Carolyn Ruff

 remember taking a pregnancy test for my  third child. I was so excited…I just knew we had timed things right. AND I  wanted an April baby SO bad I could just spit. We had moved to Minnesota the  summer before and I was adamant about NOT being big pregnant during a Minnesota  summer. And sure enough, I was right! Those two lines seem to get easier and  easier for me to achieve. This time it took precisely once! I figured my due  date to be April 10

, 1998. While I was excited about this, my  husband's family was less than thrilled. My in-laws were planning on taking all  their kids and their spouses to Ixtapa in February. I wasn't about to make such  a journey 8 months pregnant. Nor would they take everyone else. So, Mexico was  off for us for another year.

I have always considered myself very lucky. Although I tend to gain between  40-45 lbs (on my 5’10" frame it isn't TOO bad), I have had incredibly easy  pregnancies. I don't get morning sickness. Nary a bout of nausea. I guess if my  husband were to throw in his two cents, he'd say that my worst symptom would be  mood swings. And just my luck, that's something HE has to deal with.

With my first pregnancy, I had what was considered borderline Pregnancy  Induced Hypertension. Personally, I thought it was pretty much my normal blood  pressure, but I went ahead with a greater amount of monitoring, which amounted  to weekly BP checks after 32 weeks. I went to 41 weeks and was induced without a  problem. My son was 8 lbs 10 oz , born after a labor that started with Pitocin  at 9am and ended with 20 minutes of pushing and his arrival at 5:52pm..

With my second pregnancy, the PIH failed to make an appearance. My BP  remained pretty constant at around 100/70. Unfortunately, having had my son just  19 months before hand left my abdominal muscles unwilling/unable to support this  baby's weight. This baby dropped into my pelvic girdle at 5 months and settled  itself on my bladder, refusing to budge unless I put on a dry pair of undies…then  it moved just enough to force any liquid in my bladder out. I wish I had stock  in Depends. I was so incredibly uncomfortable and literally begged my Dr. not to  make me go past my due date. That wasn't to be an issue, as my daughter arrived  the day before she was scheduled to be induced. She weighed in at 9lbs 3oz and  arrived 7 hours after my water broke, 3 hours after productive contractions  kicked and 7 minutes of pushing. The placenta, however, failed to detach and was  removed in pieces. I was never sure if it had deteriorated or if the only way it  could be removed was in pieces.

I was convinced that this pregnancy would be a piece of cake. The only thing  that had me concerned was my age…I would turn 35 one month before I was to  deliver. So, I decided to do the research. I met with a genetic counselor to  discuss what my options were, with regard to prenatal testing. I had taken the  AFP with my first 2 and, in retrospect, I started feeling rather sheepish.  Baaaaaa. I had no idea what they were testing, what the possible outcomes could  be, how I would proceed should we receive word that testing put us in a higher  risk category. Nope…just went along with it. This time, I intended to be  informed. Don't get me wrong, I FIRMLY believe that maternal screening is an  incredibly valuable tool, I just believe that it should be explained in detail  what the results could mean BEFORE you consent to the test.

At 8 weeks, I was sailing along in this pregnancy…still in my pre-pregnancy  clothes, which I considered wonderful at the time, after all, who wants to dive  into those tents before absolutely necessary?. In retrospect, I should have  heeded the sign. In September, at 9 weeks, I began brown spotting. THIS had  never happened with the first two. The spotting began on a Friday night (isn't  that ALWAYS the case). It was light, never really staining my undies, but  apparent when I wiped. I called the Drs. office Sat morning and spoke with the  OB on call. (Remember, this is a new practice for me as we had moved from MD to  MN the year before). She said that as long as it wasn't bright red, I was in no  immediate danger, but strongly recommended that I rest as much as possible. If  it continued to come in Monday. Monday, I was still spotting so I was squeezed  into my Ob's schedule that morning. He couldn't find a heartbeat with a doppler  but said that it wasn't unusual. For some reason, my hCG levels weren't in my  record so another blood test was performed. In the meantime, I was scheduled for  an US that afternoon. I had my husband come home from work to attend it with me.  But I already knew. It was an empty sac. My OB gave me the option of a D&C or  waiting it out. I chose the D&C and he scheduled it for the next morning. Right  before we were to leave for the hospital, I passed what I am sure was the empty  sac. I went ahead with the D&C. My recovery was very easy and I was back at work  on Thursday, having felt like a fraud on Wednesday. I was still numb, I guess,  but emotionally, I accepted that this happens to LOTS of women and there was a  reason for this. I would find that out later.

