“Ariana’s Story, Part 1: TFMR, termination for medical reasons” – with Dr. Ariana Huselid

Dr. Nathan Fox: Welcome to today’s episode of Healthful Woman, a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At Healthful Woman, I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.

Ariana, thank you so much for volunteering to come on the podcast. I really appreciate it. How are you doing today?

Ariana: I’m doing well. I’m very happy to be here.

Dr. Nathan Fox: Terrific. So we’re going to be talking today about your recent story, which is very important and difficult. And I’m just curious off the bat, what was it that made you reach out to tell your story?

Ariana: Yeah, as I’m sure your listeners already know, and as we’ll be talking about over the course of this podcast, earlier this year, I underwent a termination for medical reasons of a very wanted pregnancy. And it was such an eye-opening experience for me. You know, I am someone who is in the medical field. This was not something that I knew was unexpected. But going through it myself, especially going through it knowing that I’m in such a place of privilege, it was just still so hard. And since this happened, I’ve gotten to know so many other women and just recognizing how much silence and stigma, and misunderstanding there is around this topic, made me realize that I want to share my story because I think it’s important for others to understand that this very sadly is a thing and is not as uncommon as people may realize. And what folks can do who may have loved ones who are going through similar situations in order to support them. And especially in this current political environment, I think it’s more important than ever to be talking about some of these things that so often are just brushed under the rug. And yet they’re unfortunately a reality for a lot of people who are going through the process of trying to start a family.

Dr. Nathan Fox: Yeah, I mean, I really appreciate that. And you know, termination abortion is such a tough topic for so many reasons, and sort of the overshadowing all of it, as everyone knows, is it’s so politically and emotionally charged for people, understandably. And it makes it difficult to even have conversations about it. And you know, in this podcast, it’s you know, we’re about women’s health and pregnancy, and it’s a part of it. And on the one hand, like we don’t want to be a podcast where 50% of the population feels unwelcome, right? In either direction, we want everyone to feel welcome here and comfortable here and that they can gain something here. And so it’s always challenging to figure out, like, how do we talk about this topic in a way that’s helpful to people and not in a way that’s going to sort of like validate half the population and piss off the other half of the population? And it’s tough and it’s tough. But I think, you know, what you’re bringing up and we’re going to talk about is that however people feel about this, this is a reality and this is a situation that people don’t always envision when they talk about abortion and termination. It’s just not something that’s, you know, that comes from their wavelength, so to speak.

Ariana: Absolutely. And even, you know, going through pregnancy for those people who are listening, who are like me, which I’m guessing most of your listeners are, who want all the information and love learning about this stuff. It was so interesting going through this process and just recognizing any book about pregnancy you pick up, any podcast you might listen to about pregnancy. There’s so much information about prenatal genetic testing and the importance of getting ultrasounds and all these things. You know, it feels like there’s just this void about, well, what if you get this bad news? And it’s not talked about like this horrible decision that one might be faced with. And most people don’t think about what it would be like, or even if they do, it’s so different to actually be in that situation and trying to navigate this. And I think there’s so much guilt and shame for women and families who get negative diagnoses and really in either direction of what they choose to do. It’s just a horrible situation to be in. And over the last number of months, I’ve gotten to know so many women in this community. And, you know, what I want to share, even for those people who really don’t think that there’s ever a time for abortion to be okay is these decisions are not made lightly. They are made out of love. These are unbelievably challenging parenting decisions is really what it is, which is so hard to do before you’ve ever even met your child. And they’re not taken lightly. And they’re with a lot of anguish. And people are trying to “choose” if you can even consider it a choice what to do when you have no good option in front of you. You know, in my case, I knew my baby was going to die. It was the question is when and what was going to be the least harmful to him. And that’s a horrible position to be in. And that guilt on top of that and the feeling like I can’t talk about it is like it’s just it’s bizarre. But and it makes sense because it’s such a hot-button issue, of course. But ugh.

