Elizabeth Petrucelli

Author, Blogger, Educator

Author: ElizabethPetrucelli (page 1 of 18)

Postpartum Depression – Part 1

It’s not an addiction. It’s not an injury. It’s not something that is easily seen yet is extremely dysfunctional and can be fatal. No one chooses to experience it. The timing of it’s existence isn’t planned. People who suffer through this don’t do it on purpose and don’t want to hurt you or mess with your life or plans. Believe me when they say it affects them much worse than it affects you.

Many people don’t notice and more often choose to ignore it. Much the same way as when multiple people hear a gun shot and say, “Did you hear that?,” yet don’t call the police to check on it; those suffering through it are ignored. They are often dismissed when they mention they are struggling, “get more rest, do less, stay strong, this too shall pass.” It’s as if recovery is easy.

Yet, the people suffering through this, don’t see an easy path. They see discombobulation, inconvenience to others, a burden, worthlessness for needing help, and some see themselves as a failure. Even the best laid plans to help get through it or prevent it; fail. Even when you can tell people, “I struggled through it last time and I am afraid I will struggle through it this time,” and those people you shared with say, “I will be there for you. I want to help you. I don’t want you to have to suffer again. Just let me know.”

They will forget. You will be a burden. You will be an inconvenience. They will ignore.

Oftentimes these will be the same people who say, “Why didn’t she tell me? Why didn’t she say something?”

But their busy lives or the uncomfortable thought of having to inconvenience themselves, their family, their vacation, their trip, their work, their plans, their lives…comes over the triage and treatment of someone suffering through postpartum depression. Because the illness can’t be seen and can’t be easily noticed, the women continue to suffer. Sometimes, we don’t even realize we are suffering with an illness that we are so far into the destruction, it’s hard to fix or back out.

The irrational and impulsive nature that can come with postpartum depression might be fatal if it is not recognized or noticed by a loved one AND that same loved one reaches out and ensures help is given. Follow-through is important. It is crucial. Waiting or ignoring leads to poor outcomes. Thinking, “It will get better. She is going through a rough spot. It’s her hormones. She is strong and will survive;” all of those statements from those on the outside are damaging to her.

She is strong, but right now her strength is the reason she hasn’t sought help. Her strength is actually her enemy. And a woman who is believed to be that strong, who is believed to survive anything, who is believed to have survived worse; well…by the time she reaches out for help, she is in the depths of despair and needs immediate attention, support, help, treatment, and love.

This is me, in the depths of despair.

Her thoughts can be dangerous yet if she shares them, her biggest fear is her children will be taken away so she keeps the thoughts suppressed, furthering the danger she is in. She continues to suffer in silence, hoping someone will notice, just enough, to reach out and step in. “I’m here for you’s,” are ignored because it’s not direct enough. It’s open-ended.

“I’m bringing you lunch or dinner or coming over to clean or hold the baby so you can shower” are better. A friend said it like this to me which made it hard for me to say no “How about I come over after my meeting at 1:30?” Then she asked if I was okay for dinner because she was going to bring something.

 

You can’t tell a mom has postpartum depression by looking

But these require the other person to be inconvenienced in some way and many people won’t do that. Many people also don’t want to really know or hear what’s going on because it requires follow up, follow through and maybe more support than they are willing to give. It also makes them uncomfortable for a variety of reasons but they likely don’t know how to support someone through this. It’s not an addiction, it’s not an injury. It’s unseen and uncomfortable.

All of this makes postpartum depression worse. At least it does for me.

Society also makes a woman believe she is weak for asking for help. The medical field furthers these thoughts by only “testing” women within the first six weeks of having a baby. At the first newborn visit (2 days postpartum) a few questions might be asked. At the 2-week newborn visit, the mother fills out the Edinburg Postnatal Depression Scale.

Both of these tests are administered very early in the postpartum period. At the 6-week postpartum visit, the test is given again. Keep in mind, the test at the newborn visit and the test at the postpartum visit are given by different practitioners who most likely do not talk with each other. If something came up at the 2-week visit, the OBGYN would most likely have no idea. After the 6-week appointment, assuming the mother did not score a 10 or above on the scale, the assessments are complete.

Any help needed after 6-weeks postpartum the mother would have to recognize on her own. 

I noticed a random question on the well-baby check-up sheet for my daughter at her 4-month visit, “Is anyone at home irritable, angry, sad, or depressed?” I marked YES. During the 45-minute visit, it was never addressed with me. Why?

It requires follow-up.

Because the doctor never explored the question with me (keep in mind he is a pediatrician, I feel the question is merely a band-aid. It’s not a solution. It’s fluff to make it look as if someone cares but it’s not real. Because no one asked a thing when the box was checked. It was ignored. Little did they know that it took everything in me to check that box YES. I was ready for an uncomfortable conversation but I didn’t want to initiate it. If you asked me during the appointment you might have received tears and seen that something was up and that your probing could have helped. You could have potentially saved me from going deeper into despair.

Postpartum Depression – Part 2

Termination

Eighteen months ago, I embarked on a journey. A journey I have never been on in 26 years I have been employed. I have been relatively silent about this journey, mostly to protect myself from embarrassment and my current employer. But like most things, opportunities present themselves and doors are opened which allow the silence to open into dialogue.

I am an educator. I have been a certified childbirth educator for over four years but I have been teaching childbirth education on and off since 2004. I have also served in the role of educator in various occupations so teaching isn’t new to me. Whenever I teach, it’s been important for me to share as much information as I can so people can make informed decisions about what I am presenting to them.

As a childbirth educator, it is not my job to sway a parents choice in one way or another. New parents have so many decisions to make and as their educator, I try to make that process easier by presenting all facts. I take great pride in having a diverse curriculum.

As a pregnancy loss advocate, I too try very hard to present all the options and choices families have. Options which are rarely presented to them by their care provider or hospital staff. Even though hospitals believe they have strong bereavement programs, they still miss the mark on some of the tiniest of options which parents should have the benefit of choosing because it can make all the difference in the world.

Care providers may begin to sway families in a particular direction because they feel it may not be important to the family or because it takes more time and/or effort to provide a particular option. It’s a huge disservice to families. I have written about organizations who are agenda driven and aren’t clear on the populations they serve. I have shared experiences from families who felt their care provider didn’t care. And today, I will share an experience that is so very hard to tell but really needs to be told.

I was fired.

I was fired for providing evidence-based information to students within a hospital prenatal class; which led to them asking questions during appointments with their care providers. Various complaints came from these care providers such as: “my patients are asking too many questions and I am getting behind in my patient load,” “I only allot five minutes of time per patient and they are asking too many questions,” “it’s not my job to inform them about ____,” “What kind of information is the educator giving because it’s not evidence-based,” and more. If you think that doctors enjoy educating parents on important topics, this study shows how doctors find less job satisfaction by spending more time talking with parents concerned about vaccinations.

I worked closely with my manager any time a complaint about my curriculum came up. So much so, that my presentations were reviewed and approved numerous times throughout my tenure. After receiving an update that I shouldn’t talk about delayed cord clamping (which is now a standard of care at nearly every local hospital), future complaints involved my education on circumcision. If a student asked about something that was too controversial or a topic my manager “implied” that I should not speak about, I was told to defer them to their care provider to ask those questions. Despite the changes, nearly every few months, I was pulled into my managers office because of the information I presented about newborn circumcision.

The information I provided was given to me by my manager from the hospital’s system “Up-to-Date.” My manager informed me that they didn’t care if patients weren’t choosing to circumcise but too many questions were being asked and I needed to stick with the evidence. Each time, my manager would review my presentation and approve it. I was sure to stick with what was on the slide during my classes but I couldn’t stop students from asking their doctor questions about the procedure.

