Because my daughter could have died alone

This post is the one I don't want to spend the weekend writing.  I thought of funnier topics and cuter topics, but this is the post I need to write.  This post is part of Blogging for LGBTQ Families Day sponsored by Mombian, but today I'm not talking to my usual audience of friends, lesbian moms, feminists, and fellow travelers.  Instead my imagined audience for this post is someone like Kendra, who blogs at Catholic All Year.  I hope she won't mind a shout out (and just a note that this post contains no cursing, no explicit content, and a minimum of typos).  I thought of Kendra when I began this post because she is an intelligent and thoughtful blogger who engages with political and social issues, and also finds gay marriage in my words: morally, culturally, and theologically abhorrent, and in her words "immoral" and "sinful."

This is our story:  I married B in a civil ceremony at the courthouse in D.C., attended by our parents, and occurring two days after we found out our first attempt at IUI was unsuccessful.  A month later I was pregnant.  A few months into my pregnancy (2nd clinic IUI, anonymous donor from a bank), we made the obligatory trip to a family lawyer.  In most urban areas you can find a small cadre of lawyers specializing in gay families and you find them by asking around or googling.  I believe we paid $2,500 for a 2nd parent adoption and an additional $1000 for estate planning. In Maryland, our part of the process included a doctor's note, some essay questions, letters of support from friends and family, and pictures including a required picture of our front door.

While we were happy with ourselves for being diligent and starting the process early, the legal reality was that no guardianship or adoption paperwork could be filed before a living baby was born.  I could make my belief that this baby belonged to both B and me and that we would parent the baby together known through unofficial channels, but we could not formalize B's relationship to our baby until after the baby was born.

At the time, that didn't seem like a big deal.  Life continued, lots of sleeping, trips to IKEA, inhaling chicken and bulgogi beef, picking up extra work to earn extra money, procuring my great grandmother's rocking chair.  Throughout I was nervous but healthy, as was B.

Then, an ultrasound showed that baby's previously normal growth had slowed: monitoring.  And long after my nausea had subsided, I had some episodes of violent puking (in the bushes outside my classroom and in a plastic bag in the car and on the sidewalks of my neighborhood where only junkies puke).  Not great, but I knew that puking could be a normal 3rd tri thing.  Then were some headaches so bad that they made me cry, but my screenings and blood work were okay, so I went about my business.

We hit week 27 and I was headed out of town for one final conference.  I went in for my regular checkup: blood pressure pretty high, concerning level of protein in my urine - for the first time, blood work ordered.  The next day I was prepping for class and one of the midwives called to request my presence at L&D - immediately.  The blood work had shown significantly raised liver enzymes.  "But I have a class to teach.  I don't have a bag packed." I negotiated for two hours, hustled over to my classroom to put a sign on the door, burst into staff meeting crying, and called B. to come get me.

At the hospital we went immediately to the MFM practice.  I had previously met the doctor there when he brought some med students in to observe my impressive fibroids.  Extended and anxious scanning, discussion of IUGR, a steroid shot, and the doctor: "You have severe preeclampsia.  We need to prepare for you to have this baby in the next 48 hours," he said pulling a sad face.

On L&D we sat on a bench in the hall.  They brought a woman through as she screamed that she was losing her baby. Our midwife waved from behind the nurses' station, but didn't come out to greet us (still bitter).  My blood pressure was 160/100.

The night in the hospital was long and loud.  The nurse's default was to turn up the baby's monitors as loud as possible so that it sounded like I was in my own womb, women screamed endlessly, my blood pressure monitor alarmed every 15 minutes because my pressure was too high and no one came to turn off the alarm.  But I had B there with me, sleeping fitfully, together.

A second night B went home to stay with our freaked out dogs.  A nurse told me she wouldn't be able to come back until visiting hours started again the next morning.  "We're married, we have a certificate, she's my next of kin."  The nurse said we could get it sorted in the morning.  B remembers that the visitors desk swapped her "visitor" wristband for a "family" wristband that gave her access to L&D 24 hours a day without any hassle.

Despite the frustrations of the hospital, I started to simply exist.  The days blurred quietly together with tests and scans and quiet.  I read steadily through the collected Sherlock Holmes stories.

B and I couldn't discuss the what-ifs, we lay in my little hospital bed and tried to imagine our baby's future.  I had a half-waking dream about a little boy and a little girl on a beach, and I felt a wave of peace.  We had already chosen LB's first and middle names after her great-grandmothers, but I told B that if they baby was a girl and she lived, we should give her a second middle name, Grace, after the Our Lady of Grace statue in the hospital lobby.

