Tag: hypertension

Hi, thanks so much for coming on the show, can you tell us your name and where you’re from.

Sarah: Thank you for having me. My name is Sarah and I’m from Connecticut. 

P: Cool. And how many kids do you have?

S: I have two daughters, my eldest is four and a half, and my second will be two in April.

P: Wow, that’s a lot of work, that’s a busy time. 

S: Yeah I mean it’s definitely been different this year given everything that’s happened, but it’s been fun having two girls close together and watching their relationship grow and it’s been special.

P: Yeah that’s awesome…. so I have two girls also two years apart. 

S: Okay.

P:  And they’re besties now. 

S: Yeah, that’s what I’m, fingers crossed, that’s what I’m hoping for down the road, you know, we had, they have their moments. 

P: And what did you think pregnancy would be like before you became pregnant?

S: I don’t know if I ever really thought specifically about what the pregnancy would be like I kind of just took what I had seen from movies and TV, but I always knew that it was something that I wanted to do, even as a young girl I always love to pretend that I was having a baby or that I had a baby, you know, so it was definitely something I’ve thought about a lot, but I don’t think I actually thought about the actual pregnancy or delivery or any, any of that stuff really.

P: So the first time was it easy to get pregnant?

S: So yeah, so my husband and I got married, September of 2015. And we, we weren’t trying, but we weren’t not trying, and in January 2016 I was about 10 days late, which I’m never late, I’m one of those people who is annoyingly regular, but I kind of just attributed it to like the holidays and you know I was a teacher, and maybe just the stress of kind of getting back into the groove of break and everything. And then one day it kind of like slapped me on the head You need to take a pregnancy test. And sure enough, it was positive so yeah we found out in January that we were expecting.

P: Well that sounds like a pretty gentle entrance. That’s nice. 

S: Yeah, yeah, I mean it definitely, it was a little bit of a adjustment for me mentally and I had so I suffer from anxiety and panic attacks and so it just took me a little bit of time to wrap my head around it, but then once I was there, you know, I was very excited and happy but I was also the first in my friend group to get pregnant and to, to have a baby, and you know we weren’t wildly young I was, I was 28 when I got pregnant with my daughter, and I felt a little isolated and alone just because I didn’t really have anyone to talk to you about it except my mom and her standard answer to things I don’t know this along I don’t really remember, I guess I felt isolated and a little scared and just kind of anxious about it in those first few weeks.

P: Yeah, all that seems like spot on, right, that seems like the appropriate reaction. And I always think nine months is a nice long time to get used to the idea.

S: Yeah, actually my mom did say that I remember being like it’s not like you’re gonna have this baby tomorrow like you have a lot of time to kind of, wrap your head around things. And, and she was right. 

P: nd how was the pregnancy,

S: it was interesting, I guess to say I was working I was teaching I had spotting my whole first trimester, I didn’t know that it happened, I would go into my OB, quite a few times to kind of check it because it just kept happening and they would do ultrasounds and every time they kind of reassured me that everything was fine and that it was probably just my uterus, you know, shedding the old blood or whatever it was they couldn’t find a cause for it and the baby was growing and developing fine so they were just kind of like, take it easy and there’s nothing we can do.

P: Spotting can definitely be stressful, especially if you don’t expect it. According to the American pregnancy Association spotting in the first trimester is pretty common, about 20% of women report this happening, and other sources say it’s one and four many things can cause spotting like implantation sex hormone changes and changes in your cervix.

S: But that kind of, it just set me up for being even more anxious because every time I would see the blood, I’d be like, well what’s happening but then I got out of my second trimester and it stopped literally right when I hit my second trimester the spotting stopped and then I started having really bad round ligament pain I had heard about rounding a bit pain but I did not expect it to hurt this month.

P: I file this underneath the heading, it’s hard to throw another human being inside you were going to have mid round ligament pain is one of the most common issues in pregnancy. Where does it come from. There are several thick ligaments that surround and support your uterus, one of them the round ligament connects the front part of the uterus to your groin. As the baby grows ligament stretches and can become strained certain movements can cause the ligament to tighten quickly like a rubber band snapping.

S: One time I even actually ended up in the emergency room because it was just so painful. I was worried something else was going on but they said everything was fine,

P: so did it feel like cramping or it felt different?

S: no it felt different, it was like, sharp pains, and it just didn’t feel right to me and I felt like I didn’t really hit my stride until the end of my second trimester, and then I started feeling really good. I had my energy back and I just, I felt that pain was gone and I was enjoying my pregnancy more and I just felt like I was in a good place, from about 26 weeks to like 35/36 weeks I felt really great, and then I went in at 36 weeks, for my checkup and my blood pressure was starting to go up. And because my blood pressure, I’ve been in the low pretty low, The whole pregnancy, they kind of reacted strongly to an elevated, reading, and they were like, alright, we’ll try it again in a few minutes it was still up so they sent me over to the hospital because they wanted to do some monitoring and more tests, and, you know, all the standard things because they were concerned about preeclampsia, even though I had no other symptoms of it except for elevated blood pressure, it was also the middle of August and I was 36 weeks pregnant and you know I anxious person to begin with. So I think there was a combination of things, but they wanted to be safe, so they sent me over.

