Wednesday, September 17, 2014

Our High Risk Pregnancy 2003- 2004

I wrote this many years ago.  For some reason I thought about adding it to my blog.  It's about where I've come from after all.

Our high risk pregnancy


Timothy Coral Mair

When the test for pregnancy done in the summer of 2003 came back positive for our fourth child, we were excited.  As the pregnancy went on we became more and more aware that things were different.  Tina didn't seem to have many problems with morning sickness this time and we’re not really sure that was an indication of what was to come.  The doctor we were going to also was new for us because we had  the understanding that the OB that delivered our first three didn't have rights at Davis hospital where my wife now worked and we had to deliver for our insurance there.  The doctor was concerned about Tina’s Spotting even though Tina had had some spotting with the other three before.  At the 12 week ultrasound things became more and more troubling because of the lack of growth of our little fetus.  He was at least two weeks behind schedule for growth and it made things more uneasy.  There also appeared to be a small pool of blood in the ultrasound and the OB believed it to be in between the placenta and the uterine wall indicative of a small abruption.  It was a wait and see thing said the Doctor because it could get worse.  

We continued on for a month or two with regular appointments.  My wife worked, I took care of the kids.  One day I took them to visit my parents and shortly after my wife and I noticed our youngest (Michael) could not be fully roused.  This concerned us enough that we took him to an urgent all night pediatrics clinic and they were concerned as well and he was admitted to the emergency room.  After lots of tests and lots of worrying and waiting all night the blood tests showed that Michael had Opiates in his bloodstream.  I called my Father because we had been there and I knew he was on many medications I wondered if one of his might have fallen on the floor and Michael had ingested it.  My dad said that he had spilled his morphine and that he and mother had cleaned them up but they had not counted them so it was possible that one might have been missed.  They were the fast dissolving kind and after hearing the dose my father was on the Doctor at the hospital was concerned that if Michael had actually gotten the entire dose it could have been even more serious.  

As with all cases like this a case worker met us at home shortly after we got back from the hospital.  (Possibly as short as 30 minutes after) She looked at the home and interviewed us.  This lady had a son that had been friends with my younger brother and this helped us because she knew the type of kids we were and the type of parents my folks were.  She did interview my parents and we never did have to hear anything else from DCFS so the case was dropped but it was stressful.  

Sometime there after maybe a day or two my wife had some more spotting and went into to see her Doctor again. The Doctor ordered another ultrasound and felt that the pool of blood on the placenta had enlarged and put Tina on one week bed rest.  This put a small strain on our finances because my wife worked and still does work full time at the a regular hospital but works per diem at a long term hospital and receives a higher wage in exchange for no benefits since her work schedule there can change so much.  

We made it through with not too many problems and it didn't kill our Christmas fund but it did hurt it a bit.  It ate into our food reserves a little too and I as the home maker was trying to build that up from month to month so that we would have extra for my wife’s Maternity leave when I knew things would be tight once more.  

My wife was seen shortly after her bed rest for an ultrasound and a week later to see the OB again.  The OB still felt that the pool of blood was getting bigger and the baby just was crawling forward on growth almost a month behind now.  She told us that Tina would have to go on bed rest for the rest of the pregnancy and lay on her left side as much of the time as possible.  This was devastating news to us my wife was the bread winner and I had no job.  I spent all of my time taking care of the kids and cleaning and cooking and trying to make sure my wife wasn't disturbed while she slept because she worked nights.  I even felt I was pretty good at it too after doing for 2 and a half years by that time.  Tina was a nurse and made much more than I could my skills were as a musician though I did have a CNA license.  My wife asked her boss at Davis Hospital if she would hire me as a CNA if this really had to happen.  She said she would but I would have to work more than 90 hours a week just to make sure we could pay the bills until my wife’s disability benefits from work kicked in after which I would still have to work at least 60 hours a week at a CNA’s wages.  There was no way anyone would give me that many hours at one job and it would be difficult to get two since I had been out of the workforce completely for almost a year and had been only part-time before that and I must admit I suffered the same problems many stay at home moms have if my kids were sick I didn't always have babysitters who could take them for an evening shift so my work history did not look that great for that reason as well. 

