“Kayla’s Story, Part One: Preeclampsia and HELLP” – with Kayla Holtz

Dr. Fox: Welcome to “High-Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High-Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth. Kayla, welcome to the podcast. How are you doing today?
Kayla: I’m good. Thank you for having me.
Dr. Fox: It is my pleasure to have you today. Thank you for volunteering. And I believe this is the first time we are having a sibling of a prior podcast guest come on to tell her birth story. So we’re going sisters here. I love it.
Kayla: Yeah. My sister was on recently and she had such a positive experience, and we’re really close, and I guess you would say, fortunately, or unfortunately, we had some similarities in our postpartum experiences with both of our first children. So we’ve been able to really connect with each other through that, and she just really encouraged me to share my story too and she thought it might help others and be good for me to, you know, talk about as well.
Dr. Fox: For our guests, we’re talking about Ashley who was on the podcast in December, so just a month ago from when we are recording, about two months ago probably for when you’re listening. And I know that during the podcast, she did mention that knowing about your pregnancy impacted her, so now we’re getting sort of the…This is like the prequel basically to her story to get your story. So that’s great, but no, really thank you for volunteering. I think it’s terrific, and I’m excited to hear your story. We were talking about your first son, Wesley, who was born in 2019. You currently have two sons, right?
Kayla: Yes. I have Wesley who is 2-and-a-half. He was born in 2019. And then I just had my second son, Theodore, who was born this past June of 2021. So, it’s a little bit busier around our house right now.
Dr. Fox: Two boys tearing up the house, I assume.
Kayla: Oh, yes, they are. I definitely…It’s funny because I come from a lot of girls in my family and so it is my husband, and when we first got pregnant, we just assumed we would have girls, and my sisters also assumed they would have girls. And right now, we have all boys. So, you know, it’s just funny how things turn out.
Dr. Fox: It’s funny. Is Theodore mobile yet? Is he on the move or is he still grounded?
Kayla: He just turned 7 months a couple of days ago, and he is now pulling himself.
Dr. Fox: Oh, boy.
Kayla: So, he can get really far by pulling himself. He’s not up on his hands and knees yet, but definitely, it happened quicker with him than with my first, and I think that’s because my first is running around all the time and he’s trying to keep up. So, yeah, he’s definitely getting around and I have to, you know, shift some furniture and some toys around so he can’t get his hands in everything.
Dr. Fox: He’s doing that army crawl with the forearm to pull yourself forward.
Kayla: Yes. Yes, he is.
Dr. Fox: That’s a cute phase. Well, God bless you when he gets up and he’s running around because it’s gonna be a disaster. So get ready for it.
Kayla: Oh, I know. It is.
Dr. Fox: Excellent. So we’re talking about Wesley, and he was born in May of 2019. So I guess the beginning of the story takes us back to 2018 or so, right?
Kayla: Yes. So it was the fall of 2018 I found out I was pregnant. I was living in Florida with my husband, who, at the time was active duty military. He was a naval officer. Now he’s in the reserves and doing other things. But we were in Florida and he really wasn’t home for much of the pregnancy. We added up the weeks one time and it was about 12 weeks total, but all, you know, sporadic chunks of time that he was around, and actually, funny enough, he was supposed to be away for the due date, but my son came a couple of weeks early so he was there. And all my family lives up north, so it was a little bit tricky because I didn’t have a big support system where I was living at the time.
Dr. Fox: Were you living just in a regular town or were you on a naval base?
Kayla: Yeah, we weren’t living on a naval base. We were living in an apartment building actually in Jacksonville.
Dr. Fox: Was he overseas not around, or just around the U.S.?
Kayla: He was just around the U.S. He had done a deployment previous to that, and then he had been home for a little bit. And so, when he was away, you know, the ship’s kind of come in and out very, very frequently so he would go out for a couple of days, come back, go out for two weeks, come back, you know, just in and out throughout those nine months or so.
Dr. Fox: What’s that like to have, you know, your husband in and out because he’s in the military and, again, you’re in Florida where you’re not from? Was that very isolating or did you have any friends down there yet? I don’t know how long you’d been there already.
Kayla: Yeah. So I moved there in 2016 after I finished grad school and my husband had gone to officer school and that’s when he moved down there and I followed him. We weren’t married at the time but we’ve actually been together since we were 15 years old. Yeah, so we’ve been together for half our lives and we got engaged down there and we got married back up in Connecticut during that time when we were living in Florida. And it was definitely isolating, you know. I’m very close with my family, with my siblings. And even with my husband’s family, I’m really close, in particular, with my mother-in-law and my sister-in-law. It was kind of hard to be away from all that. But luckily the job that I got when I moved down there, I made some really, really good friends and I don’t know how I would have gone through everything down there, but particularly my pregnancy, birth, post-postpartum without their help. And I met some other navy wives, which was really helpful because most of them were around and most of them have kids too so they had been through a lot of this as well.
Dr. Fox: Yeah, I would imagine because that’s why I was asking because if you’re on a base, obviously even if he’s not around, there’s gonna be a lot of people in similar circumstances and you can all, you know, bond together, but if you’re off the base it’s a little bit haphazard where they live and where you live and whether you’re gonna be connected to them. So I’m glad that you were able to have those friends and those connections. I’m curious, what’s it like from his end to be…? You know, you’re out at sea or you’re, you know, somewhere else, you’re in a different state and your wife is pregnant. How stressful is that when already…? I guess it must be stressful to be in the military in general.
