So much of caring for patients with chronic conditions that can interfere with pregnancy and childbirth is personal, which is why today we talk with Zehava, a listener of the podcast, who shares her personal journey through pregnancy with ulcerative cholitis, in the midst of COVID protocols in hospitals around the country. Although she delivered her son at just over one pound and 30 weeks, both mother and baby are doing well.
“Colitis and Fetal Growth Restriction: Zehava’s Story”
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Dr. 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. Zehava Cohen, welcome to the podcast. How you doing?
Zehava: I’m good. Thanks for having me.
Dr. Fox: Well, thanks for volunteering. I appreciate it. What led you to volunteer?
Zehava: Oh, I just enjoy listening to the podcast. Since I found it, I’ve been binging through since the first episode. Almost at the end. And I just think it’s great to share the story, something that I wish I had when I was going through it. I only discovered the podcast like a few weeks ago. And I think it’s great for other people to be able to hear, even if it’s not a similar story, hear that other people go through hard times and that not everyone’s birth story is as easy as it may seem when you first get pregnant.
Dr. Fox: And we’re talking about your birth of your son Ellie, [SP] who is a little more than a year old, correct?
Dr. Fox: All right. How’s he doing now?
Zehava: He’s doing great. I mean, he still has some things to catch up on since he’s a preemie. But he’s doing really well for his adjusted age.
Dr. Fox: Take us back to either right before or right when you got pregnant just so our listeners know who you are, where you’re living, you know, what’s your situation in life, so we can sort of set the story beforehand.
Zehava: So we got married in August of 2019, just a few months before COVID. And we were living in Baltimore. And I started working from home when COVID started. And I was on birth control, which was really triggering my anxiety. So I decided that I wanted to go off of it even though I was in the middle of a flare for my ulcerative colitis, which, in hindsight, was not the best idea. It’s best to go into pregnancy when you’re in a healthy state. But I didn’t really contact either my OB or my GI, I just decided on my own that I was gonna stop birth control. At that point, I was having a lot of symptoms with my ulcerative colitis. And in July, I had gone for a colonoscopy to see what the disease was doing at that point. It was about three or four weeks after that colonoscopy that I got a positive pregnancy test. The first thing I did was called my GI instead of my OB because I was supposed to be starting steroids to help the flare and I wanted to make sure those were safe during pregnancy.
Dr. Fox: Tell us a little bit about ulcerative colitis and what it was like for you, meaning when you were diagnosed and how it affected your life and then also, whether you and your GI had a conversation about it at any point prior about what it might mean for an upcoming pregnancy.
Zehava: So I was diagnosed when I was 21. I got married when I was 25. So this was about five years after I was diagnosed. In the beginning, it took about…like I had symptoms for about six months before I was fully diagnosed. The symptoms I had, which can vary in everyone’s case, so this isn’t particularly about somebody else. But for me, it was that I had a lot of diarrhea, I had an urge to use the bathroom every 20 to 30 minutes. And then when I would go, it wasn’t necessarily anything would come out. And if it did, it would a lot of times be blood or mucus because ulcerative colitis means you have ulcers in your colon. And those usually are bleeding, which is what causes the blood, the bleeding when you go to the bathroom. It causes tiredness because your body isn’t absorbing nutrients. I was very, very skinny. And I was, I think, 98 pounds when I was diagnosed.
So then, after diagnosis, they put me on prednisone, which helped cure the flare I was in and then they put me on maintenance medications which had changed over the five years, but I was never put on biologics, which is the next step of medication. But I was on this medication pretty much those five years. And I would flare around once a year. And when a flare happens, they usually prescribe prednisone or some other kind of steroid. When I moved… I’m originally from St. Louis, and when I moved to Baltimore when I got married, I got a new GI, and each GI has their method of how they like to treat a flare. But in general, I usually went on prednisone. Usually, within six to eight weeks, I would do a taper and it would help and I would be cleared out.