I was very anxious to become pregnant again. My Dr. was aware of this and  cautioned me that things won't happen on MY schedule, like they did before.  October came and I had what appeared to be my first period post miscarriage. So,  I worked out the timing and we tried again. No luck. November was the same. In  December, I broke down and bought an ovulation prediction kit, just to see if I  was even ovulating yet. The results were less than comforting. The first test  showed the test line to be only slightly darker than the control line, which at  first I read as encouraging. The second had the control line lighter than the  day before…NO I thought…it’s supposed to be getting darker as I head towards  ovulation. The third day was lighter yet. On the fourth day, I was almost  resigned that there would be no pregnancy this month when lo and behold the  control line was darker than the test line. The opportunity was at hand (wink,  wink…nudge, nudge).

A week before Christmas, I was seated at the table with my 3 ½ year old son,  discussing Santa and what he would be bringing everyone for Christmas. He was  hoping for sports balls…basketball, football, soccer ball. He outlined what  Santa was bringing for each of our family members and I just smiled. When he got  to me, he cocked his head to one side and said to me, "Santa's bringing you a  baby, Mommy". My heart leapt into my throat. We hadn't discussed the previous  pregnancy with him or its end. I was floored. But I also knew that his  prediction would come true only if both Santa and Mommy were late.  Coincidentally, my husband's brother and his wife announced their pregnancy on  Christmas Eve. December 26

 a pregnancy test showed what I read as a  "faint" positive. So, I called and got an appointment the next day and had  another urine test and a blood serum. We didn't need to wait for the blood test  as the urine showed a clear positive. My due date was set for September 8

.  So much for not being pregnant during a Minnesota summer… And we had committed  to Mexico, so I would be going to Ixtapa 10 weeks pregnant.

Because of the recent miscarriage, my Dr. wanted to see me early, against  what is the popular trend in this area of not seeing your OB for the first time  until you are near the end of your first trimester. My first appointment with  him was at 5 weeks. At that point, everything appeared to be proceeding as  expected except he believed my uterus to be larger than it should have been for  5 weeks. So, he ordered an early US to confirm the dates. I knew that if they  were able to see the heartbeat, my chances of miscarriage would be pretty low so  I scheduled it for what I thought would be 7 weeks. Then, I was talking to a  cyber friend of mine who had miscarried the same day that I had and she said  that she was concerned that her hCG levels were very high. Her first pregnancy  was a set of twins and this was scaring her. Feeling that I wasn't as involved  as I should be in my pregnancy, I called and found out that at 5 weeks, 24 dpo,  my hCG levels were 29686…higher than expected and the nurse assumed that my  dates were wrong. So, now I had a new worry.

My US showed a fetus this time with a tiny flashing heartbeat! Never has  anything been so reassuring as that little flash of light. We had waited to tell  my husband's family about this pregnancy until we were more comfortable that it  wouldn't end in miscarriage. However, we had told my family as soon as we knew.

I spoke with my Dr. at great length about Mexico and the possibilities of any  problems and he reassured me that there shouldn't be any problems. I was  determined to do everything I could to be as healthy as I could, especially in  Mexico. I took long walks on the beach. I ate tons of fresh fruit. The last day  we were there, we had a volleyball tournament in which we all played. I  sustained no falls. I went upstairs to shower and finish packing. I was waiting  in a line to check out when I felt something "leak". I tried to ignore it and it  worked for a few minutes before it happened again. I asked my husband to finish  checking out and I was going to the restroom. Sure enough, I was spotting bright  red blood and was scared to death. One of my SILs was staying in the hotel  another couple days so, I used her room to lie down. The spotting seemed to  stop. The entire flight home, I was scared to death that it would begin again.  It didn't. We got home on a Sunday evening and Monday morning I called the Dr.  The CNP found the heartbeat right away with the doppler and assured me that  sometimes spotting like this can occur. So, I looked at it as a one time  incident. I started a new consulting position the next day. During lunch, I was  again lightly spotting. I called the Dr. to tell them and, since it had occurred  after a BM, they said that was probably the cause. I had no cramping and an  appointment scheduled for 2 weeks away and I had no further incidents in the  interim.