Kayla: He definitely found it stressful. He’s a pretty…I would describe him more of like an easygoing guy, so if he has plans and he has structure and he knows what’s gonna happen, you know, that’s very helpful to him. So I think knowing that I had backup people to help me…I was actually delivering at the hospital that I worked at at the time. So I really was there, you know, Monday through Friday, 9:00 to 5:00, or longer. I was where I would be delivering. So that was really helpful to both of us knowing that, you know, if I went into labor earlier or anything chances are, you know, it’s gonna happen at work and I’d be fine. You know, he had a hard time when he would go away just being nervous about things and that’s ultimately why he decided to end his time in the military and, you know, go back to…He was working in, like, corporate finance world before the military and now that’s what he’s doing again now. I think that he dealt with it very well, and he’s a very calming presence to me. He was a little bit more anxious maybe about some things.
Dr. Fox: What is it you do professionally that you would be in a hospital?
Kayla: So I worked as a clinical dietician.
Dr. Fox: Oh, cool.
Kayla: Yeah. So I did school for that and then moved down to Florida and got my first real job. I mean, in grad school I worked but it was more in outreach-type areas, and so that was my first clinical job. It was actually an hour south of where I lived, which is kind of important later in my birth story. But I decided to go to an OB practice there because I was gonna be there for most of the time, you know, while I was working. I planned to work up until I delivered and my appointments were gonna be there and I could just go to the appointment and then go on to the floor and see my own patients. So it worked out really well in that sense.
Dr. Fox: No, that makes a lot of sense. And did you have any, I’m just curious, experience from your clinical rotations or from your job in the world of pregnancy and prenatal care or were you in a different area of nutrition?
Kayla: While I was pregnant, I was working as just a clinical registered dietician on the floor. So I saw all sorts of patients. I did some internship work, actually, at a maternal-fetal medicine clinic and got to see a lot of really interesting patients from a nutrition standpoint and from a pregnancy standpoint. And also we did provide support. So we did a gestational diabetes class. I did some outpatient work with gestational diabetes patients. So I have a little bit of, you know, experience in that but not…It was never my main focus.
Dr. Fox: Right. So you have some familiarity with, like, you know, pregnancy and high-risk pregnancy and whatnot, but it wasn’t your focus.
Kayla: Yeah.
Dr. Fox: Okay. So, that’s who you are and that’s what’s going on. And how did the pregnancy proceed? How was, you know, like, the beginning of pregnancy first, second trimester?
Kayla: Yeah. It was all pretty normal pregnancy, some typical, you know, morning sickness, fatigue. One time I had a really high fever and vomiting and my son wasn’t really moving a lot. You know, they tell you do those kick counts and whatnot. And he wasn’t meeting those, and that was at the beginning of the third trimester. So I went in and they kept me for a couple of hours, gave me some fluids, you know, put him on the monitor, but everything was totally fine. I don’t know if I just had a stomach bug or what it was. But other than that, yeah, baby was growing well. There was, you know, no concerns. I was, you know, young, pregnant for the first time, healthy. It wasn’t difficult for us to get pregnant, thankfully. So it was, you know, kind of textbook from that point.
Dr. Fox: Was there anything that you were specifically concerned about either going into pregnancy or through early pregnancy? I mean, obviously, there was sort of like the logistics, is my husband gonna be around when I deliver? And all of those. But did you have any…? You know, some people because of something that happened in the family, something they read about that they were acutely concerned about over the course of pregnancy, and others are just sort of like, you know, they take it as it comes.
Kayla: Yeah. I was really not worried. I mean, my mom has…There’s five children in my family and I have a lot of cousins and whatnot and I always just assumed…It’s like, “Oh, all these women in my family get pregnant, have babies easy, no one had ever had any complications that I’ve been aware of.” So I just assumed that it would be a normal healthy pregnancy. I believe I was 26 when I got pregnant. So I, you know, just thought I’d be all set. And I think the only thing I was worried about was the actual, you know, giving birth part because, of course, I think all pregnant women are a little bit nervous about that just a lot. But I was really interested in pregnancy. Before I even got pregnant, I used to listen to birth stories all the time and podcasts and things like that. So it was a topic of interest for me, but it wasn’t the cause of any concern that I had.
Dr. Fox: You said you’re one of five sisters?
Kayla: Four girls and one boy, actually.
Dr. Fox: And where do you fall in line?
Kayla: I’m the second.
Dr. Fox: The second. Now, at the time you were pregnant, were you the first?
Kayla: Yes, I was.
Dr. Fox: Oh, so this was gonna be the king grandchild.
Kayla: Yeah. The first one.
Dr. Fox: All right. So that’s a big role in the family, I mean, to be the first sibling pregnant, to have a baby, I mean, everyone sort of like focused on you and, you know, everyone is gonna be looking to you afterwards as the elder statesman of what to do with pregnancy, but you didn’t have anyone in your own family directly to look at.
Kayla: No. But luckily, actually, the dieticians that I worked with, the job that I first got was to cover somebody’s maternity leave, and then right after she got pregnant, the other dietician that worked there also got pregnant, and then I pregnant. And so, I had…Everyone I…
Dr. Fox: Wow. It’s a fertile group.
Kayla: Yeah. After I had my first, another one of them had their second. So we all kind of were pregnant around the same time and they were a huge help to me in so many ways just about pregnancy and just life in general. And like I said, my husband was gone a lot, so I spent a lot of time with them and with their kids. And that was also, like, you know, a good step into this is what motherhood looks like, especially motherhood when you’re working and all that, so…
Dr. Fox: Wow. Well, whoever does HR and scheduling, you know, practice for the dieticians really deserves a bouquet of flowers because that’s a lot to juggle.
Kayla: Oh, yeah. Yes, it was. It was.