Going into the pregnancy, I was in a flare, and I went to the doctor and they prescribed prednisone, and it wasn’t working. So that’s why in July I had that colonoscopy to see what was going on and if maybe the disease had spread, or maybe it was in a larger area than it usually was. And at that point, they prescribed steroids through enema so that they could treat it directly rather than a pill that I swallow. And that was the medication that I wasn’t sure I should start when I got the positive pregnancy test.
Dr. Fox: Uh, okay.
Zehava: I don’t remember discussing pregnancy with them. I mean, obviously, they would have told me that I should not try until I was in a healthy state. I had done a little bit of like my own research. I’m on like a WhatsApp group of other people who have Crohn’s and ulcerative colitis. And a lot of them mentioned that they had babies that were low birth weight, but they went full-term, or maybe a few weeks, early 37, 38 weeks. So I knew going in that I could be considered high-risk. And then at my first OB appointment, I discussed it with my OB, and she’s like, “It could be that it will cause some problems. It could be you’ll have a perfect pregnancy and nothing will go wrong.” She said. “It’s just something we’ll keep an eye on.”
Dr. Fox: Right. Okay. So the pregnancy was a little bit of a surprise. And what did your GI say after you mentioned that you were pregnant so soon after the colonoscopy and the recommendation for new treatment?
Zehava: So my GI was concerned about my health, obviously. So he said that there’s no problem with the medications, and I should take them as needed. So I started the enemas and I still was not getting better. And he was saying that the next step would be biologics, but he didn’t want me to start such strong medications during pregnancy. So he was really deciding if I should hold off until after I give birth. So he was kind of like watching me over a few weeks. And I was concerned about taking prednisone during pregnancy because based off the research I did, I saw that if you take it early in pregnancy, there’s a chance of cleft lip, cleft palate. Is that what it’s called?
Dr. Fox: Yeah, that’s what it’s called. Correct.
Zehava: So I was concerned about that. And so before I messaged, my GI, I messaged my OB to ask her opinion on whether I should take the prednisone to help myself or a concern to the baby. And she told me that it’s no issue, and I should go ahead and take it. I think it was around my 18-week.
Dr. Fox: Right. I mean, especially if that’s what you need to get well. At 18 weeks, it certainly wouldn’t have an effect like that on the baby because, I mean, the baby has, you know, lips in a pallet at that point, so it wouldn’t, you know, damage them or anything like that. What was your GI’s concern about the biologics in pregnancy? Was he or she concerned that they would somehow harm the baby or just that you wouldn’t respond the same way because you were pregnant? Did you get a sense of why there was hesitancy?
Zehava: I’m not sure exactly what his concern was. I think he was afraid to switch my medicine during the pregnancy. And once I was already…at that point, I was already like halfway through the pregnancy. I think he wanted to wait until after birth. I’m not exactly sure his reasoning.
Dr. Fox: Okay. All right. I mean, it could be a number of things. So you’re sort of at the midpoint of pregnancy. You did go on the prednisone, and did it help?
Zehava: Yes. So it helped… Oh, also, what he did is he did a much shorter…usually, I started at 40 milligrams, and then I would do a week of that and then taper off, because of the medication, that you have to taper. And for this, he’s like, “Well, let’s try a quicker taper just because you’re in pregnancy, and we’ll see if it works.” So I did it over…I think I did three days at 40 and then three days at 30, three days at 20.
And so I got off it faster than I usually do, and it worked. Which is interesting because if you do a lot of research, some people say that pregnancy heals the gut. And like for years, they’ve had issues, and then when they get pregnant, all their symptoms go away. And some people have the opposite where they get pregnant, and then it just causes issues. So I was wondering if it was like a combination of maybe pregnancy and the medication. I don’t really know. It’s just some stuff that I was reading up on.
Dr. Fox: Well, no, you’re correct. I mean, some people get better, some people get worse. Hard to often know who that’s gonna be. It tends to be that people who get worse are people who go into pregnancy, you know, in the middle of a flare or the middle of sort of a run of flares, like you did. In general, since ulcerative colitis is, you know, one of these autoimmune diseases, you would think a lot of people will get better in pregnancy because your immune system is lowered. And that’s what we sort of hope happens, but not for everyone. But maybe it’s possible that, you know, you sort of went into pregnancy with some flares and that they were still acting up, but the reason that prednisone worked quicker is potentially because your immune system was already sort of pre-lowered. Like, prednisone lowers your immune system, and that’s how it works there.
