Thank you nurses and midwives

This week is a big week in my healthcare world.  It is Nurses’ Appreciation Week and tuesday was International Day of the Midwife.  In honor of both celebrations, I wanted to thank my beloved nurses and midwives.

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Dear Nurses,

thank you for bringing some laughter into my triage room as we waited for the maternal fetal medicine doctor to come and give me terrible news.

Thank you for being the protector of my privacy- making sure I was ready for visitors in the midst of emotional turmoil.

Thank you for telling me about the “secret menu” the hospital offers where I can order quesadillas and pork bacon.

Thank you for sitting and chit chatting during my two week stay, keeping me sane and reminding me that things were happening beyond the fetal monitor I was trying not to watch.

Thank you for watching that fetal heart rate monitor so I could have the freedom just to be pregnant, knowing my baby was safe.

Thank you not commenting on how ridiculous i must have looked in in my sleeping outfit- it was just too hot to wear pants even though I knew you’d be coming in to readjust the monitor.

Thank you cheering me along in my in hospital exercise regimen.

Thank you agreeing to be my labor nurse, knowing my case would be emotionally hard and would likely sit in your memory for a long long time.

Thank you for taking photos of Mabel’s birth- not in your job description, but so meaningful to me.

Thank you for watching my baby in my stead, while she was whisked away to the NICU and I got my stitches.

Thank you for repeating everything the neonatologist said, right after he left because I could barely process it all.

Thank you for getting Mabel skin to skin with me for as long as humanely possible.

Thank you for the footprints, in ink and in clay, that turned out amazing, all done while she was on my chest.

Thank you for making sure she wasn’t in pain.

Thank you for taking out her breathing tube, gently, allowing me a first good glimpse of my daughter’s face free from medical equipment.

Thank you for taking photos, during her life and her death and in the after.

Thank you for feeding me, which I needed direly, but was unable to recognize myself.

Thank you for being present but unobtrusive.

Thank you taking her gently when I gave her up that very last time.

Thank you for giving me peace and solitude to sleep and to grieve in the hours after I gave her up.

Thank you for coming to her wake, taking me for walks, bringing me food in the aftermath.

Thank you for being part of it all and keeping her safe, in pregnancy, in labor and in the NICU.

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Dear midwives,

Thank you for all the extra care

Thank you each for calling and checking in when we got the news about Mabel’s Down Syndrome.

Thank you for letting me make tons of extra visits to help keep me sane.

Thank you for letting me use my appointments as mini therapy sessions

Thank you listening for a heartbeat first thing, so I knew she was still alive, before doing the rest of the visit

Thank you for having the hard conversations with me- the ones that were hard for me and hard for you.

Thank you for being honest, saying “I don’t know,” when I asked how I was supposed to return to midwifery if my baby died.

Thank you for giving me the few things I had hoped for- skin to skin, Chris cutting the cord and announcing gender (if he could figure it out!).

Thank you coming to meet her in the few hours she lived- so that you are part of the proof that she actually existed.

Thank you for her dress, an outfit given with love and purpose, the only outfit she worse outside her grave.

Thank you for eating wings with me, bringing me cabbage leaves for engorgement and looking at photos in the aftermath, reminding me that you are not only my midwives, but my friends.

Thank you for the donations you made in Mabel’s memory

Thank you for the lilac bush that you gave me because you know purple is my favorite.  It’s beginning to bloom right now.

Thank you for remembering dates- due dates and anniversaries.

Thank you for saying her name, easily and freely, just like she was any old living child.

Thank you for keeping her safe in my womb and alive in memory.

 

 

 

 

 

Work update!

I have a new job!

I still have my old job too.