Dr. Fox: All right. So, you’re going along at pregnancy. Things are going well. When did it take a turn for the left?
Kayla: So I went to my 36-week appointment. I felt like I was really swollen. I’m a decently small person and I just remember my hands and my feet and my ankles looked crazy to me. And I had some more weight gain. My midwife…I saw midwives. It was a midwife and OB practice but you kind of stuck with one unless needed. So I saw the midwives and then they worked with the OBs as they needed to. So when I was seeing them, you know, I was like, “Oh, I gained, like…” I think it was like 10 pounds since my last appointment, which was like two weeks, but my first 34 weeks of pregnancy I only gained 20, so to gain that much right away. And they were like, “Oh, no, you’re fine. You still have only gained like 30 pounds.” I was like, “Okay.” And my blood pressure was high for me. And again, I know they don’t use that as a criteria, like comparing to your old blood pressure for preeclampsia or HELLP syndrome or anything.
Dr. Fox: We used to No, we used to. That’s…Yeah.
Kayla: Oh, you did. Okay. I know now when…you know.
Dr. Fox: Yeah. It used to be something called the 30/15 rule, meaning if let’s say you started at 90/60 and then you come in at 120/75, that’s a totally normal blood pressure, but it is, you know, significantly higher from when you started. Again, we don’t use it as criteria anymore because so many people have that and it means nothing. Sort of like swelling. So many people have swelling and it does not mean preeclampsia. But, you know, noticing you’re swollen and gaining 10 pounds in a couple of weeks. So, you know, it’s all water. That’s not the baby.
Kayla: Yeah, exactly.
Dr. Fox: Yeah. How high was your blood pressure?
Kayla: It was 130/80 and my blood pressure in life in general and throughout my pregnancy was always like 100/60. So when I saw that I was like, “Oh, that’s high,” but my midwife was like, “Oh, you’re totally fine. You’re 2 centimeters dilated. You’re 100% effaced.” And I remember specifically her telling me, “Wow. This baby’s head is,” she said, “crazy, super low.” I was like, “Oh, okay. I don’t know what that means, but I guess, like, you know, starting to make his way out.” So that was at my 36-week appointment.
And then two days later is when I first ended up in the hospital. I had a really bad headache at work. And luckily, obviously, I worked with a lot of nurses so I just asked one of them to take my blood pressure. Just, obviously, being in the medical field, I knew that, you know, having really bad headaches is not necessarily a good thing, especially because I was already a little bit concerned about my blood pressure at that appointment two days prior, and my blood pressure at that point was 150/95. So I was like, “Oh, that’s too high.” And I called down, and I was working on the fourth floor and I just went right down to the third floor and they admitted me overnight for observation and to do the whole urine collection, non-stress test. My blood pressure went up to like 160/100, and my urine was positive for protein, and they said I had elevated uric acid. My liver function test, all that was normal, and my platelets were a little low but they weren’t concerned at that point about anything other than my blood pressure. That was, like, the big concern.
Dr. Fox: What about the headache? Was that continuing?
Kayla: It was continuing, but they were able…After giving me medication a couple of times that started to subside. And I didn’t really have vision changes at that point. So it was just the one headache that I had and the high blood pressure and the protein in my urine. So they started me on labetalol. They gave me some steroids for the baby. They did a cervical check again and I was 3 centimeters dilated, and yeah, so they were like, “Okay, we’ll see what happens,” and they discharged me home on labetalol. I think it was like 100 milligrams twice a day.
Dr. Fox: Whoa. Whoa. You went home?
Kayla: Yeah. I went home. I went home.
Dr. Fox: Oh. All right.
Kayla: Yeah. And they planned to do weekly labs and a biweekly non-stress test, and they said, “We’ll induce you at 39 weeks if the baby hasn’t come by then,” but the nurse told me after the midwife left, she was like, “There’s no way you’re making it to 39 weeks with where you’re at now.”
Dr. Fox: Wow. Yeah. I don’t think I would have had you go 39 minutes.
Kayla: Yeah. Well, that’s interesting to hear because I always just wondered some things about how different people would handle these different situations that come up.
Dr. Fox: You know, when someone has preeclampsia, it sort of depends, you know. The way we decide when to deliver someone is there’s really two variables. Number one, how bad is it, meaning how severe it is, and the more severe it is the more likely we are to recommend an early delivery, and how far pregnant are you? So if someone is after their due date, no matter how mild the preeclampsia is, we’re gonna recommend delivery.
Kayla: Yeah, of course.
Dr. Fox: Whereas if someone is, you know, 28 weeks, we’re gonna…It has to be really, really bad for us to recommend delivery. And those two variables play off each other. When you get to 36, 37 weeks, that’s sort of the breaking point for gestational age, meaning most people, if you’re 37 weeks or maybe 36 weeks, even if it’s mild, you’re gonna get delivered. Some people are very religious about waiting until 37 weeks, and so that’s my guess is what they were doing, they’re gonna watch you very closely in this. But I would say if you need to be on medicine for your blood pressure and you had a headache and your platelets are a little low, A, probably that’s bad enough that it’s time to be delivered or, B, even if I weren’t delivering you, I would predict you’re gonna be delivered really soon because that’s not getting better. That’s only gonna get worse.
Kayla: And actually, I was supposed to work. That was a Thursday. I was supposed to work on Saturday and they’re like, “Don’t come into work on Saturday,” because I got discharged on a Friday night. I was telling my midwife I’m not planning on coming back to work after this baby is born. With my husband being away, I’m not going to work. So it doesn’t necessarily matter to me when maternity leave started, and I was wondering if I could, you know, not come back to work on Monday just if I’m gonna stay pregnant and I might be at any risk for these things. And she said, “You know, we really don’t recommend bed rest so, you know, I don’t think there’s any reason for you to not be able to work come Monday.” I was like, “Okay, well, I guess we’ll see what happens.” I didn’t make it until Monday.
