Tag: stillbirth

K: I got to the same gestational age or as became hyper concerned that something was wrong.

P: And that because you because you felt something different or just that I felt like

K: there was too much similarity. You know, gestational li small, not a ton of movements, you know nothing that should have really blossomed as a second pregnancy should you know once your body’s gone through that once but again, my first pregnancy being so a typical no one could really say well, maybe this is just what your body does. Or there’s you know, this is this wasn’t like that kind of thing, but I yeah, there just didn’t come a date in May 2008 Or I said I think there’s something wrong and going in kind of thing.

P: did you drive to the far hospital or you went to the near one?

K: Yeah, I by that time, we we’ve had a few emergency trips for various reasons. And it was very clear that if you’re, if there’s anything at all complicated about it, you’re gonna get transferred anyway, so you might as well just drive there. So we did and we were admitted. And that just started the whole process of figuring out how much of this is normal, you know, yes, your fetus is in distress you know, we don’t know but we don’t know. What’s what’s normal here. And

P: when they say the fetus was in distress because of a heart rate issue? Okay,

K: yeah, and and it became, you know, became our decision quite quickly, you know, within a matter of hours, you know, do you want to just wait this out and see what happens with this traumatic history, or do you want to start on I forget what it is. It’s a surfactant that they unstart to help the baby’s lungs in emergency situation.

P: So surfactant is a substance that makes the lungs more pliable. Premature babies can be born before enough surfactant has been made with the poor lung function

K: and or do you want to just deliver her early and take your chances on what she wants you can get from the NICU. And I don’t remember the pin drop of the decision. But I remember both of us being a man of our chances were better with her being delivered. 

P: Yeah. 

K: And it was not an easy decision. And it was not scary. But I did discover after the fact that the one thing that was right in that decision is that the NICU was very successful. They hadn’t lost a baby of any kind of distressing many years. 

P: Oh, that’s great. 

K: And the OB, I discovered after the fact is was a doctor that all the other nurses really wanted on their own case. 

P: That’s lucky. 

K: Yes. And so between the two of them, we had good feedback, but the OB was very much there’s something wrong my guess is that this is a dire situation. And the NICU, who’s a very cerebral research renowned, published researcher, was much more, you know, thoughtful, he’s like, Well, this could just be normal for your body, but that was came straight out of the confidence that whatever happened happened, and they would deal with it. 

P: yeah, Yeah. 

K; And, and we were lucky that those two things came together at the same time. So yeah, it was delivered in 27 weeks and five days.

P: What was that birth like?

K: Again, it wasn’t prepared for it. It wasn’t prepared for a cesarean. chose to be awake. Which for me is the cocktail of sedatives and and everything else that I am not familiar with. So when they say as they pull on plunger, this is going to give you a headache it Did you know immediately the headache what was cool about that the operating room. I learned after the fact again, that every single practitioner was a woman.

P:  Oh, that’s so cool.

K: the anesthesiologist, t the OB forming a surgery and everyone else attending so

P: that feels comfortable. I like that. 

K: Yeah. So they did an emergency C section as well. 

P: It sounds like yep.

K: An emergency and then I didn’t see her for a whole night. We didn’t she was going in the afternoon. You know, whisked away before I saw anything. And then a whole night I mean, we got reports, but at the same time, you know, in order to see her you have to get yourself physically out of bed after a C section. Get yourself down there. And that’s after they’d already been flying you to start pumping. You know, in the night I remember thinking whoa, but at the same time, yeah. You have to do the things that no one tells you that you need to be prepared for but you do and yeah, so we got we did that here.

P: let me ask a your question about the birth? Did you hear her cry?

 

K: No, she was way too small. They you know, if, if there was anything to be observed, I think they could tell me or it’s written somewhere in the record. You know that she’s super active. I think about premies that you don’t realize you’ve never watched one in the NICU is that they’re really mobile. But think about how mobile they are in the womb. Yeah, that’s how mobile they are outside the body too. 

P: Yeah. 