After two years teaching at this hospital, I was fired. Patients were asking too many questions of their care providers. Were they upset that parents weren’t choosing newborn circumcision? Did they feel the patients were questioning their ability? If they weren’t going to present the real risks and benefits of procedures, who would?

I had worked for this hospital in varying roles for six years. I knew the in’s and out’s of the political environment there and I knew that doctors were to be kept happy at all times. Doctors must be catered to at all costs and were not subject to the same rules and policies that regular employees were. Doctors were special; they were to receive free meals, special lounges stocked to the brim with food, and were not subject to discipline if they were found stealing food or destroying property. The more prestigious their specialty, the more important they were and the more they got away with.

So it was no surprise that I would take the fall when these doctors complained about what their patients were learning in childbirth class if it didn’t fall in line with their opinion. In the last class I had, before I took the fall and was fired, a student kept asking if a doctor could force her into a particular procedure. I had been suspicious of her probing because she kept asking and other students were getting nervous. It seemed she didn’t have trust in her care provider. I explained that she should work closely with her doctor to ensure a mutual trust but ultimately, she cannot be forced. It’s assault, it’s against the law. That statement sparked an investigation and led to a meeting with HR.

But in that meeting, HR was only focused on the circumcision information. “We think you are teaching out of scope,” she said. “Really?” I replied. “I was hired to teach newborn care. It is well within my scope to provide the risks and benefits of circumcision. The information I provide was given to me by my manager and approved several times.”

She fell silent. After she explained their concerns, she presented me with two options. Resign or be terminated. I have never been terminated in my life. As a 40-year old woman with a military service-connected disability, I played the card. “I am not resigning, you will have to terminate me,” I said.

She then explained that she couldn’t fire me and would have to call me back in next week after talking with my manager. My manager was not on my side. She was tired of having to field phone calls about what I was teaching. There was a six-month period of time where I did not have her as a manager. I reported to a director and not once during that six-month period was I summoned to her to answer questions about what I was teaching.

My current manager had a bias against me. I don’t say this lightly but she did. Numerous times she talked about how I was a doula and that skewed my view of childbirth. She thought I was focused on “natural things” only and that I was against epidurals (never mind that I had an epidural at each of my births). She was angry when students called me in to support them through the death of their baby and required me to put up a flier for staff stating I was not employed by the hospital when I assisted families through stillbirth. So my manager was definitely not on my side and I knew she would do everything in her power to fire me.

I felt I had a good standing though. Not a single poor evaluation, 4 and 5 star evaluations from students, and of course, I had followed her requests and my slides had been approved by her. A week later, I received the call. “We could not come to an agreement from both parties,” said HR. “What is the solution?” I asked. She would call me in a few days.

A few days later, HR called with my manager where I was informed that I would be terminated because I present too much controversial information. I knew what she meant. My manager frequently stated that our patient population is “highly educated.” She stuffed that down my throat nearly every meeting. However, she hasn’t taught the classes and she didn’t hear their questions. Just because patients have high school diplomas and college degrees does not mean they know anything about childbirth and the procedures that come with it. They may have the means to look things up but they take a class to learn all they can.

I asked for a termination letter and received it. Then I applied for unemployment; which I also received for a short time.

The bottom-line was this; the hospital did not want their “educated” patients to ask questions. Even though my slides were approved and my manager stated that what I was teaching was great information, I was thrown under the bus when the pressure was too much for her. Instead of standing up to what her educators were teaching, she chose the easy way out. Fire the educator who encourages students to research and develop a trusting relationship with their care provider through asking questions.

By now you must be thinking that I am some sort of “intactivist” who is against circumcision and that I had to have been breaking rules or giving biased information. Students in my classes were taught the “evidence-based” information from Up-to-Date; the hospitals own resource center.

BENEFITS OF NEWBORN CIRCUMCISION
May reduce the incidence of urinary tract infections for the first six months of life.
May prevent certain sexually transmitted diseases such as HIV (although this study was done on adult African males circumcised as adults).
May reduce the incidence of penile cancer.
May reduce the incidence of inflammation of the glans (head of the penis).

RISKS OF NEWBORN CIRCUMCISION
Pain
Bleeding
Infection
Meatal Stenosis
Removing too much foreskin
Buried Penis
Loss to or damage to all or parts of the penis
Death (mostly attributed to infection and/or bleeding)

Students were informed of the statistics such as circumcision is on the decline in Colorado, that the AAP does not have an official recommendation and leaves it up to the parents, and that this is an elective procedure so double check with your insurance company to see if it’s covered and if your doctor performs the procedure.

Numerous times I had been called by students because their doctor would not do it and they needed a recommendation. They were referred to call a urologist when their OB or pediatrician would not perform the procedure. So you can see, the information I provided was not biased.

I still teach. In fact, this information is or has been presented at three other metro hospitals with no complaints. It is the culture at this hospital. A culture where they don’t want patients informed. They don’t want patients to ask questions or to research information. It’s a culture where “I am the doctor, therefore you will do what I say.”

I am not making this up. I have witnessed doctors making these statements to women and their partners during labor. I have seen doctors threaten patients with child protective services or calling law enforcement if they don’t do what the doctor recommends.

What’s the big deal with circumcision anyway? It’s just a snip right? Check out the video below and tell me if you think it’s just a snip? Wouldn’t you want to be fully informed before you subject your baby to this?

I have two boys. With my first, I was never informed about circumcision. I assumed it was a painless procedure where they just cut of a bit of skin. I had no idea that the foreskin is attached to the penis and they would tear it off. I had no idea the foreskin was functional. No doctor or childbirth educator talked with me about circumcision other than to say, “everyone does it.” When my son was returned to me after his circumcision, I knew something wasn’t right. I knew he would never be the same. I knew I had taken something from him and what I saw when I opened his diaper was shocking. It was an unexpected outcome.

This prompted me to learn more and as an educator, I wanted parents to be informed. I wanted them to know what to expect, not just with circumcision, but with any decision they make for their labor, delivery, and newborn period. Those decisions can affect them and their baby for the rest of their lives. How can a parent make an informed decision about any procedure if they are only given a one sided view or pieces are left out?

By the way, I also educate on how to care for the intact penis. I have observed five different newborn care educators and only ONE also educated on caring for the intact penis. Did you know that not everyone chooses to circumcise and if parents are not educated on how to care for their intact son, damage can be done? A patient population is being blatantly ignored.

We cannot leave out the bits and pieces to sway parents into a decision we believe is right for them because they may fail to research or understand it. They may not have known there were other options available to them because bits and pieces were left out.  Isn’t it a childbirth educators job to inform?

Use of a Fetal Doppler in Pregnancy

DISCLAIMER: I am not a medical professional. Please consult with your doctor or midwife if you have any questions regarding this information and opinion on the use of a fetal Doppler in pregnancy.

I want to address this fear-mongering article from Bustle. In the article, This New Pregnancy Trend Among Millennial Women Could Seriously Harm Unborn Babies, the author makes some “serious” claims. First, I want to pick apart the title. “New Pregnancy Trend,” “Millennial Women,” “Seriously Harm Unborn Babies.”

This is not a new pregnancy trend. Unless “in the last 15 years” is considered a new trend. When I was pregnant with my now 14-year old, home monitoring devices were around. Back then, it wasn’t easy to find a fetal Doppler to use at home, but I had a home monitoring device called Bebe Sounds Prenatal Listener. I could listen to my baby’s heart, record it, and also play music to my baby. It came with headphones and an adapter for my mp3 player or Walkman. We have really come a long way in the last 15 years!

I remember thinking it was odd that no gel was needed to hear my baby’s heartbeat but once I was far enough along, I could certainly hear him in there moving and the little thump of his heart. It probably was far into my third trimester before we could hear anything. Fast forward 10 years.

