“Rachel’s Story, Part 2: The Pregnancy After a Loss”

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

Rachel, welcome back. Last week’s podcast was a very moving one. Obviously, it ended very, very difficult after a real tough, complicated pregnancy and then delivering prematurely at another hospital and then your baby daughter passing away. And when we ended last week, you were talking about how you are trying to comfort us, your doctors, which is very gracious of you. But I’m curious, what was actually going on in your mind at the time, right? So, you’re such a good person. You’re so sweet and you have such a positive outlook, that you’re thinking about how can I make others feel good while you have this horrible thing that just happened to you. But in your mind, I’m just trying to sense because people have loss and it was a horrible loss. Are you feeling at that time hopeful, hopeless? I mean, obviously, it’s a very dark place, and it’s a very sad place to be. But what were you thinking? I guess is what I want to say. Not what were you doing, but what were you thinking at that time?

Rachel: So, I think leading up to that point, even after I did the RFA, I remember thinking, “Okay, this is terrible. This is not what I wanted. But maybe I was supposed to have another miscarriage, and this was the way of me getting a healthy baby without having to go through a miscarriage and then another pregnancy.” So, I sort of was able to see the positive in that too. And then after the baby passed away, at this point, I think it was about a week of just hopeless. I was so… I couldn’t even… I was grieving. I was really grieving, and I couldn’t even think in the future. I couldn’t think… I kept saying, “But what’s going to be now? What now?” I kept going there. We live in Israel. We were in America at that point, and I kept saying like, “We’re going to go back?” I couldn’t think of going back to real life. My mother, she actually had great advice and she told me that, “Right now, don’t think about the future. You need to think about it. Take it one day at a time. Don’t try to go there because it’s too big, at this point, to start thinking about all your plans and what’s going to happen now.” And that did help me a little bit but, yeah, it was for sure at least a week that I was just hopeless. I think I stayed in bed most of the week, had pancakes, tried to cheer myself up.

Dr. Fox: I was going to ask you what helped, so pancakes.

Rachel: I guess pancakes.

Dr. Fox: All right.

Rachel: It was also… It was a time of… The baby passed away October 6th. So, the day afterwards, October 7th.

Dr. Fox: Oh, God, I don’t think I remember that.

Rachel: Yeah, it felt like… And I don’t even think I processed when October 7th happened, the magnitude of what happened, because I was so in my own grief, that I didn’t even… I couldn’t fully process. It was too big. It felt like I was living a horror movie. It was…

Dr. Fox: I’ve totally forgotten that date. I mean, I knew it was during that week because like you mentioned last week when this was going on, I was out of town, right?

Rachel: Right.

Dr. Fox: I remember vividly, I was in Florida and I remember speaking to you on the phone. I remember texting. I remember all of this.

Rachel: Right, we texted.

Dr. Fox: And I also have a separate memory that at the end of that week was October 7th, but I never in my mind put those two memories together to realize that you had your loss one day before one of the saddest days in modern history.

Rachel: Yeah, I felt like the world was going down. And other things were happening. It wasn’t only that. People I knew were going through hard things. I thought the world was ending. It was crazy.

Dr. Fox: Wow.

Rachel: It was a crazy time. Yeah. It was during the holiday. So, that in a way was a good thing because I was with my family. We were all forced to just no phones. We sat together, we cried, we talked about it. And I think it helped. It helped to process it in a normal way, to really just sit together, and think about it, and talk about it. So, that’s after a week.

Dr. Fox: Right. It’s interesting. It’s a week because when you lose a baby that young, you don’t have…

Rachel: I know.

Dr. Fox: There isn’t a formal…

Rachel: There is no Shiva.

Dr. Fox: …Jewish Shiva process, which all the rules are a little bit odd and hard to understand, but there isn’t one, but you basically had one essentially. You had a week of being at home, being with your family, visiting you, talking, processing all the things that people go through in Shiva, which are meant to be in some way healing to some degree but you had that sort of by default.

Rachel: We did, yeah. After the seventh day, I remember me and my husband, we sat sort of joking… I guess we used a little dark humor at that time like, “Okay, we got up from Shiva now,” even though we didn’t really. That wasn’t but really we gave ourselves that time to really be in it and mourn and cry and talk about it and be really, really sad. But then I think after that point, we actually met with a rabbi and we walked… Whatever he said to us, it gave us so much strength.

Dr. Fox: Really?

