A mother who is also a doctor shares her arduous journey through infertility, pregnancy and infant health challenges in the hope that it helps women going through similar journeys of infertility and insufficient guidance during pre-natal and intra-natal periods. Plus the importance of advocating for yourself and your child.
Embarking on the path to parenthood, my husband and I, both being healthcare professionals, conscientiously planned our pregnancy. Despite my medical background, the unexpected twists of infertility, early miscarriage, and a tumultuous prenatal period were profound revelations. The journey unfolded, revealing that the vulnerability of a first-time mother transcends professional credentials, leaving me as vulnerable and uncertain as any other expectant woman.
Navigating Infertility: After eight months of unsuccessful attempts, we underwent comprehensive fertility testing as a couple — I can’t emphasize enough how male testing is as important as female testing and saves a lot of time, money and emotions, if both get tested at the first goal rather than waiting for the female to go through a battery of tests which is more extensive and expensive. In my case, infertility was idiopathic, meaning nothing was really found as a cause. The diagnosis was idiopathic infertility, an enigma with no discernible cause. This led us down the path of Intrauterine Insemination (IUI), involving artificial insemination supported by hormonal interventions. Following two unsuccessful IUI cycles, a natural conception ensued, only to result in an early miscarriage.
Subsequently, in the very next cycle, a perplexing twin pregnancy emerged. Beta HCG, the pregnancy hormone, can be high for some time. I was asked to come back at around 5 weeks when an ultrasound was done trans vaginally and it was discovered that I had two gestational sacs, meaning a twin pregnancy. Only one sack had a heartbeat. Sometimes the heartbeat can be a little delayed to be discovered (or discovered a little late). I was asked to return in a week’s time to check the viability of the second sac. I was also advised that one twin may get aborted if there is no cardiac activity, which can sometimes, as a complication, lead to both the fetuses being aborted. The facts are all stated in a very detached manner and for a first-time mother who has been through the stimulus journey to conceive, it can come as a tremendous blow to say the least. Nowhere along are we as doctors taught to take into account the crucial factors like the emotional and hormonal status of the mother. As a doctor it’s rare to think beyond the physical and lab status of the mother and account for social, emotional and financial aspects which have a huge bearing on the entire pregnancy journey.
Pregnancy Unfolds: After having lost one fetus, the pregnancy carried on as usual and unfortunately, I suffered with hyperemesis gravidarum, which is an excess of vomiting during pregnancy. This continued until the eighth month of my pregnancy. While I did receive medication to help with it, I was never sensitized about ways to maximize my nutrition or to take some additional measures. I did the best I could basis my lifestyle and nutritional research and available time to tide over the situation. It is noteworthy at this point I was also in the final year of my post-graduation in public health, which entailed a lot of travel using public transport carrying heavy books and my thesis, all the while being nauseated and vomiting all the time. No doctor ever bothered to ask me what my day looked like or how much I was actually able to take down. It was all about what they wanted me to do as opposed to what I could really do. That created the biggest lacuna between advice and the compliance. There was also no information about the consequences of the lack of nutrition. There are clear guidelines for the recommended dietary allowance of various nutrients and calories, however, no one takes the time to factor in the feasibility for a working mother with no support and hyperemesis gravidarum (excessive vomiting). Finally, towards the end, around 37 weeks, I had to receive parenteral nutrition, which is injectable nutrition, as due to excess vomiting there was failure of absorption of nutrients and weight gain was not adequate and it was found that the amniotic fluid was very low, which put me at a higher risk. Right after crossing 38 weeks, we decided to have an elective cesarean, which of course my gynecologist was not very happy with but given the high risk and my journey, I felt it was a high-risk pregnancy that needed to be protected. My baby was born at 2.15 kg, which is a very low birth weight (bear in mind that the last ultrasound did show that the baby was above 2.5 kgs however, there can always be a difference in reality).
Early Months of Motherhood: While my baby initially thrived, God put me through some testing times and my baby landed up having a viral infection, a common flu which caused a viral pneumonia. We kept visiting the doctors back and forth as I felt some it was something beyond and the child never looked comfortable even though he fed and passed urine and stools. As a doctor and a mother, I kept advocating that my child is unwell and has a wheeze, but the specialists kept undermining me, as I was a fresh postgraduate, and they did give off a sense of superiority. I was always asked to think as a “mother” and not as a “doctor” and to let the specialists do the rest.After several visits, one night my baby wouldn’t stop crying and looked extremely pale. It was then that we decided to rush him to the ER. My baby was immediately taken away from my hands and an ECHO was done which revealed that the heart function was 1/3 of what it should be. Our whole world collapsed, and it was like a series of nightmare thereon. The beds in the ICU were full so we waited while our baby was on oxygen support and everybody in the hospital seemed to be giving us a worried and sympathetic look while we had several doctors come and examine him to learn.
Finally, he was shifted to the NICU where a central chest tube, maximum number and dose of medications to maintain his blood pressure and every possible supportive care, including a ventilator, was used. I could barely see his little body entwined in the array of tubes. The doctor there revealed to us that the situation was not as seen on face value but was rock bottom. My baby had a low hemoglobin around 6gm, low calcium, low vitamin D and was struggling to maintain his blood pressure even with his normal breathing. It was one of those rare cases where the antibodies that were supposed to fight viral pneumonia had cross reacted with the heart muscles and caused a swelling of the heart and thickening of the heart muscles, also known as viral myocarditis.
The intensivist did their job and I had minimal visits to minimize chances of infection. The days passed by in a daze and I was in a state of emotional upheaval.
It was a two-month long ordeal of 20 day stay in the NICU and thereafter in the HDU. All I can say is no mother should have to go through what I went through, there were days where I had to throw away breast milk from my leaky breasts and every day, we heard the term “the prognosis is guarded” which we as doctors knew that it translated to don’t expect the child to return. Against all likelihood, my baby did show extreme resilience even when we were ready to give up.
Lessons Learned: Reflecting on this challenging journey, I share these insights to empower others facing similar trials:
- Advocate for Your Child: A mother’s advocacy is paramount, persistently addressing concerns even if met with dismissal by healthcare professionals.
- Comprehensive Preconception Care: The journey to parenthood begins with self-care, including meticulous preconception planning, health maintenance, and emotional preparation.
- Choose Your HealthCare Partners Wisely: Selecting a healthcare provider who listens and understands your unique journey is crucial for a positive pregnancy experience.
- Informed and Prepared: Approach consultations armed with knowledge, goals, and specific queries, ensuring a proactive and engaged approach to your healthcare.
- Pre-pregnancy Vaccinations and Infection Screening: Prioritize essential vaccinations and screenings to safeguard against potential infections during pregnancy.
- Prioritize Your Health: Throughout pregnancy, prioritize your emotional, physical, and mental well-being, recognizing the profound impact on your child’s temperament, weight, and overall health.
In sharing my tumultuous journey, my intention is not to instill fear, but to offer insights that may empower others, navigating the intricate terrain of infertility, pregnancy, infant health and unforeseen challenges.