Since I returned to work I’ve been seeing patients in the office 4 days a week, the fifth day is a day of appointments- therapist, chiropractor, acupuncture and general mental well being. I took a significant pay cut to work this schedule, one that kept me out of the hospital, and I am thankful that my practice was able and willing to accommodate me. But the “(when) will I go back to births” question always hung over my head. When I first asked to be an office-only midwife, I left the door open to return to birth, but with no time line. I still like having that option, but my practice needed something a little more definite. I honestly thought I’d be back by the holidays (Thanksgiving and Christmas) so I could repay my co-midwives for unexpected holiday time they put in for me last year. But I soon realized that goal was unrealistic. It caused me a lot of stress to even hear my co-midwives even talk about holidays and schedule, knowing they had more to do because of my absence from the hospital. When the topic came up at our winter midwife meeting, I conveniently had to use the bathroom at that moment. In addition, my practice wanted to know whether they should hire another midwife to replace me or if I’d be back soon. Well I finally was able to give them an answer.

As of April first I took on a part time position as Program Director for Hope After Loss, my local non profit helping those who have experienced pregnancy and infant loss. The organization runs peer-led pregnancy and infant loss support groups in four towns, does outreach and education to hospitals, medical providers and anyone who asks, and provides burial or cremation financial assistance to those who cannot afford it for their babies.

Taking on this new position means I plan to remain in the same capacity at my other midwife job- no call. I gave them the go-ahead. Hire another midwife! Takes a huge burden of guilt off my shoulders. I know my colleagues are sad to hear I’m not doing birth in the near future and I’m sad too- there are some things I miss about it, certainly the hospital staff I almost never see anymore! But I know I’m not ready. Some may call it avoidance, but I call it self-preservation. I need to still work on enjoying midwifery in the office and finding fulfillment there before I can return to joyful birth in a place that holds so many memories for me.

This wonderful new part time position has kept me a busy bee these past few weeks, hence my absence from the blogosphere.  But my dear friends, I have missed you!  And I”m trying to be back.  I have much to tell.

That same day

“has not had a period since birth of her son on February 15, 2014”

I read the last note I had written on the patient before I went in to see her.  I rarely am so specific in the dating- usually I’d say something along the lines of  “has not had a period since childbirth 5 months ago.”  Clearly the date had struck me.  I wrote it down mindfully, deliberately in the note.  I remember that visit.  I was seeing the patient in the same room actually and thought of how that was also Mabel’s birthday.  At the time all I could think of was how she had a baby to go home to and I did not.

On this day, many months later, a new thought crossed my mind when I re-read my note.  As I stared at her, all I could think of was how she had been on the labor floor at the same time as me.  She was there, down the hall, when I was wheeled from the NICU back to my labor room so that we could call our family in private and tell them our daughter was going to die soon.  As I said “it’s a girl!” in the same breath as “her time with us is short,” picturing the five pound wonder child I had just left on a warmer, tubes criss crossing her slowly bluing face and body, this woman was holding her baby on her chest, shushing those first newborn cries and excitedly cooing over her own little wonder.  Not long later I held my dead daughter as I struggled to keep my eyes open, having been up all night in labor, but not wanting admit I needed sleep for it meant saying good bye to my baby forever.  She probably struggled with fatigue as well, wondering how on earth she would be able to take care of her needy little one when she was just so tired.  I returned to a postpartum room, crawled into the hospital bed with my husband and slept, undisturbed in a quiet room.  She went down the hall, her attempted sleep punctuated by cries telling of a needed diaper change or feeding.  I walked out of the hospital with a box and she was wheeled out with a baby.

I write these words not out of bitterness and jealousy, as I would have many months ago, but out of fascination… that here we both were, face to face, our lives forever changed by the birth of our first children on that same fateful February day, in the same place, but how very very different our lives are now.

 

 

Play Date

I was at the dog park with Muppet and she was having her usual blissful time running around with the other dogs. The snow has begun to melt creating a large muddy patch at the park, which of course tends to draw all the dogs. Muppets fur soaks its all up and she gets crazy dirty, loving every minute. This day she found a couple of puppies that she played so well with. Coco was a brown and white dog (I am terrible at remembering breeds) just a few months older than Muppet and about the same size. They romped happily giving chase and play biting.

Dog parks are friendly places. Conversation seems to flow easily between puppy parents.

