High-risk pregnancy. Geriatric pregnancy. Advanced maternal age. Whatever you call it, I’ve been through it…twice. They say women in health care have a “curse”—meaning if you work as a health care provider, you are likely to have a complicated pregnancy. It’s probably a myth, but I put that superstition to the test and discovered that no two pregnancies are alike.
My husband and I married in 2005. By 2008, I had not achieved a pregnancy and was entering medical school. In 2010, still not pregnant, we sought professional help; I was 33 and my husband was 39. After unsuccessful trials of clomid and IUI, we were diagnosed with “unexplained infertility”. Numerous lab tests, semen analyses, and hysterosalpingograms revealed no cause. After the 3rd IUI failed, we decided to move forward with IVF. I diligently took all of my meds and injections, went through mood swings and bloating, but ultimately ended up with 3 precious embryos. Two of the embryos were implanted and we chose to save the third for a later pregnancy. Eleven days later I had a true positive pregnancy test. Ultrasounds showed two yolk sacs and heartbeats. I was due on Christmas Day and would be 35 by the time I delivered. We were thrilled!
I was released from my reproductive endocrinologist at 8 weeks of pregnancy to a regular OB with an appointment scheduled around 14 weeks. In that time, the first of many complications arose. I woke up to brisk bright-red bleeding and went to the ER. I was told I was having a miscarriage, but an ultrasound showed one strong heartbeat. Sadly, the other baby was gone. I met with my OB the following week, and the remaining heartbeat was still present.
In July, I started my clinical rotations in medical school starting with surgery. I worked long hours and was often dehydrated. At 22 weeks, my cervix was 2cm in length (a normal length being 4cm). Concerned for preterm labor, I was admitted to a high-risk unit, given magnesium and steroids, and monitored for preterm labor. I was discharged after a couple of days rehydrated and refreshed. One week later my cervix was 1.5 cm so a rescue cerclage was placed. I started bedrest at 23 weeks.
Frankly, bed rest sucks. I was used to moving around. I was bored, weak, and cranky because of my situation, but I endured it for the baby. At 33 weeks I felt awful and went to see my OB. I was puffier than usual and not thinking very clearly. My blood pressure in his office was 210/110, which earned me a direct trip to the hospital to get my blood pressure under control. Sure enough, I was spilling tons of protein from my kidneys into my urine and was diagnosed with severe preeclampsia that required an expeditious delivery of my preterm baby. On November 16, 2012, at 33w5d, my little peanut was delivered vaginally. He was perfect at 5lb 2oz. Once he was delivered, the effects of the preeclampsia were mostly gone. I was up walking around after the epidural wore off and felt so much better. My blood pressure never returned to normal, though, and I remained on blood pressure medication indefinitely.
After delivery, my son was whisked off to the NICU, and stayed for 3 weeks to learn to control his temperature, coordinate his suck/swallow and gain weight. Sadly, I wasn’t encouraged to breast feed while he was in the NICU, but I did pump my breast milk for him for about 6-8 weeks. Six months later I graduated from medical school.
Fast forward to December 2014. I missed my period. My cycle was always extremely predictable so when I was 2 days late, I took a pregnancy test. It was positive! I knew we had unprotected intercourse in the days surrounding ovulation, so it was definitely real, and the subsequent blood test and ultrasound proved it. My OB decided to continue my blood pressure medication and place a prophylactic cerclage at 13 weeks. At very appointment thereafter, my blood pressure and weight gain were normal. I opted for a blood test at 13 weeks that screens free fetal DNA in maternal blood for genetic disorders (I used Materniti21) and knew there was a normal genetic profile. We also found out we were having another boy!
During this time I was working long hours as a resident. Around 32 weeks my blood pressure started to creep into the 130s, but everything else was normal. My cervical length shortened to about 2.5cm, but remained in a safe window. At 36 weeks, though, I started having some sharp abdominal pains. I ended up going up to labor and delivery and found I was contracting somewhat and that I was quite dehydrated. After I was discharged home I decided to stop working. I made it another two weeks then I developed a persistent headache; blood pressure was 170/110. This time I was diagnosed with mild preeclampsia. I was sent over to the hospital for a term labor induction. Four hours after my induction started, I delivered my son vaginally. He was a perfect 7lb 4oz. No need for NICU this time! After delivery, my blood pressure was well-controlled without medication, and I was discharged home with baby after 2 days. I needed to start my blood pressure medication once I got home and now have a diagnosis of chronic hypertension.
Did I have the “health care curse”? Quite possibly, if you believe in curses! Having a complicated pregnancy over age 35 is physically and emotionally taxing. It was important to focus on getting through each day and to try not to stress over what might happen “tomorrow”. I advise any mother in this situation to try to preoccupy their mind with reading, projects, and anything that helps relieve the stress. Above all, though, do whatever is necessary to achieve a healthy pregnancy. Who knows what will happen next for me; our little embryo is waiting for possibly a third pregnancy!