Aviva Breda tells her High Risk Birth Story, which includes complications from a short cervix, contractions at 24 weeks, and weeks of bed rest.
“Short Cervix, Long Story” – with Aviva Breda
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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.
Aviva, thank you so much for coming on “High Risk Birth Stories.”
Aviva: Thank you for having me. I’m excited to tell the story.
Dr. Fox: Excellent. So, yeah. So, we originally met via your kidney donation and the podcast we did on “Healthful Woman.” And when we were talking, it also came up that you have an interesting birth story. Nothing to do with your kidney, this is 15 years before, whenever it was.
Aviva: Yes, exactly.
Dr. Fox: We’re talking about the birth of your son, Caleb. And he was born in 2004.
Dr. Fox: So, he’s currently a high schooler. So, this is a while ago. So, tell us at the time, I guess it would be in 2003 when you got pregnant. Where are you in life? Where are you living? What’s your story? So we can just set this up.
Aviva: Okay. So, I was 21 years old. I got married pretty young when I was 19 to my high school sweetheart. We had been together since high school, so it was time.
Dr. Fox: This is Ben, right?
Dr. Fox: Okay.
Aviva: His name is Ben and yes, we’ve been together a long time. So, we were living in the apartments in Teaneck [inaudible 00:01:30] all the little young couples who live there. And I got pregnant… About two years after we’d gotten married, we decided we were ready. So, we thought we were…ah, who knows.
Dr. Fox: Who’s ever ready? No one is ready. It’s whether you think you’re ready.
Aviva: Who’s ever ready? Exactly.
Dr. Fox: Yeah.
Aviva: And I got pregnant relatively easy, pretty quickly, no issues and things were okay.
Dr. Fox: You’re young. Listen, I got married young also. None of us know anything. I still don’t, all these years later. But you’re young, did you have any concerns or fears going into pregnancy? Or just like, “Hey, this is what we’re doing, it’s gonna be great?”
Aviva: I was so naive. I don’t even know if I… I’m sure I’d heard about miscarriage at that point, but I don’t even know if I knew anyone who had had one. I was so naive. I just thought you get married, you wait a year or two, you get pregnant, you have a kid, then you do it again, and then you do it… No. I really didn’t.
Dr. Fox: Listen, that’s a wonderful way to walk through life, especially if nothing happens. It’s great. So, the pregnancy is going fine and you said you’re feeling well physically and everything is going okay. And was it your plan to stay where you’re living or were you thinking of moving somewhere? What was your just thoughts maybe more short-term?
Aviva: So, our plan was actually to…we were living in a very tiny, tiny apartment and we were hoping to move within the complex to a larger apartment. And there was at the time…you had to know the right people or speak to the right people to get the good apartment. So, we were working on that. I was actually in graduate school at the time. I was doing interior design school at night and I was substitute teaching in the local schools just to…whenever it worked out with my schedule during the day.
Dr. Fox: Right. And what was Ben doing at the time?
Aviva: Ben is an accountant, and he, at the time, was at Ernst and Young and he was an auditor. So, he had that chunk of the year where I did not see him for more than 15 minutes a day. It was busy season and he was not around that much.
Dr. Fox: But not traveling though, he was just into the city, I guess.
Aviva: No, no. Yeah. Exactly. Yes. Into the city.
Dr. Fox: And where are your families from?
Aviva: My family is from Fairlawn, so pretty local. My parents were there at the time, still both working. I have two sisters who also…one in Riverdale and one in… Actually, my sister was not in Riverdale at the time, I think she was in the city. And another sister who at the time was living in Florida.
Dr. Fox: Okay.
Aviva: Ben’s family is also local from River Edge, New Jersey.
Dr. Fox: Okay.
Aviva: So, everyone was pretty much around.
Dr. Fox: Okay. So, you had support and excitement.
Aviva: Yes. Exactly.
Dr. Fox: And so, tell me what happened in your pregnancy when things went a little bit more sideways.
Aviva: Everything was really great and fine, normal, I guess. I went for my 20-week sonogram and everything looked fine. The only thing that came up, and I think actually might have been before this was the doctor had recommended I do a nuchal translucency, which was… She said you could do this, this and this and that one sounded like the least invasive so I went with that one. And that came out fine. Everything was fine. I went for the sonogram, everything looked good. And that was kind of it. The day after that sonogram, I believe, Ben and I went to Paris. We went to Paris over the Christmas week holiday. My birthday is on Christmas, so we went for that and we came back right after New Year’s. And a week or so later, I went in for, I guess, my next regular appointment and the doctor said to me, “Oh, this is so exciting at the forefront of everything. I just came back from a conference and we learned all about cervixes.” I don’t know what the plural of cervix is but cervexes maybe.
Dr. Fox: People say both and neither sounds right.
Aviva: Okay. So, those. So, we’re gonna measure your cervix and just see where you fall on this list.
Dr. Fox: Measure by ultrasound.
Aviva: Yes, measure…right, not with a tape measure.
Dr. Fox: Right, right. Well, not by exam. Yeah. Because you get an exam and it’s sort of looking at it with a speculum or using ultrasound.
