On Closure

This time last year, I was filled with grief . . . and uncertainty.  I had just experienced my fourth miscarriage on my journey to have a fourth child.  I was reminded that I’m not normal—whatever normal really means.  My heart was broken, but I was more concerned about my broken body.  It’s painful enough to experience a miscarriage.  Add to that grief the fear that your body will continue to betray you, and you suddenly find yourself mourning two distinct losses simultaneously.

As I was thinking about either giving up or seeking the help of a recurrent pregnancy loss specialist, I suddenly felt compelled to blog about my feelings and experiences.  My writing journey began nearly 13 months ago, just a few days after my fourth miscarriage and second D&C.  As I was admittedly feeling sorry for myself, I began to meet those of you in the blogging world braver than I who had experienced as many or more miscarriages than I had—all without bringing home even your first “take home baby.”  I realized that I was not alone . . . and remembered to be grateful for the the living children that I already had.

I didn’t know then that I would be blessed with a new life one year later—a life that nearly died from an unexplained massive fetomaternal hemorrhage months after my war with My Mighty Miscarriage Foe had officially ended.  With the birth of my son comes a victory of sorts, even as I am still healing from our recent ordeal.  Though the traumatic experience of our fetomaternal hemorrhage has reminded me that I will never be immune to the potential perils of this sinful world, even after My Mighty Miscarriage Foe can no longer hurt me, I still choose to rejoice over the new baby that graces my world.  Beyond that, I finally have the closure I need to say good-bye to my childbearing years—something I didn’t have after my third baby was born.

Back in 2008, I naively believed that my third miscarriage had been a random event (since I had given birth to two babies after being treated for PCOS following my first two miscarriages).  But after my fourth miscarriage, I could no longer ignore the fact that My Mighty Miscarriage Foe would be there to do battle with me each time I chose to conceive another baby.  The only way to put him behind me forever was to stop trying to have more babies.  I nearly stopped trying before my sweet Luke was conceived, forging ahead only after the woman on the cruise ship (who I believe to have been an angel) told me one week after my D&C that I needed another child so that my son could have a brother.  So the first reason that I choose not to have any more children now is that I do not want to risk having another miscarriage.  My risk has already proven to be greater than average, and as I get older, this risk will only increase further due to age.

The second reason I choose not to have anymore children is that I am fearful of experiencing a massive fetomaternal hemorrhage again.  What if the next time my baby bleeds to death before I make it to Labor & Delivery?  Each day that I was pregnant in the future, I would wonder whether my placenta was stealing precious blood from my baby.

The third reason that I choose not to have anymore children in the future is that I had my first C-section and that C-section was complicated by wound dehiscence and a post-operative infection requiring a second surgery and hospital stay.  Two weeks after my son was born, I developed high fevers from a wound infection that didn’t respond to oral antibiotics, so I had to undergo an incision and drainage under general anesthesia followed by two more days in the hospital for IV antibiotic therapy.  And my wound, though closing nicely, is still open (as expected) two weeks following that incision and drainage.  As far as repeat C-sections vs. VBACs go, I know that this subject is controversial, but for me personally, I could never undergo a VBAC due to the 1% risk of uterine rupture and possible fetal death even in women who had a low horizontal incision previously.  For some women, that risk is acceptable, but for me, it is not.  I lost too many babies due to miscarriages that were beyond my control.  I couldn’t knowingly take on the 1% risk of a catastrophic outcome when that risk is in my control.  For me, that one percent risk is HUGE.  That would leave me with another C-section, and after experiencing this complicated wound infection (with my only risk factor being the fact that my C-section was done emergently), I have no desire to ever have another C-section again.

The fourth reason I choose not to have anymore children is that children and prenatal & delivery care are expensive!  There are only so many times that you can fork out that kind of money to have a baby.  Plus, each time I add another child to our family health insurance policy, the monthly premium increases significantly (by more than $200 just for my new baby boy, even before they knew that he would require a NICU stay).  I will be paying these medical bills for months to come.  And, of course, these bills don’t take into account the amount of money that it will cost to raise a child until adulthood once you actually bring your baby home.

Had I stopped at three children, I personally would have always wondered if I should have had another baby.  For many women, this question wouldn’t enter their minds even after having just two children.  But for me, it would have been there.  And in my case, I would have wondered if I had stopped at three children only because I was afraid of having another miscarriage.  I now know that this isn’t the only reason that I am done.

