The first trimester of pregnancy is the worst, as the body is trying to acclimate to supporting a new life, but the third trimester is no picnic. Pregnancy guides walk a thin line of preparing you while scaring you to death. “The following symptoms are normal for the third trimester,” the guide begins, “including higher blood pressure, headaches, abdominal discomfort, or mild pain increased fetal movement, increased swelling/edema, increased difficulty breathing, increased heart rate, difficulty moving, etc.”
The guide continues, “However, should you experience any of the following symptoms, call your doctor immediately: high blood pressure, headaches, abdominal pain, headaches, too much or too little fetal movement, increased swelling/edema, difficulty breathing, increased heart rate, difficulty moving, etc.”
So when my blood pressure began to steadily increase at around week 34 (out of 40 weeks of gestation) no one was that worried. When I began to get steady headaches at around week 35, no one was that concerned. Due to my age I had twice-a-week Non-Stress Test (NSTs) and Biophysical profile checks, and as of 36 weeks my obstetric checkups were weekly, and I’d passed all of my tests with flying colors.
On Monday I’d had my NST and completed my 36 week growth ultrasound, which estimated our baby was about 6 pounds and 2 ounces. Tuesday I’d had my Obstetrics checkup, which showed my blood pressure wasn’t improving, and my headache was getting worse, but my other preeclamspia indicators like protein were good, so they recommended I come in for a quick blood pressure check on Friday, since Thursday I was busy with my second weekly NST. What was another appointment, really? It seemed silly to drive 20-30 minutes for a 15 minute doctor appointment, particularly since the only appointment they had required me to drive at rush hour. How good would my blood pressure really be at that point, I wondered.
And so on Friday I took an early lunch at around 9 am Pacific Time and told my coworkers I’d be heading out for yet another doctor’s appointment and that I thought I’d be back soon. I took the back roads to keep my blood pressure down, and I was seeing my favorite doctor in the practice, so I was hopeful I’d have a positive outcome. An hour later I had to pop back onto the company chat to let them know I’d be longer than expected, as I had to go to the hospital for a few more routine checks. Based on my results, my doctor referred me for some blood tests, and an hour of serial blood pressure checks and continuous NST. I told my husband, Matt, that I might also have to do extensive long-term urine testing due to the risk of preeclampsia. ( I really didn’t want to spend my weekend collecting pee in a jug.) There was a chance I’d have to induce the following Monday or Tuesday, but since Sunday would be 37 weeks, it would count as “Early Term.”
The hospital might have been more intimidating if I hadn’t had to do one of my NST appointments there for the ironically named Labor Day holiday. I also knew the nurse handling me, Jen, as she had been the one who gave the birth center tour a few months beforehand. Jen was upbeat and cheerful as she drew some blood, and for the next hour or so I calmly I waited through the tedious tests by listening to the humming and beeping of various machines. I considered myself an expert at the NST, having had them for weeks now, so I tuned out the whoosha-woh-woh-woh-woh of the baby’s heartbeat and movements and the whiiiiiiiiiiiir of the blood pressure cuff tightening every 15 minutes. I ignored the part of the NST that measured contractions as I hadn’t even had a Braxton Hicks yet, let alone anything real. I tried to focus on the calming repetition of it all rather than the inconvenience of the unexpected hospital visit. I also tried to ignore my rapidly draining phone battery. I hadn’t brought my charger, having expected only a 20 minute blood pressure check appointment.
After an hour, things were looking good. My blood pressure was high, but not too high. My NSTs were good. My blood panel was mostly fine, although one of my liver enzymes (ALT) was a bit higher than it should be. The hospital staff assured me it was nothing to worry about, however, as it wasn’t that far out of normal range. My obstetrician was on her way to the hospital to review the results once she finished her appointments, and I’d probably be released shortly. I would probably have to do the annoying urine tests over the weekend, however, and it was looking more and more like I was going to have to be induced the following week.
At week 34 one of the doctors in the Ob/Gyn practice (not my favorite one) had mentioned the possibility of being induced and I’d balked at the suggestion. Although common enough now, I had strong feelings about not using pitocin, and I wanted to baby to come whenever he was ready, not based on what was convenient for the doctor. The doctor mentioned that due to my age, I was at higher risk and induction was much more likely for me. I’d spent the last two weeks researching this, initially wanting to ease my mind about her being wrong, and then to accept that this was a possibility. The end birth plan was a healthy baby and a healthy family, I reminded myself. It wasn’t about the labor, it was about the life, just as it isn’t about the wedding, but about the marriage. When the nurse mentioned I’d probably need to induce the following week, I’d made my peace with this idea.
At a little after noon on Friday a lunch arrived for me, delivered by a new nurse. The doctor arrived to review my tests, and I had to get clearance to eat lunch, as I might be leaving soon or need to have another blood panel done. I held off on texting my husband as my phone charge was now down to under 10%.
The doctor gave clearance for me to eat at 12:30 pm, and I probably should have suspected then, given the old adage about free lunches. I had only had the drink when she came in to give me the news: My individual symptoms weren’t cause for alarm, but in combination warranted caution. My blood pressure was continuing to rise, from 138/86 the prior week, to 146/84 when I got to the hospital, to 156/90 by the end of my testing. My headache wasn’t improving despite Tylenol, the only thing I was allowed to take. My edema, which had been restricted to my chubby sausage toes and inflexible cankles was rising up my calves despite being in a hospital bed for two hours. The last straw though was the ALT figures. Although they were only 64 U/L with a normal range of 13 – 56 U/L, it was nearly twice my AST and 4-5 times my personal norm. I was being admitted to the hospital and I would start the process of inducing labor ASAP.
I had already signed the standard forms for my hospital visit about paying my bills, privacy, and whether or not I had an Advanced Directive. “The blood pressure cuff would have to get pretty tight for that, right?” I’d joked, which now seemed hollow as I filled out the same forms for my unborn child. Both the plans Matt and I made together and the plans we hadn’t yet made were swirling and mingling in a storm in my head as I was given forms to consent to procedures before I even had a chance to tell my husband about our abrupt change in circumstance. My smartphone battery was now at 2% and my phone had only the most vital of applications running in Extreme Battery Saving Mode. It was about 1pm, four hours into my lunch break, and I would need to tell work I was going to be even later back than expected by a few months. My imminent to-do list began to occupy my mind as nurse Jen adjusted the hospital bed for my first of several future cervical checks.
My lunch was a turkey sandwich, and I suddenly realized after months of careful eating, I could eat all the damn cold cuts I wanted.