  And even though neither of us would admit it out loud to anyone because it seemed selfish to put such trivial things before the well-being of our little unborn child, it was not quite two weeks into December and we were concerned about how this would affect Christmas for our other children.  We decided that if this was what had to be done then we would have to try and make it work but we wanted to be sure.  

We knew our old Doctor didn't deliver at Davis but he knew Tina’s history better and he was well known for his care of High-risk Pregnancies.  He did Ultrasounds every visit and we didn't know then but he had Doppler technology in his office to check placental blood flow and this was something that was catching on but right then could only be done at the hospital besides his office.  We scheduled a hasty appointment and they fit us in quickly.  We signed release of records forms.  Doctor Jed Naisbitt talked to us about what had been going on and was even a bit confused about why we had waited so long in the pregnancy to see him thinking my Nurse wife had gotten no care at all and should have known better.  We said we had been seeing Dr. Durbin because his office told us that he did not deliver at Davis.  He said that he didn't "as a rule deliver there" but he did have rights to do so and he sometimes made exceptions for people who were already patients of his and had had insurance changes.  He also said that Davis’s fees for private pay were usually cheaper as well and so he often Delivered there for patients with no insurance.  

This made us feel a little better about things.  He checked Tina out and checked the records from the other Doctor as well as the Ultrasound reports and pictures from earlier in the pregnancy.  He realized he would need one of the machines that did the Doppler and so we were moved into a Exam room with a newer Doppler equipped ultrasound machine.  He looked at the placenta and the pool of blood and looked at the Doppler readings.  He said he felt that this particular pool of blood didn't look to be under the placenta but on one of the outside walls, possibly from placenta previa.  He talked to us about our concerns and what the other Doctor told us was our ONLY option.  He said he did believe in bed rest as a treatment plan but wasn't sure if it was necessarily right in our case.  He said that left side bed rest was theoretically a sound idea that that position could increase blood flow to the fetus but the studies about it were inconclusive.  He felt that blood thinners though also inconclusive in some studies might be better, at least they seemed to be in his experience.  He decided to try baby aspirins once a day (as a side note he suggested I, the father, talk to my doctor about this as well since I was over 30 and over weight and had a history of heart problems in my family this type of anecdotal comment often made by this particular physician made us feel more at ease like he was looking at our whole situation) and saw her again in a week.  He also thought that my wife would do better with this therapy if she stayed active.  

After a week the baby’s growth changed for the better he was moving forward at a more normal rate even though he was still way behind.  The doctor felt like the baby aspirin was still the best option but did not rule out the need for possible bed rest and or heparin in the future.  He also told us to be ready because things could change on a dime for our pregnancy and though our goal was to make it to 34 weeks at least, that an earlier delivery might be required.  Though we were stressed and going in every week and a half approximately, our Christmas was fairly normal and a happy one.  We even nearly became complacent.  

On January 7th, 2004 we went in for our regular appointment and after looking at the blood flow volume through the placenta with the Doppler, Dr. Naisbitt suddenly became urgent in his speech towards us, usually a jovial funny guy (as funny as anyone who does pap smears can be) he now was very concerned and though he spoke in a calm manner and tried not to be visibly agitated there was a tension in his manner. He asked a colleague to come in and look at what he had seen and conferred with him after asking us if it was ok to bring the colleague in for a consult.  They were concerned that the blood flow had changed so dramatically in such a short time.  Dr. Naisbitt said that though Doppler studies were new and the full impact of their use was still to be discovered that they were able to indicate problems inside with the placenta and a change this drastic often led to still births within weeks if left to mother nature.  He said he wanted to get steroid shots into Tina that would help the baby develop a little faster and that they had to be given at the hospital and she needed to be monitored for reactions and for fetal distress after being given them.  