Dr. Fox: So, at this point, since you’re a month early, though, your husband is home.
Kayla: Yes. Yeah. Actually, like I said, it worked out. He ended up being home when Wesley was born. But yeah, so they had me go home. I went home that late Friday night after they waited 24 hours just to give the baby steroids again, and I went home and I had some cramping that next day. I didn’t feel awful but I didn’t feel great. I just kind of felt uncomfortable, like, altogether. And I had a blood pressure cuff at home and I took my blood pressure the next day and it was 160/110 still. And I was definitely having…it wasn’t vision changes. I mean, I guess I shouldn’t say that because they always said if you have floaters or if you’re seeing spots, things like that, and I never had that, but I had a hard time, like, focusing my eyes on things. It was very hard to explain to them, and they were like, “You’re not seeing any spots, right?” And I was like, “No, but isn’t it a bad thing if I can’t, like, focus on what I’m trying to look at?” So I called the midwife and she said, “Yeah, come right in.”
Dr. Fox: And that’s also despite being on a blood pressure medicine.
Kayla: Yes. Yes. I was taking that as they instructed, and I know the cuffs at home aren’t 100% accurate, but I would imagine they at least can tell you the trend.
Dr. Fox: They’re close enough. Yeah.
Kayla: You know, 160/100 is obviously too high.
Dr. Fox: Okay. So this is Saturday.
Kayla: Yeah. Well, this was actually…I didn’t call on Saturday because I felt okay. It was Sunday morning by the time…
Dr. Fox: Okay. So it’s two days later. Okay.
Kayla: Yeah. Two days later. So I was readmitted about 48 hours later, and at that point, they said, “Yeah, you definitely have preeclampsia.” I looked back at my labs just the other day and my LFTs were, like, a little bit elevated, those liver function tests, but not anything crazy again. My platelets were definitely starting to trend down a bit, and the midwife said she wanted to discuss with the OB and they did decide that an induction would be best. I was 36 weeks and 6 days at that point.
Dr. Fox: Yeah. Did they put you on magnesium or just induced labor?
Kayla: Not yet. So magnesium came later. So they decided to induce me. They actually put me on the monitor and they’re like, “Are you feeling any of those contractions?” I was like, “Not really,” and apparently, I was having contractions that they were picking up pretty consistently, but I wasn’t…I was just overall uncomfortable, so I wasn’t picking up on any specific contraction. But it wasn’t until 10:00 p.m. they checked me and I was 5 centimeters and they were like, “Okay, so we’re just gonna rupture your membranes and see what happens before we start any Pitocin and see if he comes fast enough,” which he did five hours later. I just walked the halls a ton. I had continuous monitoring and all that, which was great. I could still take that in the shower. I didn’t really have restrictions for labor purposes, and he was born in five hours. So it was a pretty quick labor.
Dr. Fox: Yeah. That’s amazing.
Kayla: Yeah.
Dr. Fox: Epidural or no epidural?
Kayla: So I got an epidural. At about 9 centimeters, I was like, “Okay, now I’m scared for the pushing part,” and I was a little bit…not realizing it was gonna all happen so quickly. So, at first, you know, I was trying to hold off on it because I really wanted to be able to be up and walk around. So at 9 centimeters, I was like, “Okay, I think I need this now.” And by the time they gave it to me, they went to check me and they were like, “You’re 10 centimeters.” And it didn’t work. Like, it was…I could still feel everything. They had it in place but the dose wasn’t really right. And so, I had one, but I don’t really think I got the benefits of that.
Dr. Fox: How long did you have to push for?
Kayla: I pushed for…I remember very specifically looking at the clock. At 3:00 a.m., I started pushing and he was born at 3:51.
Dr. Fox: That’s pretty good.
Kayla: Yeah.
Dr. Fox: What did little Wesley weigh?
Kayla: He was small. He was 5 pounds 14 ounces, but he was healthy. He spent no time in the NICU.
Dr. Fox: That’s so small for 36 weeks.
Kayla: Yeah. No, I mean he was fine. Like, they weren’t concerned about him at all. He was breathing fine. You know, all that was good. He didn’t really have too many issues after he was born, anyway. All the problems were on me afterwards so…yeah.
Dr. Fox: All right. All right. So you deliver him, you have your healthy boy, and then what happened after he’s delivered?
Kayla: So, of course, they were monitoring my blood pressure. I always had a million IVs, medications. They were drawing my blood constantly. I kind of assumed my blood pressure would go back to normal after delivery. I think I was so, you know, focused on having a new baby that I wasn’t really thinking about what was going on with myself.
Dr. Fox: Well, you assumed correctly. Your blood pressure would go normal after delivery. It just might take, you know, an hour, a day, a week, or a month.
Kayla: Yes. Yeah. And then the OB came in, and he kind of mentioned really quickly, again, all these diagnoses. I mean, of course, I think I had heard of things like preeclampsia and whatnot but it was very…I don’t want to say nonchalant but the way they kind of mentioned it I was like, “Okay, now I have preeclampsia.” And after I delivered him, the OB had come and at one point he was like, “Yeah, well, with HELLP syndrome, we really wanna make sure we’re monitoring blah, blah, blah,” and I was like, “Wait, what?” I had to stop for a second. And I was actually…After he left, I remember googling things on my phone. It was an OB that I didn’t know. I knew most of them but he was one in particular that I didn’t know and maybe he thought the midwives had already discussed this with me, but they hadn’t.