P: It feels like every day we get updated information about the short and long term effects of preeclampsia and gestational hypertension. So I asked Dr. Patricia Robertson, a perinatologist who specializes in high risk pregnancy at UCSF, about what the current criteria are for diagnosing preeclampsia,

Dr. Robertson: you can have gestational hypertension, diagnosed, no proteinuria usually not severe range pressures, and a third of those women will turn into patients with preeclampsia. So, if you do get diagnosed, and the definition is to elevated blood pressure’s four hours apart. We’re still using 140 over 90 or greater, then that puts you into a high risk category and then you usually to get labs once a week for preeclampsia, you go to antenatal testing, twice a week to check the function of the placenta and the fact that baby is doing well. I also want to emphasize that we have several readmissions for patients with gestational hypertension and preeclampsia, so they have to be really careful for the first 12 weeks after birth and take their blood pressure at home, sometimes they’re discharged on oral anti hypertensive medication, trying to avoid severe maternal morbidity and mortality is one of our goals because you look at the leading causes of maternal deaths in the United States, it’s hemorrhage. It’s hypertension. It’s embolism, whether it’s pulmonary embolism or amniotic fluid embolism, and infection. So anything we can do to avoid those is good.

S: They did blood work they monitored the baby monitored my blood pressure, my blood pressure, then was normal, at every reading when I was in the hospital there, they did blood work it all came back fine but they sent me home with a 24 hour test for preeclampsia, so it was a 24 hour urine collection where literally every time, you pee you have to collect it in this job, and then you have to bring it in to the hospital for them to test it, and

P:  that sounds glamorous, 

S: yes it was so glamorous, one of our favorite stories from the whole pregnancy is that they gave… it was one jug, I mean it was pretty large, but it was summer and I was supposed to be hydrating a lot so I was starting to run out of room and I started panicking, so my husband had to run the labor and delivery, because my OB was luckily on call and she gave him another one because they were like, usually people don’t feel too and I was like, well I need an l came back negative, so they just said it was kind of, you know, pregnancy hypertension, but that they since I only had a few weeks left and I felt like I was working and it was… end of the summer they just thought I should be on modified bed rest till the end just to be safe. again a little isolating but you know friends visited and my mom was with me every day, thank God and I just kind of waited it out.

 I woke up the morning of the six, my due date and I don’t know if it was like a mental thing because it was my due date, but I was definitely having like some cramping and they were getting more close together. A little more intense so my husband said, Well, you know, I’ll stay home today and let’s call and see what they say and they said come in and get checked. So I was like, Is this really happening,is she really coming on her duty and you know we just were like wow, so naive right. So we went in and they said you’re only two centimeters, go home, and we’ll probably see you within the week I went home and just kind of like went about life for the next two days.

P: How did you feel, were you having more contractions?

S: has definitely having them on and off. I remember the on call OB, he told me that you’ll know it’s like a real, it’s really time when you have a contraction and it takes your breath away and you can’t talk through it, so I was like, All right, and I was definitely disappointed, I think I was done, you know I was just ready I was 40 weeks, I was a personally a month early so I thought maybe I. This baby will come early since that happened to my mom and you know so on the eighth at about 130 In the morning I woke up and I was having definitely having contractions and kind of just tried to move around our bedroom, before waking up my husband and then they started getting more and more intense, and we called, and they were like, come in. I went in and I got there at about 4am, and I was four and a half centimeters so they were like, you’re, you’re staying and I remember being like, yay, I get to stay, and the doctor was like Yeah. Yay. I was positive for Group B strep and they took blood and then they hooked me up for fluids and antibiotics, and then once they did that and did some monitoring on the baby, they basically told me I could take my IV bag and walk around the halls,

P: let me ask you, are you hoping for a natural birth or what are you hoping for?

S: well yeah I guess I should say you know people always say they have a birth plan and I said my birth plan was just showing up, we took a one day class at the hospital, it was a full day Crash Course, so I didn’t really think I retained much of that but I was open to like, whatever, you know, I was kind of like if I need the epidural look at it if I don’t, great, I won’t. I’ll do what I have to do now, looking back, I wish I had been a little bit more of an advocate for myself and maybe understood a little bit more but I was again a little bit naive and just our first baby and kind of had a lot of trust in the system and just was kind of like they know what they’re doing, and then the contractions were getting stronger the contractions but again I wasn’t in terrible pain, but they came in and they told me that the anesthesiologists had five scheduled C sections that morning. 

P:Wow, 

S: if I wanted an epidural now was the time, because he was going to be really busy all day. And if I change my mind at some point they were going to have to find someone else to come up and do it, which was kind of a weird thing to say, in my mind because it made me feel like, okay, they’re kind of telling me it’s now or never. And if I change my mind in two hours they’re gonna find someone from, from where, like, you know, the way they presented it was like, we’re just trying to find someone 

P: exactly….we’re going to go out on the street and see who we can rustle up….. 