I had experienced one miscarriage before I became pregnant in 2013. I knew how easy it was to rent a home fetal Doppler and I wanted one. I didn’t want to rent one so I bought one on eBay ;the Sonoline B. Guess what, Walmart now sells them and they are cheaper than the one I bought on eBay five years ago.

This is hardly a “new pregnancy trend.”

The next claim in the title is that this is by millennial women. I am NOT a millennial and many pregnant women in my age group (35-45) are not millennial either and they use fetal Dopplers. In fact, many of my millennial friends would never and have not used a fetal Doppler. I dislike the authors use of a generation.

Just plainly say “women.” Does this mean that only millennial women are so ignorant they could not figure out how to use a fetal Doppler?

And finally, the author’s fear-mongering statement, “Seriously Harm Unborn Babies.” Wow! That’s a catchy title and unfortunately, it’s click-bait. In the article, there wasn’t a single bit of information proving that using a fetal Doppler causes “serious” harm. Yes. I purposely removed the word, “Could” from my picking apart because I guess ANYTHING “could” cause harm. This article was meant to scare women from using the fetal Doppler.

This Pop Sugar article calls it a new “fun” trend, so not fear-mongering. It’s also almost a cut and paste of the Bustle article.  For me, it certainly wasn’t fun although there may be women who use a fetal Doppler for “fun.”

Do I recommend women use a fetal Doppler in pregnancy?          NO

Why? I don’t think every woman needs or should have one.

But to scare women from using one is a disservice. Elizabeth Hutton, CEO of Kicks Count UK, even has a petition to ban the private sale of Dopplers. I love Kicks Count and I utilize their brochures, cards, and documentation in my childbirth classes. It’s important to assess your baby’s fetal movements and this can be a very bonding experience for the parents. I don’t agree with banning a tool, where if a mother is trained properly, she has a tool which can help her immensely.

Let’s talk about training, because in the article This New Pregnancy Trend Among Millennial Women Could Seriously Harm Unborn Babiesthe author claims that women are untrained and speculates that no woman can or should be trained. Instead, the article warns women not to use this tool because it can cause stress which is harmful for a baby (due to not finding a heartbeat) and it can cause reassurance when there is actually something wrong (because the mere finding of a heartbeat does not signify health of baby).

If the author is mistakenly referring to ultrasound Doppler or even fetal heart monitoring on a strip, then yes, there is more training that takes place, but not years of training as the article states: “Midwives and doctors train for many years to interpret what they hear through a doppler.” I took a weekend class on reading and assessing fetal heart tones as a labor doula.

If stress is going to be cited as harmful for the mother and baby, raised blood pressure for mother and premature birth (which is a stretch to say the least), what about the mother who has chronic anxiety in her pregnancy because she is a loss mother and is in a constant state of worry over the health of her baby?

If a mother couldn’t find the heartbeat on her home fetal Doppler, she would have acute stress and need to see her OBGYN or midwife for reassurance (this is a good thing). Once the mother receives reassurance that the baby is okay, her stress would diminish. Many pregnancy after a loss mothers are under chronic stress. Chronic stress would more likely lead to raised blood pressure and potentially, prematurity. If a woman had a tool which could potentially reduce that chronic stress, wouldn’t we want that available to her? Now you are saying that doctors should then prescribe a home fetal Doppler. I will agree with you there.

The final concern is that a mother may “think” she hears the heartbeat when it’s actually placental flow, her own heartbeat, or hears the fetal heartbeat but there could still be something wrong and she is reassured when she shouldn’t be. This is the biggest concern for me and I have experienced this first-hand (although my baby was fine).

This is where a little bit of training would be beneficial on the use of home fetal Dopplers. In addition, doctors and midwives who know their patients are using them, should have serious discussion about fetal Doppler use and when to be seen. I can’t tell you how many times I was told, “If you feel like there is something wrong, or your baby has reduced movements, come in.” Let’s not forget that there are plenty of You Tube videos out there to show women how to use a fetal Doppler.

I would have been in the doctors office every day, all day. 

It’s really not feasible or realistic for women enduring pregnancy after a loss. And with my insurance, after hours requires a visit to the ER as no urgent care is available for pregnancy so once 5-o’clock hits, it’s ER time or suck it up until morning (which can be fatal for a baby).

How about training women how to use the fetal Doppler. I know I have said this before. Instead of avoiding the conversation because you don’t want the mother to use the fetal Doppler and if you talk about it you will encourage her, have that difficult conversation and help her to know when something isn’t right and she needs to seek care.

It didn’t take much training for me to learn what I was hearing; my baby’s heartbeat (fast or about 130 beats per minute in my last pregnancy and 165 in my second living pregnancy), placenta (more of a whooshy sound with heartbeat), and what was my heartbeat (much slower or around 60 beats per minute). I was always sure I heard the heartbeat but just because I heard it, didn’t mean everything was okay.

We can teach women that just because they hear the heartbeat doesn’t mean everything is okay and that they should also seek care if there is a concern such as reduced fetal movement or their intuition tells them there is something wrong. I surveyed labor and delivery nurses, who work in different parts of the country, on how much training they received on the use of the fetal Doppler. It ranged from “on-the-job” training to “I don’t remember being trained in nursing school,” and “we had training in nursing school and on rotation.” Nurses did have a competency to complete each year while on labor and delivery.

The article implies that women are not trainable, nor should be trained on how to distinguish their baby’s heartbeat from their own or the placenta. I disagree and believe that fetal Doppler’s can be a very effective tool at lowering chronic stress in pregnancy after a loss or in any woman who is experiencing chronic stress in pregnancy related to the unknown of the health of their baby. Women should be directed to visit their care providers with questions on fetal health, with reduced movements (COUNT THOSE KICKS!) and if their intuition tells them something is wrong.

If we can combine the use of a fetal Doppler with the instructions women are already given in pregnancy on when to see their care provider, the use of a fetal Doppler can be helpful for the woman.

DISCLAIMER: I am not a medical professional. Please consult with your doctor or midwife if you have any questions regarding this information and/or concerns about your baby’s health.

#SuicideAwareness

#SuicideAwareness has been circulating the internet over the last year or so. I am sure it has been around much longer but recent events have caused this hashtag to spread dramatically. It’s a great hashtag and is usually preceded by someone asking to post a status that says, “Share this so others can see that someone is always listening,” or something similar.

Honestly, I roll my eyes at this. Before you jump on the hate train, let me explain why.

I have experienced postpartum depression.

I have been in the depths of postpartum depression. It sucks and I don’t wish it on anyone. It was a surprise to me as I had not experienced postpartum depression after the birth of my first baby. 10 years later, following the birth of my second living child, postpartum depression appeared. I didn’t realize that’s what was happening to me. A therapist pointed it out when I arrived to her office, in tears, fearful that what I was about to say meant that my baby was going to be taken from me.

I don’t share this story lightly. I realize this can hurt my career and any future career. I know that in sharing this part of me there will be judgment and that clients may question my abilities. I also want to assure you that postpartum depression or depression for that matter, does not occur in a vacuum and people can be extremely functional with depression. This is why suicide can be so shocking. There isn’t always a sign that can be seen before, sometimes it occurs after an attempt or completion of suicide.

For over five years, I sat with suicidal patients in a hospital. These patients had either attempted suicide or had what is called suicidal ideation (they are contemplating suicide or have had thoughts of suicide but may or may not have a plan to act on it). Twice I sat with patients who actively tried to kill themselves in front of me or my staff.

I empathized with them although I didn’t understand completely how they could be in such despair. They had people in their lives that loved them and they had their own children and families (people who were worth living for). I sat next to one person who had just attempted suicide. I asked them why they felt so deeply that they should be dead.

The emotional pain hurts much worse than any physical pain I have experienced. 