So my hemoglobin, my platelets had dropped really low. My liver enzymes were up really high. So, at that point, I obviously had progressed into the HELLP syndrome, and that’s when they started me on magnesium, the evening that I delivered Wesley. And that was absolutely horrible. I know at first I had never really heard about the magnesium treatment when I was in the situation, and the nurses were like, “Okay, we’re gonna start you on this now,” and everyone was so somber looking. I was like, “What’s the big deal?” Like, “What is it gonna do to me?” I had no idea. And they were like, “Oh, yeah, you’re not gonna feel good on this.” I was like, “Okay. So I guess we’ll just, you know, see what happens,” and it was horrible, for sure. For me, personally, I couldn’t really see straight. I couldn’t lift my arms to feed Wesley. I wasn’t allowed to stand up to go to the bathroom. It was horrible.
And I credit my husband a lot because he did everything in the hospital. He changed all the diapers. He brought Wesley to me to, like, help him latch onto me to breastfeed and everything. And it was definitely a tough 24 hours. And at the end of that 24 hours, I was so excited because I was like, “Okay, I’ve been doing this now for 24 hours. They’re gonna stop it.” The doctor came in and said, “We’re not really satisfied. We don’t want you to have any events overnight. We’re gonna extend it for another 12 hours.” I was like, “Oh, my God. Okay. Another 12 hours. I can do it.” Like, not sleeping and just not being able to move at all, it was awful. I felt like I was, like, drunk or hungover while I also had the flu.
Dr. Fox: Yeah. People say flu in the bag for magnesium.
Kayla: Yeah.
Dr. Fox: You know, interesting, some people don’t have side effects from it. It was just remarkable. Some people like, “Yeah, I feel fine,” like nothing, and other people are like totally zonked on it and there’s everything in between, and it’s pretty hard to predict who’s gonna have what. It’s sort of luck of the draw.
Kayla: Yeah. Well, I was definitely on the bad end of that.
Dr. Fox: Okay.
Kayla: That was not a fun time. But after that, things started to stabilize a little bit, and again, I was so focused on Wesley. Because he was smaller, they were worried about his weight. He lost a little bit more than they wanted him to and had a little bit of jaundice but nothing crazy. He didn’t have to go under the lights or anything like that. But I was trying to pump and do some syringe feeds and all that kind of thing.
Dr. Fox: Did you deliver it in, like, a big hospital where it was pretty obvious that these nurses and doctors that they’ve seen this, they’ve done this before, or was it more of a smaller community hospital where it seemed like this might have been a little less common for them? I’m just curious.
Kayla: It was a small community hospital where I was working. Definitely, it was not a big facility at all. And I stayed on the labor and delivery floor the whole time I was there. They didn’t wanna move me to post-partum because they were worried that post-partum, they wouldn’t be able to, like, handle everything.
Dr. Fox: Did the hospital have a NICU?
Kayla: Yes, it did. A small one, but they do have a NICU.
Dr. Fox: Okay.
Kayla: And I will say a lot of the babies are transferred if they need substantial care. They’re transferred out and they would go to Gainesville or something like that to go to the NICU there. So they didn’t keep babies there in the NICU if they were really compromised, but they did have a small NICU and some neonatologists and whatnot that worked there and the pediatricians and everything. Yeah, it didn’t seem like it was an everyday occurrence for them, for sure.
Dr. Fox: Was there any discussion about maybe transferring you to another facility or they were confident they could take care of you there?
Kayla: It was never discussed, and it wasn’t something that I even, like, discussed with my husband. My mom actually flew down as well, and she’s a nurse so she was obviously very concerned. But it wasn’t something that we really talked about.
Dr. Fox: Yeah. It sounds like they’re doing all the right treatments. I was just curious because sometimes if someone is that sick, they’re like, “Oh, you know, maybe this isn’t the right place for you. Maybe you should recover at a different hospital.” Again, I mean, it doesn’t sound like they did anything that was incorrect or anything like that. I’m just curious because sometimes when you’re at a smaller hospital, they take one look at you after delivery. They’re like, “Bye-bye. We’re shipping you out of here.”
Kayla: They thought it was okay, and then I stayed there…I was there for five days. At that point, they said, “Your labs seem to be, you know, holding steady.” My son was finally discharged and I went home on…They gave me labetalol to take, 200 milligrams 3 times a day, and they actually specifically told me not to check my blood pressure and that I didn’t need any parameters for the medication. And I was a little bit concerned because I was somebody who always had low blood pressure. So I was worried that what if my blood pressure corrects and then I’m taking all these blood pressure meds and then I, like, bottom out?
Dr. Fox: Why would you not check your blood pressure? What was the thought? That it was just gonna worry you or…?
Kayla: They said it wasn’t necessary because it was starting to normalize and you’ll come back in a week, you know, to the office and get it checked. And so, you don’t need to worry about it. Of course, going home and having my mom who’s a nurse at home was like, “Oh, we’re checking your blood pressure.”
Dr. Fox: She’s like, “Yeah. Okay.”
Kayla: Don’t worry.
Dr. Fox: I mean, yes, it could happen that you recover quickly and you’re on medicine, your blood pressure is getting too low, but you would generally notice that because you would start feeling lightheaded and dizzy and it’d be pretty obvious, but I’d be worried about the opposite that you’re home when you’re on 200 milligrams 3 times a day and after a few more days you realize, no, you need double the dose or triple the dose. Because that happens. I mean, when you go home on a dose it changes. It’s not like everything always moves in the same direction.