Aviva: Yes. Ultrasound.
Dr. Fox: Correct. The cervical length.
Aviva: Yes. So, she did that and she definitely was a little weary, I guess. I don’t know. She just, “Huh, oh. Okay.”
Dr. Fox: Oops.
Aviva: Yeah. Like, “Maybe I shouldn’t have done that, but I did. Oops.” Right. Exactly. So, she said, “This is shorter than I’d like, but it seems pretty closed so you’re not a candidate for a cerclage,” which I think is when they sew it closed. Okay. So, she said, “We’re not gonna do that, but let’s just take it easy. Don’t…”
Dr. Fox: By let she means you?
Aviva: Yeah. Exactly. Yes. Yes. “You take it easy.” Don’t go hiking, obviously. But it was really more like, “You can live your life, but try to just do it a little slower, maybe go places where you’re seated, go out for lunch, get your nails done, don’t walk in the supermarket for an hour and a half.” I said, “Okay. Fine.”
Dr. Fox: Can people do that? Do people walk in supermarkets for an hour and a half?
Aviva: I think people do. I don’t know.
Dr. Fox: God. That sounds horrible. Yeah.
Aviva: It’s actually funny, Ben and I really both like supermarkets, but…we like to find different ones. Okay. Whatever. Anyway. So, she said just take it easy, which didn’t seem like such a big deal to me at the time, I didn’t have any other kids at home.
Dr. Fox: Did she say why? Was she worried about you delivering early? Did she go into all of that or was it just like you’re still blissfully unaware of what’s going on?
Aviva: Yeah. I think it was a little bit of that, I don’t think she wanted to scare me. I’m not even so sure that she knew exactly what to do here, but she just felt like something wasn’t perfect.
Dr. Fox: Okay.
Aviva: So, that was fine. I said, “Okay. That’s a little weird, but all right. I’ll take it easy. Fine. No problem.” I was substituting at the time, so I decided… Okay. I was working with little kids in pre-K and I said, “Okay. I won’t do that.” Bending up and down, picking them up, whatever. I won’t do that. So, I stopped doing that and I was still going to graduate school at night. And then my next appointment, I made the terrible mistake of going by myself. It didn’t feel like it would be a mistake because that’s a very normal thing to do when you have your regular scheduled pregnancy appointments. And at that appointment, they did my cervical length again, and they hooked me up to a monitor and the doctor told me I was having contractions pretty close together, and I had no idea. I didn’t feel anything. So, that was pretty terrifying because I felt like, “Oh, my God. How would I ever know?”
Dr. Fox: How far pregnant were you at the time?
Aviva: I was probably around 23 weeks.
Dr. Fox: Okay.
Aviva: So, it was 24 maybe. It was still pretty early. And the doctor said to me, she said, “Either I can hang you upside down, or we can send you to the hospital.” So, it was pretty obvious that I was going to the hospital. I think my mom picked me up. I don’t even remember, I was so traumatized from that whole thing. I ended up in the hospital. Immediately, they put me on magnesium sulfate. Wow. That is a rough…
Dr. Fox: That’s unpleasant.
Aviva: That is wow. Yes. I remember being in the triage area and the doctor ran in. It was like she was…. And at that point, they did actual exams, it wasn’t just the ultrasound to see. And I don’t think that I was dilated, maybe minimally at the time, but they were certainly unhappy with whatever they were seeing.
Dr. Fox: Right. The cervix was at least short and they saw contractions.
Aviva: Yeah. Exactly.
Dr. Fox: But again, if they didn’t do…you feel fine? You feel normal?
Aviva: I totally was… I had no idea anything was happening.
Dr. Fox: Until they started the magnesium you felt fine. Yeah. That’s pretty gruesome, the magnesium.
Aviva: The magnesium, I was so exhausted. I could not physically keep my eyes open. I asked my husband to bring me a pair of glasses. I don’t even really wear glasses, just sometimes. I thought maybe if I had glasses on, I’d be able to keep my eyes open. And I could hear everything that was going on, but I physically could not get myself to be awake. That was really tough. And that went on for at least a day, a full day. And then they moved me to sort of like in you’re never leaving area of the hospital and they put me on monitors. I had an IV and everything. And they just were watching, watching, and watching. They were able to slow down or stop the contractions. And we met with the perinatologist and all these people there. And they would come in every morning and tell us, “Okay. If the baby is born today, this is…”
Dr. Fox: “Here’s all the horrible things that could happen to your baby if born today.”
Aviva: And they gave us a book and I was, “Don’t give me the book.” It was terrible. Yeah. Exactly. They literally would tell us this is what you’ll be facing if the baby is born today.
Dr. Fox: That situation when someone is potentially gonna deliver around 24 weeks is really, really hard. It’s hard for you, obviously. And it’s hard because on the one hand, we’re supposed to tell you everything that’s going on, but on the other hand, it’s terrifying. And we don’t know what’s gonna happen. It’s not like we know your baby is gonna deliver, and so you have to balance it. Sometimes I’ll ask people, “What do you want me to tell you? What are you looking for here? Do you want everything you want? You wanna know nothing? What do you wanna know? And I’ll tell you what you wanna know. And otherwise, I’ll only tell you what you need to know.”
