When It Doesn't Go As Expected: Guest Post

     Not long after I finished my rotation in women's health, my friend Mallorie posted to Facebook about some of the things she went through during and after the birth of her daughter, Quinn. I won't spoil the story now since you will read it below, but as I read her words I couldn't help but realize that she was shedding light on yet more aspects of pregnancy and womanhood that are rarely shared or discussed, and it was obvious how her words touched those who read them. My initial thought was to ask Mallorie if I could reprint her story on this blog as a guest post, an addendum to some of my thoughts from my women's health rotation. The more I thought about it though, the more I realized just how many women I know who could share their own tales of how pregnancies and entering motherhood didn't quite go as they'd planned. I started to ask myself, why stop with Mallorie's story? Why not share them all? The short answer to that question is that there are too many stories to share and not enough space or time, but I still wanted to do something. As I was pondering how I could bring my ideas to reality, October began, and I was reminded that it is not only Breast cancer Awareness Month, but also National Pregnancy and Infant Loss Month in the U.S. It seemed a fitting time for my idea, so I contacted a few friends, compiled their stories, and post is the result, even though taking the time to get everything together means that it's no longer October.

     Before I get into my friends' stories, I'd like to take a brief moment to spotlight miscarriage, the most common form of pregnancy and infant loss, as it does not come up in the stories below. I have many friends I could've asked to to talk about their own experiences with miscarriages, but instead I'm going to simply link the stories of two women who have already written about their own experiences. One is from Jessica, a doula and friend of my family. She shares the story of the stillbirth of her daughter, Daphne Grace, at 34 weeks in The Beginning of a Life Long Journey. In her post, Hello, Goodbye, Jessica provides summaries of all four of her pregnancies (only two of which ended in live births), and explains what October means to her in light of her miscarriages. The other story is from Laura Benanti, an actress, who wrote about her own miscarriage, and the lack of public discussion about them, in her article My Experience With the Voldemort of Women's Health Issues. In the article, Benanti mentions the song Beyonce wrote after experiencing her own miscarriage, which you can listen to here: 

     And now, finally, the three stories that are the focus of this post. Each of these dear friends tells a true story from their lives that deals with a different difficulty of pregnancy and/or becoming a mother. I apologize that this post is a bit long, but I think these stories are too important not to share. I am so proud of these women and so grateful for their willingness to share some rather personal, and painful, experiences from their lives. I know that I have many more friends and relatives whose stories could have been included in this post (in fact, I came up with 15-20 names in just a few minutes of thinking), so if anyone reading this would like to share their own experiences of pregnancy and/or motherhood, let me know. I would certainly be interested in turning this into a recurring series. 

Mallorie & Davide

Photograph by: Helen Carmina Photography

      When I saw this photo to the right I couldn’t help but get teary eyed. This is my story. This sweet mama in this photo had a birth plan and it played out a different way. I had a home-birth planned….we bought all the supplies and even had the birthing pool at our house, but I also had a breech baby. After going to two separate chiropractors a couple days a week, for a couple months and going through an ECV (External Cephalic Version WITHOUT an epidural—never again) the baby still would not flip. After much prayer and discussion, Davide and I decided a cesarean was the best route for us, and one that brought us the most peace in all of what was going on. It was SO HARD to come to that conclusion because it was the last thing I wanted. I wanted so badly to labor for my baby and even just feel what a contraction felt like (call me crazy, I know), but God had different plans. Without the support of my midwife, doula, doctor, midwives, friends, and family, I would not be able to look back on this day and see it as a blessing. They supported me and gave me the best experience possible even though it was not on my birth plan.

