“Shoshana’s Birth Story: 5-week admission for fetal hydrops”

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. All right, Shoshana, welcome to the podcast. So happy to speak to you. How are you doing today?

Shoshana: I’m good, thank you for having me.

Dr. Fox: It is my pleasure. Thank you for volunteering. I always ask my guests, how did you, like, find us? Like, how’d you find the podcast, for example?

Shoshana: So I found you. I listen to another podcast, “The Happy Birthway Podcast,” by Chanie Fingerer, and she interviewed you, like, this is a while back. This is during my first pregnancy, I think she interviewed you. And then after she interviewed you, I looked up your podcast because I was fascinated by all things pregnancy and birth really, and I wanted, like, more information and more stuff. So that’s how I found your podcast. And I don’t think I listened so consistently during my first pregnancy, especially during my second pregnancy that I really, like, became, like, I mean, I think I listened to the high-risk birth stories. And then when you merged, I like, I think I more listened to the high-risk birth stories and when you merged, I started listening to the regular podcast.

Dr. Fox: Got it. You came over with the birth stories folks. All right, awesome. And what compelled you to volunteer your own birth story?

Shoshana: I thought it was a really crazy experience. And I think after my first pregnancy, which was, thank God, I got an uneventful, healthy baby, I didn’t realize, even though I listened to these high-risk birth stories, like, I didn’t realize that, like, I can end up inpatient in the hospital for five weeks waiting for this baby to be born. I didn’t realize that. And I feel like it’s important to share that message and let other people hear what could go, I guess, wrong or what could happen. Not so much to scare people, but just to be aware of what the realities can be that pregnancy isn’t so simple and straightforward always. You know, and what you have to appreciate when it does go well and is straightforward.

Dr. Fox: Yeah, it’s always a mixed bag. And, you know, because I obviously do this podcast and it’s sort of like on the one hand, you don’t want everyone to be like, “Oh, my God, like,” and just scare everyone because that’s not the goal. But on the other hand, you know, I think it’s also important not just for people who are or are going to be pregnant, but also the people around them. Right? To understand, like, oh, like, even though, let’s say, the people in my life had uneventful pregnancies, thank God, there’s a lot of people who don’t and just have, like, an appreciation for that and what they go through. You know, and like you said, A, to have, like, compassion and empathy for them, but B, to have a lot of gratitude and appreciation if you’re lucky enough to have an uneventful pregnancy, which is obviously terrific.

Shoshana: Well, for sure. And I think also there’s also an element of some of these things when they were thrown at me were like, what does that even mean? Like, the beginning of my pregnancy, obviously, I didn’t even realize I was pregnant. And I was bleeding. I thought it was my period. But then it was weird because it was just spotting. But I was confused. I reached out to the doctor’s office and I kept… They’re like, “We need you to come in.” And then they’re like, “Oh, did you do a pregnancy test?” I’m like, “No.” So then they did. And then they made me do, like, repeat blood work. And that’s how I even found out I was pregnant. But then when I went for my first trimester screening and they started talking about this elevated nuchal, I don’t even think, and I had had another baby, I don’t even think I knew what an elevated nuchal meant. It was something like that. And then I actually did, I listened to your podcast at that point. I looked it up because I don’t even think I knew what they were looking for on these screening tests because nothing came back. So no one even explains it to you. They just do the test. And if something comes back, then they tell you. And, I think that that was, like, another reason why I wanted to, you know, just to be aware of some of these terms and things that I learned about. Like, I only learned about them as they were thrown at me. That’s why I love your podcast because if you just listen on a regular basis, you learn about things that if they get thrown at you, you’re like, “Oh, I’ve heard of that before.”

Dr. Fox: Wow. Well, thank you for the plug. I appreciate it. All right. Cool. So take us back. I guess let’s go to your first pregnancy. You delivered in 2022. So I guess when you first got pregnant, it was 2021. So, you know, who is Shoshana, like, where you live and what are you doing? What’s the story going into pregnancy, number one?

Shoshana: Yes. So my husband and I got married in February 2021. We were living in Washington Heights. And then I was a teacher and my husband was studying in Yeshiva and his plan was to start law school in fall. So in August, we moved to Queens because he was studying in Hofstra Law School. And it was closer to where I was working at the time. And we moved to Queens and we got pregnant shortly after that. Like, we were ready to start a family. And, you know, thank God, we got pregnant pretty quickly. And, you know, that’s where we were at. And, you know, I was teaching throughout. My husband was in school and was, you know, fairly uneventful. You know, I went for my screening test, as I said, I didn’t even know that there’s anything, ever thinking God was great. It was COVID. And I dragged my husband to most of my appointments, but it was COVID. And I remember the anatomy scan was, like, January 2022. And there was, like, a big uptick around then. And I remember it was December. It was December or January. It was a big uptick at that time. And they didn’t let my husband in. So he sat and those appointments take a really long time. So he was stuck in the car for, like, an hour waiting for me. And after that, he refused to come to my appointments. I mean, like, “I’m not sitting in the car anymore.”

