressure%20that%20exceeds%20140,Severe%20headaches

Recurrence of preeclampsia

https://www.preeclampsia.org/the-news/community-support/after-preeclampsia-another-pregnancy-or-not#:~:text=Research%20suggests%20the%20risk%20of,you%20may%20get%20it%20again.

Umbilical cord and preeclampsia

https://www.longdom.org/proceedings/umbilical-cord-and-preeclampsia-11223.html#:~:text=Preeclampsia%20has%20been%20associated%20with,alterations%20of%20the%20umbilical%20cord.

Paternal determinants in preeclampsia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330890/

Sucking reflex

https://www.stanfordchildrens.org/en/topic/default?id=newborn-reflexes-90-P02630

Dr. Rana’s research

https://www.tandfonline.com/doi/full/10.3109/10641955.2013.784788?scroll=top&needAccess=true

https://pubmed.ncbi.nlm.nih.gov/26105375/

https://www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAHA.111.054361

(for more of her research, you can search https://pubmed.ncbi.nlm.nih.gov/ with Dr. Rana’s name and ‘preeclampsia’ as the keyword)

Audio Transcript

Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka. Like many women, today’s guest imagined that having a child would be straightforward. That’s the way she’d always seen it portrayed the culture around her, and at the start, her expectation and experience lined up well. But into the third trimester, the swelling hit, followed by an episode of fainting, and she and her husband found themselves caught up in the whirlwind of preeclampsia, including some of the more disconcerting features of this condition.  Fortunate to have excellent medical care, now both she and her daughter are immersed in the joy of toddlerhood.

After our conversation, I went back into the interview to add details about some of the medical issues that came up. I also spoke with a great maternal fetal medicine doctor who specializes in preeclampsia research. I’m including her insights, not to scare anyone, but to give a full picture of what pre-eclampsia involves.

Let’s get to the interview.

P:Can you tell us your name and where you’re from.

A: My name is Audrey tipper and I am from St John’s Michigan.

P: Oh wow, cool. Is it snowing there.

A: And we just finally got our first dusting of snow yesterday.

P: Do you have one child?

A: We have one we’re one and done actually.

P: Oh, great.

A: We were originally planning on two we thought but because of my experience, and also because of my own personal history, and we’re really happy as a triad and we’re just gonna stick with that I think

P: that’s awesome.

A: Yeah,

P: well good I’m glad that you’re, you know over this part of it right,

A: yes. Yeah,

P: so before you ever got pregnant, what did you think it would be like?

A: you know, I, looking back, I thought that everything was gonna go like this textbook right like, I think that I thought that it was just, you know you get pregnant because they constantly, like your whole life, like you gotta be careful to not do that right. And so I just thought that it would just be super easy and then there you go, and then you go through the process and then you have a baby. And that’s it, and that’s not that I mean, that’s not really what happened for me. Yeah, the getting pregnant was for us we were thankful it was easy, but I know that that can be a challenge for other people and so that part was not our challenging part.

P: Good, we’ll take what we can get right.

A: Yeah, exactly.

P: Did you find out you’re pregnant from a home kit.

A: Yep, yep, we just did it. Yeah, just a little over the counter first response or something.

P: Yeah, yeah. Well, that’s exciting. Yeah, and then take us through the story like what, what, how was the first part of your pregnancy, did you have morning sickness or

A: I had a bit of morning sickness and I was still working, I have a degree in Hospitality and Tourism Management and at that point I was managing a property that rented space to a variety of food vendors or. We also had a lot of events and that sort of thing. So some weeks my hours were decent other weeks were long so you know that was just part of what I was doing. And so yeah I definitely had some, some morning sickness, a little bit in the beginning but then the next like like I guess you’d say the second trimester was was just fine. I was just pregnant and it really didn’t affect too much going upstairs. I was a lot more winded, you know, that kind of thing. But other than that, it was what I thought was pretty normal really then past that I started having issues with swelling. Then as I have, I started swelling like a lot, and I mean it was, it was so much that it was, it was painful,

P: does that I mean like ankles or…what’s getting swollen?

A: My hands, my feet, my legs just really everything honestly my face, you know, looking at pictures you can see it in there too. I was just really swelling and my aunt had had some issues with with her blood pressure and that sort of thing. And so she asked me hey have you talked to your doctor about this, she’s also a nurse so she’s, you know, that’s very you know, the thing that she would notice right away.

P: Yeah,

A: and I said yeah I did actually and they that the doctor that I saw, because that that the practice that I had had several doctors, and at that point in the I was seeing a different doctor every week so that way I could get to know them, if in case they were the one on call whenever I went into labor. Oh yeah so I was seeing all the doctors and the doctors that I saw that day. She really didn’t make me feel at all comfortable about my worries, and my husband and I laughed and we were like, Oh man, that was, was terrible. I hope she’s not the one on call whenever we, you know, go in and.

