“Postpartum Preeclampsia: Trust Your Body” – with Tammy Balaban

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. Tammy, welcome to the podcast. Thank you for joining. How are you doing?
Tammy: Great. Thanks.
Dr. Fox: So, you volunteered to come on the podcast and we were chit-chatting beforehand that not only have our stories intersected clinically, because I was a partial participant and partial bystander for your pregnancies, but also, like, we have all these connections socially that friends with my friends, and you know all the people I knew growing up. It’s a whole thing. It’s wonderful.
Tammy: Yes.
Dr. Fox: What made you volunteer your story? I’m curious.
Tammy: I’m in a mom’s group and everyone talks about your podcast. I was in mourning for my father, so I wasn’t listening to music and so I got very into podcasts. And I was just binging different ones and everyone recommended yours. And I was listening and I thought some of them were interesting. And then I was… You always say if you have a story. And I was like, “You know what? I think I have a story. And I know I have a story.” But I was like, “Do I wanna share it?” So, I asked my husband and we decided, yeah, it’s a good story to share because there’s a lot for people to learn.
Dr. Fox: Right, right. Okay. Well, thank you for volunteering. I do think you have an interesting story. And I’m glad that you’re willing and happy to share it with all of our listeners. So, take us back. We have basically two stories, right? Because you have two children, thank God. You have Lily and Ami. And we’re gonna start with Lily, who was born in the beginning of 2019. So, she’s turning three soon. Yes?
Tammy: Yes. Yes.
Dr. Fox: What’s she up to nowadays? Is she tearing up the world?
Tammy: She goes to school. She has a lot of opinions. She’s very smart and funny and will tell you what’s what about everything. She is a big boss. But she’s a great kid. I love her. She’s funny and she’s smart. And I actually enjoy spending time with her.
Dr. Fox: Oh, that’s nice. How is she as an older sister?
Tammy: Not great. It’s funny. She was 20 months when Ami was born. And she was kind of oblivious to him for the first six months because during COVID my nanny just took her out every day and he was home with me. And when he was six months, she kind of noticed that he was starting to come on her turf. She would say over and over, “I don’t want to share with Ami. I don’t wanna share with Ami.” So, she likes him from afar.
Dr. Fox: I understand. She likes him but she doesn’t like him mobile.
Tammy: No. The day he reached for her toys was the day everything changed.
Dr. Fox: She’s perfectly fine with his existence, but not with his encroachment.
Tammy: No.
Dr. Fox: Well, that’s cool. I think that’s pretty par for the course for a three-year-old older sister and for her baby brother. All right. Well, they’re gonna have an amazing relationship as they get older, which is nice. So, take us back to that pregnancy. So, if she’s born in the beginning of 2019, we’re talking about essentially the beginning of 2018, or maybe the end of 2017. Where are you in life? Who are you married to? Where are you living? What are you doing professionally? And how did you get into the childbearing business?
Tammy: So, I got married in November 2017. I had been living on the Upper West Side for 10 years. I had a number of different relationships that didn’t work out. And I married my husband. We lived three blocks from each other. And so I moved to his apartment in November 2017. I am a pediatric occupational therapist. I work with kids, mostly zero to three-year-olds, so a lot of babies, and I hear a lot of birth stories. And I’ve worked with a lot of preemies. So, I’ve heard a lot of stories about, you know, things that can go wrong during pregnancy and I think I’ve always, like, internalized it, and put it in the back of my head. I work just in homes and Steve works in finance. So, I didn’t see him that much. But it was… We were happy on the Upper West Side. I got pregnant April 2019. I had a really rough…you know, throwing up, the usual. I’m 4 foot 10. And I was 5 pounds, 11 ounces when I was born. When I was engaged to Steve, my mother-in-law said, “Did I mention he was nine, seven at birth?” And I said, “You never told me that. And I wish I would have known.”
Dr. Fox: This is gonna hurt.
Tammy: So, I was just like, “Okay. Let’s just hope that this baby averages between us.” So, pregnancy is moving along. I’m working. I’m going into homes. And it was all very exciting, having all the ultrasounds. So, I went to Carnegie for all of my appointments.
Dr. Fox: Okay. We appreciate that. Thank you.
Tammy: So, everything was smooth until I was 26 weeks. I had my ultrasound and you called me in to your office and you said to me, “Do you feel extra big?” And I was like, “I don’t know what you mean. I’ve never had a baby before.” And you said, “Your fluid is high. We don’t know why. And it could mean diabetes. It could mean something’s wrong with the baby or could just be nothing.” So, I was like, “Can we figure this out?” And you said, “Come back in two weeks.” So, I was not satisfied with that. We were actually going on a trip and I was like, “How am I gonna survive this trip emotionally not knowing what’s wrong?” And you said, “Maybe you need an amnio, but at this point, it was pretty late in the game.”
