Author: admin

My Birth Story (warning: things get graphic!)

My birth story is a bit on the traumatic side (but really, whose isn’t?)…so much so that I am still contemplating whether or not I am willing to brave another pregnancy to have more children in the future.

Anyway, it’s taken me almost 8 months to get to the point where I finally feel ready to share what happened to me…so, here it is…laid out in its gory detail for all the world to read.

Labor officially started just after midnight on the morning of March 28.  I had just gone to the bathroom and noticed that I lost my mucous plug (I know – gross!) and then literally within a minute or two I began having strong contractions.  They were probably 5/10 in intensity, lasting 45-60 seconds, and coming every 5 minutes.  So, I did what any excited first-time mom would do: I downloaded an app (Full Term) and proceeded to spend the next 7 hours timing each and every contraction I had at the expense of getting any sleep (but who could really sleep anyway with constant contractions, am I right?).  Unfortunately, my contractions never increased in timing or intensity, and then…rather anticlimactically, my contractions suddenly fizzled out around 7am and labor officially stalled.

I felt emotionally and physically defeated, and I began to wonder if my baby would ever *actually* come.  Stalled labor is quite possibly the worst thing that can happen when you’re a week overdue and entering into straight-up crazy territory with thoughts like “this baby is just going to keep growing until my abdomen literally ruptures” and “there is no way this baby is ever coming…there’s just no way this point.”  Don’t judge…there is no sanity in the final moments leading up to the birth of your baby.

So there I was…tired in every imaginable sense of the word…and yet inexplicably wired.  I attempted to get caught up on some much-needed rest, but felt too wound up to actually sleep.  Around 1pm on March 28, I called my OB/GYN and explained what had happened earlier that morning; I was informed that labor would likely return later that evening and to prepare to have my baby within the next 24 hours.  Spoiler alert: my OB/GYN was right.

So, I took a long-ish walk with my husband (to be completely accurate, he walked and I waddled…and by “long” I mean mayyyyyybe like 0.25 miles), and by 3pm, I was starting to have contractions again.  They were more intense than they had been earlier that morning, but coming at very irregular intervals.  I kept waiting for things to speed up, but they never did…instead, my contractions seemed to plateau once they reached the 5 minute interval mark.

By 11pm that evening, my contractions were starting to slow again and I was on the verge of tears fearing that labor was going to stall for a second time.  At 11:30pm, my husband urged me to get into bed since my contractions had all but stopped…and I kid you not, the moment my head hit the pillow, contractions revved up and started coming back-to-back with a ferocity I hadn’t experienced earlier in the day.

I looked at my husband and said “This is it!  It’s finally time!” and so we grabbed a few last minute items for our go-bags, then got into the car and drove to the hospital.

We arrived just after midnight (if you’ve been counting, this marks 24 hours of intermittent labor), and were rapidly admitted to the L&D unit after a quick check by one of the nurses.  I was a little worried that we might be turned away because I had been checked 2 days prior by my OB/GYN and was only 2cm dilated with a posterior cervix.  But, in a shocking turn of events, I was 4cm dilated when I arrived at the hospital and my cervix had already begun to tilt into a more anterior position (hooray!)…also, the nurse assured me that there was absolutely no way they were letting me walk out of the hospital without a baby in hand since I was a week late.

Although my goal was to have a completely natural labor (i.e., no pain meds or epidural), my body was in shambles and the sensible nurses reminded me that I should really try to get some sleep before pushing out my giant baby.  Again, if you’ve been counting, we are approaching nearly 48 hours since the last time I got any sleep.

My barely functioning brain decided to chuck my birth plan out the window in favor of sleep.  And so, around 3am, I agreed to be given a dose of a magical drug called Stadol (generic butorphanol) which promptly put me right to sleep and gave me about 3 hours of blissful contraction-free slumber.  When the dose of Stadol wore off, another nurse checked me and said I was about 6cm dilated and that it was now or never if I wanted an epidural.  The anesthesiologist was already on the floor giving an epidural to another patient, so I agreed to get one for the convenience of it all.

Boy do I regret getting that fateful epidural.

The anesthesiologist (well-respected with >30 years in the field) strode into our room offering me and my husband a perfunctory greeting, then proceeded to rattle off his many accomplishments in what we believe was his awkward attempt at making us feel more comfortable with the procedure he was about to do.  He then had me sit with my legs dangling off the side of the bed while he positioned himself behind me and prepped my back in a sterile fashion, which was followed almost immediately by him giving me local anesthesia that was mercifully quick and painless.

All of this went exactly as I imagined an epidural would go.  But, then this happened:

As the anesthesiologist placed the epidural into my back, he said, and I quote: “Oops.  That’s not supposed to happen.”  Wait, what the WHAT?! When I asked him what was wrong, he informed me that I am a “shallow stick” and he accidentally put the needle in “too far.”  He was apparently seeing clear cerebrospinal fluid (CSF) leaking from the needle, indicating that he had punctured my dura mater.  He reassured me that my epidural would still work properly, but warned that I *might* get a complication known as a spinal migraine in about 24 hours.  I vaguely remember him offering some sort of brief apology, but also reminding me that this was a well-known risk of having an epidural.

I didn’t think much about the botched epidural again for several hours.  Labor progressed and, as promised, I didn’t feel any pain from my contractions.  I could tell I was having them, but did not feel any discomfort.  As my cervical dilation increased, so did my urge to push…and let me tell you, that is one heck of a strong urge.  Finally, around 1pm, my OB/GYN arrived on scene and gave me the green light to start pushing.

I had read lots of mommy blogs in the weeks and months leading up to this moment.  I knew that you had to push as if you were bearing down to have a bowel movement.  I knew that this phase took a lot of energy and many moms reported that they grew worrisomely tired partway through, and some ended up needing to be converted to a C-section when their heroic pushing efforts did not yield the desired results by a certain point.

But I naively believed that I was strong.  And that pushing would be the least of my worries.  I admittedly hadn’t gotten more than about 4 hours of combined sleep over the last 52 hours or so, and I was definitely NOT in good physical shape.  I used to be a Division I rower in college, but sadly I did not keep up with any form of exercise post-college, particularly during pregnancy.  My peak activity level during pregnancy consisted of waddling to the fridge to grab ice cream, then shoveling said ice cream into my mouth.