Dr. Fox: And different people feel differently about that. Some people love stats and numbers, and they’re really analytical about it. And other people are like, “Dude, that’s just gonna freak me out. Just don’t tell me those things and we’ll deal with it.” And I’ll say, “Okay. That’s fine also.”
Aviva: I could have used a little discretion, I’ll tell you. It was terrifying. It was really terrifying and I really started to dread that time of day when the team from the…
Dr. Fox: The team.
Aviva: The team from perinatology would come in to tell me what would be that day.
Dr. Fox: That’s my team.
Aviva: They managed to stop my labor.
Dr. Fox: Did they think you were going to… They’re telling you all the horrible things that could happen, but your cervix is closed, you felt fine.
Dr. Fox: Did you get the impression that they felt you’re actually going to deliver in the next few days, week? Or just that they…just in case we’re gonna tell you these things?
Aviva: Definitely in the first couple of days that I was in the hospital, it felt very imminent. It was constant…
Dr. Fox: That was the messaging you were getting or the attitude, in a sense.
Aviva: For sure. And for a while, there was contractions on the monitor. There was stuff going on. So, I definitely did feel that, but after probably like the third… I was in the hospital for 11 days, and I was on complete bed rest. I mean, catheter…
Dr. Fox: Oh, God.
Aviva: The whole thing. They did not let me move. The catheter was just a… That was a horrible experience. And I’ve had after C-sections and after other surgeries and I had no issue.
Dr. Fox: Right. Listen, you’re 21 years old and this is like…
Aviva: And I have never been hospitalized before.
Dr. Fox: Yeah. And that’s probably since the day you were born.
Aviva: Exactly. In the same hospital, actually, as a matter of fact.
Dr. Fox: Oh, my God. Yeah. It’s [inaudible 00:11:50] this is 17, whatever years ago, things were a little bit different then from now and we definitely treat those situations differently now, we don’t use… Interestingly, magnesium at the time, when you got it, it was given as a medication called the tocolytic, which is to stop contractions. That’s why it was given. We’ve learned subsequent that it doesn’t work and so we actually don’t really give it for that reason anymore. It might stop some contractions, but if you’re gonna deliver, you’re gonna deliver whether you’re on it or not. But what we have found, interestingly, is that, if let’s say you did deliver, the babies do better if you got magnesium. It doesn’t stop the contractions, but it helps the baby’s outcome.
So, now we actually do give it in that circumstance, but for a different reason and for a much shorter amount of time just like… And we just learned that by dumb luck that because a lot of moms got it to stop contractions. Also, moms got it sometimes if the reason was preeclampsia. And then we learned subsequent and then did it, not we but the world, they did a follow-up study and they found that babies do better.
So, it’s given now much shorter amount of time and so that torture that you felt is minimized, but it’s interesting it didn’t work. And the other thing is with the short cervix, we know that a lot of people have a short cervix and it doesn’t always mean anything. For some it does, for some it doesn’t and that’s tough. And we…at least we try not to…and I rarely tell people to take it easy, bed rest because mostly it doesn’t work. Now, but also, it can be very difficult in someone’s life. Well, so you’re there 11 days and at some point, they said “All right. You’ve made it through. You’re not delivering and then we’re gonna put you on some parole from prison.”
Aviva: Pretty much. While I was there, actually, now that…when you were talking about the magnesium, I remember I also got some…
Dr. Fox: Steroids.
Dr. Fox: Yeah. That’s a steroid.
Aviva: A very big shot. Yes.
Dr. Fox: Yeah. That’s to help the baby’s lungs.
Dr. Fox: Same thing. If you deliver the baby does better if you got the steroids. These are like the plan for the worst, hope for the best.
Aviva: Right. Hope for the best.
Dr. Fox: And this is the, if you deliver your baby is better off with these things. Okay.
Aviva: So, yeah. So, after 11 days…and this was the time before Netflix. There was like none of that…
Dr. Fox: Oh, yeah. Prehistoric.
Aviva: I remember sitting in the hospital…
Dr. Fox: Did you even have a cell phone?
Aviva: I don’t know. No, I must have. I must have had some sort of cell phone.
Dr. Fox: Was it ’04, ’05? Yeah. I think that was…yeah, that was cell phone time.
Aviva: I must have had something. But I remember my father brought me a mini DVD player so I could just watch a movie or something. It was…
Dr. Fox: Your kids right now are listening and saying, “What is that?!
Aviva: What is that? Is that…
Dr. Fox: What?
Aviva: It was great, and you were limited by what DVDs you had.
Dr. Fox: Sure.
Aviva: It was like what? It was… So, after the 11 days, they…
Dr. Fox: You were watching Clueless.
Aviva: I don’t even…. Yeah. Clueless, that’s my favorite movie. They released me. Now, this got a little complicated because I was released on full bed rest, meaning I was not allowed to move. I fought for a shower every day. It was really severe. And because Ben, at the time, was working crazy hours, the doctors also asked that I please not be left alone. They were terrified that something would happen.
Dr. Fox: In case you went into labor, started bleeding, something.