Dr. Fox: Let me take you back to that moment because, you know, you’re in the middle of your first pregnancy and, you know, 25, 26 weeks, the fluid is high. I’m pretty sure what I would have said because it’s sort of a standard thing that, you know, “Usually it’s okay, but there can be this, can be that,” particularly because this is a little on the early side. We typically… When we see high fluid…this is for our listeners fluid around the baby, amniotic fluid. We call it polyhydramnios or high fluid. Usually, it’s okay. Sometimes it’s an issue early in pregnancy. It’s a little more suspicious of an actual problem versus nothing. But I’m trying to get a sense in your head. Right? So, you work with kids with issues potentially, right? So, you’re doing pediatric OT. Some of them it’s, you know, straightforward, you know, the pencil grip or whatever. But others, like you said, are premature or have, whatever, diagnoses or conditions and you’re working with them. How much of that is flying into your brain at the time? Is it like… Are you getting inundated with, “Oh, my God. Oh, my God.”?
Tammy: There was two parts to it. One is that I worked at that time with a kid that the mother had polyhydramnios when she was pregnant, but that was an indicator that something was wrong. And the kid had some severe issues when he came out. So, that was pressing. The other was my father-in-law is a retired pediatric neurologist. That weekend we were going he was being given a Lifetime Achievement Award. And so I went to this conference where it’s a room of pediatric neurologists and all they’re talking about is everything that can go wrong. And I’m sitting there, and I’m looking at all these doctors, and all they’re talking about is the need for pediatric neurology. And of course, I had Googled polyhydramnios, which I shouldn’t have done. And it had said it could mean something’s wrong with the baby. And so, of course, all I’m thinking is, “Okay. This mother of the kid I work with, and all these people at this…all these pediatric neurologists are all saying there’s such a need for them right now. There’s clearly something wrong with my baby.”
Dr. Fox: It’s so hard because on the one hand, right, if you just look at the odds, like, on the numbers, the numbers are in your favor, right? If you have high fluid around 25, 26 weeks, the majority of the time everything’s gonna be okay. All right. That’s good to know. But it’s not nothing, right? It’s not something you could just blow off because it could indicate a problem. And it really actually could, you know, with the baby, genetics or whatever. There’s always things that it could be. And you have to talk about that and you have to sort of bring it up and say, “How are we gonna test for this? What are we gonna do to ensure that it’s not happening? Or what if.” And so it’s very hard to have that conversation without either scaring the hell out of somebody or ignoring the truth that’s in front of us. And some people want to ignore it and just like, “Don’t tell me the bad news. I don’t wanna know.” And other people, you know, wanna know every single thing about it. And on top of that, you go home, and then it just, like you said, it’s either you’re going to a conference of pediatric neurologists or you’re on the Google or you have your own experiences. And it really just… It’s very difficult. And part of the reason we see people frequently for this, it’s not just to see the baby, which we wanna do, but it’s, “We need to talk,” over and over and over again because there’s so much more to process and so much more you’ve learned in the past week or two that we need to talk about more. And it’s hard. And listen, it’s what we do every day. It’s a very hard thing for you to go through. There’s no question.
Tammy: So, I remember saying to you when you diagnosed it, like, “I wanna come back tomorrow,” because I remember just thinking, like, I was so nervous. And you said, “No. You’re gonna come back in two weeks.” So, in the interim, we went on this trip. Steve came with me to the next appointment because I was so nervous. We get there. The fluid was higher again. So. we had another talk about an amnio. They said, “Look, if you do an amnio now, you won’t get the results till you’re like 32 weeks.” And then the question is, “If you find something’s wrong, what are you gonna do?” So Dr. Gelber, she came in, and she sat us down and she said, “I don’t think there’s anything wrong with your baby.”
Dr. Fox: Right.
Tammy: And we called her the angel doctor because I came every week after that. And every time she was the doctor, she said, “I think everything is fine.” So, we decided against the amnio. And so I went every Friday. It was like part of my routine. I’d go to Carnegie and we monitored the fluid. And they ended up saying, “You know what? Your baby is measuring very big. You’re extremely small. We have a feeling your baby it’s like a mismatch. The sizing is just wrong because your baby is measuring…like, taking after your husband and you’re a very small person.”
Dr. Fox: Right. So, this was Steve’s fault.
Tammy: Yes.
Dr. Fox: Okay.
Tammy: The first thing that was his fault in our child rearing.
Dr. Fox: Yeah.