Anyway, I entered into the pushing phase with a mix of excitement and trepidation, and an overly confident expectation that I would rock this leg of the journey (thanks to my very distant past as a has-been athlete).  I began pushing and, at first, there was no pain…just wave upon wave of contractions coursing through my body, urging me onward toward my prize.  I was full of an energy I didn’t recognize, and I let it fuel my motherly powers of perseverance.  I pushed and I pushed and I pushed some more.

But I couldn’t feel any progress being made, had no sensation of a baby coming through the birth canal.  So when I asked my OB/GYN for an update and she informed me that she could see my baby’s head beginning to come into view…I had this crazy notion that I was being lied to in an effort to make me continue pushing.  Although my thoughts were almost certainly not coherent at this point, I recall having the distinct revelation that my baby was never going to make it all the way out.  I didn’t believe a word my OB/GYN was saying to me, and I was ready to pull the plug on the whole pushing thing and opt for the C-section even though this was the one outcome I knew I wanted to avoid.

Discouragement settled over me and I began to feel twinges of pain with each contraction.  When I did a quick mental assessment of my energy level, I could feel my strength wilting before me like a flower under the blazing light of the sun (or, in my case, the glow of about 3 overhead surgical lamps).  I was about an hour into pushing, having changed positions several times, when I began to whimper in my most pathetic voice ever that I couldn’t do it.  I needed to give up.  I needed someone else to rescue my baby from my exhausted body.

But just then, something extraordinary happened.  My amazing husband, who had been dutifully placing cold washcloths on my forehead and gently massaging my back with lavender oil, did something I will forever be grateful for: he conquered his fear of looking “down there” and assessed the situation for himself.  And when he told me that he could see the top of our baby’s head, this was all the reassurance I needed to keep pushing.  I knew my husband was telling me the truth, and I dug down deep and found that inner Division I athlete that had been dormant for the last 10 years.

I pushed with a vengeance I didn’t know I had.  The room suddenly filled with about 7 nurses and a second OB/GYN (I later learned that this was because they were concerned my baby might get shoulder dystocia as she was projected to weigh about 10 lbs based on ultrasound measurements).  With the very last drop of energy that I had, I gave two final pushes…and that was it.  At 2:37pm, after 90 minutes of pushing, my baby girl made her debut.  My husband cut the cord and Ellery Metta was placed on my chest.  I was beyond tired and couldn’t sit up to hold her, but I tilted my head down and kissed her soft head.

And this is where things get a little hazy for me.

I don’t remember having a chance to really see my baby before she was whisked away by a nurse.  I began to panic: was my baby okay?  What was wrong?  And that’s when I felt it.  A giant gush of hot liquid.  My OB/GYN was still at the foot of my bed and had a concerned look on her face.  She proceeded to press down on my sore belly and once again there was another gush of hot liquid.

The flock of nurses returned to my bedside and kept telling me that everything was okay…even though I knew it wasn’t.  Then I felt the absolute worst pain in my life, like someone had taken a searing hot knife and sliced through my abdomen.

The pain almost made me black out.  And all I could think was “shouldn’t all the pain be over now?”  All of the mommy blogs I read told me that labor and delivery officially ended when the baby was born and the placenta was delivered.  The hard part was getting the baby out, and the easy part was the placenta.  And my placenta had come out whole shortly after my baby was born…so what on earth was all this commotion about?

The look of concern on my OB/GYN’s face darkened and the nurses around me all had an undeniably somber quality to their gaze.  I soon pieced it all together and realized that I was hemorrhaging.  Those gushes of hot liquid were my own blood.  Pouring out of me.  In the not-so-distant past, this would have been the kind of situation that caused a woman to die from childbirth.  And the gravity of this realization was not lost on me, even in my hazy postpartum state.

That searing hot pain came back time and time again as my OB/GYN frantically tried to scrape my uterus with her hand, looking for possible placental remnants.  Fun fact: your uterus does NOT want to be touched right after it’s given birth.

So my uterus was literally screaming in agony as my OB/GYN did manual maneuvers to try to stop the bleeding.  And if you’re asking how in the world she was reaching her hand way the heck up there (“elbow deep” as my husband would say), it’s because I was torn wide open.  Yup.  My giant 9lb 8oz baby and her extra large head did not come out gracefully.  I had a third degree tear, meaning that it stretched all the way through my perineum and involved a portion of the anal sphincter.  Look it up.  I dare you.

Anyway, I was lying there helplessly hemorrhaging, feeling repeated violations to my tormented uterus, wondering if I might die soon.  And eventually I just couldn’t take the pain anymore.  So I mustered one last ounce of strength and sat upright and screamed at my OB/GYN.  I can’t remember my exact words, but the gist of it was “get the F@CK out of my uterus!!!!!!!!”

Being the wise doctor that she is, she quickly exited the scene and booked me into the OR where she could safely continue her maneuvers while I was under sedation.  Before I was wheeled away, I asked my OB/GYN what the best and worst case scenarios were.  Without missing a beat (time was of the essence here), she said “best case, you have retained placenta and your bleeding stops when I remove it.  Worst case, I have to do an emergent hysterectomy.”  And that was it.  My husband and I held hands, exchanged tearful “I love you’s,” and parted ways, not knowing if I would come back sans uterus and our dreams of having more children would be surgically removed.

My husband had to describe the next part of the story to me as I really wasn’t aware of what was going on around me at this point.  He said that just as quickly as the delivery suite had flooded with extra staff, it was suddenly empty.  And he was left holding our brand new baby girl in his arms, surrounded by the graphic aftermath of childbirth.  He says this was the closest he has ever felt to living in a war zone:  the walls were spattered with blood, and the floor was covered in debris with various degrees of his wife’s bodily fluids.  He told me later that he didn’t think someone could survive the degree of blood loss that was left behind in the room around him.  And since he was left utterly alone with his thoughts, my husband had one of those soul-searching moments with God.  He prayed and called our pastor to ask for support.  I share this last bit only to highlight the seriousness of the situation as my husband is not one to call people for help…let alone call our pastor.

I’m not sure when I was rolled back to my room, but it was sometime after 5pm.  And I thought to myself “The worst is over now.  They are going to give me my baby and all will be right with the world.”

