“Julia’s Story: Making peace with difficult decisions” – with Julia Nudelman

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.

Julia, thanks for coming in. It’s so nice to see you in person. You know that I love seeing you, that you’re the most sunshine patient here, and it’s just wonderful to have you. And obviously we’re on the tail end of this pregnancy that was quite a ride. And thanks for coming in to talk about it.

Julia: Thank you so much, Dr. Fox, for having me. I feel so many different emotions at the moment, one of which is just complete and utter gratitude towards you and the whole team at MFM. It really is a miracle that I’m here, and I found you. And we really are at the end of this and I’m excited to tell my story.

Dr. Fox: So, what a great way to start. Thanks for that. That’s so nice. How’s little Liam doing?

Julia: He’s wonderful. He’s four and a half months.

Dr. Fox: Amazing.

Julia: He’s thriving, has chubby cheeks.

Dr. Fox: I love it. I love it.

Julia: Born at 5 pounds, 10 ounces, but now he has chubby cheeks. So, here we are.

Dr. Fox: It’s amazing. And the other kids are taken to him. They like him. They appreciate him. They’re not trying to murder him.

Julia: No, not at all. It’s a beautiful blessing. Thank you so much for asking.

Dr. Fox: Amazing. Good.

Julia: They’re all excited.

Dr. Fox: And Lenny’s good?

Julia: Yep.

Dr. Fox: Lenny’s working? Lenny’s working?

Julia: You know, four kids… Yeah, you know what they say. Four kids, a puppy, a husband, it’s a lot of work. But we get it done.

Dr. Fox: That’s amazing.

Julia: So, here we are.

Dr. Fox: That’s amazing. So, I guess we’re going to start at the beginning, right? We’ll do this, I guess, chronologically. Obviously, we’ll throw things in. I’ll ask you questions. But I guess before even we met, right, whenever that was, just give us, like our listeners, a sense of who you are, you and Lenny, like where you’re from, what are you doing, you have your three kids, where you live, just go into just who you are coming into this pregnancy.

Julia: Yeah, I’ll give you a little synopsis of who I am. So, me and my husband, I’m 37 years old. Me and my husband met in pharmacy school. We had three children. We live in Brooklyn, and we’ve kind of grew our family. We’ve had pharmacies. And we’re both pharmacists.

Dr. Fox: You can plug your pharmacies. Yeah, just plug them. They’re great.

Julia: Yeah, I’m actually the owner of Madison Apothecary. It’s on Madison & East 83rd in the Upper East Side. So, we’ve grew together. We’ve grew our family. And it was always in the back of my mind that I was very fulfilled professionally, but I’ve always wanted maybe to have one more child in the back of my mind. And I did have three C-sections with my other pregnancies. And when my OB retired, who I previously used with the other kids, I was where a lot of women are, “Who do I use as my OB? Where do I go from here?” And we were doing some research, and I came across this wonderful man on a podcast named Dr. Nathan Fox.

Dr. Fox: Oh, is that…? I didn’t know that that’s… You found me through this podcast?

Julia: That’s exactly how I found you.

Dr. Fox: Wow.

Julia: And I’m not really into podcasts, actually, to be honest.

Dr. Fox: Yeah, me neither.

Julia: But here we are today. And I was like, “Wow,” just the tone of your voice and the way that you spoke, it resonated with me. And I knew a lot of OBs in the area and I asked a colleague of ours who they recommend and he’s like, “Oh, do you know Dr. Naty Fox?” And I said, “I don’t, but is that the guy on the podcast? I really liked him.” And that’s how I found out about you. And it was just fate and God and our roads aligned. And that’s how I found out about you. And so here we are.

Dr. Fox: See, you learned so much. It’s so interesting. You may have told me that, but I definitely don’t remember that. So, we met before you were even pregnant.

Julia: Correct.

Dr. Fox: We spoke just to talk about like can you do it.

Julia: Yeah, I wanted to have a preconception consult, especially because you weren’t my OB with my other pregnancies. And I knew I had a few issues coming into another pregnancy, all of which were doable. But we just wanted to just make sure that everything would be on pace and it would be monitored. And so our first consult together was a preconception consult and it went very well. And then it kind of all began.