Rachel: And we walked out like, “Okay, we got this.” And I think that was the turning point that like… Obviously, we were still sad. And of course we cried, still cried even after those seven days. But I think that’s when I felt like I could be a person again, yeah, after those seven days. And I think really what got me through it was my faith. I was lucky that I felt that way. But I remember I had this mantra going on in my head over and over, “This is what was meant to happen. Nothing could have changed it. No doctor could have changed it. I couldn’t have changed it. This is what was supposed to happen. And it would have happened. Whatever we did, this is what would have happened.” And I think that’s really what got me through it because anytime I felt myself getting to a place of, “What if we would have done this or what if I would have called earlier?” I think I had a very easy time forgiving…not forgiving but saying everything, “What every doctor did was okay. I had a very easy time doing that.” But when it came to myself and me calling and me waiting that night and not calling the minute I saw something, the minute I felt something, I think that was very hard for me. I think that was the hardest part for me to get over. And every time I went back there, I would feel that guilt of, “Maybe I could have changed something.”

So, I had this mantra that anytime I felt myself going there, going to a place of what if, I would say nothing could have changed. Whatever we would have done, this is what would have happened.” And it would help me because as soon as I felt like I was in control or someone was in control, something could have been different. That would be endless. I wouldn’t be able to stop my thoughts from, “Maybe I could have had a healthy baby, maybe something would have been different.” And then that would be even more painful for me to think that something could have been different when really it couldn’t have because that was the way things were supposed to be. And whichever procedure we chose to do or whatever point I stayed in the hospital or whatever I did, that was what was going to happen. And for me, personally, that was the only way I could get through it. I think that a lot of times… And it’s not wrong. People like they turn towards a little bit of anger, “You know, the doctor could have done something different,” or angry at someone because it helps to sort of… Maybe that’s a coping mechanism to help get through it. For me, that was so much worse. If I would go there, then I wouldn’t have been able to live thinking that something could have been different.

Dr. Fox: Wow. So, how long ultimately after the loss did you guys say you were ready to start trying again?

Rachel: In my mind, it sounds crazy, but as soon as I had a healthy baby in my hand, I knew that I would be okay. And obviously, it never leaves my mind that I never forgot about the other babies. But at that point, that was our fourth baby, three pregnancies but there were four babies. But I knew that that would be the only thing that could comfort me to have a healthy baby in my hands. And I wanted that as soon as I could. Yeah. And I think that that’s a very personal thing. A lot of people need time to heal emotionally and physically. And I knew that was the only thing that would help me.

Dr. Fox: So, you got pregnant pretty quickly.

Rachel: Yeah. Yeah, that was crazy. I remember I emailed you like, “Plot twist, I’m pregnant.” And, yeah, that was crazy. I didn’t expect it to be so soon after. I think it was a month or two later, and it was one. And actually, the doctor again, saw two. But he said maybe it’s fluid or maybe it might be fluid or it might be another baby. And I was like, “Oh, no, not again.”

Dr. Fox: Can you figure this out?

Rachel: Yeah. Please let me know. And I think it was 10 days where we weren’t sure.

Dr. Fox: Wow. So, I mean, obviously, the next pregnancy, it’s sort of hard to process. Are you high risk? Are you not high risk? Because you had a very complicated twin pregnancy. But if you’re carrying one baby, you’re not going to get twin-to-twin transfusion again, obviously. So, that’s not really going to happen. And maybe your service is going to get short. Maybe it’s not going to get short. But no one would think it would be as complicated as the one before.

But on the other hand, you just had the most horrible pregnancy known. And so I know, on our hand, I would think about this. But how did you think about it? Again, I think it’s pretty apparent from listening to you for our listeners over this week and last week, that you’re a pretty positive thinking type of person. But were you thinking, “This is not going to be the same. This is going to be a breeze. We’re going to do this,” or were you thinking, “I’m cursed. This is not going to happen for me. Everything is going to go wrong because it always goes wrong”? Where were you headed and which direction in your mind?