S: Exactly, they were like, think about it for a few minutes, you know, up literally like a few minutes, and so my husband and my mom and I talked about it and my mom was like, I mean, you seem to be doing well but you know what if you do end up wanting it, my husband kind of had the same thought and I was like, I guess I should get it. I told them Yeah, let’s do it. They came in to get started, it felt like forever. When they have you hunched over holding a pillow and the nurse was holding me, because I also have slight scoliosis so he had a harder time getting it in the right spot, and you have to save so still and that was the hardest part because the contractions were definitely ramping up at this point, and just trying to be still, I’m an anxious person, especially in medical situations so I kept being like, is it in is it in and he kept like No, he didn’t have the best bedside manner, but whatever. No, it’s not a no and then finally he was like it’s in wow you’re, you know you’re like made a comment about how I’m a terrible stick or something like that so I was like, okay, like thank you. And he left, and I instantly had a panic attack, I did not like the feeling of being numb it sent me into a tailspin, I started freaking out my heart rate started going up, I was asking them if they could take it out, or turn it down, and they were like, um, we don’t really do that and the nurses, I could tell were getting a little nervous because my heart rate was spiking. I could hear them calling the anesthesiologist and explaining to him what was going on and I guess he said, just watch her. And then I explained that I also had panic attacks and I could see this like sense of relief come over the nurses face that they were like, Okay, this is probably not anything to do with the epidural it’s probably just her having a moment. 

P: Yeah, 

S:so my OB came in and she was actually very like kind of sat with me and put a cold washcloth on my head and talked to me for a few minutes and then I just calmed down and kind of leaned into the epidural and was honestly feeling pretty groovy. At that point,

P: I also freaked out I didn’t have a physiological response but i grabbed the anesthesiologist as he’s leading by the shirt, I was like, What have you done to me. Yeah, feel my legs. It’s so he was like trying to pry my hand off his shirt, I was like, This is what we want, you know, supposed to be or whatever. It’s such a weird feeling. I didn’t expect that either. It’s not like a numb tooth…it feels very different right 

S: yeah and I think it’s also like you have this fear like well what if I know, like, never regain the sensation. So, but then once I kind of realized that this was fine and, and okay, I just was like, Alright, it’s time to relax now and we just kind of hung out for a while, you know, I wasn’t really feeling any contractions i They told me to try to rest Scrum, you know, 830 to 334, I had only progress one centimeter. So, she was like, let’s break your water. And I was like all right, again, just kind of like sure, do whatever you want to me. So, 

P: does that feel like anything?

S:  It feels like a little bit of a sense of relief, it’s just kind of like a Gush, it’s like a little pop. So when she broke my water I kind of heard her whisper to the nurse, there’s meconium you know and I didn’t retain half of the things from the lesson at the hospital but I remembered hearing about Meconium, she was like it’s, don’t be concerned it’s very common, especially in babies that go past 40 weeks. The only thing that’s it’s going to change for you is that we’re going to have a nurse from the NICU in when you deliver.

I was a little concerned but they kept reassuring me everything looked great, and to not really think about it, and again as a first time mom I was just kind of like, okay I guess it is what it is… they kind of left me alone after they broke my water but they came in to check a few hours later and I was, I was stuck at a seven I was not progressing and so they decided to start Pitocin slowly making progress, I guess, at 10pm they checked me, and I was eight centimeters, I was starting to get pretty frustrated I was tired I was hungry. I was emotional, why am I not further along in the morning, they were kind of joking that I would have a baby by dinnertime and and you know it was 10 o’clock and I still hadn’t had her so they were just like there’s really nothing we can do because I had had the epidural so it wasn’t like I could move around. Finally, around midnight I was fully dilated, and it was time to push and I was a little nervous but I was also kind of excited because they said, a lot of people find there’s relief in the pushing. Unfortunately though, I pushed for three hours. So, 

P: Wow

S: yeah, yeah, so it was not like this kind of immediate release for me 

P: was it tricky because you couldn’t feel your legs ?

S:  I don’t know because they, they said I was a good pusher, you know, they, they can tell and they were pushing great I don’t know if she just hadn’t descend like she wasn’t down enough and just had to come down I had she looks great on the monitor and like I was doing okay so they just kind of let me keep going at around the two hour mark, they brought in a I’ll never forget this woman she was amazing, a seasoned very seasoned nurse, and she basically was stern but compassionate and got in my face, and he gave me the pep talk I needed she was just like you need to do this now, because at this point I was like, I want to go home. I was like, I don’t want to do this let me out of here and they were like, all right, she’s freaking out, and so she came in and she was like helping me through multiple pushes and contractions and she was great… 3:47 in the morning. Our daughter was born, I didn’t feel anything, but it was this relief and just like everything and, and they had mentioned to me that they weren’t going to let her cry because of the meconium. They wanted to immediately suction her and not let her cry. So when she came out I kept being like why isn’t she crying Why isn’t she crying, and they were like, we told you we need to suction her, we’re not letting her cry than they are, they’re

P: so they are worried that she’ll aspirate the meconium, that’s the issue? 