Tammy: So, there I go. Every week, baby is measuring extremely big, extremely big. I go to Carnegie at 35 weeks, my fluid is suddenly normal. It just went back to normal. And they had said to me, “If your fluid stays high, we’ll induce early because we’re worried about the cord prolapse because there’s different risks with polyhydramnios.” So, at that point at 35 weeks, my fluid is normal and I’m just huge. At this point, I’m like 36 weeks. The only things I’m doing are going to the OB and going to Carnegie every week. And at Carnegie, they measured Lily at like eight pounds the day I went into labor. So, I was at Carnegie on that day. And I could barely walk. As I said, I’m 4 foot 10. I could barely move. And they said, “She’s eight pounds.” And so I was at the OB and I said, “I really think I should have a C section because,” I said, “I’m so small, she’s measuring big.” And they said, “We think everyone should try to push. You might be able to.” So, I was very nervous, but, obviously, I decided to trust the doctors.
So, I was due Friday, the 18th. My water broke Tuesday night, the 16th, in the middle of the night. I took the epidural right away because the pain was so excruciating. So, then I was in bed all day dilating. So, my doctor said, “Okay. You’re ready to push at 10:00 p.m.” So, remember, I’m 4 foot, 10. I have approximately eight-pound baby. So, I’m pushing for two hours. She doesn’t move at all. They said I was doing a great job, but she didn’t move. Her head didn’t move. So, at midnight, they said, “Okay. You’ve been in labor for a day. We’re calling a C section.” So, I burst into tears because at this point, I just felt like I had gotten there. So, they called the C section. I was so exhausted and sick that, like, I didn’t even open my eyes. I heard them say when she came out…I couldn’t even open my eyes. And they said she was eight, four. And I was like… I couldn’t open my eyes but I just said, “It makes so much sense now why I couldn’t get her out.” So, I couldn’t even look at her. I was so sick. I couldn’t… I just lay there and I was just miserable.
Dr. Fox: Miserable you mean physically because of the long labor and everything.
Tammy: Physical.
Dr. Fox: Okay.
Tammy: Physically I was so nauseous. I was so depleted from being in labor for the day and pushing and then… And now it’s Friday morning. This is obviously pre-COVID, so you stayed three days. So, it’s Friday morning. My mom flew in… I’m Canadian. So, my mom flew in from Toronto because, I remember I was in labor all day Wednesday, so she made the ticket. She came in Friday. I couldn’t move. I couldn’t walk. I was in so much pain because of the pushing and then the C section. So, they kept saying to me, “You need to try to get out of bed.” And I was like, “I can’t. I can’t. I can’t.” So, I felt really, really sick. My mother was with me the whole time. And Lily was in the nursery and they said, “You have to go walk to the nursery.” And I was like, “I can’t. I can’t.” So, they kept saying, “Try to walk. Try to walk.”
So, my mother helped me walk. Then they said, “You know what? You need a blood transfusion.” And I said, “I really don’t want one. And they said, “Okay. We’re gonna check you again tomorrow. We’ll see what happens.” So, Saturday comes, my mother was with me, Steve is with me. I’m really… Lilly was in the nursery most of the time because I was really… I couldn’t move. And Saturday night, they said, “We need to give you a blood transfusion because your iron is way too low and we can’t send you home.” They gave me three units of blood. And at this point, I really was feeling very unwell, but what they said to me was, “If you have a blood transfusion, we think you’ll start feeling better.” So, I took it because I was like, “I need to start feeling better. I’m going home tomorrow. I have a baby. I can’t just not move.”
So, Saturday night they gave me the blood transfusion and right away my iron started improving. And the nurse came in and she’s like, “It’s weird. Your blood pressure started going up.” And I was like, “Whatever. Okay.” So, Sunday morning, I’m really not feeling well still. And the doctor came in and she said, “Okay. You’re going home.” And I said, “My blood pressure was up.” And she’s like, “Oh, but you know what? It’s trending down. We really think you should go home.” It was actually Martin Luther King weekend. So, she’s like, “It’s gonna be really quiet here. We think you should just go.” And look, what do I know? I was new at this. I knew I felt awful, but I was like, “Apparently this is how I feel, like, after having pushed for hours and then having a C section.” So, Steve came to get me. By the time we left it was the afternoon because they wanted to watch my blood pressure a little bit. So, we live on the west side anyway, so we just took a cab, my mother, Steve, and me. And we get home and, you know, I had to…
Dr. Fox: And Lily, I assume, right?
Tammy: Yeah. Lily. Yes, she was with us. And I really was out of it. I remember being there but not being there. We were looking at clothes for Lily and I was just not focusing on it. And I hadn’t been able to take a shower in the hospital because I couldn’t stand up. I was so sick.
Dr. Fox: The transfusion did not help this really.
Tammy: No.
Dr. Fox: Okay.