My twelve year journey to build my family is finally over.  My war with My Mighty Miscarriage Foe is finished once and for all.  Along the way, I was called upon to experience infertility initially and then one miscarriage for each baby that I eventually brought home.  And even after experiencing these losses, I never thought that my journey would end like it did—with a massive fetomaternal hemorrhage requiring an emergency C-section at 35 weeks and a complicated post-operative wound infection.  But life rarely unfolds as planned, does it?  I am a different person because of these things that I have experienced, but I have peace nonetheless, and God was with me every step of the way—even when I couldn’t see Him.

As I say good-bye in this final post, my wish for all of you is that you will eventually discover the same peace and closure that I have been blessed enough to find—that your journeys to build the families you dream of will go smoothly . . . and that you will remain strong and eventually prevail—even if they don’t.

PTSD Even With a Happy Ending?

Until now, I didn’t know it was possible to experience symptoms of post traumatic stress disorder when your “trauma” had a happy ending.  But that’s how this feels.  I know that I should be focusing on the positive.  My baby is living and breathing in the next room as I type this right now.  In spite of his near death experience, he is well now.  As our pediatrician put it during Luke’s first clinic visit this week, though he was once “a very sick little boy,” it is “time to transition” to treating him like a normal healthy newborn.

And yet, I cannot seem to get past that traumatic nearly-catastrophic day:  3/27/13.  This week my husband was looking for my coffee thermos and asked if it might be in my car—the car that I haven’t driven since I took that fateful trip to labor and delivery on Luke’s unexpected birthday.  As I opened the car door twenty-three days after my emergency C-section, my heart began to race, and I felt a lump in my throat.  Everything was as I had left it.  My dirty coffee thermos and cereal bowl were still on the passenger side floor board where I had put them when I left work that afternoon.  I had driven to the hospital and assumed that I would drive back home the same day, feeling silly for overreacting about my perceived lack of fetal movement.  But instead my car was driven home by my husband after I was admitted to deliver my baby at 35 weeks without even having packed my hospital bag.  I had planned to pack that bag when I was 36 weeks pregnant….

Then today, I stopped myself as I reached for my favorite long sleeved pink maternity shirt.  I had worn this shirt that day . . . and three days earlier for my baby shower.  It felt strange—and even a bit scary—to wear it again.  Would wearing that same shirt bring me back to that terrible wonderful day?

I still relive the events of that day over and over.  I cannot help myself.  If my baby had died because I ignored my instincts that something was wrong out of fear that I was overreacting, I would undoubtedly be reliving those last several hours repeatedly for a different reason.  But thankfully, I listened to those instincts—or more accurately, God would not leave me alone!  So why am I still reliving those fateful moments?  Each hour and minute of that day plays in my head like a movie reel several times a day.  And each time, I think to myself:  What if I had gone home instead of to Labor & Delivery?  What if I had made the wrong choice?  The neonatologists and nurses made it clear to me that my son had only hours left to live when I arrived at the hospital that afternoon.

Nearly all of us have all wished for a “do over” at some point in our lifetime—a chance to do something that turned out badly differently AFTER the fact.  This response seems natural, even  expected, right?  What I didn’t expect, however, was to be reliving an event that turned out happily (even though it nearly didn’t).  Does an Olympic gold medalist have PTSD because they ALMOST made a critical error?  Does a lottery winner have PTSD because they nearly chose a different number?  What is wrong with me?  And will I ever get over this?

To Cry or Laugh

Baby Luke is doing well, thankfully, after a rough first two weeks of life. After he received his two blood transfusions, got phototherapy for jaundice and showed everyone that he was able to maintain his body temperature on his own, he was graduated to a regular bassinet. Still in the NICU, his final challenge has been to learn how to suck—something that doesn’t come naturally for preemies, especially boys. This inability to take all of his breast milk by mouth has kept him in the NICU . . . until now.

For the past 48 hours (after pulling out a grand total of seven nasogastric tubes), my sweet baby has finally taken every last feed by mouth (through a bottle since he is still learning how to nurse during my visits with him). This is his ticket home! And while I would normally be thrilled, the news of his readiness for discharge has been surprisingly bitter sweet. Why, you might ask? Because life continues to throw unexpected challenges my way.