We called someone to watch our other children, Tina called her work and indicated that things were going poorly and that she would not be able to work for the time being unless there was a miraculous change in the Doppler readings. We went up and got the first of two shots that had to be administered 24 hours apart.  After being monitored after the first shot Tina was sent home and we woke up the next morning to go to another OB appointment because the Doctor now wanted us in his office daily.  The Doctors looked at the results of the readings again and things looked better.  

We were temporarily excited and were told that improvements in placenta function often happened after the steroid treatment but it was still good because before the “steroid holiday” (as the Doctors called it) wore off the baby would have that much more time in the womb to get ready to come out.  Tina and I went to the hospital again for the second shot that evening.  

We saw our children less this day than the day before. Because Tina also had a non stress test before leaving her Ob’s office.  

We went back in the next day (Friday the ninth) for more Doppler ultrasounds and another stress test and her Doctor told us that we were to come back on Saturday to be seen by his colleague who he had conferred with previously because he would be out of town from Friday evening to Sunday Morning.  But that unless she had to be delivered on Saturday we were to call his answering service Sunday after 4:00 PM and tell them to page him.  He might not even be all the way home yet he said because flights in winter often were delayed and he might still be driving home from the airport but he would call us back and we would meet at his office for more tests and possibly have to go back up to the hospital for a stress test to see how the fetus would handle labor.  

Saturday things looked OK so on Sunday we waited and worried until it was time to page the Doctor.  After calling us back we met shortly thereafter at his office which seemed so creepy without tons of ladies and midwives and doctors and nurses running around.  It was quiet and ominous.  

He looked at the Doppler and felt that the blood flow might have gone down slightly but that we still were in the “Steroid Holiday” and that after a simple stress test at the hospital to check how the baby was doing and how he could handle the stress of labor we would go home and we might have a few more days maybe even a week.  Tina and I went in and they started the pitosin (not sure of the spelling on that) and watched how the baby did on the monitors during each contraction.  The nurse was very good about keeping her concerns from coming out too much when she talked about his heart rate and how he was doing but called the Doctor sometime after full dark to tell him that she was concerned and give him the results and see if he wanted to come in to check her or deliver her.

During that call I was on the phone with family trying to work things out with kids and tell everyone what was going on and Tina called me over cause something was wrong.  As I hung up the phone I saw blood coming out from under her hospital gown and I ran to get the nurse.  She was still on the phone with the Doctor and had convinced him that he should be there and was hanging up as I came to find her.  She rushed in and told me that my wife’s placenta had abrupted and that she would have to be delivered by caesarean section very soon and that the Doctor was already on the way.  She was Prepped for surgery and another Doctor who was already in the Hospital was called to assist.  Shortly after Dr. Naisbitt arrived she was brought in for the C-section and during the time between the abruption and then we had seen so many people (including the peri-natologist) that I can hardly remember who all we talked to.  The baby was born quickly and even cried on his own when he came out.  He was so tiny he weighed very little.  I used to remember his weight by heart but now over two years later I can hardly recall especially considering all that happened after that. 

Little Matthew started life in the big world on January 11th 2004 but saw very little of it.  His world was the NICU at Davis Hospital for 2 months then University of Utah Medical Center NICU for 1 and a half months and Finally Primary Children’s Medical Center for 2 and a half months.  He had many treatments. Many successes and in the end many more setbacks.  He received lots of blood.  I gave blood because he, my wife and all our kids are O-  but during the donation my blood clotted so badly it was unusable.  He had lung problems and problems with his heart and developed retinopathy in his eyes.  

When he had heart surgery at Primary Children’s his retinopathy still wasn't responding properly to treatments done prior and they had to choose to wait til he recovered from heart surgery to try anything else.  He never truly did and by the time he would have been well enough to look at for surgery he was already blind.  He developed problems with lymphatic system putting fluid around his lungs.  He also had something happen to the white matter in his brain during this time and was experience uncoordinated jerky motions.  