Tammy: No. So, it’s now… We only got home at 3:00, so it’s now Sunday at like 6:00, we got takeout. And we’re sitting there and suddenly, like, my feet, which had been… They had swelled during the C section, but the swelling had gone down. So, we looked down and my feet are starting to swell again. And I’m eating dinner. And I was like, “I really, really don’t feel well.” And I didn’t eat all my food. And I was kind of sad about that because I hadn’t eaten in days. And my mother said, “Maybe we should call the doctor.” And I was like, “No, no, no. I wanna stay home. I’m finally home.” And I said, “Can you just help me take a shower,” because I hadn’t had anything since Tuesday. So, she helped me and I was, like, really… I could barely stand. I couldn’t get in and out of bed. So, she was like, “I really feel…” She was staying a few minutes away. And she said, “I really feel weird leaving you.” And I thought, “No, no. Steve and I, we’re gonna figure this out. It’s our first night at home as a family. Just go. Just go. We’ll be fine.”
So, she left very reluctantly. I’m one of four and she has other grandkids where she was very hands-on. So, she felt like she could help, but I was like, “I want you to just go.” So, she leaves. And I try nursing and I’m just totally out of it. And Lily seemed fine. We’ve been giving her formula as well. So, I said to Steve, “Help me get into bed,” because I couldn’t climb into bed. So, Steve helped me get into bed. And as soon as I got there, I felt like someone had, like, crushed my head with a hammer. And I thought I was gonna throw up and, like, my head was gonna explode all at once. And I said, “Steve, come here right now.” I said, “I need to go back to the hospital.” And I had worked once with a kid where the mother had preeclampsia and she described how it felt. And this was… I was sure how it felt. And he’s like, “What’s wrong?” And I was like, “My head is gonna explode. There’s something neurological going on. It’s not just a headache. I need to go back to the hospital.”
Dr. Fox: When you went home from the hospital that day and, you know, your blood pressure was sort of high, you’re borderline or trending down, all these things, were you given, like, warning signs, “Hey, watch out for this or a blood pressure cuff,” say, “Hey, check your blood pressure at home.”? Nothing like that.
Tammy: No. Nothing.
Dr. Fox: But you sort of knew instinctively.
Tammy: Because of this kid I’d worked with and I knew… A lot of people said to me after, like, “How did you know it wasn’t just a headache? I would have just rolled over.” And I was like, “I felt like my head was gonna explode and I was gonna throw up all at once. I felt a headache.” And this was like, my head was like my brain was falling out. So, we looked at each other. We have this three-day-old. It’s January. At this point, it’s 2:00 in the morning. And we’re alone. And he was like, “You have to go by yourself.” And I was terrified. I hadn’t done anything by myself. And I couldn’t walk. So, I went to West End Avenue. I hailed a cab.
Dr. Fox: Oh, my God.
Tammy: It was 2:00 in the morning. Well, we had no one around. And I didn’t even think to call my mother back.
Dr. Fox: Right.
Tammy: So, I hailed a cab. I was not dressed. And the cab… I said…oh and I called the doctor and he said, “Come back to labor and delivery right now.” So, we went straight back to labor and delivery. They were waiting for me. And I go in and my blood pressure was 190 over 80. And they said, “Okay. You have preeclampsia. We need to give you magnesium right away because you could have a seizure or a stroke.”
Dr. Fox: Right.
Tammy: It was terrifying. They said, “You basically saved yourself by coming in.” And I was just freaked out because they were like, “Magnesium is gonna be 24 hours. You have to stay here and we need to keep you on labor and delivery. So, we need to watch you.” And so here I am, like, three days postpartum, I can’t move. And Steve’s at home with Lily. And I’m freaking out. So, I started the magnesium. They said like, “We need to start it right away.” My head is pounding. And they said, like, “You’ll feel better soon.” So, the morning comes. And Steve’s, obviously, we were texting the whole time. And he’s sending me pictures of Lily. And I was like bawling. And he’s bawling because we’re just like, “This is crazy.” In the morning, my mother sent a text, “How is it going?” because she has no idea. And we said, “Well…” And we told her. She came straight to the hospital. She stayed with me. Steve was with Lilly and they actually advised him not to bring her to me because they were like, “Don’t bring a three-day-old to labor and delivery. It’s not safe.”
So, I was in labor and delivery with magnesium for 24 hours. Really, really, really sick. They kept making me pump every time Lily ate to try to keep my supply up. It was Martin Luther King, as I said. And the heat in the labor and delivery was broken. So, it was frigid. To make a long story short, my blood pressure didn’t go down and my head kept hurting. So, they said I had to go have an MRI. I jumped out of the machine. I was so freaked out. And I yelled at the tech. I was like, “Do you know what I’ve been through? I have a baby.” And they were like, “Oh, okay.” So, they called the neurologist in and he said, “You can have a CAT scan. But if we see a blood clot, because we’re concerned you have a blood clot, then you’re having an MRI.” So, they gave me a CAT scan. Everything was okay. They took me off the magnesium after 24 hours. They took me out of labor and delivery and then I had to be observed in the regular floor for 24 hours before they’d let me leave. I was sent home on blood pressure medication and with a blood pressure cuff. And I had to write down my blood pressure twice a day. I had to go back to my OB, like, every few days and I still had headaches for weeks, which were, obviously, very scary because it took a while.