Just as my little Luke is finally ready to come home, I learned that I must undergo another surgery and be admitted for intravenous antibiotics. My C-section incision opened up on one side ten days post partum, and by the thirteenth post partum, I began to have high fevers. I was started on oral antibiotics, and my OB packed the wound with iodine gauze, but to no avail. My wound remained red, continued to drain pus and kept the fevers coming. I was left with only one definitive treatment. Incision and drainage in the operating room under general anesthesia, a treatment that will delay my baby’s homecoming and leave me with a deep open wound that will take at least one month to close on its own (since you cannot close a wound with sutures once it has been infected). As I thought about my predicament—yet ANOTHER trial to face during an already difficult time in my life, I realized that I had two choices. I could either cry . . . or laugh. I have already cried so many times since my baby was born. Tears of heartbreak. Tears of relief. Tears of disappointment. Tears of joy. Tears over the unfairness of it all. And finally, tears of gratitude for The Great Rescue.

My new challenge seemed ALMOST humorous to me. Par for the course, as my husband likes to say about such things. As I almost let the tears engulf me once again, I realized that I was tired of crying—at least for now. And so I decided to laugh instead.

The Great Rescue

Each time I look into the face of my sweet baby boy, I cannot help but to remember the great rescue that came on his birthday.  I will never forget.  I cannot forget.  March 27th, 2013 will always be the day of The Great Rescue in my book.  For as I have already shared, my son was doomed to die and would have perished had he not been rescued by God, my doctor, and a host of others.  Of course, many have given me credit, because I listened to my instincts and sought help when my baby stopped moving, but I cannot take any credit for what my merciful and loving God has done in my life for my baby Luke.

Luke’s rescue naturally brings to mind another Great Rescue story—one that happened for me, baby Luke and YOU over two thousand years ago.  Without this earlier rescue, Luke’s recent rescue would be temporary, just as the medical help I give my patients is fleeting.  I can prolong their earthly lives, if they will heed my advice, but what good is an extra twenty years on this earth in the grand scheme of eternity?  Jesus gave us so much more than that when He offered up His own life for us on the cross in what I can truly call a cosmic rescue—the greatest rescue story ever told.  So while I am beyond grateful that He spared the earthly life of my precious baby boy, I am more thankful that He rescued both of us with His own life before we were born and even knew that we needed to be rescued.

Tiny Hands, Big Miracles (Part 7)

On Baby Luke’s second day of life, I learned of his long brave struggle from within my belly.  Our Kleihauer-Betke test results were overwhelmingly positive.  A preemie Luke’s size normally  has a total body blood volume of 180 to 200 mL, and they found 350 mL of Luke’s blood in my bloodstream.  His fetal-maternal hemorrhage was graded as severe, and because you can’t lose more than your total body blood volume all at once, his neonatologist estimates that the hemorrhage of his blood into mine had begun at least four weeks before he was born.  During the last month of his time in utero, he tried to keep up with his blood loss as fast as he could by making new red blood cells, but eventually he was unable to compensate for the hemorrhage that was stealing the lifeblood from his little body.  He tried to tell me what was wrong the only way he knew how—by not talking to me anymore.

It breaks my heart to think that he was suffering in my womb, and couldn’t ask for help all those weeks.  He must have felt tired and weak, and even scared as he began to feel his body failing.  His doctors agree that he would have died had he stayed in my belly much longer.  Whether he would’ve been able to survive for another day or only for another few hours, no one knows.  But it’s clear that his time was limited.

My little Luke is a celebrity up on the 2nd floor—in the Labor & Delivery, Post Partum and Neonatal Intensive Care units.  Nurses and staff members who weren’t even there when he was born have been praying for the “sick miracle baby” in the NICU named Luke.  And those who were there have told me how pale he was when he first made his arrival into this world (“as white as a sheet”) and how they literally watched the color come into his body as he received his blood transfusions.  Most tell me that they have never seen a case quite like ours, and that he is lucky to be alive.  Of course, I would rather my son not be famous for nearly dying.

There are many questions I will never get answers to—like why my placenta stole my baby’s blood from his little body even as he needed it desperately or why I didn’t know that something was wrong the day before Luke stopped blessing me with his reassuring kicks.  But one thing is certain.  The God who loved to bring me rainbows of hope and promise whenever my anxiety threatened to engulf me earlier in this same pregnancy was still watching over my baby—even when I didn’t know that I should still be afraid.