P: Did she say it wasn’t an issue or like what did she say?

A: Yeah, she was like, I’m sorry, so she was like basically just that I had to suck it up, that it was just part of being pregnant with some people swell and that’s just the way that it is. And so I, so I laughed and I cried actually because I was so upset that that because I was in pain and it was difficult and frustrating. And…

P: I don’t know that I would anticipate that either Right?

A: no, no, I figured she was gonna do something to help me whatever it was I didn’t know but you know she has degree she’s got way more experienced than I do. So yeah, I really didn’t anticipate that at all. And so then at that point I guess we would have been. Let’s see, we would have still had eight weeks ago, so what’s that 32 weeks Iguess

P: Yeah, exactly.

A: So two weeks later, I had another appointment that afternoon, but that the night before, I had gotten up in the middle of the night, to use the restroom because that’s what we do when we’re pregnant.

P: Yeah.

A: And the way my, my bathroom is set up the toilet actually sits in a little alcove so I can, I can put my elbows, you know to wall to wall if I were to, you know, press them out a little bit so it’s just, it’s really just the toilets in this little piece I mean, there’s the bathroom is larger than that but that’s just where the toilet, and I’m really thankful that our house is set up that way because while I was using the restroom, just like what I felt like it was in the movies. I literally passed out on the toilet.

P: Wow.

A: Yeah. And so, I remember thinking, like the next day I’m like that’s just crazy who does that, that’s totally like in a script that’s not real life.

P: Yeah, yeah.

A: And so once I came to I was leaning to the left side of the wall. I had not fallen off, and it took me a few minutes to really come back, mentally to because I realized just lay there against the wall for a while because I didn’t feel like I could stand up or have been set up at first. And so then I went back upstairs to our bedroom and I you know told my husband that I had passed out. And he said, Well, do we need to go to the ER like are you okay and I said, Well no, it felt like a normal passing out.

P: Wait, I’ll have to stop you there for a second. How often are we passing out? What does that mean?

A: I don’t know. in hindsight that should have been a sign that things are not right. Yeah, to be fair, the reason that I thought that I have a vasovagal response to getting my blood drawn. There’s nothing wrong with me. Like I’ve had my heart looked at and everything, I’m totally fine, but and I’m not afraid of the needles so I don’t know what happens for whatever reason, my body’s like oh no that’s not supposed to be here and sometimes I’ll pass out when I get. And so, to be fair, I know, like that’s like I pass out enough from that maybe less than once a year, it’s not really that often, but it’s enough that I have done it, and you’re like, okay this is normal,

P: right, right, no, no, that’s, that’s the only story you can tell, and that makes total sense.

A: Right. It is I, but, but still, that should have been like okay that’s weird to even say a little bit and so my husband and I, we went back to sleep. We didn’t get up and do anything and the next morning when we’re both thinking more clearly. He said, You know, maybe we should call the OB, and just ask about this and yeah that’s probably a good idea. So we were, we went to work, we actually carpooled that day and we’re in the car and I called the OB and I said hey this is what happened last night you know i What do you think, and I don’t know why don’t you just go into OB triage and get monitored and just have the level, you know, a checkout done. So we call our bosses, we’re gonna be a couple hours late, you know, sorry, you know, this is what happened. Okay, no big deal. So we get to OB triage and they check us in and my blood pressure is 179 over 103.

P: Uh-oh

Just a quick aside here, we know this is going to be a story about preeclampsia, There are a collection of symptoms that define preeclampsia, but elevated blood pressure is one of them. And the cutoff for what’s considered high blood pressure is 140 over 90. So Audrey’s blood pressure is way too high already.

A: They were like, Yeah, you’re not going anywhere. So they gave me this, because at this point would have been six weeks early, and or about, I mean, give or take a day I forget what the exact days were at this point that the doctor that came in. Once they moved me on to the to the actual board of delivery board was the doctor that I saw two weeks previously that we didn’t like

P: rut ro…we meet too soon.

A: And I have to say that in hindsight, the day to day business just isn’t her thing. She was amazing. Maternity Ward and, And we were like, is this the same woman but I was really really really surprised and she was able to get things done that we needed to get done for tests and you know, she just really made us feel comfortable and like she was just going to take care of us and so we were really quite thankful actually that she was the one that was there because she just handled things in a way that we felt was not only comforting but just really professional. She just did the right things.

P: That’s awesome.

A: It turns out just the day to day stuff just isn’t her bag. Yeah, yeah. We all have different things.

P: Did they think the fainting was related to the swelling like had you had high blood before?.