I will never forget that statement. This person explained that cutting off a leg would hurt less right now than the pain they were feeling. I asked many more questions but ultimately it boiled down to this one statement; how to calm the emotional pain so they wouldn’t want to die. I am not saying there aren’t other excuses for wanting to commit suicide, there certainly are but this really struck me. This person had so much going for them.

As I sat in my therapists office, it took me several tries to say these words, “The other day my baby was crying and I wanted to throw him into the wall.” She stared intently at me and didn’t say a word as I blurted out, “Please don’t take my baby away from me.” She smiled and stated that was not in the plan at this time. I felt safe to also share, “Another time he was crying, I just wanted to smother him.”

I was glad that it was a safe place to share these thoughts with her. They were horrible thoughts and I felt extremely guilty and scared about them. I had lost a child a few years before, why wasn’t I cherishing every moment I was having with this child? Then I made one of the most shocking statements, as if what I haven’t already disclosed wasn’t shocking enough.

My husband left his gun on the counter and when the baby was crying the other night, I looked at it and thought, “If I just blow my brains out right now, the crying will stop.” Then I picked up the gun. Obviously I didn’t use it. I picked it up and placed it in the gun locker and locked it away. Then I closed the door to the storage room it was in. Sure I had the key but I had also placed several steps in front of me that may stop me from using it.

There was so much that went into why I was having these feelings. Lack of sleep, a difficult baby, feeding problems which meant sleeping problems (for the baby and me), unresolved grief from the miscarriage, little help at home (an inability to ask for help),  expectations for how my baby should be compared to my last baby, and hormones. What was even more confusing for me was that I was at least five months postpartum. How could this be happening now?

We talked and came up with some plans. I had already had a day where I handed my husband the baby, bawling as I looked at him and said, “I am not leaving you or the children but I need to leave. I need sleep.” My husband looked at me and replied, “You do what you need to do, we will be here when you get back.” If that night away didn’t help me, what would?

When my therapist said to me, “I know you don’t want to hear this and don’t believe it but you have postpartum depression,” I didn’t want to believe it. I couldn’t have depression. People like ME don’t have it. I have a good support system, people who love me, children and family to live for, and very little wants and needs. Plus, I was at least five months postpartum. How could I have “it?”

Ultimately, it didn’t matter, I was in the depths of postpartum depression.

The plans we came up with did not involve medication. I was glad for that and after a few months of therapy, I was feeling so much better. By the time my son was nine months, the fog had lifted, I felt sane again, and I bonded and fell in love with him from that point forward. By twelve months, I was contemplating another child.

Roughly a year later, we were pregnant again but sadly, our son Gus had triploidy and passed away at 10.5 weeks gestation. I processed his loss very well and move through my grief more quickly. I think it really helped having a commendation ceremony/funeral for him.

We had decided that our family was complete and began our journey of utilizing Natural Family Planning (NFP) to avoid having another child. With my age (I was now over 40) and the depression I had experienced, we decided it wasn’t healthy for us to attempt another pregnancy. In Gus’s short life, I had experienced several weird illnesses and was under the care of a GI specialist. This can happen when a woman is pregnant with a baby who has triploidy.

To our surprise, God had other plans for us an in September last year, I became pregnant. Ensuring my mental health was priority and this is something we planned ahead for. I will blog about this journey on another date but it is important to share with you my thoughts on the #suicideawareness and how it may not really be that successful.

It is suspected that a friend and former employee of mine may have committed suicide. There is some speculation on how that happened (not necessarily related to depression) but friends are left wondering how they missed the signs. What signs are those people, who are not experiencing depression, looking for? Are you looking for someone to say, “I am going to kill myself.” How about, “I just want to die.” Or, “I am in the depths of despair.”

What does it look like to you to see that someone is depressed or contemplating suicide. You see, I have reached out in the past and no one noticed. I felt I was pretty blatant in my post. I was really struggling and needed some help that evening so I shared something on Facebook and seven out of 500+ friends of mine responded with a “like.” It was the only way I knew how to ask for help because a person like me doesn’t ask for help. Yet, no one knew. No one saw that my message was asking for help and if they did but did not reach out to me, well…I don’t want to think about that.

So the signs can be there and can be extremely subtle. I am highly functional through my postpartum depression. I smile, I laugh, I visit with friends. I am not crumpled up on the floor.  If you ask me, “how can I help,” or “let me know what I can do,” you won’t get an answer. If you want to help, HELP. Say, “I am going to bring you dinner on _________ night,” or “I will hold your baby so you can take a shower,” or “I am going to pick you up and take you out on _________ night. I have already talked with your husband and he is going to watch the children.” Just help someone when they are experiencing depression. (After I wrote this blog, a friend passed along this article. It has pictures and explains the faces of depression well.)

When I write these down, I see they are familiar. These are some of the same things that can be done when someone is experiencing grief or just had a baby. These are helpful things and when you are doing these helpful things, you are opening the door to conversation, for planning other ways to reduce stress, anxiety, and depression, but most of all, you are showing this person that they are loved.

I see it all the time. “Didn’t _________ know how much we loved them?” Or, “I told them I loved them and that I was here for them but they still are still sad or they still committed suicide.” It might not be enough to say, “I love you.” So it might not be enough to say, “Could one friend please copy and repost? I am trying to demonstrate that someone is always listening. #SuicideAwareness”

Miscarriage and the Flu Vaccine

Several mainstream news sources, to include USA Today, have recently posted articles on miscarriage and the influenza vaccination. Newly pregnant mothers want to know, is the flu vaccine safe in pregnancy? The flu vaccine is recommended for all pregnant women and women are told there is little to no risk in receiving the vaccination during their pregnancy. Yet many vaccinations haven’t been tested in pregnant women. 1 in 4 miscarriage

So let’s talk about it. This is the recently published study by the CDC that shows an increased risk of miscarriage after receiving the influenza vaccination containing pH1N1. The 2017-2018 influenza vaccination looks to have this virus in it. Here are the three viruses for this season:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

The risk of miscarriage was only looked at for the 1 – 28 days following the vaccine and the woman had to have received a prior influenza vaccine which contained pH1N1 as well. The 2016-2017 influenza vaccine contained A/California/7/2009 (H1N1)pdm09-like virus (I am only listing H1N1).  While the study authors stated that it cannot establish a causal relationship, the association of receiving the flu vaccine during pregnancy and having a miscarriage (SAB) was significant.

What we do know is that pregnant women ARE at a higher risk of contracting illnesses during pregnancy and the flu is one of those illnesses. I used to receive the flu vaccine but as I have aged, I have become allergic to the ingredients in many vaccines. Even if I weren’t allergic, I personally would not receive the flu vaccination, or any vaccination for that matter, during pregnancy. I was pregnant this year and in February, I contracted Influenza B. Not a single person in my family was sick or became sick. I was miserable and I did what I could to protect my baby.

I am not certain where I contracted Influenza B but I do work in a hospital so maybe that’s where I picked it up. My symptoms did not present normally. I did not have a fever at all but I felt very sick, headache, muscle aches, heart palpitations, and I felt like I was struggling to breathe. I put off visiting the ER, mostly because my husband did not want to take me in the middle of the night. In addition, we knew the visit would be costly and that is always a consideration.

It was not easy waiting through the night not to be seen. I couldn’t sleep and honestly, I wanted to be put out of my misery.  Instead of going to the ER, I asked for a walk-in appointment the following morning. When I arrived at the clinic, the doctor was upset I was there and not in the ER. While my oxygenation was fine, I was clearly struggling to breathe. Their concern was that I had been breathing rapidly (over 33 respiration’s per minute) for more than 12 hours and my body would give out and I would “crash.” That was their nice way of saying, die.

