Our Birth Story

I meant to get this posted near her birth! But the 4th trimester has been wild! … more on that another day. Alas, here we are, and it is finally time for a catch up! If you had been following along you know pregnancy was going well. (And I’ll share my 3rd trimester update eventually…) Due to my age we were candidates for induction at 39 weeks. My doctor and I had made this the tentative plan. I wasn’t super into a ‘birth plan’ per se, but I am type A and like to have some semblance of a strategy in place! But baby girl evidently did not feel this was a good plan… we discovered she was breech, and for a first pregnancy this would mean you cannot have a vaginal delivery due to safety reasons.  If she did not flip to the appropriate direction (ie: head down versus up), I would need a caesarean.  Spoiler alert: she stayed breech. Google “spinning babies” if you want a laugh thinking of me laying upside down while very, very pregnant in a feeble attempt to turn this strong-willed little lady.  We also tried an external cephalic version (ECV) where my doctor attempted to rotate by pushing on my belly.  Yes, it looks as barbaric as it sounds.  It was tolerable pain (nothing compared to what was to come…) but, sadly not successful. Baby girl was showing her stubborn streak. I blame her dad.

Speaking of the hubs… he had a work trip leaving 4 days before our planned induction/now possible c-section. The day before his departure his parents were flying in to stay with me while he was away and help once baby arrived. They were somewhere mid-flight when I went in for one last OB visit before he heads out of town. You know, just in case…

At the doctor I reported the standard late pregnancy symptoms of feeling tired and uncomfortable but overall, feeling well. I had been having mild intermittent belly tightening, and a few episodes of tightening that were more intense but random and rare, nothing too crazy to me or that would signify labor was near. My doctor checked me, and we found out those pains were actually contractions! I was dilated in early labor. The best laid plans, am I right? Since baby girl was breech, suddenly time was not on our side. If we waited I could further into labor and need an emergency c-section. Not ideal. Instead, we opted for a more controlled urgent one. This meant… we were having our baby that day. What! We left the doctor’s office at 10 am. Drove home. Francis got a potty break (of course) and I grabbed my hospital bag. (I almost took it to the doctor appointment that day but was thinking what a rookie move that would be… go figure!) We were back at the hospital and in the operating room by noon. We attempted one last ECV after my spinal (numbing me from the waist down for surgery) … but again she wasn’t willing to flip. 

There was such a mix of emotions this day. I felt like I had done everything the best I could during pregnancy and still ended up having a c-section which I really did not want. I was scared. I know too much medical stuff. But not enough at the same time, if that makes sense? The nurse with me saw my fear. While wheeling me back to the operating room she paused the bed and told me a story about my baby girl. She gave me breathing techniques and promised to stay with me throughout. And then we were on our way again. At this point it all happened so fast. There was a mirror overhead and I watched my doctor working. I remember squeezing my husband’s hand in pulses to focus on something other than the fear. I watched as baby girl arrived and heard her little cries. My fear now mixed with a whirlwind of other emotions. It was one of the most overwhelming moments in my life. As they brought her over and placed her on my chest, I knew nothing would ever be the same.  Welcome to the world Everette Hazel. You represent the hope and dream of your parents. And we can’t wait to get to know you.

Photo: Stephanie Honikel Photography

2nd Trimester Recap.

Ah, the second trimester. The time when you (usually) start to feel a little more normal. For me, this rang true. At about 14 weeks the fog finally started to clear. It wasn’t a quick process. I did not wake up one morning and say “whew I made it.” But over a few days to a few weeks, I noticed improvement. And wow after the first trimester it was great to break through. 

To start, my fatigue dissipated, and my daily nap was no longer required to survive the day. I also felt like getting back to my ‘normal’ foods again including salads and smoothies. Although, my craving for avocado toast certainly did remain… My motivation to exercise also improved, as did my ability to make it happen. This was a welcome gift! It felt great to finally be able to move my body to keep myself and baby healthy knowing how important it is to get regular exercise in pregnancy. (SEE my post here) I changed my walks to my usual jogging and I was able to get back to 2 miles at a comfortable pace.  I started to take longer hikes with my husband, but still could not keep up with him… I also restarted a strength program focusing on short full body circuits to get my muscles going again. 

With my overall renewed energy, I made it a priority to break some of my first trimester habits and remove the crutches I no longer needed. Sadly yes, this meant I said goodbye to my daily bagel and purse stash of crackers. Feeling better overall allowed me to eat and move better, and in doing so (you guessed it) that I felt even better making these healthy choices. 