Dr. Fox: How long were you on the blood pressure medicine for when you were at home?
Tammy: I was on the blood pressure medicine for a month because then my blood pressure went very low. So, they realized everything was okay. It was very terrifying. I really did not… Steve took care of Lily for three days without me. My best friend came over, gave her a bath with him because he was terrified. My mother slept over with him to do nights with him. I did not go to her first pediatrician visit. The doctor was very lovely. She called me to tell me how well he did.
Dr. Fox: Oh, that’s nice.
Tammy: The amazing thing was I had, like, three days lying in a bed and I felt so much better physically when I got home.
Dr. Fox: Yeah. No. It makes sense. I mean, preeclampsia is a real thing. I mean, it can make you feel pretty miserable. And then the magnesium can make you feel miserable. And it takes time.
Tammy: It was terrible.
Dr. Fox: Yeah.
Tammy: It was also very traumatic. We were terrified. Steve didn’t want to take me home because he was very scared, like, what if something happened again? He kept saying to the neurologist, like, “I want you to do an MRI. I want you to do an MRI.” And they kept saying, “No, we think she’s okay. We think she’s okay.” And he said, like, “I’m afraid to take her home.” And I was also… I was very disconnected from Lily. And my milk didn’t come in. So, I was like… I got the hospital pump and I ended up… I breastfed her for a year. But it was like my whole body, they said, like, went into shock.
Dr. Fox: Yeah.
Tammy: And I was just completely… Steve took two weeks off. And for those two weeks, like, I didn’t even wanna go near her. I was in so much pain and I was always afraid my head is hurting. I was afraid to walk. Everything was scary.
Dr. Fox: When did you finally feel better? Was it a month or was it sooner?
Tammy: I would say it took over a month because it was also winter. And I really didn’t go out very much.
Dr. Fox: Right. And back then that was uncommon.
Tammy: Exactly. Pre-COVID.
Dr. Fox: Now it’s like, “a month, please, I could do a month, two months at a time easy.”
Tammy: I was just very afraid to go out. I was afraid to take Lily out by myself. I didn’t trust myself. Steve went back to work and I was constantly like, “I need to stay home. I need to…” And he would say to me, like, “I think you should go out. I think you should go out.” And I was so traumatized and afraid, like, “What if something happened again?” So, it took, I would say…she was born January 17th, until March.
Dr. Fox: Yeah. I mean, that’s legitimate, though. I mean, anytime you have, even without the preeclampsia, you had major surgery, you had a C section, it’s always a little bit of a gamble when you go out and you go for a walk or you go for a drive or wherever. What if you started feeling pain? And then for you, obviously, what if you have something else, you don’t feel well, you’re out there with a newborn, and it’s the winter? And it’s not that easy. Most of the time it goes fine, but that’s a legitimate concern. That wasn’t… I don’t think that… That’s not paranoia. That’s real. That could happen.
Tammy: It was also because Steve took care of her for those three days. And he, like, stepped up. He did amazing.
Dr. Fox: Good job, Steve. Good work.
Tammy: Yeah. He did amazing. He actually took a parenting course before we had Lily. And I made fun of him for doing it. But it was actually so helpful. And so I actually came home feeling, like, very incapable of taking care of her. So, I felt like I needed to be taken care of, I was very sick, and I was like, “I can’t take care of Lily. I can’t take care of Lily.” And when he was going back to work after two weeks, he kind of was like, “You have to do this.” And at that point, we have no family around. My mother had left. And I had no choice.
Dr. Fox: Yeah. Wow. I’m curious how this experience didn’t stop you from doing it again.
Tammy: I was actually so scared. They were gonna tell me I couldn’t have more kids. But they said to me, “You can. You just need to wait a year.”
Dr. Fox: Okay.
Tammy: They said, “After C section and your body went through major trauma, we want you to give your body a rest.”
Dr. Fox: Yeah.
Tammy: So, I did. And in January 2020, we said, “Okay. We’re ready,” because it really was a year. And in February I got pregnant. Obviously, everyone knows what happened in March 2020.
Dr. Fox: What happened in March 2020? Nothing happened.
Tammy: Oh, I don’t know. I was seven weeks pregnant when the lockdown happened.
Dr. Fox: Oh, no.
Tammy: It was very terrifying. Everything about the pregnancies was different scary. So, I started on baby aspirin when I was 12 weeks and they said I was not gonna push again. They said, “You know what? You’re obviously prone to bigger babies. You’re going to have a planned C section.”
Dr. Fox: I assume you were on board with that plan?