Oh how wrong I was.

Once I was back in my room, the nurse sat me up so that I could finally hold my baby…and then my brain went dark.  I didn’t know what had hit me, but a pain unlike any other I had ever experienced before slammed into my head as if I had been struck by lightening.  The nurse immediately laid the head of my stretcher back down and told me that I needed to lay flat until the anesthesiologist could come back.  Why?  Because I was having a spinal migraine.

Remember earlier in this post when I mentioned the anesthesiologist said I *might* get a spinal migraine?  And that, if I did, it wouldn’t happen for another 24 hours?  Well, that turned out to be the most misleading piece of medical information I have received to-date.

Turns out that a spinal migraine (also called a post-dural puncture headache) happens when the highly sensitive pressure system contained within your spinal canal develops a leak and no longer has a high enough pressure gradient to keep CSF circulating at an appropriate volume to cushion the brain.  The net effect of this disrupted pressure system is that you develop a severe migraine when you sit/stand, and the migraine significantly lessens when you lay flat (i.e., the CSF doesn’t have to fight gravity to support the brain).

In keeping with its terrible reputation, my spinal migraine went from a 10/10 while sitting up to a 4/10 when laying down.  And since I couldn’t sit up to care for my baby, she was once again whisked away by the nurses and spent her first night with them…instead of me.  I hadn’t even been able to properly hold her at this point.  To say that my heart was broken would be a massive understatement.

I spent the rest of that first horrendous night in the hospital lying perfectly still with cold washcloths on my forehead and taking small sips of Gatorade through a straw (which, notably, my husband had to go out and purchase at a nearby gas station since the hospital only had ice water on hand).  For those of you thinking of delivering at a small community hospital like I did, make sure you consider all the little details…like the fact that the kitchen will be closed overnight with no access to special beverages, and the fact that there won’t be an anesthesiologist in the building overnight to fix you up if you get a spinal migraine.

I digress.

Anyway, so the anesthesiologist finally re-appeared the next day around 10am and proceeded to do a blood patch.  For those of you who are unfamiliar, this is the corrective procedure that is done when you have a CSF leak.  It consists of drawing a relatively large syringe (about 20cc) of blood from your arm and injecting it directly into your spinal canal in an attempt to correct the pressure gradient and introduce clotting factors that can seal off the hole in the dura mater.

The procedure went about as expected:  my migraine miraculously went away almost instantaneously…but the sudden force of all that extra fluid in my spinal canal caused brand new pain and disrupted sensation in my lower back and legs.  These side-effects are well-known and did not surprise me, but the supportive care I received afterward had an unintended consequence that I was utterly unprepared for.

Let me back up for a second.

If you haven’t read my post about PUPPP, now would be the time to do so.  To give a brief summary, I developed PUPPP (pruritic urticarial papule and plaques of pregnancy: aka the dreaded rash of pregnancy) around 37 weeks of pregnancy just after my stomach suddenly developed stretch marks (oh joy).  This insanely itchy rash was initially confined to my abdomen, but after giving birth (which is generally considered to be the “cure” for PUPPP), my rash became infinitely worse…and I credit a lot of that worsening to the heat packs that were applied to my lower back and legs after getting the blood patch.

I don’t think anyone could have foreseen the terrible way that my body would react to the seemingly innocuous act of putting a heat pack on my skin.  But, it turns out that PUPPP is an extremely heat-sensitive rash.  And so, everywhere that a heat pack touched my body, I broke out in new itchy blisters.  Before I knew it, more than 70% of my body was covered by PUPPP.

So there I was.  Covered from chest to feet (thankfully my neck/head, palms, and soles were spared) in this intensely and RELENTLESSLY itchy rash.  No matter how hard as I tried to focus on everything else that was going on around me, my brain kept dragging me back to the itch that was consuming my body.  I literally could not concentrate on anything else.  It would definitely be safe to say that PUPPP stole an incalculable amount of precious time and memory from me in those first few weeks after Ellery was born…all because my mind could not stop thinking about the constant itch from that God forsaken blistery rash that raged all over my skin.

Cue the giant pity party.  Because my first real interaction with Ellery didn’t happen until after the blood patch was done which was around 10:30am…nearly 20 hours after she was born.  Read that again.  I didn’t get to truly meet my new baby for almost 20 hours.  I realize that many moms are probably thinking that 20 hours is nothing when your baby is in the NICU and it’s literally days or weeks before you can meet him/her.  But, we only know our own realities, and mine is that the first 20 hours of my baby’s life are forever missing from my memory thanks to a combination of bleeding to death and blacking out from spinal migraines.

And so, while I was desperately trying to soak in all the details of my beautiful new baby girl, PUPPP kept trying to steal my attention back.   Those first moments of getting to know Ellery are marred by an itch so intense that I found myself scraping my skin until it bled just to gain a few seconds of sanity with which I could clearly count each little finger and each little toe…feel her soft breath against my neck…take in her sweet new baby smell…hear her adorable new baby coos.  All of the things I should have been able to do as a new mom were, in part, destroyed by PUPPP.  So to all the moms out there suffering with PUPPP right now, know that you are not alone.  I hear you.  I feel you.  I was you.  And it gets better.  I promise.

Anyway, the rest of my hospital stay was pretty much unremarkable (aside from the never-ending itch from PUPPP and the new blisters that were constantly bubbling up all over my skin).  Lots of family came and went amidst multiple blood transfusions.  And by the following day (March 31), I was ready to be discharged.

The sun was shining, the temperature was downright balmy for CT weather in March, and I felt like my health was finally turning a corner.  As a nurse rolled me out to meet my husband (thank goodness for wheelchairs when your hemoglobin is only 8 after 3 units of blood), I remember thinking that life was about as glorious as you could ever hope for.

And indeed it was.  But sadly there are more hurdles to clear in this never-ending birth saga.

Our first full day at home together as a family of three was April 1 which happened to be Easter that year.  And that little detail becomes very important about 8 hours into our day.