Time felt soft, I was floating and waiting.  Baby stayed strong.  And then her heart rate was alarming.  And she went off the monitors and couldn't be found.  The head resident efficiently and calmly, too calmly, pulled the portable ultrasound into the room.  She was so calm that I didn't know when she found the heartbeat, and asked several minutes later "is she there?" I called B and asked her to leave work and come sit with me.

B talked to our lawyer, who said she would drive up to Baltimore after the baby was born with our paperwork.  "What if something happens to me during the birth?" I asked a nurse.  "You'll be okay," she said.  It wasn't a question I asked with fear for my own mortality, it was a technical question.  "What if something happens to me?  They'll put our baby in foster care," I said to B.  "We have a lawyer, if there's a problem your parents will come down and sign over custody, it will be okay." B understood, but we didn't have much of plan, and I couldn't dwell on the future.  When I did, I was forced to consider a future in which our baby did not live.

For the first nine days in the hospital, I felt okay.  On the 10th day, I did not.  I saw floaters before my eyes, that I did not report.  I felt off.  My MFM popped back in with the verdict: rising liver enzymes, stubbornly high BP despite major meds, baby not growing, and now dropping platelets.  "It's time, you'll have this baby tomorrow morning."

B stayed with me that night and we cried and imagined our baby.  Surgery prep started early, but we were already awake.  A nurse came in to start the magnesium sulfate, which I describe here.  Mag acts as a muscle relaxant, and after I stopped sweating and puking bile, I felt very calm.  B put on her gown and held my hand as I was wheeled to the OR.

The anesthesiologist was waiting for us, he asked me to sit on the table and put both my arms around B's shoulders.  "It will feel like bee stings" he said.  I was too relaxed to talk, but I thought, "I've totally got this!" having been stung several times by a wasp in my office with no ill-effects.  I lay on the table, relaxed and unable to see without my glasses.

I'm sure B was trying to crack some jokes, but I don't remember much until there was a flurry of movement and someone said "You have a daughter."  "Is she alive?" I asked.  "Yes, Yes" and a tiny pink bundle was flashed somewhere near my face.  I thought I heard a tiny mew.  "She's breathing on her own."  B ran back and forth between me and LB(G) managing to snap the first baby-in-a-plastic-bag (to conserve body heat) photos.

As the NICU nurses prepped LB, my team got louder and more energetic.  "Blood, I need blood!" became "WHERE'S THE DAMN BLOOD!"  Muttering, orders, cursing.  "Okay, we need to put you under, okay?  B, you'll need to step outside after she goes under." I tried to nod, thinking "yes, I don't really want to be awake for this." I breathed as deeply as I could, trying to make it go as fast as possible.

The next five hours or so are not my story, but what has been told to me.  Medically, my low platelet and fibroids combo had complicated delivery, and led to extensive bleeding requiring extensive surgery.  Thankfully the replacement blood did arrive in time.  Meanwhile, B was sent back to my room to wait with a friend who had just happened to come visit us.  She prayed the rosary with a Quaker, and sweated through a Code Blue not knowing that it wasn't me.  A nurse came in and sent her up to the NICU to see LB.  Born at 29weeks, weighing 2lbs 3oz, LB was holding her own.  B kangarooed her (I would share the lovely pics, but B isn't wearing a shirt), and took more pictures.

LB's first hour in the NICU

I came to around noon, looking and feeling rough.  It was hard to remember what had happened, but I did remember "you have a daughter," and I felt waves of joy and love.  A nurse, one of the ones who was both kind and efficient brought me a gingerale with a straw and it was the best thing I ever drank. B came bouncing into the room flashing pictures and telling me all about the NICU and about how she held LB.

In 1995, Julie and Hillary Goodridge had a daughter:

"When their daughter was born, she breathed in fluid and was sent to neonatal intensive care. Julie had a difficult caesarian and was in recovery for several hours. Even with a health care proxy, Hillary had difficulty gaining access to Julie and their newborn daughter at the hospital."[full text here]

As Julie lay in the OR, Hillary sought to see their daughter in the NICU.  She was turned away because  she had no legal relationship with the baby.  She waited until shift change and lied to a new nurse, saying she was her baby's aunt, and was allowed access. Hillary and Julie became the lead plaintiffs in the case Goodridge vs. Department of Public Health, the case that brought gay marriage to Massachusetts.

