I write this with my daughter, Hunter, sleeping peacefully on my lap. As I look down on her, I am filled with a sense of awe, and of gratitude, for her journey to us was long. Here is her story......
When I moved to Tahoe in May of 1994, I was looking to balance my career as an ob-gyn with the pursuit of the good life -- skiing, biking, boating, gourmet meals, travel. I was not thinking about having any children to disrupt my very comfortable lifestyle. In July I met a man with the sweetest smile and the bluest eyes who, on our second date, told me how he'd always dreamed of being a dad and how he hoped at age 39, it wasn't too late. In September, he asked me to marry him and I began to think that maybe a family wasn't such a bad idea after all.
Jeff and I were married on a snowy Saturday in January 1995. I added maternity coverage to my health insurance that Monday -- there was a 6 month waiting period for coverage to be effective and we wanted to start our family as soon as possible. I, the successful physician, had always accomplished what I had set out to do, and was sure I'd get pregnant as soon as we tried in September 1995; besides, I was an ob-gyn, so how difficult could it be for me to get pregnant?
As it turned out, pretty darn difficult. After 6 months of not using contraception, I started doing ovulation predictor kits. Surprise, I wasn't ovulating! I had prescribed fertility drugs such as Clomid and I'd seen my patients turned into raving lunatics by these drugs, so I opted to try alternative approaches initially. I consulted an acupuncturist who stuck me full of needles and prescribed foul tasting herbal concoctions. We also shifted my cycle so I'd ovulate when the moon was in the same phase it was when I was born! Well, my cycles became more regular, but I still wasn't pregnant.
Being an ob-gyn, I certainly knew how to get someone to ovulate, so I prescribed Clomid for myself (now, that's a real smart move -- taking care of yourself as a patient!). Not only did it not make me a lunatic, it mellowed me out so much that Jeff asked if I could take it all the time! I conceived right away, in August of 1996. We were ecstatic! We were going to be parents! I scheduled an ultrasound in my office for 10/19/96, my husband's birthday -- I thought seeing his child on the screen would be a wonderful present. Unfortunately, what we saw was an embryonic demise -- a fetal pole but no heartbeat. We were sad, but thought we'd do better next time.
Next time took longer than we thought. I resumed the Clomid in December but didn't conceive until the 4th cycle, in March 1997, after an IUI. It was strange -- obviously I couldn't do the IUI myself (I had my partner do that), but I brought the sperm sample from home, prepped it myself and set the room up so Lauren could do the insemination. 14 days later I had a positive pregnancy test. This time, I knew from the start something wasn't right. I kept telling Jeff not to get too excited. We drew progesterone levels (excellent) and HCG levels. The HCG levels barely rose appropriately, and an ultrasound soon thereafter confirmed what I'd known all along --this was another blighted ovum.
At this point I took advantage of being a doctor and began the workup for repeated miscarriages. Jeff and I had chromosome analysis done (both normal) and I had an anti-phospholipid panel done; although the initial screening tests were normal, a more extensive panel revealed a very minor elevation in anticardiolipin, an elevation that should not have been clinically significant. At this point I decide it was crazy to continue treating myself, so I saw a reproductive endocrinologist. He felt that my lab tests were inconclusive, but he said a very wise thing to me when I asked if I should take the aspirin and heparin injections that are the treatment for anti-phospholipid syndrome; he said, "if you do the treatment and you have a miscarriage again, how will you feel?" -- my answer, "devastated, of course." Then he said, "and if you don't do the treatment and you miscarry?" and I answered, "devastated, and guilty, because I didn't do everything possible."
I was emotionally a wreck after the second miscarriage. I felt I was a double failure -- as a woman and as an ob-gyn (I mean, I helped women get pregnant and I delivered babies every week and I couldn't even do it myself???). I joined the multiple miscarriage e-mail support group. I told my story on the Women's Health Forum at obgyn.net. The support I got helped me through a very difficult time, as did the understanding that I wasn't alone in my suffering, that many other women out there had been through worse and many had gone on to have a child. Jeff was incredible; he held me when I cried and told me he would be behind me 100% whatever decisions I made about trying again or not. It took me 6 months to get up the courage to resume infertility treatments.