Dr. Fox: Yeah. So, what were the issues that we were speaking? Because I remember when we met…

Julia: So, when we first met, it was, A, going into a fourth C-section because I did have three prior C-sections, even though the kids, they had an age gap. The three of them were all two and a half years apart. But my youngest at that time was 9. So, now Josh is 10. So, it would have been a little bit of an age gap, but nothing to do with age, just to do with, I guess, your healing and all of that. So, that was number one. With my last pregnancy with Josh, I also had some preeclampsia towards the end of the pregnancy. So, a lot of times, it comes back again with another recurring pregnancy. So, that was an issue we addressed. What else did we address? I’m trying to think now. I don’t remember. I think those were the two major issues, if I’m not mistaken, that can come to mind.

Dr. Fox: Yeah, those are the big ones. And what I recall at the time is you guys just wanted to be sure that it wasn’t…

Julia: It was safe.

Dr. Fox: …that it wasn’t crazy.

Julia: And crazy. That was Lenny’s question.

Dr. Fox: I mean, I remember… And this is not an unusual question that people would ask me like, “Am I being irresponsible? Am I putting myself at risk? I have three kids, thank God. And I want to be a mother to them. Am I doing something…” or, “Is she doing something?” He basically was asking the question. That’s sort of nuts. And I remember at the time I didn’t think so. I said, “I think you’re going to do okay. And you’re still relatively young and you’re healthy and it should go fine.”

Julia: Yeah, it’s funny that you say that because a lot of times, like even my patients, they ask like, “Oh, how many kids you have or…?” And it’s really not necessarily a set number. It’s what you feel fulfilled in or at at that moment in your life. My other kids I had when I was 23, 26 and 29, and you really evolve as a person and at different points of your life, you feel like, is this it for me or there’s something else that I feel like I need?

Dr. Fox: Right, right. I mean, you definitely… You had that bug.

Julia: I did.

Dr. Fox: I mean, you definitely felt it. And it was palpable. You’re like, “I really want another kid.” I mean, listen, you have a lot of love to give. It’s good.

Julia: Amen. Yeah.

Dr. Fox: So, we had a plan. We said, “All right, you’re going to do this,” right?

Julia: We’re going to try.

Dr. Fox: Give me a holler when you’re pregnant.

Julia: Yes.

Dr. Fox: And then what happened?

Julia: Wow. So, I remember it was like yesterday. So, we began to try because you said it was okay. You gave me the green light. And it was a few months, and I remember this was in February. I did a pregnancy test.

Dr. Fox: It’s like a year ago. Exactly.

Julia: Exactly. Yeah. And I tested positive. It was February 17th, to be exact. I tested positive. And I mean, as a medical professional, I know that just because it says that you’re pregnant doesn’t mean that you really are. We need to get blood work done. And I got so excited. I remember I texted you. Let’s come in. We’ll get some blood work done. And we did. And my hCG was high. And for some reason, I didn’t think that it was like, “Is it really high?” But it was high. I didn’t even pay attention to the number, to be honest. At that moment, I was just overwhelmed with so much gratitude and excitement that we’re actually really doing this.

And it was a few weeks in. And I remember I went to get another consult with another physician. And they did some blood work, too. And they said the hCG was high. It was good. And they did a sonogram. And there was only one sac at that moment. That was about three, four weeks. And when I came to you, it was five weeks. And I remember that when we… And Lenny wasn’t with me at that moment. I went and one of the OBs was there doing the sonogram. And it looked like two circles on the scan. And at first, honestly, it didn’t even come to my mind that it could be two babies or two sacs. And I’m like, “Is that two babies?” And I’m like laying down and I thought I was with it. And I was like, “No, I’m hallucinating.” I mean, we didn’t do any IVF or any IUI. And this was all-natural conception. Even though we have twins in the family but none of the prior pregnancies I got pregnant with twins.

And here we are. And I remember she turned around to me and she said, “Yeah, you’re having twins. This is two sacs.” And this was five weeks. And I took a moment and I said, “Wow, is this possible?” You know, I mean, you hear about twins and you think about twins, but you can’t imagine you being pregnant with twins, you know? It’s like just one of those things that you can’t really imagine happening. And here it was… We took it in. And I’ll never forget, at that moment, as she’s saying, “You have twins,” and I’m looking at the scan and I’m like, “Oh, my God, there’s two circles. That means there are two babies, Julia.”