“Which one is yours?”

“What’s his name?”

“How old?”

“Where do you get her groomed?”

We exchange advice on boots for the snow, where to get a cheap light up collar, where there is a do-it-yourself dog bathing station near by.

On this day, Coco’s mom and I struck up conversation. She seemed about 15 years older than me and very friendly. She spoke with an accent and I soon learned she was from Columbia. She told me how she met her husband, an American, while she was vacationing here and ended up moving here for him.

“Our puppies get along so well!” she said. “If you ever want, we have a fenced in yard and live down the street. You can come over with Muppet and they can play!”

She told me how she works, but her mother is at home with Coco during the day.

“but she doesn’t speak English,” she warned.

“Esta bien. Hablo espanol!”

Her eyes widened and she smiled! “That’s great! She would love you! Even if you speak just a little Spanish.” She wanted to know what I did and I explained I was a midwife (“una partera o comodroma” I said when she wasn’t familiar with the English word. “pero en la hospital,” explaining that here midwives practice a little differently). I joked about how my obstetrical and gyn spanish was much better than general conversational Spanish, so hopefully her mother wouldn’t mind if I talked about vaginas! She laughed.

I left the dog park with her name and number to later arrange a puppy playdate. I thought, is this what parents with living children do? Would I be making similar playdates for Mabel, had she lived? Or not because she would have been sick?

Grief exposed

It was the end of my day and I walked my last patient up to the front desk. “She needs an appointment in 4 weeks,” I told my secretary.   As she searched the schedule, the patient tapped me gently on the arm.

“And how’s your little one?” she asked, continuing some of the friendly banter we had started in the exam room. She remembered that I had been pregnant the last time I saw her.

I am so prepared for this question. I’ve answered it time and time again. I’ve come to terms with the fact that people will ask- a lot of people, because I have a lot of patients who saw me pregnant. Probably hundreds of them. Some know what happened and some don’t. I no longer get emotional or shut down when asked. I have my go-to words that fill the once awkward space the question leaves.

But this time was different. I had an audience. I am usually asked about my baby when it’s just me and the patient in the exam room. I don’t think I’ve ever been asked in front of others who know and here I was, with the patient, sweetly asking in about my daughter with my front desk staff there to witness. I felt self-conscious.

“I have sad news about the baby. She died last year,” I told the patient. She was kind- gave me a quick hug and expressed genuine condolences. And then I quickly moved on and brought the conversation back to the future appointment for the patient.

It was a little different than what I usually do in privacy with the patient. If it’s someone like this patient I usually give a little more space for them to react and leave room for conversation if it happens. I think it helps me and it helps the patient. But this time I felt almost embarrassed that my staff had to watch this awkward interaction, perhaps thinking about how awful it must be to get this question over and over. Part of me is glad they witnessed- people getting a little window into the ongoing grief I have, but another part of me is so very shy about it. I can open up about the raw grief I have more easily in the privacy of an exam room, but not while being watched.

Have you had this question asked in a group setting? How have you reacted?

World Down Syndrome Day 2015

World Down Syndrome Day.

March 21- 3/21-  a day picked to represent trisomy 21 or three of the 21st chromosomes (most of us have only 2- the third is what is responsible for what we know as Down Syndrome).  It’s a day of celebration for the Down Syndrome community- a group I tentatively belong to.  For me it’s a day of celebration, a day of sadness and anger, a day of reflection.

Last year I wrote a letter to those who were expecting a child with Down Syndrome.  I’ve written a lot throughout the year about Down Syndrome- what I see in the news, how it crosses my path on a daily basis, my memories… I recently reblogged this post by Sadie at Invincible Spring, which I wanted to share again today, of all days.

1) Prenatal screening can detect the risk of delivering a baby with Down syndrome.

2) Prenatal screening can detect the possibility of delivering a baby with Down syndrome.
They mean basically the same thing, but not. We welcome possibility, while we shy away from risk.