And maybe the same, you know, maybe you sort of made more effective because your immune system was a little bit lowered just from pregnancy. Who knows? Hard to say. So tell me what happened after that. I assume they were measuring how you’re doing and how the baby’s growing as well, because like you said, with nutrient deficiency and whatnot.
Zehava: Yes. So I went in at 20 weeks for my anatomy scan and that was the first time it was concerning that he was not growing at the regular rate. I don’t remember what percentile he was in at that point, but he was measuring small. And then they thought maybe the dating was off. So they went back and they checked my previous ultrasounds, and based on the week and his weight at that point, it was correct. So they sent me to maternal-fetal medicine at the hospital three weeks later, at 23 weeks just to get another growth scan and to see if they could pick up anything else.
So at 23 weeks, I went for that scan, and he was still measuring small. At that point, they asked if I wanted to do genetic testing, which I didn’t think was necessary because there wasn’t anything else of concern. The heart was healthy. They didn’t see any defects. I’m petite and my husband is petite. So I thought it could also be genetics, maybe it’s just smaller because we’re smaller people. And then I also knew that ulcerative colitis can cause smaller babies. So I didn’t think there was necessarily reason at that point to do the genetic testing.
Dr. Fox: Was it your impression from them that they were saying, “Well, you know, you can do an amnio because that’s like one of the things on the checklist to make sure that everything’s okay?” Or did they give you sense that they really thought there was a problem genetically with the baby? Right? Because, I mean, everyone’s sort of like, you know, an amnio is one of the things you do if the baby small in the second trimester, but you can say, “Well, we’re doing this just to be sure,” versus “Whoa, I think there’s a problem genetically, let’s do this.”
Zehava: At that first initial appointment at MFM, they didn’t seem concerned. Like, they gave us the option. I was also there by myself, because it was COVID. So my husband wasn’t with me. So it was like, I didn’t really wanna do it without my husband there. And at that point, they didn’t seem so concerned. So I didn’t think it was absolutely necessary. And they just asked me to come back for a follow-up again just to check on the baby again. So I think I was going in every… They can only do a growth scan every three weeks to check for…because that’s how long they need too…period of time in order to check the growth. But I think they were already having me come in every two weeks at that point just to monitor the heart rate and do… Yeah, it was like I would come in, I think…
Dr. Fox: Probably the blood flow, like the Dopplers, yeah.
Zehava: They were doing the Dopplers and they were checking his heart rate. And at 26 weeks, they did another growth scan. And at that point, I think he was even lower on the charts. So his growth was possibly even slowing, which, at that point, they had me start coming in twice a week. And then they would do an NST. And then once a week, they would check the blood flow.
Dr. Fox: And at this time, obviously, that’s, you know, pretty scary situation. But your colitis was not acting up at this point, that was sort of behind you, so to speak?
Dr. Fox: Okay. So you’re there, there’s concern about the baby’s growth, you’re coming twice a week. Did they give you the impression that you may need to deliver the baby in the near future, you know, because the growth was not doing so well?
Zehava: I don’t remember at that point if they said it would be an early delivery. I’m trying to remember. I don’t think at that point they were concerned. I think they just were having me come in just to ensure that everything was continuing. I remember them showing me like a growth chart, that he was growing, it was just on his own curve. So it wasn’t as if the growth had stopped.
Dr. Fox: Understood. Okay. And then when did things sort of change?
Zehava: So at 27 weeks, I came in for one of my NST appointments and they hooked me up to the monitors, and then they took my blood pressure and my blood pressure was high. So they were concerned, but they said it was… I don’t remember exactly what it was. It was high, but it wasn’t like 170. I think it was in like the 140s maybe. And so they said they’ll let me sit there for half an hour run to keep me on the heart monitors and then they’ll take my blood pressure again before I leave. So, I mean, I wasn’t too concerned. I have anxiety and I was like, “Maybe I was nervous, and that triggered my blood pressure to rise.”