Lenny comes in. And as Lenny comes in, I see him and he looks at my eyes and he knows that something’s off, but he can’t really say anything because the doctor’s in the room. And I’m like, “Please don’t speak out loud. Please don’t speak out loud,” in my mind. And she turns to us like, “Congratulations. You’re having twins.” And I could have sworn he almost fainted, but he, kind of, fell to the seat. That was at five weeks. And then I remember we came upstairs to see you and you’re like, “Whoa, Jules, I told you to have one baby, not two.” And I remember you sat down with me and you wrote down all the pros and cons and, kind of, not really pros and cons but the risks going into a twin pregnancy as a fourth pregnancy. And I told you that I’m not scared of the work by any means, as long as it wouldn’t take a very big toll on my body and as long as I would be able to carry twins going into a fourth pregnancy with some blood pressure already going into it. And you looked at me and you said, “I think you’ll be fine. We’ll monitor you. We’ll take it week by week,” as we did, as you promised. And we took it week by week.

Dr. Fox: Right. Now, at one point shortly thereafter, a big wrinkle happened where we suspected that the lower twin was actually sitting inside the Cesarean scar, one of your prior scars, which we’ve had a podcast about this, Cesarean scar pregnancy. It’s potentially very, very dangerous. And we, sort of, preliminarily had those conversations because it wasn’t entirely clear from the pictures and we were going to check it again. But what did that do to your psyche when we said that, based on how this plays out, it could end up being a much more dangerous pregnancy.

Julia: So, it’s funny that you say that going into it, it’s just like going into anything in life. You know the risks. I had a preconception consult, but we, kind of, didn’t even think of that. We didn’t even think that could have been an option. And honestly, I’ve had three prior C-sections. I wasn’t even aware that every single time you have a C-section, that when you get pregnant again, that there’s a risk for a Cesarean scar ectopic. I had no idea. That’s, kind of, scary to say that… Let’s say you’re just pregnant your first time and then the second time you get pregnant, God forbid that can happen. So, it’s definitely something that I think that women who have C-sections should be told or at least know about that, when they’re pregnant, their next pregnancy, that if you are requiring a C-section, that that’s just something to consider that, when you do get pregnant, that implantation is so critical because it’s really dependent on where the baby implants. And if it’s anywhere close to the Cesarean scar, it could be a very, very dangerous situation.

Dr. Fox: Right. Now, as it turns out when we saw you a week or two later, the pregnancy that was in the Cesarean scar, it turns out was not viable, meaning you weren’t going to be having twins. You had two sacs, but you’re only going to be having one baby. So, you sort of went from, “I’m so excited, I’m having a baby,” to, “Oh, my God, I might be having twins,” to, “Oh, my God, one of them might be Cesarean scar,” to now, “I’m not having twins. I’m having one baby.” Was that a moment of relief for you? Was that a moment of great sort of sadness for you? Probably a little of both. You know, how did you feel sort of finding out that it wasn’t going to be twins, it’s actually going to be one, but the one that was in the scar is not going to develop anymore? I mean, that one should stay stable.

Julia: It was such a range of emotion that I think to answer it as truthfully and as honestly as I can is that it was a little bit of everything, to be honest. I was so grateful that I had an act of pregnancy because this was something that I was hoping for and dreaming about. And I just wanted the baby to be healthy and me be able to sustain the pregnancy because I do have three other children that we take care of. And we live our life as a family. And I didn’t want to impede any issues on them as well for them to be worried, “Oh, Mommy got pregnant. But this is a major issue that God forbid something can happen to her.” So, it was a lot of emotion. I was thinking within myself, in addition to the family of how we’d be able to take this information that we just received.

It was definitely a little bit of sadness in the aspect that… Not that I wished for twins, I just wished for a baby. But I definitely didn’t want anything to, kind of, take a chance and hurt myself already in deterrent to what the family is used to. But ultimately, I realized that everything like in life that God gives you, He gives you the ability to be able to digest that information in time and really have faith that whatever is meant to be will be as long as you’re under the proper care of physicians that you trust and are knowledgeable. And I genuinely feel that, if it wasn’t for you, we wouldn’t be sitting here today.