Tammy: I was very on board. I did not wanna try to push again. So, it’s March 2020. So, then it’s April and, obviously, a very scary pregnancy. We were extremely safe, you know, because there was no vaccine. And, you know, we were working from home and my nanny wasn’t coming. And so I was just watching Lily. We were being very careful. Most of my appointments were telehealth. I’ve missed so many appointments we don’t even know about my high fluid except at 32 weeks, I went to Carnegie and I had high fluid again. And they said, “This time we’re not worried about it because,” they said, “you’re obviously prone to it. We’ll just keep watching it.” So, I was going to Carnegie every week, watching the high fluid.
Dr. Fox: We were your only field trip, right?
Tammy: Yes. I was not even going to the OB. The OB was telehealth.
Dr. Fox: Yeah. We can’t… We’re not ready to do ultrasound remotely. It’s tough. That’s a tough one.
Tammy: Carnegie was my big outing.
Dr. Fox: Great.
Tammy: I got dressed once a week. At 36 weeks, I went to the OB because I hadn’t been there since 28 weeks.
Dr. Fox: Right.
Tammy: And they said, “Your blood pressure is high.” And I fought with them. And I was like, “I’m not having a baby.” Also, like it was COVID. We didn’t have great childcare plans except for if I had a baby at 39 weeks, my nanny was gonna watch Lily. So, they sent me to labor and delivery because my blood pressure was high. And I called Steve and I said, “Okay. You need to come. My blood pressure is high.” So, right away, they’re watching, they’re watching. It went down. They said, “Okay. We’ll send you home.” So, the following Thursday, I’m 37 weeks and I go in, my blood pressure is high again. And they said, “Okay. You now have gestational hypertension. You have a history. Plus, you’ve had two different events of having high blood pressure. We’re sending you back to labor and delivery.” I called Steve and I said, “Don’t come because this time I’m gonna convince them to just let me go home.”
Dr. Fox: Did you not think that what happened last time could happen again? I’m just curious, because you went through such a difficult course with the severe preeclampsia. I’m just curious. In your head, you’re sort of trying to decide, “Am I gonna try to convince them not to deliver me?” versus, “Oh, my God, I can’t believe this might happen again. Get the baby out right away.”
Tammy: First of all, I was so mentally not prepared to have a baby that… Thirty-seven weeks, obviously, isn’t that early, but it was COVID, the height of COVID. It was when the cases were all rising and we didn’t have childcare. It was in the midst of all the Jewish holidays. So, we really did not feel ready. And also they had told me, “We really wanna get you to 39 weeks.” So, I kept… Also, he measured smaller. So, Lily always measured huge. Ami measured much smaller. So, I kept saying, “Let’s get him bigger. Let’s get him bigger.” At Carnegie, he had measured, like, five something the week before, but I was like, “You know what? I wanna get him a bit bigger.”
Dr. Fox: Okay.
Tammy: So, I get to the hospital and my doctor goes to me, “Where is Steve?” And I was like, “I told him not to come because I’m not having a baby today.” And she’s like, “Did you eat anything today? You’re having a C section.” I was like, “No, I’m not. I’m going home.” And she’s like, “We need to give both of you COVID tests. So, Steve needs to get here right now.” And I was like, “No, I’m…” I was like, “I really wanna get to 38 weeks.” And my sister who’s a doctor, who does low-risk obstetrics, she was like, “Ask her you can get to 38 weeks.” And I was like, “I wanna get to 38 weeks.” And they were like, “You’re gonna have to leave against medical advice.” And I was like, “You know what? My stomach is really hurting.” They were like, “You’re having contractions two minutes apart.” And I was like, “That would explain it.” So, they said, “Do you still wanna go home?” And I said, “I do not.” I said, “I’m having this baby today.” And they said, “Since he’s much smaller, do you wanna try to push?” And that I was not willing to do. So, I knew he was smaller, but I knew my body. I knew there was no point.
Dr. Fox: Got it.
Tammy: So, I did not wanna have another preeclampsia, but at this point, also my blood pressure was better, and so I just… They said to me, “We think your blood pressure will be fine as soon as we take him out.” So, I called Steve and I was like, “Get here now. Bring a bag. I’m having a baby today. You need to have a COVID test.” So, he raced over. We both had our COVID tests. And I told my family, I was like, “I’m having a baby today.” And they’re like, “What?” And I said, “I was pushing them not to, but now I’m having contractions. I’m not going home.”
Dr. Fox: Right. Who watched Lily?
Tammy: So, my nanny was with her. And then my best friend, the one who gave Lily a bath, she’s a nurse at NYU. And she was our one person we trusted in our apartment at that point.
Dr. Fox: I got it.