I felt absolutely awful but I wanted to avoid the ER so I asked for any testing or procedures they could do in the office. They said they couldn’t test for the flu in their clinic and I would have to go to the ER for that, but they would give me a nebulizer treatment and see if that helped. I did not want to take any medication during my pregnancy but I needed some relief. I was convinced to take the treatment in hopes that it would help and I would avoid the ER.

It did nothing, so we were sent to the ER. I again received an ineffective breathing treatment and was sent home. I was told my blood labs were normal and that my influenza test hadn’t come back but they would call if it was positive. They had no explanation for my illness, other than I must have a bad cold (even though I wasn’t congested at all) and because I was “old” and pregnant, I was responding harshly to the virus. I later learned that my labs were not “normal” but the doctors didn’t believe my labs were indicative of anything.

During the 15 minute drive home, the doctor called my husband to confirm that I had Influenza B. I was surprised they didn’t admit me as my respirations were still horrible but they sent me home with Tamiflu. I hesitated to take the medication. There are no studies of the use of this drug in pregnant women but I needed relief. In addition, I had been symptomatic beyond the 48 hour window for the effectiveness of this drug.

I conducted a little research before consuming the drug. I had immense anxiety over this. I was well into my second trimester and  was passed the gestation where the defects could occur. There were three babies whose mothers had taken the drug who had defects (although some babies were aborted but according to the study, this was not statistically significant). 24 hours after taking Tamiflu, I began to feel relief. By 72 hours after Tamiflu, I was feeling well although exhausted.

I worried throughout my pregnancy that I somehow hurt my baby from the Tamiflu. Only time would tell and a future ultrasound did not show any defects with her heart. Once she was born “normal” I felt okay about taking Tamiflu although it’s still possible she could have been affected but we won’t know until later in her life. So far, all is well with her.

Despite the CDC study, women are still urged to get the flu shot in pregnancy. Why? The reasons cited are to reduce hospitalizations due to complications from the flu, morbidity and mortality, and to pass on antibodies to the unborn baby. This study shows that the influenza vaccine in pregnancy is 91.5% effective in preventing hospitalization of the infant in the first six months of their life (this does not say the infant does not contract influenza). I am sure my daughter has antibodies for Influenza B since I had it.

So what should a pregnant woman do? There is clearly a relationship between miscarriage and having received the influenza vaccination so it would be up to the woman to assume the risk. Do the research, make the decision. I don’t ever recommend just listening to a doctor. I want to be very clear in what I am saying; the doctors recommendation IS important; however, it should not be the only deciding factor. If a woman receives the vaccination and then miscarries, how would she feel knowing that ?

I know I would never forgive myself so I choose not to receive vaccinations during pregnancy and most especially during the first trimester. Only you can decide if it’s right for you. As someone who has experienced miscarriage twice, I worry so much during subsequent pregnancies about losing the baby and anything I can do to reduce that anxiety is helpful. Once the baby is born, I know there are many things I can do to help keep the baby healthy and I follow all those precautions and recommendations during such a fragile time.

Making the decision to receive or not receive the flu vaccine is difficult. There seems to be good research out there to help make an informed decision, although much of it is irrelevant if the baby does not make it to term if the flu vaccine causes miscarriage.

My Unexpected Pregnancy

When I received the positive pregnancy test, I wasn’t met with feelings of excitement and joy; rather, I experienced intense fear and anxiety. I had just been to my priest to confess that I had been having thoughts about abortion if I were to become pregnant again. Shocking, I know. If you know me, you will also be very shocked to see me write that. I am a devout Catholic yet there I was, contemplating abortion if I were to ever become pregnant again. I didn’t feel like I could handle another child.

Here’s why.

I was already extremely irritable and distant with my kids. I already felt run down to the max trying to care for them and to be there for them. I already felt extreme exhaustion trying to manage my household and enjoy my marriage and children. I had experienced suicidal thoughts and intrusive thoughts after I had my last baby. I did not want to suffer through baby blues and postpartum depression ever again. And I had just finally started to feel “normal” again after having lost a child the year before.

There were other concerns as well. My age was one. Being over 40 at the time was a huge concern and worrying about issues, disorders, and conditions with the baby and the risks of an older woman being pregnant, were among them. There was not much I would have control over either. I also wanted to retire at some point with my husband and have an empty home. Having another child would render that nearly impossible, especially if the child were to have special needs.

Much of my thoughts seemed to be selfish. I certainly wanted to be alive for my living children and a pregnancy at my age could cause my demise but most of my concerns were selfish. This was a motivating factor in seeing my priest. I just couldn’t handle another pregnancy so if I were to become pregnant, I told him I was considering abortion. I wasn’t pregnant at the time I confessed this. I had only gone in because my husband and I had not been careful the month before and I was actually relieved that I did not become pregnant. I was panicking though, because I knew that we would make another “mistake” in practicing natural family planning and we might not be so lucky the next cycle.

You see, we don’t use any form of contraception. We have been tracking my cycles for 19 years. For 18 of those years, we were trying to become pregnant. We finally became pregnant for the first time after seven years of marriage. I was mostly infertile for those 20 years of marriage but we always joked that God would somehow make me fertile in my 40’s. Apparently, we were correct.

As I got older, I became more fertile and this became a challenge later. Since every cycle was purely another attempt at conceiving, we found ourselves in a precarious situation when we all of a sudden needed to avoid sex during the most fertile time. I will say that it is an extreme challenge and we felt shameful that we had never mastered this. After all, we were in our 40’s so we should have this mastered. In our 18 years of marriage (at the time), we had only used a condom once and that was a horrible experience.

Having always given our full selves to each other, using a barrier made us feel sick and used. Instead of feeling close to each other, we felt like we were selfish and used each other as a pleasure toy. This did not go over well in our relationship but since both of us felt the same way, it was something we vowed we would never do again. We would have to master avoiding each other during our most fertile time.

After my confession, I left feeling empty. I did not feel good like I normally did. I felt like something was missing and I remember walking through the parking lot thinking to myself, “That was pointless.” I don’t know what I was expecting. Maybe I wanted him to tell me no? Maybe I wanted him to tell me some amazing story about how I will be converted to being open to life again? All I remember him saying was that women my age struggle with this and I wasn’t alone. That didn’t seem helpful at all.

As the next few days progressed, my fertile time came. It was impossible to avoid. We were like teenagers who could not hold ourselves back. It doesn’t help that we are intrinsically designed to desire each other during the fertile time and that it is the time where it is the most pleasurable. God wasn’t dumb in making this so.

I prayed that I would not conceive. I worried that I would and prayed hard that I wouldn’t. As the days progressed though, I went through times of panic about having to choose abortion and times of openness to life and feeling like I could do it if I were pregnant. By the time the pregnancy test was positive, I had experienced a conversion. I was at peace with being open to life despite being extremely scared and anxious that I had found myself in this position.

I messaged my sister right away and told her I was pregnant but that I couldn’t do this. I didn’t feel like I could but I knew I couldn’t kill the new life inside me. I tried to justify it though, thinking that I was only 3 weeks 4 days pregnant and it’s not really anything but a ball of cells. I thought about not taking vitamins, drinking alcohol, not taking progesterone supplements, and other things that could potentially be harmful but I knew I was only hurting myself and of course, not providing for the baby inside me.

I struggled. It was hard. I didn’t think I could love the baby inside me. I was concerned with loss and how I would manage another loss. I thought a lot about and planned this child’s funeral. I had plan, after plan, after plan as my pregnancy progressed. If the baby dies at this gestation, I will do (blank) and have (blank), and ask for (blank) and plan for (blank). It was a constant planning for the death of this baby.

I talked with my sister numerous times about how I didn’t think I could do this but somehow I was doing it. I never really thought past going to the hospital. This brought on some anxiety about if I would love my daughter, how I would fit her into our life, and I was extremely scared about baby blues and postpartum depression.