Dr. Fox: Oh, you’re so sweet. On our end, from the medical end, it’s not a common phenomenon, right? So, Cesarean scar ectopic or Cesarean scar pregnancies are not that common. And they happen, but they’re not that common. But in a twin pregnancy where it’s also uncommon, but particularly where you have a twin pregnancy where one baby is what we call viable, is healthy, looks great and is in the correct spot, and the other one, which is not viable, is in the Cesarean scar pregnancy. So, it’s not something that we see a million of, right? It’s an uncommon phenomenon.

I remember at the time we’re discussing internally amongst the doctors, “What do we make of this? Do we think Julia is at the same risk she was at before with the Cesarean scar pregnancy? Do we think she has no risk as if it wasn’t there? Is it somewhere in between? How do we counsel her? What do we do?” And we discussed it because, again, this is really just based on people’s experience and wisdom. There isn’t a lot of literature on this to go to. It was just not a common thing to find. And internally, we sort of concluded we think you’re going to be fine. We think that the healthy pregnancy is going to grow in the right place. We think that the pregnancy that’s not viable is eventually just going to sort of go away and get absorbed and everything should be okay with the uterus. So, we were pretty confident it’s going to go okay.

But there’s disagreement about that, right? And you definitely got some other opinions about this that were a little bit more pessimistic, right?

Julia: Yeah.

Dr. Fox: I mean, you were recommended to terminate the pregnancy, right? So, let’s talk about that, because that’s… Listen, I’m not saying this like who’s right, who’s wrong. To be a patient being told by one doctor or group of doctors, “I think you’re going to be okay,” and another doctor group of doctors that says, “I think you’re not going to be okay, and you should terminate the pregnancy,” that’s wildly different advice and information.

Julia: And it’s outrageous as a patient to feel all this emotion because you look at your medical team and you have to trust those people that are taking care of you. As much as even I’m a medical professional, there’s only so much you know that you specialize in and that you see cases of. So, when all of this information was brought about, I was obviously followed by yourself and the team here at MFM in which that you said you really think that the other sac over time will subside and the other pregnancy will continue to grow and develop normally. So, you felt confident in that we should keep the pregnancy and that everything will run its course, pending that we’re going to be obviously monitoring you and everything else.

So, as a patient, we obviously got another opinion with a very reputable medical team as well in New York City, in which they also did some scans and they said that this is a disaster and that not only should I terminate the pregnancy, that I can have a hysterectomy. And it, kind of, was like a snowball effect that they said that this is a very big risk to myself, not only for the baby that’s already in there, that’s growing but to myself as well and that it would be in my best interest to schedule an appointment and have an abortion.

And when they told me that, it was like a knife going into my heart and I was hearing what they were telling me, but I couldn’t absorb what they were telling me. It was like an out-of-body experience at that moment. And I said to myself, it’s like, “This has all been so much—the last few weeks of all of this information.” I honestly didn’t know what to make of it. All I knew was that deep in my heart, I felt that I could do this.

But at the same time, I’m getting these brilliant medical professionals that are telling me otherwise. And it’s very hard as a patient when you’re getting different information concerning the same issue. And because there hasn’t been so much on this topic, at least with the twin ectopic Cesarean, that’s why I felt it was so imperative for me to tell my story because it’s a multitude of factors. But the more that you learn and the more that you hear about, the more you can make a decision as a patient, that you always have to get a second opinion. You have to listen to yourself, that you should do your due diligence. But ultimately, we came to the fact that I felt confident that yourself and your team had the better outcome of what we were going to choose to go with.

Dr. Fox: I’m trying to understand how you guys would make that decision, right? Because that’s terrifying to be in that situation.

Julia: It was very scary.

Dr. Fox: I don’t know, is it just because you’d rather pick the one that’s more positive or was it an issue of…? You sort of looked at it. And was it a logic-based thing? Was it an emotional thing? Do you go with your gut? How do you make that decision?

Julia: It was both, it was both. Lenny was a little bit more wary. He was very petrified, which I understand as a husband and a father. And for him, the most important thing was that we already have three healthy children. And for him, my well-being is of utmost importance, which I understood completely. I’d never wanted to jeopardize our family emotionally and physically. Because with any pregnancy, even a normal, healthy pregnancy, it’s a range of emotion that we go through as women and the family. If you currently have children, as you expand your family, the dynamic changes and it’s never the same. Sometimes you feel sick. Certain days, your kids see you being not well. So, it’s a lot that the family goes through as well, in addition to the actual person who’s going through the pregnancy.