Aviva: So quickly.
Dr. Fox: That’s actually more reasonable than the bed rest. The bed rest isn’t…we’ve learned it doesn’t work. So, it’s not gonna keep the baby in, you shower, you don’t shower. I wouldn’t have you train for the New York City Marathon or say, “Hey, this is a great time to hike the mountains of Tibet.” But regular activity should not seem to matter, but that’s actually one of the circumstances. What would you do if you did start bleeding or break your water and it’s labor? What’s your exit plan?
Dr. Fox: And also back then Uber didn’t exist, you’d have to get a ride or call an ambulance. So, that makes more sense logistically today.
Dr. Fox: Yeah.
Aviva: So, they asked if we could please…someone could please babysit me all the time. So, we ended up moving into my parents’ house.
Dr. Fox: Yeah. That happens. How did that work out for you? Okay?
Aviva: It was okay. It really was, truthfully…
Dr. Fox: What hospital? Just so I know a little history.
Aviva: Valley. The Valley Hospital in Ridgewood.
Dr. Fox: Valley. Okay.
Aviva: So, I was in Teaneck, my parents were in Fairlawn. So, they were actually even closer to the hospital.
Dr. Fox: Yeah. [inaudible 00:15:43] like in between. So, that works. Okay.
Aviva: So, I moved in with my parents. And like I said, I didn’t have any other kids, so it wasn’t a big… I literally laid on the couch and watched TV all day, really. I just put everything on hold.
Dr. Fox: It was like my high school.
Aviva: Yeah. Exactly.
Dr. Fox: Okay. Got it.
Aviva: So, I really I’m so lucky to have such an incredible family and someone from my family switched off… Ben really couldn’t take almost any time off. Someone took a different day and they stayed with me every single day, my mom, my dad, my two sisters. Actually, one sister is also an accountant, so she had a little bit of a harder time. But whenever she could, she did. And they switched off. My dad actually, I think, had the brunt of it because he has his own practice, so he had a little more flexibility.
Dr. Fox: He’s a physician or something?
Aviva: He’s an eye doctor.
Dr. Fox: Okay. Got it. Yeah.
Aviva: So, he had a little more flexibility and we just sat at home and watched TV.
Dr. Fox: Right. So, you negotiated to be able to shower, and they let you use the bathroom?
Aviva: They let me use the bathroom and shower. And those were my big…. Those were big, big parts of my day, I gave them…
Dr. Fox: Big events.
Aviva: Yeah. Very, very exciting.
Dr. Fox: And did your friends know this was going on? And there was like a safe Ferris campaign for you, were people coming to visit you and send you food and balloons and everything or?
Aviva: They did, but you know, truthfully, I was pretty depressed. It was really hard. It was really hard. I felt really isolated, I didn’t really wanna talk to friends. I didn’t have a ton of friends who were having kids. I was pretty early in that but the ones that did, they were having regular, normal pregnancies. It was hard. It was hard.
Dr. Fox: That’s FOMO. That’s serious FOMO.
Aviva: It was hard. It was very hard. I didn’t want guests, I didn’t like how I looked. I hadn’t gotten my eyebrows waxed in months, things like that. It was very hard.
Dr. Fox: Bed rest is such a complicated topic. It’s actually not a complicated topic, but it’s become a complicated topic in pregnancy and it used to be used all the time. All the time for everything. Pretty much any problem you had a pregnancy, rest. Whatever it is, pain, bleeding, contractions, go rest. And essentially, all of the data shows it’s completely worthless. It just does not help. And so people think, “What’s the harm?” Okay. Maybe it works, maybe we don’t know, but there is harm. That’s the problem. Just from a mental health perspective, it is very depressing to tell someone you have to lie in bed all day, you can’t leave your home, you can’t go out, you can’t get sunshine. It’s a very difficult thing. Some people will prefer, “Okay. Maybe I could stop working,” which is good for some people, but then for others, financially, it’s a problem.
Aviva: For sure.
Dr. Fox: You’re talking about disability, you got to move in with your family. And then physically, muscle wasting, constipation, blood clots. It’s just really… It’s a tough intervention. And it’s being used less and less frequently nowadays, but many people are still very big on bed rest. I spend so much more time taking people off of bed rest than I ever would spend putting. Unless someone has like heart disease, I almost never tell them to go on bed rest. Other than again, just some common sense, don’t do anything crazy. If it causes contractions back off.
Aviva: Right. Of course.
Dr. Fox: But you’re talking 2004, and a lot of people did it, and a lot of people even believed in it. So, you were the recipient of that.
Aviva: Yes. Very much.
Dr. Fox: And again, was the messaging like, “If you don’t do this, you’re gonna deliver and you’re gonna deliver anyways and we’re just gonna try to stretch out a day or two and…?
Aviva: Every day was a big deal. It was like, “If we can make it through today” every day, that’s what it was. And my big outings, I think I was going to the doctor at that point weekly.
Dr. Fox: Yeah. Field trip.
Aviva: Yeah. I got dressed up. I remember fighting with my sister one time.
Dr. Fox: Is there an eyebrow waxing place next door?