K: And so they are flip flopping like little fish in their isolettes because they don’t have the body weight to slow them down.

P: Yeah, that’s interesting. Yeah.

K: So I think there was somewhere on our record saying that mobile you know, it moving the clincher that we didn’t know learn until after the fact is that she did not receive she didn’t require intubation. She came out breathing, and stayed that way. 

P: Amazing. For 27 weeks. That’s amazing and stayed

K: that way for two full weeks.

P:I feel like you have an Olympian.

K: She does she does like to swim. She preferred to ride horses. And then when she did receive oxygen, this is jumping. headwind go back and get details. But it was supplemental, it was never intubated. And so the weaning process was was pretty easy. And I did meet other NICU families in that timeframe. Some of them are burdened by by oxygen for life. Yeah. And I remember thinking how much how cumbersome it was just to bring them home with a little aid, you know, an eight milliliters of oxygen,  which is barely, you know, barely the threshold to even have to monitor for anything, but many families don’t have that experience.

P: So let’s talk about the NICU. How long was she there for

 

K: a shockingly short amount of time for a smallest us she was born at one pound? 13 ounces. So you don’t realize how light they are? Because they are they look fully formed? Yes, but they fit in the palm of your hand. And she was there from May 22 Until honestly the middle of July. So probably just under two months. 

P: that Does seem really short. 

K: Yeah, she came home weighing four pounds

P: How did that go? That’s easily My mind was had all kinds of issues but she was like six pounds. I found that very stressful. Yeah.

K: Oh, there’s I mean, they come home with you know, the tiny micro diapers that they only issue to hospitals and the preemie clothes don’t fit and, you know this and that. Well, it was you know, it was a pretty steady progression. But of course we didn’t know what the progression was at the time, the whatever the developmental hole in their heart muscle that needs to close between the ventricles that closed on time. Even though she was outside the womb. She never had lung pulmonary issues. They were concerned at the time they released her about her vision and her hearing. Hearing is all resolved and vision did not she was she didn’t meet the threshold for retinopathy of prematurity. And that launched into an infant laser surgery when she was a little guy but

P: okay, so retinopathy of prematurity. ROP is an eye disease. That’s my current preemies form before 30 weeks are babies who weigh less than three pounds at birth. ROP happens when abnormal blood vessels grow in the retina which is the light sensitive layer of tissue in the back of your eye. Normally the blood vessels of the retina finish developing closer to the end of 40 weeks. So babies born very early, these blood vessels may stop developing normally, blood vessels can grow in the wrong direction. Blood vessels are attached to the retina. So if they go too far in the wrong direction, they can pull the retina up off the back of the eye. 

K: Anyway, coming home at four pounds. What was cumbersome to me was the fact that she did have that whiff of oxygen. And so then they come with a heart monitor. And so between those two things, you’ve got four wires tethering you to 10 feet of space and, and needing to change it a couple of times a day. 24 I can’t remember what that was. But anyway, it was a lot of stuff. And we had to we wanted to make sure we were at least responsible with it. So we had to stay overnight with her in the hospital under surveillance to make sure that you know we could monitor these systems.

P: And Did did you appreciate that adult supervision or did you think oh, we could definitely do this

K: at the time it was an all new parents stuff. I was like Okay, here we go. Because it just is what it is. And in the meantime, there had been this weird learning curve with pumping 

P: Yeah, 

K: because I you know, I’m felt strongly about it, but I had no idea of what kind of commitment pumping was when your intent wasn’t nursing at all. 

P: Yeah. 

K: And so I was pumping, freezing it in essentially, you know, those little two ounce urine cups that they issue from a hospital or they used to and happens to be the right size for feeding a NICU. Baby. 

P: Yeah. 