And I was aware of that. And I understood everybody’s feelings and emotions. But to answer that question, there was Dr. Timor who… He is actually a specialist on ectopic scar pregnancies. And we got him through another specialist and they recommended that I go see him. And I believe this was at about 9 or 10 weeks, which was a pivotal moment. That’s when the other facility was saying that you need to get an abortion. And you were telling me that, “No, we can do this.” We said, “You know what? Let’s go see Dr. Timor.”

Dr. Fox: Tie breaker.

Julia: Yeah, here we go. And let’s see what he has to say. This is his specialty. And I remember this was in… We went to Mount Sinai, I believe it was about 9 or 10 weeks. And I remember meeting him and he came into the room and he goes, “Well…” I saw him and I needed to crack a joke because that’s just who I am. I said, “I hear you’re the specialist on this.” Well, he goes, “Well, you’re in the best hands with Naty. And I know you went here and everybody knows me. So, let’s look inside what you got there.” And he went inside. He did the scan. And again, it was very important for him to see the implantation of the sacs, which we were aware of. But he did it with his own eyes. And he said that, “We have to monitor you closely.” But from my vision of what he saw, he said, “I think you’re going to do great. I think that the other sac will subside over time, that it is on the Cesarean scar, but because it self-terminated itself, that it almost it was like a gift that it went away on its own as opposed to, God forbid, it would have continued to progress. And then it could have been a perfect storm.” And he said that, “You’re being followed by Naty, who’s phenomenal at his trade. And I think you’re going to be okay, kiddo.” Those were his words. And he made sure to tell me, he said, “Please do me a favor and keep a journal of everything that you go through, because it’s such a rare case that I think a lot of people will benefit from your story.” And that’s what I did.

Dr. Fox: Amazing. Yeah. So, I remember he called me and we spoke and we had sort of felt similarly about you and about your uterus and whatnot. And, yeah, and I remember telling you and telling Lenny, “You’re not going to die. We’re going to take care of you. And you never know how pregnancy is going to end. You don’t know. You can’t tell the future, but we’re going to watch you very, very closely.” And so we spent a lot of time together.

Julia: A lot. It was weekly.

Dr. Fox: A lot of visits, a lot of visits. We got to know each other very, very well, which is terrific and delightful, obviously. Over the course of the pregnancy, did whatever anxieties and fears that you guys had, did it get better because you were getting further away from that initial, sort of, shock or did it get worse because you were getting closer to the day we have to do the C-section?

Julia: You know, to be honest, I was never scared of the C-section, I guess, because I’ve had prior C-sections. So, I wasn’t scared of that at all. For me, it was just mostly… Because every time I would go for the scan, it was weekly. I would see the other sac. So, it was eating a little bit at me that I hope that it doesn’t…

Dr. Fox: Has it gone away yet?

Julia: Is it going away?

Dr. Fox: Has it gone away yet? Has it gone away yet?

Julia: And it was like, in one aspect, I knew it was there. And in another aspect, I knew it was supposed to get smaller, but it takes time. And I think that that fully anxiety went away by around 20 weeks is when we really couldn’t see the other sac anymore and it was just the healthy baby progressing through. And it was just a sigh of relief. But I would have to say probably till about 20 weeks…

Dr. Fox: Yeah, a couple three months.

Julia: Yeah, it was in limbo. I mean, I knew we’re doing this, but I was just hoping and praying every day that whatever God had in store for me, that I can handle. And I was doing everything that I could. And we were just taking it day by day, and that’s all we could do.

Dr. Fox: I remember it again. It takes a while for the sac to get smaller, but it did. And you always had a positive attitude. It wasn’t like you were coming in shaking or anything like that. You were always, you know, and we were pretty confident things are going well. And actually, the pregnancy was pretty unremarkable as it turns out. I mean, you got admitted once for some contractions, which we had to take very, very seriously with your uterus. And you needed a blood transfusion at one point more for medical stuff, not because you were bleeding or anything. Okay, it was…

Julia: Relatively minus the anxiety of the whole pregnancy in general.