S: Yeah. So then they pulled her out and they held her up and they showed her to me and like I briefly saw her like I don’t even really remember. My husband got to go over and see or my mom latched over and sear and they were you know weighing her and doing all the things so I kind of thought things were okay, I had a secondary chair. So they were stitching me up and I was trying to look over, they wrapped her up very quickly, and she was crying at this point but they said, she’s having some trouble breathing, so we want to take her to the NICU for supervision, and that was it I mean they like wrapped her up. They took her. I told my mom husband to go with her because I just wanted people I knew with eyes on her.  I was kind of like, I’ll be fine. Go which in hindsight is so funny cuz it’s like I literally was left alone almost in there but I told them to go, so I got stitched up the nurse gave me a hug and she, you know, was encouraging and she brought me some snacks because it was for morning there was an open, you know they make you stand up and take your first pay, which I didn’t know could be so horrifying, I never thought that having to pee would be this horrific experience but standing up, I remember thinking, oh my god are my legs gonna work and they did. Once I peed and was able to walk around, they were like okay we can reel you into the Nick you so you can see her. And so I went in, and she had a C pap in her nose.

P: According to the March of Dimes, with C pap, or continuous positive airway pressure. Air is delivered to the baby’s lungs, either through small tubes in the baby’s nose, or through a tube that has been inserted into her windpipe… the tubes or attached to a machine which helps the baby breathe, but does not breathe for her, which is unlike a ventilator which does breathe for the baby. The C pap the baby breathes on her own, but the steady flow of air coming in through the tubes keeps enough pressure in the lungs to prevent the air sacs from collapsing after each breath.

S: And she had an IV in her arm and she had a little like heart monitors on, and I just remember thinking this is not what I signed up for this is not what it was supposed to be but she was so beautiful and I just couldn’t, like it was just a such a weird feeling of, she’s so perfect and beautiful and I can’t believe she’s mine but also, I’m so scared because she has all these machines and we’re in the neonatal intensive care unit and just never had I thought that that’s what would have happened, and then the neonatologist came in and he basically explained that she had aspirated the meconium. It was common. Most times this, they see this in babies and they’re able to come to the back to the parents room into the regular nursery later that day. The next morning you know it’s, it happens and do not worry, she would be fine. 

P: Dr. Robertson, can you tell us why Meconium aspiration is such a big issue for a newborn, 

Dr. Robertson: because it’s very irritating to the baby’s lungs, and it can cause a pneumonia is very rare meconium aspiration syndrome, it’s very common to have, like, greenish or yellowish fluid at UCSF, we have a pediatrician present when there is meconium. So the pediatricians are there so the baby comes out vigorous and it’s processing the meconium coughing and all that stuff. We leave it alone, and do the bonding skin to skin. If the baby comes out blobby and blue, then we hand it out to the pediatricians and they suction meconium out first, hopefully to help it might go into the lungs and then they vigorously resuscitate which sometimes means putting a C pap mask on the baby and pushing them sometimes the meconium as well as the oxygen and that’s not ideal. So they’re sick meconium. They’ll do a lamb and gossipy and go down the baby’s lungs suck that out the baby’s really quiet during this time it’s really hard and the parents with the babies that crying. They don’t want the baby to cry, so they want to get out as much meconium amount as possible before they start the resuscitation. I’m in a very tiny proportion of those babies do get meconium aspiration syndrome, sometimes they end up on a ventilator in the NICU it’s very upsetting.

S: He left and my husband and I were just sitting there and it was this moment of this is just not how I pictured it. I pictured my baby being next to us, and then I just wanted to be in the NICU at all times. I didn’t even get to hold her until she was about 12 hours old, my best friend did come, and I just remember kind oflaying in the bed trying to hold a conversation but also just kind of being catatonic we laugh about it now and she was like yeah I just like to tell you it really gone through and so I was just there to be a support person, I didn’t sleep much. I just would rest a bit. Go back. Watch her…. 

P: and they’re, they’re feeding her intravenously at this point, 

S:yes. And then the next day, they put a feeding tube in her nose, and I was able to give her my collostrum through the feeding tube, and any milk I was producing and also they were giving her formula, and the neonatologist was like, you know she’s doing well, they were able to start weaning her off the C pap she was on room air at this point.  she was turning a corner but he was concerned because her white blood cell count was elevated, and he said it could happen from stress, but usually at this point, it would have been down. So he basically told me that he want to do chest X ray, they diagnosed it as neonatal pneumonia, from the aspiration and the decision was that she needed to be in there for seven days for full IV antibiotics, and they were also going to do blood cultures and if those came back positive, it will be longer, which, when I heard that I just internally flipped out but yeah,

P: this is a really hard thing to hear right it’s really hard to be in your room without a baby, 

S: yeah 

P: in the maternity ward….Now it sounds like they’re gonna let you leave but keep her.

S: Yeah, because I think in the beginning, I held on to the hope that alright maybe the first night, she’ll be in the NICU and then she’ll she’ll come in with us, or maybe she’ll have to be there the whole two days and then we’ll get to take her home, but this was a pretty concrete she needs to be here for seven days for the full round of antibiotics, I had taken a shower I put on real pajamas I was starting to like feel like a little bit more of a human but it still was like this weird pays and emotional feeling.  Our hospital does a celebration dinner the night before you’re discharged, they bring you this big, beautiful meal, it’s something I’d heard about my whole life, I delivered to the town I grew up in so I knew all about this and I had envisioned a sitting at this table eating this dinner with my baby next to me and I just cried through the whole dinner, and My poor husband was just trying to do everything he could to make it somewhat enjoyable. Yeah, and I just couldn’t I was just not there with it yeah I couldn’t