Dr. Nathan Fox: Yeah, ugh. And like you said, the shame goes and the guilt in both directions. People either again, some of this is internal, obviously, and some of it is external. Some of it’s just people intrinsically feel shame and guilt, which is unfortunate. But that’s just human nature and others. It’s directly placed on them or indirectly placed on them. And it’s the shame or guilt of ending a pregnancy or the shame or guilt of continuing a pregnancy with a baby that has abnormalities and problems and serious problems. And so it’s just like you said, there are no good options and people don’t always recognize that, which is why, again, I really appreciate that you’re going to talk about this with us. And so our listeners can really benefit from what you went through to put any possible positive spin on a horrible experience that others can learn from what you had to go through yourself. And I really appreciate that.

Ariana: Absolutely. Well, thank you for giving me the time and space to do so.

Dr. Nathan Fox: So take us back to, I guess, right before you got pregnant. So I guess this would be last year. So just give her a sense of who you are, where you’re from, what are you doing? Like, where are you family life? What’s going on in your life at that time?

Ariana: I was in a space. It was last year at this time when my now husband and I were starting to try to start a family. It was a really exciting time. I, you know, for a little bit of background, I was someone who did not realize until I was 33 and seven months and maybe a couple of days when I woke up one morning and suddenly realized, “Oh, my goodness, I think I actually do want children.” It was bizarre. It was like a light switch had flipped. And up until that point, I really didn’t think that I even wanna have kids or at least was very much on the fence about it. So that led to a lot of scrambling. So first of all, get out of the marriage that I was in. I’m just someone who definitely did not want kids at that time. And we realized this was not something that we could compromise on. We couldn’t really have half a baby. And, you know, so that marriage ended and I moved home to North Carolina. I had been living in California at that time and was around my family and was really, really fortunate to meet an amazing man very briefly after or very shortly, I should say, after moving to North Carolina and who is now my husband.

Going into that, though, you know, I knew that I was older. And I had also after moving to North Carolina, gone through a couple of rounds of egg freezing, knowing that I was older. And in that process, realized that I had diminished ovarian reserve. So even though I had some eggs on ice, I knew it wasn’t a ton. And we wanted more than one kid. So the time pressure was on. So it was an exciting time to start having kids. And yet it was also very anxiety-provoking. And we had assumed that we were going to have a hard time getting pregnant. And in retrospect, we really didn’t. It felt like it took a while. But by early October of last year, 2023, we had a positive pregnancy test and we’re just over the moon.

Early pregnancy was just such a joyful time. Both of our dreams to become parents was coming true. We’re also at that time planning our December wedding, which was really all of a sudden becoming not just a celebration of the two of us coming together, but also a growing family and early scands. Our NIPT were all completely normal. We were on vacation in Bali when we sent out and found out that we were having a boy. I mean, it was just an amazing, amazing time.

That being said, I, you know, as I mentioned earlier, I was doing a ton of education. I don’t usually do things halfway. And I had completely thrown myself into learning. You know, I am in medicine myself. So, you know, I had some knowledge from going through medical school of all the things that could go wrong. And then I felt like I was just bolstering that by doing extra research on all the things that could go wrong. And I was, you know, happy, but cautiously optimistic about how things were going to go. And Kevin, my husband, was really in a lot of the same boat. And we were frequently talking about how it almost seemed too good to be true and obsessively checking miscarriage calculators and saying, “Okay, today our chance of miscarriage is down by, you know, 0.2%. Excellent. Let’s celebrate.” It was a little bit nuts.

Dr. Nathan Fox: Is Kevin in medicine?

Ariana: He’s not, but he’s an engineer. So, you know, he’s wired, you know.

Dr. Nathan Fox: Yeah, he’s a different kind of abnormal from our abnormal.

Ariana: I believe exactly.

Dr. Nathan Fox: And what kind of medicine are you in?