A: So, I was diagnosed with preeclampsia, so they put me on a magnesium drip right away, you know, and then the goal was to induce labor at that point because there’s, there’s nothing else to solve the situation from where, from where I was. So yeah, that’s, that’s just the the next steps that we started to do, and, and we didn’t, we didn’t think really too much of it we said oh I didn’t know what preeclampsia was, I had never heard of that before I was told that I was in the hospital with it.

P: I talked to a maternal fetal medicine doctor on the cutting edge of preeclampsia research, to give us some context for what Audrey is experiencing. Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you’re working.

Dr. Rana: Yeah, hi. Thank you for having me here. So my name is Dr. Sarah Rana, I’m a maternal fetal medicine specialist. That’s the high risk OB provider, and I work at the University of Chicago medicine.

P: Okay great, thanks. So let’s talk for a minute about preeclampsia. Do you know how common that is,

Dr. Rana: yeah, so it kind of depends. So if you’re looking in the United States is about, I would say anywhere between five to 7% worldwide and maybe a little bit higher prevalence, you know, overall, all kinds of high blood pressures in pregnancy is like close to 10% So it’s pretty, pretty common,

P: That is common

A: And the doctor did tell him he’s like, look, this is, this is bad, you’re really sick, and this is the solution the only solution is that we have to take the baby and. And this is just this is the next steps and so okay. My husband and I carpooled so we could have date night but I guess we’re having a baby instead

P: new plan,

A: New Plan….Yeah.

P: So are we are we feeling nervous in the hospital now or you feel like I’m where I need to be and so this is okay,

A: you know, the entire time that I spent in the hospital, there was only one time that I was nervous and but otherwise I really just felt like the our doctors and nursing staff and other hospital staff just really were great. You know we were at Sparrow and Lansing here in Michigan and they just did a phenomenal job of doing what needed to be done to keep both my myself and our baby safe as well as, you know, you know they made sure Nick had drinks or snacks if he needed some of that too. So, in hindsight I realize that for us that was it was a really quite serious situation, and in hindsight, I’m a lot more nervous about it, and that majorly played into a piece of why we’re one and done because I don’t want it, I mean if you’ve had preeclampsia are statistically more likely to get it again, you know,

P: yup, yup

according to the preeclampsia Foundation research suggests that the risk of having preeclampsia, again, is approximately 20%. That’s one in five. But experts say to range from 5% to 80%, depending on when you had it in a previous pregnancy, how severe it was an additional risk factors you may have risk factors include things like age, race, whether you’re having multiples in a pregnancy, and a few other things.

A: I want to be here to raise my daughter. You know, I don’t. It’s statistically one of the leading causes of death in pregnant women, and

P: it’s totally scary. I totally agree.

A: Yeah, it’s just, I, it wasn’t worth the risk for me.

P: Yeah, and I actually. Yesterday I talked to a maternal fetal medicine doctor. Yeah, and I was saying can you explain it to me like what do you think is going on and she said we don’t understand like how I preeclampsia, comes about.

A: It’s amazing. They think I’ve read that there’s some relationship between the umbilical cord and preeclampsia, but they don’t know how or why that is. And they also think it’s possible that there’s some relationship that the husband is actually can give it to the baby so to speak to the pregnancy. And so it can come from either line, which is really interesting from a pregnancy standpoint.

P: Yeah, well his genetics are affecting your placenta Right,

A: right.

P: So it makes sense.

A: I agree.

P: So take it so obviously you’re here, and so is your daughter, so take us through the process.

A: I wasn’t sure if I wanted to do an epidural or a natural birth at first. So when I was in, originally I didn’t have that we just didn’t do anything until I, I was ready to make the decision they give me, I forget what was the Pitocin maybe or something but they gave me something, they started trying to induce, and for whatever reason, it just wasn’t working for me at all in any way shape or form. So then they tried …

P: Does that mean like you had contractions but no, your cervix didn’t

A: I didn’t have anything: no contractions my cervix wasn’t dialating was like nothing was happening. And so at that point they tried to forcibly dilate me. Which,

P: that sounds comfortable.

A: It was awful. It was incredibly painful because they stick some balloon in your cervix and then they try to blow it up.

P: Is that the Foley bulb?

A: Yes, yeah, it was really painful. That was terrible, I’m sure, like, yeah, I didn’t like that at all. So they wound up doing that twice over the. Let’s see. I don’t know how many hours but from the time I checked in. So the time we had to make different decisions was like 36 hours was a long time.

P: That is a long time.

A: And so we, we were just waiting for me to start doing anything, and nothing was happening. And this whole time I’m still on this magnesium drip which is terrible.

P: Is the magnesium sulfate making you loopy?