     The interesting thing in all of this and that I find God teaching me as well… is to LOVE my body. I was so self-conscious of having a scar and what would my husband think of me after the scar, stretch marks, and saggy boobs. Society feeds us ALL DAY long with messages that suggest we are not worthy if we do not fit a certain mold, and I tell you what….there is something so empowering in getting caught up in what our bodies can actually do, rather than getting caught up in what the world tells us about our bodies. My body created a human being and is now also sustaining that little human being. ARE YOU KIDDING ME??? That. Is. INSANE. So many women would take all the scars, stretch marks, and saggy boobs in the world just to be able to carry a baby, and here we get caught up in the saddest body image struggles because society tells us otherwise. The human body is incredible and God does not make junk. He makes powerful beings and enables us to adapt and overcome the hardest struggles even when our body is physically failing and doing things we don’t want it to. He gives us the strength to see the bigger picture and to push forward in hope even when things don’t plan out as we think they should.

Photo Credit: Abigail Andrus

     And to continue in my soap box….I just want to say choose LIFE. There are so so so so many families who would LOVE to build their family through adoption. It is an incredible, selfless, and priceless gift that a mother goes through in choosing life and adoption. I’m also sharing a second photo just to show off how badass of a team I had supporting me the day of Quinn’s birth. They did every measure possible to help me in accepting what was happening while doing what was necessary. This is them putting her straight on my chest and leaving her there while I was getting stitched up. Also, I understand everyone has their own opinion, which they are entitled to; all I ask is that comments are not rude or hurtful and are kept respectful. Thank you!!

Lynnea & Donovan

     My whole life, well more like since I was 12, I couldn't wait to be a mother. I have always loved kids. I started babysitting since I was 14, and kids became a huge part of my life. Later my career path has led me to be a full time nanny for the past 6+ years, I have become accustomed to potty training, swift meal making, tooth pulling, bedtime telling, boo-boo kissing, and many more uncontainable joys of helping to raise children. Experiencing kids learning how to write their name, after countless hours of singing our ABCs, have brought much happiness! And there is nothing more enchanting then post-nap snuggles. It's safe to say, I love kids. Always have and always will.
     So my husband and I decided Christmas last year, we would officially "try" for a baby.  Figuring it would take a couple months to actually get pregnant, I was happy, I was finally ready to be a mother, and I dreamt about taking care of my own baby very soon, where I could be the one to kiss them goodnight AND goodmorning. Not to mention, I've had The Box, ever since I was 16. The Box, is a collection of baby possessions I have saved, found or have been passed along from other mothers, that I'd hoped would one day be a part of my baby's life. I have always expected I would have a baby.
     But, life almost never goes as we expect does it? After several months of trying to conceive. I knew something was wrong. And after countless doctor visits, tests, hormone therapies, and other expensive and uncomfortable procedures, I received the news that at this time it appears as if body won't be able to conceive. And they are not sure why. I have seen over three doctors, all coming to the same conclusion. My body appears as if everything should work fine, but it doesn't.     

     Pretty big news. And I could go on for pages and pages of what Donovan and I have talked/argued/prayed/cried about for the past month since we got that news. And how many hours I have wrestled with this news and how it honestly has shaken me to my core. But I won't. I will only say, that despite everything, I have felt an overwhelming sense of Gods peace throughout this entire journey. He has helped me realize, that often what we expect for our lives, is not what He has planned for us. But He promises that what He does have in store for us will be good. And I believe that with my whole heart. That no matter what I have always expected for my life, what God has prepared, is grander than anything we can comprehend. That's not saying there wont be heartache, for I have shed many tears these past weeks, but trusting God and His will, is beautiful. I also fully believe that I will be a parent someday, maybe not in the way I have always expected, but Donovan and I have always wanted to adopt. So we decided to forgo any expensive procedures of attempting to make my body try and conceive, and put that money into a adoption fund. I also believe God is a God of healing and miracles, and that maybe down the road, He could heal my body, and allow Donovan and I to get pregnant. But, I'm ok if that doesn't happen. Because I know that whatever happens in my life, if I remain trusting in Him and resting in His peace, my life will be filled with contentment. Because the one thing I know I can always expect is God is good. And He has an exquisite plan for my life.

Summary: Life doesn’t always go as we expect, but we can learn to ride the waves that come our way when we trust in God and take on this crazy and exhilarating life.