And so, at the end of the appointment, it was still high. So they were like, “We think we have to admit you.” And at that point, they made it sound like it would just be overnight, just for monitoring. The hospital was really full at that time, and all their triage rooms were filled. So they put me in this small room, closed off, nobody was in there. And I just kind of sat there. And I didn’t really know what was going on. I texted my husband like, “I think I’m gonna be admitted.” So then a nurse came in and had me give them a urine sample so they could test for protein. But there was no protein in my urine, which was good, because that means it wasn’t preeclampsia. I kind of sat there a little longer and then my OB came in. In my practice, there’s five obese, and each one has a different day of the week that they spent in the hospital.
So my OB came in and she discussed that it’s probably something that they just need a monitor overnight, maybe they would send me home with a blood pressure cuff. So at that point, I think they hooked me up to an IV and I just was kind of sitting in the room waiting to see what would happen.
Dr. Fox: Did they talk to you about the possible connection between the baby not growing well and your blood pressure being high?
Zehava: I don’t think so. I kind of was, like, overwhelmed with what was happening and I don’t really remember them explaining much. Once they came in and told me I was being admitted, that’s when, like, I got bombarded with all the medical team. And I was just crying. And I was by myself and had my OB come. And then they also had the MFM doctors. But then they also had like an anesthesiologist in case I needed to have an emergency C-section. And this point, I was getting really overwhelmed, and I’m like, “My blood pressure was high, and now they’re talking about delivery?”
And the neonatologist, there were a lot of people coming in. There were residents, it was just a lot of people giving over a lot of information that I didn’t necessarily understand everything. So then they moved me… They didn’t have any rooms in triage and they didn’t have any rooms available for me too. So they brought me to, I guess recovery, or, like, post-C-section area. So I was over there and hooked up to like a monitor. And then the nurse said that I was starting to contract.
Dr. Fox: What were the COVID rules at that time for your hospital? Meaning no visitors?
Zehava: No visitors. I think if you were coming in for birth, you could have one person with you. And then once they left the hospital, they weren’t allowed back in.
Dr. Fox: For you, what did that mean practically? Were you there alone, or was your husband able to come and stay with you? How did that work? Because you were admitted, so you were gonna be staying overnight, at least.
Zehava: Right. So I came in around noon. So my husband was at work. So I was like, “Well, I don’t really know what’s happening, so don’t come yet.” And when he got off of work, I was like, at that point, I knew that I was being admitted. So I sent him home to, like, pack up stuff that I would need. Like, I was wearing my wig, which I was like, “I am not staying in this while I’m in the hospital. Bring me some clothes, my cell phone charger,” like, some basics that I needed. So he went home, and then he met me there. And then at that point, we didn’t think he would be allowed to leave. And if he left, we didn’t think he would be allowed to come back.
Dr. Fox: And this is when…and we’re talking now, this is at the beginning of 2021?
Zehava: This is…yeah, January 2021.
Dr. Fox: So this is, like, right around the time, I guess when the vaccines were coming out, if I’m correct? Like, just started?
Zehava: Yes. So the hospital staff was just starting to get vaccinated. It wasn’t open to the public, it was open to that first tier of the qualified.
Dr. Fox: Right, because that’s basically when it rolled out. Okay. So when he showed up, was he ultimately able to come and go, or he had to stay with you, like, on lockdown?
Zehava: So the first three days we were there, he didn’t leave. And then once we saw that it was gonna be long-term, he had special permission that he could leave once a day and come back, whereas most people, once they left, they weren’t allowed to come back. So he had, like…he was in their system. He had to go through the security guard, and he had a past that he could come and go once a day.
Dr. Fox: Okay. So you’re there, they’re monitoring you because your blood pressure’s high, the baby is small, you’re having contractions, but not in labor. And what was it like at that time? Was it always…were you always like sort of living under the cloud of, “I could be emergency delivered every second?” Or was it sort of like day-by-day, that it felt to you?