My parents came over around 2pm to share some leftover Easter dinner goodies with us…and it was right around that time that I started to get a dull ache in my head.  I took some acetaminophen and tried to guzzle as much liquid as possible while I repeatedly told myself that my headache was just a byproduct of severe dehydration and sleep deprivation.  But, alas, no matter what I did, the pain kept escalating.  By 6pm, it was clear that this was no ordinary headache.  If you’re a Jeopardy fan and just yelled out “what is a spinal migraine?!” you are correct.  That pesky blood patch had not won the battle after all.

You might be asking right about now what the significance of Easter was…and the answer is this:  even though my head felt like it was being crushed by a vice, the itch from PUPPP was even worse.  Like so bad that I had to call my OB/GYN.  And, of course, given that it was a holiday, it took the covering physician about an hour to call me back.  And when he finally agreed to send in a script for a potent topical steroid, he sent it to my usual pharmacy…which was closed…because it was Easter.  After a bit of Googling and another call to the covering OB/GYN, the steroid prescription was finally sent to a 24-hour pharmacy that was about an hour away from our house.

My amazing husband picked up the steroid while my parents looked after Ellery and I laid flat on my back on our bed in the darkness of our bedroom…removed, once again, from my baby girl…feeling utterly helpless as I listened to the sounds of other people taking care of my baby.  It was like a horrible case of deja vu where my parents were playing the role of the nurses who had cared for Ellery that first night in the hospital when I had to lay flat on my back while they cared for her.

The following morning, we went back to the hospital.  Not only was my spinal migraine raging, but my PUPPP was worse than ever and my breasts were beginning to look and feel like giant boulders stuck awkwardly onto my chest.  Turns out that nursing is nearly impossible when you have to lay flat on your back and you don’t have any experience with getting your brand new baby to latch properly.  So with my new milk supply coming in hot and heavy, I was beginning to worry about getting mastitis on top of everything else.

When we got to the Emergency Department, the staff immediately called the anesthesiology department about doing another blood patch…and, as luck would have it, it was the same damn anesthesiologist who had done my botched epidural and my failed blood patch!  And instead of giving me what I would call a well-deserved sympathetic (or even, dare I say, apologetic) bedside manner, I was greeted with a response of “it can’t be a spinal migraine.  I’ve only ever had 2 blood patches fail in my 30 year career, and both of those were because the patients went bungie jumping afterward.”

Nevertheless, the anesthesiologist dutifully stuck a needle in my spine to investigate the matter…and that’s when he said “Oh whoops.  Okay.  You were right.  That’s definitely CSF leaking out.”  I didn’t even have the energy to feel vindicated in that moment.  But you can be sure that when he did another blood patch and my migraine miraculously cleared for a second time, I made a clear mental note not to let this man touch my spine again.

So now my spinal migraine was gone (and thankfully, it did not come back again as the second blood patch held up)…which was awesome, but it left my brain vulnerable to even more consuming thoughts about the relentless itch from PUPPP and this new problem of extremely tender/swollen breasts.

But here’s where my birth story FINALLY gets its bright moment.  And if you’ve read all the way to this point, I commend you.  It was exhausting to live through it in person, it’s been exhausting to write about it, and I have no doubt that it’s been equally exhausting to read about it.

Anyway, the ED physician was a kind and caring man who took pity on me and my pathetic state of health.  He gave me a dose of IV steroids to help jumpstart the attack on PUPPP and then sent me home with oral steroids to finish the job.

About an hour after being discharged from the ED, we went to the Pediatrician’s office for Ellery’s first appointment.  And once again, there was a shining moment of happiness amidst all the darkness of my birth saga.  The woman we saw that day was an APRN who also happened to be the office’s designated lactation consultant.  To describe her as an angel would be an understatement.

She listened with rapt attention to all the drama that had occurred with Ellery’s birth and beyond, injecting sincere empathy at all the right moments in the story.  Then she patiently watched as I fumbled to try and nurse Ellery in her presence, providing constant reassurance about her latch and her access to milk.  But I will always be most thankful that she definitively squashed out any worry I had been having over mastitis.  She immediately recognized that my breasts were overly swollen and literally rock-hard because of all of the IV fluids I had received in the hospital.  She told me that within the next 24-48 hours, all of that excess swelling would recede as my lymphatic system worked to reabsorb all the extra fluid…and she was right!

By the following day, my breasts had found their new normal as milk delivery vessels and had no trace of the rock-hard swelling that had been there 24 hours earlier (don’t get me wrong – my breasts had plenty of rock-hard moments afterward when they would fill with milk, but they never again had the same appearance/sensation as they had when they were congested from all the IV fluids I had received in the hospital).

Ellery was nursing like a champ and I felt a surge of hopefulness that my body was on the mend.  The steroids were helping to a modest degree to keep the itch from PUPPP at bay, and even though they prevented me from getting any sleep, I would have taken a thousand sleepless nights over one day of ceaseless itching.  The bruises on my body were also starting to fade, and I could feel my energy stores beginning to return as I moved further and further away from the catastrophic postpartum blood loss I had endured.

The weeks slowly crawled by, and each day I grew stronger and stronger.  And my appreciation for life and good health became so much more vivid.  I was able to focus on Ellery and found great solace in nursing her.  In fact, I would credit our nursing bond with providing the greatest level of healing I have encountered thus far…more powerful even than the steroids I was on.

And so, although I faced a mild resurgence of PUPPP several weeks after thinking I was totally healed from it…and despite developing a horrible fungal infection on my arm where the IV tape had trapped moisture (which, by the way, took months to recover from and which I will not bore you with since it’s probably taken you at least 7 hours to finish reading this blog post), I consider myself lucky to have had the recovery I did.

Had I given birth in a place with less access to modern medicine, I might not be around right now to be writing this piece.  I am so grateful for the heroic efforts of my OB/GYN, the kindness of the ED physician, and the empathy of the pediatric APRN.  I will forever be indebted to these wonderful people as they quite literally saved my life.

And now I would like to sincerely thank you for taking the time to read through my birth saga.  We all have difference birth experiences, and I would love to hear about yours in the comments.  Whether you were in labor for 30 minutes and your baby basically fell out…or you were in labor for 72 hours and were so exhausted that you had to be converted to a C-section, I welcome you to drop a line below!