K: And so I had a stash of Lowe’s at the hospital to refer to it in that and then deliver it to the hospital, you know, every couple of days, but that regimen was working. And so they were very adamant about that. And so that’s what she started on and by the time she was able to take a bottle that she did and stayed on stage on a breast milk regimen. She had a few other supplemental weird things like liquid caffeine. couple little things that had to be added supplements to her milk. But the clincher there was a she refused to nurse and so even though she was home, the pumping continued. I realized many many women do that by choice. It’s their profession and they’re there. The rest of their life more, but at the time, it was still cumbersome. Maybe I just had old technology or bad bad attitude about it. I don’t know I did it. And I didn’t do it begrudgingly. But it was it was a lot.

P: That sounds like a lot. It’s you know, bringing home an infant under perfect circumstances a lot. So in this case, it’s just when we were in the hospital, we have baby in the NICU. Also, I wanted to stay forever with like, you know all the nurses every day. How can you send us home to be on our own? We don’t know anything. So I’m amazed that you did all that on your own

K: well, it was a leap of faith, you know, at the time because I couldn’t afford care for her in order to keep working. So I had some back and forth with my employer at the time as to when exactly my maternity leave should start. Because I had been spending oodles of time in the NICU and it didn’t work out very well. So I ended up needing to maintain whatever my insurance margin was from my employer, but I needed to leave my work to be able to care for her time. And you know, there’s a little tiny baby who sleeps even more than a regular sized infant and you know, so there’s a lot of downtime, but it’s still care. You find the replays, especially in a rural setting. And so that’s what we did.

P: How old is she now?

K; She’s 13

P: Oh my god, that’s amazing. Wow.

 

K: And what was even more amazing. Besides the scent was written off to the approved maturity is that nothing else seemed to falter. By the time she was a year old. She was on the growth chart for her actual age, gestational age, and has since gotten way off. She’s 510 her feet are size 11 and a half. 

P: Wow. That’s amazing. 

K: Yeah. Her father is very tall. And so at the time I remember someone telling me well, you know, typical, you know, she gets her overall stature could be stunted by the time I joke, like, Well, I hope I hope so. And she No, I think he’s plateaued out now. She’s taller than I am. She takes very seriously.

P: I don’t know if he was very funny. My daughter does, too. I don’t know if you’re a Phineas and Ferb fan. Have you ever seen that show? Yeah. Well, five for 10 is a flawless girl.

K; I will tell her that. That’s funny.

P: Never less than five for 10 My girls say it all the time. None of us are five or 10. So we’re all yearning for that accomplishment.

K: Yeah. Yep. I have to I have learned field to be as tall as she is. And it’s such a it’s such a strange thing to be looking her in the eye that that she comments on it every time.

P: That is amazing. Wow. Yeah, that is some journey. So with, I wonder with her birth, you didn’t examine the placenta or anything like that after the delivery.

K:  I think there was so many things I didn’t know or think about there. She has that big fat medical record. Again, because her NICU primary was a researcher. I didn’t realize until after long months after maybe a year after when they were just codifying everything. That went into her care and everything they surveilled for a year or more that the surfactant they gave her at birth was some of the earliest they’d ever administered to a baby that small 

P: oh wow. 

K: And, you know, of course, I probably signed signing something that gave them permission to pursue that therapy. But at the time, I couldn’t No, probably couldn’t have lived with that information at the time. But you really

P: you wouldn’t have signed it. You wouldn’t have said yes to it. If you had known.

K: I don’t know if I wouldn’t have said yes, but I didn’t want to know about that risk. And I would have had an opinion about that risk at that time. But the way it worked out, you know, that’s what it is.

P: Yeah. In those emergency situations. It’s interesting to see what they would do. And it’s amazing that she spent such a short time in the NICU given how young she was. And it sounds like you didn’t get steroids before they delivered you to help with lung maturity.

K: Probably they probably did, but the window of time was too short. Yeah, yes. So the, you know, as you needed, what, eight hours, 12 hours, something like that, and the gap was only three hour. 

P: oh Wow, that that’s kind of amazing, right? The progress they’ve made in helping premies to breathe is is an amazing accomplishment. Yep. Yep,

K: I follow up on that was good again, or hearing if good or vision is not a you know, not great, but it’s not a documented you know, when people from getting a driver’s license or anything that is isn’t a hardship that they will have dealt with

P: But does that mean that she wears glasses or it’s something more expensive than that?