Dr. Fox: Yeah, a few bumps but nothing crazy.

Julia: Yeah, nothing crazy.

Dr. Fox: It was really… I mean, you were basically home the whole time. And then ultimately, tell us about when you delivered. A little earlier than planned.

Julia: Yeah, we delivered at 34 weeks.

Dr. Fox: We talked a long time about the date of this delivery.

Julia: Yeah, we were like…

Dr. Fox: And then you blew it up.

Julia: Yeah, because my birthday is October 4th. And I knew I was going to have a Libra boy, which was good because I wanted to have a Libra. So, I was having some contractions. Nothing was anything crazy from about 20 to 30 weeks, right? It was unremarkable. Just like your basic pregnancy, I was getting a little bit bigger and some nausea here and there. My hemoglobin was a bit low, so we needed to get some blood transfused. But other than that, I felt perfectly fine. From around 30 weeks, I would say, is when I was starting to begin to have some contractions. I had to come in. We got a check. Then it was just very mild. And I would come back home.

And so at around… It was our 34 week checkup. It was September 30th. I came in in the morning. I had you I think one of the first appointments. And it was in actually Mount Sinai West. It was across the street from the hospital. And I came in and I had a really crummy night the night before, just like I couldn’t go to bed and I wasn’t feeling myself. I was having a little bit of pain. But I never went into labor with the other pregnancies. So, I couldn’t even tell you what it is to go into labor, believe it or not.

Dr. Fox: Right. Me neither. You and me both. All right.

Julia: Exactly. Both of us. Here we go. So, I never went into labor. So, I never had my water break. So, I was like, okay, so maybe I’m just feeling a little wonky. Who knows? And when I came in, the contractions were… They put me on the monitor, and the contractions were coming in a little heavy. And I remember you coming in and you saying, “Kiddo,” I guess I’m a kiddo for everybody, and you’re like to me, “What do you think, September 30th or October 1st? Both are good days. Well, we’re having a baby. We don’t know which day we’re having a baby, but it’s either today or tomorrow.” So, I was like, “Really?” My eyes opened up as if all this time, I didn’t know we were having a baby. I knew we were having a baby. I just didn’t know that it was going to be that day.

And then I went across the street and actually you called Lenny and then you’re like, “Lenny, I need to speak to you.” So, Lenny’s like, “Yes.” He doesn’t like when you scare him a little like that. He gets a little nervous and you’re like, “We’re going to have a baby either today or tomorrow. Lenny, is that okay?” And he’s like, “I guess we’re having a baby. So, here we go.” We went across the street and I didn’t know it was going to happen that quickly but it all, kind of, happened really quickly. We came in.

Dr. Fox: I had a sense it might happen just because you had told me… because it had been brewing. Things have been brewing, and you told me 34 weeks with your uterus and three prior sections and this thing that was implanted in the scar and you’re contracting regularly. Again, the only thing I have to make sure doesn’t happen is something horrible happens to you, all right? And that’s the possibility if we just, at that point, blow it off and say, “Oh, you’re not actually in labor.” If it was your first pregnancy, you’re having some contractions. We make nothing of it usually in 34 weeks. But for you in this uterus, it could be a disaster. It’s not worth it at this point, right?

Julia: Right. Well, I think our goal…

Dr. Fox: And so it was time.

Julia: …was to 36 weeks.

Dr. Fox: Yeah. We were scheduled, I think, for two weeks later just to make sure it was done before I left town.

Julia: And I remember I said, “You can go on vacation, of course, as you should because you have such a difficult job dealing with all these women and their babies. But please don’t leave before I have my baby. It’s a very rare case my case,” I told you.

Dr. Fox: It was all planned out, but you made it even easier, so two weeks early. So, yeah, it wasn’t a difficult decision on the medical end. It was a no brainer. You need to deliver that day. You came around to that very quickly. There wasn’t much pushback because of… And also 34 weeks, it’s a win. I’m like, “Your baby’s going to be great.”

Julia: Right, and I believe he was… When we did the scan that day, he weighed about 5 pounds, 10 ounces, which was exactly accurate because he was born 5 pounds, 10 ounces. At 34 weeks, I think it’s pretty good.

