Part I: A birth story

This post series has been one year in the making. I never quite had the chance to write it, because—well, figuring out how to manage life with a newborn is one wild ride. The journey leading up to birth was pretty crazy, too.

Fair warning: I’m a scientist. I’m analytical. Therefore, I use scientific and medical terminology and I don’t stay away from the squeamish. If you’re sensitive to these things, be prepared for a blunt discussion of pregnancy and women’s health or move along.

As a first pregnancy, I was surprised at how “hands-off” things are early on. We found out we were pregnant around 5 weeks but I wasn’t actually seen in the clinic until I was 8 weeks along. It was so strange just waiting and knowing my body was going through drastic changes, though I felt no different.

At my 8 week appointment, I had a bunch of bloodwork done and they attempted to do a bedside ultrasound but they couldn’t detect the fetal heartbeat, which isn’t too concerning for that early of a gestational age. Luckily, they were able to squeeze me in for a transvaginal ultrasound to get a closer look. A few moments felt like forever until a little gummy bear-shaped figure appeared on the screen. Fetal heart motion detected! We had a healthy little fetus, hereafter named “Boop” (because my husband and I liken ourselves to robots—*beep boop beep*).

But that wasn’t all. There was a dark shadow that spanned across the left side of my uterus. I was diagnosed with a uterine fibroid, which is a benign, muscular tumor that can grow from the tissue lining of the uterus. They are fairly common in women and don’t typically become cancerous or increase risks of developing cancer [1]. In fact, most women don’t even realize they have them. I certainly had no idea. But based on the positioning of my fibroid at the time, the risks of complications during the pregnancy were low.

During pregnancy, women’s bodies adapt is through an increased blood supply which is integral to the process of growing a placental ecosystem and nourishing a new life. And when fibroids become enriched with blood, they grow.

My fibroid started out around the size of a lime. I did a bunch of research on PubMed and googled tons of images (not for the faint of heart), and based on their appearance I came to the conclusion that my fibroid was actually Krang from Teenage Mutant Ninja Turtles, trying to steal resources away from my precious Boop.

Then around 19 weeks into my pregnancy, I woke up one morning with a sudden sharp pain in my abdomen. Obviously, my biggest fear was miscarriage so I called my OB right away. Remember how I said fibroids grow from the increased blood supply?  Well, Krang was a greedy one, because he was getting bigger and outgrowing the blood supply. The scientific term for this is red degeneration [2]. As the fibroid grows larger, the lack of sufficient blood supply leads to necrosis, and the tissue essentially dies. In most cases, the fibroid will shrink back down in size as well. So, a week or so on pain medication, and I was back to normal, felt great, and anticipated smooth sailing into in my 2nd trimester.

Around 24 weeks, most pregnant women take a glucose test. During pregnancy, the placenta releases all kinds of hormones that influence the body’s ability for insulin to respond to glucose in the blood stream [3]. So in some cases, insulin resistance occurs and a woman can become a gestational diabetic. I was that woman. But it turned out this diagnosis was actually helpful in the long-term.

As a gestational diabetic, I had to be strict with what I ate and tested my blood sugars four times a day. As a detail-oriented scientist, I actually enjoyed logging all the numbers in a spreadsheet so I could show off my data at every OB appointment. But after a few weeks, my blood sugar levels were still too high, so I had to be put on a low dose of medication. And because of the risks of gestational diabetes on fetal development, I had get an ultrasound once a week, and  a fetal non-stress test (NST) twice a week. The NST monitors fetal activity via heart rate–it increases with movement before returning to a baseline (between 120-160 beats per minute) which indicates good oxygen flow to the fetus [4].  It was a scheduling nightmare, but we made it work.

Despite all of this, I felt really healthy and little Boop was growing nicely and loved to dance and kick around my belly. Things were going well and I was on track for a routine delivery with the potential for induction at 39 weeks (recommended for gestational diabetics who are medication-controlled to avoid the risk of the fetus growing too large or further complications from occurring).

At 36 weeks, my NST results were normal, but my ultrasound indicated that Boop was measuring small and hadn’t grown at an appropriate rate. It was also found that my fibroid Krang had continued to grow and was about the size of a bagel. Krang had also started moving toward my cervix, essentially blocking any possibility of Boop being able to drop down into my pelvis to prepare for delivery (also called “lightening”). This was concerning to my medical care team, and it suggested that Krang was essentially stealing nutrients so that Boop might not be getting what he/she needed. So it was decided that they would check one more ultrasound the following week and if there was no improvement, I would need to has a Caesarean section at 38 weeks.

I specifically asked the maternal-fetal med doctor if I could have a picture of the fibroid along with the usual photos we received. He thought it was a strange request, but obliged 🙂

Well, I had a C-section at 38 weeks. Being a scientifically-minded individual–and having a great OB team who kept me well informed–I was completely calm and ready for the surgery. As I was being rolled into the surgical suite, the nurses commented on how calm and collected I was, and I essentially just said “I’m a science nerd. This whole process is just so amazing!” I asked if they could use a clear curtain so that I could “watch” the delivery, but my OB wasn’t fully comfortable with that (probably because there was risks with my fibroid being in the way), so she requested an opaque curtain over the clear one so that they could drop it and we could see through the clear one right when the baby came out.

(I did kind of cheat and tried to watch the surgery through the reflection on the metal of the light fixtures above. Not going to lie, I saw a lot of red, and later my OB did tell me that I had a significant amount of bleeding that was hard to stop and was a bit concerning. But it all turned out just fine!)

My surgery was a success and Boop was born–A GIRL! 6lbs 2oz, 19 inches, a ton of cute. There were no post-op complications and the nurses all commented on how my incision was so clean, they could hardly tell I had a C-section (that changed over time as the scar formed). Basically, my OB was magical and made me feel great throughout my entire pregnancy through delivery.

“What happened to Krang?”, you might ask. A lot of people wonder if the fibroid was removed during the surgery. But Krang still exists inside of me to this day. Since fibroids are directly influenced by the increased blood supply during pregnancy, removal at the time of delivery could result in severe bleeding. And as mentioned previously, fibroids are essentially harmless, so leaving Krang in place was the best course of action. Krang’s future will be revisited if we decide to have any more children, but that is a topic that is shelved for the time being.

We stayed in the hospital for 4 days after our daughter was born (2-3 days is typical for C-section deliveries but we had the option of staying an extra day so we took it!), and we had great support from the nursing staff as we tried to navigate the first few days/nights with a newborn. More to come in PART II: A year in the life.

mom_and_baby

References:
[1] http://obgyn.ucla.edu/fibroids
[2] Lee HJ, Norwitz ER, Shaw J. Contemporary management of fibroids in pregnancy. Rev Obstet Gynecol. 2010 Winter;3(1):20-7.
[3] Desoye G, Hauguel-de Mouzon S. The human placenta in gestational diabetes mellitus. The insulin and cytokine network. Diabetes Care. 2007 Jul;30 Suppl 2:S120-6. doi: 10.2337/dc07-s203.
[4] http://americanpregnancy.org/prenatal-testing/non-stress-test/

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