K: She had surgery when she was an infant infant, like babies basically at her term date. And what was interesting about that time was that she saw an ophthalmologist at Mayo in Rochester. And they had recently changed the threshold for qualification for surgery, and it’ll have lowered and so because she was one of the first babies to meet that threshold, the entire clinic was looking at her she was probably served by 12 different physicians just to make sure yes, definitively, this qualifies and we’re going to do XYZ. 

Some kids have that needs the same surgery and never need visual correction. In her case, by the time she was a year, maybe, you know, their eyes can still pass but by the time she was a year they were they were starting to look at lenses and then as soon as we could keep goggles on her head she started wearing lenses and then there was the biting your nails wait and see how long it takes for their eyes to fully adjust and settle and stop changing stop getting worse. So the first couple of years of her life and probably stabilized by the time she was around nine. But it is what it is. And I don’t think it necessarily gets worse. But the question then becomes what has their little infant brain done to account for the fact that their vision has always been lopsided, substantially lopsided, even with correction. 

P: does that mean one I worked for them the other way better?

K: Yep, revision even with glasses is probably 20/40. And without it I don’t know. And and that launches into my most recent chapters, which is you know, how to address education issues, and how much of them can be pegged to prematurity. So vision was a first thing developmental delays. And, you know, I’ve been the one along the way saying, you know, what, yeah, there’s this, this and this happening where there’s clearly delay, but I don’t see the gap necessarily getting bigger. I just see that it’s a delay that we’ve defined a little bit better with each passing year. You know, is it a year, two years, you know, what’s, what is it? And then you want to say that you just learned to compensate for all for all the things vision for academic things that are academically challenging things that are socially challenging. In her case, it helps a lot but she is so called because she was there. And people wouldn’t notice that she might have any kind of academic challenge unless she was around and asked to do something that’s difficult for her

P: that’s such an inspiring story. That she’s done. So well. If you are looking back on this experience. Now, is there any advice you would have given to your younger self?

 

K: I’m not sure. Honestly, I think I’m just that much older than people who would be experiencing or pursuing anything. Even like what I experienced because of the age of the internet that you can, you know, as scary as it is to research anything medical on the internet, you have such access to all the scenarios. And I think you could at least learn more about what could happen and be aware. So you know, my younger self, I think it’s all the same options. I’m still learning and I’m now divorced, still learning all the same license that when your gut tells you there’s something wrong or stressful or toxic in your life, your relationship. It’s not always wise to just bootstrap it. 

P: Yeah. 

K: That’s you, you really have to stop and get to the bottom of those things because you know, whatever you want to read about epigenetic trauma.

P: So this is an issue that Kristine has brought up a few times how trauma could have affected her pregnancy, and the development of her babies I took this question to Dr. Natalie Stevens. Today, we’re lucky to get a chance to talk with Dr. Natalie Stevens, a clinical psychologist and assistant professor at Rush Medical Center in Chicago. Thanks so much for coming on today. Doctor.

Dr. Stevens: Thank you for inviting me.

P: I wanted to talk with you because you study the importance of the impact of a history of trauma on pregnancy, and how trauma informed care can benefit patients. But rather than distill all your work and effectively capture the scope, why don’t you tell us a little bit about your work?

Dr. Stevens: Yes, absolutely. Well, prior to going to graduate school for clinical health psychology, I trained as a childbirth doula, and I was trying to see which path seemed to fit most whether I wanted to go a midwifery or medical school path or more psychological path and I knew that I needed to have some experiences from the setting in which I would be working and it turns out that I chose the health psychology path which doesn’t involve providing any medical care but rather depends on understanding from the patient’s perspective, what it is like being in a medical setting when you’re going through some kind of health related experience. And so my research and clinical focus has always been on the transitions. of care, through pregnancy and postpartum which also includes fertility and fertility loss, other topics like that. And when I started this over 10 years ago, it the concept of trauma really wasn’t considered a lot of the attention. Back then was mostly focused on depression, preventing and treating perinatal depression. So that area has come a long way.