Ariana: Yeah, I’m a psychiatrist or specifically a forensic psychiatrist, which I would say is the last thing I ever thought I would do when I started medical school. I didn’t even know this is a thing, but I had the best job in the world. So that’s a probably a different podcast. Yeah, very interesting job.

So by Christmas though, I think we had started really relaxing with the fact that this is going to happen. We started making plans for a nursery. A friend of mine had driven down for a wedding and it dropped off all of her baby supplies, started applying for daycares. And this really started sinking in that it was going to become a reality. Then we got to our anatomy scan on January 9th of this year. And I was nervous going into it. I remember posting on a what to expect message board saying that I was really worried. Even though I knew, you know, I knew the statistics, I knew more likely than not, much more likely than not, things are going to be just fine. And I worked hard to use some CBT techniques on myself to really convince myself that it was almost certainly going to be okay. And this was an opportunity to enjoy and meet our baby and really see him.

And by the appointment, I mostly relaxed. But that really is when, you know, kind of the other shoe fell off, so to speak. So the scan itself is one of the most disturbing memories, I have to say. I have the entire experience looking back on that. Remember, you know, Kevin was very excited and I was excited. But and I immediately knew there was something really not right. And, you know, the ultrasonographer, you know, was a little bit subdued. But what I now realize in retrospect and, you know, very quickly in retrospect was I just didn’t have any amniotic fluids. I was staring at this image on the screen. I was like, this is not what a baby looks like. But it wasn’t… I was so flooded with anxiety then that I couldn’t even put it together or even like voice my concern. It’s just like, this is a weird. What am I seeing? Is she was pointing out the ultrasonography, you know, here’s its leg and I’m measuring it. But I was like, this is something’s really wrong. Something’s really wrong.

Dr. Nathan Fox: Right. How far pregnant were you at the time? Was it 18 weeks, 20 weeks, 16?

Ariana: Yeah, I was 18 weeks.

Dr. Nathan Fox: 18 weeks. Okay.

Ariana: 18 weeks. So I wanted to get in for as early as early as possible for that anatomy scan. And she did so. After, you know, after she finished, she did say, you know, “You know, I’m not seeing any, you know, just about any amniotic fluid. See, you know, there’s just this little pocket over here.” And she showed us this little pocket. And then I was like, “Oh, yeah, of course, of course.” That’s what’s so utterly wrong with what I’m looking at here. And she just asked if I had had any leaking. And I said, you know, I hadn’t. And she then let us know that she was going to go get the doctor to take a look and to be back soon. And I remember her leaving the room and just being [inaudible 0:12:12] just flooded with anxiety and kind of looking at me and said, you know, “So do we start Googling now?” [inaudible 0:12:18] change. I mean, I think we chuckled just a little bit. And I said, “Oh, that’s probably not a good idea.” But we have to. Right? So, of course, we did like the very quickest Google search in the world. And as I expected, you know, of course, you know, pulling way back into any medical knowledge I might have had of reasons why somebody might not have amniotic fluid at that point, but I quickly confirmed that there is no reassuring reason not to have any amniotic fluid at this point. But, you know, it was still confusing and pretty quickly. Fabulous, fabulous, fabulous maternal-fetal medicine doctor, Dr. Rachel Wood, came in and she repeated some parts of the scan and then letting us know, you know, what she was looking for, that she was mostly trying to see if his kidneys were anywhere else. And she ultimately sat down in front of us and said that she wasn’t able to find them, that our baby boy didn’t have any kidneys. And at that point, I crumpled because I knew immediately what that meant. And in her second breath, if she even did take a breath, she quickly said, you know, this condition, I’m sorry to say, is incompatible with life. And at that point, I saw Kevin just kind of crumple at that point as well.

Dr. Nathan Fox: Boy.

Ariana: And I just want to pause here to acknowledge what an amazing clinical interaction this was. I mean, it was textbook. Dr. Wood was so compassionate. She shed some tears herself. She paused at that moment to let us know that she can provide as much or as little information on the situation and potential next steps as we’d like, really looking to us to figure out what we needed in the moment. And, you know, I was thinking about this recently. I was listening to your podcast with Dr. Jorda about perinatal trauma.