After so many things had been tried and did not work and my wife and I could see that he was getting worse and worse we told the doctors that we wanted to take him home for whatever time he had left with us.  He deserved to see more of the world than the hospital and to have people who loved him hold him as he slipped away.  

We had him home for less than a week before he finally succumbed.  Our kids had seen him only briefly during his time in the hospital.  They were angels about helping us with him while he was at home and each in their own way seemed to understand what was happening.  I felt I had neglected them a lot during the months before trying to see Matthew and hold him and talk to him and sing to him every chance I could.  It was my responsibility to be there the most since I was the care-giver in the home and my wife the bread winner.  

It hurt her to not be able to go as often as I did.  I tried to hold all of my pain in and be strong for her and wore myself out trying to maintain home and complete things that I had promised to do that spring and summer.  I eventually cracked though I was very near the depression I had dealt with years before when I had suicidal thoughts.  My wife almost had to get mad at me to make me let it out and cry and I sobbed like a baby in her arms one day. 

I was angry too often and I still feel terrible because I know my kids saw me as a mean dad a lot that year.  After one incident when they threw my newly folded laundry around our front room instead of getting their shoes on like I had told them, I lost control and threw laundry around, too angrily though.  I grabbed one of their shoes by mistake in one of those handfuls and our front window still tells the tale of that mistake.   After the window broke my kids cried and I cried and I apologized but had a hard time looking at them I felt so low about what I had done.  They were scared that Daddy had broken a window.  

My wife and I learned just how many people cared about us. And we developed many coping skills that we wouldn't have if this had not happened.  Our finances were a wreck and we had never been good at them before but we often neglected even looking at them unless there was an emergency.  We got behind on many things and after had to make many special arrangements.  Our credit still haunts us from then and we still keep finding things that were missed.  But since that time I have been very careful about our budget and we have both come up with a system that works.  

I wouldn't trade one minute that we had with Matthew for anything and I know I grew as a husband, father and person but I was very scared to have another.  I could see terrible outcomes in my mind’s eye and often worried that my wife would fall victim to something terrible. 

It was with great trepidation and the strength I draw from my religious faith that my wife and I decided to try once more.  We watched her cycle every month and she began taking baby aspirins after the normal time for ovulation occurred.  

This summer we discovered that we were pregnant again and went just days after the positive test to the OB to get his recommendations.  He put her on Heparin to thin her blood because there had been clots in the placenta with Matthew and though it was hard to tell if the clots caused the problems or were symptoms of whatever had happened to Matthew and his placenta he thought is was a wise precaution because Tina’s father had had some problems with blood clots.  

We are excited about this baby but I still get nervous.  I love my children ALL of them.  I love my wife and want only the best for them.  I suggest that every person with high risk pregnancies communicate with their partner and Doctor constantly.  If you have concerns make sure you get a second opinion.  No one wants to have tragedy occur but it does so try to be happy no matter what it’s just as easy and much more pleasant.  Don’t be afraid of every step you take but be smart where you place your feet.  

P.S. 2014 - Our 5th son Jacen Solo Mair was born in April of 2007.  Though she was on heparin the whole time he made it all the way through and was slightly under normal weight but in good health.  He's brought a lot of joy to us as have the others.  He makes it so that when I look at him and wonder about Matthew and what he would have been like it is with joy for the time I had with him.  Jacen is precocious.  For many years we had to fight with him to change his clothes, even for bed.  He wouldn't let us even take off his shoes.  I was the only one strong enough to change him on my own, Tina needed a guard from the flailing limbs and squirming, though there were times that I needed help too. and I got bruises.  He is a joy.  People often look at us with a weird eye when we mention ages and they notice the closeness of the others and the gap before Jacen.  Sometimes I tell them.  These things are important.  I always try to be a better dad than I was when things were so stressful.  I haven't always succeeded and that has often made me hard on myself.  But for some reason those kids still love me and so does my sweet wife.  You can make it through anything if you cling to family, whether it is blood family, school family, church family, we're all family.