Hellobee

The short story of my two high-risk pregnancies is that I had a lot of monitoring and tons of doctor appointments because I tested positive for ANA and SSA antibodies, two antibodies that can affect pregnancy in different ways. During my first pregnancy, I had more than thirty doctors’ appointments, one hospital stay after a placental abruption at 32 weeks and mandated bed rest/house arrest. During my second, I had significantly less doctors’ appointments (probably somewhere in the neighborhood of the low twenties), one hospital stay at 33 weeks and a premature birth.

Both of my kids were born healthy, so at the end of the day I was very lucky. While we had a few scares along the way, they happened post-32 weeks when the rate of survival is very high, around 98%.

Every pregnancy is, of course, different. But when I was pregnant, especially after having my first placental abruption, I found reading about other experiences to be calming even if they didn’t mirror my own situation or experience.

How I Found Out I Was High Risk

When we first thought about trying to get pregnant, I decided to go in to see my OB/GYN for a pre-conception consultation. I was under 30, healthy, a non-smoker and non-drinker and so I thought we would just chat about how long it might take to get pregnant, prenatal vitamins, and advice on what not to eat. I brought my latest labs from my general practitioner just in case my OB wanted to take a look.

During the appointment, my OB said that it could take six months to a year to get pregnant and to call him in that timeframe if we were having difficulty conceiving. He absently flipped through my multi-page lab printout, clearly not expecting to find anything either. On the last page, he stopped and asked about a particular antibody that I had and why my general practitioner drew that particular lab. There was actually no particular reason and not all doctors will order a test for ANA antibodies, but mine did it as part of his standard annual exam. Our OB said he was glad that he had taken a look at my labs after all and sent me off for follow-up labs.

When additional antibodies came back positive, he sent me to see both a Maternal Fetal Medicine (MFM) specialist and a rheumatologist. They both drew the same labs, all of which confirmed positive results for ANA and SSA that would make me a high risk pregnancy (side note: the rheumatologist was awful and re-drew the labs because he directly told me, “You look so happy, there couldn’t possibly be anything wrong with you” and dismissed all the symptoms that I’d actually had for years which I didn’t realize wasn’t a normal part of adult life).

To be honest, at the time, I wasn’t particularly worried. It sounded like I might need some additional monitoring, but nothing I should be too concerned about. I was also warned that testing positive for SSA antibodies leads to an increased risk of congenital heart block. But when the doctor said that it was only a 1% rate, I dismissed it.

High Risk Experience the First Time Around

My first trimester went by extremely smoothly with virtually no morning sickness. I had a normal set of appointments with my OB and then he sent me back to the MFM for a 20-week appointment.

Looking at my charts, the MFM said that I would need weekly monitoring from weeks 20 through 28, the weeks in which the risks of fetal heart block are the highest because of SSA antibodies that can cross the placenta. I alternated weeks between Children’s National, where I spent an hour or two each week getting a fetal echocardiogram done, and going to my MFM for ultrasound monitoring (about an hour each appointment). After 28 weeks, we celebrated a healthy heart (after a small scare at week 25 where the pediatric cardiologist recommended that I stay away from drinking green tea). My MFM said that I would get a break until 32 weeks, at which point she would probably want me being monitored either weekly or every other week, depending on how things were progressing. Lion appeared to be developing well and around the 50^th percentile mark, so I thought things were going well.

At my 32 week appointment with my MFM, she took a look at the ultrasound scans and heartbeat and told me everything looked great. She congratulated me on a smooth pregnancy and told me we could make my next appointment for 34 weeks. Well, of course, the very next day, right before I was about to go into a celebratory party for a departing colleague at work, I went to the restroom and saw a lot of blood. I called my OB in a panic, explaining that it looked like I had started my period.

He had me come in right away and when he examined me, he immediately said that there was a lot of blood and I needed to go to the hospital for monitoring. While in his office, he called my MFM who asked her ultrasound tech and RN to stay late so they could do an ultrasound. I was nervous, but still unaware of how serious they were taking things. Everything looked fine on the ultrasound and the RN explained that she would be bringing me down to the labor and delivery floor for monitoring. I asked whether I should have my husband meet me at the hospital because it would take him at least an hour and a half to get there, and I didn’t want him to come all that way if I was just going to turn around and go home. She gave me a look and said, “Oh, you’re not going anywhere. You are getting checked in and staying at least overnight.”

My doctor came in later that evening to explain what was going on. He said that they had confirmed a partial placental abruption—where the placenta partially separates from the uterus. He said that they would continue to monitor me, but would start me on betamethasone to speed development of the baby’s lungs and also give me a medication to stop any contractions. He warned me that there might be a possibility that if contractions continued or the baby’s heart rate dropped, we may need to deliver the baby that night by caesarean section. Fortunately, things seemed to stabilize.

One day after I was released from the hospital at 33 weeks pregnant. In addition to not having a bed or couch, Mr. Dolphin was still in the process of putting in our new flooring. Not exactly ideal timing!

Five days later, I was discharged from the hospital and sent home with strict orders to stay home and off my feet. I asked whether I could still do errands like grocery shopping and was firmly told no. I asked whether I could walk to our mailbox—about fifteen yards from our front door—and was again told no. My MFM said, “You are basically under house arrest. When you’re home, I want you in bed or on the couch with your feet up.” Little did she know that we had moved into our new condo just the week before and had sold all our furniture before we moved, meaning we had no couch and no bed! After two days home all day without a bed, I told Mr. Dolphin that we needed to go to the mattress store that day and have one delivered ASAP!

