Excitement and Early Days
As soon as I confirmed my pregnancy, I signed up for everything. I saw my prenatal provider as soon as the hospital assigned one. I signed up for classes and mailing lists and interviewed a doula. I had been reading the Mayo Clinic Guide to a Healthy Pregnancy while I was planning for pregnancy; I continued reading it, and also devoured the thick book created by the hospital. I even signed up for a service that would send a nurse to my home once a month to work with me. I wanted to know and be prepared for everything.
My pregnancy with Adrian was fairly textbook. I experienced some typical pregnancy symptoms early on (sore breasts, slight nausea), and my quantitative hCG numbers were high and doubling on schedule.
One morning, around the seven week mark, I almost pulled over on my way to work because I thought I was going to throw up. This was the beginning of a period of nausea so ever-present, I understand why many women call it “all day sickness”. For the next six weeks, although I never actually threw up, I felt like I had a constant cross between a bad hangover and the flu. Ironically, intense morning sickness is moderately accepted as a sign of a strong and healthy pregnancy.
While I was slightly overweight when I became pregnant and I turned 35 during my first trimester, none of my providers seemed overly concerned. I was categorized as “low risk” throughout my pregnancy.
Other Symptoms and Events
Because I had done so much reading, I wasn’t surprised when I first felt round ligament pain. It was a moderately painful sensation that would have caused concern if I hadn’t known it was a normal part of the process of expanding the uterus. I really thought I knew and was prepared for everything.
I also wasn’t surprised when I experienced two intense migraines towards the end of my first trimester. When I became pregnant, I stopped receiving my quarterly Botox injections for migraine control, and I knew that withdrawal and/or the pregnancy hormones could potentially stimulate unpredictable headaches. They were difficult, but not unbearable.One thing that bothered me more than expected was back pain. Beginning about halfway through the first trimester, I experienced a low-grade but nearly constant ache in the small of my back. Although my providers said it was normal with weight gain in pregnancy, I thought it was interesting that the ache started before I gained any weight.
To assist with both the migraines and the lower back pain, I saw a chiropractor nearly weekly for the second half of my pregnancy. The back pain never went away entirely, but the chiropractic care definitely helped. Perhaps more surprisingly, while I continued to have a few small headaches, I did not experience another intense migraine after working with the chiropractor.
The Natural Movement
Being a vegan, a sometimes yogi, and a lifelong tree hugger, I often lean towards the natural side of things. My pregnancy was no different. My prenatal vitamins were vegan. I subscribed to both the nature-oriented and more traditional sites. And I gave a lot of thought to unmedicated childbirth. After discussion with several moms who had delivered without medication, I signed up for childbirth classes in the Bradley method. Although Bradley is also known as “husband coached childbirth”, I felt that the core principles, which were centered around childbirth with minimal interventions, were well aligned with my own core values. Additionally, my doula was available to take on the role of “husband”/coach. Looking back, I value what I learned in Bradley classes, but I do wish today that we had spent at least a little time discussing scenarios in which interventions are medically necessary. Such scenarios aren’t common, but they also aren’t rare enough to justify a lack of genuine consideration.
It was partially because of Bradley, and partially out of examination of my own feelings, that I decided to establish concurrent care with a midwife practice. It wasn’t covered by my insurance, but it was important to me to have the option to deliver in an environment more conducive to nature and with minimal interventions. Although this was my preference, I did also understand that dangerous conditions could develop, and because of this reason, I continued to see my insurance-covered, more traditional provider as well.
Related: Miranda’s Blog: Nature Isn’t Perfect
To document my wishes, I created a very simple birth plan. I used visual images and short phrases to describe the handful of items that were important to me — minimal interventions, freedom of movement, immediate skin to skin, delayed cord clamping and delayed bathing. Everything fit neatly onto one page with room to spare. In concert with my doula, I also considered the alternative — should a c-section become necessary, I still wanted immediate skin to skin and delayed bathing, but everything else would go according to the recommendations of my providers.
I think every woman fears the worst case scenario. After my son died, I thought for a while I might have been a tiny bit prescient for sometimes worrying about my pregnancy, but now I wonder if maybe that’s just normal; if maybe every mother worries just a little bit? In the early days, I didn’t have much cause to be concerned.