Margaret & Cesar

     My husband, Cesar, and I were married in November 2010. It wasn’t too long before we were expecting our first child, and on August 3, 2012 Noah Alexander came into the world. I had wanted to have a natural birth, but that plan went out the window when his heart rate started dropping. After the third drop, our doctor warned us that they’d need to perform an emergency C-section if his heart rate dropped again. I opted to have an epidural so I could be conscious for the birth, if it came to that, and it did. Despite the scare with his heart rate, he seemed fine, at least for the first 24 hours. By the next evening, while trying to do skin to skin, we could see that he was struggling to breathe. He had also developed a fever, and his platelets had dropped, so he was admitted to the NICU that night. Your hormones go crazy after a C-section, so I felt so sensitive, and I just kept crying. I felt like I was an electrical cord that had been severed and everything was out of whack. In short: I was a hot mess. It didn’t help that I was lacking sleep.

Noah's last feeding before being
discharged home.

     Eventually I was discharged from the hospital, but Noah had to stay. On the way home from the hospital my milk came in, so I had to figure out how to pump. A nurse friend had told me to pump as much as I could, but I wasn’t sure how long to pump for, and I didn’t have a feeding baby telling me when they were done. I just kept pumping because I didn’t know when to stop. In return, my body kept making milk. During those first days though, while I was busy figuring out pumping, my husband was at the hospital with Noah, keeping a close eye on our son and worried that there too many babies for each nurse in the NICU. Finally, after 4 days, Noah came home. 

     Noah had been home for 11 days when he started to become yellow and lethargic, and we noticed bruising between his belly button and scrotum. When we brought him to the ER, the doctors thought the bruising was just from a bump that we hadn’t noticed, and we returned home. The next day though, he started crying more. That night we started co-sleeping, which was amazing, but we realized in the morning that Noah hadn’t woken up during the night to feed. The urine in his diaper seemed concentrated and unusual, so we returned to the ER. He was hooked up to IVs and placed in a radiant warmer, before eventually returning to the NICU. This time though, Noah was given his own room with his own nurse because he was so sick. Cesar and I were given a private room so we could stay with him. Noah spent 2 weeks there. During that time, Noah had to be NPO and he couldn’t drink any of the milk I pumped, so soon we had quite the collection. We had milk at home, milk at the hospital, and then we had to borrow a friend’s refrigerator space for even more milk. It made me feel like a cow. We ended up donating much of it to the Mother’s Milk Bank in Colorado because I pumped more than 300 oz.

The only family photo of Cesar, Noah, and Margie

     Initially Noah was diagnosed with an infection contracted in the hospital during his first days, but despite treatment he wasn’t getting better. One doctor finally raised the possibility of Neonatal Hemochromatosis (NH), and wanted to investigate the possibility, but warned me not to look it up, because “it was kind of a sad diagnosis.” They’d already looked at Noah’s belly with an ultrasound, but it hadn’t been enough, so they did an MRI. Noah couldn’t hold his breath like you’re supposed to for the MRI, but despite the blurry images, iron deposits were clear all throughout his liver and into his pancreas. It was NH, a very rare condition that is basically liver failure in the womb, which causes iron deposits throughout the liver and sometimes other organs. Most babies with this condition don’t make it to birth, and those that do rarely live long afterward. The only known successful treatment is a liver transplant.

     Cesar wasn’t there when we got the MRI results so I called him, explained that it didn’t look good, and said I needed him there asap. That was Thursday. On Saturday Noah was flight-lifted to Seattle. Cesar flew in the propel airplane with Noah, and I arrived on Sunday with my mother in-law. We had the option to stay at the Ronald McDonald house, but we weren’t approved at first, so we stayed with friends until we could move in on Tuesday. Being there allowed us to be closer to the hospital and surrounded us with other families who were going through similar, and even harder, things with their children. Being there made it all a better experience. It wasn’t as scary as it could’ve been, and we had something to come home to. The volunteers put so much time and effort into caring for everyone. We didn’t even have to pay because the house only asked for a suggested donation of $30/night and our insurance covered it all. Despite the house and other families, it was a crazy time. I’m glad I got rid of the pictures from this time in Seattle because one of the hardest things was seeing how much Noah was hooked up. I have never seen so many lines of support as all the lines going into my son. I wish I could forget that image. We had brought lots of luggage with us and prepared for a long stay because we’d been told that it could take months to get Noah better, but in the end he was only there for 5 days. Noah passed away on September 7, just five weeks after he was born. 