Tammy: So, I said to her, “Can you come over and relieve Janice? And Steve will come whenever…” We knew I was gonna have the C section that day anyways. So, we said, “Steve will relieve you.” She said, “Absolutely.” So, she relieved Janice. She was with Lily. Lily did not know people at that point. She’s 20 months. We’ve had no one in our apartment, but she’s very friendly, so that worked out. I walked into my C section, which was… Also, I was, like, very much like, “I want this C section to be different.”
Dr. Fox: Sure.
Tammy: So, I said, “I’m walking in. I’m gonna hold him because, you know, I couldn’t hold Lily.” So, they said, “We will give you everything you want this time.” So, I walked in, I lay down. I was completely… I felt autonomous. Steve was with me. I watched him come out. I held him. It was amazing. And it was exactly what I wanted. And it was interesting, because of COVID, everything with Ami was done in the room with me. So, I just watched everything. He latched right away. It was amazing. It was… And because of COVID we were alone and we had this great bonding time with him. And I felt so much more present.
Dr. Fox: Yeah. You didn’t have that long labor. You don’t have, you know, preeclampsia swirling around in your veins the same way as before. Did your blood pressure get better after you delivered, like they predicted?
Tammy: So, it was funny because I felt like I needed to advocate for myself because during COVID, they kept saying everyone is staying two days for a C section. And my blood pressure went up on the third night with Lily. So, I kept saying to them, “I’m staying for three days. I’m not leaving after two.” because I said, “I’m not going home and coming back again.” And so they agreed with me. And everything was different. So, I was walking right away. I was up and about. And my blood pressure went down right away as soon as they took him out. And everything stayed fine. I didn’t need a blood transfusion. And so I went home three days later.
Dr. Fox: No blood pressure meds. No nothing.
Tammy: No. Nothing. And I had my blood pressure cuff, obviously, and I monitored it, but it was… As soon as they took them out, I was fine. And they said to me, “They were actually really glad he came at 37 weeks because they think it was much easier on my body.
Dr. Fox: Yeah, that makes a lot of sense. And not more time for the preeclampsia to develop and for you to get more swollen and all these things. And that does make sense. He must be about 13 months old now, right?
Tammy: Thirteen months and giving Lily a run for her money.
Dr. Fox: Is he up and about, 13 months?
Tammy: He’s running around. He’s a crazy…
Dr. Fox: The child of an OT.
Tammy: He’s a COVID baby, so he didn’t meet any grandparents till he was eight months.
Dr. Fox: Who are these people?
Tammy: He didn’t meet anyone. He didn’t know people. But I have to tell you, in June, I went back to work and my nanny started taking care of him and he’s the most social baby. He loves everyone. He’s met everyone. He’s not afraid of masks. And he’s amazing.
Dr. Fox: Tammy, looking back on your deliveries, your stories, what is it that you take away from all of this?
Tammy: I think with Lily, I’m not upset that I pushed because I’m glad that I tried. I think if I hadn’t tried I would have never known. I’m really glad I tried and I’m really sad it didn’t work out, but I’m glad she was healthy. That’s all it came down to. I wanted a healthy baby. I think it’s important for women to know, trust your body, know the signs because, as I said, I essentially saved myself because so many people said, “Oh, I would have just gone back to sleep. I would have laid down.” And I was like, “No, no, no.” I knew it wasn’t right. And it was terrifying to leave Steve and Lily, but I was so scared of dying and I said, “I thought I would die.” So, I think the story of Lily is, you know what, it’s okay to push. It’s okay for it to turn into a C section, but trust your body, trust your gut. If you don’t feel right, don’t just say, “I think this is normal postpartum feelings.” With Ami, I’m really, really happy that I didn’t push. And I’m really…my recovery with him was so much smoother because I felt so much better physically and emotionally and I was walking. I just felt better. So, I think trust that also. When they said, “Do you wanna try to push?” And I was just like, “No. No. I made my decision.”
Dr. Fox: I agree with you 100%, particularly…you know, when I trained everyone home after C sections at day four. And when I was training all the older folk would say, “When I trained, we sent everyone home on day seven, and you crazy people send them home on day four. And now we tell people you crazy people send them home on day three and then day two.” But there is a plus and a minus. You send someone home early. On the plus side, your postpartum units aren’t as crowded. People can have rooms on their own. People like to be home. They can be in their own bed, their own shower. Great. The downside is things happen after you deliver. And they don’t always happen within 10 minutes after delivery. They can happen two, three, four days later. And everyone who you send home a day earlier, if something were to happen, they’re either gonna be coming back to the hospital, which is annoying, or they won’t be coming back to the hospital, which can be very dangerous.
And so we’re definitely more conscious of that. And when we send women home on day two or day three, particularly those who had something going on, whether it’s a fever or a high blood pressure, we have to have a plan to monitor it at home because there is no nurse seeing you every four hours or a doctor coming by your room twice a day. You really need some plan, whether it’s symptoms, whether it’s blood pressure, whether it’s temperature. Again, it depends on the situation. And it is very fortunate that you instinctively knew something was wrong, like, this is just not right and you came back because it could have been a disaster had you not come back. Absolutely.