The biggest surprise of this trimester was my crazy dreams and insomnia. Some nights I would wake up in a full panic over a dream. I also would wake up with full on tears streaming down my face over something that happened in the dream! This was so wild. The insomnia nights were equally crazy.  I could be wide awake for no reason until 3-4 am or fall asleep normally then wake up at 3 am ready for the day. There was no use fighting it. I had the urge to do something productive during these times, (3am laundry anyone?), but instead finished a book on my iPad. The night feels very long when you are awake! Something tells me I will learn this more after baby is here… maybe this was just preparation.

I had hoped my renewed sense of energy would mean more normalcy in my day-to-day life. Unfortunately, this trimester coincided with a peak in COVID-19 in our area. Given pregnancy is a high-risk condition, I continued my time staying safer at home. It was a huge bummer to think I was wasting some of my best days of the pregnancy stuck at home. The emotional toll of being pregnant during this pandemic is something I will write on another day. Bottom line, it is really sad, and I know I am not along in feeling that it has made this already crazy adventure very tough for pregnant women. I feel a lonely and fearful and grieve the ‘normal’ experiences I should be having like registry shopping and babymoons and baby showers. I know most importantly I am safe and healthy, but still sad for losing the first-time mom pregnancy experiences.  

Physically I started to have a very tiny bump and at 16.5 weeks felt my first flutters of movements. It honestly gave me butterflies.  Such a strange sensation! And although I don’t automatically feel attached to them in a ‘oh hi there’s a human in there’ sort of way, (I am way too practical for that) it definitely hits on the mystical magical spiritual process that is occurring on a deep level. 

Logistically we hit our regular appointments with our OB, had our anatomy scan and the glucose tolerance test. I added in a visit to the dentist for a much overdue cleaning- dental care is super important during pregnancy! Poor dental health can lead to worse outcomes including things like preterm labor. I started my registry- if anyone is interested in what I picked and what I passed on a future post could be devoted to that as well.  I read every website known to womankind as I prepared it, and often went down unnecessary hour-long rabbit holes to learn more about all the things… I guess that is how my Type A pregnancy brain + staying at home passed the time and rationalized what might be ahead in this grand adventure. 

Overall, this trimester has been pretty good. I hate to complain with any negatives as I know how lucky I am, but the reality is everyday still isn’t roses. I still did have days when fatigue would hit or dinner wasn’t happening due to my stomach discomfort. The fullness in my stomach has been one consistency throughout and it is still wild to me that so much more growth still has to happen.  I can’t decide if everything is flying by our creeping along… Even though I am a doctor somedays I just feel in the dark about what is going on with my body and realize my control is gone. Again, likely preparing me for the future with a baby, I guess!  Nothing to do but wait it out, stay as healthy as I can, and allow nature to do its magic.  

See you in the 3rd Trimester! Ah!

Orthopaedic Injuries of Pregnancy

It is no secret that pregnancy comes with a host of changes for your body. These changes allow you to accommodate making a new life but also can put you at risk for musculoskeletal issues along the way.  This is often because of some combination of loosening of ligaments due to hormones, changes in the center of gravity due to your new “bump”, added weight in general, and increases in overall body stress.

Most common Issues I see in practice:

#1 Injuries from a Fall:

As a specialist, I usually see a patient when they hurt something that needs further investigation.  Injuries happen to even the healthiest of pregnant patients.  One of the most common I see is an ankle sprain (see my full post here on all things ankle sprains) Pregnant patients often feel unbalanced.  A movement as simple as stepping off a curb awkwardly can lead to an ankle injury. The great news is the treatment for ankle sprains during pregnancy is very similar to the average patient, and most do very well without long term issues. 

Another common injury from a fall is a broken kneecap (patella).  Again, these tend to happen because of being a little off balance.  With a slip or fall, you can land directly on the knee causing the patella to break. This is painful! The injury is not usually subtle and makes it difficult to stand or walk.  X-rays will show us the problem, and sometimes the problem needs to have surgery to fix, but often you can get better with a period of resting your leg in a straight position. Though keeping your leg fully straight for weeks is not easy while pregnant… something I appreciate even more now that I am pregnant! But my patients have made it through, and you will too! 

Other broken bones can also happen during pregnancy from falls. The second most common fracture in my practice is a broken wrist. When you start to fall you naturally reach for the ground to brace yourself. Unfortunately with this motion, you can land on your outstretched hand break a bone in your wrist called the distal radius. Again, sometimes these need to be fixed with surgery. The ones that do not are treated in a cast for several weeks. Being in a wrist cast while pregnant also seems absolutely no fun, but it is achievable and safe.  Keep in mind these things can happen in pregnancy (just like outside of it), and orthopedic doctors are trained to do what is best to make sure your bones heal well, and your pregnancy stays safe. It is key to let your OB know if you have had a fall or are seeking care with another doctor. This allows us to all work together to be sure we are optimally treating you and keeping everything as pregnancy safe as possible.