I was monitored two to three times each week from that point on, generally with two appointments with my OB and one appointment with my MFM, where I would have an ultrasound done and have a stress test done. I was finally released from house arrest at 35 weeks and told I could resume normal activity—minus any sexual activity or exercise (which I could resume at 37 weeks).

At this point, both my OB and MFM recommended we schedule an induction date for around 39 weeks. I was opposed to this course of action because I wanted an unmedicated birth, but when my MFM explained that having a placental abruption and positive ANA and SSA antibodies put me at a higher risk of a stillbirth after 40 weeks, I quickly agreed. As it turned out, no induction was needed because at 37 weeks I had another abruption and ended up giving birth (and I got my unmedicated birth).

High Risk the Second Time Around

During my second pregnancy, I no longer tested positive for SSA antibodies and was released from the fetal echocardiogram requirement. As a result, I had many fewer appointments and despite a rougher start to the pregnancy which involved morning sickness for twenty weeks (I had zero morning sickness the first time around), panic over some bleeding (I also had zero bleeding in the first trimester the first pregnancy) and panic over a car accident (rear-ended on the freeway by a truck during the first trimester), it seemed to be going much more smoothly.

How we announced at 16 weeks pregnant. Panda ended up being a January baby, instead.

There was one small issue at my 20 week MFM appointment where they saw two blood clots, apparently signifying some separation of the placenta from the uterus. At the subsequent 24 and 28 week appointments, the growth seemed to be developing normally and the blood clots had stabilized so we weren’t worried.

By around 30 weeks, things started to change, though I can’t actually say how different things were from the first pregnancy. By the second pregnancy, I’d learned to recognize what a contraction was. During the first pregnancy, I’d been having Braxton-Hicks contractions since around 22 weeks but didn’t realize it. At the time, I would just feel that my stomach was tight like a basketball and assume that the baby was somehow pushing himself against my stomach. I know it sounds ridiculous now, but having never experienced labor, I really thought the baby was just stretching.

Enjoying the home-stretch at 32 weeks pregnant.  

At 33 weeks, I had regular contractions spaced about 5 minutes apart for several hours and drinking water and laying down didn’t reduce them. My doctor had me go into the hospital for monitoring, bethamethasone and another medication to stop contractions. After a few days, they released me, but said that other than restricting exercise, I was free to lead a normal life. My house arrest/bed rest sentence from my first pregnancy drove me crazy and would have been much more difficult with Lion around, so I was very grateful to have some normalcy.

At 35 weeks, in the middle of the huge blizzard that shut down the federal government for several days, I again had serious contractions for several hours. They weren’t particularly strong and I ended up waiting them out, but the day that the government reopened, at 35 weeks and 6 days, I went into active labor and we welcomed Panda into the world. Born at 36 weeks, he just missed the cutoff for not being premature and when my MFM came in to see Panda, she informed us that I now qualified for treatment to prevent premature birth: “If you thought you had a lot of appointments before, you just wait. You’ll start your MFM appointments in the first trimester next time.”

What I Learned

Before I became pregnant, the thought that anything out of the ordinary would happen did not enter my mind. Even after finding out that I was high risk, I thought that it was just a pain because I had to have a bunch of useless appointments. After the placental abruption, I realized that there is a reason for all of that monitoring and it is definitely better to be safe than sorry.

Extra monitoring didn’t prevent a placental abruption or premature birth, but it did ensure that the babies were healthy and growing properly, allowing us to make informed decisions about whether we needed to deliver them or whether they would be better off staying in the womb a little longer. Extra monitoring after the placental abruption and regular contractions also gave me peace of mind. I no longer saw them as useless appointments cutting into my workday, but appreciated being able to see my babies and hear their heartbeats.

Initially, during both pregnancies, I felt guilty when something would go wrong. Did I exercise too much, causing the placental abruption? I did not have any of the risk factors for a placental abruption and I desperately sought a reason that it had happened. When I started having regular contractions at 33 weeks in my second pregnancy, I again wondered if I had done something that caused it, like roughhousing with Lion. Ultimately, I had to learn to accept that sometimes these things just happen. Blaming myself wasn’t going to help and I was never going to find the cause, if there was one, for the abruption or premature birth.

I learned the importance of having a good team of doctors. I loved my OB and MFM as both took a lot of time to explain everything that was happening and all the possible courses of action from that point forward. They prepared me, for example, for the possibility of a c-section even though they knew it wasn’t what I wanted; they felt it was important for me to understand that was a possibility if it was necessary to ensure the health of the babies. They also made their advice very clear and explained their reasoning behind the recommendations, but ultimately told me that I was the one who would be making the decisions. They would tell me their concerns, while reassuring me when whatever they were worried about was a more remote possibility. I felt empowered by the fact that they gave me detailed information and reasoning, for example when I pushed back about scheduling an induction date, but let me make my own choices. Ultimately, they supported the decisions we made. If we do decide to try for a third (and I won’t lie, the thought of even more appointments does factor in our decision-making process), I absolutely want to have the same team of doctors.