Rachel: So, I definitely wasn’t at the, “I’m cursed. This is a wrong point.” I think I was in between because I was, again, excited to be pregnant. I guess I was excited each time. Never changed. But I was very, very, very nervous. And I knew—I think I said this before—that in my mind it was like, “First, I have to get through the first trimester. One bump. And then I have to get through the next bump and then I have to get through the next bump. Then I have to make sure it’s one baby. And then I have to…” There are all these things in my mind that I also barely let myself get excited, because till I had a baby in my hands, who knows what could happen? I was obviously much more aware of what could happen at that point. So, yeah, I was very nervous, but I was in between. I was thinking I’m very nervous but it could happen. And I remember at that point the third pregnancy I had, the last pregnancy, like I told you, I went every other day. Blood test, ultrasound, and I was crazy about it. And then this time, I was thinking, “Where did that get me?” I got myself nervous. Every other day, I got myself nervous to be calmed down and nervous again for the next appointment. I’m not doing this. I’m being regular. I’m just being a normal pregnant person and going when the doctor tells me and I’m not going to go more often. And I think that sort of was like… I kept a lot of my head at that point. This is going to be regular. I was trying to manifest I guess.

Dr. Fox: You weren’t exactly regular. We saw you a little more often than regular, I would say.

Rachel: Yeah, yeah. Very often.

Dr. Fox: A little more often than regular.

Rachel: I think I came once or twice a week.

Dr. Fox: I mean, that was part of the plan, right? So, there’s sort of…

Rachel: Yeah. Oh, you’re right at that point.

Dr. Fox: Yeah, there’s the medical plan, “Okay, are you an increased risk for preterm birth? Are you not an increased risk?” So, there’s the medical plan. But then there’s like, “We got to get you from point A to delivery in one piece mentally,” which is hard, right? It’s understandable. You’re going to be a disaster during the pregnancy. And so what can we do? Because there’s only… One of it’s just time obviously, but we’re going to see you more often and we’re going to figure that out and exactly what that means. We’ll sort it out. But the expectations was you’re going to come a lot and that’s fine. We’re here every day. That’s cool, you know?

Rachel: Yeah, and also just to be clear, I was talking about the first trimester.

Dr. Fox: Yeah, yeah, yeah.

Rachel: Yeah, yeah, yeah. No, exactly.

Dr. Fox: Yeah. Once you were at the second trimester, it was definitely a lot.

Rachel: Second trimester was a different story.

Dr. Fox: Yeah, we did a lot. But obviously it’s a very stressful pregnancy obviously. A lot of worry. But from a medical side, the majority of the pregnancy is actually pretty, thank God, low key. Like you said, pretty normal. Whatever. This is a… And that’s, you know… But at what point in the pregnancy did you say in your head this is happening? Whatever happens, it’s happening. I’m having a baby.

Rachel: I think it wasn’t in my head. I think I told you. So, the first milestone I had to get to was 12 weeks and then I let myself breathe a little bit. And then the second milestone I wanted to get to was to get past 24 weeks because after 24 weeks obviously that’s still extremely early but that’s my ability. So, I can have a healthy baby, I mean, eventually at that point. So, I think I was definitely still nervous from 18 to 26 weeks. I probably came into… I was having contractions also the whole time. So, it wasn’t like I wasn’t feeling anything. I was nervous. I was also feeling the contractions that I was thinking how do I know when it’s going to be the type of contractions that’s going to change my cervix from long to short like it did the last pregnancy. Even though that was a different scenario, it happened.

Dr. Fox: Right, right. And in all fairness medically also, you do have one family member who needed a cerclage. You had one family member who needed progesterone. You had one family member who needed progesterone. You had one family member who needed a pessary. You had one family member who needed nothing. So, you’ve seen all of the possible…

Rachel: I’ve seen it all.

Dr. Fox: And you yourself obviously had a cerclage. Again, it was twins but you had this. And so anything is possible and how it’s going to play out with you.

Rachel: And I think the last pregnancy, the concept of getting a cerclage didn’t scare me so much because I knew that it really helps.

Dr. Fox: Yeah.

Rachel: But then once I had a baby through the cerclage…

Dr. Fox: You know what, maybe it doesn’t.

Rachel: …even that didn’t comfort me. I was so scared of getting a cerclage at that point because of what I went through.

Dr. Fox: Right, right, right. And you didn’t get one, you didn’t need one. And it turns out…

Rachel: And, yeah, thank God, I didn’t need one.

Dr. Fox: We were also worried that, A, you may have needed one just because you may need one. But, B, it’s possible that the delivery prior by delivering through the cerclage…

Rachel: Could cause them.

Dr. Fox: …could then damage your cervix to the point that you are now a person who does need a cerclage. So, we really didn’t know what was going to be. And we looked at your cervix before pregnancy. We did all these things to try to check it. It seemed fine. And actually it held up nicely. I think it got short later in pregnancy at 29 weeks. And it took some progesterone. Basically it held up the whole pregnancy, which is, thank God, it was a good cervix. Good job.