So I was discharged that Sunday morning, we had our bands on, I went home, I tried to get settled. But I just wanted to go right back, it was just this kind of back and forth from the hospital. Home hospital home hospital home until it was time for the last feeding which was around 930 And then I would stay home. So at this point she was off the C pack the feeding tube was out, we tried nursing, it was a little iffy, but she took bottles well, and she was really turning a corner, but I should also know when I was discharged, kind of talking about your when you asked about expectations, again, you know, in the movies and TV and whatever you always see people being wheeled out with their baby and I was being wheeled out with all these beautiful pink flowers and it’s a girl balloons and, No baby and I just felt like everyone was probably staring at me. What was her baby, it was just such a weird experience and pulling away it just felt like my heart was still in that building. 

P: Yeah, 

S: I did wake up every night for the whole seven days around 4a.m. and called the nurses, and to check in and I mean I just have to say. The NICU nurses, they are the most some of the most amazing people I’ve ever met in my life, they were just angels and above and beyond, never made me feel like I was annoying them or bothering them loved on her so much. It was so hard but knowing that she was in good hands.

P: Those people clearly have a fast pass to heaven. Right, 

S: Oh yeah, yes, I think all nurses in general but NICU nurses… we had this week, every time we go they would teach, teach us how to give her a bath. Teach us how to do certain things, you know, they were just wonderful and like I just thank God for them every day, and the seven days and her blood was great, her she was feeding she was gaining weight. She was wonderful and they send us home. I often feel guilty because I felt like it was so hard this week in the NICU and if you and I know that there are some families that it’s like, not a week it’s months, and it just, we were very fortunate, but it did set me up for some, I think some postpartum depression. And just because I think everything was so out of my control and unexpected that I struggled with postpartum for that, that, that first year of her life, and looking back I think it was a culmination of the birth and then leaving her as in the NICU experience and it always envisioned, giving my child a sibling just because I was an only child and I wanted her to have that but I was like I don’t, I don’t know,

P: so two things: it’s interesting because on your way in you are the first person I talked to who doesn’t have this very intricate birth plan. So while you’re telling the story I’m thinking oh she might be fine with whatever happens because she doesn’t have, but it seems like buried in there and you did have some expectation, and it wasn’t, you know, part of this disconnect is holy crap, it’s not what it was supposed to look like,

S: yeah, right, because I just think anytime I’d heard of someone having, you know, someone I knew we’d get a check saying I’m going in and then the next morning, there’d be a picture of the baby and it was just kind of like this, everything was fine, so I was just, holy shit, what was this whirlwind experience that I had like what happened, You know, and it just took me a really long time to wrap my head around at all, and I was just really anxious and depressed and I isolated myself a lot from friends, it wasn’t until, I think she was about till her first birthday that I felt like I really turned a corner.

P: So your next meeting with the OB do you say I’m not feeling right, or

S: No, I mean because it might so the next meeting with Toby was what six weeks and I think I was kind of just still in the haze of it all, and then I just didn’t really tell anyone I mean, like, I, my husband and my mom I don’t even think realized it until I was out of it when I told them that I think this is what happened, because I was just internalizing it all and just like doing what I had to do to kind of get by,

P: I think it’s a giant transition that’s really hard to manage and harder if you’re anxious, and 

S: yeah, 

P: harder if it, you know goes off the rails and 

S: yeah, 

P: so all that sounds like, I mean it makes sense,

S: right. Yeah, definitely. And when my daughter was about a year and a half, I guess, I found a therapist and I kind of talked through my birth and we went up you know my anxiety and I felt like I had gotten to a better place with, with the idea of, of doing it again because in that first year and even a little after I was kind of like, I don’t know if I ever want to do this again, or two months before she turned two my husband and I were kind of like, let’s like try and see what happens. And again, I know this is not everyone’s story so I feel so fortunate, but I got pregnant that first time. 

P: take the easy ones where you can get them. 

S: Exactly like thank you yeah I’ll take that one because the other end sometimes wasn’t easy but I got pregnant with our second, I found out in August of 2018…felt pretty similar to my first pregnancy except I was just way more tired because I had a toddler, there will be time to go out on the Forgot I was pregnant, I think because I just had other things going on because you’re caring for another child and it was a pretty easy pregnancy, we found out we were having another girl. So I was so excited, just, you know, for sisters, everything was pretty easy and straightforward and then around 32 weeks I went in for an ultrasound. And I could tell something was up. Because of my blood pressure, kind of like jumped around a bit. Throughout both pregnancies, I was also seeing a maternal fetal medicine doctor who was amazing and she came in and she was so great and she just said everything’s great, the baby’s measuring fine your fluid is on the low side of normal, the plan going forward now would be weekly non stress tests weekly ultrasounds and I would have to do daily kick counting, which I never even heard of was, I know like they tell you to make sure you’re feeling the baby move but I’ve never done kick counting during my first pregnancy or anything like that.

P: Counting kicks is exactly what it sounds like you’re tracking the movement of the baby in utero, and it is actually an evidence based practice to prevent stillbirth, you can check out countthekicks.org to get more information. 