#2 Aches and Pains

Ah yes, the joys of pregnancy…  Sometimes if feels like everything hurts whether you move or sit still! Joint pains, achy muscles, and stiffness all over are very common.  Muscle imbalance mixed with a growing belly often leads to a very common complaint, back pain.  It is estimated that 50-80% of patients experience back pain during pregnancy (2). Other super common areas of pain are the hips/pelvic girdle, knee, and neck. Most of this can again be attributed to the normal changes that occur during pregnancy, and keeping active throughout is the absolute best way to keep these issues at bay.  

#3 Wrist and Hand issues

Again attributed to the changes of pregnancy, wrist and hand pain is also very common. One specific condition that plagues pregnant patients is carpal tunnel syndrome.  This condition usually experienced as hand numbness and tingling in the thumb, index and middle fingers and has been estimated to occur in up to 62% of women who are pregnant (1). Great news, this most often resolves on its own after delivery. Until then, stretches and braces for the wrist usually help relieve the symptoms. 

How to stay safe:

First and foremost, listen to your body! The changes of pregnancy alter so much about your function and physiology. You should avoid risky activities where falling could occur, be careful on wet ground and ice, and always be extra vigilant of where you are walking. Stepping off a curb requires attention as does hurrying across a street or walking on a dirt road/path. Be careful! 

Another great tool is a daily body “check in” to see how you are feeling. Is your back tighter today? How do those hips feel? If you can catch an ache or pain early before it becomes severe, you can likely fix it faster. Add in stretches or targeted exercises for your problem areas, and keep moving throughout pregnancy.  Another tip is to remember to take a break if you are sitting for a prolonged period. This helps keep your body from becoming stiff.  It is important to avoid heavy lifting, and be sure you are using proper techniques to lift with your legs (not your back) to stave off further back pains and injuries.  Avoid reaching far away from your body as much as possible to keep your center of gravity stable.  Sadly, since your balance is a little off, retiring your high heels short term is the safest thing to do. 

As always on this website I preach an overall healthy, active lifestyle. In pregnancy this doesn’t change! If anything, it means more focus on these techniques to keep you fit as everything changes. Daily stretching, strengthening, and cardiovascular exercise help keep your body healthy and strong all pregnancy long. This helps you avoid injuries, keeps a better mind-body connection to avoid falls, and keeps aches and pains away.

Finally, what to do if you have pain or get hurt:

First, think about the severity (how bad is it?). If on your daily body check you noticed some general soreness and aches and pains, start with easy-to-do changes at home. Sit in a more proper position while working, remember to take standing breaks, and be sure you are getting proper exercise and stretching.  Always keep in mind your daily routine and that you may need to change something if your body is aggravated by these activities. Also, as always, talk to your OB! Bring up these concerns at appointments or even before if you feel they are significant.  Many small aches and pains are common and not a big deal, but you should always discuss with your doctor to be sure something further doesn’t need to be evaluated. Also know that even for general aches and pains, sometimes braces or other supports can be used to ease the discomfort.  Sometimes your doctor may recommend a pregnancy-safe medication such as Tylenol or even refer you to physical therapy to aid in your recovery.

If you have a larger amount of pain related muscle or joints or if you have had a sudden injury, an urgent/emergency evaluation is the way to go. You should also absolutely reach out to your OB as they can work with your orthopedic team to be sure you are optimally treated as a whole by coordinating specific recommendations based on pregnancy. If you need an X-ray, don’t panic. You can use a shield, and the doctor will do everything possible to keep you safe by only taking x-rays that are necessary to treat you properly. Trust your doctor, and ask questions along the way. I never feel bad when a pregnant patient asks about the necessity of a test or treatment. 

Sources:

1. https://pubmed.ncbi.nlm.nih.gov/19753825/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306025/

3. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

1st Trimester Recap

(secretly pregnant in these workout photos… just another day in the life!)

When my now husband and I first started seriously dating we had a talk over a diner breakfast one lazy Sunday morning that went something like, “hey I like you, this is going well and to get the life we both want we need to move quickly…” From engaged to married to expecting all during a crazy pandemic year that tipped everything sideways… I believe that is the definition of moving quickly! 2020 was the best and most insane year of my life. 

In August 2020 we pivoted away from our dream wedding and celebrated with an intimate micro-wedding that turned out more perfect than I could have hoped (still working on sharing those photos…)  Around this time we decided to let what would happen in the baby making department, well happen. Being 37 years old gave me doubts that this it be an easy road. To that end, my sincerest love to anyone struggling with infertility. I have a personal story to share another day that makes me extremely sensitive to this and the emotions of saying we were open to trying was enough to bring me to tears. After some soul searching I choose to focus on the word ‘surrender’ knowing none of what might happen was in my control.  People ask if we were trying and I have debated if that is TMI?… but if sharing helps anyone then it needs to be done. Making babies isn’t always as easy as they teach in high school!  There is a small window in a woman’s cycle when babies can happen called ovulation. This time varies for each woman and most don’t actually know exactly when this is. I wanted to approach this little journey as much like a doctor as possible. This meant using a basic drug store ovulation kit.  When the little guy flashes a smiley face that is go time. It doesn’t always work like magic but can be very helpful to learn your cycles and for us, that was it.