A: it makes me….It made me incredibly weak. I couldn’t sit up on my own hardly I couldn’t move my muscles and from what I was told the goal with the magnesium drip is to is to keep you from having strokes and seizures.

P: Yeah.

A: but I mean I couldn’t even like turn over on my side in bed, it was incredibly difficult,

I hated that. My mother in law did drive out because I hadn’t even packed a go-bag, I thought I had six weeks.

P: Yeah,

A: I thought I had all this time, no time. And so, you know, we didn’t have anything that we would have, like we had this great list, you know of all this stuff that we were going to pack, but none of it was with us because we did not plan for six weeks early. So yeah, we’re, we’re just at that point we’re just waiting. We’re waiting for my body to do anything. And so I finally start to have contractions 36 hours later. And every time I have contractions. Her heart rate drops through the floor. It basically just is completely almost non existent like they don’t even know where, like, it doesn’t even register anymore.

P: Good Lord. That’s scary.

A: It’s really scary. Yeah. So, at that point, they decided I needed to have an emergency C section because they told me Look, something is wrong. We don’t know what it is, but we need to get her out of there, and we don’t think that natural birth is the way is the way to do it safely. And so we were, you know, at that point we’re like, Oh God, this is really scary, because, you know like, this is not part of our birth plan, this is not written down. And, and so they started to prep us for surgery and, you know, I met the anesthesiologist was was awesome, actually he, he and his partner there was two of them that that work together to do that part of the job. One of them was from one of them had spent time in the army and the other expense, I want to say, Navy, Marine Corps Navy I forget which I know they’re completely different but and I have some friends in my life that I consider family that have spent time in the Marine Corps, so I like this fun banter that was normal to me, you know, between the branches was, was what they were doing and I just it felt really comfortable, which was nice because I needed something to feel semi normal in this crazy situation that. Yeah, so they wound up doing the, not the epidural, the other one, put it in the same place but it works slightly differently. And, you know, my husband was able to be in the OR with me and he’s up by my head and they took took her out, and it’s such a strange feeling because you can’t feel any of the pain but you can still feel them moving things around and you can still feel their fingers and it’s very strange.

P: I thought it felt like being on a roller coaster. Yeah, like, move all your organs back to where they’re supposed to be, I thought that was weird, I had a C section, too.

A: Okay, yeah, just the feeling of, like, yeah, that’s just strange and my husband, he said I wanted to look, even though I know that sounds weird, but I didn’t want to be a liability in case I had a problem with it. I was like thanks honey I appreciate that because I really needed to be the priority right then . They had taken right away to the queue with being six weeks early, we didn’t know. You know what state she was going to be in and what type of care she was going to need. So he went right with her and then my mother in law came in to my like recovery room and she’s so she stayed with, with me for a little bit in there, and then I still spent like another week, not quite a week in the hospital recovering because I was just that we couldn’t get my blood pressure down. And we really, they they gave me all these different types of meds I was on like three different blood pressure meds at once to try to regulate it, and we couldn’t they just couldn’t get it to come down and I want to say, maybe for like the weird thing too, because I was so sick. And because of, I think partly because of the magnesium, like I had this one picture with Linnea and I got to hold her for like a half a second, and then they took her way to the NICU and I didn’t like I didn’t get to do you know like the chest thing that you that like

P: skin to skin

A:Yeah, like you have skin to skin and you get to do any of that. And I didn’t even register that I was missing it and I didn’t even miss her at first because I was just so sick that I wasn’t functioning.

P: Yeah,

A: and like looking back on that. It feels weird because I hear all these stories from other women whose, you know, who got to experience that skin to skin and who still got to be mentally present, you know, with, with, with their babies when it after birth and I can’t relate to that at all. I didn’t even register that I needed to go see her, because I was so sick.

P: Yeah I think that’s, I think that’s fair. I think it makes sense, right. Like, you don’t have all the oxytocin because you’re not supposed to be delivering and you’re not right, you’re like, not in that frame. So yeah, that’s perfect sense.

A: Yeah, yeah, it does, I get the logic side of it, the emotional side of it, it’s a little weird. Yeah and then then like three days later, I woke up in the middle of the night. My husband had been staying with me this whole time because they had like a cot thing that they were he was able to stay on in my room. And I couldn’t breathe, I had some my chest was like, like, painful, and I couldn’t figure out, I didn’t know what was wrong with me so I press the call button for my nurse, and she came in and, and she told me later that when she called the doctor she was like, You need to get down here now I’ve been taking hair care of her for three nights and she has never acted like this. So, my husband had just stepped out for a few minutes because I was sleeping and he had went up to the NICU checked on Linnea stayed with her for a little while to spend time with her, and then he went down to the cafeteria got himself a candy bar, so he’s walking down the hallway. And here all these like, people with, with supplies, you know the rolling supplies that they bring to the rooms, they’re like running past him like he’s like, Oh, I hope they don’t turn down my hallway, they turned out my hallway. Nick’s like I hope they’re not turning into her room, she was fine when I left her, so of course like he turns them and there they are like this room is full of like 15 people and my husband’s like, what’s going on. She was fine. A few minutes ago. And so they did, like they did all kinds of different things to try to figure out what was going on and basically what was happening is I was drowning my lungs were filling with water because I had been. So, I was still so swollen and still so many issues from the, from the preeclampsia that it, it was the water was starting to release a little bit and chose to settle in my lungs.