Cesar and Margie in 2013

     When you lose a child, it haunts you for the rest of your life. I thought that the way I carried myself after he passed was it. But it wasn’t. The grief comes in waves. It comes and goes. Cesar and I briefly moved from Oregon to Hawaii to grieve. Noah had been conceived in Hawaii when we visited after our first anniversary, and it was almost like we had the chance at a fresh start. During our three months there, I became pregnant with another son. This time I went through 22 IVIG treatments starting at the 18th week of pregnancy to prevent NH, and just one year and eight days after Noah’s birth, his brother Micah Leonel was born via VBAC, healthy and whole. There were a lot of triggers about Noah at that time, and more in the months to follow. I am so glad that my mother was with me when another wave came when I was 6 months post-partum from Micah. For anyone else who goes through grief, know that you need to surround yourself with those who love you. It’s a big part of your healing. Reach out to the people who know you and love you well. You should know too, that moments of “set backs” are not bad things. They’re a part of the grieving process.

Cesar, Micah, and Margie in 2013
A daughter will be joining them in January 2016

     If you ask what I learned from everything that happened with Noah, I’d say that it didn’t feel like a lesson; it was more an experience we have had to grow from and share with others. We saw how much God was with us in it all, good and bad. Looking back now I wonder too why on earth I worried about the little things. Those were the least of my worries! As a new mother I was so worried about the little things, like if I’d have enough diapers and wipes. Little did I expect for my son to go. Cesar and I ended up having so much left over, and we just gave everything away to other expectant mothers. There were more important things to be concerned about. With that I’d like to advise new parents out there to do what you feel inclined to do. If it’s not to write the baby showers thank yous in the first few weeks, don’t do it. If it’s to just enjoy nap times, do that rather than worry about getting everything clean. Let your baby sleep with you, enjoy everything, rather than get caught up in little details. 

     To close I’d like to say that Noah lives on. I see him in his brother Micah, and I continue to tell his story. I hope that through it others can find healing for their own tragedies, remember to treasure their own loved ones, and see God’s work in us, even in times of grieving. 

     
Further Resources
     If you'd like to support or learn more about some groups mentioned in this post or who seek to help women and families all over the world, here are some links to get you started: 

Ronald McDonald House
Mother's Milk Bank
Hope Through Healing Hands
For further discussion of some of the body issues Mallorie raised at the end of her section, I recommend this post on We Seek Joy: Babies Ruin Bodies. To learn more about neonatal hemochromatosis, this article by Medscape is a pretty good summary. To learn more about what childbirth used to look like in the 1950s in the UK, and to hear how the medical world finally started giving attention to maternal health, I recommend the book Call the Midwife by Jennifer Worth. To learn more about how women around the world experience pregnancy, and how much more work still needs to be done in the area of maternal health and prenatal care, I recommend Half the Sky by Nicholas D. Kristof and Sheryl WuDunn. Just know that you might need tissues while you read. 

Further Thoughts on Women's Health

Sunshine in Lynch Park

     I started my June post remarking how surprising it felt that yet another month was over and that I was already in another rotation, and I could repeat those exact same thoughts now as July ends. Even though graduation next May still seems years away, the days have flown by ever since I started my clinical rotations. Since my last post I've completed my time in women's health, and I'm already done with two weeks in primary care. Leaving women's health was even more difficult than leaving my psych rotation, so before I move into full general medicine mode, I have some reflections from my time there. 

This has nothing to do with WH, I'm just
proud of my first batch of cold brew
that I made with my coffee sock.