Dr. Fox: “This is not fun for me.” Yeah.

Shoshana: Until, like, towards the end, when, like, my practice, there is, you know, a team of doctors and I kind of just… My first pregnancy actually just bounced around from one doctor to the next. And I just wanted to make sure I met everyone who does delivery. So towards the end, I made him come back to the appointment so that he had met most of the doctors with me in case for whoever would be on call when I delivered. And it was actually great because I think we saw the doctor who delivered Abigail, like, two weeks before she was born. And, like, we had asked her, like, I wanted to go to YU graduation. So my brother is graduating and a bunch of my siblings in law we’re graduating, and I wanted to go to the graduation. But, like, COVID was still somewhat concerning, especially because I knew they test in the hospital. So I asked the doctor and she’s like, “Well, you can use me as an excuse either way. If you don’t want to go, tell them your doctor said COVID and you’re having a baby and you don’t want to get exposed. And if you want to go, tell them that your doctor said you could go.”

Dr. Fox: I like that. I say all the time, like, what answer are you looking for here?

Shoshana: She’s like, “Call me either way.” And then in the living room, she’s like, she says, like, she said, “Did you go to the graduation?” I was like, “Well, I was having contractions. I didn’t go to the actual graduation, but we went out for dinner with everyone.”

Dr. Fox: All right. That’s nice. And the delivery went smoothly, right?

Shoshana: Thank God, it went smoothly. I mean, it was a long…like, I started having contractions early Wednesday morning and she wasn’t born until Friday afternoon. So it was a long, you know, Wednesday afternoon, I had an appointment with the doctor. And then Wednesday night, I thought my water broke so we went to the hospital. And they sent us home because my water hadn’t broken. And then Thursday night, the contractions, like, finally started to pick up. And I told my husband, like, “Go take a shower, because we’re going to be in the hospital for Shabbos, so go take a shower and shave. And then we’re going to go to the…” And then I’m calling the doctor. I’m getting us sent to the hospital. I’m like, I can’t do this anymore. I need an epidural. That’s what we did. We went to the hospital. And at this point, I was doing enough, like, they were willing to give me the epidural that I wanted. And then the next morning, I think I got the epidural some point, like, 3 a.m. The next morning when the doctor came in, they augmented my labor with Pitocin. And then the doctor broke my water at some point, like, around noon and she was born by, like, 3.

Dr. Fox: Wow, that’s great. That’s pretty quick.

Shoshana: Yeah. Yeah. And like, I remember we were…my husband and I remember, so I was pushing and the doctor said, “You’re doing great. You’re doing great.” And we’re like, we thought she was just being a cheerleader. Like, you know, whatever. And then she’s like, “It’s a girl.” And we’re like, “What?” We’re like, we just thought she was, like, being a cheerleader because that’s what doctors do.

Dr. Fox: That is amazing.

Shoshana: That’s how fast the pushing was with her. And actually with my second one, when I was pushing, and like [inaudible 00:07:51] all the time, my OB, who was doing this delivery, she was like, “How long did you push with for Abigail?” I’m like, “Maybe half an hour.”

Dr. Fox: Wow. All right. So that’s great. So great experience. Relatively uncomplicated. So tell us about…

Shoshana: And I thank God.

Dr. Fox: Yeah. Tell us about pregnancy number two, this is the pregnancy in question, the one we’re talking about.

Shoshana: The pregnancy in question. Right. So, yeah. So as I said, I didn’t even realize I was pregnant. I was still breastfeeding at the time. And I saw everything. The bleeding was weird. And, you know, and then I went to the doctor and they’re like, “No, this bleeding is actually telling us that you’re pregnant. But we need to, you know, track the HCT levels to make sure that this pregnancy is actually implanting and this isn’t, you know, leading towards miscarriage.” And yes, I found that I was pregnant. And yeah, Abigail wasn’t even a year old yet, but we were excited, you know, to have another baby to keep growing our family. And yes, so then we just kind of went on. And then I scheduled my first trimester screening and my husband didn’t come with me because first pregnancy I dragged, since everything… But now there’s Abigail. So it’s like if there’s an appointment, who’s watching Abigail? And Abigail’s daycare arrangement was that she was in daycare where I work. Which means that if I’m not at work, she’s not in…

Dr. Fox: Right, someone has to watch her, yeah.

Shoshana: Somebody has to watch her. So I went to the appointment and I didn’t think anything of it because nothing had happened in my first pregnancy. So I didn’t think anything of it. Like, it was fine, to be honest. And then the doctor comes in after the screening to tell me that we have an elevated nuchal translucency. And at that point, I didn’t even know what that meant. Maybe you want to share what they’re looking for. So our nuchal was 3.4. The threshold that which they get concerned is if it’s higher than 3. You wanna explain what they’re looking for? Or do you want me to explain to them that.

Dr. Fox: Yeah, no, no, no, that works. I mean, when you went into the ultrasound, you may not have understood, like, the numbers in this, but did you know conceptually that they’re looking for things to screen for genetic abnormalities like Down syndrome? Was that, like, even on your radar?

