Third Time's a Charm

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. 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^th, 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^th 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^th. 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^th 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^th 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^th 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^th, 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^rd 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^nd.

By mid August, I was at 3 cm and hoping to hold onto the baby until my sister arrived on the 28^th 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^th at 7am.

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.

Marissa - 13 weeks old

Chris, Carolyn, Dylan, Alaina and Marissa