If not for Hillary and Julie, what would have happened to our LB?  Would she have laid alone in an isolette while B fought to get to her?  Would she have been denied that time sleeping against her mother's skin?  If things had gone worse, would she have died never being held by someone who loved her?

"We're married" were magic words for us, words that opened doors and produced wristbands.  These are the stories of unfortunate couples who possessed only lowly civil unions: Brittney Leon and Terri-Ann Simonelli, Janice Langbehn and Lisa Pond, Kathryn Wilderotter and Linda Cole, and Bill Flanigan and Robert Daniel.  This latter case is particularly sad, because Robert died alone after Bill was denied access to his hospital bed.  In each of these cases the couples were in a legal domestic partnership.

The sad fact is that "we're in a domestic partnership" is not a magic phrase.  Say domestic partnership and very few people know exactly what rights you possess. Say marriage and everyone knows you should be at your spouse's bedside.  In 2010, the federal government offered additional guidance to hospitals receiving some types of federal funds, telling hospitals that they must allow patients to designate their own visitors.  That's a step forward, however, at least one of the cases above occurred after 2010.  The workers at the hospital front desk don't necessarily follow changes in federal guidance, but they do know what marriage means.  Marriage means you get the bracelet.

I am not equipped to speak to matters of theology.  I have freely chosen not to know what, if anything, exists after this life.  I am living this life with love: the intense love I feel for my wife and daughter, the joy I feel for my friends and coworkers, for clerks and bus drivers and randos, the perplexity and fascination I feel for those who claim to love me, but would deny my daughter a mother's love.

as a big girl

Thanks to Mombian for hosting the 9th Annual Blogging for LGBTQ Families!

Pregnancy in the News

Not in our news, which is all of the boring "thinking about trying" and "paying money to store sperm until whenever" variety.

First, it's New York Times official, baby aspirin is a thing for preeclampsia.

The Navel Gazing Midwife is running a series of uterine rupture birth stories.  They aren't easy to read, but important.  This link is to the first post, which talks about the series itself.

Also, I'm reading a very long biography of the Brontes, and Charlotte just died of hypermesis gravidarum.  I had no idea.

And, one bit of older and not-exactly pregnancy news.  Again from "The Well," a statistically small but deadly risk from power uterine morcellation procedures for fibroids.  Basically, the surgery can grind up cancer cells and release them into the body.  Definitely worth discussing with your doctor before having a uterine morcellation, which is offered as a less invasive procedure than traditional fibroid surgeries.

Preeclampsia in the News (short version: Juice Plus does NOT cure preeclampsia)

Most people who come to this site through search engines are looking for information about preeclampsia or giving birth on magnesium sulfate, both topics I've written about.  I have a google alert for preeclampsia news, and when I come across interesting or useful information I post it.

Most of the stuff I come across is really depressing, like this facebook thread. I don't think the woman who asked the original question about how to treat her preeclampsia at 27w (with two previous pre-e pregnancies) was wrong to ask this question on the internets.  That's what we do these day, we ask on the internets.  But I do think the crowdsourced advice that she received is scary.  Will it hurt this woman to do the Brewer's diet or give up hotdogs or take magnesium supplements?  No, probably not.  The problem is that our little human minds want so desperately to believe what we want to believe.  It's too easy to take advice based on no scientific evidence and think "I definitely feel better.  I definitely have less swelling.  My head hurts less.  That high BP reading must be a fluke." Which is fine until you wake in a hospital bed after passing out on your bathroom floor.

This thread from the Midwifery Today facebook thread was more useful in terms of offering a diversity of opinions, but worse in the multiple recommendations of Juice Plus (that's a trademarked product name) as a cure for preeclampsia.  Yes, from the "you've got to be kidding me" files, you can both participate in a multi-level marketing scheme AND cure preeclampsia.  In addition to JP, most supplement purveyors seem to have a number of expensive supplements to prevent and cure preeclampsia.

I wish there was a simple and natural cure for preeclampsia.  I'd love to be able to tell every woman who comes to this site desperate and scared that for only $44.50 a month she can buy a cure.  Instead I'm a adding a new rule to my rules for preeclampsia--never trust a health-care provider who seeks to involve you in a multi-level marketing scheme.  