P: Good lord is that, is that a normal preeclampsia reaction.

A: I haven’t heard anyone else having that happen. I don’t know,

P: three days after the baby was delivered. Audrey had fluid in her lungs.

Dr. Rana: Uh huh, pulmonary adema

P: yeah and her description of it was, I had so much fluid in my body from all the swelling and everything that it was the fluid was looking for a place to go and it ended up in my lungs. Is that an unusual outcome from preeclampsia.

Dr. Rana: Oh, actually not a lot of people can tell up so what happens in preeclampsia and any kind of, you know, hypertension, is after delivery. So first of all around the time of delivery people get IV fluid, and then by about like day three, day four, they start to mobilize these fluides. So in a sense, She’s kind of right in a sense that she’s saying that I had all this fluid in my body like it had to go somewhere. Normally people kind of reabsorb it back into your circulation and just merely peed out. Yeah, so you just have like, so but now you can have not only edema postpartum, it can develop even during pregnancy and, and during labor but it’s actually quite common to develop with that, after delivery and a lot of people are saying it’s because of this combination of your pre eclampsia because your vessels are leaky, then you get all this extra fluid when you were in labor and then you re mobilize all this food like three to five days after delivery, and then some people say maybe even taking drugs such as motrin, you know NSAIDS, especially if you have renal dysfunction that can also cause you know some of this impaired renal function to diurese and get all the, all the fluid out so you can then accumulate food in your lungs.

A: That was the moment before I initially gave me some lasix and it thankfully cleared me up. But that was the moment where I started to wonder if I was going to go home or not.

P: That’s terrifying.

A: Like I I started to wonder if I was gonna die like if I didn’t get to be a mom if I didn’t. If my daughter didn’t get to have both parents.

P: I’m so sorry. That is terrifying.

A: Thank you.

P:, it must have been a terrifying, it’s like must be a terrifying feeling.

A: Yeah, yeah it’s it’s really scary like. Not sure. You’re going to keep living I. Yeah, it was tough. That was the hardest night for sure.

P: So what did they give you? and it worked immediately.

A: Pretty, pretty close to immediate, really fast at least it’s called Lasix, it’s basically just a dehydrator. And it basically makes all the water, P and they say P out like a ton. And so,

P: thank God for that.

A: Yeah, seriously. Yeah,

P: so they figured out that there was water in your lungs.

A: Yeah, they did a chest X ray right there in my room that was one of the machines that they had brought in and that was one of the things that, that, that showed but because I complained of chest pain. The next day they also did like a heart like a sonogram like yeah so I had to do that. The next day, and a couple other tests that they wanted to just make sure that I wasn’t having heart issues and thankfully, it didn’t show any heart issues at all, and I was on blood pressure meds another oh I don’t know, three or four months.

P: Wow.

A: For a few months and I’ve read that some women never get off the blood pressure meds after having preeclampsia and for some women it’s about like what I experienced a few months and I’ve also read that myself and my daughter are at a higher risk factor for heart issues the rest of our life because we had preeclampsia together. There’s a lot of research that still needs to be done in order to figure out why and what can be done to help and that sort of thing but, you know, I try to stay as updated as I can now that I’ve had it

P: What does preeclampsia mean long term for women who’ve had it

Dr. Rana: There’s really no cure to preeclampsia, so there’s lots of data that preeclampsia leads to long term physical cardiovascular damage. So patients who have preeclampsia, are at risk to have lots of outcomes that are happening related to all the insults that happened during pregnancy or intrapartum period, immediate postpartum so patients who have preeclampsia at high risk will have high blood pressures after delivery, their higher chance to get readmitted with heart failure. And then after that they have a higher chance to have developing chronic hypertension, they have higher chance to have cardiovascular disease such as they can have MI and heart failures and edit me as an cardiomyopathy, they in fact have a higher chance of dying Absolutely. When you adjust for all of the risk factors of preeclampsia is a massive risk factor for long term cardiovascular dysfunction which lots of studies have now come out is not so long term actually start soon after delivery. So a lot of specialists in the, in the field are trying to walk away from the fact that just like write it off and it gets cured , we don’t want to say that you say well, delivery of the placenta and the baby will resolve some of the signs and symptoms of preeclampsia so your hypertension resolves in the acute phase, and you upload your lab abnormalities it resolves your renal function recovers, you know your kidney, your liver function will recover, but it does lead to long term, short term and long term postpartum outcomes. So, we are not saying now that it’s a cure. It’s actually just, it was all some of the symptoms but you have to watch these women really really carefully postpartum to prevent some of these complications that are happening to them after delivery.