When I was about five months pregnant, I spent several hours driving in one day. I worked a volunteer job that required some travel outside the city, and that night I didn’t get home until almost 10 pm. I had noticed some stiffness in my legs during the day, but it wasn’t until I got home and undressed for bed that I realized my ankles no longer existed; they were that swollen. Thinking of the late hour and the long drive to the hospital from my home outside city limits, I called the triage phone number, and asked them about my symptoms. We decided together that as I was feeling in generally good health, and with no other warning signs, I was fine to wait to see my provider at my regularly scheduled appointment the following day.
Looking back on my pregnancy to this date, even including my decision not to go to Labor and Delivery that evening, I don’t think I did anything wrong. I don’t think there was anything I missed or dismissed without thought. My main concerns came afterward.
Some Possible Signs
My prenatal provider gave me compression socks during my appointment the following day. The swelling went down the day after that, though it seemed to come back very easily. I then noticed one morning that the one ring I wore on my right hand was tight. My hands didn’t seem very visually swollen, but I started wearing my ring on the chain around my neck. It was around this time, but maybe a little later, that my blood pressure started to slowly but steadily increase. Not very long later, the nausea that had disappeared at the start of my second trimester began to return. It was never as bad as those early weeks of all-day sickness; it mostly came and went. I noticed that the midwives were the only ones to even ask me about it, but everyone said it was normal.
The midwives were also the only ones to test my urine at every visit. They never specifically told me the results, but I also never asked, and again — nobody seemed concerned. I wonder about this a lot today. I wonder about this the same way that I wonder about my screening for gestational diabetes. Nobody ever explicitly provided my results for either of these things¹. I always just assumed that no news was good. Now of course I will always wonder.
If you’re familiar with the symptoms of preeclampsia, you may have caught on that I displayed many of them. In my eighth or ninth month I asked my doula about it. I don’t know why I never asked my providers. Or, I guess I did, but always in an offhand manner: “So, I feel like I have all the symptoms of preeclampsia except for protein in my urine?” Looking back, I don’t know why I was so reluctant to be more aggressive. This was my body, my pregnancy, my child. Not speaking up more is one of my strongest regrets.Throughout this time, my back pain continued to bother me. I tried several support bands, but none seemed to help for long. As I put on weight and as Adrian began to move, I also discovered some pain in my groin area, in the same place I had fractured my pubic bone about ten years previously. My provider referred me to an orthopedic specialist, who confirmed that the bone was still intact, but stated that the surrounding tissues were probably tender and aggravated from the pregnancy. He recommended physical therapy, and stated that I may have some added pain in labor. While this referral was processing, I continued to experience pain, often to the point where it was difficult to walk. One day when the pain was particularly intense, I went in to Labor and Delivery for an evaluation. While there, they discovered I was having low-grade contractions. I was familiar with the feeling of Braxton Hicks from our exercises in Bradley class, but I was still surprised that I could have contractions and not be feeling them at all. After monitoring, increased fluids, and a pelvic exam confirmed I was not in actual labor, I was sent home with instructions to drink more water for the rest of my pregnancy. Towards the end of my ninth month, I also experienced pain in my upper right arm and in my wrists. I had heard that wrist pain was common in pregnancy and generally went away after delivery, so I didn’t raise the issue with anyone. The arm pain, though, was odd for me. On several mornings towards the end of my ninth month, I awoke feeling as if there were an electric shock running through the fleshy portion of my right upper arm. I never found out the cause of this pain.
The final issue that was never clear to me concerned kick counts. There was a section in my book from the hospital to document counting, but none of my prenatal providers ever really discussed the process with me. I mentioned in centering one day that my baby seemed more active on some days than others, and that I wasn’t sure when to be worried. All my provider said was, “Yes, kick counts can be important.” I blame both of us for not being more concerned.
Non-Stress Testing & Discussion on Induction
Although I had no other risk factors for a high-risk pregnancy, as a nod to the fact that I was exactly 35 years old and therefore considered to be of advanced maternal age, my hospital provider wanted me to do two things: attend weekly non-stress testing (NST) starting at 36 weeks, and be induced at 39 weeks.
