Elizabeth Petrucelli

Author, Blogger, Educator

Category: pregnancy after loss

What Pregnancy is this for you?

I remember when I attended my last pregnancy prenatal yoga class. On the first day, the instructor asked, “What pregnancy is this for you?” She asked all the attendees. She started with “Raise your hand for #1,” then said, “#2?” “#3?” With each number, women would raise their hands but she stopped at #3.

I felt left out. I hadn’t raised my hand yet. She only went to pregnancy #3. So after a few moments, I raised my hand and said, “#5.” The instructor was happily surprised exclaiming, “WOW!! You are amazing! How wonderful that you can get away for self-care.” Then I thought, “Geez, that’s kind of presumptuous.” I responded, “Well, not really.”

She immediately jumped up off the floor and ran over to give me a hug. She embraced me and told me how amazing I was and then I became embarrassed and angry at the same time. She assumed I had four children at home because this was pregnancy #5 for me. I became quiet. I didn’t want to scare any of the other attendees, especially on the first day.

But as the class continued, she kept focusing on me and asking me for advice to share with the class, such as how to manage the schedules of four children. I ignored as much as I could and offered advice where I could. This continued through several classes and it became harder and harder for me to participate, not because I was sad but I was annoyed. Her question, “What pregnancy is this for you?” did not leave any room for explanation and left tons of room for assumption.

This created a conundrum. How do I explain to her at this point that I only have two living children? I thought about talking with her after class but this instructor was not good with time management. She consistently held us over by 20 to 30 minutes each class and I had a family at home to feed. If I really did have four kids at home, I couldn’t understand how she could be so inconsiderate of my time.

I ended up dropping the class. Questions like this make me wonder if I am approaching my questions about pregnancy in my childbirth education classes appropriately. While I don’t ask what pregnancy it is for my students, I have asked if they are first-time moms. It doesn’t really leave an opportunity for babies born early. I have decided that asking the question differently is the way to go.

I could ask, “how many of you have given birth before?” but that would probably confuse women who have had miscarriages as many of them (especially early losses) do not believe they have given birth. “How many of you are first-time moms?” is really no different.

“Is this your first pregnancy?” might offer better availability for an answer but could also be awkward if the family isn’t acknowledging their prior losses. So what DO you ask?

It’s complicated. You have no idea who is in your classroom and I have had several students talk about their stillbirth or losses. In one of my last classes in particular, the mother blurted out that this was not her first pregnancy and that she had lost her son at 20 weeks. She was attending this birthing class at 20 weeks and I think she was attending as an act of bargaining or a way to validating the pregnancy. 20 weeks is very early to attend a birthing class. I suppose it could be useful if there is a concern the next baby would be born early.

Still, “what pregnancy is this for you?” puts mothers enduring pregnancy after a loss in a precarious situation. It’s often anxiety provoking because mothers want to share their deceased children yet do not want to scare or upset a person and if they don’t share then they may feel guilty for not sharing. A seemingly joyful question has turned into an anxiety provoking question.

When I think about it, why even ask? What’s the purpose of asking? Maybe it’s an “ice breaker?” I know I ask in classes because if a woman has given birth before, her experience this time around might be different and we talk about that. I am considering no longer asking the question.  It’s important that all mothers feel comfortable in class and asking “how many children do you have,” or “what pregnancy is this for you?” is not necessary.

So what should we ask? How about, “How are you feeling about this pregnancy?” “What anxieties are you experiencing that we can talk about?” Be prepared for someone to share about their loss and if they do, please don’t blow them off. Recognize what they have said, offer condolences, ask about their baby/child, share if you have had a similar experience, and follow-up. drt5ye

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.

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!

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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