Aviva: I tried to negotiate a manicure one time. No, that was a no-go. But I did manage to get my sister to take me for a milkshake one time. She didn’t let me get out of the car, but at least I was with her while she got it for me.
Dr. Fox: Oh, my God.
Aviva: Yeah. It was a really hard time. That part was really, really tough.
Dr. Fox: How much fear did you have? Obviously, it’s like this is gruesome to do, but did you have fear? Because you said you went into this blissful.
Aviva: I did have fear but I didn’t know what I was afraid of. I was afraid, to begin with. The idea of having a baby…
Dr. Fox: Being a mom.
Aviva: …labor. God only knows what that was gonna be like. I was terrified, regardless. So, this was just more of that. I didn’t know… As much as they told me…and I brought that book home that they gave us and I never read it. And I think I even might still have it and I’ve never read it. And it was just terrifying, but it was something that I was just so… it was like a baseline terror.
Dr. Fox: How about your parents? This must be so hard on them.
Aviva: Yeah. Also, just nobody really knew what was going on. It was like, okay, this is our new schedule, our new normal, Viva just laying on the couch all the time and don’t let her get up.
Dr. Fox: Are they the kind of people who are like, rah, rah positive, “It’s gonna be okay, it’s gonna work, it’s gonna be great.” Or are they like, “Oh, my God. You’re gonna explode at all times and…”
Aviva: It was a little bit of both. It was a little of both. A lot of time… I think for a… Because it was such a long time, a lot of times, we just didn’t talk about it. We just didn’t talk. It just was.
Dr. Fox: Just a new norm, the new reality.
Aviva: Yeah. It just was. We really just didn’t focus on it. Doctor days were a little more stressful. Everyone needed an update the minute I got back or the minute I got out.
Dr. Fox: What were the updates, though? You’re still pregnant. What were they gonna say?
Aviva: Yes. Pretty much, “You’re still pregnant, your cervix is either the same or shorter.”
Dr. Fox: “I’m confident you’re still pregnant.”
Aviva: Yeah. It was pretty much that. And it was, for me…they would check to make sure I wasn’t having contractions. If I was, they would make me wait for a little while or whatever. Once or twice, I think it got to the point where they said, “Okay. Hang out here for X amount of time, and if we can’t get it to come down, then we’ll go back to the hospital.” I think I might have gone back to the hospital once just for fluids or something, but I was never admitted again after that.
Dr. Fox: And were you seeing multiple doctors or primarily one doctor? And if it was multiple, were you ever getting differing opinions and advice? Did that happen?
Aviva: Interesting. So, I was seeing multiple doctors within the practice like you normally do and their messaging was pretty much the same. They had all attended this cervix conference, and they were all, I think, in an unchartered territory. And I really felt like I had gotten messed over a little bit, that they had…like why did they have to go to this conference right before my appointment?
Dr. Fox: What if they hadn’t checked? What would have happened?
Aviva: Yeah. But then they did refer me also to Maternal-Fetal Medicine in Paramus and I saw a number of doctors there. I would go there, alternating for a cervical length measurement and just for more in-depth sonograms and make sure the water levels were good.
Dr. Fox: Everything. Oh, and those were not the people who you were seeing in the hospital, the doom and gloom? Because it’s… Well, there’s two groups and it’s always complicated who’s who. There’s the perinatologist, who are the maternal-fetal medicine doctors like me, the obstetricians, then there’s the neonatologist, who are the pediatricians from the NICU.
Aviva: From right after. It’s possible that…
Dr. Fox: And it could have been both.
Aviva: It’s possible that the neonatologists were the ones giving me the…
Dr. Fox: The data.
Aviva: …the doom and gloom updates, and the perinatologists were the ones doing the other stuff. Although I have to tell you afterwards, the neonatologist, his name is Dr. Frank Manginello. He was the most unbelievable person I’ve ever met. And he might have been one of the ones who were telling me all the terrible things, but he was…
Dr. Fox: Great.
Aviva: …incredible after. But I did go to Maternal-Fetal Medicine and there…at least twice I had to go for…they weren’t happy with the water and it wasn’t looking right and I had to go for further testing. But in the end, everything just always was…
Dr. Fox: And ultimately, as you’re getting more and more pregnant, you’re getting close to 32 weeks, 34 weeks, did they start relaxing the restrictions on you because you were getting more pregnant?
Aviva: So, they didn’t. Our big goal was 36 weeks. They always said if we can get to 36 weeks, that’s where we were gonna be. So, I was really counting down the days. The doctor said at 36 weeks, you can get up, you can go for a walk, you can do whatever you want. That night, me and husband, the night of the 36th day, when I was starting the 36th week, we went to the mall, and we just walked and walked and walked.
Dr. Fox: Not to a supermarket to walk around?
Aviva: No. Surprisingly. I didn’t buy anything, I didn’t do anything. I just…
Dr. Fox: Walking around the mall.
Aviva: We just walked around the mall.
Dr. Fox: Physically, how did that feel? Because you hadn’t walked that length in months now.
Aviva: It was exhilarating and exhausting.
Dr. Fox: Yeah. You’re out of shape.