The next appointment, my BP was normal, which was odd because I had just  heard from my dad and he was falling apart. My mom had been diagnosed the week  before Christmas with TIAs (transient strokes) attributed to her smoking and I  was hoping that this would give her the incentive she needed to cut back and  quit. The hope of another grandchild. Unfortunately, she had been misdiagnosed.  The end of January, she was hospitalized with a brain tumor that had grown 300%  in 30 days. The prevailing thought was, based on the rate of growth, it was  bacterial in origin. So she was started on massive antibiotics. Although she had  a lung x-ray as recently as September, another was performed and a spot was  found on her lung. A needle biopsy indicated it was cancerous. The antibiotic  therapy stopped and radiation began. At that point, the Drs. were more concerned  about the brain lesion and stopping and reversing it's growth than they were  about the spot on her lung. She had been in the hospital for the radiation  treatments, released for a break, then went back in for further radiation. Dad  claimed the entire time that he could handle the situation. Well, now he was  falling apart and asking for help. I booked my airline ticket. I told the Dr.  what I was doing and he checked my cervix to make sure that it was firmly shut  and gave me the ok to go. Dad and I devised a plan to get mom eating and  drinking and regaining her strength. It appeared to be working as we all went  out to dinner to celebrate my 35

 birthday that week. We had  arranged for Dad to get help from the hospital. When I left a week later, the  situation seemed to be turned around. My sister was due to fly in on March 30

  and I needed to be back for a scheduled amnio.

My Dr. and I had discussed AFP test and the amnio and I decided that I would  rather put myself through the waiting period just once and be positive of the  results. Unfortunately my husband didn't agree with the procedure, claiming that  it wasn't necessary. He did however support my decision to have it. He came with  me to the appointment. We had a level 2 US which did not give any physical signs  of Downs Syndrome. It did however indicate an anterior placenta and it was also  low lying. My Dr. came in. I asked him if he ever did an amnio and had to repeat  it for some reason. He said yeah, but it rarely happens. So, he inserted the  needle through the uterus but stopped short of entering the amniotic sac. The  baby's head was right where the needle would enter. After several unsuccessful  attempts to move the baby, he decided to try a new site. This time he entered  near the baby's feet. Each time he tried to perform the draw the baby would  position it's foot over the catheter, effectively blocking the draw. Again all  attempts to move the baby were unsuccessful. The Dr. removed the needle and gave  me the option of a third stick, or coming back later. I chose not to repeat the  amnio. I was confident enough, with the level 2 US and the fact that none of the  "soft" signs showed up, to let go the "having" to know.

Mom was hospitalized with pneumonia the day my sister flew home. Apparently  the radiation had weakened her immune system. Within days, her original symptoms  were back. April 6

 an MRI showed that the lesions had returned in  the area of the brain that surrounded the initial lesion and had been radiated  and it was believed that any further attempts at radiation would be futile. Mom  died April 8

, just 2 days before my due date of the baby I lost.

The emotional upheaval of Mom's death weighed heavily upon me, as did the  guilt of not going home again before she died. I began rethinking my decision  not to redo the amnio and discussed if it was still an option with my Dr. He  said most definitely and it actually carried a lower risk of miscarriage than  one done earlier. We rescheduled for April 23

 with it proceeding as  it should have the first time. Now came the wait.

Early May had the trees and grasses blooming and my nose started running like  a faucet. I called the Drs. office to find out if there was any kind of  antihistamine I could take. And, even though it had only been 10 days the  results of the amnio were in. I said "WAIT" we don't want to know the sex. The  nurse didn't tell me the sex, only that no chromosomal problems were detected.  The sense of relief was overwhelming.