     The first is that you learn to get over awkwardness in women's health. I'd say you get over it quickly, but that's not 100% true. There were still days toward the end of the rotation when it felt odd to ask a woman about her bathroom habits or if she had any discharge, not to mention all the times I said, "you're going to feel me touching you" or "do you have any irritation in the vagina?" Asking about a woman's sexual habits was pretty awkward at the beginning as well, especially if you started realizing those women were the same ages as some of your female relatives. That being said, my classmate and I needed to get over the awkwardness quickly. All these questions weren't asked just for kicks and giggles. They were necessary to get to the bottom of a diagnosis, determine if treatment was working, and figure out how a patient's issues were affecting their life. Plus, I quickly realized that the answers were not ones I could just guess or assume, especially when it came to sexual activity. A 50-year-old might look at me as if it was was crazy to imagine she might still be interested in sex, whereas a 79-year-old might answer "yes" so emphatically that it would seem crazy that I could think a woman might ever lose interest. There were a few women who asked why I needed to know, and at the beginning I might have wondered myself, but it was amazing how asking such simple questions could lead to important diagnostic information. I think of the women who'd given up sex because it had become painful or uncomfortable, but who had never mentioned it to a clinician because they were too embarrassed or because they thought nothing could be done, and then how elated they were when we could tell them that there was in fact a treatment for their interstitial cystitis, or vaginal atrophy, or pelvic organ prolapse, or whatever their particular problem was. It was pretty rewarding to be able to give someone back a part of their life. 

     The second reflection is a bit of a long one. It began with how we joked frequently during my rotation that being a woman sucks. Sometimes it was the playful joking of saying that women go through the awfulness of periods just so we can go through the agonizing pain of childbirth, or that once you hit menopause everything starts falling out (at least one kind of prolapse was found in 14-34% of women in the WHI study, and some studies think this is closer to 50%). At times though it was a rather dark sort of joking, especially when you looked at statistics. For example, 1 in 8 U.S. women will develop breast cancer in their lifetime. That sucks. Cancer of reproductive organs in general has the potential to be more deadly for women than for men because the reproductive organs of men are more easily examined, whereas the reproductive organs of females are primarily hidden inside the body. To often this means that symptoms of a cancer are not detected until the cancer has progressed and spread, a primary reason why ovarian cancer is the fifth leading cause of cancer death in women, even though only 1-3% of women will ever get ovarian cancer. Looking at younger females, 1 in 15 sexually active young women (ages 14-19) will have chlamydia at some point. This is can be quite tragic since chlamydia is most commonly asymptomatic in females (possibly as few as 5% have symptoms) so it's not treated, but left untreated chlamydia can lead to pelvic inflammatory disease (PID) in at least 10-15% of women. PID in turn can have drastic effects on a women's fertility: 1 in 8 women with a history of PID will have a hard time becoming pregnant, and the rates of infertility increase dramatically with each incidence of PID. For any woman who does become pregnant, she then faces the possible heartbreak of a miscarriage. Depending on which study you look at, miscarriages happen in 31% to 70% of pregnancies, though most of these occur early in a pregnancy, often before the woman even knows she's pregnant. Still, 15-20% of confirmed pregnancies end in a miscarriage, a rate much higher than many people realize, which can lead many women who miscarry to believe that the miscarriage was their fault or that they must suffer alone because they think no one else knows their pain. 

     The hardest statistics to look at are the ones where a woman's suffering is not related to purely medical causes, but to what other people do to her. For example, there's the disturbing statistic that the rate of abuse of women INCREASES during pregnancy. In the UK it's estimated that 30% of domestic abuses begins when a woman becomes pregnant, and in the US almost 1 in 6 pregnant women have been abused by their partner. The fact is that I need to be more concerned about screening pregnant patients for abuse than for preeclampsia or gestational diabetes because the rate of abuse for pregnant women is higher than the rate of both those conditions combined. That's absurd. Even if a woman is not abused during pregnancy, chances are she has already been abused in her life because studies show that 1 in 4 women in the US were sexually abused as children. While I may not have statistics for it, there also seems to be an alarming number of women being sterilized against their will. I saw 3 such patients over the course of 4 weeks. Three! That's a lot in such a short time frame. These weren't old women either; all three had been sterilized by force or without their knowledge within the last 5-20 years, so this is a current problem. While all 3 were from countries other than the U.S., this is not solely a foreign problem. California didn't pass a ban on forced sterilization of prisoners until last September, and that only after an investigation had revealed over 140 females patients were coercively sterilized between 2006 and 2010, at least 39 of those without legal consent. This doesn't just suck; it's horrifying. 