Shoshana: I don’t even think so at that point.

Dr. Fox: Got it. And did they do that blood test, like, the NIPT, the one that can tell you if it’s a boy or a girl?

Shoshana: So with Abigail, we did that when I went for the first-trimester screening. Because the way it works is my OB’s office doesn’t do ultrasound in-house. So they send us to the Center for High Risk Pregnancy associated with the hospital. So that’s where we did the ultrasound. With Abigail, I remember that they did the blood test at the time. But I think they started doing those tests in-house by the office because they told me just to go for the screening. And she’s like, “I’m on schedule to do the blood work next time you come in at, like, 16 weeks.” She’s like, “We’ll do the blood work then,” because she thought, like, it was probably a low-risk pregnancy. And like, it doesn’t matter if we do it now or then. And we don’t really want to know what we were having anyway. So like, it didn’t make a difference to us when we did that.

Dr. Fox: And so meaning when you went in for the ultrasound where they saw the nuchal was elevated, you did not yet have any blood test done.

Shoshana: No, so then at that point, we actually moved up when we did the blood test. After they shared with me that the nuchal is they’re looking for genetic abnormalities and a higher nuchal which means that, like, there’s genetic abnormalities, then at that point, when I called my doctor to see, number one, how panicked should I be? And number number two, like, what else do you want? She’s like, “Maybe either it should be moving up when we do this blood work.” Because she’s like, “Yeah, like, come in next week. And let’s do the blood work now, just because that way we’ll know how stressed do we not have to be.”

Dr. Fox: Yeah. I mean, the way I would have explained it at the time, you know, if you’re walking in, you’re young, you’re healthy, and the nuchal is 3.4, what I would have said is, you know, we’re looking on ultrasound for certain features that can sort of indicate an increased or a decreased risk of a genetic abnormality. So meaning if everything is normal, so to speak, it does not mean your baby does not have a genetic abnormality. Just means the chances are very, very, very low. And for most people, if that’s the case, they’re basically done. They’re not going to do anything else or they’ve done the blood test. And between those two, they’re pretty much good to go. Whereas if it’s “abnormal,” it means your risk is higher. And how high it is depends on exactly how abnormal it is. Right? Is it 3.4 millimeters, or 4.4 millimeters, or 5.4 millimeters? And also some other things like baseline. Are you younger or older? Are there other things we see on ultrasound? And so what I would have told you is that 3.4, the majority of these babies are perfectly fine and do not have a genetic abnormality, but your risk is higher than you’d like it to be. And so you have a few options. You could either do nothing and say, you know, the odds are in our favor. I’d rather not find out till after birth and get worried. And fine, okay. Another option is to do that blood test, which is assuming it’s normal, it lowers your risk even further. Not not to zero, but even further. Or you can be aggressive and do an invasive test like a CVS or an amnio to find out 100%. But I would have stressed that again, most people in your shoes have normal babies with that number.

Shoshana: That’s what my OB basically said. We did the blood work earlier and everything came back that it was low-risk. And at that point, genetics from the hospital wanted us to maybe pursue an amnio. But we weren’t interested. We said this is enough, like, basically what my doctor was saying, we were willing to say, okay.

Dr. Fox: Yeah. And, you know, it’s always something we bring up because, you know, with the blood test being normal, that’s really, really good for the things the blood test looks for, things like Down syndrome, trisomy 18 and 13. But there are other genetic abnormalities in theory that could be going on when you see the increased nuchal. And so from the genetic side to be most thorough, you would do a CVS or an amniocentesis. But again, it’s an option. It’s not like a requirement. Some people don’t want to be that thorough because they don’t want a needle stuck in their belly because it hurts or because there is risk associated with it. Not much, but a little bit. And because they may say, “You know what, I ultimately, you know, I don’t need this information before birth and we’ll just figure it out after birth.” And that’s totally reasonable. So some people choose to do the invasive test, the amnio or CVS, and others don’t. Like, you did. And that’s fine either way.

Shoshana: We opted not to.

Dr. Fox: Yeah, which is fair.

Shoshana: You know, and then we continued. Now they’re treating it obviously as a more of a high-risk pregnancy. So we did an early anatomy scan at 16 weeks, we did the anatomy scan at 20 weeks. We did a fetal echo at 22 weeks.

Dr. Fox: All makes sense. Yeah. Just to make sure the baby looks good. And the baby looked good?

Shoshana: Yeah. And thank God the baby looked good. At the anatomy scan, though, we had a different situation where Dr. [inaudible 00:14:16] says, “It looks like you have a placenta previa,” which means that my placenta was hanging over my cervix, which would mean that baby cannot be pushed out vaginally because the placenta would get in the way.

Dr. Fox: Right. If it never moved.