How did I find out? In a word, I KNEW. I am super aware of my body. There was something the tiniest bit off. Slight belly discomfort, a minuscule amount of something not even considered nausea but something. I took a very early test and voila – positive. I didn’t get too excited, knowing early tests aren’t always the outcome, but sure enough!!  I had an immediate mix of emotions from excitement to gratitude to fear to wow this is so weird! I was shocked. So shocked that even though I know some women take time to figure out a cute way to tell their husband… I instead choose to blurt it out on the next phone call.  I knew I needed his support immediately.

Everything that followed was new.  I kept telling every doctor how weird it was. I had treated many pregnant women before, but never imagined what it actually felt like to be pregnant. I also never realized how isolating it can be. It is crazy that in the time when hormones are all over the place and this huge life change is on the horizon there is taboo in telling others. There is something to be said for privacy if you choose, but this taught me it is important for everyone to tell as much or as little as they want whenever they decide to do it.

What I felt:

Tired. So tired. In weeks 3-13 I slept more than ever in my life. I am NOT a napper, but this fatigue was no joke.  I would sleep on the couch 2-3 hours in addition to going to bed early. And by early I mean at 8pm I was under the covers. I felt guilty but didn’t have a choice.  My body needed rest. Lucky for me my husband was super supportive and kept encouraging me to listen to my body. When he asked what I did that day and I said I ate a bagel and napped, I swear he said awesome great job.

Digestion changes. Many women have severe nausea or vomiting way worse than I.  But for me this was still terrible.  I was nauseous and my digestion slowed down like crazzzzy.  There was a 2 month period where dinner wasn’t something I could eat.  I would start the day with a little breakfast, do okay at lunch and at dinner couldn’t eat without being nauseous, overly full and very uncomfortable. In general carbs were my friend and a fancy dinner became saltines and a slice of cheese at 4pm.  Not wanting to fall totally off the healthy food train I tried my best to sneak in salad and protein when able. I loved eggs and avocados so much this kid is half avocado toast.

Body changes. Despite no actual bump my lower stomach became super sensitive very early. I couldn’t tolerate any seam across my belly.  Pants felt strange and uncomfortable. One of the silver linings of staying home during COVID was there was rare instance I actually needed to wear anything other than cozy sweatpants.  And then there are the boobs. People say they get bigger… and that is no lie.  Everything on the front half of my body felt swollen and hard to recognize. Contrary to most women instead of super luscious hair and nails, mine fell out and were brittle to the point of asking my doctor, but it was nothing of concern.

The usual suspects. Peeing all the time, sensitivity to odors, cramping legs at night and bleeding gums are super common issues and I experienced them all. 

Things that helped:

Listening to my body. It felt like the day after you have a bad flu… but for the whole trimester. Naps were on repeat. It was hard to feel so lazy but I didn’t have a choice. Hormones and the body changing rapidly, as well as growing an entire new organ (the placenta) means required rest.

Trying to make healthy food choices as much as my body allowed- although I ate more bagels than in years, I gave myself grace.  This wasn’t a free pass to follow every craving.  I was very aware it was easy to say I craved pizza… when honestly when do I not crave pizza? I also kept in mind the nutritional needs for this tiny addition are in fact tiny. If I could stomach a few pieces of broccoli those nutrients were enough!

Exercising as I could. I wanted to try to keep something from my normal routine even if it had to be very limited.  I prioritized daily walks to feel better physically and mentally. I went on slow bike rides while my husband ran alongside (running was out of the question with that weird stomach sensation). I stretched nightly to try to help with leg cramps. 

Hydrating. Normally I am terrible at drinking water. It is a job hazard. Seeing patients all day means no time to stop to drink or use the bathroom. But after I made hydration a priority – 80+ oz per day, tracking it on free app on my phone – I noticed a huge improvement.  I was worried about going to the bathroom a million times per day. But my sister in law said it best reminding me I was doing that already- at least this way I was hydrated. And it actually made bathroom trips better because I needed to go as opposed to just having the sensation. 

Preparing. Carry the big purse at all times. Trust me. I had citrus fruit, sparkling water, pretzels, crackers, and plain bread on hand anywhere I went. I’m not sure anything really helps during this phase, but having something to try gave me the sense of control I desperately desired.

Onto the next trimester…