This time, with the guidance of my RE, we did a combination of Clomid and Pergonal; again my partner did the IUI. No luck. We took a vacation, then came back and started a Pergonal cycle. I was giving myself Pergonal shots in my hips (ever the doctor, I gave myself the shots rather than having my husband do it -- besides he HATES needles!) and heparin injection in my abdomen twice a day; I was black and blue. This time we decided to have the RE do the insemination. For the first time I didn't prep the sperm and for the first time Jeff was actually I the room for the actual insemination. The karma must have been better, for this time worked. As we were driving back to Tahoe, I turned to Jeff and said, "we just conceived".
I knew, just KNEW with all my being, that we were having a girl. I had thought the two miscarriages I had were boys. I had a brother who died when I was 4 and he was 3, and I had always thought that I should have a boy to take away some of the pain of my parent's loss; I had told Jeff early on in our relationship that if we ever had a son I would name him Timothy after my brother. I know now that you can't force a spirit to come to you, that any son I have will not be my brother and I cannot make up for his loss. I was told there was a little girl spirit hanging around me, and I just had to let go to allow her in (our dear Barbara Nesbitt was one person who told me long before I became pregnant with Hunter that I would have a daughter). Now I knew she was here, and I hoped, here to stay.
Being an ob-gyn is not always an advantage -- too much knowledge leads to neurosis, and I was definitely neurotic throughout the entire pregnancy. First I worried about miscarriage, then about incompetent cervix, then about preterm labor, then, finally, about stillbirth. I was taking 81mg aspirin a day and injecting heparin twice a day from ovulation through 36 weeks. We did ultrasounds weekly until 12 weeks. I had CVS done at 11 weeks due to my age (38 at delivery), which confirmed what I already knew -- we were having a girl (BTW, Jeff lost a $50 bet on that one!) and, at least from a chromosomal standpoint, she was fine. We did weekly ultrasounds to check my cervix from 18 - 24 weeks (after I checked myself and thought my cervix was shortening -- I told you I made myself nuts!). After that, it was monthly ultrasounds to follow growth, then weekly again from 36 weeks to check amniotic fluid. This child had more pictures taken before birth than the average supermodel has in an entire career!
I threw up every day for 6 weeks in the first trimester and thanked God every time; to me it was a sign of a healthy pregnancy and I was grateful for every reminder that she was okay. I felt her move for the first time at 19 weeks, and almost wrecked the car calling Jeff to tell him. I got varicose veins, but just got in the habit of putting on support hose every morning. I was constipated from the progesterone I took for the first 12 weeks, and from the pressure of the growing uterus for the next 27. I got up every 2 hours throughout the night to empty my bladder. Despite all that, I never felt better. I rejoiced in all the signs of pregnancy and I glowed. My husband told me every day how beautiful I was. I loved being pregnant.
By the middle of November, at 37 weeks, I really began to worry about stillbirth. Jeff did too. A friend of ours, and a patient of mine, had a history eerily similar to mine (same age, husband same age as Jeff, 2 miscarriages, mild anti-phospholipid syndrome), who had a stillbirth 8 days from her due date; I was in the first trimester at the time and was devastated. We were so afraid that same thing would happen to us. I was already doing twice weekly NSTs and weekly amniotic fluid volume checks. Jeff wanted me to deliver the baby -- now. My cervix was only 1cm at 38 weeks, but she was engaged. We decided if I hadn't gone into labor by 12/1, at 39 weeks, I'd be induced. We tried everything to get labor to start -- spicy dinners, taking Jeff's 10 year old beat up pickup with lousy shocks down bumpy roads, cutting down a Christmas tree, driving off the Hill (people in the mountains think the altitude change will start labor), sex, and even cross country skiing -- uphill!