I wished she would just die inside me in the first trimester. I knew how to plan for that. I knew how to manage it and I knew how to grieve that loss. Morning sickness was horrible and I blamed her for it. I almost hated her for it but then I took solace in it because being sick likely meant she was healthy and growing. It was such a roller coaster. Yes, there were times I was excited. The kids really made me happy because they were excited. They were overjoyed and hubby was ecstatic about another baby. When we discovered the baby was a girl, he was over the moon and just wanted her out so he could be her daddy.

Those were the times that really helped me to feel better about the journey we were on. My pregnancy was so hard. I couldn’t exercise. I couldn’t even walk. I was pretty much bound to my couch and even my couch hurt. I sat in the chair in my room more than anything because it was one of the only places where my pubic bone didn’t hurt. I blamed her for that too. I am surprised she lived but I knew she was strong. Because she was strong, I needed to be strong.

I made plans with several care providers to help reduce the baby blues and depression but I didn’t know if they would work. I had back up plans for back up plans. But as I worried about these things, I didn’t think I would be taking a living baby home. My prayers began to change because as she grew, I wanted her to be born alive. “God, please let me bring this baby home alive.” The plans for combating the depression really helped and we worked with a doula to help with my concerns about labor.

We also came up with postpartum plans and hired a postpartum doula. These were imperative to helping reduce baby blues and postpartum depression. Hubby knew I would need daily naps and he was prepared to do what was needed to keep me mentally sound. If he wasn’t so supportive, I don’t know where I would be headed.

When I labored with her, I didn’t think I would actually see her alive. Her heart was beating like crazy but I still felt like apathy towards the whole situation. I questioned why my induction wasn’t working and felt like my emotional state and how I felt about this baby was blocking my induction from working. I literally would have contractions for an hour and then they would fizzle away. Pitocin would be turned up. I would contract for an hour and they would again fizzle. Up the Pitocin, repeat. Up the Pitocin and repeat.

I wasn’t even in labor with the Pitocin. I would contract but they weren’t that bad and if I did have any contractions that were remotely uncomfortable, they didn’t last. Labor was enjoyable and we had a grand old time. Once things picked up, I literally had her within 35 minutes.

Somehow, the moment she was born and I placed her on my chest, everything was perfect and right. Yes, I placed her on my chest. My husband caught her, the doctor untangled the cord, and she was passed to me where I set her on my chest and instantly, all was right with my world. ALL was right in my life. I was at complete peace and there were no worries about her, about me, about anything. For some reason, I felt like I could handle it all now. I would have to but I wasn’t feeling pressured or like I was being forced. This was my calling. I was now the mother to a daughter. A daughter so strong and fierce she could withstand my power. A daughter whom I know, will change me.

She already has.

I’m back!

My blog has been quiet for months. I apologize for that and will try to get it back on track. Several things have been keeping me from writing. First, I have a writer’s block. I have it very badly. Ever since I unexpectedly became pregnant last year, my mind has been blocked and was overly focused on growing a person. Now my mind seems to be blocked and overly focused on raising that little person. I am certain less sleep is also contributing to the slow down in writing.

Second, I had to step away from loss work during the pregnancy. I stepped farther away during this pregnancy than the last pregnancy. Part of it was just the pure sensitivity of the issue but the other part was I did not have the energy. My body was literally so focused on growing the baby I had no energy. Being three months postpartum, the energy is slowly returning.

The third reason, is that the pregnancy was extremely hard. It wasn’t just hard physically, it was hard emotionally. I don’t think I truly believed I would be bringing a baby home. I was pregnant in my 40’s and the risks were so much higher. My body fought the pregnancy. I was very sick in the beginning but the pregnancy was also very unexpected. All of my previous pregnancies had been planned. This pregnancy came out of nowhere.

I have never experienced an unplanned pregnancy and I did not expect to carry some of the feelings I was having. I won’t go into detail on those feelings in this post but I will say that the genuine excitement many women have during pregnancy was not there. When I was nauseated and couldn’t eat, I blamed the baby. She was so strong to put up with all the thoughts and feelings I was having. She grew despite the feelings and I am glad and so blessed that she continued to grow.

This was my third pregnancy after a loss. I have five children but only three are here with me on earth. No matter how many pregnancies you have, I think that pregnancy after a loss is still very difficult. The worries and concerns are still there. I know that with this pregnancy, I felt “right” from the very beginning. I felt like she was “protected.” Maybe that was because of all the details that surrounded her conception (I will write about that later) or maybe I was naïve but I only felt anxious and nervous a few times during the pregnancy, instead of the entire pregnancy.

The times I worried, made sense. I also purposefully postponed some ultrasounds because they almost always made me anxious so postponing them during this pregnancy really helped to reduce that anxiety. I had two in the first trimester instead of one every week and I only had two because during the first one, while a positive ultrasound, the baby was measuring a whole week behind. I had a brief thought that this was similar to Gus’s pregnancy so I thought the baby would also die but she obviously didn’t.

The 20 week ultrasound was fine although I kept having thoughts that something was wrong with her heart. There wasn’t anything to base that on, other than I had a client during that time who terminated because of a heart condition with their baby and then several posts on Facebook showed people who had babies with heart conditions. This was a big factor in me stepping away from loss work while I was pregnant, more so than I had in past pregnancies. Those were the only times I really felt anxious or nervous about the baby. Oh, except this one time where the baby wasn’t moving.

I wanted her to be born at 37 weeks to prevent stillbirth. That was something that made me anxious and nervous, but not the pregnancy. I just wanted her out. I wanted her safe in my arms where I felt like I had more “control” over her surviving. It’s silly to think that I have more control. I don’t have any control, but getting her out was important.

Induction scared me too but that’s only because of my work and the stories that people tell. Ultimately, my doctor would not schedule an induction earlier than 39 weeks. I was scheduled for induction at 39 weeks merely because I am advanced maternal age but even my doctor didn’t rush that. She was open to me waiting even longer. I couldn’t. I needed her out as soon as I could get her out. Knowing that they wouldn’t schedule an earlier induction, prompted me to have my due date adjusted.

At the first ultrasound, the baby measured a week behind but I knew my dates. I knew when she was conceived. I had charts showing this so even if she was a week behind, technically, I should be correct. All babies gestate at a different rate and implantation can certainly affect the gestation and growth but I wanted my due date to reflect the conception period. After much debate and several conversations with my doctor and the maternal fetal medicine specialist, I was allowed to change my due date. I was given two options, one based on last menstrual period, and the other number was in between.

As much as I wanted to take the earlier date, I knew that I ovulated a week later than the average woman so I went with the date in between. Although my entire pregnancy I felt she would be born on May 25th, my induction was scheduled for May 22nd. She wasn’t born on either of those dates.

I will share my labor story later as well. It’s a pretty amazing one and I loved every minute of my induction. Yes, I just said I LOVED my induction. Inductions can be horrific or they can be great. Just keep an open mind (which is what I focused on most).

As I progess over the next months as a mother to three living children, I will write more and share more about my pregnancy and birth of my first living girl. It’s been a ride for sure and one thing I really want to address is the difference in pregnancies from becoming pregnant after trying to be pregnant to becoming pregnant when you didn’t want to be pregnant; an unexpected pregnancy. I had no idea there was a difference in feelings and I was shocked at the thoughts I had. I have a newfound respect for women who have had unintended/unexpected/surprise/oops pregnancies.

For now, keep checking back! I have other posts written that I haven’t shared but I wanted to get this out there in case you forgot about me. I haven’t forgotten about you!