S: When I heard that I was kind of like, Is this serious, and they but they weren’t like overly concerned, they just wanted to keep a tab on it and so I did that every week, and my fluid continued to be on the low side of normal, but never to the point where they were like, We need to induce you forgot to 36 weeks, and I went for my weekly checkup and my doctor was like, You’re not dilated at all. I think it’s gonna be like with your other daughter the whole time, the whole 40 weeks. And I was kind of like okay so I like scheduled on my appointments for the next week, so the next day, I was feeling uncomfortable, but it almost felt like I had kind of a UTI like maybe the baby was just sitting on my bladder in a weird way or I didn’t really think much of it because I had a two and a half year old and I was just going through the days and trying to get her to school and home and you know being with her and I felt like that for that whole day and then Friday I woke up it was still kind of there, it would come and go, but I like took my daughter to school didn’t my errands still was feeling kind of weird, I had dinner plans that night with, with my girlfriends and I actually canceled it.  So my husband got home from work, he picked up dinner and I didn’t have much of an appetite, and I had a contraction and then my body started shaking which I didn’t experience my first time around, maybe because of the epidural, but now I know that’s common. Luckily we only live about five seven minutes from the hospital but we were I will never forget we were at this red light stopped in front of the high school, and which is like kind of the halfway point, I had a contraction, and I was, I couldn’t see through it, and I remembered from way back. And my husband was, are you okay and then I just started banging on the window like I don’t know what came over me but like I needed to like find a release of it, in some way and he was like, should I speed up and I was like yes, so we got there and they come down to greet you and walk you out to labor and delivery. And I had another one and this nurse looked at me and looked at my husband and she was like, your labor and but I was still not sure like I didn’t know when I was just, I don’t want to be sent home like I get in the room they, the nurse comes in. She was so wonderful, and she just, you know, get changed we’ll see what’s going on, let’s check it out. I had also again, tested positive for the group B strep so, so she checked me, and she looked up at me with this face and was like you’re eight centimeters dilated. 

P: Oh My G-d

S: Yeah. And I was like, what, like, I was shocked like I, the way they started moving to get the IV and to get like they really started hustling, and then she was like, Do you want an epidural. And I, this time, did not want an epidural, that was really my only part of the plan like I knew that I didn’t like the way it made me feel the first time I really wanted to try to do it without it and the fact that I was already eight centimeters, I was kind of like, I think I can do this, and she looked at me and she said, Okay, well, I used to be a midwife, before I was an RN and let’s do this.

She was fully on board, and I guess it was it’s pretty rare in our hospital where I live for people to forgo the epidural, but she was excited about it and I was excited about it so it really kind of gave me the confidence I think to do it, 

I was admitted at 10pm and I labored for a bit, it was really painful like I mean you know like I was still able to obviously got through it but it definitely hurt, much more than the first time, And then all of a sudden around 11:30 I was like I need to push, and they were like okay don’t like hold on, and they checked me and I was fully dilated, I started pushing and in two pushes, she came out and she was born at 11:54pm. And she was perfect, she was six pounds 10 ounces, so she was great and it was just night and day, to what had happened the first time, and I had another second degree tear, but it was so different because she was on my chest this time while they were switching it up, I was weirdly aware though I was like, Did, my placenta come out and they were like, because I felt something come out and she said no, that was just to large clots. But she said but that’s normal, and then a few months later she like okay your placenta is out, and I was like okay, I didn’t really think anything of it. I went to my postpartum room with the baby which was exciting for me and we were just in shock that she was here, and just a really nice two days.  

As a second time parent, and I think because my daughter had been in the NICU. The first time I was a little more comfortable letting her sleep in the nursery and bring her back in the morning and I was also, I guess I should have mentioned this before but I think breastfeeding also contributed to my postpartum, the first time around because it was really hard for me, she didn’t latch very well and I felt like I was like failing. So this time around I was way more of an advocate for myself and like when they were like, do you want us to do breastfeeding or formula, I was like, both, but you can give her a formula in the night, it’s okay, like I was just a way more open to whatever like I didn’t feel the pressure anymore I took that off myself. And then Saturday, my mom and my 94 year old grandmother got to come and meet her. And then my mom came back with our daughter and it was just such a special moment to see your first baby, meet your new baby, and then we had our celebration dinner and she was there and it was like, all these things that like I felt like I had lost out on last time I got them, and it just felt very healing, and wonderful and we went home, and that Sunday and things were really great and she was a very, very easy baby and I just felt really blessed, it was like felt like it was the birth I needed. Don’t speak too soon right Monday, so this was now the day after discharge, you know things were fine. That night I kind of started feeling a little weird, but I was, you know, it’s like you never know what after your baby like it was just normal postpartum What’s something else, and I was really emotional really feeling anxious, but again like my hormones could have just been leveling out, and I was also having a lot of digestive issues and I was just kind of like well, I have IBS, to begin with, my body’s probably regulating, I was just playing it down. 