Tammy: We were just also, like, we were very traumatized. And I think that so many people said to me, like, “I didn’t know you get preeclampsia postpartum.” And I think a lot of people also don’t know that you can get it for six weeks postpartum. And I think that’s also something that people should know because you can also miss the warning signs because it’s… I texted someone that had had preeclampsia and they were like, “No, you don’t. You don’t get it postpartum.”
Dr. Fox: Oh, yes, you do.
Tammy: And so I think people need to know that as well because that’s… I was home. I wasn’t feeling well. Luckily, we took action. But if people don’t know you can get it postpartum, you could miss those signs.
Dr. Fox: Yeah. No, it is really important. It’s a condition of pregnancy, but yes, it can be caused by pregnancy, but manifest one, two, three days, one week, two weeks up to six weeks after delivery. It’s much, much less common once you get past that two-week mark. But yeah, it can happen. And it’s one of these things where people need to be educated about it. It’s one of the things we try to talk about routinely on the way home from the hospital. But it’s still… A lot of the symptoms, however, overlap with symptoms that could be normal, right? It doesn’t mean… Not everybody with a headache has preeclampsia. In fact, most people won’t. And not everybody who has swelling has preeclampsia. Most people won’t. But it is tough and sometimes it just means, “Hey, come and get your blood pressure check.” Let’s just be sure what’s going on and get some blood tests done. We always prefer someone over-calls us rather than under-calls us. Sure it’d be great if everyone got it right on the head and only called us for a problem and never called us for something that’s not a problem and never missed the problem, but, of course, it’s not possible. So, better to be cautious and say, “Is this fine?” or sometimes we could say, “Listen, just go down to the corner. Go to CVS, have your blood pressure checked.” And that’s it. If it’s 110 over 70, it’s not preeclampsia. We could figure out what it is.
Tammy: We ended up getting… We got, like, a very fancy blood pressure cuff. And when I was pregnant with Ami, anytime I had a headache, Steve was on me to check, “Check your blood pressure. Check your blood pressure.”
Dr. Fox: Because it’s not one of these things where, you know, you get false… I mean, if you have a cuff that’s broken, fine. And some people when they get false…you can get falsely high blood pressures, but that’s usually the opposite. That’s usually when you go to the doctor, you know, because we freak people out so the blood pressure goes up. And at home, that’s actually the best time to take your blood pressure because you’re in your, like, natural state, your coma state. That’s the best place and the best time to take it. So, it’d be great for everyone to have a blood pressure cuff. We don’t tell everyone to do that, but during COVID we did for people who were missing visits. Someone’s not gonna come to the office too much, we’re like, “Yeah. Just at least get your blood pressure checked.” That’s important.
Tammy: Well, that’s also the craziest thing about having… Lily was a crazy everything, I felt. It was very scary, very crazy. And Ami was crazy because it was COVID. But the irony was, I was much higher risk, I thought, with Ami and they took it much less seriously because it was COVID and all they kept saying was, “We don’t want people coming in.”
Dr. Fox: Yeah. You’re trying to balance how important are these visits versus the risk of potentially getting COVID. And again, you’re talking in terms of pre-vaccinate. All these things, it’s much scarier when… We didn’t have as much data about what it would mean in pregnancy. Should you be super scared? Should you not? All these things were being developed we didn’t really know what to expect at that time. And so people were genuinely worried about bringing anyone into the office. And so you’re gonna start picking which visits we can maybe skip or push off or this. But the blood pressure is something you can do at home. “Okay. You don’t need to come in here to get your blood pressure checked. Do it at home.” And then, you know, the things you need to come in for to check, you know, the heartbeat or blood tests or whatever.
Tammy: Also, as the COVID numbers were going up and down in New York, they also would give me options, like, you know, when I was 20 weeks, they were like, “Okay. The numbers are down. You can come in.”
Dr. Fox: Right.
Tammy: And so I don’t want… They didn’t totally discourage me. They just left it up to me based on the numbers.
Dr. Fox: Yeah. No, that makes a lot of sense. And I think you did the right things in your second pregnancy and I think, obviously, it worked out well. I definitely would have wrestled you a little bit harder at 37 weeks when you said, “I’m not having a baby today.” I probably would have said, “Oh, yeah, I think you are.”
Tammy: I was about to leave against medical advice.
Dr. Fox: Yeah. No. I think we would have had a serious conversation at that point. Tammy, thank you so much for coming on the podcast telling your story. Interesting story. Exciting story. A little bit of a scary story, but obviously a really important one both for you to tell, but also for our listeners to hear. A lot of stuff in there about being safe after delivery. And thank you so much for bringing it all to light. I appreciate it.
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