Dr. Nathan Fox: Yeah.

Ariana: And just thinking about how, you know, in some of them I was hesitant to share my story and a little bit sheepish about it because I had it, I mean, about as good as it could possibly be in some ways with regards to this. I mean, Dr. Jorda, you know, talks about in her podcast the three potential things that can be done to lower the risk of it being a traumatic experience. And I feel like all of those things that were really in my favor.

So one of those that you talked about was education. So both before and during the potentially traumatic experience. So I felt like I knew what could potentially happen before. I was very much educated about that as well during which I’ll share, you know, Dr. Wood meeting us where we are at. And then I’ll share about some more providing education. The communications are taking the time, meeting us where we are at, figuring out our style. And then also expectations. I mean, you know, for better or for worse, I feel like for better. In this case, I didn’t have the highest expectations. I didn’t think that this was all going to be great. I’ve talked to a lot of women in the last couple of months who’ve gone through similar things and I had no idea that something like this can be discovered at this ultrasound.

So a little bit of a sidebar there. But I do feel in some ways a little bit sheepish because again, I do think, man, this was as good as it possibly could be in a really, really horrible situation. So, you know, Dr. Wood, then, you know, after I let her know. And I do wonder how like Kevin might have chosen something different. I don’t know, I actually hadn’t explicitly asked him that. But, you know, I did say, you know, “No, I want absolutely all the information.” And she said, “Well, here are the next steps.” So there is always the opportunity not to do anything. You know, you can just continue the pregnancy. And, you know, “What I have to let you know is that we’ll have a high rate or high risk of miscarriage, stillbirth, fetal demise versus preterm birth. If you do make it closer to term, you’re at a high risk for a C-section. And the baby’s likely to either be born deceased or would die shortly after birth.” To say, I think that’s what she said. I’m sure I’m getting her words exactly right. So if she ever listens to that, I’m sure this is not word for word what she said. But that was kind of the general idea. That was clearly an option. Or you know, there was the option to end the pregnancy. And she let us know right then that could be done either surgically or by labor and delivery. And I remember very quickly saying that, first of all, I was really grateful that there was an exception to North Carolina’s current 12-week ban on abortion. So there is an exception for if you have a diagnosis of a life-limiting fetal anomaly, you are then able to get an abortion up until 24 weeks.

Dr. Nathan Fox: Right.

Ariana: And I was also, I remember one of the first things out of my mouth was I am so grateful that this is such a black and white diagnosis. The fact that this is a clearly legal abnormality made it so much easier.

Dr. Nathan Fox: Right. Right. In many ways.

Arian: Oh, gosh.

Dr. Nathan Fox: Yeah, I mean, legally, practically, emotionally, obviously. You know, I’m even emotionally, but at least sort of, I don’t know, whatever grappling goes on in Toronto. Just for just for our listeners. Just to explain that the reason that diagnosis is lethal. If the baby has no kidneys, the first problem that you would think is, okay, people need kidneys to survive. Well, you don’t really need kidneys to survive in utero. After birth, you do. But someone will say, “Well, can’t you do dialysis or a transplant?” So, yes, that part of the diagnosis can potentially be treated. But the issue is, if you are a fetus with no amniotic fluid throughout pregnancy, the lungs don’t develop. And so even if you could somehow fix the kidney issue, which is itself not really a great thing to do, you know, it’s not a great success rate. But even if you could, the baby doesn’t have any lung function at birth. And so that’s the reason it’s essentially they don’t survive after birth. And it’s considered a lethal diagnosis. So that’s just for our listeners to understand why that particular…Because, you know, we have babies born with one kidney all the time and they’re perfectly fine. And, you know, if there’s situations where there’s sort of low fluid for different reasons, but there’s enough fluid, it’s not quite as bad. But this is a classic, unfortunate, lethal diagnosis. But yes, it makes it much more straightforward, at least in terms of counseling and decision-making for a lot of people, because they don’t have that ambiguity of, well, your baby might be this or might be that, in which case you’re like, “How do I process that?” You know?