P: So I know there is this higher risk of cardiovascular disease, but the pool of women who run into preeclampsia, is pretty heterogeneous so you can have preeclampsia at 34 weeks so you can have it later than that, it can be mild, moderate, severe are all those people at risk of cardiovascular disease or do we know whether some are more at risk than others because those two things seem like different kind of syndromes.

Dr. Rana: So they’re like two types of people like you were saying, so not just when they develop the patrons, but also what risk factors they have so there are, there are people who have pre existing cardiovascular risk factors, so if you are obese if you have higher, you know, BMI you are African-American race you have diabetes, you have other kind of risk factors that you came into pregnancy, and then that predispose you to have preeclampsia, so you know pre patients who develop preeclampsia have some of them, a lot of them have underlying chronic conditions that predispose them to have preeclampsia and then after they have preeclampsia the same cardiovascular risk continues right so then there is inflammation. There is androgenic imbalance there is all these hypotheses oxidative stress that all happens during, During pregnancy, then it kind of makes your cardiovascular system even more under stress, and then it kind of continues postpartum and then you develop long term cardiovascular disease. So that’s one group, but there’s obviously this group of patients who have no underlying cardiovascular dysfunction so you know they are not obese, they’re not have any other risk factors and they develop preeclampsia, so this is a kind of debate in the literature, whether it’s the pre existing cardiovascular disease that predisposes you to preeclampsia than that confused or preeclampsia per se, creates an insult in your body that predisposes you to have the cardiovascular dysfunction, but in terms of epidemiological evidence so yeah you’re right, patients who have term preeclampsia to slightly lower risk to have cardiovascular dysfunction compared to patients who have early eclampsia. Similarly, if you have severe preeclampsia, those people are at higher risk. If your preeclampsia in multiple pregnancies. Those people are at higher risk. If you have preeclampsia with preterm delivery so preeclampsia was that bad that you ended up delivering less than 34 weeks lesson 37 days you are at higher risk to develop cardiovascular disease and of course postpartum. If you have other cardiovascular risk factors and you certainly are at higher risk to have, you know, such as if you develop hypertension, then that’s independently increasing your risk of cardiovascular disease, above and beyond your risk to have been a risk, just associated with PMS, yeah. So yeah,

P: this sounds like this also answers another question which is, which I asked every maternal fetal medicine doctor does pregnancy reveal underlying conditions or does it cause it, and it sounds like you’re saying, both

Dr. Rana: Oh yeah, yeah, it’s a little bit of both, because there are some people and you know that’s why people are saying that maybe there are women whose cardiovascular system just cannot take the burden of whatever the markers are or whatever the, you know proteins are being released from the placenta and they just, then they develop preeclampsia. A lot of people are saying that it is like very chicken and egg theory, And the only way to prove that would be to take a cohort of people before they get pregnant, and then follow them out, you know, and then none such good studies have been done, but animal there’s animal evidence that you know if you just create preeclampsia in an animal they are at risk to have cardiovascular dysfunction later, after they deliver.

P: this is a long list of  trouble that can follow on the heels of a pregnancy visited by preeclampsia. When i listened to my conversation with Dr. Rana again, I emailed her to ask if there’s anything positive that women can take away from this information and she basically said that Knowing that these risks are present, and finding them at a relatively young age, women have the opportunity to make changes to their lifestyles to potentially change their risk profile. if you  follow up with your internal medicine dr and cardiologist, tell them that you had preeclampsia so that they can help you with life style changes.

P: I mean I did I say, the woman from UCSF Why do people continue to have high blood pressure after the placenta has been delivered, if that is the mechanism causing the high blood pressure and she said she didn’t know and maybe it’s a good sign that yours has, has actually resolved.

A: Yes, I am, I definitely feel like I was really lucky, I know, I mean I know it can go either way you can go on to have preeclampsia again or you can go on to never have it again and have three more kids and never have the same issue. So, it is just, you just don’t know at this point but I’m very thankful that I haven’t had any other issues, You know, after we left the house after I left the hospital we were, we were able to stay at the Ronald McDonald House, we were just so thankful for that we, that really made a huge difference for us

P: that’s an amazing organization right?

A: Oh, amazing…

P: so that you can be close to the baby in the NICU.

