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Dr. Keith Eddleman is the Director of Obstetrics and a senior member of the Division of Maternal-Fetal Medicine at The Mt. Sinai Medical Center. He also co-authored the books Pregnancy for Dummies and The Pregnancy Bible with Dr. Joanne Stone.
Welcome to your Pea in the Podcast. I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey as someone’s mom.
This week, we’ll continue our conversation on pregnancy complications. This time we’re talking to moms who spent months fighting for their babies before they were even born.
Whether by staying in bed…
“I was terrified to just go to the bathroom.”
Or giving themselves 2 shots a day…
“I gave them to myself throughout the entire pregnancy up to the day I was induced.”
They fought for their babies’ lives, and won. They promise you can, too. We’re talking about pregnancy complications and the courageous moms who faced them down. Stick around.
For most women the moment you find out you’re going to be a mom is one you’ll never forget. That was certainly true for Meghan.
“I found out I was pregnant about 2, 2 and a half weeks after I had an appendectomy so I was pretty surprised. But everything seemed to proceed as normal and I had an ultrasound at maybe 7 weeks or so. They wanted to make sure it was in the right place because one of the risks of getting pregnant right after an appendectomy is a tubal pregnancy so they verified everything was in the right place and we saw the heartbeat and it all seemed fine and we went on our way.”
Meghan and her husband were thrilled. Over the next couple of weeks, though, she had some bleeding so they scheduled another ultrasound not really expecting a problem. But there was a problem, the baby had died.
“They said it and I was a train wreck. I started crying right then and there on the ultrasound table and I was by myself because I had thought everything was fine, so I told my husband not to worry about coming in, and I just started crying so hard I still wonder how I got home safely, actually. I was devastated.”
Meghan had had a miscarriage, which one study says may occur in as many of 25% of all pregnancies.
“Most commonly in the first trimester and more commonly even in the first part of the first trimester. About 50% of the time a first trimester miscarriage is due to a chromosome abnormality.”
Dr. Keith Eddleman is the author of Pregnancy for Dummies, and he says while Meghan experienced her loss after seeing her baby’s heartbeat, most moms can take comfort in that little flicker on an ultrasound.
“Once you hear a heartbeat it dramatically reduces your chances of a miscarriage down to some people say 1%. It never goes to 0, but it dramatically reduces your chances once you hear the heartbeat.”
Meghan’s doctor tried to reassure her with that information.
“I remember her exact words. Her words were ‘1 in 3 pregnancies ends in a miscarriage even after you see the heartbeat,’ because I countered back with I’m told there’s only a 3 or 4% of a miscarriage after seeing the heartbeat. She came back with that statistic and she said, ‘but you have an 85% chance of carrying your next pregnancy to term.’ And I took hope from that statement and just went home and tried to recover both physically and emotionally.”
Many women who experience a first trimester loss miscarry naturally, which may include heavy bleeding, cramping and the passing of some tissue. Meghan didn’t. Her doctor listed her options.
“We talked about whether I would wait for it to happen naturally, whether I would take something that would induce the miscarriage or whether I would have a DNC. So I took all the information I could have and decided to think about things over the weekend and I went back that Monday afternoon.”
She chose a DNC and then tried to move on.
“It was torture. It was really hard. I had really wanted to be pregnant and it was just very discouraging.”
But in a few months she was pregnant again, and in a few weeks she experienced another loss. After changing doctors Meghan got pregnant again and miscarried again. Dr. Eddleman says Meghan was experiencing what’s called recurrent pregnancy loss.
“The technical definition by the American College of OBGYN is 3 or more. It’s really 3 or more unexplained miscarriages, in other words if you have a miscarriage and you check the chromosomes and you find out that it was Down syndrome then that’s an explained miscarriage, you know why you miscarried. So it’s 3 or more unexplained miscarriages.”
Meghan’s doctor now sent her to someone who could help her figure out why she kept losing her babies.