Zehava: I was kind of in denial the whole time that I was gonna give birth so early. I mean, when I was admitted, I was contracting and then they did a cervical check and I wasn’t dilated at all. I was only contracting because I was so nervous and everyone coming over and telling me all this information was making me stressed out. Once I was admitted, it was kind of like they were monitoring my blood pressure, I was hooked up to the…the heart monitors were hooked up 24/7 the first three days I was there.
So once I was, like, more settled… The first three days were stressful because I didn’t understand what was happening, but then I got a better picture of what was going on, then kind of just…I settled into routine. And every day was the same. They kept the monitors on, the baby seemed fine. My blood pressure was a little high. That was pretty much it. So it didn’t seem like, “Oh, today or tomorrow, I’m gonna deliver.”
Dr. Fox: Why did they keep you in the hospital as opposed to send you home or something like that?
Zehava: They were keeping me in the hospital because of the blood pressure.
Dr. Fox: Because they thought it may get worse at any point?
Zehava: Yes. They were like, “We have people in your situation where they can be here for 10 weeks, or they can deliver tomorrow.” They just said there’s no way of knowing.
Dr. Fox: Right. And your urine was normal, no protein, and your blood tests were normal?
Zehava: Right. They called it gestational hypertension.
Dr. Fox: If you had that alone, probably they would have sent you home, but that and the combination of the baby being very small very early probably made them worried that your placenta was not functioning well, and that it could go at any moment. Yeah.
Zehava: Once a week, they were monitoring the flow from the placenta. The first day I was on a liquid diet because they thought maybe they would need to do an emergency C-section. But after that, I was able to start eating. And then after three days, they said that because I’m pretty steady, nothing is getting worse, they would move me from labor and delivery to Mother/Baby where I didn’t have to be hooked up to the monitors 24/7. Which was a lot easier on me because every time you…
Dr. Fox: Yeah. You can move around.
Zehava: Yeah. I could get up out of bed, and then sleeping is a lot easier. So we got moved to there. And it was a lot nicer. I mean, nicer, it wasn’t nice being in the hospital, it was nicer than being in labor delivery and hooked up to monitors 24/7.
Dr. Fox: And ultimately, how long did you stay in hospital till you delivered?
Zehava: I was there for three weeks.
Dr. Fox: And what happened that you delivered three weeks later?
Zehava: So I was getting NST test twice a day. And they took me for my morning test. And the heart rate was dropping at some points. I don’t think they were so concerned about that, but when they did the Dopplers, they were concerned about the flow from the placenta. I didn’t understand exactly what they were showing me, but they like showed me the screen and there were like breaks.
Dr. Fox: Yeah. It’s the flow, actually, from the baby to the placenta. You would think it’d be the placenta to the baby. That’s like what would make the most sense, but it’s actually from the baby to the placenta. And the reason is a placenta that’s nice and healthy, the blood flow from the baby to the placenta flows like a river, nice and smooth, easygoing, just keeps moving forward. Whereas if the placenta starts getting resistant, right, it’s not as good, it’s not as healthy, it’s like putting a dam there. So the blood doesn’t flow so nicely, it sort of backs up a little bit, and can even go in the opposite direction than it’s supposed to periodically.
So when you see the pattern going from a nice, healthy forward flow to sort of stopping, which is probably what they saw with you, like sort of standstill, or potentially going in reverse, that’s a sign of a placenta that’s getting much worse. And, you know, certain features of that would lead us to say, “You know what, you really should be delivered in the near future.”
Zehava: Yeah. So that was their main concern. That’s what they were showing me. And so they moved me back from the Mother/Baby unit to the labor and delivery so that I could be on 24/7 monitoring again.
Dr. Fox: Right. And they probably gave you like magnesium and maybe steroids, like saying, “You may get delivered, we have to give you all these things in advance.”
Zehava: Yeah. So they gave me…actually, they gave me steroids at 27 weeks when I was admitted. And then they gave me… So then again, when they moved me… So that was a two-shot series. And then when they moved me back to labor and delivery, they gave me a shot again, and then the next day, they were gonna give me a second one, which didn’t happen because I delivered.