Kayla: Well, funny you say that because I went home and I really did not feel well when they were discharging me. I felt like, you know, maybe it’s just magnesium is still lingering. This is how you’re supposed to feel after birth. So let me just go home. I’ll be able to maybe rest in my own bed and people can help me with the baby between my mom and my in-laws had also driven down from Connecticut. So we had both sets of parents and my husband. I was like, “Okay, I’ll feel better once I get home.”
Dr. Fox: Oh, my God. Were they all staying with you?
Kayla: No, they weren’t actually. My sister-in-law also lives in Florida, so my husband’s parents, you know, went and stayed with her until we needed her and until, like, my mom left, and then they came and stayed with us. So they kind of did like these flip-flops back and forth, which was super helpful.
Dr. Fox: Oh, that’s nice. Yeah. That is nice.
Kayla: Yeah. But I made it home. I developed a fever and my mom took my blood pressure. It was like 2:00…I got discharged at 5:00 p.m., and in the middle of the night, my blood pressure went up to 180/110, and my mom was like, “Okay, we’re obviously not staying home.” And again, I had a fever, so that was a new thing. And less than 12 hours after I was discharged from the first hospital, I was readmitted.
Dr. Fox: You’re an hour-plus away from where you delivered, right? That’s what you said.
Kayla: Yeah. So the problem was…So I called the midwives and they were like, “Okay, your blood pressure was never that high in the hospital. You need to get to a hospital as soon as possible.” But I lived an hour away and I was like, “So what am I supposed to do?” And I was very…I remember sitting on the couch and my husband and my mom talking and putting Wesley in the car seat and trying to figure out what to do. And I was really out of it. I was like, “You guys need to make a decision. I can’t.” Like, I was definitely having vision changes at that point and I was like, “I can’t make this call.” And I couldn’t really walk or stand very well. So they actually ended up calling an ambulance because we also didn’t know…We had just moved to this new part of Jacksonville. Jacksonville is huge. And the only hospitals we knew were the naval hospital, which is 45 minutes in one direction, and then the hospital I delivered at, which was an hour in another direction. So we just wanted to get to the next place the fastest. So I was readmitted but to a different hospital, which isn’t ideal.
Dr. Fox: The naval one or a different one?
Kayla: No, another hospital that was actually only 10 minutes away from us. So that was great. I got there quickly.
Dr. Fox: Another community hospital or a big hospital?
Kayla: No, a really big hospital.
Dr. Fox: Okay. Got it.
Kayla: Yes. Very different. Very, very different hospital. But it was hard because when I went to the ER, the doctors there were really confused. They were like, “Why are you here? Are you pregnant? What do you mean? You had a baby?” And they couldn’t really figure out what was going on. And I said to the ER doctor, I was like, “Can you get an OB here? Like, I think an OB will understand what I’m trying to say.” Like, I can maybe…
Dr. Fox: Right. I’m certainly not pregnant despite…And did they make you do a pregnancy test? They sometimes do that.
Kayla: They actually didn’t because my husband comes walking in with Wesley in a car seat who’s 5 days old. I was like, “Here is my baby I just delivered at a different hospital.” So, finally, they got an OB to come down. They had OB hospitalists at this hospital, which I had never heard of. I didn’t realize they had hospitalists that were also OBs at the hospitals.
Dr. Fox: Yeah. Yeah. Hospitals with busy labor floors will frequently have someone who is hired by the hospital to, like, just sit in the hospital, you know? So they rotate. So they take 12-hour shifts or 24-hour shifts, and they’re there for whoever, someone like you who comes in or someone who comes in labor or sometimes they cover for some of the practices, people in labor. But yeah, I’m sure they knew exactly what was going on with you immediately.
Kayla: Yeah. So they admitted me right away to labor and delivery. And it was a little bit tricky because I was not…Wesley was not admitted with me. He was not a patient, which makes sense, obviously, but it just made it a little bit…
Dr. Fox: Right. He was a visitor.
Kayla: Yeah. He was a visitor and he wasn’t allowed to be left alone with me. And they were strict on that. Understandably so.
Dr. Fox: Yeah, because you’re sick.
Kayla: Yeah. Even if my husband went to the bathroom, like, somebody else had to be in the room. Even if Wesley was sleeping in his bassinet, they were like, “No, somebody has to be here.” They got me admitted up to labor and delivery. And when I talked to the OB, they were like, “Okay, we have to put you back on magnesium.” I was like, “Is that normally what they do?” And they’re like, “Honestly, we don’t do it very often because this usually doesn’t happen, but we don’t have any other choice.” And the second time around was way worse, I will say. I’m not sure exactly why but it just was…
Dr. Fox: Well, you were sicker.
Kayla: It was horrible.
Dr. Fox: I think you were sicker.
Kayla: Yeah. Well, and then I also…
Dr. Fox: You had a fever.
Kayla: I had a fever. I developed some sort of infection that they never really pinpointed, but they just assumed it was a uterine infection is what they told me. My fever at one point jumped to 105.
Dr. Fox: Wow.
Kayla: Having a fever of 105 plus being on the magnesium, that makes you feel that hot flashy feeling, and the protocols at this hospital was to get a catheter, complete bed rest. Like, I was not moving at all.
Dr. Fox: I mean, it’s not an intensive care unit in the sense that people think of it, but you are getting the equivalent of intensive care because you have a hypertensive emergency. Your blood pressure is dangerously high. You have potentially sepsis, right, where you have, you know, let’s say bacteria in your blood and you have a high fever, and yeah, they’re really worried about you. I mean, things can go very south very quickly, and so they’re treating you as if you’re in an intensive care unit, basically, which is also the same reason it makes complete sense that they don’t want you having any responsibility over that baby for even a second.