“At that point he decided to refer me to a specialist; a Reproductive Endocrinologist who ran a variety of blood tests on me and also did an outpatient surgery on me to make sure that there was no scar tissue from my DNC or any other issues that we just couldn’t see from the outside. The surgery went well, everything looked good. I was told that I am unremarkable, which is a good thing in this case. About 2 weeks later the results of the lab work came back that I had a blood clotting disorder and that it was treatable, hopefully. In my next pregnancy I would have to do a baby aspirin everyday and also do 1 shot of heparin twice a day. Heparin is a blood thinner.”
Some doctors question whether these blood-clotting disorders cause recurrent pregnancy loss, but Meghan’s doctor was willing to treat it.
“We went in to discuss our plans for treatment and what we would do on the next cycle and while we were there I mentioned that I thought I might be pregnant, and he gave me blood test and it came back positive. So I was just in the very, very, very early stages of pregnancy. A home test probably wouldn’t even have picked it up. I started the heparin treatments that very day.”
From then on Meghan referred to herself as the human pincushion.
“My husband had to give me the first shot. When I realized, hey that really doesn’t hurt, I was able to start giving all my shots from there on out. The shots themselves just became part of my day; it was something that I did at 8:30 in the morning and 8:30 at night. No big deal.”
But all those losses don’t just fade with another pregnancy.
“There were sometimes I would basically think to myself, why am I bothering, I’m just going to lose this baby anyway. I don’t know why I’m bothering to do this. Those were the times when my husband basically had to kick me in the pants and tell me if you don’t give yourself the shot, I’m going to do it for you. But yeah, I mean it’s hard to go through an entire pregnancy expecting to lose it.”
But she didn’t lose it; Alex was born in January at nearly 6 pounds and almost 20 inches long, strong and healthy. Certainly he was worth the shots and the bruises and the anxiety and the fear, but would Meghan do it again?
“Bring on the needles. So yes, I’m willing.”
Carrie’s story begins in the first trimester but not with a loss.
“Everything went great up until about 7 and a half weeks and I went in for an ultrasound and everything looked good and then we went out swimming with my family and my nephew jumped into a hot tub and went under water so I kind of belly flopped on the hard tile and got him out and instantly felt kind of crampy, a couple hours later started bleeding.”
She was assured this was normal and the bleeding would stop. After all, between 20 and 25% of moms-to-be experience some bleeding in the first trimester, but for Carrie the bleeding didn’t stop.
“At 9 weeks they said I was developing a subchorionic hemorrhage, and then they said that my amnion and chorion sacs were separating. That’s when I went on bed rest shortly thereafter and I finally stopped bleeding and we thought everything was okay, but I went in for an ultrasound and his growth had slowed down and my fluid level was slightly under normal.”
A subchorionic hemorrhage is what it’s called when there’s bleeding between the layers of the gestational sac, so this was not a textbook pregnancy. But Carrie continued hearing reassuring voices until 3 weeks after the bleeding did stop. Her water broke. She called an ambulance and several days later when her OB gave her an ultrasound Carrie was ordered to go to another hospital with specialized care.
“I went home and showered and drove 5 hours down to Minneapolis and stayed at a hotel, which was horrifying because here I am leaking fluid the whole time. It wasn’t like normal clear color; it was rust color because I had been bleeding for weeks before that.”
When a doctor in Minneapolis took a look, the news wasn’t good.
“His exact words were ‘I’m not happy, kiddo’ and he said ‘you have no fluid whatsoever around this baby.’”
She was 23 weeks pregnant and even in the best of circumstances most experts say a baby doesn’t begin to be viable to live outside the womb until 24 weeks.
“Then the peri’s come and tell me that it’s probably best to induce labor because my membranes ruptured before his lung buds could form. That was what they kept telling me. You could be pregnant with him for the next 10 to 15 weeks and it won’t matter because his lungs buds aren’t going to be formed. He’s going to come out and his lungs are going to be plastic and he won’t be able to breathe. So Moy and I and my family kind of talked about it and I just thought that’s wrong and I’m not going to deliver him. We’ll just see what happens and let nature take its course. So they said okay. I mean they can’t make me deliver. They just had to put up with me. I was not fun to put up with either, by the way.”