After reading her words, I have totally changed my practice.  In the babyloss community we are admittedly very sensitive to words and phrases, even if they are well intentioned.  “God needed another angel” is well meant, hoping to give us comfort- but those words sting us, even those in religious communities.  Those in the Down Syndrome community, can experience the same hurt.  And it starts early- before a diagnosis is even made.  We obstetrical providers are the first to address the idea of having a baby with Down Syndrome.  Sadie’s words has made me rethink how my simple words as a midwife portray Down Syndrome in our society.  I no longer use the word “risk” when discussing  genetic testing.  I now talk about the possibility of having a baby with Down Syndrome.  One little word, that connotes so much.  Especially for me.

I was open to the possibility of having a child with Down Syndrome.  I opted for testing even though based on my family history and my age, I was “low risk.”  But as I have counseled patients in the past, low risk doesn’t mean no risk.  I wanted to know my chances of having a baby with Down Syndrome, even though I didn’t think it would change my management- I thought I would continue a pregnancy with that information.  I have also learned, we don’t really know what we would do until actually faced with a certain situation.  When I was told, “it’s Down Syndrome,” I felt relief. The initial abnormal screening had me worried about all the life limiting conditions it connoted, but Down Syndrome was livable in my mind.  My baby could live!  I certainly cried my tears later over the loss of the dream child I thought I was having, but I also eventually embraced the idea- going to my state’s annual Down Syndrome conference, talking with parents of children with Down Syndrome, researching therapies and pediatricians who specialize in children with Down Syndrome.  I had a registry full of special baby wearers and toys made for children with Down Syndrome.  I accepted.  My baby began to feel extra special- yes, a wanted baby, but a wanted baby with Down Syndrome.  An estimated 92% of pregnancies diagnosed with Down Syndrome are terminated.  I was proud to be part of the minority, and also sad that I was part of the minority.  In some ways, I feel future pregnancies may never have that same specialness.  Don’t get me wrong, I hope for nothing but as healthy a baby as possible, but having a baby with the typical number of chromosomes seems almost easy.  Almost.

International Down Syndrome Day is also a little painful for me.  I see photos of smiling children on the news and flooding my facebook and blog feeds, their features of Down Syndrome evident in their faces and their stories of how happy and loved they are written underneath.  I so badly wish I could be in that club- that club I at first never wished I belonged to- the parenting a child with Down Syndrome club.  It’s a lovely community, full of support for people having both an easy and a hard time.  Raising a child with Down Syndrome is a challenge- no one can argue that.  But what child doesn’t have his/her challenges?  Learning your baby has Down Syndrome simply makes your baby’s challenges known and upfront.

At times I can be a little angry- it was the extra chromosome that stole my baby from me.  Mabel’s kidney defects are rare, but they are more common in babies with Down Syndrome.  I sometimes get angry that I was in that minority that said “yes,” that I would raise a child with Down Syndrome, while the overwhelming majority chooses not to.  But I was given a child that wouldn’t live, while others terminated a pregnancy of child that might have lived.

I still believe in a woman’s right to choose. I just simply wish that more people would choose yes, when it comes to Down Syndrome.  It is not an easy road- sometimes it can end in heartache, like with me- but I don’t regret taking the risk of loving my child with Down Syndrome.  I would carry another child with Down Syndrome, despite the risks of loss.  There are no guarantees in life, in love, in family- all we can do is hope.

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In remembrance of our daughter Mabel, my husband is fundraising for Best Buddies, an organization that helps people with intellectual and developmental disabilities- including those with Down Syndrome.  On May 31 he is biking 100 miles across Cape Cod to raise money in her name for Best Buddies.  If you’re looking for a way to celebrate World Down Syndrome Day, consider donating by clicking here.

 

A patients grief for her dad

I was reviewing her medical history and when we went over her family history, she told me that her father had died last year.

“I’m so sorry to hear that,” I replied.

She told me how his birthday just passed and the anniversary of his death was coming up. I asked if she did anything for the birthday or was planning anything for the anniversary. She peered at me with a look of surprise- like she never thought about doing something in remembrance.