The rest of my pregnancy was pretty uneventful. I expressed concern about the  placenta and it's condition with my daughter and the Drs. decided that I would  receive weekly NSTs to monitor the baby's progress. This also set my mind at  ease. I did notice that varicose veins started to appear and, being summer, my  feet started to swell. THIS caused concern for the Drs. and based on my  swelling, the increased size of my babies, and the deteriorated placenta, it was  decided that I wouldn't go over my due date, which had been moved to Sept 2

By mid August, I was at 3 cm and hoping to hold onto the baby until my sister  arrived on the 28

 as she was also going to attend the delivery. My  fears went unfounded. I had my membranes stripped the day before my due date and  was told at the time that my membranes were bulging. The procedure did nothing  to speed up the process. I returned on my due date and induction was scheduled  for Sept 4

We arrived at the hospital, and I was monitored for about half an hour. I  searched for something to watch on TV while waiting for my Dr. He arrived and,  at 8:15am, proceeded to break my water. There was meconium. I guess I knew early  on that my birth plan wouldn't be followed but this seemed to cement things. The  Dr. said it wasn't much but that the baby would have to be suctioned right away.  I was monitored again for 20 minutes then given the OK to go walkin’. I sent my  husband to get something to eat and my sister and I walked down to the  postpartum/nursery wing of the maternity floor. We returned to my room and I  switched walking partners. We discussed names. I was POSITIVE it was a boy and  had Aidan Jonah (Jonah after my mom, Joan). For a girl, we had fought about  Carissa and Marissa and I relented and decided to use Marissa. Middle name for a  girl was still up for debate. He wanted Lauren, I would only accept Laurel. The  contractions were coming a bit harder but were manageable. We went back to my  room and I putzed around, trying to figure out what to do. Since the  contractions were still not too painful, I decided to see if a shower would be  of any benefit. Unfortunately, the water was barely lukewarm and there was NO  water pressure. I stood there, cold, for about 15 minutes before I figured that  it was not going to be a useful tool. By now, it was about 930 am and I was at 4  cm. It wasn't as encouraging as I thought it would be since I had been at 3 cm  for the proceeding 3 weeks. So, I started discussing whether or not to get the  epidural. We decided to get an IV and then I'd decide and it was then that the  contractions took on a life of their own. After the IV was inserted, I told my  LDR nurse that YES, I wanted that epidural. She returned and told me that the  anesthesiologist was with another patient and it would be about 20 minutes. Yes,  I noted the time. 20 minutes later I was watching the door for the  anesthesiologist. He arrived at 10:15 am and gave me the speech that epidurals  were safe but they had their risk. He would be using a spinal block followed by  an intrathecal. This surprised me as I had specifically asked if intrathecal's  were used and was told "No, not at this hospital".

I was asked to sit on the edge of the bed with my hands placed on my knees  and to roll my back like a cat. So, I practiced this while I wasn't having a  contractions but attempted to lie down when a contractions hit. I was told NO.  So, I was trying to maintain this position while the Dr. readied the  instruments. The automatic BP cuff, however could not get a reading on my BP and  continued to inflate. The lower part of my arm started turning purple. Still I  maintained this position. During contractions, which were hitting every 2  minutes now, I was squeezing my husbands hand in a pulsating manner. This seemed  to help me deal with the contractions better. I stayed in that position for what  seemed like a long time. The anesthesiologist had a difficult time with the  insertion site, saying that there was too much scar tissue from the first 2  epidurals and decided to go up a vertebrae where he was finally successful. I  never saw my nurse's face but I kept hearing her say, "Dr., she has a habit of  going fast, I NEED to check her" It was 11:10 am (and I was in that position for  about 40 minutes) when she finally got the opportunity to check and literally  RACED out of the room. I told her that I felt A LOT of pressure and she said  that was because the baby's head was less than a finger's length away. At this  point the anesthesiologist inserted the intrathecal drug and I began to itch. It  wasn't that bad though. I did get pain relief and it gave me the few minutes  that I needed to rest and wait for the Dr. before pushing. He arrived at 11:35  and literally threw scrubs on. I pushed once and the head was out. He suctioned  the baby then and told me to push again. I pushed once more and my daughter was  born at 11:46 am. She weighed 8 lbs 10 oz and was pink from head to toe. They  suctioned her again but believed that they got anything that she might have  inhaled on the first suction and immediately handed her to me. Well, I got my  surprise. I was sure she was a boy. When my husband said to me Marissa Laurel? I  said No. I wanted to use my mom's name. Since we both are of Irish decent, we  used the Gaelic version. Marissa Siobhan.