Preeclampsia Links

Today someone found this blog while searching, "I'm not gay, I just really like rainbows."  Well, all the best to you my non-gay, rainbow loving friend.  Mostly people who come through searching are searching preeclampsia related topics.  Some of those searches are sad like the "when can I see my baby after mag sulfate." (Dear medical professionals, please seek to reunite mother and baby as soon as possible!)  Some sound suspiciously like med and nursing students searches: "what to check for before administering mag."  (Should you people be reading on PubMed and not here?)

From XOJane
"It happened to me: I had pre-eclampsia during pregnancy."
Straightforward discussion of one woman's experience with preeclampsia.  Worth a read.

From Midwife 1010
"Preeclampsia"
Okay information, except for the suggestion that dietary choices can prevent or slow preeclampsia.  I see too many women, particularly on natural birth boards, holding out hope that they can cure their preeclampsia with food or herbs as their condition deteriorates.

From Mamalicious in the City
"The Brewer's Diet: Have Some Steak with that Seizure"
This friend speaks my mind.

From BMJ
"Magnesium Sulfate and Preeclampsia"
What my non-medically-trained self got from this article is that mag sulfate works well to prevent seizures in women with preeclampsia, but as with so many medical treatments, it may be overused for women with mild preeclampsia in the US.  In England they use mag less frequently, and they don't have women seizing all over the place.  Mag sulfate sucks, and defensive medicine sucks, but seizures, stroke, potential injury and death would be worse, and the treatment itself isn't without risk.  I guess those are the hard choices of potential over-treatment.  (I hope you med students are paying attention!)

Preeclampsia Awareness: Preeclampsia and Denial

May is National Preeclampsia Awareness Month, yay!  I've already done posts on my personal experience with preeclampsia, so this time, in honor of Preeclampsia Awareness, I thought I'd write about "Preeclampsia: The Disease Nobody Wants to Have."

The Preeclampsia Foundation describes the symptoms of preeclampsia as follows:

No Symptoms
Hypertension
Proteinuria
Edema (Swelling)
Sudden Weight Gain
Nausea or Vomiting
Abdominal (stomach area) and/or Shoulder Pain
Lower back pain
Headache
Changes in Vision
Hyperreflexia

Racing pulse, mental confusion, heightened sense of anxiety, shortness of breath or chest pain, sense of impending doom

Some women have no symptoms, and others have atypical symptoms like liver pain that presents in an unusual place.  Women like myself always have an impending sense of doom, so a sense of impending doom isn't really helpful as a diagnostic clue.  All of these symptoms are also experienced by some women who go on to have uneventful pregnancies.

The ordinariness, vagueness, and inconsistencies of preeclampsia symptoms present a lot of problems for pregnant women and health care providers.  When my blood pressure first started rising around week 24, my providers took notice, but they also suspected because it was so early in my pregnancy that I likely had PIH rather than preeclampsia.  They told me to take it easy, eat calcium-rich foods, and monitor my blood pressure at home.  They also ran a pre-e blood work panel, which came back fine.  In retrospect, I think I received good care, but I wish that they had had me come in for an office blood pressure check once a week.  It was too easy to explain away my high BP readings at home (I had the cuff too tight, I just walked up the stairs), and when at 27 weeks, I had an in-office reading of 160/100 I had absolutely no idea that I was doing so poorly.