Kayla: Yes. Of course.
Dr. Fox: Because again, the baby, if you deliver and you’re in the hospital, you can be with your baby because if there’s any concerns they take the baby, put the baby back in the nursery and the nurses watch. But they’re like, “This isn’t our baby.” It’s a little bit odd, but it makes a lot of sense, actually…
Kayla: Yes, of course.
Dr. Fox: …that they couldn’t really pull that off. And it’s one of the…These are the struggles when women who just have babies get admitted to the hospital for any reason, what do they do with the baby, right? So you can leave the baby at home but who’s taking care of the baby? Who’s gonna nurse the baby? Like, you have to…There’s like a whole thing that has to happen. So it is complicated, but yeah, you were really sick and they had to do everything to pounce on you, unfortunately for you because it is quite annoying, to say the least, to have all these treatments because they’re not pleasant.
Kayla: Yeah. So between the magnesium, the IV antibiotics, and just overall that, you know, weakness, vision changes, and I had some significant tearing, so I was in a lot of pain from that. And then putting the catheter in, that was…Putting the catheter in was, honestly, I feel like worse than pushing the baby out just because there was so much stuff going on down there so…
Dr. Fox: You teared up by your urethra as well?
Kayla: My gosh, I don’t even remember exactly all the places but I know the one that was really painful. I had a sulcus tear.
Dr. Fox: Oh, yeah.
Kayla: …they said it was. Yeah. And it was more internal and it was almost a third-degree, I believe they said, so it was…The midwife actually didn’t do the suture. She called the OB to suture me up because she said that…
Dr. Fox: It was a little extensive. Yeah.
Kayla: Yeah. And she wanted somebody with more experience, obviously, and a surgeon to be able to do it.
Dr. Fox: Yeah. And her putting the catheter in, it’s possible you had some tears up there at 12:00, which is where the catheter goes and that can be pretty painful. Yeah, because that’s much more sensitive than the other side.
Dr. Fox: Well, I definitely was, and I don’t know if the magnesium was…I’m obviously not a doctor so I don’t know what the doses of these things are or if it was just harder on my body the second time, but I was having a lot of difficulty breathing the second time around with it and it was causing some, like, respiratory depression. And I remember it was very scary because I would almost have these like apneic episodes where I was so tired and I would fall asleep, but I was so scared to fall asleep because every time I did, I would, like, stop breathing, but I knew that I was stopping breathing so I would wake back up and kind of like sputter. And at one point they were really concerned because, you know, they check your reflexes and all of that to make sure that’s intact. And my reflexes were intact but my breathing was really shallow and erratic. And I know my oxygen stats were down to like 80/82. So they were like, “What’s going on?” So they actually, at one point, came in. All of a sudden, a flood of people came in. My husband had just left to go home and take a shower, the first time he left my bedside the entire time, and my mom was there holding Wesley, and they rushed in and put me on a stretcher and whisked me away to go to CT because they wanted to check for pulmonary embolism.
Dr. Fox: Magnesium can make people sluggish in general, and so sometimes it can cause respiratory depression. The only reason it might be different is…well, there’s a few reasons. Magnesium is cleared by your kidneys, so sometimes with very severe preeclampsia or infection, your kidneys don’t work as well and so the magnesium can sort of…on a typical dose and it’s cleared quickly can sort of build up if your kidneys are a little bit slower. So that’s one reason. But I assume they checked it out with a blood test. But also, you know, remember, you have a fever and you’re infected, and so that’s another reason. And number three could also be that you had fluid in your lungs. That could be another possibility that, you know…yeah.
Kayla: Yeah, which is what they said. When the scan came back, they said it was negative for a PE, but you have some pulmonary edema. They ultimately determined that we just need to turn off the magnesium because it’s depressing your respiratory system even more. So I made it…at that point I had been on it for 20 hours. So it was just shy of the…The doctor is like, “Okay, we’re gonna turn it off because you also were on it for 36 hours prior,” and they thought that at that point things were starting to look a little bit better in terms of the preeclampsia, HELLP syndrome side. So they turned that off and yeah, it was so much better once that was off, you know, when I was able to get out of bed and breathe normally, and they put me on oxygen for a bit but…
Dr. Fox: Did they have to give you a diuretic, like a water pill?
Kayla: No, they actually didn’t.
Dr. Fox: So it happened on its own. Okay, good.
Kayla: Yeah. They weren’t super concerned with the pulmonary edema. They said it was just a little bit and they actually said, you know, maybe this is causing part of the infection. We don’t know if it’s a uterine infection. And I’m not sure. I always wondered why they didn’t, like, check if there was any retained placenta. Like, I don’t know if that’s something they can do post-delivery or if that’s too dangerous to introduce more potential bacteria or anything, but they never, like, rechecked me in that sense, if that makes sense.
Dr. Fox: When they did the CAT scan, did they continue all the way down to your uterus or they just did the lungs?
Kayla: They just did the lungs.
Dr. Fox: Yeah. I mean, you can see it sometimes on CAT scan but it’s hard, you know. A week after delivery, it’s sometimes hard to differentiate, you know, things like blood clots, which are normal to be in the uterus, versus small portions of placenta. And so, sometimes if you do an ultrasound or a CAT scan too soon after delivery, it actually falsely scares you that there’s stuff remaining when there isn’t.
Kayla: Interesting.