In the meantime, as you ponder how to sum up your birth story without going all War and Peace about it like me, I recommend a strong cup of coffee (or a shot of hard liquor) to replenish your energy as the calorie expenditure required to read this ridiculously long post is probably on par with running a marathon…just saying. 😉

The Woes of Weaning

As I write this post, I am alone in my bedroom, sitting on my bed with the door closed to the sounds of the rest of the house. But, I can still hear my baby’s joyful screams and my husband’s dinner preparations as they clatter against the lilting strains of Frank Sinatra crooning in the living room. It’s a completely unremarkable evening, full of the familiar and beloved chaos that is usually found in my house at this time of day…and yet, I am unfathomably sad. These last few days have been some of the hardest of my life, and I am trapped right now in a moment of deep sorrow that I hope will be lifted by writing this post.

I was diagnosed with Graves Disease 8 days ago, and although the prognosis is very good, the diagnosis has brought with it physical and emotional changes that I have yet to come to terms with. About 3-4 months ago, I began to notice a dull ache in my neck that was accompanied by extreme fatigue, palpitations, hot flashes, muscle weakness, and a jittery sensation that made sleeping nearly impossible. I immediately suspected that my thyroid might be acting up, but I didn’t seek medical help right away because I figured I would be seeing my OB/GYN soon and she could order any tests I might need.

Let me explain: my husband and I were just beginning to try for another baby, and since we were extremely blessed with getting pregnant on the first try with our baby girl, I didn’t think I’d have too long to wait before I saw my OB/GYN for a second pregnancy. And when we had a positive pregnancy test in the middle of October on our second month of trying, I felt reassured that I would be getting my thyroid checked soon enough.

But one week later, those happy dreams of a second baby were shattered when I began to have heavy bleeding and cramping. And it became painfully apparent that I had had an early miscarriage. Needless to say, I was not thinking about my thyroid at that time. Instead, my husband and I were mourning the loss of what could have been, and I was distracting myself with applying for a new job.

Fast forward a month, and I tearfully went back to work full-time after spending 7.5 blissful months at home with my baby girl. I barely noticed my sleeplessness, my extreme heat intolerance, my near inability to lift a laundry basket, or my racing heart. My mind was solely focused on thoughts of missing my baby girl while I was away at my new job.

And then Thanksgiving rolled around, which was closely followed by a week-long business trip to Baltimore for work. And, by the time I got back home and felt like I could breathe again from all the craziness of life, I realized that the dull ache in my neck couldn’t be ignored anymore. As I was sitting on my couch the evening after getting home from Baltimore, I absentmindedly touched my neck…and that’s when the big and scary “C” word began to creep into my head. My thyroid was now undeniably swollen and painful. And even more disconcerting was the fact that all the lymph nodes in my neck were suddenly enlarged when they had previously been undetectable.

The very next day after becoming acutely aware of all these frightening transformations in my neck, I made a same-day appointment to see an endocrinologist. I was completely and utterly convinced that I had thyroid cancer as there is a strong history of this condition in my family. Thankfully, the endocrinologist told me straight away that he didn’t think I had cancer. Instead, he said he thought I had a condition called postpartum thyrotoxicosis, which is a form of autoimmune inflammation that causes the thyroid to become overactive following pregnancy.

After a few blood tests and a thyroid ultrasound, I went back to see my endocrinologist. He told me that although my results looked promising for postpartum thyrotoxicosis, he could not rule out a different autoimmune hyperthyroid condition called Graves disease. Furthermore, he told me that my miscarriage in October was almost certainly caused by my overactive thyroid. To differentiate between postpartum thyrotoxicosis and Graves disease, my endocrinologist ordered a radioactive iodine uptake study: if there was no uptake, then I had postpartum thyrotoxicosis and could expect my thyroid to calm down all on its own within 2-3 months. If there was a lot of uptake, then I had Graves disease and would need to either take medication to suppress my thyroid for the rest of my life, or eliminate my thyroid altogether (either by surgical removal or a heavy dose of radioactive iodine to ablate it).

Well, as I’m sure you’ve guessed by now, my scan showed a very high degree of uptake, which is consistent with Graves disease. And this is where things started to get a little dicy for me in terms of my emotional stability. Let’s back up a little bit: in order to have the radioactive iodine uptake scan in the first place, I couldn’t be within 12 feet of my baby girl for 66 hours due to the risk of potential radioactive emission. I also had to pump and dump my breastmilk during that timeframe for the same reason. So during those 66 hours, I watched from afar as other people took care of my baby girl, feeling helpless and lonely.

After waiting 3 long days just to be extra cautious, I finally got to hold my baby girl again, and that feeling of being reunited was more euphoric than anything I’ve ever experienced before. I pressed her tightly to my chest and when she nursed from me, I truly felt as if the emotional bond between us became tangible for an instant. But that instant was destined to be short-lived, and the knowledge that our nursing bond would be severed all too soon hung over my head like a dense fog.

You see, with the diagnosis of Graves disease came the need to begin treatment with an anti-thyroid medication whose safety has not been properly demonstrated during pregnancy or breastfeeding. That’s not to say that thousands of women haven’t had healthy babies while taking this medication; it just means that the theoretical risk is high of passing this medication through the placenta or into breastmilk and potentially causing the baby to become hypothyroid (among other things). My endocrinologist advised me that I should immediately stop breastfeeding in order to protect my baby, and so the decision was clear to me: my baby’s health meant more to me than the enjoyment of continuing to nurse her.

I decided to give myself 3 last glorious days of nursing my baby before beginning my anti-thyroid medication. And each precious moment that I held her to my breast, I was both elated and depressed, feeling torn between living in the moment to soak up every last second of nursing…and worrying about all that the future had to hold when breastfeeding came to its abrupt and premature end.

And before I knew it, my baby was weaned. Nothing about it went according to plan, and yet all of it went exactly as it should have. I had hoped to nurse my baby girl until she was 12 months old, whether that meant 1 feeding a day or 12. And, truth be told, she had naturally weaned herself to about 4-5 feedings a day as her diet had already transitioned to being predominantly solids.

On the dreaded morning of December 26, I nursed my baby for the last time. I knew it would be our final session ahead of time as I couldn’t delay taking my anti-thyroid medication any longer…and there comes a point when you just have to face the music and not put it off anymore. Time seemed to stand still as I gazed down into the eyes of my child. She reached her small fingers up towards my face and caressed my cheek. She stared deeply into my eyes as if she could tell that something was different about this particular feed. We stayed like this for several utterly perfect minutes…then, all on her own, she pulled away. And, just like that, our nursing bond was broken.