• I don't want to be a baby about it.  Looking back, my biggest symptom of pre-e was exhaustion, but I kept going.  I'd taken on extra work to build up our savings.  I did multiple weekend of work travel.  I don't think being crazy-busy caused preeclampsia, but I wished I had listened to my body more and rested more.  In the big scheme of things, none of that work stuff really mattered, but at the time, but I didn't want to be a baby and say "I can't do that because I'm pregnant and exhausted."  Note to self: don't lean in.
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• I'm healthy (thin, fit, eat a great diet, eat tons of protein, etc., so I can't have preeclampsia).  Being overweight is a risk factor for preeclampsia.  Many women, particularly in natural birth circles, extrapolate this fact to mean that thin women who eat a natural foods diet can't get preeclampsia, or that preeclampsia can be cured by eating certain healthy foods.  I am a thin, healthy woman, who ate a high-protein natural foods diet before and during pregnancy, and I got preeclampsia.  Any pregnant women can get preeclampsia and all the hard boiled eggs in the world won't change that fact.
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• I don't want to have to change my birth plan.  I did not want to have a c/s.  I did not want to have a medical birth.  Although I planned to birth in a hospital with midwives, I was terrified of the hospital.  And then I got very sick, and much like my worklife, my plans for the birth didn't matter as much as staying alive.  I consider myself very lucky to have been a baby friendly hospital where staff was used to working with women who wanted natural births.  If you are sick and have to change your original plans, do look for the best options in your area for providers and hospitals that respect women.  Don't deny/downplay/ignore your symptoms in hopes that you can stick with your original plan.
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• I don't want to be pushed into a c/section or induction.  As a patient you have the right to know your options and to receive factual evidence about those options.  You should not feel bullied or railroaded (another reason it is important to have a provider and hospital you trust).  There are doctors out there who might jump the gun too soon for minor symptoms of pre-e.  They might do this for understandable reasons-maybe their last preeclamptic case was a bad one, or for self-interested reasons-the classic combo of convenience and defensive medicine.  As patients it's not our job to manage all the complexities of pre-e, so you really, really need a qualified, ethical, and decent provider who will act with your best intentions at heart.  I did not have the birth I had wanted, but I always felt that my providers were acting in my best interest, and that made me feel better about the experience.
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• My doctor says I'm find and I don't want to be a whiner.  This wasn't my experience, but a significant number of women report being ignored or having their symptoms downplayed.  This story is a harrowing example with a happy ending.
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• That blood pressure reading was just a fluke.  Yeah, I said that a lot.  My retrospective advice: keep a log of your BP readings, ask to have an in-office reading at least once a week, and call your provider any time that your reading is over 150/90 (or whatever numbers they give you for your threshold).  Also call in and report any of the symptoms on the big list at the top of this post.  When in doubt, get checked out.
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• I feel fine.  Even though I was exhausted in the days before I ended up on hospital bed rest, I basically felt fine.  In the hospital, I basically felt fine.  I had no swelling, no headaches, just some bad heartburn.  I really don't like to think about how things might have gone, if I had trusted the way I felt rather than my blood pressure readings and blood work.  It was really only in the day before I had LB that I started to feel bad, and even then it was a non-specific bad, likely due to my rapidly dropping platelets.

I wish no one needed this post, and I wish that there were more resources for women with preeclampsia or possible preeclampsia.  The fact that this little blog gets so many hits from people searching for preeclampsia info suggests to me that there is still a dearth of information.  I'm wishing all of you safe passage this May.

Downton Abbey: Spoiler Edition

Be advised: this post contains Downton Abbey spoilers.



The internets are abuzz about Sunday's episode of Downton Abbey.  Opinion seems divided between "spoilers suck," and "preeclampsia-what the hell is that? and who knew it could kill you!"  For me and B, the episode was an upsetting (I think traumatic would be to strong here) walk down memory lane.

On the first issue, I think a world without spoilers is a lost dream.  On the second, I'm really glad to see so many people talking about preeclampsia.

The Preeclampsia Foundation Facebook page has some good links and comments from women who have had preeclampsia.  Unfortunately a good number of women still find that their health care provider does not take their initial symptoms seriously.  The swelling, headaches, rib or shoulder pain, vomiting, visual disturbances, blurred vision, tiredness, and feeling off  associated with preeclampsia can also be normal pregnancy symptoms.  However, as I've said before on this blog "when in doubt, get checked out!"  If you are having any symptoms of preeclampsia, your provider should take your blood pressure and screen your urine.  A 24 hour urine collection and a preeclampsia blood panel are also important diagnostic tools.

This article provides an interesting (but brief) overview of the history of preeclampsia treatment.

Some of my other posts about pre-e are linked below

My attempts to answer search engine questions about pre-e that brought people to this site are here.

My personal experience of having a baby on magnesium sulfate is here.

A basic overview of preeclampsia is here.

And my defense of scary birth stories is here.

Asked and Answered: Preeclampsia and Preemie Birth While on Magnesium Sulfate (with a little rant about why you shouldn't trust anyone who says that the Brewer's Diet will prevent or cure preeclampsia)!

