A postponed postpartum story

This is a mega-post about our daughter AB’s arrival a little over two months ago, with a bit about BB’s birth three years ago thrown in. I wanted to note some of that at the time but never did.

It’s mostly so I don’t forget, but maybe someone else will find it useful too. Maybe AB in the future if she ever decides to have kids.

This gets a bit in the weeds. If you’d rather not read about things like breastfeeding, IVs, episiotomies, etc, probably best to skip this.

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Our sweet daughter AB arrived around late July. The lead up to her arrival was almost a carbon copy of the situation we had with BB. Blood pressure creeping up as we got nearer the due date, and then reaching the point around 37-38 weeks where the advisable course of action was induction. Note that I was taking a baby aspirin my whole pregnancy (as I did with BB) because of my mom’s preeclampsia history.

One big difference from the first time round was that we needed someone to care for BB while we were in the hospital. Our plan was to have Sam’s parents look after him, but with them arriving from the UK, we also had two stellar families from BB’s daycare lined up as backups. Thankfully we saw the writing on the wall on the Friday, and Sam’s parents were able to move their flight forward by a week to the following Monday. They arrived 10 minutes after the midwife on call told us to go to the hospital. We saw them for about 5 minutes, enough time to take a photo on the stoop with our bag. Then it was a swift kiss to BB, and a short walk to the hospital with our bright orange duffle bag.

The labor and delivery was extremely similar to BB’s as well. After some initial doses of misoprostol, I was able to progress to labor without further medication. Unfortunately after an initially valiant show, my labor started stalling and the midwives nudged me towards Pitocin. The stalling hadn’t happened with BB, maybe because I was further along with him when I was induced.

At that point, our doula suggested that we try Gilligan movements. I was sort of skeptical, but my god, they worked. (Incidentally: I highly recommend working with a birth doula you trust if you have the means to do so. And if you’re in Brooklyn, reach out and I’m happy to give my recommendation. She and her partner were fantastic.)

Once we finished the movements, there were only a few major contractions before pushing which was significantly shorter than with BB. Very little tearing, and no episiotomy* this time. 🎉 We were moved to the postpartum ward (private room! 🎉), and things were looking good. AB was happy and healthy and latching well, Sam was a champion swaddler, my blood pressure seemed to be regulating, all was well. We were discharged three days after we had been admitted and two days after her birth, on my birthday, with instructions to keep monitoring my blood pressure.

Initially, recovery was a walk in the park with AB in comparison to after BB. I didn’t feel so rocked mentally (probably in part because it wasn’t the height of the Covid pandemic), and there was a lot less pain “downstairs”.

But as happened after BB’s birth, my blood pressure started spiking after we were discharged. We headed to the hospital with AB in tow, hopeful that it would be as straightforward as the first time around when I was monitored for a day and then discharged with blood pressure meds.

It was not.

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An important difference to point out before going further: at the hospital where BB was born, postpartum complications are readmitted via labor and delivery triage and you’re encouraged to bring your partner and baby. At this hospital, postpartum complications are admitted via the ER and there is no clear policy around newborns.

Brooklyn ERs are NO JOKE. This should have been obvious to us, but we didn’t think it through. We brought AB along in the hope that she could be admitted with me to keep going with the rigamarole of establishing a milk supply, but upon entering the chaos of the ER, it was immediately clear that this was a terrible idea. On top of this, the ER nurses were skeptical that Sam and AB would be able to stay with me past the ER anyway. So Sam left with her, ordering a bottle of liquid formula to our apartment via Postmates so that he could feed her and asking his parents to urgently sterilize BB’s old bottles. His first night of solo parenting two kids was five days after our second was born. I remained in the ER, lying in a brightly lit hospital bed within arm’s reach of a poor soul on some sort of ventilator, trying to use a hand pump to express milk as privately as I could in full view of the rest of the ward while Googling what sort of pumping schedule is required to keep up a supply.

Initially, spirits were reasonably high. The hand pump worked and I was hopeful that my stay would be relatively quick and uneventful. My blood pressures were high but not so high as to be life threatening. And of course it hadn’t gotten too bad with BB, so there was some precedent. Just had to wait for the blood work.

No such luck. My blood pressures would have put me in the borderline category, but my liver enzyme levels were bad and put me in the “severe” preeclampsia range. I was to be put on a magnesium sulfate infusion for 24 hours, then blood pressure medication and monitored for at least 24 additional hours. Monitoring throughout would involve a blood pressure cuff that went off every 30-60 minutes and blood draws every 6 hours. None of it ideal, but all of it necessary.

I was being admitted to the antepartum ward, but they decided to get the drip going in the ER since I was supposed to get up there quickly (famous last words…) and so that I’d be off the mag drip sooner the following day.

After about 15 minutes, the side effects kicked in. This stuff is VILE. Side effects are different for everyone but my main symptoms were double vision, brain fog, dizziness, muscle weakness, major irritation around my Hep-Lock, and especially a burning sensation over my entire body. Looking back on it, and knowing what I now know about the “minor” side effects (“minor” according to who?!), I think it also really heightened my anxiety.