Dr. Fox: You delivered overnight?
Zehava: I delivered the next morning. So they moved me to labor and delivery. And the first few hours was fine. I had convinced them when I was in Mother/Baby that I didn’t need an IV because I wanted to be able to shower with two hands and I didn’t wanna have to deal with that. So they had taken out the IV. So when I went back to labor and delivery, they said they had to put it back in. So I insisted that I get to shower first and then they’re like, “Okay, make it quick because you need to be on the monitors.”
So, I showered I got into bed. They hooked me back up to the IV and I was on 24/7 monitoring. At midnight is when everything started going downhill. The baby’s heart rate started dropping. And then pretty much the next six hours was the nurse was coming in, telling me to move from this side to that side, trying to get his heart rate to stabilize. But at 6 a.m., they were discussing… My OB who was on call came in, and she was like, “I think we have to deliver.” And so it was kind of like back and forth, deciding what they were gonna do. At 7 a.m., I think they came in with the magnesium, which was awful.
So I still was like in denial that they were gonna deliver me. I thought, “If they give me the magnesium, that might help his heart rate stabilize, and maybe I’ll be able to keep him in a little longer.” I think it was, like, 45 minutes later when the magnesium finished, and I remember texting my boss, like, “I’m not gonna be working today. I had a crazy night. I just need to sleep.” Then like an hour later, I texted her that, “Oh, it’s a boy.”
Dr. Fox: Right. I mean, you’re working remotely, in general, and you just transferred to the hospital, basically?
Zehava: Yes. And that saved my sanity because I couldn’t have any visitors. The first three days I was there, I didn’t work, and I like burned through all my Netflix shows. And I was like, “This is not good.”
Dr. Fox: I’m out.
Zehava: I cried every day, I wanted to go home. I had too much time on my hand and nothing to do. But then when we got the clear that my husband could leave and come back, he went home and he got my work computer, and then I was able to work remotely, which literally saved my sanity.
Dr. Fox: And then overnight when this is all happening, your husband’s with you or not with you?
Zehava: He’s with me. He slept with me every night in the hospital.
Dr. Fox: So basically 7:00, 8 a.m. they’re like, “All right. This is just getting too worrisome.” They did a C-section?
Zehava: Yeah. So probably like around five minutes after I sent that text to my boss that I’m not gonna be working, they’re like, “No, you’re going for an emergency C-section.” And then I started crying. I was scared. I didn’t know what was gonna happen. I felt like I didn’t have any time to prepare. You know, really, from three weeks, I should have been preparing. I just was in denial the whole time. So they took me for an emergency C-section. And he was born one pound, 13 ounces at 30 weeks and two days.
Dr. Fox: Were you able to get a spinal or do they have to put you to sleep?
Zehava: I was able to get a spinal, which they were giving me blood thinners because they were concerned about me not getting out of bed and moving. So at first I was getting Heparin, which is once in the morning and once at night, but then I was complaining about getting poked all the time. So they switched me to a different medication. I don’t remember the name, which was once a day.
Dr. Fox: Lovenox?
Zehava: Yes, that’s what it was. And I think you have to be, is it 24 hours from that to get a spinal? Yes.
Dr. Fox: So you probably got your dose at 8:00 in the morning or something?
Zehava: Yeah, I think it was around 8:00. And the day before when they decided they’re moving me from Mother/Baby back to labor and delivery, they knew the chances of delivering me were high, so they said no more blood thinners.
Dr. Fox: Yeah. That makes a lot of sense.
Zehava: I think they also put me… They told me to stop eating around midnight when his heart rate started dropping.
Dr. Fox: Oh, so the writing was on the wall, so to speak, for them?
Dr. Fox: Yeah. I got it.
Zehava: I was ignoring it. But [crosstalk 00:28:06]
Dr. Fox: Okay. That’s fine. Listen, it’s…what’s the difference? You know, whatever. It’s one of these things you can be in denial. That’s okay. It gets you through the day.