Rachel: Yes. So, to answer the question, probably at 26 weeks was when I was like, “Okay, maybe this is really happening.” And it was still early so I still obviously was nervous. But from that point on, it flew by. The pregnancy went so much faster because I wasn’t as nervous because I knew even at this point, if I have a baby… Obviously it’s very early, but it’s going to be a healthy baby, you know? And, yeah, I was so nervous about the cerclage. I’m not sure if you even told me that you were nervous about that but…

Dr. Fox: That it may damage your cervix? I did…

Rachel: Yeah, but I remember asking about it.

Dr. Fox: That was something that we were worried about and it was between… In the four minutes between when you got up from your Shiva and you got pregnant again, we did see you in the office…

Rachel: We checked it.

Dr. Fox: …to check the cervix to see that like, “How does it look? Does it look intact? Is there a tear?” We weren’t really sure…

Rachel: And the cerclage was still here.

Dr. Fox: Yeah. Oh, yes. Yeah, they didn’t actually remove that cerclage.

Rachel: Yeah, I don’t know what she did.

Dr. Fox: Whatever. We took out the rest of your cerclage in between pregnancies. It happens. It’s okay. In all fairness, it’s challenging to take out those cerclages when you labor. Yeah, and, you know, when you did get to that point, I remember I was like, “Oh, thank God. Thank God she’s 28 weeks. Thank God she’s 30 weeks. Thank God she’s 32 weeks.” Like, oh, my God…

Rachel: Every time I came in, we were both, “Whew, we made it.”

Dr. Fox: Yeah, thank God. And then did you have any of the “regular concerns” about what’s my delivery going to be like, am I going to end up with a C-section? Things that most people are sort of thinking about or it’s like totally you’re like, “Healthy baby, that’s it”?

Rachel: No, healthy baby. And I kept thinking in my mind, “I just need to get to 36 weeks, 36 weeks and then it’s going to be okay,” because my mother had all of us at 36 weeks. So, we turned out fine I think.

Dr. Fox: Yeah, I think so.

Rachel: In the third trimester, I knew I had another thing to be nervous about. I was going to start thinking, “Is the baby moving enough?” So, when it was a healthy point to get the baby out, I was like, “Just get the baby out.”

Dr. Fox: Right. And your wish came true.

Rachel: It was 36 weeks.

Dr. Fox: You went into labor.

Rachel: Yeah. I think I was in the office that day, and I saw you. And I went home and…

Dr. Fox: I didn’t do this. I didn’t put you into labor.

Rachel: You didn’t. I just saw you in the hallway. And then I remember the day before, I packed my bags for the hospital. I only let myself pack at 36 weeks because I wanted to manifest and not what happened before. And then that night, I was feeling contractions but it wasn’t really different than what I was feeling throughout pregnancy. The only thing that made me think differently and actually call and go to the hospital was that I was 36 weeks. So, I knew it was possible and I was ready. I was so ready. And it felt a little bit more painful like so, so teeny. But for some reason, I decided to go.

Dr. Fox: Yeah, and you didn’t want to deliver at another hospital.

Rachel: And I definitely didn’t want to deliver at another hospital.

Dr. Fox: Been there, done that. Yeah.

Rachel: Yeah. So, I was like, “Okay. Worst comes to worst, they’ll send us home.” And the hallway there to the hospital, I was like, “This is probably a false alarm.” And I was feeling totally fine. I walked into the hospital. I was fine. I was barely having contractions, barely in pain. And then in triage, that’s when it actually started getting worse. And then I had the baby really quick in two hours. No epidural. Not my choice. Too quick.

Dr. Fox: Wow. So, when he was born and he was… I mean, he wasn’t over six pounds.

Rachel: He was six-five.

Dr. Fox: Six-five. He’s screaming, he’s crying, you’re holding your baby. What’s that like?

Rachel: There’s nothing like that moment. I dreamed of it for so long. I always imagine that moment just holding the baby in my arms for the first time. It was surreal.

Dr. Fox: Did you know you were having a boy?

Rachel: I didn’t.

Dr. Fox: You didn’t know.

Rachel: No, no. It was a surprise but I knew. I didn’t know, but I had such a strong feeling. I don’t know why.

Dr. Fox: Really? Wow. Yeah. And then obviously it was a joyous moment for MFM Associates. It was like a little bit of a holiday for us.

Rachel: They can move my bed out.