When they started the drip, they were thinking 30 minutes before I’d be taken upstairs. 30 min turned in to an hour, which turned in to two hours, etc. (To be clear, I don’t hold that against them. Every single person that cared for me was stellar, and there are a million reasons that these things can get delayed.) My “time to pump” alarm went off two hours after the successful hand pump, and I went about setting up the hospital pump. At this point I was in quite a lot of discomfort and pain between the medication side effects and engorgement. I started pumping and tried to relax. About 7 minutes in, I looked down and…

Nothing was coming out.

From around 5pm until around 1am, every pumping session with a hospital-grade pump resulted in nothing. I had a “let down” sensation each time which increased the engorgement, but nothing came out. I verified the machine was working, all the pump parts set up correctly, and yes, still nothing.

The engorgement pain was already bad and only getting worse, so I started getting panicky. I guessed that between the pain, discomfort, and anxiety, I didn’t have a lot of oxytocin – the “love hormone” most involved in establishing a milk supply – to spare. I couldn’t control the discomfort from the mag therapy or the anxiety, but I could control the pain, so asked for ibuprofen and ice packs.

I never got ibuprofen in the ER. I have no idea why, the nurses were exemplary otherwise so maybe they just were wary of giving it to a nursing mom. As for ice packs, the well-meaning male nurse who was working with me kept insisting on heat packs. I understand that since heat was the prevailing advice until extremely recently, but it was the polar opposite of what is now the leading guidance and only exacerbated the engorgement. By about two hours in to my ER stay, I was truly frantic and very teary. I remember texting with a group of my college friends and describing it as “harrowing”, that the whole experience was overall much more painful and more stressful than giving birth without an epidural. It probably sounds hyperbolic, it does to me when I read those messages back. But it really felt like that in the moment.

When I was eventually brought upstairs to antenatal, one of the midwives came by to check in and go over my care plan. She had a look and said it was some of the worst engorgement she had ever seen. Hand expression did almost nothing. It was only after I finally got some ibuprofen that pumping started to work. I truly cannot describe the relief.

Once I calmed down a bit, I commented to the lovely nurse that I was surprised babies couldn’t be admitted for postpartum complications, especially since it’s a “Baby-Friendly” hospital. (For the unaware, “Baby-Friendly” is Whole Thing™️, but the gist of it is that they optimize for mother-baby bonding and feeding so there is a lot of emphasis on doing everything possible not to separate the mom and baby.) She looked at me with a confused smile and said, “Of course you can have your baby here!”

I lost it at that point, trying to explain through sobs that I had been told differently in the ER and found it so hard. It would have been so, so much simpler and less painful if I’d just been able to feed AB, even if it was just from when I was admitted to the antenatal ward. At that point it was too late to have Sam and AB come over, it would have been too disruptive for them. So we decided to have them come first thing the next morning and I spent the rest of the night alone pumping every two hours, failing to keep the pump tubes from tangling with the two IVs coming out of my arm and the blood pressure cuff tube on the other arm without moving my feet much since they were encased in these boots to promote circulation, with their own tubes coming out of them. No hope of introducing a pumping bra to that labyrinth, so I just held the cups in place and tried to stay awake.

There is no chance that the woman in the bed next to me is reading this, but just in case: I am so sorry you had to sleep next to a basket case that wouldn’t turn the light off.

Eventually it was 6am, and Sam + AB were allowed in before normal visiting hours. Everything was so, so much simpler from then on. Still painful and uncomfortable, but very manageable.

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24 hours after it started, the mag drip was out. I was told to let them know when I wanted to get up to pee since my legs would probably be weak, and boy howdy they weren’t kidding. It was like walking on Jello. We had to stick around for another 24 hours to get my blood pressure meds right (thank you Sam for sleeping on the terribly uncomfortable chairs), then we were sent on our way. I was even able to bring home that first bag of milk that they stored in the ER thanks to the valiant efforts of one of the antenatal nurses. Unfortunately that’s the only one I could keep, the rest had to be thrown out because I could never leave the bed to clean the parts.

Back home! Then three days later, back in the ER.

I told to go back because of super high BP readings, headaches, shoulder pain, and wrist numbness. 🤦🏻‍♀️ But this time I was prepared. Mentally, I was ready for battle. Part of the reason it was easier to face was that I knew I wouldn’t be on the mag drip again. Also, I knew it was unlikely something serious, probably just needed to adjust my BP meds. I came with nursing covers, cozy socks, audiobooks, the whole nine yards. The trickiest part was ignoring the man handcuffed to his bed who was sweating profusely and clearly on the comedown of a lifetime. He eventually figured out how to disengage the wheel lock on the bed and tried to wheel himself out, bumping in to people as he went. Through noise cancelling AirPods, I heard more and more take-no-shit New Yorkers in other hospital beds raising the alarm until a few of the bigger nurses and a cop came by to get him back in his room.

Thankfully the EKGs and CT scan were all fine. All I needed was an intravenous dose of Labetalol, and then I was sent home with instructions to double my at-home BP meds. The headaches were probably a side effect of the BP meds (how’s that for confusing, when the reason for a medication and the side effect of a medication can have the same result), and the shoulder pain + wrist numbness were probably a result of some dumb breastfeeding posture.