Ariana: Oh, I know. The stories I hear about women, yeah, this mysterious brain abnormality. I was like, “Well, they could have mild to moderate learning disabilities or, you know, be unable to feed themselves or walk.” [inaudible 0:18:32], “Well, what the heck?”

Dr. Nathan Fox: Right. But it’s interesting because it’s not even mysterious ones. I mean, there’s two issues with ambiguity and diagnoses. Right. Well, there’s three issues. One issue is sometimes people just either get bad information or don’t understand the information told to them where there is knowledge, but they don’t have it. That’s one issue. The second issue is there are definitely diagnoses where we’re not sure what’s going on, sort of what we see, what it means, this or that. But interestingly, there’s a lot of diagnosis where we know exactly what it is, like to the genetic, you know, everything to the point mutation. But there just happens to be a wide range of outcomes where like we know exactly what the condition is, the disease is, the malformation is. But we say, you know, X percent of these babies are fine. And X percent of these babies are mostly fine. And X percent of these babies are not well. And X percent of these babies are horribly not well. And like that is just I mean, it’s again, these are so gruesome to receive across the board, but for different reasons. But, you know, like you said, at least if you could say that in your story, it wasn’t one of those situations like we know what this is. This is uniformly lethal. This is terrible.

Ariana: Yes. Yeah. And I do feel like that was in some way. I mean, silverlining is not the right word, but absolutely. It was one of the first things out of my mouth. I am so grateful. It’s just it’s crystal clear.

Dr. Nathan Fox: Did you have … Before going into them, just curious if you’re comfortable answering this, going into this, did you have feelings about abortion beforehand? I mean, you know, just saying like, and were they sort of confirmed, were they challenged? I’m just, you know, I’m just trying to get a sense. You know, if you don’t want to answer that, that’s okay, obviously. But like, where were you a year ago if someone would talk about abortion with you?

Ariana: Yeah, absolutely. So I’ve always been pretty solidly pro-choice. And I think, you know, I’ve thought and I believe now it’s funny, it’s a little hard to even remember, but I’m pretty sure Kevin and I had some conversations about what this would mean. And we wouldn’t want to bring an incredibly ill child into the world. You know, I think we felt like, you know, we’re doing these prenatal genetic tests for a potential reason, not that we had sorted out, of course, every possible scenario, because you can’t do that. But you know, interestingly, if anything, I mean, in that way, you know, I think going through this experience has made me feel like even more of an advocate for, you know, for women’s choice, because, oh, my goodness, this is a different scenario than I think most people think of when they think about the run of the male abortions. Being said, it is interesting going through this, I, you know, I think before, you know, hearing some stories about some of those great diagnoses or great prognoses, I think I always thought it would have erred on the side of probably, I mean, probably erring on the side of terminating out as a [inaudible 0:21:19] on the side. But actually going through it, the more it was so far, I’m just recognizing and I think I’m not sure this is all coming out right. But I think what I’m just recognizing is how emotionally difficult it is to make that decision and do that, even if you think it’s the right thing to do for your baby, I’m more on the fence about what I would do in the future if things weren’t so black and white because it was so hard. If that makes sense.

Dr. Nathan Fox: Yeah. No, I mean, I think it makes complete sense. And I think that it sort of speaks to a number of things. Number one, obviously, that no matter, with obviously rare exceptions, it’s very emotionally difficult for everyone to go through this in any direction. And I think the other thing is sort of not not as an insulting way, but how the sort of naivete of most people about what’s actually happening and what decisions are actually being made and what people do or don’t have to go through and they think it’s this. But again, that’s why would anyone really understand that unless they have to go through it themselves or they’re, you know, I haven’t had to go through myself, obviously. But I’m in that world. And so I have a better understanding, I would think that, you know, the person on the bus, you know, about what abortion means and what the decisions that are being made and sort of what are the possible scenarios that this would come up. But I think that it, you know, like as a sort of an overarching lesson with all of the aggressive conversations about abortion is like a little humility that, you know, that most people who are very, very passionate in either direction about abortion don’t really understand the topic as well as they could. Is what I would say.