Zehava: Yeah. So they gave me a spinal. So I was still, like, up in with it during the whole C-section.
Dr. Fox: How terrified were you?
Zehava: I was terrified.
Dr. Fox: Yeah. That you’re delivering a premature baby, it was under two pounds. And I assume your terror is mostly for your son, and not for you?
Zehava: Yes, the whole…even before he was delivered, that whole night I was… No one really explained what it meant to me like that the baby can be in distress, but once you deliver him, it will help him. I just thought, “His heart rate is dropping, does this mean I’m going to lose him?”
Dr. Fox: Yeah, that’s pretty scary. And so when he was born, did he give a cry? Were the initial signs positive or negative? You know, because sometimes when they’re born and the pediatrician’s in the room, they say, “Oh, he’s really looking really good, or, you know, maybe not.” What was it like the first few minutes we’re talking about?
Zehava: I don’t remember if he cried. I remember they took him out and they’re like, “Congratulations, it’s a boy.” And then obviously the whole…there were like the nurses from the NICU and then neonatologist was there. I remember them showing him to us for like a second before they brought him up to the NICU. And he was like all wrapped up. It was like all blurred in my head. I didn’t have my glasses on, I couldn’t really see so well.
Dr. Fox: You’re on magnesium which blurs your vision, and you’re having surgery and… Yeah, it’s a blur.
Zehava: And I didn’t really know, like, what his status was for like a few hours until… I mean, I wasn’t put under, but I was still like out of it, and I had just gone through surgery. And we didn’t find out…I think it was like three hours later, the neonatologist came down to talk to us on how he was doing.
Dr. Fox: And at that time, what was their assessment, you know, a few hours after birth?
Zehava: So they said he was doing really well for his birth weight and his gestational age. He did not need to be intubated. He was just on CPAP.
Dr. Fox: Wow. That’s great.
Zehava: And he had an IV, and… They made it sound like he was gonna be okay. So at that point, I, like, relaxed a little.
Dr. Fox: Wow. Tell me about the first few weeks after delivery in terms of your recovery and also, you know, at the same time, going back and forth from the NICU while you’re recovering.
Zehava: That was an extremely difficult period. I think I went home at day five after the C-section, which I was so happy to go home. At that point, I had already been in the hospital for a month. But at the same time, my baby was still in the hospital, and I didn’t wanna have to leave him. That was probably the hardest part of the whole NICU journey, was leaving the hospital without him. I cried the whole way home. And then recovery was hard too. I mean, I was just post-surgery. I was having trouble even standing in the shower, but somehow, I was getting dressed and go into the NICU every single day to see my baby.
And then I was pumping every three hours, which is incredibly draining. People tell you like, “Oh, get sleep now while the baby’s in the NICU,” but you’re waking up every three hours to pump and you’re worried. In the beginning, I was like a lot more stressed out, like, “I don’t know what’s happening with my baby. Is he gonna be okay? I’m I gonna wake up one morning and he’s gonna be, like, gone?” I didn’t know what to expect in the beginning. When I got more into routine and I understood that he’s in a safe place, he’s doing well, I don’t have to be as worried as I am.
Dr. Fox: Who was allowed to see him in the NICU, again, with the COVID restrictions?
Zehava: So the first two weeks, it was only one parent allowed at a time. So…
Dr. Fox: At a time. So you could both go, but not together?
Zehava: Right. And so because I was post-surgery, I wasn’t allowed to drive. I was still on painkillers. So my husband would drop me off. Then he would go to work. And then he would come back. I would wait in the car while he would go in. He would do like a much shorter visit, like 20 minutes, and then we would go home. After those two weeks, they changed the policy, and then both parents could come at the same time, which was a lot easier on us.
Dr. Fox: And how long was he in the NICU ultimately?
Zehava: He was there for three months. He came home on day 90.
Dr. On day 90. And what was it like bringing him home? I mean, how much of that was unbelievable joy, and how much of that was complete fear?