Aviva: Totally. It was my first pregnancy. I had already bought all of these beautiful new maternity clothes, whatever. And I was ripping tags off just to go out to the doctor. It was hard that night and… That was a Wednesday night, by Sunday morning, I wanna say 2:00 or 3:00, 4:00 in the morning, I was already in the hospital. I was having contractions and they checked me. The doctor said, “Okay. This was the best we could hope for, and why don’t you take the day, do whatever you wanna do, whatever you think might help encourage labor at this point because we’re not gonna try to stop that, at this point.” That was where they felt comfortable that they wouldn’t do anything to stop labor.
Dr. Fox: Right. And you were 36 and a half weeks or something?
Aviva: I was just… Yeah. About 36 and a half. So, I took the day. I think I went to the mall with my mom. I needed pajamas for the hospital. My mom just reminded me actually that we also got chocolate-covered strawberries at Godiva. So, that was exciting. They told me to come back later that night, and I did. And when I got there, they said, “Okay. We’re gonna check you in.” They left me for a while to labor. I remember begging for an epidural because I was in so much pain. I finally got the epidural and then the baby’s heart rate started jumping up and down.
Dr. Fox: In a way that was concerning to them?
Dr. Fox: Okay.
Aviva: And the labor started slowing down.
Dr. Fox: Now, you can’t get the cervix to open.
Aviva: Right. Well, so it was crazy because the whole time they kept telling me the baby is gonna fall out. It was like the plug was on its way out and…
Dr. Fox: You get up, the baby is gonna drop on the floor.
Aviva: I was literally afraid of that. You know those crazy stories you hear people who have babies in the toilet?
Dr. Fox: Yeah.
Aviva: I was like, “Oh, my God. That’s gonna be me.” And then nothing, just nothing. And so then they decided to break my water and that was terrifying. It was like a hook and… Oh, that was… They did that and then that went badly. Once they did that, the baby’s heart rate really started going bad and they put water back in. And I did not know that that was something that could happen.
Dr. Fox: Yeah. We could do anything. We’re doctors.
Dr. Fox: We are licensed to practice. We do whatever we want. All right.
Aviva: So, they started putting water back in…
Dr. Fox: Yeah. That’s something that happens. We do that sometimes.
Aviva: That is okay. That’s a normal thing. Yeah. So, that happened and then things quieted down for a little while. They had me on my side, they were rocking me on all fours, back and forth. I was pushing. I think I started pushing at one point and nothing was happening. And so the doctor said, “Let’s go to the OR. And we’re gonna use vacuum suction, but let’s do it in the OR.”
Dr. Fox: Not only will this baby just baby fall out, we’re gonna have to take a vacuum to your baby’s head and pull it out.
Aviva: Exactly. Which is why I felt so screwed after the whole thing. I tried so hard to get him out and the whole time they kept telling me to keep him in because he was gonna slip through my legs. It was crazy.
Dr. Fox: Yeah. That’s imagery in terms of… When we say the baby is gonna fall out the fear is that you’re gonna go into labor.
Aviva: Right. Of course.
Dr. Fox: But even people who have issues with their cervix, it’s not always that the whole baby is gonna fit because that’s really more your pelvis. That’s more geometry than the cervix, but it is… These stories are ironic, that happens. You’re afraid the baby is not gonna be a little early, gonna come out, gonna come out and then boom, suddenly, baby is not coming out. And in fact, there’s a lot of women who we take care of who the whole beginning of pregnancy is, they’re just so scared that the baby is gonna come out. Whether it’s a short cervix, whether it’s their past pregnancy, whether they’re carrying twins or triplets. And there’s usually a day where everything flips, and instead of them saying, “God, I hope this baby stays in” to “Please, I hope this baby comes out.” And that is a very quick transition. There is not a lot of overlap, but they wake up like, “I’m done. That’s it. Get this baby out.”
Aviva: I remember feeling so strongly that I needed a break between being pregnant and having the baby. I needed a week off in between the two because it was just so much. They moved me to the OR and they were trying to suction and vacuum, and his head kept hitting my pelvic bone, the way that I was shaped. And they just couldn’t get him out. And I remember each time they would suction the vacuum and it’s just…
Dr. Fox: It’s a bad sound. And it sounds like pulling the plunger off the floor.
Aviva: Yeah. Exactly. And stuff was flying. It was not pleasant. My husband Ben is extremely, extremely squeamish.
Dr. Fox: Great.
Aviva: So, he wasn’t…at that point, he was not even in the room. My mother was with me.
Dr. Fox: Someone’s giving him oxygen.
Aviva: Yes. And suddenly… His heart rate just kept fluctuating too much and suddenly the doctor… And it wasn’t my doctor, this was just the doctor from the practice who was on call and she just said, “That’s it. Everyone out.”
Dr. Fox: Right. C-section.
Aviva: They threw my mother out and I was terrified. And she started pinching me, immediately. She started pinching my stomach and I was screaming, “I can feel it. I can feel it.” I was terrified she was gonna cut me open while I could still feel it.
Dr. Fox: Why did they send your mother out? Because they thought they would have to put you to sleep?
Aviva: They did.
Dr. Fox: Okay.