Dr. Fox: I said, “Oh, thank God.” You’ve been through so much. And also it was recent, right? I mean, I think it was…

Rachel: It was within a year.

Dr. Fox: Yeah, the births were less than a year.

Rachel: It was like 10 months.

Dr. Fox: But, yeah, they were less than a year apart from each other. And so your whole pregnancy was fresh in everyone’s mind. It wasn’t like something, “Oh, five years ago. Remember what happened?” This is like, “Oh, my God, this just happened.” And it was so awesome, and I assume obviously for your whole family, it must have been like, “Finally. Thank God.”

Rachel: Yeah, it was amazing.

Dr. Fox: So, you’re here now. You’re several months after that. How much…? Because I assume you’re thinking about this again like the next time around. How much do you think about… For your next pregnancy let’s say, sort of the same question I asked you about the last pregnancy, how much do you feel like, “All right, I’m cured. I got it. I know I can do this. I’m fine. This is going to be great every time around,” versus, “Every time I get pregnant, it’s going to be a disaster or a wreck. I’m going to be terrified”? Where are you in that right now, looking back on all of this?

Rachel: Yeah, looking back at everything. So, definitely I think the greatest blessing that I had was that the last pregnancy was so smooth and uneventful.

Dr. Fox: Yeah.

Rachel: That of course after going through everything I went through, I’m not going into another pregnancy naïve or not knowing what could happen. But at the same time, I know my body could do it because I have a healthy baby and it happened. So, I think I would still be nervous. I would still go into another pregnancy probably coming in one to two times a week between 18 and 26 weeks because also it could change every pregnancy. So, it’s not just because one time was good, every time is going to be good. So, we still have to be on top of it. But I would still be nervous. But I think knowing that I could do it and also having another baby to my mind to be busy with and not just be focusing only on what’s going to happen with the pregnancy, I think that would help us take away some of the nerves.

Dr. Fox: Wow. I want to ask you two questions before we wrap up. The fist question is… And you covered some of this earlier this weekend and also last week. You’ve been through so much but always, always you’re so delightful. Do you know what I mean? No, I mean, really, and I say that… It’s not that people who aren’t delightful when they’re going through tragedy, there’s something wrong with them. That’s what’s expected, right? I don’t begrudge anyone who is… Like, anything when they’re going through a tragedy, all emotions are totally normal in that sense. But I just remember during all of this, you always… Even when you’re going through such horrible things, you’re always… You try to be positive. You have a smile. You’re always so kind. You’re always trying to be as upbeat as possible. If you know, why are you like that? Where does that come from, that you have that?

Rachel: Honestly, I can’t take credit. I think it’s a gift. I think really it’s a blessing. It’s not something that everyone could really control how they are and how they react to things. And I think, at the same time, for me personally, it’s harder to not be happy. It’s harder to go through life and look for the bad or… Of course, I’m a normal human and of course there’s so many times when I’m going to be sad about something. But as a whole, I would never want that to take over, the sad to take over. I always try to just be positive and try to be happy because it’s an easier way for me to live life just to be happy. It’s so hard to go through life sad.

Dr. Fox: It’s amazing. Well, I mean, there’s psychology behind that, the positive psychology field. And the second question I wanted to ask you is looking back on all of this from the very beginning of your pregnancy career until now, what lessons do you take away from this? When you look back on your own story and you think about your own story yourself, what do you take away from it?

Rachel: Definitely I don’t take anything for granted. That’s for sure. Every minute with my baby, every minute that I was pregnant was such a blessing and that I think after going through what I went through, I don’t know if everyone has those feelings of all the hard times, when you’re up all night with a baby, or you’re vomiting in pregnancy, you know it’s hard to see that it’s really good. But I think that really I recognize how precious all those moments are, the good and the bad and the hard, I would say. And also, I think it’s important to really hold on to the support, and the family, and the friends that you have to really like… They’re there for you, and they want to help you. And even sometimes people say things and everyone always says like, “It’s easy to laugh at what people,” or to say, “How could they say that, what they said?” But really everyone means well and everyone wants to help and just wants you to be happy. So, to really just win on that and take advantage of it.

Dr. Fox: Amazing. Rachel, thank you so much for telling your story, for coming in. It really is amazing. I’m so happy to know you. I’m so happy to know your family. Obviously, you’re wonderful people and it’s really just a… It’s amazing to be a part of your lives and I appreciate it. And I know that all of our listeners adore you now as well.

Rachel: Thank you so much. Thank you for having me.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.