Paulette kamenecka  23:17  

For sure. It’s kind of shocking that this is new, which given the pregnancy is not that new but so thank you for your work, because this seems vitally important. One thing that when we talk about trauma I think people can get confused by is, is what does that mean? Does that mean, you know, a child survivor of a war or, you know, what’s the scope of that? Can you maybe define for us what we’re looking at

Unknown Speaker  23:41  

Absolutely. And it depends on who you’re talking to. Because when I started my work early on, working pretty closely with obstetricians and the obstetric residency program at Rush, the word trauma in the medical setting means a physical trauma that requires even more clarification. So a psychological trauma is more often what we’re thinking about when we use the term trauma and it’s an event that is a stressor that is out of the ordinary beyond the the intensity or level of threat to a person’s health, life, safety, bodily integrity than what is typically experienced.

P:Today, we’re gonna talk about perceived concerns about how trauma may have affected the outcome of our pregnancies. Can trauma cause slower growth for the fetus in utero and trauma cause issues with the placenta? Do you think there’s any connection there? And and, you know, is it related to premature delivery?

Dr. Stevens: Yeah, that this is such a fascinating and complex question. But the short answer is, yes, there. There are physiological things, processes that have been sort of teased apart by various researchers and projects to try to see what the connection might be between both having a history of trauma, but not necessarily a diagnosis of PTSD having a history of PTSD that isn’t present during the pregnancy. Or having PTSD while you’re pregnant, that has been examined in relation to prematurity, low birth weights. And those are those are the two primary outcomes, but there are a number of complications and things that quote unquote, can go wrong. That I think feed into a lot of the anxiety that pregnant people feel. So there are other things going on here. Trauma doesn’t only lead to PTSD, there’s also the risk of depression, substance misuse and anxiety. So I was thinking about that and the story you described, that person doesn’t have to have all the full criteria for PTSD in order to have a lot of hyper vigilance in the subsequent pregnancy when all of these signals are coming up that remind them in parallel. What happened before. So then there are other studies that have looked at anxiety symptoms, not specifically traumatic stress symptoms, but anxiety symptoms, that have also shown an association with these outcomes. But I think the important thing to remember about all of that is that this is the larger scale epidemiological research and it’s really, really difficult to if not impossible, and as researchers and scientists we don’t we don’t do this to extrapolate from those findings to an individual case. So the other thing I think it’s important to mention, and there’s some really great, accessible information at the National Center for PTSD website that talks about different risk factors for PTSD and how women are more likely to develop it than men are. Part of that is greater exposure to trauma, greater exposure to things like sexual violence, which are more likely to lead to PTSD and that the key here is the idea of what what does the brain do, what does the person’s thinking do or how does their thinking change as a result of the trauma? And so there’s some evidence to suggest that women are more likely to blame themselves for things like sexual assault, but also the instance you’re describing something that happened to my pregnancy and that self blame coupled with the social support, not not having those supportive people around you, that you feel safe and and perhaps are helping you to challenge that narrative are really important process. So I’m speaking more to the psychosocial processes because that’s more my area, but there is absolutely some fascinating studies that I have read about the links between trauma and inflammation. The way that it affects the fetal placental unit, you know, this kind of unit where the pregnant person’s body and the fetal unit are coming together. And there are certainly many studies that have pointed to, although not completely described, or found, that there’s there are alterations when there’s a history of trauma, even even epigenetically even in previous generations. If I can repeat back what I think they’re saying is two things. Thing Number One is there’s definitely research on the fact that history of trauma and maybe trauma during the pregnancy can have physiological effects that might be correlated with low birth weight or prematurity that can’t explain one person’s experience. But he somewhat natural inclination we all have because the pregnancy is going on in our own body to claim responsibility for the outcome is not helpful and probably not right, given how complicated this

P; process is. Right? If you had that much control over your own pregnancy, everyone would be born with like an eight pound share. Right? Exactly