The Struggle to Go In – When Baby isn’t Moving Regularly

I specialize in pregnancy loss. I have been working with women for six years now, in differing capacities as a perinatal loss specialist and bereavement doula. In my childbirth education classes, we review fetal kick counts, fetal movements, and I share that it’s a myth that babies “run out of room” the farther along in pregnancy women get. We talk about being intuitive with the baby and knowing what is the normal pattern for the woman’s individual pregnancy and baby. Each baby may not fit the pattern of X number of movements per hour but if you know how your baby moves and what you can do to get your baby to move, then it’s easier to tell when things are “off.”

If you didn’t know this, as of the writing of this post, I am 30 weeks pregnant with my 5th baby (hopefully 3rd living). Yesterday, I had a scare with my pregnancy and it was very interesting for me to see how my mind was responding to this scare. I know I had been little more anxious this past week but I chalked that up to a few new clients with stillbirths and a few stories that popped up in my Facebook feed about late losses. It had me on edge more than usual and I was listening to baby more than usual on my home doppler. That always brings me reassurance but I had found I needed the reassurance more often.

I was having periods of contractions the last few days as well. These were not typical contractions. My belly was tightening but I was also experiencing cramping and some pressure. Knowing my body, even though they were uncomfortable, I did not think these were contractions that were dilating or effacing my cervix. On Wednesday night though, I was very uncomfortable so I took a bath; which helped for a few hours but then things picked up again.

I decided to try to get some sleep and listened to the baby just before I fell asleep. She had an episode where her heartrate was really high and then dropped but then she stabilized and all seemed fine. Throughout the night, I was not feeling her. I get up often, roughly every two to three hours, because my bladder calls and when I return to bed she usually “tickles” the side I am laying on before we drift off to sleep. I briefly noted that this was not happening.

By morning, I figured my cup of coffee would rouse her. Nothing.

I took my son to his dentist appointment and didn’t feel her at all so we went to the store and I got a donut. The worst kind, a frosting filled, maple iced, long-john. Surely this amount of sugar would get her moving. Nothing.

I wasn’t worried at this point but just noted that she wasn’t moving much. I thought I had felt a few punches earlier so I rationalized that I had felt something but really knew I was feeling nothing.

I sat outside with my youngest while he played in the driveway. It was a nice warm and sunny day. I lifted my shirt to expose my belly; which was something that usually got her moving. Nothing.

After a few hours outside, I returned inside and sat at the table and did some work on my computer. I leaned forward to sort of “smush” her hands because that would usually get her moving. Nothing.

I grabbed my doppler at this point and listened. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 130’s. Normal for her. But she didn’t punch or kick the doppler like she always does. Ugh!

I had to go to an appointment at the church. I figured I would start to contract and get her moving because it was “that” time of day where my uterus liked to pick up and do something. Unfortunately, on the drive there, my uterus was silent, but so was she. As I got closer to the church, I decided to feel for her. She always moves her foot away when I push on it. I located her foot and pushed. Nothing.

When I arrived to the church, I parked and sat for a moment. I talked to her and told her she needed to move. Nothing.

I hummed and sang; which usually got me a kick. Nothing.

Then I located her butt and pushed down on her. I could feel her whole body move down into my pelvis. I felt the pressure of her head on my cervix. Nothing. She was still. I was now worried.

I called the OB office and demanded to speak to someone. I was lucky because they actually transferred me directly instead of “sending a message.” I told the nurse everything I just wrote above and she said I should be seen. I wanted to go to the clinic but it was 3:30 on a Friday afternoon and even if I got there before 4, the doctors wouldn’t be there long enough to read the strip. She said I had to go to L&D. Oh how I wish there were more options with my HMO. It’s very frustrating.

I texted my mother-in-law to see if she was available to watch the kids and went into the church for my appointment. It was quick and I returned to my car anxious about the baby. She wasn’t moving at all. I was going to leave straight from the church but I kept feeling like even though she wasn’t moving, she was okay.

Then all the questions in my mind began.

“She’s probably fine.”
“It’s probably just a growth spurt.”
“It’s going to cost me a fortune to go to L&D”
“I am going to get there and she will move like crazy and then they will think “I” am crazy.”
“It will end up being a waste of time and money to go in.”
“I heard her on the doppler and her heart rate was fine, so she is fine.”
“I don’t want to go and be admitted.”

I am sure there were many more things going through my head. I called my mother-in-law to tell her what was going on. She had texted a few times and called me but I couldn’t respond. She rationalized with me and said everything was probably just fine. We talked for what seemed like, FOREVER. I just wanted her to say I should be seen but I never heard that. I just kept rationalizing and since I was going back and forth, I decided to drive home.

I called my husband on the way home to update him. He didn’t have an answer for me either. He just kept saying that it was probably a growth spurt and she was “tired” because I had been in so much pain the night before.

“What if the cord is wrapped around her and she isn’t getting enough oxygen?” You would hear that on the doppler as her heart rate would be struggling.”
“What if my placenta isn’t working right and she isn’t getting enough oxygen?” Same answer as above.
“What if there is something wrong and I don’t go in and she dies?” There is probably nothing wrong.
“What if…”

All my concerns were shot down, either by my husband or by my mother-in-law. In all honesty, I was shooting some of my concerns down as well. But the back of my mind kept saying, “What is your advice to women who aren’t feeling their baby move regularly?”

If your baby’s movements stop, change, or are concerning to you, be seen!

I couldn’t even follow my own advice. I stress this in my classes. I stress this to women in pregnancy after a loss and here I am…the professional…struggling to follow my own advice. How are women going to follow this advice if I can’t?

I got home and laid down on the floor on my back. Surely this would get her to move? Nothing.

I poked her. Nothing.

I listened to her on the doppler. THUMP, THUMP, THUMP, THUMP, THUMP. Her heart rate was in the 140’s.  She still didn’t kick the doppler.

I grabbed some apple juice and a snack and went outside with my son who wanted to play again. I drank the apple juice and sat on the bed of the pickup truck. I had been talking with my mother-in-law who decided that we would have dinner together and decide then.

It had now been at least 18 hours since I felt any real movement from her and in the next few moments, I felt her move. It wasn’t much, but it was more than she had given me all day. This only began to complicate things more for me.

I had dinner with my mother-in-law and had two slices of pizza and a Shirley Temple. This would also HAVE to get her moving, I thought. Nothing. Nothing for an hour!

It was now after 7pm and I really needed to make a decision. I posted on one of my Facebook groups and every person who responded said to go in. I knew I probably wouldn’t sleep much if I didn’t and I knew that I would question every second of her silence. So, I opted to go in. It was such a tough decision and I didn’t want to waste the money but there was that “what if.”

So here is when things really got crazy for me. In the car on the way there, she started to move. I began to actually feel kicks. I hadn’t felt a single kick all day. We almost turned around but decided to go in anyway. Five minutes on the monitor had her moving like crazy. It was like she was dancing inside me and I was so frustrated that this happened to me and I was now here. She even got the hiccups and we decided she was fine. 12 minutes on the monitor and they said all was good with her. 

It took longer for them to “check me in” and “update my chart.”

They were about to discharge me when they took my blood pressure. It was high. While baby was fine, there seemed to be something else going on with me. It took two more hours, a urine test for protein/creatinine, and blood pressure checks every 10 minutes, before I was able to go home. Diagnosis, I have borderline high blood pressure which needs to be followed up on.

I learned quite a bit though. I learned that even though I know when I am supposed to go in, it’s not as easy as it sounds. I learned that I should have gone in earlier when the decision was technically easier. I learned that it’s not as simple as “go in if your baby isn’t moving regularly.” Now I just need to take all this information and work on a new way to present it.

Was it worth going in? Absolutely!