Dr. said that it looked like the placenta was going to come out fine, but  then had a bit of problem. Finally it released. He said that I had a small tear  and a skid mark by my urethra. I declined stitches for the skid mark and he  repaired the small tear. Unfortunately, my story goes down hill here.

I held Marissa for a while before giving her to my sister. The nurse came in  to start a pitocin drip and to catheterize me. I REALLY didn't want to be  catheterized claiming that I could go on my own but she insisted. My uterus she  said was too "boggy". I was on my second IV bag when more pitocin was ordered.  The nurse came in to perform an external massage on my uterus, in an attempt to  get it to firm up. After about an hour of this, she said, that this might be  uncomfortable but she needed to check something. She pushed down and out and  blood and clots seemed to explode from me. She took the blue bed protectors, now  soaked with blood to the bathroom to weigh, noting the amount on her scrubs and  went back to massaging my uterus. I continued to bleed and every 30 minutes or  so she would perform the down and out maneuver with results similar to the first  time and the weight again noted on her scrubs. At 3pm, I had lost roughly 4  liters of blood. My sister, who is familiar with the health care industry and  the implications, immediately became alarmed. The nurse had me typed and cross  matched and called my Dr. back to the hospital. He arrived as I was being  wheeled out of my room towards surgery. I remember being told that I was still  bleeding and they needed to stop it. I close my eyes because the effort to keep  them open was to great and they thought I passed out. I told them no, I was  still awake. I felt the Dr. put pressure on me, from the inside and moved  against the pressure. At that point, they put me under.

I woke up in recovery at 4:30pm. My Dr. came in to tell me what happened.  Apparently, my concern with the retained placenta was not only valid, it helped  them determine what happened this time. My Dr. believes, with my first daughter,  the retained placenta was placenta accreta. This time it went the next step  further to placenta increta. Portions of the placenta were imbedded in the  uterus and they needed to be removed. Had he not been able to stop the bleeding,  I would have lost my uterus. I received 2 units of blood and my iron level after  this whole affair was at 7. I was dying of thirst, having had nothing all day  and was permitted a wet washcloth on which to suck. My husband came back and  they allowed me to hold my daughter until I was finally moved to my post-partum  room at 6pm. Because the threat of complications still existed, I wasn't allowed  anything to drink or eat. Around 11pm, my Dr. was called and I was finally  allowed a clear liquid diet. Since I was catheterized still, I wasn't allowed  out of bed, so my husband stayed the night, bringing Marissa to me whenever she  needed to be fed. I was nervous about sleeping with her, especially given my  inability to maneuver about easily.

Before leaving for the day (well after 8pm), my LDR nurse came into  post-partum to check on me and told me that her own daughter was named Marissa.  Kathy was absolutely marvelous throughout then entire ordeal. She was on top of  everything as it happened. I only wish it had been an easier day for her. But  she stayed with me the entire time.

Marissa is over 4 months now. She is an awesome baby. She has been sleeping  through the night from 5 ½ weeks.. She is incredibly quick to smile, but  apparently only Daddy can make her laugh…and it is the sweetest sound you have  ever heard. She has blue eyes just like her brother and sister but she has  red-gold hair. The other two are both varying shades of blonde. The irony is,  with each of her grandchildren, my mom swore that they were going to be redhead  and not a one is…until now. I think we picked the perfect name. I take comfort  in knowing that she has a guardian angel of the same name.

Chris, Carolyn, Dylan, Alaina and Marissa

Articles

I remember taking a pregnancy test for my third child. I was so excited…I just knew we had timed things right. AND I wanted an April baby SO bad I could just spit.

Carolyn Ruff

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Third Time's a Charm