Dr. Fox: It’s great. It’s terrific. Yeah. So, we do the delivery. We do the C-section. It went great. Smooth. Not complicated.

Julia: Not at all.

Dr. Fox: Very straightforward. You healed nicely from the last one. So, thank you to you. Thank you to your last doctor. It was like a layup for us. What was it like for you? That day, you went through such a scary pregnancy. Didn’t know if it would happen, after, you were pregnant, told to terminate, all these things, and there you are, your C-section is basically uncomplicated and you’re holding this beautiful baby boy. What’s going on in your mind at that time?

Julia: I remember when we started the section and I’m like, “I just want to hear him cry. I wanted to hear his…”

Dr. Fox: Me or the baby?

Julia: Both. We were all crying. It was such and such an emotional day. But it was such a range of emotion. I was filled with so much gratitude. It was such a moment that I’ve been waiting for, that just to tell you that how you speak to yourself and what you believe in your mind and what you tell yourself is so critical in any decision you make. Even with the right team and everything else, like one within yourself, that I felt and I knew that I was going to have this baby. And it was just the culmination of all of that emotion being on the table. And when I heard him cry, it was just… I was hysterical. I couldn’t even speak. I was just in shock that this is the moment that we’ve been waiting for and all is well. All is well he’s here, and that, thank God, I listened to you and myself and of course Dr. Timor and that I always believed in happy endings. I believe in the happily ever after fairytale in my mind, and this is how I choose to live.

Dr. Fox: It’s amazing.

Julia: That there’s always a happy ending, that there should be goodness at the end of all of this.

Dr. Fox: It’s amazing. Obviously, he did great. He’s doing great. You, kind of, had a rough ride with the recovery. And you got a little bit beat up medically for one reason or another. You know, it’s been a long journey for you after. Surgically, it actually went very, very well. But what happened medically afterwards?

Julia: So, once I delivered, I knew that the recovery from C-section was a little bit difficult, but the fourth was actually the hardest for me.

So, the recovery, I would say with this pregnancy, I felt the pain. Maybe because it was 10 years prior, I couldn’t really even remember how painful it really was. But I would say a good week, it took me to fully recover and come in within myself back to normal. So, as I was recovering, they were giving me the pain medications and all of that. And I think it was day 3 where one of the on-call doctors was, “You know what, your creatinine is a little bit elevated. Let’s not give you some ketorolac,” which is an NSAID, which can exacerbate that. And I was like, “Okay,” I, kind of, didn’t think much of it because I’ve always had normal kidney function. And so they stopped the NSAIDs.

And while I was in the hospital, they were telling me that every day it would get a little bit more elevated. So, it was, kind of, trending upwards. They said, “You know what, we’ll have renal consult come take a look at it. Maybe there’s hyper perfusion. You lost a lot of blood. You were anemic going into the pregnancy.” They weren’t sure. So, we had renal come in. I actually had a kidney sonogram. The kidneys looked normal, but my creatinine was around 1.7, 1.8. So, for those that don’t know, normally your creatinine should be at around 1, maybe like 1.1, 1.2, if you’re dehydrated. And so it was definitely elevated, but I’ve always had normal kidney function.

So, it was a consensus of the team, both all the gynecologists, the OBs and the renal team, is that there was a lot of injury to the body. It was like a C-section. It was a major surgery. There was hyper perfusion to the kidneys and the kidneys take some time to come back. You know what they said? “Why don’t you make sure that you’re hydrated. You need to heal and follow up with renal consult when you are going to be discharged and follow up with your creatinine and see what happens.”

Dr. Fox: Yeah, and here we are now…

Julia: Here we are.

Dr. Fox: …months later.

Julia: Yeah, months later. And so to that point, when I delivered, Liam was in the NICU. So, to speak a little bit on that, I’ve never had any child in the NICU. So, that was a separate range of emotion, which I have to say, the NICU team and the nurses, they really do God’s work. They are so kind and compassionate to all the moms and everything that they’re going through. It’s one thing like having a C-section and being able to have a child, but it’s another thing when you can’t really see your child because the child’s in the NICU. And you know they’ll be okay, but it, kind of, changes things. It’s a different platform of emotion when you go in. And in order to see the baby, it’s a different section you have to come in. And it’s not like just people take for granted sometimes, which I also did with my prior pregnancies. You almost take for granted what it is to just deliver the baby, hold him and take him home the next day. And you take for granted what it is to be able to just do that so effortlessly.