“It’s just been so hard, losing my dad…” she started. She was young- younger than me by ten years at least, which meant her dad died young. She mentioned how her live-in-boyfriend didn’t quite understand, especially now that it’s been so long. She shrugged her shoulders, brushing it off a bit.

I looked at her in the eyes, trying to drum up all the compassion I could. “There is no timeline on grief,” I spoke the words I have read over and over again on blogs and articles and have tried to convince myself are true. “You will be sad forever. He was your dad. It’ll change over time, but you can always be sad. I’ve learned a lot about grief over the last year and one thing I know is that you grieve how and for as long as you need to.”

Her eyes got a little wet and she gave a small smile.

“Thank you.”

Have you been able to comfort someone in their grief?

Recurrent miscarriage and anxiety

Her blood pressure was high- she told me soon after we started her annual visit.

“I just get so nervous at doctors offices…especially the OBGYN.”

I explained to her it’s very common- there’s even a name for it “White Coat Syndrome.” She seemed relieved. We talked of ways to make sure her general blood pressure was normal outside my office- like at her primary care provider or at-home monitoring. She went on to tell me she has been feeling anxious lately. She’s always had anxiety but the past few months it has been ramped up- every since her miscarriage.

Reviewing her OB history she told me she had an unplanned pregnancy a few months ago and a few days later miscarried. The experience plunged her into a deep anxiety. She had a family member announce her unplanned pregnancy around that time too, which added to her complex emotions. We launched into a conversation about loss. She has had multiple miscarriages and two living children. Her recent miscarriage made her realize she how she in a way would want another child but doesn’t think she could handle the anxiety behind the risk of miscarriage. We were able to come up with a reliable birth control plan that would take away that anxiety. “It made me realize I guess I should be happy with the two children I have.” I understood her thinking, but wanted to shout, No! You can want more children! You deserve to go through a pregnancy without anxiety! I instead comforted her how I could. We side tracked a bit and talked of her family member who announced her pregnancy early, about how difficult it can be to watch others go through pregnancy without any obvious worry, without the real threat of miscarriage and loss hanging over her head. She was tearful at times and I think it felt good for her to say the words and feel validated.

At the end of the visit, she looked at me, tears still in her eye. “Have you gone through something like this, “ she asked hesitantly.

“I had a baby last year and she died after birth,” I told her. “I’ve never miscarried before. It’s a different kind of loss, I know, but I do know what it’s like to have the same feelings you do.” We talked a little more about loss and watching others seemingly easy pregnancies. She was good to me- expressed her sincere condolences and was very sweet. But what I appreciated most was the gratitude in her eyes. I could tell she just felt so thankful to have someone who understood.

Have you been on the other side of things- able to be the comforter, showing understanding?

Good Bye, Paul

My friend Paul died this week. To be honest, I was not very close to Paul. I probably haven’t spoken to him in ten years, but social media has kept me connected in that voyeuristic kind of way and I have followed his story the past couple years. His death has hit me hard for such a long ago friend and it has ripped me open a bit.

I first met Paul, or Pubby, as he was introduced by his long-standing family nickname, at a summer camp I worked at during my college summers. It was an alumni family camp for my university- staffed by current college students. Job positions were competitive- hundreds applied for sixty spots and those accepted were often known for their creativity and outgoing nature. The fun from those summers spilled into the school year as well, as my new group of incredibly bonded friends reunited on campus. It was like Dirty Dancing- but wilder and more fun- skinny-dipping, costumes, secret parties. Once I became “Staph” I joined a community of welcoming, free spirited people to whom I was always bonded, for years to come. I became instant friends with Staph from years past, even if we never worked together, simply because they were part of the community. I think Paul and I overlapped one summer there- he was a few years older- but I do remember he was a bit of a legend, as many of the older Staph were. I even kissed him once at a party, because that’s the kind of place it was- kisses were given out rather freely. I often told friends that little tidbit, because I was just so proud that I once kissed someone like Paul.