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Since then, recovery has been smooth sailing. Knock on wood.

I have to keep monitoring my blood pressure every day in the hope that I’ll be able to come off of the BP meds like I was able to after BB was born. And I’ll need to check in about heart stuff with my doctor for the rest of my life. Women who have had preeclampsia are at higher risk for heart disease, stroke, hypertension, and diabetes. Here’s a fun tidbit from Yale Medicine:

Women who have had preeclampsia are at least twice as likely to have heart disease later in life. Cardiovascular disease was responsible for one in five deaths in women in the U.S.—more than any other cause, including deaths from all types of cancer combined, in 2021.

“We now think of preeclampsia as a red flag or a ‘canary in the coal mine’ type of diagnosis that should be considered an indication for earlier cardiovascular risk factor assessment, which typically may not be pursued until later in life,” Dr. Goldstein says.

Patients diagnosed with preeclampsia would likely benefit from earlier cardiovascular risk factor screening, including cardiometabolic testing, which involves checking cholesterol levels, markers of type 2 diabetes and other diseases, within a year after delivery, she adds.

So there’s that. 🌈⭐️

In the end, I don’t know which recovery was tougher, BB’s or AB’s. You might think that surely BB’s must have been easier, but that was extremely difficult in its own ways. So much pain from the episiotomy and pushing for so long. Who knew postpartum pain could feel like your tailbone falling off!

Looking back on it, I think I had postpartum anxiety with BB. It really rocked me, and I’m sure the pandemic and wildfires in the Bay Area didn’t help. In terms of weight stuff, it took 1.5 years after BB before I was back to my pre-baby weight, and some of my clothes never fit the same anyway. After AB, I was back to pre-baby weight and in pre-AB clothes in about 2.5 months. I have no idea why the huge difference, maybe I’m a bit more active this time round? Nothing extreme though. And still no chance of fitting in pre-BB clothes, but those are long gone and forgotten anyway.

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One final thing I want to say: BB has been a superstar through this. He’s had a slight uptick in tantrums, but really minor overall and honestly all very understandable considering the significant upheaval.

Example: When my parents visited about 4 weeks after her birth, there was one day when my they were going to stop by earlier in the morning than they had on previous days. BB started to lose it, saying he didn’t want to see them. I couldn’t figure out why, he had been so excited to see him the prior days. Then I thought about his experience around AB’s birth, with his parents’ barely-planned disappearances over the course of two weeks coinciding with his grandparents’ presence. Poor little guy. He probably started to associate an unexpected arrival of grandparents with our inevitable disappearance. It breaks my heart.

Anyways yes, an uptick in tantrums from BB but all temporary and all understandable. And they are always directed at Sam and I rather than AB, which I would take any day.

In terms of his reaction to her, he was initially sort of indifferent around AB. Then about one week in to her sustained presence (three weeks after birth), he asked to hold her. Maybe about two weeks later, he started insisting on kissing her goodnight, something that continues to this day. A few days ago, I got to watch while she just beamed at him and he couldn’t stop laughing at her adorably goofy baby smile. ❤️ Now he wants to build BRIO tracks around her while she bats at things on the floor.

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I just read this back and am realizing that a lot of it probably sounds pretty alarming, particularly if you’re at risk of preeclampsia. So here are a few thoughts for those folks.

Know that all is well with us now. Even though I had some very rough patches, I am overall very happy with my experience because my care and support was fantastic.

Choose a care team that is aligned with your preferences first and foremost, and be aware of how they handle postpartum complication admissions. If you are opting for a non-hospital birth, have at least passing familiarity with where you would go if a hospital is required, and under what circumstances.

If you’re wary of how your hospital handles postpartum complications, start a conversation. Show the administrators this post if you want! The two changes that would have made the biggest differences in my experience is 1) rock-solid clarity around whether or not newborns are allowed in the ward where postpartum complications are admitted (it can vary, it was antenatal at this hospital and postpartum at the hospital where BB was delivered), and 2) having postpartum complications be admitted via labor and delivery triage as opposed to the ER.

But my biggest advice is probably to choose a supportive partner, and make sure you communicate thoroughly through all of this. (Couldn’t have done it without you Sam, not in a million years.) Have a clearly written single-page birth preferences document so that your supporters can help advocate for you if you are unable. And never, ever decline help from friends and family when it is offered in good faith. You might be surprised at how many people would love to help.

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* Quick side note about the episiotomy with BB. At the time, BB’S heart rate was dropping and I was exhausted, so when they said “Episiotomy, do you consent?” my only reaction was “Do it NOW”. A bit of topical anesthesia, the sound of a piece of calamari being cut (💀 Sorry! I had to hear it, now you can hear it in your head), and we were off to the races. I wasn’t totally with it at the time and couldn’t recall after the fact why it had been needed. When I asked, apparently it was an “intact hymenal ring”. I now know that in many cases, though not always, just the hymenal ring should be cut as opposed to tissue as well (source). Just wanted to share that link for broader awareness since it may be relatively common, and I would have advocated for only having it cut as opposed to a full-blown episiotomy had I known.