My First, Complicated Pregnancy was Unforgettable
I was thirty-four when I conceived my first child. We both wanted a baby, but the joy that I felt about being pregnant was quickly overwhelmed by my endless nausea and vomiting. I threw up every morning before work, usually able to keep down only Coca-Cola and peanut butter spread on saltine crackers. I threw up during daily rounds in the NICU because the phototherapy lights that we shined on the babies to treat their jaundice made me feel queasy. If my team and I walked past a bank of those special blue, fluorescent lights, I immediately felt sick and ran to a nearby trash can to vomit. My residents were often amused by this behavior, but I was determined to continue working through my rocky first trimester. My pregnancy proceeded along with unrelenting nausea and vomiting for twelve weeks.
My husband and I were both excited when the ultrasound at eighteen weeks gestation revealed we were having a boy. However, I found myself frightened during the amniocentesis procedure. Having observed amniocenteses performed many times, I felt confident that mine would be routine. During the procedure, though, I was truly anxious watching that large needle being stuck into me, and, like any other new mom, I worried that it might accidentally stick the baby. After my nausea resolved and the genetics test came back normal, we adjusted to the idea of having a son. Like most other pregnant women, I began to enjoy being pregnant and envisioned having a perfectly normal, healthy full-term baby. I remember being worried about catching some terrible germ from one of my NICU patients but realized that I was probably making up things to worry about. My husband kept telling me I was overthinking things.
Then at twenty-four weeks, I noticed twinges of pain low down low in my uterus, off and on in the afternoons. The pains were worse after a long or difficult day in the NICU, especially after standing to perform procedures. If I went home and put my feet up, the pains would usually subside. All my prenatal check-ups had been normal. After rounding in the NICU one morning, I was feeling particularly tired, and my pelvic pains were really hurting. I ran into my own obstetrician coming into the NICU. He took me by the hand and took me around the corner to L&D to examine me. I did not expect what happened next.
After finding that my cervix was dilated and I was in active preterm labor, he admitted me to the hospital. I was not prepared for that. No mother is ever prepared for the trauma of a pregnancy complication. All I could think about was having a tiny premature baby boy who would require NICU care for months on end. Of course, I imagined the worst-case scenario. I fully understood the long haul of intensive care that a tiny premature infant must endure for survival, and I dreaded the idea of watching my son go through this. Also, I feared the possibility of raising a disabled child. An artificial surfactant trial was being conducted in our NICU at that time. If enrolled in this trial, our son would have a fifty-fifty chance of receiving the life-saving surfactant treatment. That was a good thing.
My labor room was freezing, and my husband found me shivering with cold and fear that day. He asked the nurses to get me a blanket and a sedative. Then he went over to the NICU to see which neonatologist was on call, and who would be working with us if our son delivered prematurely during the night. He talked with the neonatologist on call and told him we did not want everything done if our son delivered early at twenty-five weeks gestation. (This was back in 1984 when survival statistics for extremely premature infants were not good.)
Unbelievably, the neo on call told my husband that he would do everything possible for our son if he was born that evening, even if we disagreed with his approach. He also said that he would only give the life-saving surfactant if the randomization sequence of his study indicated that selection, and that under no circumstances would he deviate from the study design. That I understood, but his not respecting our wishes, I did not. Now I was more bewildered than ever. My husband sought out other professional opinions while I fretted in my room.
In the dark and chilly labor suite, I lay crying, imagining the worst as I listened to my baby’s soft heartbeat on the uterine monitor. One of my older partners popped in to visit and caught me crying. He smiled and asked, “Susan, what are you so upset about?” I didn’t answer at first and felt somewhat baffled that he even asked. Did I need to justify my fears? Wasn’t I allowed some normal maternal tears? Of course, he tried to reassure me that everything would be alright, but I remained terribly frightened, and he stepped out to go find my husband.
In our personal encounter with possible preterm delivery, we got lucky, and all turned out well. My aggressive perinatologist — a high-risk obstetrician — expertly directed my care. Two powerful medications effectively stopped my premature labor, and I received antenatal steroids to mature my son’s lungs and brain. My obstetrician also prescribed valium for me, intermittently, since I felt trapped in a net of excessive worry. Of course, then I worried about the possible effects of valium on my unborn son.
After two days in L&D, once my preterm labor was deemed under control, they moved me to a room on the obstetrical floor. My private room was sunny and comfortable, but too close to the NICU. As a result, I received too many visitors during the day, and it became impossible to rest. So, the nurses taped signs on the door to keep visitors out. After a hospital stay of several weeks, I was permitted to go home. I discovered later that while I was in the hospital, all my peers, the other neonatologists and nurse practitioners, had a lottery running about my delivery date. They wagered on the date that I would deliver emergently during the night, and the loser would have to be my baby’s doctor!
At home, I was able to rest, read, and listen to soothing music. I imagined myself to be a large vessel, a pregnant uterus, whose purpose was one thing — to make this baby. I had never imagined myself to be something so simple and yet so complex. My husband cooked and brought meals to our upstairs bedroom. Surprisingly, it was not easy to lie around and do nothing all day. I remained on bed rest at home for several weeks. Our son was delivered at thirty-six weeks gestation, late one Friday night, only a month before my due date. He never needed artificial surfactant or NICU care, and he had a perfectly normal outcome.
The experience of being a patient myself, particularly a pregnant mother-patient, taught me a tremendous lesson. The degree of helplessness that you feel in that situation is difficult to describe. Your powerlessness seems inexorable if you are a trained and competent person used to getting things done or accustomed to solving problems. I had witnessed many irresponsible, unwed, teen mothers with little to no prenatal care give birth to perfectly healthy full-term babies, without even trying. Here I was an educated neonatologist, who had done everything right, and yet I could not carry a baby correctly to term. My feelings of inadequacy and vulnerability during that time were boundless. I felt like a big fat failure throughout most of my first pregnancy, and I was determined to make up for that by being a perfect mother.
Later, throughout my years of practice in neonatology, as I met and counseled other mothers anticipating a premature or complicated delivery, it was easy to empathize with them. I understood the feelings of fear and helplessness they endured through that most traumatic time. Over the years, I gladly shared my own story with mothers in preterm labor or premature rupture of membranes, as they lay in hospital beds, receiving various kinds of treatment, awaiting the birth of their own baby. When I recounted my story to them, many of them felt understood and grateful. Sometimes even the smallest sharing of feelings provided them with some comfort.