The PUPPP-date: 8 things I wish I knew about the dreaded rash of pregnancy

The PUPPP-date: 8 things I wish I knew about the dreaded rash of pregnancy

I wish I could say that PUPPP was a cute new term for a tiny dog, but, alas, it is not.  Instead, it is an acronym for the worst rash ever.  I briefly touched on this rash in my last post, but I feel that it now warrants its very own dedicated post because it ended up progressing in the postpartum period to a point that felt truly unbearable.

Background:

A little background on PUPPP/PUPPS/PEP (aka Pruritic Urticarial Papules and Plaques of Pregnancy):  I am no expert on this, but from my rudimentary internet searching, it seems there are several schools of thought on what causes this awful rash:

  1. Allergic reaction to circulating fetal cells in the mother’s blood stream.
  2. Liver dysfunction due to some type of “over toxification” that occurs during pregnancy.
  3. Inflammatory response to skin that has been over-stretched.

The rash typically affects first time pregnancies (aka primigravidas), and women who are pregnant with boys/multiples/extra large babies (in other words, women whose bellies undergo a hefty amount of stretching).  On average, it seems that PUPPP affects around 0.5% of all pregnant women, and [thankfully] has a very low incidence of recurrence with subsequent pregnancies.

PUPPP almost always begins on the belly as insanely itchy eruptions along newly formed stretch marks (usually during the third trimester, but some women get it earlier than this).  From there, it may spread to the back, buttocks, arms, legs, hands, and feet.  It typically spares the belly button, face, neck, palms and soles.

The rash is historically “cured” by giving birth, but in a small subset of women, the rash worsens in the postpartum period.  Unfortunately, this was my experience.

Prior to giving birth, my case of PUPPP was confined to my belly and a small area of my back/buttocks.  Within 24 hours of giving birth, the rash had spread to involve all of my abdomen, back, arms, hands, buttocks, legs, and feet.  It was unbearable.  And the itch always seemed worse at night, as if it was taunting my already sleepless state of health.

So, without further ado, here are 8 things I wish I knew about PUPPP when I first got this horrific rash.  However, before reading through this list, please understand that none of these things are intended as medical advice and that you should consult your OB/GYN and/or Pediatrician/Lactation consultant before trying any of them.