Shoshana: So it would mean that I would… If it doesn’t move, I would need to have a C-section. And the doctor told me, she’s like, she said, “I have people psyched out of 36 weeks that they’re having this C-section and they come in tomorrow, and they come in and their placenta move.” And I’m like, “Okay, now you’re just going to have to wait it out.” So that’s what really prepared us. And I remember when I talked to my OB, because remember, we had this nuchal and I’m like, “Okay, so is this connected? Is it not connected?” And my OB said, she’s like, “No, the nuchal was a baby thing. We ruled that based on the knowledge that we have that we’re hopefully not too concerned by that. This is a pregnancy thing. This is more of a you thing. It’s not going to impact the baby.”

Dr. Fox: Right. Correct.

Shoshana: One of the things they told me, and also, I think I listened to that point to your podcast about placenta previa. They told me at that point that placenta previa puts me at a higher risk for unexplained bleeding. If I start bleeding, go to the hospital. That was what they told me. So 25 weeks, it’s Friday afternoon. And we’re obviously [inaudible 00:15:22]. And we observe Shabbos. So Shabbos comes. It happens to be during the summer. So it’s, like, it comes, like, late, like 7:00, 8:00. But it’s 4:30, Friday afternoon and I started bleeding. So now it’s like there’s two things. Number one is we need to go. We call the doctor. You know, we need to go to the hospital. But number two is we need to figure out what we’re doing with Abigail. And it’s not just who’s watching Abigail right now when we go to the hospital because we might get sent home like, you know, in a few hours, it’s who’s going to watch Abigail for Shabbos because we’re not going to be there. So I called my mother. My mother said, “Okay, I’m getting in the car to come get her.” She called her friends who lives around the corner to come sit with Abigail so that we could go to the hospital right away. And then she came and she took Abigail…

Dr. Fox: Good plan.

Shoshana: …for Shabbos.

Dr. Fox: Good job. Good, mom. Good job.

Shoshana: No, I know. Thank God. And thank God we live close enough where that was an option. You know, and we were able to…she was able to get her before Shabbos. And so we went to the hospital and we felt like we’re going to go to the hospital. They’re going to send us home. I think my husband even said the bag of stuff that he packed for us for Shabbos got sent to my mother’s house. Not, it didn’t come with us to the hospital. In the end, we were in the hospital over Shabbos. So because I called ahead, my doctor was one of the OBs from my practice was waiting for me and she asked. She did the vaginal exam to check what was going on. My OB did it, not just one of the PAs in triage. One of my OBs did the exam. And they said it looked like it was just a blood clot and that everything would be fine. But at this point, they go into, you know, this is what we have to do in case this is a early delivery. So they gave me the dexamethasone…

Dr. Fox: Yeah, the steroids.

Shoshana: …for the steroids and baby’s lungs and magnesium for Baby’s….

Dr. Fox: Brain.

Shoshana: …neural brain. Yeah. Yeah, that was fun.

Dr. Fox: Yeah, that’s an unpleasant experience. Yeah. And not the steroids. The magnesium is unpleasant.

Shoshana: The magnesium is unpleasant. Yeah. No, my…later when I was in the hospital, one of my nurses, she’s like, “I had magnesium, I found out this is awful. This stuff is awful.” I was like, “It’s, like, nice, you know, to have somebody, like, you know, who had dexamethasone shared my experience.”

Dr. Fox: Yeah. One of my early podcast guests referred to it as flu in the bag. I was like, that’s about right. It’s like, that’s about right. So you’re there, but I guess you weren’t bleeding too heavy. They only kept you for, you know, a day or two?

Shoshana: And they only kept me basically, the dexamethasone has to be given 24 hours apart.

Dr. Fox: Yeah, so 24-plus hours.

Shoshana: They kept me… But literally after the 24 hours, then they started working on my discharge papers.

Dr. Fox: Okay, so that was a scare. But you went home.

Shoshana: Yeah. And you know, and they’re like, “Okay, when are you going to follow up?” It’s like it happens to be that my next OB visit is on Tuesday. So they were good with that. We went home and my husband was actually concerned because this was in the end of August and, like, the Jewish holidays were coming up. And his parents lived in New Jersey and he was like, “Can we go to New Jersey for the holidays?” “Yes.” My OB is like, “Or should we be concerned this is going to happen again and we’re going to end up back in the hospital”? Like, he was a little bit nervous. And my OB said, “I don’t think you need to be worried that this is for sure going to happen again. Sometimes it does, sometimes it doesn’t.” But she’s like, so just be aware of where your nearest hospital is.

Dr. Fox: Just in case.

Shoshana: That just, if you needed to go… Just in case. And thank God we made it through the holidays. About a week after the holidays, 31 weeks, I started bleeding again. It was Sunday night. And once again, we called my mom and we thought at this point, because we had the 25 weeks thing, we’re like, “Okay, great. We’ll go to the hospital. They’ll check it out and they’ll send us home.” But that’s what they thought. I mean, they did do the data [inaudible 00:18:48] again, just to be safe. But I call my mom to, you know, come get Abigail. I mean, I was already sleeping. So a neighbor came and sat with her while we went to the hospital. And then my mom came and got her. And yeah, and then we went to the hospital. So when we’re…we thought we would be staying there, you know, not for long. You know, we did the data, the triage, they moved me back to the, you know, packing [SP] room just until they figure out what’s going on to see if they need to admit me. For longer, what’s going to go on? And then the next morning, they did an ultrasound to check on the placenta. How’s my placenta doing and also to check on the baby. And they made a discovery with the baby that… This is how we knew they made a discovery when in comes a doctor who I had never seen and all the residents of [inaudible 00:19:33] following him.