I was admitted to the hospital on 12/1/98 at 6:15 AM. I was 1cm (still!) and 60% effaced. Patty, the nurse finishing her shift, placed Cytotec into my vagina to ripen my cervix. Normally, we admit patients in the evening for Cytotec, but I didn't want to keep my partner up by delivering in the middle of the night! After the mandatory bedrest and monitoring after the Cytotec was placed, I got up and played Minesweeper on the nursing station computer! I sent Jeff to work as I was feeling so good and knew it could be a long day and night. The contractions were every 3 minutes, but weren't bad at all. I received an additional dose of Cytotec at 11:00 and was 3 cm. I had had a positive strep culture during the pregnancy, so an i.v. was started shortly thereafter to administer antibiotics. I was still feeling great and even ate a veggie burger for lunch. By 2:00 I was getting uncomfortable and asked Jeff to come back; the contractions were every 1 - 2 minutes but I was still walking the halls and I still thought I could do labor without medication, but I needed my back rubbed. Jan, my labor nurse, checked me and I was 4-5 cm. Lauren came in after office hours, around 6:00, and I was barely 5 cm. She ruptured membranes -- lots of clear fluid --but I could see she was thinking I was making slow progress and might end up with a c-section. As an obstetrician, those same thoughts were in my head as well.
After the membranes were ruptured, the contractions really increased in intensity. I had also started retching -- no veggie burger reruns though! It was time for an epidural, the hell with unmedicated childbirth! Here's another example of it not always being an advantage to be an ob-gyn while one is pregnant: throughout my pregnancy, everyone -- from the RE I saw in order to conceive, to my partners, to the perinatologist who monitored growth, to my nurse -- always asked what I wanted to do and the anesthesiologist was no exception. When I asked her whether she wanted me sitting up or laying on my side to get the epidural, she asked me how I was more comfortable; well, the contractions were horrendous when I lay down, so I naturally opted for sitting. Despite the fact that I had gained only 18 pounds the entire pregnancy and my back was very easy to feel, she had a hard time getting the epidural in -- the interspinous spaces were just too tight. She tried for 45 minutes and I looked like a pincushion before she did what she would have done with any other patient from the start -- had me turn on my side. She popped the epidural in in no time flat and I was soon comfortable (and when it came time to take the epidural catheter out later, I had to be on my side -- it wouldn't come out with me sitting). I remember turning to Jan, my labor nurse, while I was trying to get on my side and telling her, "I'm in transition and I'm losing it!!" Jan was wonderful at helping me through that most difficult time (Jeff, quite wisely, had stepped out of the room for the epidural; remember he HATES needles). The epidural was the weirdest feeling -- I kept poking my legs and laughing because I couldn't feel them, although I could wiggle my toes.
Shortly after the epidural was in place I began to feel pressure, but I didn't say anything because I was enjoying being comfortable. Lauren had left to say goodnight to her 2 kids and we all thought it would be a while longer. The pressure continued to build and I began to feel an urge to push; I asked Jan, who had stayed past her shift, to check me -- I was fully dilated and +1 station! Jan didn't want me to push until Lauren got back to the hospital, and I was still comfortable, so I was happy to oblige. Once I started pushing, it took about 45 minutes. Hunter began to have drops in her heart rate down to the 60s, so on went the oxygen mask. Lauren was about to use the vacuum when her heart rate went up and stayed up. I pushed a while longer, then Lauren asked if I cared whether she cut an episiotomy --the only thing I cared about was having a healthy baby! -- so she did. Two pushes later, at 9:41 PM on 12/1/98, Hunter Katherine Shanahan Turney, all 5 pounds 13 ounces and 19 inches of her, slipped into the world. Daddy Jeff was too excited to cut the cord, all he wanted to do was look at his beautiful daughter (besides, he doesn't like blood and all involved agreed it was pretty darn amazing that he was able to be there for the delivery)
After a few whiffs of oxygen to perk her up, Hunter was placed on my chest, skin to skin. I put her to the breast and she latched on right away -- good thing one of us knew what she was doing! She was incredibly alert and just looked around. There was wisdom of the ages in her eyes. She was perfect. We were blessed.
And are blessed. Hunter is almost 6 weeks old now and is the most wonderful, beautiful, smart and talented baby on earth. She has a cry that can shatter windows and a smile to rival the sun. Her skin is like cashmere and her eyes are the color of the sky. She has the hands of a concert pianist and her feet -- well, lets just say she'll be in no danger of tipping over once she starts walking!! She is an angel and the embodiment of all that is right and beautiful and precious in this world. She is our little girl, and we love her more than mere words can express.
Jeff, Kelly and Hunter
Hunter Katherine Shanahan Turney