So Tuesday morning I woke up, I was having without TMI, a lot more digestive issues, pretty crummy, not just normal postpartum so our hospital they have a standard kind of thing where you have to follow up with a lactation consultant you bring the baby in. They weigh them they check the bilirubin and they check how you’re doing and I actually called and tried to cancel it so that I’m not feeling great. And they were like, well, because your baby was 36 weeks and five days, she really needs to be seen to be weighed. So, if you’re not going to come here to the pediatrician and I was like, Fine, whatever. We’ll, we’ll, we’ll come in there, they also check you so she did my temperature my blood pressure, my heart rate, my temperature was normal, but my heart rate was high and so with my blood pressure, and I just instantly felt annoyed because I felt like it was this back to this whole blood pressure thing where like anytime I love her was up they would freak out and do all these tests and she kept checking it and it kept was still elevated and I was like, I have been having stomach issues I feel like I’m very dehydrated like that probably when my heart rates up, but she gave me a lot of water, she tried calling my OB she couldn’t reach her. She called the on call OB for my practice, and they, she her answer was, basically, she should come to a triage room, in labor and delivery and we should do bloodwork, and rule out postpartum preeclampsia. I was just, and this is not like me, I don’t like confrontation I’m very calm go with the flow person but I was so aggravated at this point, like I was tired. I didn’t feel good I was just like I don’t have postpartum preeclampsia, like, I just want to go home. I want to be with my baby I want to be with my toddler please like you guys have tested me so many times through this, I know the symptoms of it I don’t have any other symptoms of it, I want to go home. And I kind of threw this fit in the middle of the nursing station, and they were like, silent, and they were like, Okay, you can go. They didn’t know like what they were like, just, if you feel weird come back and I was like, Okay, thank you. So I stormed out I was like, I advocated for myself go me kind of thing, you know, but I still didn’t feel well and when I got home, it started to get worse. I was really tired. Again, some things were happening, and then I got really really cold and I could not get warm. I went upstairs, I changed into really cozy warm clothes I got into the bed and put lots of blankets on me and I was uncontrollably shivering, and I called my husband, he came in and I was like, I think something’s wrong, and so he got my mom. And immediately she was like, we need to go to the emergency room, it was one of the scariest moments because I knew something was very wrong. 

And my daughter had just woken up from her nap my two and a half year old when I was, my mom was like rushing me out the door, and I like saw her from the stairs and I was like I love you I’m okay I’ll be back. She didn’t know what was going on but it was really just so scary and surreal, 

we got to the hospital. They took me right into triage my heart rate was really high and they said I had a temperature of 104.5 

P:Wow, 

S: yeah, I was shocked. They put me in a room and there were tons of people in there, and they did an EKG. They wanted to do an EKG first because my heart rate was so fast and like I just remember they like you have to lay still and I was so hot all the sudden, I was like I can’t. So then it was just, every test, they could kind of think of the EKG chest X ray of flu test, blood work, urine, they ordered an ultrasound like the doctor was asking me tons of questions about my symptoms, he looked at my stitches he like examined everywhere to see if there were any signs of infection anywhere, those first 30 to 40 minutes of being there, I honestly thought that I was gonna die. I never experienced something like this I was honestly like this is it and I’m a

 ER/ Grey’s Anatomy medical drama junkie and I was like, in my head I was like, This is the story, this is how it goes. A mother died four days after giving birth. This is it. I can’t believe this is how my story is going to end. And I was saying to my mom, I was like this is it like please take care of girls she was, she was amazing, you know my husband decided to stay with the baby because he knew girls routines and she came with me and I can’t imagine what it was like for her to watch your daughter being like this but she was so calm and rational and like I was so now looking back delirious. Yeah, theater, but I was like, get a priest, I was really like thinking this was it pretty quickly once they give you the IV of acetaminophen and my fever started to go down and I was drenched and I and my vitals, started to stabilize and they were like, now we can really try to get a diagnosis, and let’s also give her something to help her relax so they gave me, you know advant or something in an IV and I was okay maybe I’m not dying like I was kind of, whoa, like, and they brought in the ultrasound tech, and he was just this amazingly sweet man, I was very high at this point on whatever they had given me so I felt like I was just like running my mouth, and he saw it right away. He said that he saw something. And the doctor came in and they said that there was placenta, still attached my uterus basically and what they think was happening was that it was essentially rotting inside of me and, you know, causing early sepsis

P: Oh Wow.

S:  Yeah, things moved pretty fast like I felt better because they had lowered the fever and I was on ativan and I had a diagnosis but the OB on call for my practice came down and she was like we’re taking you in for an emergency D&C, the anesthesiologist came in, he was like, I think because of your stress your body has been under today, it’s just best that we put you under general anesthesia, I think I was admitted to the emergency room at around 4:30 and by 6:30 I was in the operating room, and I remember like picking up and seeing my mom, and I was being wheeled to a room and I was like Is it over like Have they started and she was like it’s, it’s over like it’s finished. And they found a piece of placenta they, you know, scraped everything else out, and they made the decision that I should spend the night in the ICU for monitoring just because my vitals had been so wild when I was brought in. So, yeah, they, it was just so bizarre because to go in so sick. 

P: Yeah, 

S: and then to get better so quickly, kind of like you know like once I was out of surgery, my and I know I was on medication but my fever was gone, they were already seeing improvement in my blood work, I felt better. My mom and I were like in this room, watching Real Housewives of Beverly Hills, we were just what just have like it just felt like such a surreal moment.