Dr. Fox: Oh, yeah, that always great.

Shoshana: And I’m in one of those rooms where the room is basically just two curtains to the hallway, so they all pile in and there’s nowhere for anyone to go. And we’re, like, “What happened?”

Dr. Fox: So what did they see?

Shoshana: So what did they see? They saw that surrounding the baby’s heart, lungs and, not heart. Thank God, not her heart, but surrounding her lungs and abdomen, there was fluid.

Dr. Fox: They call it hydrops.

Shoshana: Yes, they did call it hydrops. He said this is a very rare and dangerous situation.

Dr. Fox: It can be.

Shoshana: It can be. And because of the placenta previa, I was having more ultrasounds because they were tracking my placenta. So they knew that about a month before, none of that had been there because they had the images from that ultrasound. And they’re like, “So this hydrops is scary. And it’s clearly fast accumulating if a month ago it wasn’t there and then suddenly this is what we’re seeing.” And so they said, “The plan needs to be for an emergency C-section.” They would like to wait the 24 hours to have the second data. And they had the NICU team come talk to us for the chance of a 31-weeker and then in terms of hydrops, what that looks like. And I think like it’s still hadn’t even hit us. How does even my OB… This pregnancy is actually seeing one specific OB for my practice. She was following me and then I just saw whoever was on call or each time I ended up in the hospital. But she happened to have been on call that day. And she came to talk to us later that night. And she’s like, she really wanted to be the one to do my delivery and be there for me. And she’s like, she asked the MFM… It’s like we’re waiting until, you know, after, you know, I have the next… So she’s like, “Can I do the C-section, you know, like, early tomorrow? Like, I’ll stay late to do it.” And he’s like, “No, you’re not doing this type of C-section, you know, after, you know, a full-day shift. And you know, at 1 a.m., I’m not letting you do that.” So it’s going to have to at least wait till tomorrow. So then obviously the next day they decide that… Obviously, MPO, because they think they’re doing this C-section the next day. But they come to do the ultrasound and things hadn’t gotten worse. Because remember, when I first came in, they saw that it was fast accumulating. So they figured if it’s really fast accumulating, by tomorrow it might have even gotten worse.

Dr. Fox: Right.

Shoshana: And it looks pretty much stable.

Dr. Fox: Stable. And do they have an under-…? I assume they didn’t because it’s very hard to figure this out. Do they have a guess of why this was going on for the baby? Because this is one of the more complex conditions to figure out what the cause is.

Shoshana: No, they did not. They did some blood work on me at that point. We had not done an amnio. But they did not know what had caused it. They definitely knew it wasn’t an Rh factor and they didn’t think it was viral. So they were kind of at a loss as to what causes it. They’re assuming at this point, there must be something genetic. And actually, one of the things they discuss is instead of taking the baby out, that maybe we’re going to try to do a…

Dr. Fox: A shunt.

Shoshana: No, a thoracentesis, where they would try to drain the…yeah, they would try to drain it in utero. Because that might be better because then at least the baby can stay in utero at this point.

Dr. Fox: Did you have high amniotic fluid at the same time?

Shoshana: Oh, yes, I did.

Dr. Fox: Yeah, the polyhydramnios. Yeah, that makes sense. Okay. Did they think it was connected to the thickened nuchal you had early in pregnancy?

Shoshana: No, they didn’t. I wondered if it might have been. They did not think so, because ultimately we did carrier screening, both me and my husband and we did a genetic testing on me and on the…whatever they do on the baby. And all of it came back negative for anything that could have caused this. So they don’t think it was related to the nuchal. Because the nuchal is….

Dr. Fox: For the record, I don’t know how this story ends in terms of this. Like, I don’t have any inside information. It’s possible those two are related, but we’ll see. All right. Interesting.

Shoshana: So, they’re thinking that they’re going to. So the next day they decide that maybe instead of doing the C-section right now, let’s try to do the thoracentesis, because if we do that, then we have to get genetic information and we can see what it is that’s causing it, which will help it be able to treat the hydrops better. And so that was their next step, sort of what might make sense. And let’s keep it probably a little longer.

Dr. Fox: Did they end up doing it or no?

Shoshana: So they were prepared to do it. The MSM came in with his, you know…

Dr. Fox: Long needle.