Shout-out to the woman who first introduced me to the
beauty and strength of being a woman: my mom

     I could leave this post right here. I could end with the conclusion that women have horrible lives due to their own anatomy and the injustices of society. I could do that, but I won't, mostly because I disagree with that as a universal statement, and also because that's just not the conclusion I got from my rotation in women's health. Over and over again I was presented with the sheer strength of women. Sometimes it was the forceful strength of the woman in labor, pushing with all her might. Sometimes it was the quiet strength of the woman who'd suffered in silence, simply plugging away with her life despite lasting discomfort. Sometimes it was the plucky strength of the older woman who'd wink while reminding me and my classmate that "it's a terrible thing to grow old." Sometimes it was the resilient strength of the woman who'd faced injustice after injustice and hadn't let it break her. I've never really used the term "girl power" (at least not seriously), but there was something about working with women every day that grew in you the feeling of sisterhood and camaraderie. Yes, sometimes my patients convinced me that women were completely crazy (especially during my first week), but they also convinced me that I could work in women's health and really enjoy it, even the parts that aren't all pregnancy and babies (though there is something simply magical about locating a fetal heartbeat on your own for the first time... and every time after). Is women's health where I'll end up? I don't know yet, but I'm so very grateful that I was able to spend 5 weeks there.
     And now as I close, some last few bullet point thoughts*:

1. KEGELS! No matter your age, women, you should be doing these. They might not be the most effective treatment once a problem like prolapse develops, but starting them early might help prevent some problems from developing in the first place.
2. Uteruses are overrated. They're good for growing babies but after that they're more of a nuisance.
3. If you are menopausal or postmenopausal, a local estrogen (either a ring or a cream) is something you might want to talk to your gynecologist about. 
4. Coconut oil has a surprising number of uses. 
5. If you're being abused, or you think someone you know might be, do not keep quiet. There are always ways out and always ways to help. Obviously this post was focused on women, but this point applies to anyone, male or female. Oh, and while we're at it, instead of just helping someone who is being abused, let's work on creating the kind of society where abuse is neither tolerated nor encouraged.
6. Don't rule out a male gynecologist. My preceptor was a man and he was one of the best doctors I've ever seen. My classmate and I both talked about how we want to be clinicians like him one day, and you could tell his patients loved him. Sure, some women admitted being nervous about seeing a male gynecologist, but it was well worth it for such excellent care.
7. On a similar note to the last point: Ladies, be nice to the male students. It's always going to be awkward to have a student in the room for these kind of examinations (and a few patients did turn away me and my female classmate), and it can seem even worse if the student is some young, attractive fellow, but if your clinician asks if you mind having a student in the room, please consider saying yes. The practical experience is invaluable and many of my male classmates have left their women's health rotations frustrated because no patients would let them see them. Just think about it.

Turtles know the proper way to enjoy sunshine.

     If you've made it all the way to the end of the post, congrats! It was a bit longer than my usual posts, and somewhat lacking in photos or catchy songs (I was unable to find a song that adequately conveyed the idea of "if you're a girl there's a good chance you'll face societal injustice, multiple forms of abuse, the pain of your own body working against you, and when you' go through menopause everything will go to pot and/or fall out, but it's ok because girls are awe-inspiring and amazing," so if anyone knows of one, let me know), but I had a lot to say after this rotation. Who knows what I'll have to say after my time in primary care. For now though, it's back to the books to review all the intricacies of diabetes, coronary artery disease, hypothyroidism, and basically everything else in medicine. Hopefully I'll emerge from my study cave to get at least a little vitamin D this weekend. :)

*I'm not a licensed or certified PA yet, so any medical advice is simply a suggestion. Talk to your own healthcare provider further if you have questions.