Most of the search engine searches that bring people to this site are related to preeclampsia and giving birth on magnesium sulfate.  Below are a few of the search terms that have brought people here, and my responses (with the caveat that I have absolutely no medical training, and even if I did I wouldn't be giving people advice over the internets).  One good place to go for information about preeclampsia is the Preeclampsia Foundation site here, where they also have discussion forums where you can post questions.  The Preeclampsia and Related Conditions site here on BabyCenter can be a mixed bag in terms of advice, but it is generally a nice, supportive group of women. what does magnesium sulfate feel like I described my personal experience here.  Other women reported varied experiences.  Overall the first half hour tends to be rough, most people feel incredibly hot and incredibly nauseated.  How you feel after that initial dose of mag depends on how your body reacts, and probably whether or not you are receiving pain meds (I was given a lot of morphine, which was heavenly).  Common symptoms women report are muscle weakness, vision problems (because your eye muscles are so weak), balance problems, and mental confusion.  These issues should clear up really quickly once you go off the mag.
do you have to take magnesium for preeclampsia If you have severe preeclampsia, the answer is probably yes.  If you have mild or borderline preeclampsia maybe not.  If you have concerns about doing a mag delivery, definitely have a serious conversation with your provider and make sure your concerns are heard.  Your medical team should be able to give you a good explanation for why they think mag is necessary.  The reality is that you may not get the delivery you want, but you always have the right to be well informed.
feeling weak after mag sulfate It is totally normal to feel really weak while on mag sulfate.  Once you are off the mag, the effects should wear off pretty quickly.  If you are still feeling weak after you are no longer on mag it could be due to a number of factors:

Telling Scary Stories (About Childbirth)

The Navel Gazing Midwife posted this article on her Facebook page about the horrors of scary birth stories.  The reasoning in the articles goes something like: women tell pregnant women scary stories about childbirth, these scary births are likely due to over-medicalized birth, and talking about these scary births encourages women to seek over-medicalized births and to be emotionally unprepared for a good birth, which lead to a scary birth, therefore, women should stop telling other women scary birth stories.  The author also give the example of unspecified other cultures where women don't hear scary birth stories and have unmedicated and uncomplicated births.  Certainly this may be true for "other cultures," but Anglo American culture has a long history of fearing birth.  Just think back to 11th grade English and Anne Bradstreet's (1612-1672) poem "Before the Birth of One of Her Children."

Now I generally think women should refrain from saying shitty things to each other.  Examples of shitty things you can say to a pregnant women include: "you'll be screaming for that epidural," "only self-centered hippies want a natural childbirth," "doctors are butchers and hospitals are filthy," and "only a maniac would give birth in a tub full of jello."  If you want to have a conversation with a pregnant lady, you might instead say: "that's interesting, how did you decide on that plan?"  Or you could say, "Have you seen any good movies lately?  That new Adam Sandler flick Jack and Jill looks pretty awesome."

I also understand why some women don't want to hear scary stories while pregnant, and in that case it seems perfectly appropriate to say "Can I stop you, because I'm already nervous and you are freaking me right out."  Even though I was super nervous during my pregnancy and very scared of having a c-section, I still liked medically interesting birth stories (maybe that's why I developed pre-eclampsia).  Some birth training programs like Hypnobabies really encourage women to avoid negative birth stories. 

And if you could choose between a lovely, peaceful homebirth and surgical birth with various lives at risk, wouldn't you choose the former?  This is a really great birth story.  My story (mine, B's, and LB's) is not lovely in any traditional way.  It involves early and severe pre-e, hospital bedrest, ultrasounds, IV ports, magnesium sulfate, a surgical team, blood loss, and LB's infamous first photos that we refer to as the baby in a bag pictures (for heat retention-and her head was not in the bag).  Our story may not be a "good" birth story in the traditional sense, but for me (with memories softened by mag and morphine) it is a beautiful story because it brought us LB, and because even though B and I were both terrified we were very strong.

So does it hurt other women if I tell my story?  Should I not be allowed to participate in motherhood's ritual of swapping stories?  On the preemie message board that I read there are often women who feel desperately guilty and ashamed to have had a preemie, and as well, to have "failed" at natural birth.  I respect the emotions of those women, however, I don't understand.  Getting sick with pre-eclampsia was no more my fault than getting any other disease (although maybe if I got the flu after licking a subway railing I would blame myself).  I so desperately wanted LB to stay on the inside, and if I had been able to control my body through sheer force of will surely she would have been full term.  I really resent the implication that women have high risk births because of bad thinking or because they are duped by "The Man." [And of course there are dupers, but it my case the medical team including OB, nurses, and midwives wanted exactly what B and I wanted-for me and LB to live.]  Certainly there are mind/body connections that we don't fully understand, but I think any reasonable person would agree that telling a woman who shared her experience with breast cancer that she was A) harshing your mellow, and had B) brought it on her own self by being such a stress case, and C) maybe should take these herbs I read about online because western medicine will kill you, would be a total asshole move.