Shoshana: He came in with a needle. He was all ready to go. They take the ultrasound to check the baby. And when they had done the ultrasound earlier that morning, Baby had been in the position that he could have done it. Baby moved. So he was like, “Okay, I’ll come back in an hour.” He came back an hour later and Baby had still not moved. And so they were like, “Okay, I guess we’re not doing it today. I guess we’ll try again tomorrow.” Meanwhile, the next morning, my OB calls me. They had a big conference, you know, about all the, you know, high-risk patients on the floor. And it was decided that the thoracentesis poses more risk than benefit at this point. And they don’t think that that is the best procedure to do for my baby. So, you know, my mom said the whole time, because I was upset because I was like, “If this is what they were recommending, then this is what we need to do. Let’s do it.” So I was upset that the baby didn’t cooperate. My mom kept saying, like, she was, like, praying the whole time. She’s like, “I’m telling you that God didn’t want it to happen. And that’s why it didn’t happen.” I’m like…

Dr. Fox: Yeah, ultimately, so you’re originally in the hospital for the placenta previa, but now you got this fetal issue. What was it that kept you in the hospital for five weeks? Was it the baby or the placenta?

Shoshana: Was the baby. My placenta had started moving. I ended up having an induction and a vaginal delivery.

Dr. Fox: Did the hydrops resolve before you delivered, or the baby was born with it?

Shoshana: The baby was born with it, but when she was born, it was not as bad as they thought it was going to be. It turns out it wasn’t around her abdomen. It was around her… Her kidney was hydronephrosis, and that can be treated by antibiotic. So that and the lungs was nowhere near as bad as they thought, because they thought they were going to have to do, you know, they’re going to have to drain it right after she was born. And then be able to let the fluid reabsorb. And they didn’t have to do any procedures on her.

Dr. Fox: Right. And ultimately, did they figure out what it was ultimately?

Shoshana: No, no, they still have no idea. They still want us to come for metabolic testing after she turns one.

Dr. Fox: It’s interesting.

Shoshana: [crosstalk 00:25:29.412] maybe that can explain it.

Dr. Fox: It could. I mean, you know, sometimes, you know, when we see those in the middle of pregnancy, you know, there’s a lot, a lot, a lot of causes for hydrops. None of them are great. But sometimes babies just have sort of, for whatever reason, their, what’s called lymphatic drainage is not so good. Lymphatic drainage is what our bodies use to move fluid that isn’t like blood from place to place. That’s a way to explain it. So it’s not like your arteries or veins. It’s like this third piping system that people don’t know exists in their body. People know it if it gets blocked, like, if someone gets like a really horrible swell on the legs sometimes from that. Or, you know, when someone says, like, “Your lymph nodes are enlarged,” you get, like, those bumps under your neck or in your armpits. That’s sort of in that system. But some fetuses just have an abnormal system. And sometimes we see things that are dilated in the fetus, like the back of the neck. Sometimes they get hydrops and sometimes it ends up being nothing. And they just sort of, as they get older, it sort of develops and they outgrow it. That’s probably the best case scenario, I would say. If it’s just something weird and anatomic that was, you know, not functioning great as a fetus, but is fine now as the baby’s bigger and that system is bigger.

Shoshana: That’s what it seems to be, thank God. Thank God, she’s doing great.

Dr. Fox: That’s the one thing that I could think that would connect the thick nuchal and the hydrops that’s not a genetic condition. And again, you would usually know if the baby had a genetic condition after birth, like typically, you know, they test. It’s usually not something mysterious.

Shoshana: Yeah. No, they did a full genome on her when she was in the NICU and, like, everything came back negative.

Dr. Fox: So if it’s not genetic, so yeah, I mean, again, I don’t know for sure, but it sounds like that’s a plausible thing. I mean, people don’t come to this podcast for diagnoses, but, you know, we’re talking. It’s plausible. And that would be probably the best of the scenarios because it’s really just something that was temporary and probably is going to be fine forever. So that’s cool. So wait, so the placenta did resolve. You got induced, you delivered vaginally. That’s great that they let you do that. That’s cool.

Shoshana: Yeah. Thank God. That was, no way…

Dr. Fox: And did the birth go okay?

Shoshana: So, the birth was…it was a crazy day, number one. Because that’s when you know, so after they decided not to do thoracentesis, the goal was to get me to 36 weeks. So they kept me at every day. Every other days, they monitored the baby just to make sure the hydrops didn’t get worse, because if at any point it did, they would have gone back to their emergency C-section. Right. So they induced me. Right? So I guess the beginning was one of my OBs recommended, because, you know, I got a visit from one of the OBs from my practice every day. So, you know, I have lots of advice. So, when we were talking about the induction, one of them said, she recommended, she’s like, “Don’t get the epidural until you know you’re already having, you’re feeling the contraction just because you’ll know that the epidural is working.” So they started me outside of tech overnight. And then in the morning before they started the Pitocin, I got my epidural. That was awful. It was an awful placing of the epidural. I don’t know. Like, if I hadn’t known that there was a very strong chance this was going to C-section, I don’t know if I would have gone through with that epidural.

Dr. Fox: Oh, you mean just having the placement. It was more painful. I didn’t ask, did you have an epidural with your first?

Shoshana: I did have an epidural with my first.

Dr. Fox: But it was less painful.

Shoshana: Could be it wasn’t. I just don’t remember. Like, my micro contractions were more extreme and I just wanted it so badly. Like, whereas this was, like, you know, just a different sedative.