When went to midwifery school, I was accepted to a good program in a city in CT, I arrived at the school with my tiny car (one of those new VW Beetles) packed with all my earthly belongings. I came site unseen. I had interviewed over the phone and had only driven through the city on the highway, remembering the reputation it had as being a dangerous place. I left my car parked on the street and walked timidly around the med school campus trying to find the dorm I would be staying in. I was terrified- I didn’t know anyone or anything about the place. I thought my car would be broken into. And as I found the dorm and was walking up the path, I spotted a familiar person sitting on the lawn outside. “Pubby!” I walked excitedly to him and was greeted with a hug. He was in med school there and having lunch with another med school classmate (also former Staph, no less). He was such a warm welcome on my eyes, and my fear of this scary city began to fade- because I knew someone, someone nice and cool and welcoming there. He made my first day ok.

Throughout those years I saw him on and off, mostly in group settings, though I remember having dinner with him and his then girlfriend, now wife, Lucy- and I always still felt that sense of awe for being friends with someone like Paul. I guess I felt like he was out of my league in a way. He never made me feel that way- it’s just that he was so smart and funny and simply just cool. He and Lucy moved away to California for residency and I stayed behind in that fearful city I grew to love. I kept tabs, like everyone does these days- through facebook mostly. That’s how I learned of his illness. He was at the end of his neurosurgery (yes, brain surgery- he was that smart) residency when he was diagnosed with lung cancer. Lung cancer. A non-smoking physician in his mid 30s. What? He was a rarity. He continued to practice and wrote a lot about his unique diagnosis and how it affected his thoughts on the world, on medicine. His words and his story were fascinating, coming at a time when I needed to hear them. I didn’t talk to Paul directly during this time- just occasional messages on his health update blog, but I followed his publications. His wife even reached out to me while I was pregnant and while I was grieving and we corresponded a bit.

When I was pregnant with Mabel, he wrote this piece, which struck me. The uncertainty of prognosis. Here’s someone like Mabel- diagnosed with a rare disease, so unlikely. No real prognosis can be given. He understands that. But look! He’s living, beating the “odds.” Paul’s diagnosis and continued life gave me hope for my baby. And then my baby died; she didn’t beat the odds, but not everyone can. But Paul was doing it. When he and his wife announced their pregnancy after Mabel died, I didn’t cringe in the way I normally did when others announced such things. I actually thought, “good for them.” Maybe a little part of me was envious because I thought Paul would live- but they understood struggle, so it was ok.

I can’t believe he’s dead. He was young and fighting a rare disease. He wrote about his struggles so prolifically, beautifully, thoughtfully- I thought perhaps writing the words themselves could somehow stave off what apparently was inevitable.

My facebook feed is filling up with photos of Paul and his articles. My first instinct is that I want to look away- it is just too sad. But I don’t. Because I know Lucy can’t look away. I couldn’t look away in the early days after Mabel’s death and I envied those who could just go about their normal lives without the heavy burden of loss. They could feel sad on their own time, while I was trapped in a prison of grief- hard enough to simply be there, but worse to be there alone. It reminds me of when people say “I can’t imagine what you’re going through…” The thing is, I can imagine it. I don’t know what she is going through- my husband has never been diagnosed with a terminal illness, never died. But I can imagine it. I can imagine the sorrow and it’s terrifying. I have actually imagined losing my husband- because that’s what the death of a loved one does- it made me worry about losing anyone close to me.

Lucy announced that Paul passed away with their baby daughter resting on his chest.   The imagine… it’s the mirror image of my loss last year. My baby resting on my chest as she ceased to breathe. Paul’s daughter resting on his chest as he ceased to breathe. So beautiful. And so so wrong too. Babies aren’t supposed to die and babies’ dads aren’t supposed to die.

I am so angry at the injustice. This post is about Paul, about Lucy, about their baby. But clearly it is about me too. I wanted to write an unselfish tribute to this man, who touched so many lives both before and after he got sick and I hope some of that came through. He wasn’t supposed to die.