P: Dr. Robertson, let’s talk about retained placenta. I definitely heard of it, causing hemorrhage, but it can cause other issues too. Right, 

Dr. Robertson: right, right, it can cause most likely it’s bleeding but it can also cause an infection and when someone’s admitted with endometriosis, which is what we call an effective uterus after the baby’s been out enemy treatise, we want to make sure that the uterus is empty so we do a formal ultrasound, as well as give IV antibiotics but moms can get very sick, and so having a high heart rate can be a sign of that it can also be a sign of preeclampsia, with something called cardiomyopathy. You just have to remember that maternal deaths, half of them happen postpartum. And, yes, it’s really a drag to be readmitted to the hospital, but these are life threatening conditions and early sepsis sometimes women end up needing to go to the ICU for fluid resuscitation and their care that’s more frequent than nurses on the front end for can provide. So even though and often they won’t let you bring your baby back in and then you have to pump in someone’s got to feed the baby at home it’s very disruptive. I can understand the reluctance of acknowledging something might be wrong, but that lactation appointment may have saved her life

S: It was just like, I went from truly believing I was going to die to like watching housewives with my mom in the ICU, like it was just like what is happening. And I didn’t need a blood transfusion I should mention that when I was in the O R.  They just gave me blood because, you know, I had just given birth and I was losing blood from the D&C and so I was on IV antibiotics. The next morning they came in and they also told me that I tested positive for norovirus, which was such a weird. They think it was like a weird perfect storm like no one knows where I got it. No one knows how I got it, and they think that my immune system was, you know, suppressed from being pregnant delivery and the placenta than the Noro and it was just this perfect storm so then I had an infectious disease doctor come in I had my OB I had my general practitioner, like so many people but they just kept being like, we’re just kind of shocked at how quickly you’ve turned this corner, and they decided to move me to the regular floor for for another day. Everything continued to improve. I remember walking out with my husband to his car and like sitting in his car and just being like, I never thought I’d sit in this car again, just these little things, it ended as quickly as it began, I don’t even I don’t even know what else to say about it, I didn’t have postpartum. This time around, but I definitely had some PTSD, not from the birth, but from the after math, and that experience, I just tried to not let it bring me down because I was almost not here.

P: Yeah, that sounds like a whirlwind, that sounds like so lucky to be in the right place at the right time that you went in that they figured it out quickly and could respond

S: right and and that’s what kind of has sparked a lot of my recent interest in maternal health in this country because I just think about it like I live seven minutes from the hospital, I have good insurance, you know my hospitals affiliated with Yale, it’s a good hospital, I think about women who don’t have that, and I, it just could have been so different, and unfortunately for a lot of women it is, it kind of sparked this passion in me, so I’m actually going back to school for a Master’s in Public Health at George Washington University, because I just want to understand this more and I want to understand why there’s all these racial disparities when it comes to healthcare, especially in maternal health care and why black women are dying at such an alarming rate when they’re giving birth and I just kind of want to know why it’s like this. 

P: that’s awesome that you took that experience and I’m using it in this way because we definitely need help right there. Those statistics for black women are dire, and it feels like a five alarm fire so I’m glad that you’re on it. 

S:Yeah, I actually, I think, like, I just looked at it the other day and it was something like, black women are three times more likely than their white counterparts to die from pregnancy related complications or childbirth and it’s just, yeah, it’s, it’s not good. 

P: Yeah…if you are unfamiliar with these statistics, I’ll put some links in the show notes so you can see what Sarah is talking about… 

if you could give advice to your younger self, what do you think you would tell her about the birth experience.

S: I think I would tell her to expect the unexpected to trust yourself to be confident in your choices, and to also know that it’ll be okay, you know, It’s just, it takes unexpected turns and I really think it’s expect the unexpected. Because if you didn’t talk like, you know, my birth, birth was one thing but then if you had told me that I would have had this like wonderful delivery. And then I would be end up in the ICU, and never in a million years would have believed it, I didn’t even no I mean I knew your placenta had to be delivered within 30 minutes of giving birth, but that’s like the big, the whole placenta, I never even thought that a piece of placenta could attach to my uterus and cause this reaction within my body.

P: amazing, amazing. Thank you so much for sharing your story I totally appreciate it.

S: Thank you. Thank you for having me if I can help anyone not ignore their symptoms or anything just kind of, 

P: yeah, that’s good advice. 

S” Yeah, cuz like I said, I think as moms and as women we’re, it’s easy for us to kind of brush things off and to worry about everyone else when, especially when you’re postpartum you need to take care of yourself.

P: I’m going to end the conversation here because it’s such an important point, and regrettably true. In the postpartum period, as it stands right now, you really do have to take care of yourself…in most places in the US you won’t see your doctor again for six weeks. And, as sarah said, we can’t ignore what may be troubling symptoms. Half of all pregnancy deaths occur after birth so it really is a time that you or your partner needs to pay attention to how you are doing after growing another person in your body for ten months and then releasing them…

Thanks again to Dr. Robertson for her insights, and thanks to Sarah for sharing her story, and thank you for listening. If you like the show, feel free to like and subscribe, and if you have a minute or a view is really helpful because it helps other people find the show. We’ll be back soon with another story of overcoming.