A: Yes, yes. And we were literally our, this house is literally across the street from the hospital where we are and I couldn’t even walk at first, across the street to get to her. That’s how much I was in pain and from my C section and so you know my husband would drive us across the streets, so we could walk into the building. And now I have a friend whose son is a month younger than linea, we were two weeks apart for our due dates and so it’s pretty exciting that we were, you know pregnant together and so I went to visit her, she also wanted to having to have a C section because she’s so tiny, it just, yeah, that was probably the best for her, but she, she was a week postpartum. And at that point I would have been five weeks postpartum. And she’s like, up and walking around and picking stuff off the floor and I was, we laughed and I was like Nick and I told her this years later, but Nick I can’t go back and visit her right now. I still can’t reach the floor and I’m five weeks postpartum because I had had so many issues, and I was on so you know different drugs for everything else and I don’t know exactly what affected what I don’t know about that but like I was so sick that I literally cried in the car because i. So,

I guess, jealous, really, really that’s what it comes down to I was jealous that somebody else had this amazing experience with their birth as compared to mine, because it was so bad…

P: Yeah, that is a dramatic difference although given that you were on medication for months after the birth, like your body, obviously had a lot of things it was going through right.

A:  It was, it had a lot more. Yeah.

P: And how was linea, what how was she like, how big was, she was three pounds 11 ounces, she was very little 16 inches long, she was quite long.

P: Although, That’s not bad for that time right?

A: No. she did, she was, it was okay. Yeah, she thankfully was on breathing, assistance for only, like 12 or 24 hours, It was I can’t remember which now, but it wasn’t that long.

P: That’s awesome.

A: Yeah, the main thing that we had to wait for her to figure out was how to eat, she could not figure that out, that took probably half of the time that we were in the NICU. The doctors were like yeah she can go home but she can’t eat. So, we can’t let her go because we had a lavage feed her for a long time.

P: Is that a. Is that like a dropper or ?

A: No they stick, a tube down her nose.

P: Because she didn’t have a sucking reflex?

A: she didn’t she wasn’t able to do it. Yeah, she’s too early, I guess they learn how to do that with the amniotic fluid later on in the pregnancy. She was born too early.

P: According to the Stanford Children’s Hospital, the sucking reflex starts to develop around the 32nd week of pregnancy and is not fully developed until about 36 weeks. And they say premature babies may have a weak or immature sucking ability because of this.

A: Yeah, so she was in for, like you said three weeks, and yeah and then we said we just had to wait for it to eat and truthfully. That’s been an issue that has continued throughout her three and a half years, because we started presenting you know baby food type things at six months or so like they suggest that’s the current suggestions, and we would present and present and present and present and present and she just had no desire to eat it. I mean, I would say the first time she actually had a meal of food. She was probably 13 months old. I mean well over, it was definitely over a year old, maybe 14 months I don’t remember now, I probably have it written down somewhere that she just had no desire to eat, and thankfully I mean I was able to breastfeed, and so we just I just kept feeding her, what else to do. My plan originally was to breastfeed for about a year, and then you know transition into normal food, but she, she had other ideas. So I breastfed till about 17 or 18 months for her so about a year and a half, because she just, she just was she wouldn’t eat normal food she just had no interest. He loves yogurt. And I would say for the next year, was difficult to get her to eat anything but yogurt. She just had no desire, just didn’t we just didn’t want it.

P: Do we think it’s a texture issue?

A: No, because she eats to eat she’ll try anything. She’s very good at frying something she just won’t eat a full meal of anything. Now she’s doing okay with it. I think she eats you know, normal foods now, and she still gets quite a bit of dairy so I don’t know maybe her body just needs dairy maybe she’s pretty big. I don’t know. Yeah, but

P: yeah

A: so it’s interesting watching that progress though because she’s definitely that’s, that’s certainly been a theme for her life.

P: What she into now?

A: she was she loves school actually she really loves going to preschool she loves being outside. That’s one of her favorite things to do, but my husband and I like to you know be outside too so that’s, you know, my husband and I, we both grew up on farms.

P: Wow.

A: Yeah. And so, you know, my husband’s still enjoys farming. I am thankful it’s part of my history. I have no desire to get up and milk cows in the morning. She loves being outside. She loves to build is really a feel like a knit like. I mean, who knows, we’ll see what she really gets into but she seems like she really likes to stem type of stuff. She likes to see science experiments you know with the baking soda in the vinegar or you know stuff like that. during the beginning of the pandemic, we have a husband does 3d printing for fun, and also volunteers for a robotics team here at a local high school and so we had like, want to say with six 3d printers and in our mudroom in our back room, and we were printing, ppe. In the beginning, back there like helping with the robots she calls, B bots, of course. And so yeah she really just as into that kind of stuff.