Ariana: It is so true. And, you know, one of the refrains that I hear so often from women who have been through some things is, you know, we talk about taking on the pain so that their baby doesn’t have to. And which is so different from I think so many people might look at the situation and say, “Oh, well, you’re just taking an easy way out because you don’t want this burden of raising a sick baby or this and that. Or you don’t want to…” These are not selfish decisions. And I think, you know, in this scenario for me, too, for me, it was like crystal clear that, you know, I’ve got my baby. I do feel like it’s my baby. Absolutely. And yet he’s only 18 weeks along. And the longer I wait, the more likely he is to probably start experiencing some kind of discomfort. And I know there’s some controversy around exactly when fetuses can start feeling pain, but no, most physicians, medical organizations argue. Please let me know if I’m wrong. That’s 24 or so weeks, maybe 25 weeks. And for me, that was just such a no-brainer. You know, if I were to continue the pregnancy, he would have been so squished. He was becoming so deformed without any amniotic fluid. Definitely not comfortable, definitely in pain. And then if he did happen to make it determined to be born alive, he wouldn’t survive for long at all. And I didn’t want him to be born suffocating, gasping for air. Or you know, it’s just to me, it was just clearly the humane thing to do. And this isn’t the right thing to do for everyone. But to take the choice away from mothers and parents to do what they think is the right thing in the best interests of their kids is just cruel. And you know, it’s a little bit bizarre to me thinking that, you know, we might look at parents who are facing a child or an infant who’s been born with some kind of a terminal illness and making the decision to stop pursuing aggressive chemotherapy or whatever it is to let them be in peace. They can be looked on as heroes and really brave to make a tough decision in the best interest of their kids. But when it comes to an abortion to do a parallel… I mean, different. I mean, I don’t really get into a medical ethics discussion. But there’s a lot of parallel in what you’re doing. You’re trying to keep your child from suffering when you know that it’s not ultimately going to result in a good outcome. It’s just the guilt and shame and stigma around it. It’s bizarre. Because it’s yeah…

Dr. Nathan Fox: Yeah. And it’s unfortunate. Did you at the time, did you feel the need to, you know, I don’t know, talk to others? Or I mean, obviously, you sort of knew what you wanted to do pretty quickly, it sounds like. But did you have to feel like I’m going to run this by someone? I want to talk to a friend, a family member, you know, somebody or did you just sort of like, you know, I know this is the right decision to what we’re doing. Because, you know, people obviously to very different degrees grapple with what they’re going to do.

Ariana: Yeah, no. And this was a little bit of a difference between my husband and I and how we make decisions, which is something we know about ourselves. We make decisions very differently and we process them differently. I usually make very quick decisions and I like to pull off painful things like a bandaid. So it was really in that about, you know, 30 to 60 seconds after Dr. Wood kind of dropped the bomb and said, “These are your options.” I said, “Oh, no, absolutely. More or less as soon as possible, I would want to do a, you know, a surgical surgical termination.” I kind of had thought about it before, and it was crystal clear to me. I know, you know, she did, you know, interject several times and say, please take all the time you want. If you want a second opinion, that is totally valid. I mean, like, it’s amazing if you want us to just do a second ultrasound just to confirm things. You know, I can tell you like it’s not going to change anything, but that’s really valid. And that is something that my husband wanted just kind of for peace of mind. So we were able to work with this. The clinic was just amazing, just being able to work around our schedules and trying to make this happen. So we were able to find a way to get in for a second ultrasound with a different doctor, just double checking to put his mind at ease while also not pushing back the procedure anymore. Because I knew that limbo period is going to be so hard. So I didn’t want to, I didn’t want to delay it.