8 Things I Wish I Knew About PUPPP:

  1. Itching makes the rash worse.  Therefore, try your absolute hardest NOT to itch even though this is easier said than done.  The ugly truth is that while the rash is raging on, anywhere (and I mean ANYWHERE) that you aggravate your skin, you WILL get a new eruption.  At the end of the day, it’s not worth the misery of a brand new patch of horrendously itchy, red, blistery skin just to have the satisfaction of a few minutes of itching.
  2. Increased body heat makes the rash worse.  Unfortunately, this means that you will need to avoid hot showers and keep your body temperature cool.  So how do you do this?  Take lukewarm (or cold if you can!) showers and sleep in the nude (or with minimal undergarments).  Do not use more than a sheet for a cover to allow for maximum cooling and direct a large fan at your bed while you sleep.  Don’t wear any heavy layers and try your best to keep from sweating.  Wear loose-fitting cotton clothing as it will help cut back on incidental skin aggravation and allow for maximum air circulation to keep your body cool.  And, under no circumstances should you apply a heating pack as it will undoubtedly cause a new eruption of awful rash at the application site.  For me, the hardest part about keeping my body temperature cool was avoiding skin-to-skin contact with my husband; his skin is perceptibly warmer than mine and, as a result, his touch literally caused the rash to spread.  It was terrible not being able to snuggle up to him at night or feel his hand on my leg…I felt incredibly lonely and isolated, even though my husband would be sitting right next to me.
  3. Anti-itch creams CAN and DO help with the itch.  Proper moisturization is key to recovery, and lotions with anti-itch ingredients are like little guardian angels.  Keep a bottle of anti-itch cream with you at all times and apply it whenever your fingers are tempted to scratch.  My favorites are Gold Bond Extra Strength Body Lotion and Sarna Anti-Itch Lotion.  But, beware that both of these lotions contain menthol which causes a sudden cooling sensation about 1-3 minutes after application.  This is wonderful for chasing the roving itch in the middle of the night, but awful if you’re just getting out of the shower and think it’s a good idea to slather every square inch of your body with this stuff.  In truth, if you apply these lotions right after a shower, you will feel tremendous relief of your itch…followed by an earth-shattering sensation of hypothermia.  So…consider yourself warned.  Another important point to consider when using mentholated products is that they are very aromatic and may be harmful to your baby if he/she breathes them in when they have been freshly applied.
  4. Ice packs are your best friends.  The shock your skin receives from the icy cold will stop the itch in its tracks (sadly this relief is only temporary).  Keep a supply of ice packs handy and use them on the worst parts of your rash (i.e., where you think you will not be able to keep your fingernails from scratching off your skin).  I love gel ice packs because they are flexible and can be molded around the affected body part to provide maximum relief.  They also seem to keep their cool for a long time, so you can easily get 1-2 hours of relief.  I had 4 gel packs and at night, I would bring 2 of them to bed with me while keeping the other 2 in a cooler next to my bed.  When the 2 gel packs in bed no longer felt cold, I would swap them out with the 2 in the cooler so that I had a constant source of icy cold relief while never having to get out of bed.
  5. Don’t be afraid of topical steroids.  If your case is unbearable and the rash just seems to keep spreading, don’t delay talking to your doctor about starting steroids.  At 3 days postpartum, the rash had taken over >75% of my body and I couldn’t endure it anymore, especially with a newborn who was depending on me.  In complete desperation, I called my OB/GYN and begged for something to relieve the itch, and was ultimately prescribed a topical steroid called clobetasol propionate ointment 0.05%.  The tube was comically small and only gave me 2 applications (15g doesn’t go very far when you’re 6’1″ tall and have the rash on >75% of your body).  But, I was still grateful for it as it provided more long-term itch relief (approx. 4-6 hours) than Gold Bond or Sarna.  However, it did not begin acting immediately, so there was about 20-30 minutes where I felt the insane desire to itch while the medication took effect.  It was a terrible time.
  6. If topical steroids fail, don’t be afraid of systemic (i.e., oral) steroids.  These became necessary for me at the 4 day postpartum mark.  In spite of using a prescription high-potency topical steroid, the rash continued to spread and prevented me from getting any sleep.  Incidentally, I happened to be at the Emergency Department for a different reason that day (please see my birth story post for more details), and was able to get a prescription for prednisone from the ED doctor.  He gave me a single dose of IV Solu-Medrol in the ER, then started me on prednisone 40mg by mouth daily for 5 days.  At 7 days postpartum (3 days after starting prednisone), the rash was INFINITELY better and I had my first stretch of sleep since prior to labor beginning (no exaggeration here).  Life began to feel a little bit hopeful at that point as I could tell that the rash was beginning to fade.
  7. Alternative therapies can be a big relief if you’re open to them.  Do your due diligence to find out if they are safe for you (and your baby) to take…but once you decide to take them, BELIEVE IN THEM.  Sometimes it’s the belief in something that makes it work, not the medical science behind it.  I read on the internet that dandelion root extract and V8 juice provided good relief for lots of moms out there, so I decided to try them for myself.  I ordered Nature’s Way dandelion root from Amazon and began taking 1 capsule 3 times daily (incidentally, I also started taking prednisone the same day that I started taking dandelion root and V8).  Around 3 days into therapy, the rash became notably better…but, due to the fact that I was on concurrent therapy with Prednisone, I don’t have any good way of differentiating whether the improvement in the rash was owed to the alternative therapies or to prednisone…or, to a combination of the two.  Although the next few remedies didn’t work for me, there are literally hundreds of stories on the internet from other moms for whom they did work, and for that reason I have decided to include them here:
    • Grandpa’s Pine Tar Soap (get it on Amazon) – to be fair, this did provide some relief, but the hassle of using it made it rank low on my list of PUPPP remedies.  In order for this product to be effective, you need to lather the soap with minimal water and let it set for a good 5 minutes, then rinse off with a COLD shower.  The mere act of standing naked in the shower waiting for this smelly product to take effect, followed by the uncomfortable sensation of a cold shower made me want to never use it again.  And, in order to maximize its effectiveness, you need to lather/rinse at least 3-4 times per day.   No thank you.
    • Aloe vera gel with lidocaine (get it on Amazon) – this works well for small patch jobs, but did not provide nearly the same level of itch relief as Gold Bond or Sarna.  You can put the bottle in the fridge for some extra cooling sensation, but ultimately I found that it was lacking.
    • Over-the-counter topical steroids (try Hydrocortisone 10 ointment from Amazon) – this is good when you have a small area of rash to treat, but if your rash spreads beyond your belly, then you should not delay getting some of the other remedies mentioned above.  And, when it comes down to a choice between an ointment or a cream, please know that a cream will likely leave your skin with a residue that promotes further itching whereas an ointment will soak in completely with time and leave no residue.  For whatever reason, residues seem to only be an issue with steroid and antihistamine creams; I did not have any issues with residues left by moisturizing or anti-itch lotions.
    • Oral antihistamines (e.g.,Claritin/loratadine, Zyrtec/cetirizine, Allegra/fexofenadine) – for cases of PUPPP that care caused by an allergic reaction to circulating fetal blood cells, these medications should work in theory.  However, I did not get any level of relief from them.  I took generic Zyrtec (cetirizine) 10mg every day during pregnancy and have continued to take it in the postpartum setting because of severe environmental allergies.  In an act of desperation, I added diphenhydramine (generic Benadryl) for a while to see if this would help with my PUPPP; unfortunately, I found no difference in my itchiness when taking Benadryl.  Furthermore, I would caution anyone thinking of trying Benadryl to consider the following: it is very sedating and dries you out.  What does this mean for a breastfeeding mom?  You may be too drowsy to safely hold your baby while nursing, and your milk supply may dry up (to some degree).  Even though Benadryl is considered safe during pregnancy/breastfeeding, please talk to your healthcare provider if you want to start using Benadryl to treat your PUPPP.
    • Topical antihistamines (e.g., Benadryl Cream) – as with oral antihistamines, topical antihistamines should also help in theory to reduce PUPPP by way of counteracting the allergic reaction to circulating fetal blood cells.  However, once again, topical Benadryl cream did not seem to reduce my itchiness.  In fact, I would actually say that it made my rash more itchy because my blisters were aggravated by the residue that the cream left on my skin.
  8. Above all else, keep reminding yourself that the rash WILL get better and it will NOT destroy your life.  Your skin is dynamic and can change and heal in a matter of hours.  Most cases of PUPPP should resolve without intervention within 1-2 weeks of delivery, but if your case is severe and prevents you from being able to carry on your activities of daily living, then please please PLEASE seek medical help.
    • Even if you have a resurgence of PUPPP after it clears up, don’t get discouraged!  My case of PUPPP pretty much cleared up by 2 weeks postpartum, but came back again about 3-4 weeks later.  The resurgence was much less itchy and only affected areas that hadn’t been hit hard the first time around (mainly my legs and back).  I was able to manage the resurgence exclusively by Sarna lotion, dandelion root extract (1 capsule daily this time around instead of 3), and topical over-the-counter hydrocortisone ointment.  By 7 weeks postpartum, PUPPP had left my system for good!

The Take-Away:

Here is a snapshot of all the different remedies I tried to cope with my case of PUPPP.  In the end, it was gel ice packs, mentholated anti-itch lotions, dandelion root extract and steroids that worked for me.  To every woman out there suffering, remember that you are NOT alone, and this will NOT last forever.  Keep those fingernails trimmed short and try your hardest not to itch.  Slather yourself in ultra-hydrating lotion at least twice a day (this is especially important right after you shower), and make sure you drink extra fluids throughout the day.  Moisturized skin is happy skin.

The Endless Wait

As I approach 41 weeks in this seemingly never-ending pregnancy, I find myself full of self-doubt and worry…and physical ailments that make me feel like a pathetic version of myself.  Will labor ever start?  Will I be strong enough to get through it?  How long will my body take to heal afterward?  What will my baby look like?  Will she be healthy?