I had no problem with the non-stress testing. It wasn’t something I considered a true intervention, and it made the providers happy. So beginning on the morning of my 36th week, every Thursday morning I went to the hospital for this test. I used to joke with my sister that Adrian always “performed” on those days. Even on quiet mornings, he kicked at the NST straps almost the moment they were applied, and he always achieved at least the two accelerations the nurses were looking for, if not more, in the twenty minute time frame.
However, while I didn’t object to the NSTs, I was strongly opposed to being induced. I genuinely didn’t understand the objective; so many of the conversations made it sound like it was for convenience. And here is where I have to put some of the blame not only on the providers, but also on the literature. As much as I paid attention in prenatal visits, as much as I devoured the books², no one ever told me I was risking stillbirth. Induction was always presented to me as something that could prevent “complications”, but the specific complications were never discussed³. Nobody ever told me that there were warning signs that something could be wrong. Nobody ever explicitly said, “If you don’t have your baby now, he or she could die.”
The Last Week
On the morning of my 40th week of pregnancy, I went for an NST as scheduled. That morning I noticed my blood pressure was higher than usual for me, significantly higher than the past several months, and only a few points below the threshold marking stage 2 hypertension in the general population. I pointed it out to the nurse running my test, but although she kept me on the monitor for a bit longer than normal, she didn’t seem concerned.
The previous day, I had met with my midwives for my 40 week check. I had mentioned to them that my baby had been moving less than usual. I also mentioned that I had experienced a sharp pain in my upper right abdomen, just under my ribs. I discovered afterwards such pain could be related to both placental abruption and/or preeclampsia, but at the time, they didn’t seem concerned. At both of these visits, I was obviously swollen, my hands thicker than normal, my feet having long since outgrown anything but a single pair of flip flops.
Related: Miranda’s Blog: 22 June 2018
I think back to these two visits now, and I wonder if things could have happened differently — if I could have made more of a fuss, asked for more testing. I don’t know why I assumed that medical providers are perfect. I don’t know why I didn’t feel confident enough to push for stronger confirmation.
I left my midwife appointment and my NST appointment both with instructions to not come back for another week. That was the week my baby started to die.
Worried about my blood pressure, I stopped in to use the machine in the grocery store pharmacy on several occasions that week. About a day after my last NST, it had started to come down to a more normal number for me. I also drank raspberry tea, and started walking around the block and spending time in the pool, hoping something would jump-start my labor. Around this time, I started to feel both crampy and slightly queasy, both signs I had read and heard from my doula were good indicators that labor was coming.
On the Sunday before Adrian died, my sister and I went to a movie. Throughout the film, I assumed the loud noises were bothering the baby, because he kicked like crazy. However, he continued to kick after we left the theater, and this movement was like nothing else in my pregnancy. I learned later on that such intense fits of fetal activity are indicative of potential cord accidents. If I had know this then, I would have gone immediately back to the hospital, but I didn’t know; I simply thought this was one more sign he was getting ready.
On the Wednesday before my 41st week, I was cranky and achy and so very ready. I had been so opposed to being induced, but I had an appointment with my midwives to discuss the options on Friday. I knew a pregnancy couldn’t go on indefinitely. I was actually dreaming about the possibility of a 4th of July baby.That evening, I had planned to go to a community event, something local to get out of the house, but when we got home from shopping, I wasn’t feeling great. I decided to lie down and stare at my belly. I remember distinctly the very large kick Adrian gave me that night as I lay on the couch. It was so strong it shook my belly. It’s possible that was the last movement he ever made. When I woke up the next morning, he was already dead. 1 – Reviewing my medical records after delivery, I discovered that I did not have gestational diabetes or protein in my urine. I am still frustrated that my providers did not explicitly provide this information.
2 – In the Mayo Clinic book, stillbirth is listed a complication of disease or use of drugs/alcohol, but never as a risk of an overdue pregnancy. In the book I was given from the hospital, stillbirth was not discussed at all.
3 – A number of websites discuss pregnancy complications, but it is interesting that even articles like “Overdue Pregnancy: What to do when baby’s overdue” don’t list stillbirth as a potential outcome.
Resources Blog: Best Practices for Safest Pregnancy
Miranda’s Blog: Nature Isn’t Perfect
Miranda’s Blog: A Letter to the Woman who Wants the “Perfect Birth”
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Write your Grief: Unspoken
Write Your Grief: That Day
Write Your Grief: Windows