Tuesday, January 29, 2008

Does Anyone have a “Normal” Pregnancy Anymore??

I was talking to a friend the other night who was relaying her harrowing birth story to me, involving several days of hemorrhaging, inept doctor and nursing staff and various other incompetencies. She and her child were truly lucky to have survived the ordeal. As we were discussing this, it made us realize the many weak links in today’s medical environment as well as the high number of friends we know who have had difficulties in their pregnancies, myself included. Between the two of us, we know many people who have had premature deliveries, serious complications such as HELPP, complications from inductions, IUGR, as well as many other maladies. Luckily, all of the women we know survived and have healthy children, but it made us wonder. Are we just aware of more problems today and have a greater ability to diagnose them early due to ultrasounds, genetic testing, and other medical advances? Are we introducing too many medical interventions when they are not necessary? Are we having problems related to toxins in the environment? Older mothers? An inefficient and insurance-controlled health system that results in doctors spending too little time with their patients?

My son was born with a condition called Intrauterine Growth Restriction (IUGR), a condition where the fetus does not receive enough nutrients to grow at a normal rate. I became pregnant right before I turned 31. Throughout my pregnancy, everything appeared to be progressing normally and I was ecstatic about how relatively comfortable I felt throughout the pregnancy. I had a few issues, which in retrospect may have been pointing to complications; each symptom alone was nothing to worry about but when I review my symptoms in aggregate, I think they may have been pointing to a possible case of preeclampsia, which can cause IUGR. In the last trimester of my pregnancy, I started to have some minor symptoms. First, I would see floaters, or black spots, appearing periodically in my line of vision. I mentioned them to my OB, who stated that it was probably nothing but could be a sign of preeclampsia, but since I had no other symptoms and my blood pressure was in the normal range (although higher than my baseline BP), it was nothing to worry about. At a later visit, I mentioned that I was having some soreness on the right side of my abdomen, under my rib. I described it as feeling as if I had an organ that was aching. I received the same answer that I had received when I discussed the eye floaters. At another visit, I told her that I had been experiencing bad swelling, especially at the end of the day. My OB told me that was normal (unfortunately, all of my appointments were in the morning when my swelling was bad but not terrible; by the evenings, complete strangers would comment on how swollen my legs looked).

Also, during this time, my son’s heartbeat slowed down. For months, his heart rate would be at exactly 150 every time it was measured. Over the last several weeks of my pregnancy, it went to 140 and then down to 130. I questioned my OB about this since it had been consistently higher for months beforehand but she said that it was in the normal range and that the heart rate would naturally fluctuate. Now, I wonder if it was during this time that the placenta started to fail.

When I was about 34 weeks pregnant, my OB told me that I was measuring large and that she was going to schedule me for an ultrasound in a couple of weeks to make sure the baby was not growing too large. When I was went in for the ultrasound, at 36 ½ weeks, the technician told my husband and I that the baby was measuring where he should have been measuring at 33 weeks. When I asked her if he was ok, she told us that our OB would discuss that with us and then quickly gathered up the photos and left the room. Obviously, I started to panic at that point. My OB explained to us that our son was IUGR (they estimated him as weighing 4 pounds and 15 ounces during the ultrasound) and that the reason for the diminished growth was that the umbilical cord was not allowing enough nutrients to pass to him. She assured us that he would be fine but sent me straight over to the hospital for an induction; the fear was that if we waited, the placenta could fail to the point where our son could have died in utero. Apparently, my body was thinking the same thing since I was already having contractions every couple of minutes (I could not feel them) and I was 3 cm dilated when I arrived at the hospital, although I still got to experience the lovely experience that is pitocin. I was terrified but luckily everything worked out fine. Our son was born almost exactly twelve hours after we arrived at the hospital. He weighed 5 pounds 2 ounces and he was premature since he was under 37 weeks, but his lungs were fully developed and he was completely healthy. Our only complication was that he would not nurse, a big deal at the time but in retrospect, a very minor issue with which to deal. (I’ll have to tell you later about my very mixed feelings on nursing, pumping and the propaganda/guilt tracks you read…nursing is great but there are some situations where it just doesn’t work and you should not be made to feel as if you are going to kill your child by giving him formula!)

I am thankful everyday at how healthy my child was and is…he now weighs in at somewhere between 21 and 24 pounds (I’ll find out for certain in a couple of days when we have his ears rechecked). He’s a smart, active, wonderful little boy. In retrospect, I feel like I may have had preeclampsia but since each symptom presented itself at different times, the full picture never came together since my OB (whom I do still think is great) was really only focused on what was going on at each individual appointment versus looking at the trends during the pregnancy as a whole. I suppose we can blame the insurance companies for that…each OB appointment typically lasted about 5 minutes. I do not know if it could have been or should have been caught earlier; however I do know that next time, I’m going to be tracking things much more closely myself and I will be much more vocal and persistent about any concerns or problems that are occurring.

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