Tiny Hands, Big Miracles (Part 6)

When I first learned about Baby Luke’s anemia, I was too stunned about the severity to ask why.  But thankfully, the neonatologist had already started to investigate.  The top contender on his list of possible diagnoses was a phenomenon that I don’t remember learning during my OB rotation in medical school—fetal-maternal hemorrhage.  He had already sent my blood to the big university hospital nearby in order to definitively rule in or rule out the condition, and the results were pending when he first explained the disease to me.  In cases of fetal-maternal hemorrhage, the baby’s blood is lost to the mother’s blood stream through a “leak” in the placenta.  Instead of the baby receiving blood from the mother through the placenta, blood moves from the baby to the mother through the placenta in the opposite direction.  This happens on a small scale in normal healthy pregnancies through baby vein–maternal vein connections in the placenta.  But with fetal-maternal hemorrhage, too much of baby’s blood leaks into the mother’s blood stream—usually through higher pressure arteries on the baby’s side of the placenta.  And not all cases of fetal-maternal hemorrhage are created equally.  As with any disease state, the severity can vary.  The Kleihauer-Betke test results that were pending at the local university hospital would not only tell us whether or not Baby Luke had gotten into trouble due to fetal-maternal hemorrhage, they would also be able to grade the severity of the disease in our case.  The neonatologist believed that fetal-maternal hemorrhage was the most likely possibility for a few different reasons.  First, the signs and symptoms of the disease match ours perfectly:  decreased or absent fetal movement, abnormal fetal heart rate tracings and severe fetal anemia.  And second, fetal-maternal hemorrhage is more common than congenital or chromosomal causes of neonatal anemia.

While we waited for the results of both the Kleihauer-Betke test and Luke’s karyotype or chromosome analysis, I researched fetal-maternal hemorrhage on my own and was disturbed to discover that not every baby survives.  It is one of the known causes of stillbirth, so the Kleihauer-Betke test is routinely checked in cases of fetal death in utero.  Could it be that my baby would have died had I not gone to Labor & Delivery when I did?  And how long had he been in trouble?

Tiny Hands, Big Miracles (Part 5)

Two minutes after Luke made his emergent and dramatic entrance into this world, his father arrived in the OR, having driven 72 miles per hour on a back road to try to get to us in time for the birth.  When he arrived, he saw my already-empty belly still open and “full of blood.”  I got to tell Daddy that our mystery baby was indeed a boy just as the stranger I believed to be an angel had predicted.  They let him hold Luke only for a minute before whisking him away to the NICU, and what I saw frightened me.  My baby appeared lifeless in his blanket with his eyes closed and his skin as white as a ghost.

As I lie there waiting for my C-section to finish, I heard my obstetrician explain to the nurses and anesthesiologist that her decision to operate was “25% the abnormal fetal heart rate tracings and biophysical profile and 75% her (aka me) instincts that something was wrong.”  I don’t recall what much of what happened next.  The anesthesiologist said that I appeared a bit anxious and offered me some Versed & nitrous oxide, and I took him up on his offer right away.

When I was finally back in my hospital room and more alert, I noticed that my legs still felt numb and paralyzed.  I tried to move my toes but couldn’t and wondered if I was still supposed to feel this way.  As I was pondering this, the neonatologist came in to give us our first update on Luke.  He weighed 4 pounds 10 ounces and was 17 3/4 inches long.  And he was severely anemic with a hemoglobin and hematocrit of just 4 and 13.  The numbers were shockingly low (a healthy newborn’s hemoglobin and hematocrit are usually 17 and 50).  I would later meet a nurse who was there when Luke was born and took the call from the lab with his critical test results.  She relayed the lab technician’s words to me this way, “He told me the results and then said, ‘This can’t be right.  These numbers are incompatible with life.’ “

Tiny Hands, Big Miracles (Part 4)

It wasn’t long before I heard a faint cry coming from the other side of the green “curtain of sterility.”  I had waited 8 months to hear the big delivery room gender reveal, but no one spoke until finally I heard a nurse ask my doctor, “Is it a girl or a boy?”  The reply was significant . . . and also provided a brief moment of much-needed comedy in the midst of a fear-driven emergency  C-section.  “It’s a boy, and he’s peeing!”  

The significance of the reply dates back to the mysterious comments of a stranger that came nearly one year ago on a Disney cruise ship as I was grieving my fourth miscarriage.  The vacation had been planned long before I found out that I had a blighted ovum and underwent my second D&C just one week before the ship cast off.  My wounds were still fresh, and they were already changing my heart.  I had been the one to ask my husband for a fourth baby, so even he was unaware that I was thinking about NOT trying to conceive again after the recent miscarriage.  As I tried to enjoy our vacation, I was starting to believe that I should simply enjoy the three children we already had and “stop while I’m ahead,” because the thought of experiencing a fifth miscarriage was just too painful and not worth the risk.