So Carrie and her husband, Moy, settled in for the long haul as Carrie tried to give her baby as much time in the womb as she could. But adding to her anxiety, her baby, whose growth was already slower than it should have been when her water broke, remained small.
”He never grew after that really and so I sat in the hospital for 6 weeks and I never grew. He just kept kicking in that one same spot and I knew he wasn’t growing but at least having him kick I knew he was alive.”
At 28 weeks, 4 days, Isaiah, the baby whose lungs were not supposed to have developed beyond the day Carrie’s membranes had ruptured, was born.
“He came out, wasn’t crying but he came out and about 30 seconds later after they were working with him he gave a good cry and that was really reassuring to us because we had just said if he can cry, he can breathe. That was our rationale.”
Isaiah’s APGAR score, the evaluation of his appearance, pulse, responsiveness, muscle activity and breathing at 1 minute after birth and 5 minutes after birth, were both 8 on a scale of 1 to 10. He was tiny, 1 pound, 5 ounces but he was alive and he was breathing. That was more than 2 years ago. Now Isaiah is thriving.
“He is doing so awesome. I seriously have never been more in love in my life. He’s in occupational therapy but that’s because we choose to have him in. We think it’s good for us and good for him. I think they would have dropped him out of the program about a year and half ago, but it’s a state run program so we have the option to stay in until he’s 3. All of his developmental testing shows he’s ahead for his actual age. He’s small; I mean obviously when you start at 1 pound it’s going to take a while to catch up. He may very well be small the rest of his life. I’m only 5 foot 3 so I don’t expect him to be 6 foot or anything like that. But developmentally, and that’s what we care about, he’s doing way better than anyone would have ever expected.”
Isaiah is a survivor of preterm, premature rupture of the membranes. Risk factors for PROM include a uterine infection, poor prenatal care, sexually transmitted disease, a previous preterm birth and smoking during pregnancy. For Carrie the dominoes started to topple toward the rupture of her membranes that day at 7 weeks pregnant when her nephew fell into the hot tub.
“Everyone kind of agrees that me falling, not falling but belly flopping to get my nephew out, caused the bleeding and the bleeding and subchorionic hemorrhage caused my sac to weaken. Then just at whatever point it decided that it was time to break. Then they say that his poor growth was due to having no fluid.”
Sometimes a mom-to-be’s membranes fail, and sometimes it’s her cervix.
“A patient comes in complaining of severe pressure, not feeling right, sometimes cramping and then you do an exam and you find out that the cervix is dilated.”
That’s Dr. Keith Eddleman, and this is what happened to Laura. For her, though, it didn’t start with pressure or cramps.
“My mom had been at the hospital the night before and while I was up there I had passed a very gross discharge, it was snotty with some blood in it. I did not know at the time but that was my mucus plug.”
The next day while at work, Laura had a brief fainting spell. She didn’t think it was any big deal but her boss insisted she go to the doctor.
“I went and peed in a cup and the normal variety of stuff you do when you go in to get checked. My doctor happened to be off work that day so I saw a nurse practitioner and she said there was some protein in my urine so she wanted to check me, no big deal. She looked and she said she wanted the doctor to come look but she didn’t seem concerned so I didn’t get scared or anything. Another doctor that was in the practice came in and checked me and he yelled ‘Stop’ and my heart stopped because I knew at that moment something was terribly, horribly wrong and I said stop what? And he said don’t push. I wasn’t pushing. He said you’re pushing right there, there you’re having a contraction. Then he said you have an incompetent cervix.”
Laura’s cervix was opening up, and if it continued her baby would be born that day at 24 weeks gestation. Dr. Eddleman says there are a couple of things you can do to keep that from happening.