Aviva: They put me to sleep. So, I was all alone.
Dr. Fox: All right. You had an epidural. It just wasn’t working perfectly or wasn’t strong enough?
Aviva: I guess maybe it wasn’t enough. I don’t know. She was pinching me and I was terrified. And I remember the anesthesiologist was petting my face like, “It’s gonna be okay. It’s gonna be okay.” And then I was out. And that’s the last thing I remember. And then Ben told me that he was outside of the room when my mom came out and they saw my doctor running down the hall, and the doctor who was in the operating room with me came out and said it’s a boy, before the assisting doctor had even gotten there.
Dr. Fox: They did it that fast.
Dr. Fox: Once you’re asleep, the baby could be out in 60 seconds.
Aviva: Oh, wow.
Dr. Fox: One minute, two minutes. It’s really very, very quickly. Okay. It was fine when he was born.
Aviva: So, his Apgar scores I think were pretty low. And they took him directly to the NICU and they just said it was a traumatic birth.
Dr. Fox: Yeah. That’s a great term to use. Traumatic birth. Okay. Is he traumatized?
Aviva: It’s funny actually when I was preparing this story… I don’t even know if he’s ever heard any of this.
Dr. Fox: Oh, here’s his chance.
Aviva: Yeah. I remember we talked a little bit about at his [inaudible 00:30:27], but he wasn’t certainly…
Dr. Fox: He doesn’t remember.
Aviva: He doesn’t remember that.
Dr. Fox: Yeah. That’s traumatic. That’s a traumatic birth. Yeah.
Dr. Fox: Wow.
Aviva: So, they actually kept him in the NICU for the whole time. He was in the NICU for five…I believe I was in the hospital also for five days.
Dr. Fox: Give or take. It makes sense. And he was there the whole time. But ultimately, he came home with you and he was okay.
Aviva: Yeah. He came home with me.
Dr. Fox: How much did he weigh when he was born?
Aviva: He weighed 5.10 when he was born and we left the hospital at 5.4.
Dr. Fox: That makes sense. Okay. And then how was your immediate recovery? You’re in the hospital, you just had this crazy pregnancy, you’re a new mom, you had an emergency C-section, all this is going on. You’re put to sleep, you wake up. What’s going on in your head at this time, if you could remember back to that?
Aviva: I remember waking up in a room and I was like, “What did I have?” I didn’t even know. And I couldn’t even see him because I couldn’t get up.
Dr. Fox: So, you didn’t know if you were having a boy or girl?
Aviva: And then they told me I had a boy and they got special permission for me to be wheeled in on my bed, gurney, to the NICU so I could see him. And he had a ton of wires and… He had a ton of wires. And I don’t think I was able to try to feed him until the next day. They had me try to pump right away, which was also very uncomfortable and horrible. But he was the healthiest baby in the NICU at the time so they gave him his own little area. It was…
Dr. Fox: He’s the biggest, he’s the strongest.
Aviva: Yeah. Exactly. Thank God there really wasn’t anything wrong with him…
Dr. Fox: Yeah, they just had to watch him.
Aviva: It was just a whole to do. I pretty much told Ben we were not having any more children. That was the end. I remember even when I was laying in the hospital during that 11-day stint, I told my in-laws, anyone who… I was like, “You better enjoy this one because this is all you’re getting for me.” Other than that, once we finally were able…we passed the Kersey tests and did all those things, then it was pretty much okay.
Dr. Fox: Did things feel normal again after you got home? Like, okay, now we’re just a young couple with a baby and clueless and whatever, or was it…?
Aviva: Not for a little while.
Dr. Fox: How long did it take to get… Again, you could use the word trauma, whatever it is, it’s a really hard pregnancy to go through. And it stirs up a lot in your brain. How long did it take?
Aviva: It took a while, and I definitely suffered from postpartum depression for sure, which I think was probably spurred on by the…
Dr. Fox: Was it diagnosed postpartum depression?
Aviva: Yes. Okay, I mean, it took me a little while to get there…
Dr. Fox: To figure it out.
Aviva: …I didn’t know that that’s what was going on by any means.
Dr. Fox: Right, you think this is normal, that I feel so miserable.
Aviva: Yeah. It was also my first time so…and I had just felt so miserable for the past four months, so I didn’t know to feel any different.
Dr. Fox: I mean, these are real risk factors, having a C section when you didn’t expect it, having a prolonged hospitalization, having a tough pregnancy, having a baby in the NICU, first time mom. I mean, a lot of people don’t have it but those are all sort of risk factors for getting some sort of postpartum depression or anxiety or something.
Aviva: Yeah. Thank God I didn’t have any of the like, you know, wanting to hurt myself or the baby or anything. It was a lot of crying and sadness and weepy and all of that stuff. But until I got that under control, it took a while, you know, to feel okay again.
Dr. Fox: Right. Right. Well, and when you look back on it all these years later, or even prior to now, just over the past, you know, 15 years of his life, 16 years of his life, do you sort of think about the what if, like, what would happen if they didn’t check your cervix, that it would have been just an uneventful pregnancy? Or maybe what they did helped and you would have delivered a preterm baby? How do you process that?