Dr. Nathan Fox: Yeah. Yeah. What was it like going through the procedure?

Ariana: Yeah. So I would say the hardest part of the whole thing was the waiting. One of the other, you know, I’m really grateful that I didn’t have to travel out of state. Many, many women are traveling out of state these days for this. I was able to do this in North Carolina. And I’m grateful even if I did have to travel and had the means to do so.

Dr. Nathan Fox: Right.

Ariana: But, you know, one of the things in North Carolina is that there has to be a 72-hour waiting period after providing a person informed consent. And oh, my gosh, going through that is about some laughter with the tears with Dr. Wood reading all the statements like. And I understand that adoption is an option. And I understand that the father’s responsible, would be responsible for no pain. You know, child support is like this is utterly insane. And she’s like, “I’m so sorry.” I mean, yes. Insanity when politicians get in the exam room is just… Anyway… Because of that waiting period and with OR schedules, there wasn’t that waiting period. We would have been able to get in and get this done in like a couple of days, which is really what I had been hoping to do because it’s just so painful walking around and getting increasingly bonded to this baby. And just feeling like I’m pregnant and starting to look pregnant. And yet, oh, my goodness, it was just horrible. So we ended up having to wait, you know, 10 days. It could have been worse.

The procedure itself, you know, very difficult to show up in the hospital that morning, you know, knowing I was pregnant, but also knowing that I was about to not be anymore. One of the great things is that, you know, in that week or so, I had gotten connected with a lot of women in support groups, you know, in local communities as well as around the world, really, which I knew from going through other hard things in life is like the key when you’re going through something really hard. Talk to people who’ve done it before. It was really helpful. I was texting with some of them waiting, waiting in pre-op, kind of what I was going through. My husband was there and absolutely lovely. Just my biggest support. Some things that were also hard is, and I don’t blame anybody. I remember the nurse, the pre-op nurse, not acknowledging at all what was going on, and I don’t blame her. But she is, you know, it was just otherworldly. You know, I’m just another surgical patient.

Dr. Nathan Fox: Yeah. I mean, for all, you know, it’s like you’re getting your gallbladder out.

Ariana: I know. And yeah, it’s like, oh, my baby’s dying this morning. Don’t you…

Dr. Nathan Fox: There is some compartmentalizing that is sometimes needed to be done for people to care about their day. But it is, like you said before, bizarre,

Ariana: Very bizarre, very bizarre. But in, you know, I would say being wheeled into the, you know, out of the pre-op room away from my husband was probably the hardest moment of the day for, you know, all of us. I just remember, you know, just the tears like really started coming out that moment and saying goodbye to him, knowing that it was like our last moments as a family of three in a way. And I was going to wake up empty.

Dr. Nathan Fox: Yeah. Was it your doctor who you knew or someone who you got referred to?

Ariana: It was someone that we got referred to to do the procedure itself.

Dr. Nathan Fox: Yeah, [inaudible 0:29:53] procedure. Okay.

Ariana: But he was fantastic to me. You know, we had just met in that morning with Dr. Jonas Schwartz, who this is kind of the kind of stuff he does. And he also came in with the right tone, answered questions, really left the exam room feeling very heard and cared for by him. So really grateful for that. And yeah, yeah. One thing, you know, in retrospect that you know, one of the options was to deliver. you know, I can go through labor and delivery. That for me at the time was completely under the question. It seemed way too painful to go through that. I mean, part of it was, you know, prior to year about labor and childbirth in general and having that first experience, any of the dead baby’s really traumatic, but also just seemed to personalize.

Dr. Nathan Fox: Right. When you say painful, you mean you mean emotionally.

Ariana: Emotionally. Well, and physically. The whole thing just sounded like that’s the worst of both scenarios.

Dr. Nathan Fox: Right.