Dr. Fox: It could be a different experience each time. I mean, the needle is going into a very tight space and sometimes it goes in smoothly and sometimes it’s more challenging. I don’t know. People definitely have different experiences.

Shoshana: Also, like, I flinch a lot. Like, I’m very ticklish. And I think that the anesthesiologist had no patience for me with that. And I wanted…my previous baby, just dealt with it, like, you know.

Dr. Fox: Got it. All right. Yeah, I agree.

Shoshana: I think that was part of it also, you know.

Dr. Fox: All right, and then and you said you pushed longer this time, the second time?

Shoshana: No, but even then, that was crazy because I had polyhydramnios, the doctor wanted, she wanted to break my water and, you know, that’s late. But even before that I felt my water broke. It turns out I was bleeding again because I bled multiple times even during my hospital stay. Like, I bled multiple times, you know, like…

Dr. Fox: Even though the placenta had moved.

Shoshana: And yeah, so I started bleeding. So I thought, okay, great. This is the end of my induction. Like, we’re going to go to C-section. And my OB had them do some blood work. And she said, “Okay, we can keep going.” You know, she broke my water at some point in the middle of the day. And one of the other OBs in the practice actually happened to have been there that day doing, like, other gynecologic surgery in the hospital. And she helped her with breaking my water. She, like, counted me down, you know.

Dr. Fox: Yeah, just to make sure that everything… Because when there’s a lot of water, sometimes you worry when you break the water that maybe, like, the cord is going to come out or something.

Shoshana: [crosstalk 00:30:05.213], yeah.

Dr. Fox: And so you have to be, you’re a little more cautious. You know, we’re always cautious, but, you know, just sort of more things can happen. So you sometimes want more people around just in case.

Shoshana: Right. And then, like, at 3-ish, they, like, increased the -5 centimeters and they increased the Pitocin. But some point after that, that did not go so well for me. And I got like a cough and, like, I had to put, like, an oxygen mask. And they have to actually stop the contractions, just to give me, like, some time to recover from that before they restarted the Pitocin. And then, like, around 4, 4:30, I was 8 centimeters dilated. And the whole plan all along had been that even though I was having a vaginal delivery, I was going to deliver in the O.R. because…

Dr. Fox: The NICU team.

Shoshana: …the NICU team has their setup right off of the O.R. So they wanted me right away.

Dr. Fox: Just in case they had to drain the baby’s lungs after birth, but then intubate. They don’t know if this baby’s going to be healthy or sick.

Shoshana: They didn’t know where they were going to have to be, so they wanted… Right. So they wanted me in the O.R, so that the NICU team… Because they were operating under that this baby was going to be very sick. And, you know, so, like, they wanted me to deliver in the O.R.

Dr. Fox: Yeah. What was that like? What was that like for you? You know, obviously your first pregnancy went, you know, relatively well. And now you’re in labor and you’re worried that you may have a sick baby. Like, what was that like just experience-wise going through labor with the uncertainty of whether your baby is going to be well or not?

Shoshana: I think it was actually more just like, what are we going to, like, knowing that the baby wasn’t going to… They were taking the baby straight to the NICU. And it was like, kind of like, who was going to be there for me? Like, my husband needed to go with his baby. And, like, so my mom and my mother-in-law actually spent the day sitting downstairs in the hospital waiting for me to have this baby so they could be there for me. But I didn’t want them. I didn’t want either of them in the delivery room. But I wanted that. I needed them. I needed at least one of them to be there for me after the baby was born.

Dr. Fox: So it was more the logistics of it than sort of the existential part of it.

Shoshana: I think, like, to some degree, we were trying not to think about it. I think my mom and my mother-in-law had different, you know, coping mechanisms. My mom’s head like, “Everything, God was going to take care of us.”

Dr. Fox: Yeah, and that was a lot.

Shoshana: “God was going to take…” In my mom’s head, “God is going to take care of us and everything is going to be fine.” And my mother-in-law was a little bit more worried about, like, the sick baby and what the logistics of that were going to look like. And I think we were somewhere, like, in between, like, we knew the baby was going to go to the NICU. We knew it was going to take some time. We knew there was a possibility that, you know, beyond that, we might be going home eventually with a sick baby. But, like, I don’t think we really took so much time to think about that. I think we were more, you know, trying to, you know, like, initially, we hadn’t even known what we were going to have, and, like, at some point, like, after all these daily ultrasounds, my husband’s like, “Maybe we should just find out so we can celebrate who this baby is going to be before she’s whisked off to the NICU.” So, like, we found out, like, early on in my hospital stay, we found out what we were having so that we could celebrate who Yohanna [SP] was going to be before… Because when she was born, like, they really, like, whisked her off. So, like, it was… But, yeah, no, it was…

And I think that was, I think the whole thing was, you know, it was very stressful. I think I was pushing for a while and I realized, like, I just can’t do… I mean, actually, even before I started pushing and then on the operating table and then the… And then I don’t remember what happened, but they ended up stopping the contractions again and gave me a little bit more of rest time. And then we started pushing again, like, a half hour later. And at that point, you know, we were pushing for a while. And I actually think it’s interesting because Abigail, one thing was she was sunny side up. So my doctor has to help rotate her before we could get her out. And when I asked the doc this time whether [inaudible 00:33:27] was sunny side up, she’s like, “I think it’s very slight. I don’t think it’s going to make a difference being, you know, the pushing.” But I honestly with everything, you know, with what I’ve been through that day and, you know, the past bunch of weeks and knowing the baby was going to the NICU and being stressed about that, I don’t think I necessarily advocated for that piece of things, like, maybe we should be rotating the baby because, like, I was just more, like, you know, worried about everything else.