Aviva: Well, it’s interesting. With my second, when I did actually decide to have another one. I waited four years, but they were cautious in the beginning and they would send me for cervical lengths. But then about… All of my kids were delivered… Caleb was 36 and a half. Charlie was about 37. And then Ruby, my youngest, she made it all the way to 38…38 and a half baby. And all three I went into labor with… Well, Caleb was an emergency c-section. My other two were scheduled c-sections.
Dr. Fox: At 39 weeks probably, yeah.
Aviva: I went into labor first.
Dr. Fox: But you didn’t have any of this in between.
Aviva: But with Charlie, I did have preterm labor but it was much later. It was only… He was born December 23, he was due January 6th, I believe. And by mid-November, I was done working. I had to stop working.
Dr. Fox: You never had anything like this.
Aviva: Nothing like this. No.
Dr. Fox: And were they checking the cervix and it wasn’t short or they were checking the cervix and it was short but they didn’t do the same things?
Aviva: I’m pretty sure they were okay with the length. I’m not sure if it was the same short that it was just now they were okay with it right or it just wasn’t short.
Dr. Fox: Okay, so now that you know that, what do you think about your first pregnancy?
Aviva: Well, it’s hard to say because, you know, I did feel like I really got, you know, messed over, and it was the luck of the draw that that’s when I happened to have my appointment. But on the other hand, what if what they said helped, you know? And the doctor subsequently… I actually ended up having to switch doctors after that for my next two but not because…that practice stopped doing OB they only switched to GYN so I switched to..
Dr. Fox: Right, meaning not out of being upset it just worked out…
Aviva: Yeah, not at all. They’re wonderful doctors. But yeah, I did feel like, you know, I wonder what would have happened. But the truth is, and they’ve even said, you know, we have no idea if it was the right call or not, but it was almost like, how could we not make that call, because who knows the other way? So it could have gone either way. I mean, it’s dunk, it was a horrible way to have first pregnancy, but…
Dr. Fox: This does happen a lot in medicine. I mean, this situation specifically, but just conceptually, that we see information and it means you’re at an increased risk or something. But even if you know, mathematically, most likely it won’t happen, there’s a higher chance it will and what do you do? And I think for this in particular, we have a lot more information. We know more about cervical lengths and what it means and what the risk is. And there are other treatments aside from bed rest. There’s, you know, various vaginal progesterone preparations. There’s things you can sort of do and get better information. I think that if you, you know, if what you had presented today, the outcome may have been exactly the same. But I think the experience from the day of until you delivered would have been a little bit less freaky, potentially, and probably less interventional.
And again, it’s not an issue that they did anything right or wrong is that’s, you know, it’s different in 2004. But yeah, who knows, it’s possible if you went through their pregnancy again, they wouldn’t have checked and you may have delivered the exact same time, or maybe you would have contractions later and they would have done this for a shorter… I mean, who knows? But it’s hard and… Does that sit okay with you that you don’t know? Or does that always like [inaudible 00:36:52] you, that you’re not really sure what would have been?
Aviva: I think at this point, you know, it’s okay. It’s just the way it happened, it was a really hard thing to go through. It was a really hard way to have my first pregnancy and to be introduced to the whole idea of motherhood and everything. But, you know, I did end up having more kids, thank God. And those pregnancies were pretty much uneventful, and certainly way more enjoyable. And I got to wear all my nice clothes. Yeah, I mean, in a perfect world, I’d love to know, right? I’d love to know, what would have happened if but… It’s just the way it is, I guess.
Dr. Fox: Do you ever tell the story like to people who are going through pregnancy? Or you find someone, you know, they say they have a short cervix? Or is it something you sort of like have kept yourself mostly?
Aviva: I mean, I’m a pretty open person so I will share. But mostly I’m cautious to tell anyone who’s pregnant anything about this because…
Dr. Fox: That’s kind.
Aviva: You know, no reason to scare them. But especially I think, because like medicine is so evolved from then, I feel like it would be a completely different, different outcome. But I do remember at the time, there were so many people who were… I remember people saying, “Oh, yeah, I have a cerclage.” Or I did that or I did that. And I just felt like, why don’t I just have a normal cervix issue? Like what’s going on with me, but… It’s definitely a story that I’ve shared but, you know, I try to keep it.
Dr. Fox: Well, now you’ve gone public.
Aviva: Yes. Most definitely. Now Caleb can hear the whole shebang.
Dr. Fox: Great. Well, I hope he listens. And I hope, you know, the next time he’s, you know, not doing what he’s supposed to be doing you could say, “Listen here, bab,” you know, “this is what I went through for you. Clean your damn room.” Excellent.
Aviva: Thank God, he’s a pretty good kid.
Dr. Fox: Yeah. Well, thank you so much for coming on and telling your story.
Aviva: Thank you for having me.
Dr. Fox: I really appreciate it and I’m sure our listeners will. It is a really fascinating story and the sort of the what if and how…you know, these pregnancies they can sometimes go really sideways. I mean, ultimately, obviously, you’re well and he was well, but that’s a tough thing to go through and to try to navigate that when you’re just…for the first time.
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