I think of Lucy, and her family of three- though one is now here only in memory and I think of myself and my family of three, though one is now here only in memory. Paul will forever be tied in my mind to Mabel because their stories are so different, but also so similar. Good bye, Paul. I wish you were here.

one of his most recent pieces….

http://stanmed.stanford.edu/2015spring/before-i-go.html

An interview years ago… (scroll down to the “His Girl Lucy” section.  so worth it, I promise)

http://www.thequietquiet.com/archives/doctor_paul.html

 

Validation at work

“You’re really good at this!” she exclaimed as we finished up her visit. I had just put in a Nexplanon in her arm (a small subdermal form of birth control that lasts 3 years). It’s popularity is growing, mostly in my younger patients, who love the idea of something easy and long acting.

I smiled somewhat sheepishly. “Thanks!”

“No really, I mean it,” she went on, with her teenaged enthusiasm. “You’re so thorough and just really friendly. I’m so glad it was you who did this. You’re really good at your job, you know. It’s so cool, finding something you’re good at.”

Her words were well timed. I often have so many doubts about my place at work. Some days I feel like an empty shell. I smile and say all the encouraging words that I’m supposed to, but then go how and stew over things people say, especially around pregnancy. It doesn’t feel good to be “faking it” all the time. But on a visit like this, it was really easy. I love my teenaged and early 20s patients. I’ve made it known in my practice that I have a special interest in the adolescents, so my staff and fellow colleagues often book patients in that age range with me.   I need these patients right now- they remind me (even without them saying so) that I enjoy parts of my job, that it can be fulfilling and that I can find meaning in it.

“Thanks,” I told her more earnestly. “I sometimes need to hear that. I do love my job sometimes.”

She jumped off the table, her arm neatly bound by the pressure dressing, and I knew she’d be back next year to see me.

A few patients later, I sat in front of one of my prenatal patients. She comes weekly for an injections that helps prevent preterm labor in those who have already had a preterm birth, so I’ve see her frequently. Last time I saw her, she had been struggling terribly with heartburn that made her vomit and caused bad headaches after. She had exhausted all the over-the-counter and lifestyle changes to try to combat her discomfort without any relief. Las time I tried a non-traditional medicine- one for nausea that helps with headaches, though not usually used for heartburn. I told her I was unsure it would work, but worth a try because the safety was well established and her symptoms were non traditional.

Now, two weeks later, I asked how she was doing. She told me the new meds still didn’t help. She had waited to talk to me about it, avoiding the topic at her last visit with a different provider.

“I think it’s time we try a prescription heartburn medication,” I said. I explained how the medication is “category C”- a category given to medications to rate their safety in pregnancy. We usually try to stick to category A and B medications and take category C medications on a case by case basis. In her case, I think its worth the risk (not that there is established risk, simply many of the category C medications there is just not enough information).

“See, this is why she’s my favorite,” she turned her head and was speaking to her husband and brother in law who tagged along to the visit. “She explains everything and really tries to help.” She looked back at me and continued, “let’s give it a shot. If this doesn’t work, then really, I’m just going to have to deal. I don’t have that much longer anyways.”

I smiled for several reasons. Her compliment, like my other patients, was well needed, especially coming from a pregnant woman. I also appreciated her attitude- she felt like she didn’t have that far to go, she could put up with discomfort if she had to. She was 24 weeks and had plenty of time to go. I know so many patients who feel like the last 3-4months are an eternity with their discomforts, and here was this woman who understood the transience of pregnancy and recognized that sometimes we just have to put up with discomfort to simply be pregnant. It was a relief for someone to understand that. I put up with many discomforts during Mabel’s pregnancy- and though I might have mentioned some of them to my providers and friends, I always tried to make the point that I wasn’t complaining, just stating- because really I was just so grateful to be pregnant. Every day I had still pregnant was a gift, considering how high my risk for loss was. Even without that risk, I do truly believe everyday being pregnant is a gift. I just wish some of my patients realized that.

What gets you through the days? Where do you get your validation?