While these thoughts and plans were circulating in my head, a stranger on the cruise ship stopped me with my husband, son & two daughters and said, “You need another one.”  At first I thought that the brunette woman in her late forties was referring to an inanimate object, and I wondered what it could be.  Did I need another purse or perhaps another shirt?  Had she noticed that something of mine was broken?  When she could see that I was perplexed, she clarified her statement while pointing to my son, “He needs a brother.”

Now I’m no stranger to the odd comments of others, but never before had anyone made a similar comment to me.  In fact, after I did later become pregnant with baby Luke, I spent the majority of the 8 months fielding inappropriate comments from people who acted shocked that I would choose to have four kids.  But even before I realized how most people would react to my decision to have a fourth baby, I found the woman’s comment strikingly unusual.  Especially since it came on the very day that only God knew I was ready to give up.

When I didn’t answer the woman right away, she added, “You probably think I’m really strange for saying this to you.”  I was still unprepared to reply, so I said nothing and nodded instead.  And then she was gone.  But it wasn’t long after she left before it dawned on me that she may have been an angel—sent by God to encourage me NOT to give up on my dream of having another baby, and with a message of promise that it would be a little brother for Thomas.

Tiny Hands, Big Miracles (Part 3)

What happened next is a blur.  I had just enough time to call my husband and urge him to meet me in the operating room before I was whisked away.  He called my parents to stay with the kids and they were quickly en route but stuck in traffic, so thankfully our next door neighbor agreed to watch them so he could rush to the hospital.  The anesthesiologist had my spinal block in within three minutes of my arrival in the OR, and then had me lay down so he could pinch my abdomen until I felt nothing.  I just kept thinking, “This is really going to happen.  No turning back now.”  Little did I know that the God who’d been protecting my little one since his conception had set this all into motion by first whispering and then yelling into my ear, body and soul that something was wrong even as I tried to tell myself that I was simply overreacting.

Tiny Hands, Big Miracles (Part 2)

Even as I arrived at Labor & Delivery with fear in my heart, I told the triage nurse that I was probably overreacting.  To try to make me feel better, she told me that she had come to L&D for her own concerns about decreased fetal movement twice during each of her own two pregnancies.  When she attached the monitoring belts to my belly, the room was immediately filled with the sounds of a fast fetal heart beat in the 150s.  “Feel better?” she inquired reassuringly.  I supposed I should, but then she added, “We still need to watch the tracings for a while.”  A short time later, she asked me to lie on my left side.  Then she mentioned casually, “I’ll need to call your doctor to ask her to look at your tracings from her office, because I’m not seeing any variability in the heart rate like I normally do” (she would later confess to me that in 13 years of obetetrical nursing, she had never seen a flat fetal heart tracing like mine).  She explained that because I didn’t pass the fetal heart rate variability assessment, I would be getting an ultrasound for a biophysical profile.  

As I was waiting for the ultrasound tech, my doctor showed up unexpectedly at my bedside herself with a concerned look on her face.  She asked me to tell her about my concerns, so I gave her the details about the baby’s decreased movement.  I confessed that I was scared to go home after hearing about the fetal heart tracings, but acknowledged that I’m a worrier and didn’t want to overreact.  She mentioned the physician’s mantra, “First, do no harm” in reference to taking a baby by c-section prematurely, and I could sense some hesitation on her part.

By this point, she had already ordered a stat ultrasound, but she quickly became impatient and went to get an ultrasound machine so that she could do the biophysical profile herself.  The baby took two practice breathing movements during the first 15 minutes (and only two are required in 30 minutes), but he only moved one limb once, and she assessed his tone (the third part of the profile) as being poor before terminating the biophysical profile early (it was supposed to last a half an hour).  Quickly, anesthesiologists and nurses swarmed to my bedside to ask me medical questions, draw stat labs, put an IV in and have me sign consent forms.  I never saw her leave to call them and later learned that she had already reserved an OR and asked anesthesiology to prepare before she even started the ultrasound.  And still I wondered if I was overreacting, because the baby had displayed two practice breathing movements and at least moved his arm once during the 15 minute biophysical profile.  Was I bringing him into this world too early simply because I was letting my anxieties get the best of me?