But I do have to speak on the fact that he was in the NICU for 16 days and they took wonderful care of him and he did so well. It takes time. They have to develop the sucking reflex. And by the time he began to, slowly but surely he began to drink more and take more milk. And once he passed all the rubrics to pass and leave the NICU, he did so 16 days, but they were such a wonderful team. So, I just have to tell them that I’m forever grateful for that. As scary as it was an experience, I knew that he had the best care and that put me at ease and allowed me to heal better, because when you can’t psychologically get your mind off your baby, it affects your healing as well. And it all worked out for him, thank God. And he was there for 16 days. We took him home and it’s been wonderful ever since with him.

Dr. Fox: They felt the same way about you because the head of the NICU text me and said, “Wow, Julie is the nicest person ever.” And so I was like, “Yeah, she really is. Yeah.” They’re like, “We love having her.”

Julia: She mentioned to me, she’s like, “You’re very compassionate. I know you’re a pharmacist, but maybe you want to switch careers and be a NICU nurse.” I was like, “I don’t know. I’m just going through a lot. I need a minute. But they were wonderful.”

Dr. Fox: Yeah, they’re terrific. They really are. And I agree. They do God’s work, and they only work with scared people. I mean, only. So, it’s not like anyone has a kid in the NICU and they just feel, “Ah, you know, nothing to worry about.”

Julia: Yeah, it’s not a big deal.

Dr. Fox: It is a big deal.

Julia: But just to speak at that, with parents even moving forward, if your child does get admitted to the NICU, it’s not as scary as it seems. It seems really scary at that time, because there’s so much unknown like, oh, my God, you have a newborn and then they’re going into the NICU. And you just get overwhelmed with so much emotion, but ultimately they’re in the best care possible.

Dr. Fox: So, here we are four months later. You look great. You look terrific. What do you take from all this? What do you want our listeners to get from this awesome story?

Julia: I want our listeners to know that sometimes we plan for things in our lives, and it doesn’t always work out the way we plan. And it’s okay to get another opinion on certain situations that occur in your life, specifically with this pregnancy, because it was this 1 in 10 million situation that happened with the twin ectopic pregnancy. But ultimately that, when you come to a decision within yourself, you have to learn how to make peace with it. So, whatever it was, I knew that I had to make the peace and I knew that I had to be okay with that decision. And the fact that this was around… I’m trying to now think back because it’s been a minute. I don’t remember… This was after I saw Timor, so that was definitely after 9 or 10 weeks, so maybe this is around 12 weeks. And we came in and you’re like, “Yeah, you spoke to Timor. And like I said, I really think that we’ll be okay with this.” And I was petrified at that moment. I had a really bad anxiety attack that day with you, and I looked at you and I said, “I hope I’m not doing the wrong thing, because I really feel like I have so much more love to give.” And you looked at me and you said, “If you abort this baby, it’s going to be one of the biggest mistakes that you do, I think.” And I looked at you and, at that moment, I felt it and I knew that deep in my heart that you were right. And I knew that we can do this. And from that moment, I didn’t self-doubt myself. I didn’t second guess myself. I didn’t question myself again. That’s when I made the peace that day I said that we’re going to do this, we’re going to do it with grace, we’re going to do it with the medical science and the team that we know who will take care of this information as it’s coming to us. And ever after that moment when I made the piece, it just made it a lot easier for myself. So, to everyone out there that’s going through something that they didn’t expect on their journey, it will be okay, that there’s always a happy ending at the end of everything, irrespective of if it’s what you wanted or it’s not what you wanted. It always makes sense in the end.

Dr. Fox: Amazing. Thank you so much for coming in. Thanks for being such a delight always. You’re a very supportive patient. You really are. You always make me and my team feel very special, and it’s appreciated. And really we are just over the moon happy for you guys that this worked out, despite the crazy pregnancy and the scariness and all that. We’re so happy for you guys and you deserve everything.

Julia: I love you with all my heart.

Dr. Fox: You’re so sweet.

Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.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 hw@healthfulwoman.com. Have a great day.

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