The D&E for Miscarriage

When a baby dies in the second trimester of pregnancy, their death is either a miscarriage or a stillbirth. Stillbirth in the U.S. is defined as when a baby dies after 20 weeks gestation. A death before 20 weeks gestation is called a miscarriage. A second trimester miscarriage is a miscarriage between 12 completed weeks and 20 weeks. How a second trimester miscarriage is managed differs greatly between care providers. This post is the information I give my clients when they are told the unfortunate news that they are experiencing a second trimester miscarriage.

There are multiple factors when it comes to options for delivering a baby who has died or will die before 20 weeks gestation. Many care providers immediately state that the patient needs a surgical procedure called a D&C; although beyond 12 weeks gestation (in the second trimester), the surgical procedure is a D&E; which is different and I will explain those differences.

First; however, let me state that if the woman is experiencing a missed miscarriage, a D&C may be performed instead of a D&E. For example, if the woman goes to her 16 week appointment only to discover her baby died at 11 weeks gestation, the doctor will likely recommend a D&C. But, if the woman goes to her 16 week appointment and the baby has recently died, then a D&E would be recommended (even if the doctor calls the procedure a D&C).

When a doctor recommends surgery for the miscarriage, a woman usually schedules the procedure either for that day or within a week but rarely is the woman given any other options.

There are other options for second trimester miscarriage.

Just like with first trimester miscarriage, a woman has three options for miscarriage.

  1. Expectant Management (wait and see approach).
  2. Medical Management (using a medication to induce the miscarriage/delivery)
  3. Surgical Management (D&C or D&E)

When it comes to second trimester miscarriage, the number one cited reason for surgical management of miscarriage is risk of infection from leaving the baby or “pregnancy tissue” in the uterus. Yet, in the several hours of research on this particular topic, I could not find any substantial data to prove that a woman was at a higher risk of infection with expectant management of miscarriage versus surgical management of miscarriage.

This Cochrane Review explained that the risk for infection with expectant management of miscarriage was similar to surgical management; although I did find information here that suggests there is a 1% risk of infection with expectant management and this site suggests 0% to 10% chance of infection with expectant management. This leads me to believe it’s not well studied, especially in the second trimester since second trimester miscarriage and pregnancy loss is less common.

Nearly ALL the websites I explored stated that the woman’s preference should be utilized. But here lies the conundrum because care providers are only presenting one option for second trimester miscarriage; the D&E.

The D&E (dilatation and evacuation) is generally performed for miscarriages over 12 weeks gestation. The difference between a D&C and D&E procedure is that during a D&E, the surgeon dilates the cervix and then uses a grasping instrument (forceps) to remove the baby (sometimes in parts) and then uses a vacuum or curettage to suction and scrape the remaining tissue in the uterus.

In essence, because the uterus is not dilated big enough to remove the entire baby all at once, the baby must be removed in pieces and once removed, a curettage procedure is performed. While this is a very effective and viable option, some women and their partners would like to see and hold their baby, possibly take pictures of and with their baby, receive handprints/footprints from their baby, wash their baby, dress their baby, provide dignified services such as baptisms or blessings, and bury or cremate their baby. Some of these options might be available with a D&E but not all of them.

If I were your bereavement doula, I would personally walk you through these options and discuss them at length so you can make the best decision for your family. Hiring a bereavement doula is highly recommended for miscarriage and stillbirth. It is nearly impossible to explain in such detail here all a bereavement doula would present and help you with in this scenario. Please reach out if you would like to know more, I can help from afar as well.

There is no definitive amount of time on when labor will begin with expectant management. I use the term labor, because it is labor. It is NOT a heavy period, especially in the second trimester. Your cervix still has to soften (efface) and dilate (open) in order for the uterus to contract and push out the baby (“contents”).

Expectant management of second trimester miscarriage could take days, weeks, or even months to complete. Waiting is not always an option for women both physically and emotionally. Preparing to deliver a baby at home would also need to be considered as many women are sent home to give birth to their deceased baby. I do not recommend having such a large baby at home on your own and always recommend to my clients that they are admitted to the hospital for induction. Too many women have gone home to either wait for the baby or utilize medical management (taking medication to induce a miscarriage) and ended up in the emergency room bleeding severely and requiring a blood transfusion.

In my blog post, How to Prepare for Your Miscarriage, I explain in depth the materials needed in order to have a miscarriage at home. If you are considering this option, please read the information and prepare accordingly. If you are uncomfortable with the risks or seeing such an early baby, a hospital induction is an option. Care providers may give some push-back on this option and of course, there may be higher medical costs associated with this option but if you want to deliver your baby in a hospital with all the medical equipment needed for the risks, you can and should have this option.

I want to end this post with the risks of D&E. I have not linked to any specific website on this procedure as it may be too traumatic because the websites that list the risks are for abortion, not second trimester miscarriage. However, should you want to confirm the risks I list, you may conduct an internet search “Risks of D&E” which will provide the information.

The risks of the D&E are very similar to the risks of a D&C.

  • Injury to the cervix and/or uterine lining.
  • Uterine perforation (the provider punctures a hole in the uterus)
  • Infection
  • Bleeding/hemorrhaging
  • Retained products of conception, fetal tissue, or other tissue (requiring a second surgery)
  • Uterine rupture (from medications frequently used before the procedure to prepare the cervix)
  • Blood clots

It is also important to note that with a second trimester miscarriage, you may go through baby blues and/or depression just like a woman who has a full term, live birth and you may lactate and/or have engorged breasts. These are more likely to occur after 16 weeks gestation although I have had a few clients with 14 week losses who lactated (breastmilk).

I highly recommend you purchase the book, It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook to help you through this process. It explains miscarriage more in depth.

Pregnancy After Loss – Bargaining

Day 1 - miscarriageWhen you pee on that stick and see the positive, you are elated…usually. Even in pregnancy after loss, there are moments of excitement which appear immediately upon seeing the positive test but it isn’t usually long until the worry and anxiety sets in. It’s almost as if entering pregnancy after loss means restarting the stages of grief.

Bargaining!

We will do whatever we can to ensure this baby will come home. That includes delivering early either by c-section or induction. I’ve been there, begging my OB to induce just so I could bring my baby home alive.

Hiring a doula – Some women will hire a doula immediately after peeing on the stick…as if to say, “there, now the baby HAS to come home alive with me because I hired a doula.” We know this isn’t true, but absolutely feels like this can be a sure way to ensure a living baby at the end.

Testing – Some women have as much testing as possible and others refuse all testing.

Ultrasounds – Extra ultrasounds, one each week or more is another way to “bargain.” If I see the baby more often, I might be able to pick up on something that is wrong earlier and hopefully correct it.

Creams – Progesterone creams or other hormonal treatments can be another way women bargain with the universe to keep their baby.

Herbs – Special herbal remedies were definitely something I explored. I remember trying False Unicorn Root during my pregnancy with Ruby. I just KNEW I would get to keep her because I was taking it. She died only a few weeks after starting it.

Prayer – If I pray more, go to adoration more, attend church more, etc…God will give me this baby.

Heck, I would have hired a drummer to come into my home and drum on a daily basis if that would have guaranteed I would bring my baby home. But we know, nothing can guarantee that.

Sometimes it’s about rituals; appointments at the same time and on the same day of the week.  Or still others have avoidance rituals:

Never returning to the same doctor/hospital/clinic.

Not purchasing anything for the baby until they are here.

Not announcing the pregnancy until very late in pregnancy or not at all.

These are all forms of bargaining. It’s a way for us to feel a sense of control. We desperately need to feel in control. We need to feel that we can do something, anything to bring home a living baby because the opposite of that is so extremely painful we feel we won’t survive again. Another loss feels as if we would surely die.

I think deep down we know that it’s still out of our control but we really need to feel a sense of control so we do things. Things that can confuse others and sometimes even ourselves. It’s not wrong to do these things. Some of them may help but at the very least, they help us feel better and as long as we are not putting ourselves or our babies at risk, then why not?

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