I am a woman and a mother, and I have a beautiful story to share about the birth of my daughter.

(If you had a scary birth, how do you tell your story?)

Preeclampsia Awareness: Giving Birth on Magnesium Sulfate

The short answer is "yes, it does suck."

If you have severe preeclampsia, you will probably need to be on magnesium sulfate while you have your baby and then for some time after the birth.  Magnesium sulfate prevents preeclampsia from becoming eclampsia (seizures).  You can have either a vaginal delivery or a c section on mag, but either way you will likely have a catheter and be confined to bed. "This is now a medical birth" was the phrase I heard a lot when I was in the hospital waiting to have LB.

I knew that mag would not be fun because the nurses looked really sorry for me when it was time to start the IV.  Usually patients on mag get a big dose at the beginning and then a smaller dose for up to 48hrs.  The big dose tends to be the worst part, and almost everyone feels very hot and vomits or dry heaves. My worst symptoms lasted about a half hour.  Mag also causes muscle weakness, which meant that I was burning hot, and dry heaving while lying flat on my back (Badger was there holding a basin).

I know that Baby Center can be a terrible place, but this thread in the group for people with preeclampsia has a nice roundup of women's experiences on mag.  At best, women report having very few symptoms, at worst they describe really vivid hallucinations.  Nurses warned me that I would probably feel hot and vomit, but they didn't talk about the weakness, confusion,  and visual problems that seem common with mag (or maybe they told me but I was too out of it to remember).

In my case, the best thing about mag (and the morphine cocktail I received) was that it made me feel very relaxed and unafraid.  I had been very frightened of having a c section, but as they wheeled me into the OR and did the spinal I felt very calm.  [I don't know what it's like to have a vaginal birth on mag.  It doesn't seem like it would be pleasant, but women on the internets report that they got through it just fine. If you are planning a vaginal birth on mag, you might want to check out the peanut ball.]

After having LB, I stayed on mag for about another 24 hours.  My most annoying issue was being unable to focus my eyes together and I ended up reading the Sunday Times with one eye closed so that I could focus.  About 12hrs after LB's birth, I was able to go up and see her in the NICU even though I was still on mag.  From hearing the stories of other women, I think it is unusual to be allowed to get out of bed so soon.  I had to have a L&D nurse with me the whole time, so perhaps staffing and liability issues limit early trips to the NICU?  If you know you are going to delivery on mag and your baby will be/might be going to the NICU, you should talk to your medical team about when you will be able to see your baby (and push them if it seems like it will be a long wait).

One final issue is bonding with your baby while you are still on mag.  Some women report that they felt an immediate bond, while others do not.  The first time I went to see LB, most of what I felt was fear.  LB was intubated (had a breathing tube) so we had to hold her very carefully.  She was handed over to me all bundled up and she looked so fragile and I felt very hot.  The lighting in the NICU was very weird and I felt like I was having an out of body experience.  At that moment, I really realized what a long road we had ahead, and I was so very afraid something terrible would happen to her.  A day or two later, when I really got to hold LB, I felt an overwhelming amount of peace and love, but not on that first night.  All that is to say, if you've given birth on mag, you've probably been worried about you baby and about your own health.  You probably did not have the birth you imagined.  You may be on a cocktail of drugs.  None of those factors help you have a blissed out early experience with your baby.  Many women who have been on mag, describe feeling emotionally distant or emotionally flat.  It's not a great feeling, but it's a normal feeling.  Give yourself a little time to recover from the birth and get off the mag.  Even if you don't feel bonded with your baby immediately, it can come with time (and it will feel just as amazing).

[And my advice for c-section recovery, take your pain meds.  If you are feeling significant pain you need more or different meds.  I found that Percocet made me feel terrible and didn't control my pain well, but Dilaudid worked great.  Also, use an abdominal binder during your recovery.  It makes it easier to move around sooner, which helps recovery.  I was given a big, industrial looking binder at the hospital, but you can also buy one through a medical supply store.]

My other preeclampsia awareness posts are  here and here.

Preeclampsia: You Might Get It, You Can't Cure It

It's Preeclampsia Awareness Month! Yay!  Before I got preeclampsia, I had no idea that there was such a month, and therein lies a serious problem with issue months-the only people who care are those who have already "been touched" by the disease.  But, in any case, this is my combination PSA and rant.