“You can admit the patient and put them in a position in bed to try to see if the cervix will partially close back down so that you can attempt to put a cerclage in, a stitch in to close off the cervix. Although it’s very, very, very controversial about whether or not that works. The literature is all over the place. Some women will decide at that point that it’s too risky and they’ll decide to not proceed with the pregnancy any further and some women will choose to wait and see. Sometimes you can get a little bit of time out of it. Sometimes you can’t.”
Those were basically the choices Laura was given.
“The choices were either I go ahead and let my baby be born at 24 weeks and have a pretty low shot of survival and high risks of problems even if he did survive. Or I could try this cerclage.”
As Dr. Eddleman says, a cerclage is a stitch in the cervix and the hope is that that little stitch will keep the cervix closed and the baby will stay where it belongs. But when it’s an emergency, the procedure isn’t fun.
“I was scared. They couldn’t get it closed and had to try a dozen times. I just buried my face in the nurse’s chest and cried like a little baby. I don’t want to do this. I don’t want to do this. I’m scared. I’m scared. I did not care if I did sound like a 2 year old at that moment.”
After the cerclage was in place, the anxiety didn’t really ease up all that much.
“I was terrified to just go to the bathroom that I might push my baby out. But after few days it was fine. It was a little painful and from that point on I could feel my cervix, I could feel the pulling on my cervix. So it was a little frightening.”
But Laura and her stitch bought her baby important time in the womb. At 31 weeks, her water broke and she was again prepared for the imminent birth of her premature baby. But Laura and Jamie weren’t done surprising doctors yet.
“Well 5 weeks later at 36 weeks we removed the stitch so I made it 5 more weeks beyond all expectations. Very successful for a rescue cerclage, very successful for membranes being ruptured and he was pretty happy when he was born. He weighed 5 pounds, 10 ounces. He had a little trouble breathing and had to be in the NICU (neonatal intensive care unit) for a week. But by all accounts he’s pretty much a miracle.”
Many moms who’ve carried their babies through potentially catastrophic pregnancy complications become advocates for moms who find themselves in similar situations. Carrie volunteers for an organization called Sidelines.
“It’s for women who are on the sidelines, they’re on bed rest because of complications and that has helped me kind of get over this too. To help other women going through it and see a lot of positive outcomes. So that has helped me a lot.”
Laura is fighting incompetent cervix with an ally, another mom who lost one child to IC and recently gave birth to his baby brother after a preventative cerclage. They started a website called FightIC.com. At FightIC.com you can find out if you are at risk for IC, you can find the symptoms of IC, although there are very few, and once the cervix begins dilating it can do so very quickly. You can also find a community there for women who have experienced the devastating consequences of incompetent cervix, you can hear their stories of hope and you can fill out a questionnaire that Laura hopes to use to encourage further study into this pregnancy complication.
Thinking about these complications can be overwhelming to a mom-to-be, I know, and rest assured they are the exception, not the rule. If you’re concerned about anything that is going on with you, or your body, or your baby, Carrie says talk to your doctor.
“I say trust your gut for sure and I say you’re paying for these medical services if you’re in America. For the most part you go around and you find answers. If you’re doctor is not willing to listen then find someone who is, because that’s your right and they can hate you and they don’t have to like you, that’s not what it’s about. It’s about your health and your baby’s health and you need someone to take you seriously.”
She won’t get any argument from Laura.
“First thing is that it never hurts to get checked. So the doctor thinks you’re paranoid, so what, it might save your baby.”
If something does go wrong and you think you’re not up to the fight, Meghan begs to differ.
“The amount of people when you tell them you’re doing a shot twice a day, giving yourself a shot, they say ‘Oh, I could never give myself a shot.’ You know what, you could. Sure you could, if it meant losing a child, you could shoot yourself every hour on the hour if you had to.”
We hope you’ve enjoyed this Pea in the Podcast: More Pregnancy Complications. Please visit our website, peainthepodcast.com, for more information about our experts, to find links and transcripts, and to register to receive tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie, thanks for listening.
A Special Thank You To…
Meghan in Missouri, Carrie in North Dakota and Laura in Tennessee for graciously sharing with us their pregnancy stories of triumph over great odds for this podcast.