Meanwhile, I am struggling with an ever-growing list of pregnancy woes:

  • SPD (Symphysis Pubis Dysfunction) – aka severe pelvic pain.  I began developing this pain around 32 weeks and thought there was no way I would be able to cope with the remaining 10 weeks of pregnancy.  The first time I felt it, SPD gave me the sensation that my pelvis was literally cracking in half.  I couldn’t walk without causing 9/10 pain (I would say 10/10, but as a rule of thumb, I always assume there is something more painful out there).  After some careful research, I found a few ways to cope with the pain and have been able to [mainly] keep it in check.  However, it’s still a constant background discomfort that flares from time to time.  In fact, the pain always seems to peak in the middle of the night as I try to turn over in bed from one side to the other.
  • PUPPP/PUPPS (Pruritic Urticarial Papules and Plaques of Pregnancy) – aka the itchiest rash EVER.  Thankfully, I have a mild case that did not begin until week 39.  But, regardless of its severity relative to other mothers out there, it has been an increasingly difficult problem for me as I face the home stretch before baby comes.  Basically, PUPPP is a cruel skin condition that tends to affect first time moms, is more common in moms carrying boys (70% of cases), and targets stretch marks.  Yup, as if stretch marks aren’t bad enough on their own, PUPPP basically causes an intense eruption of itchy blisters within the stretch marks, themselves.  And, in many cases, PUPPP then goes on to involve the arms, legs, torso, etc.  One of the hallmark features is that it spares the belly button and face, but that’s not much of a consolation for women who are experiencing constant discomfort from this awful rash.
  • Sleeplessness.  I am literally going to pull my hair out if I hear one more person say “make sure you stock up on sleep now because you won’t get anymore once the baby comes.”  I think the worst part about this expression is that it’s almost always other moms who say it!  They should know better.  In the final weeks of pregnancy, if you can get 3-4 hours of sleep a night, it feels like a win.  Between the mental angst that keeps you awake at night worrying about all the things that could go wrong (When was the last time the baby moved?!  Is that contraction the beginning of labor?) and the inability to find a comfortable position, sleep honestly feels like a distant memory at this point.  I want desperately to use this time before baby comes to “catch up on sleep,” but the reality is that I. Just. Can’t.
  • Lower extremity edema – aka leg swelling.  This is by far the least of my worries.  If I’ve been on my feet a lot during the day, it’s now a given that my calves will blend into my ankles and become the most glorious of all anatomical anomalies:  the dreaded cankle.  But the good news is that with compression stockings and leg elevation, the swelling seems to subside within 24 hours.

So.  What am I doing to get through this time?

39 Weeks and Counting…

So this is it.  The last week (or so they tell me).  My official due date is March 22, but I’m hopeful that RehnBabyGirl will arrive before then considering that my due date is 41w1d from the first day of my last period…and don’t get me started on why my due date was set so far back…because I have no idea and I am convinced that due date estimation is a lot of science with a dash of voodoo mixed in.

Anyway, I am finally in the 39th week of pregnancy (or 40th week if you count from the first day of my last period…but who’s counting, right?), and I have decided to share a list of a few things that I am doing before baby comes:

  1. Have a date night with my husband every night.

There are lots of ways to have a date night, but we tend to keep things pretty low key.  I’m talking food and TV/movies.  Because let’s be honest:  what else do you have energy for at this point in pregnancy when your biggest accomplishment of the day is avoiding the inevitable cankles that glamorously appear just from spending a few hours on your feet?

  • Dinner: I am still working full time (40 hours) and doing 12-hour shifts at the hospital, which is an hour from our house.  My amazing husband has taken it upon himself to make dinner for us when I get home from work so that we can eat together even though it’s usually not until 9-9:30pm.  And you know what?  We cherish every second of that limited time together.  And on the rare days that we both have off, we share the responsibilities of making dinner…or we head out for dinner at one of our favorite restaurants.
    • Pro Tip: For an extra special date night, we sometimes order a box from HelloFresh to keep our culinary skills from .  If you’ve never tried a meal delivery service before, I highly recommend this one.
  • TV/Movies: We love binging on our favorite Netflix or Hulu shows, but we also love renting new movies from RedBox or PlayStation.  And whenever we cuddle up on the couch to watch something, we always take that opportunity to snuggle with our dog, too, who loves being smooshed between us when we have family couch time.
  1. Read Baby Wise with my husband.
  2. Get a mani/pedi.
  3. Get waxed.
  4. Finish any outstanding laundry.
  5. Go grocery shopping for easy meals and snacks.
  6. Do a terminal cleaning of the house.
  7. Take a bath.
Winter Maternity Shoot

Winter Maternity Shoot

I knew since the moment I found out I was pregnant that I wanted to do a maternity shoot…but I neglected to schedule one until I was nearly 30 weeks along.  Luckily, my little sister had some awesome photography connections (check out her amazing event design company here: kate&co events), and we were able to book a last-minute shoot with the oh-so talented Joanna Fisher.  And so, at 33 weeks, my husband and I met up with Joanna on a chilly February afternoon to do a romantic photography session at what turned out to be a ridiculously gorgeous and whimsical venue: the public greenhouses and Conservatory at Edgerton Park in New Haven, CT.  Take a peek below at some of our favorites from that day!

 

Blush maternity gown from Etsy.

Teardrop necklace from Etsy.

Navy polka dot dress from PinkBlush.

Statement necklace from The Loft.

Floral headband from Amazon.

Sequin tulle dress from Asos.

Blog Launch!!

I just launched this blog as a way to scratch that writing itch I was born with.  But I know myself, and that same Becky who loves to write also loves to procrastinate.  So who really knows how all of this will really go…but I’m down for a little trial and error.  I don’t know about you all, but I could definitely benefit from pushing my boundaries and doing a little self-exploration.  I have layers upon layers upon layers of baggage I’ve accumulated from every era of my life, and I can feel it in my bones that this blog will be my catharsis.  I will work at it, and I will let it work at me.  So if you’re ready to take this journey with me, then stay tuned…no promises on when blog posts will come out, but I’d like to think that when they do, they will be worth waiting for.

Thanks for reading with me, friends!