The Preeclampsia Foundation (a group of smart women with good information) tells us that the risk factors for preeclampsia are as follows:

Previous history of preeclampsia

Multiple gestation (i.e., pregnant with more than one baby)

History of chronic high blood pressure, diabetes, kidney disease or organ transplant

First pregnancy

Obesity, particularly with Body Mass Index (BMI) of 30 or greater. Calculate your BMI here.

Over 40 or under 18 years of age

Family history of preeclampsia (i.e., a mother, sister, grandmother or aunt had the disorder)

Polycystic ovarian syndrome

Lupus or other autoimmune disorders, including rheumatoid arthritis, sarcoidosis and multiple sclerosis

In-vitro fertilization

Sickle cell disease

Of these risk factors, I had exactly one: it was my first pregnancy.  I developed preeclampsia sometime between week 23 and 27, went into the hospital on bedrest at week 27, and then delivered at week 29 with a diagnosis of severe preeclampsia.

When I got the call to head to the hospital immediately, I was feeling fine-a little tired, but normal for the third trimester.  I had no headaches, no rib or shoulder pain, no swelling, and no visual disturbances.  My only symptoms were silent ones-blood pressure of 160/100 and elevated liver enzymes.

There are a variety of current theories about preeclampsia.  This article from the New Yorker "The Preeclampsia Puzzle" discusses some of the theories, as well as some of the problems involved in trying to conduct medical research about pregnant women.

What I took away from my experience with preeclampsia: 1) Generalized risk doesn't matter as much as  what actually happens to you.  In my case, knowing that I was statistically unlikely to develop preeclampsia made me less willing to acknowledge the seriousness of my rising blood pressure.  2) Keep a close eye on your blood pressure in pregnancy and don't be embarrassed to call your care provider if you feel off.  Many of the symptoms of preeclampsia are also normal pregnancy symptoms, but the good news is that the tests for preeclampsia (blood pressure checks, 24hr urine collection, and pre-e bloodwork) are relatively cheap, easy, and non-invasive.  When in doubt, get checked out!

And now the rant....

If you are a health food eating, healthy living, natural birthing type pregnant woman with signs of preeclampsia, you have probably come across online advice about nutritional therapy for preeclampsia. This advice comes in a few flavors, preeclampsia only happens to poor women who don't eat well (and we feel bad for them), you got preeclampsia because you ate white bread and fried chicken (and if you say you didn't you're a liar), and no one who follows the Brewer's diet will get preeclampsia.  Some natural birthers do disagree with these ideas, but dietary solutions to preeclampsia seem pretty widely accepted, particularly by those affiliated with the Bradley Method.

This advice is based on the research of Dr. Tom Brewer who experimented with nutritional therapy for malnourished pregnant women.  When his book came out in 1967 it was very poorly received.  But even the fact that the Brewer's diet is old hack research wouldn't necessarily lead me to dismiss it.  Sometimes you have the right solution at the wrong historical moment.  For example, the Ketogenic Diet was used to treat epilepsy in the 1920s, then it fell out of favor, and now it is back.  But those who promote the Ketogenic diet do not suggest that it can be used successfully for all people with epilepsy, and it is really the 100% cure absolutism of the Brewer's Diet folks that drives me crazy.  To me someone who says they have a 100% cure for preeclampsia is the same as someone who says they have a 100% cure for cancer-he or she is a person with some snake oil to sell you.

And really, if preeclampsia was all about nutrition, wouldn't having an eating disorder prior to or during pregnancy, or having hyperemesis be major risk factors for developing pre-e?

And below is a couple days of Mary's Diet to Promote Early and Severe Preeclampsia (from my pregnancy food diary).  Interestingly I ate a ton of calories, but gained very little weight.  I was also taking a prenatal, vitamin B, and fish oil with vitamin D.

Monday
B. hardboiled egg, 1 slice Ezekiel, 1 orange
S. hardboiled egg, almonds
L. hummus and cheese on Ezekiel, yogurt, carrots
S. steamed whole milk, almonds
D. meat and bean chili (homemade) on baked potato, sour cream, broccoli, melon, pint of whole milk, homemade ice cream
S. Cheerios with whole milk

Tuesday
B. oatmeal with whole milk
S. hardboiled egg, berries and melon
L. hummus and cheese on Ezekiel, orange, salad
S. hardboiled egg, cheese and wasabread
D. chicken, tomatoes, collard greens in homemade cream sauce on pasta, pint of whole milk, berries
S.Cheerios with whole milk

My other preeclampsia posts are here and here.