Ariana: In retrospect, if I can make the decision today, I would do that. I wish, you know, I wish, you know, if I had a chance to hold that baby, I wish I had that option. But I don’t regret it because I couldn’t have then. I could not. It would have been too painful.

Dr. Nathan Fox: Yeah. Yeah.

Ariana: Gosh. To have met him would have been amazing. So…

Dr. Nathan Fox: Yeah, that is… Yeah. That’s part of that decision, which, again, you’re not equipped to make that decision, you know, before you go through it. I mean, you know, you just can’t be, obviously. And so you can only look in hindsight and say, “Oh, you know, if I could do it again, I would do it the other way or whatever that is.” Again, either someone like you, you know, you chose to do the surgical procedure. You know, so basically go to sleep, you wake up, it’s done. Versus the induction, which is a little bit longer. But obviously, you get a chance. You’re not put to sleep and you get a chance to hold your baby or vice versa. Someone who chooses the induction or because there isn’t someone with the skills necessary to do the procedure. Right. They’re not they’re not readily available. Certainly in other states, they’re not readily available. And so they do that. And they’re like, this was too emotionally painful. I wish I could have just gone to sleep and wake up. And you don’t know that. How would you possibly predict that about yourself to take your best guess? But it’s almost impossible to guess right other than flipping a coin.

Ariana: Absolutely. Absolutely. Yeah.

Dr. Nathan Fox: Wow. And so, you know, obviously, I assume the procedure went well medically. What was it like when you’re done and you guys went home?

Ariana: Yeah. So the procedure physically was very easy. I have to say, you know, I really, just thoughout no pain, minimal bleeding. Of course, it was a very sad time afterwards, especially, you know, it’s sad. I could totally feel my [inaudible 0:32:34]. It’s like plummeting. And it is bizarre, you know, suddenly postpartum, but without a baby. And one thing to mention for some of your listeners who might not know is one of the things that can absolutely happen after a late pregnancy loss like this is, you know, your milk can come.

Dr. Nathan Fox: Yeah, I was going to just ask you, did your milk come in?

Ariana: No, you know, I had asked on the day before procedure when they were starting the cervical dilation, you know, I had specifically asked for a dose of Cabergoline to stop that. So that’s, you know, a dose of medication that can stop you from lactating afterwards, because I knew that would be really emotionally challenging. So that did not happen.

Dr. Nathan For: Okay.

Arian: I was grateful for that. And, you know, so that was a Friday that we had the procedure. And it was an incredibly sad weekend. I made probably insane decisions to try to go back to work the Monday after that. And I did end up having to leave that day at midday. You know, I was just teary and just I was not in the headspace to do that. And I still probably made those similarly nutty decision to go back to work the day after that. And I did work, which I have to say, from at least the people I talked about, it’s very unusual. I think part of it was actually most of it, I think, was coping strategy. I like work. It’s where I feel like I can be a little bit in control of things. And it was a distraction. And I thought about taking time off and my work was very supportive of me taking time off if I needed to. But I was just like, “What am I going to do? I’m just going to sit on the couch and be sad.” That seems scary to me, which probably suggests I should probably get back into therapy to process that. Although I will say I was in therapy at that time. I was in therapy for a little while. But like, why, why is that so hard to just get with emotions? But it was, you know, it was a challenging time. And there are all of these other decisions you have to make and fall out. Right. Do you want a funeral? Do you want to be cremated? Do you want footprints? All of these things that you’re just not printing, you know, and you’re just cleaning a nursery weeks before. Yeah.

Dr. Nathan Fox: What I would like to do is I want to pick it up next week and talk about sort of the aftermath of this, you know, personally in your family, amongst your friends and also the future for you, like where you see yourself headed. And then importantly, I want to talk about this topic and why your story is important and why you think it’s important and what people, you know, what you hope they take away from the story. So I want to do that next week and give it its own time so we don’t rush it and do it in a separate podcast.

Ariana: Sounds great.

Dr. Nathan Fox: So thank you so much. And we are going to pick it up next week with part two of your story.

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