Zehava: It was definitely more joy than fear. I had already wanted to bring him home a few weeks earlier. At eight weeks, he was at a point where we thought he was gonna come home. Then he got his two-month vaccinations. And he was having a lot of freeze again. And they were concerned about sending him home. So then they were talking about maybe sending home on a monitor. And that’s what I wanted to do, because I wanted him to be home already. My husband was a little more concerned about bringing him home on a monitor. In the end, they kept him those extra four weeks until he stopped having Bradys. They gave him a reflux medication, which after he started that medication, his heart rate was steady.
So the fear of bringing him home was kind of like, “Oh, my gosh, is he gonna stop breathing in the middle of the tonight and we won’t know because he’s not hooked up to a monitor anymore?” Like he was [crosstalk 00:33:29.545]
Dr. Fox: Yeah. I mean, even though in the NICU.
Zehava: …being taken care of by this team.
Dr. Fox: Yeah. There’s 45 people watching him for, you know, 10 weeks or 12 weeks with monitors everywhere and then they’re like, “Yeah, it’s all good. Go home.” And you’re like, “What?” It’s like, “No, you don’t get weaned off of that.” You know?
Zehava: Yeah. So that was like my biggest concern. Although I knew what to do, like, okay, maybe the first week or two he was in the NICU, every time that happened, I like panicked, like, “Oh my gosh, he’s stopping to breathe, his heart rate is going down.” But then at some point, you learn this is normal for premature babies and you learn what to do to stimulate them and have their heart rate go back up. So, like, it was a little bit of a concern when I brought him home, but I knew that he would be okay. I was just so excited to be done with the NICU and just have him home with us.
Dr. Fox: Looking back, you know, a year…I guess it’s about a year since he came home right now, plus, minus?
Zehava: Yes, he came home the beginning of May.
Dr. Fox: Yeah. Okay, so we’re recording in middle of May. So it’s about a year since he came home. So, you know, the three of you are home for a year. Looking back on it now and sort of retelling your story, what do you take away from this, or what are some of the, you know, key lessons, or moments that you remember?
Zehava: The biggest thing is that birth is a miracle. And there’s so much that can go wrong, but having a healthy child at the end of it is the most amazing part of the journey. And I’m just so thankful that we have a healthy baby after everything we went through.
Dr. Fox: It’s amazing That’s amazing. Well, listen, thank you so much for volunteering. It’s a tough story. I mean, it’s really hard, a lot of things going on. And what happened to you was unexpected. It’s not typical for someone with ulcerative colitis to have that happen in pregnancy, and it may have had nothing to do with it whatsoever. And it’s rough, but it sounds like, you know, obviously, you did all the right things and sounds like your doctors did all the right things and took really good care of you and really good care of your son, and it worked out. And it’s amazing.
And what are you thinking about the future? What kind of thoughts do you have or fear do you have about upcoming pregnancies now that you’ve been through this? Do you feel like you’re more resilient or do you feel like you’re gonna be more afraid that something like this might happen again?
Zehava: I mean, I definitely will be afraid going through pregnancy that something can go wrong, but I also know that I’ve been through it, and I know that this could be the outcome, like, everything will be okay. In the end. I think that would be easier. I also know not to go into pregnancy unless my body is healthy. And I’m taking care of myself, which I have actually started a diet for ulcerative colitis called the SCD diet. I don’t know if you’ve heard of it. And I’ve been doing that since… Because post-pregnancy, I also went back into a flare. And they wanted to start me on the biologics I mentioned earlier.
And I knew that I needed to do something with my diet to help along with medication. I’m not opposed to going on biologics if that’s what I need, but I wanted to try this diet before switching my medication. And I started that the beginning of October, and since then, I haven’t had any symptoms. So we’re hoping to just stick with this, and my body is in a lot better place than it was going into that pregnancy.
Dr. Fox: It’s amazing. Wow, I’m really happy to hear that. Zehava, thank you so much. And, you know, best of luck to you guys, and, obviously, to your baby. And again, thank you for coming on the podcast. I really appreciate it.
Zehava: Thank you for having me.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L W-O-M-A-N .com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at firstname.lastname@example.org. Have a great day.
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