Dr. Fox: So, yeah, I don’t know had they done a CAT scan all the way to your uterus if they would have properly diagnosed the retained products. And I guess since, ultimately, you told me you had them, some placenta left behind, I guess they would have seen it and it would have been correct, but it’s also possible that you would not have had it and they would have thought they saw it. And it’s hard. I mean, most people with a fever don’t have placenta remain behind. They just have an infection, but if it doesn’t get better with antibiotics, that’d be one reason.
Kayla: There was one OB that came in and talked to me and they said if the fever lasts for…it was X number of days, then we’re gonna check for something that was really rare. And, gosh, I wish I could remember the name of it now.
Dr. Fox: Septic pelvic thrombophlebitis.
Kayla: Yes, that. That’s what it was. I don’t remember what it is but I just remember them mentioning it.
Dr. Fox: It’s like infected blood clot. It’s like infected blood clots in your pelvic veins, which can happen. They would have diagnosed with a CAT scan. So that would have been the way, but yeah, and you would have been treated with blood thinners. Another thing to put you on. So glad you don’t have that.
Kayla: Luckily, I didn’t need that. So my labs at that point started…you know, things started to stabilize. My blood pressure was still elevated and I still had a fever. And again, they presumed that it was a uterine infection and I just was on lots of IV antibiotics and I still stayed there for another…I don’t remember what day I’m on now in the story, but I was at that hospital for an additional four or five days. So, it took a while with the IV antibiotics because they wanted me to be 24 hours fever-free before they discharge me.
Dr. Fox: Yeah. Yeah, 100%.
Kayla: Which makes sense. So it took them a while to actually discharge me. And then once I was discharged, I was on oral antibiotics for another two weeks, but I didn’t have to be on any blood pressure medications.
Dr. Fox: It got better.
Kayla: Yeah. They told me at that point it had been a couple of days of really stable blood pressure. So luckily, that seemed to correct itself, and it was just the infection at the end that was really keeping me there.
Dr. Fox: Right. And you ultimately found out you had some retained placenta. Did it have to get removed surgically or it came out on its own?
Kayla: I went for my six-week post-partum appointment and we had discussed, you know, maybe placing an IUD or things like that. And so, when she was doing an exam, she was like, “Is this uncomfortable?” Because it was pretty painful. And she was like, “I definitely feel that there’s something still there.” So, unfortunately, that was another whole complicated thing because she sent me down for an ultrasound, a transvaginal ultrasound, and it was the end of the day so then they all left before they got the results. And then the ultrasound tech sent me to the ER for them to read this. And the ER doctor was like, “Why are you here? Like, what’s going on?” And they sent me home on antibiotics that I wasn’t allowed to breastfeed on. And they said, ‘You don’t have any choice. This is the only antibiotic you could be on. Call your doctor tomorrow and schedule a D&C.”
I was very confused and frustrated because breastfeeding was actually going really well at that point, and it was the one thing after all this crazy traumatic birth experience that I was excited about and was going good. But when I went in finally to see the OB later, they said it’s minimal enough, it’ll pass on its own. And I did have bleeding and then turned into spotting, of course, but for about nine weeks. So it was a long time. But they didn’t think it was enough to do a D&C. They thought that would be, you know, more harm than good, I guess.
Dr. Fox: And that worked?
Kayla: Yeah.
Dr. Fox: Okay. That’s good.
Kayla: As far as I know.
Dr. Fox: Yeah. I think the ER doc probably did not need to…If you didn’t have a fever, they didn’t need to start antibiotics. They could have just waited until the next day probably, but that, you know, whatever, what do they know? It’s hard. It’s not their field.
Kayla: Yeah. The OB did correct that once I went and saw them and they were like, “You don’t need to be on these. You don’t have an active infection.” Because I didn’t have a fever. I wasn’t in that much pain. It was just more uncomfortable than she wanted me to be, and then I guess she said she felt some, you know, retained material. But I’m lucky. I’m very happy I didn’t have to have a D&C because just would have had one more, you know, thing.
Dr. Fox: Look at you saying you’re very lucky after that whole story. By that time, you know, six weeks, did you feel like you were basically recovered physically from the whole ordeal? Because it’s a big ordeal, you know, to go through with the preeclampsia and the swelling and the hospitalizations and infection. I mean, it makes the recovery physically more challenging, forget about emotionally. We’ll get to that afterwards. But physically, do you feel like you were mostly yourself by that point?
Kayla: I would say physically I was obviously very tired and it’s hard for me to separate what is just normal being tired, being up all night with the baby, and just being extra tired from having everything happen. I think the biggest thing physically is I had a lot of pain from my tearing for like five months. I didn’t feel normal even just like sitting down, standing up type of thing. So that was the worst part. Not the worst part, but that was the worst part, you know, post-partum physically-wise. Mentally and emotionally was a whole another thing that I never really expected to have to deal with, I guess.
Dr. Fox: Thank you for listening to “High-Risk Birth Stories” brought to you by the creators of the “Healthful Woman” podcast. If you are interested in telling your birth story on our podcast, please go to our partner website at www.healthfulwoman.com and click the link for sharing your story. You can also email us directly at hrbs@highriskbirthstories.com. If you liked today’s podcast, please be sure to check out our “Healthful Woman” podcast as well where I speak with the leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Have a great day.
The information discussed in “High-Risk Birth Stories” is intended for information and entertainment only and does not replace medical care from your physician. The stories and experiences discussed in our podcasts are unique to each guest and are not intended to be representative of any standard of care or expected outcomes. As always, we encourage you to speak with your own doctor about specific diagnoses and treatment options for an effective treatment plan. Guests on “High-Risk Birth Stories” have given their permission for us to share their personal health information.