P: That’s cool. That sounds fun.

A: Yeah, yeah, it is a lot of fun.

P: So let me ask you, if you could go back and give advice to your younger self, what would you tell her?

A: You know, I’ve thought about that actually. And the one thing that I would do differently than what I did before, because there wasn’t any sign, other than my swollen this, I would have started taking my blood pressure at home.

P: Yep.

A: That’s and I would have taken it every day a couple times a day, once I realized that I was that swollen and, and, you know, I talked to the doctors about that later, like what, you know, then they had actually tested me for preeclampsia, while in the office, the two weeks before I went in, so they, There was nothing at that point showing up in any of their tests that I had preeclampsia. The only thing was just that I was swollen and they’re not wrong but some women do just well when they have pregnancy.

P: So I have read a bunch of your work, and it looked like some of the things we’re working on our biomarkers to try to identify preeclampsia early and it looked like you had one specific measure that was the ratio of two chemicals. Can you tell us a little bit about that.

Dr. Rana: So there are two proteins, one is called soluble fit one and the other one is plgf placental growth factor so there are studies, lots of them, animal as well as, you know placental studies that this protein specifically soluble fit one is high, and women who have a fancier, and then calculating levels we can measure them in your approach so it’s like some similar to measuring for example a blood count in your in your blood, so you take out the blood, and then you measure this protein. And then this other protein plgf which is placental growth factor so soluble fat is high in women who have preeclampsia and plgf is low. So when you combine that ratio. That actually is a very good test to predict who is going to develop adverse outcomes, or who’s going to develop a plan so a lot of papers that I have written and what we’re trying to figure out is if you see a woman who has a suspicion of preeclampsia, so for example your lady was complaining or swelling, and blood pressure was probably fine. So preeclampsia has a lot of nonspecific signs and symptoms so you can have a headache, but headache is a very serious symptom because a lot of them who have a cloud of seizure, can have a headache that precedes your Atlantic seizure, so we can’t ignore headache, the concept of like somebody who’s pregnant and even without the potential, then it has things such as swelling, it has like, you know you have some pain here in the right upper corner but your labs are fine in patients who present some silence of preeclampsia, so they have mild amount of hypertension, but they have no protein or their mind about a protein, they don’t fit the diagnostic criteria, and even fit the diagnostic criteria these biomarkers are really good to differentiate who are the women that are at risk for example, people who are the women who are going to develop help syndrome, who are the women who are going to develop like some of the similar features of the fancier so identifying patients who are at risk among patients who have some clinical suspicion of preeclampsia, so that’s one of the kind of the ways that we look at the use of biomarkers in women, and you know you can imagine if you can do an early identification that will potentially you know in the real world will potentially help patients by either triage in them out and saying hey you know your levels are really normal and no so you’re probably not at risk, even though you have hypertension, compared to somebody else who whose levels are very high, you can say hey you know what you are at risk to have some sort of a preeclampsia related adverse outcomes, not that I’m going to deliver you, but maybe I’ll follow you really carefully.

A: Yeah, that’s the one thing that I would do differently, I was immediately start taking my blood pressure.

P: Well, as you said like preeclampsia was not on your radar,

A: I didn’t even know what it, I’d never heard of that word before.

P: Yeah,

A: which is now like anytime I talk to pregnant women that are like what should I know and I’m like, Well, yeah, I’m not saying you’re going to get this but what I am telling you is just to be aware of it.

P: Yeah,

A:  all kinds of other things that could be a potential thing with pregnancy that could be your thing that, or maybe not that you wind up dealing with, but I guess the fact that it’s one of the leading causes of death in pregnant women now terrifies me that we don’t know about it that it’s not something that, That is a common thing that we are aware of.

P:Well, I mean, as you suggest, and this is my kind of motivation for this podcast as well. You kind of go into it thinking it’s gonna be fine.

A: You find great babies for millennia.

P: Yes, and like it just it seems like it might be easy, right, like, it will get pregnant without trying and yeah so I agree that it’s that we need to kind of be a little bit more aware of like all the things that can come with pregnancy.

A: Yeah,

P: but that certainly isn’t the way the system is set up now. No. So yeah, so hopefully you know, as we as we learn more, there will be more available to people,

A: to, yes, yes, I mean, that’s true. Yeah, that’s very true.

P: Thank you so much for coming on and sharing your story today, I really appreciate it and I’m happy to. Thanks again to Dr Rana for sharing her insights about preeclampsia, and some of her amazing research. And thanks also to Audrey for sharing her story in the shownotes, a link to some of the research that Dr. Rana described. If you’d like this episode, feel free to like and subscribe if you’d like to be a guest on the show, go over to the war stories from the wound website and sign up. We’ll be back soon with another story of overcoming.