Dr. Fox: That’s a particular skill and it’s a particular situation. And it’s not always the right thing to do. It’s hard. I mean, that’s not… You know, each circumstance is unique, whether it’s the right thing to do or not, and based on the exact position, what’s going on with your pushing. So it’s hard. I mean, you know, whether you advocate, it’s not typically like, “Hey, can you please rotate the baby?” Like, “Oh, yeah, great idea.” And, you know, it doesn’t usually work like that.

Shoshana: No, it would have been more of a discussion. But, like, it wasn’t even on my mind at that point. The doctor was having to do an episiotomy, which I wonder, had she rotate the baby, might that have…

Dr. Fox: Maybe. I don’t know.

Shoshana: Would it? But honestly, I don’t know. I was happy she caught me when she did. And she said she hadn’t done an episiotomy in, like, three years. And she’s like, “And your baby made me do one.” But I was just happy that I got my vaginal delivery.

Dr. Fox: Yeah, of course.

Shoshana: And, you know, like, I was grateful for her for when she did the episiotomy when she did, because I remember thinking at the beginning of, like, that set of pushing down, like, I’m not sure that I can do this for much longer. And thank God she got me and Baby is [inaudible 00:34:42]. And she cried right away. Which is we were kind of expecting. We were kind of expecting that that wasn’t necessarily going to be the case given the fluid on her lungs. And thank God she cried right away. We were all very excited by that.

Dr. Fox: How long did it take until from when she was born that pretty much you realized she’s good, you know? I mean, obviously, there’s always question marks and this and the few… You know, but basically, was it one minute, one hour, one day? Like, at what point did you realize this kid’s fine?

Shoshana: She was in the NICU for three and a half weeks. But she came off of CPAP after, like, 24 hours. They took her off CPAP, they took it off to clean and she was doing well. So they kept her off and I was able to breastfeed her already after 24 hours.

Dr. Fox: Which was pretty quick.

Shoshana: That was very quick. I was expecting that, like, I was going to be pumping for weeks before I even, you know, got to breastfeed the baby. And, like, by the second day, I get put her to breast. And like, that was, like, that was really great. The doctors kept saying that night I actually didn’t even go see her that night. My husband went to her and I think his parents. This is, like, a little weird. His mother held the baby before I did, you know. Like, but the doctors kept saying, “She’s doing great. She’s doing great. She’s doing great.” Because they were expecting this really sick baby. And here we have this baby who’s, you know, it was a 36 weeker who needed some, you know, breathing support. She needed, you know, some antibiotics for her hydropnephrosis. But other than that, she seemed to be doing great. And, you know, she was six pounds at birth. And, you know, compared to a lot of the other babies in the NICU, she was, you know, substantial.

Dr. Fox: Yeah. Yeah. It’s one of the bigger kids there. Yeah.

Shoshana: And thank God, you know, she was doing really… I think, by, like, the second or third day, we thought there was a possibility she would be home before Shabbos. Ultimately that didn’t happen. And I think that was very hard for us because, like, we kept getting our hopes up and then, like, down again. I think my husband had the most… My goal was, like, this was… She was born November 20th. So my goal was to have her home for Hanukkah, which was, like, I think, the second week in December. And my husband’s goal was to have her home before her, like, by around her due date. And I was originally due December 17th, and she came home on December 13th. So I think his goal was the most realistic, you know, like just in terms of, like, how we handled that, you know.

Dr. Fox: Look, so, you know, you’re six, seven months out now. You have this beautiful baby you’re holding. Right? So looking back on all this, what’s your takeaway? What do you want our listeners to know about this?

Shoshana: I think number one, I really learned a lot about, you know, being in the hospital, the medical community and, like, what it’s like to, you know, be in patient in the hospital for five weeks. Like, that was, you know, an experience. And really, like, how important friends and family rallying for you, whether it’s, you know, offering to bring food, whether… Honestly, it’s the visitors in the middle of the day, like, the people from my family and community who just, you know, would take a day off or had, you know, time out of their day who just came to visit and spend time with me. Because it’s extremely boring to be in the hospital for long periods of time, especially in a situation like this where I was fine. Like, yeah, I was nine months pregnant. So, like, uncomfortable. But like, I was fine. And like, I was there because this is what the best thing that my baby needed.

And I really one of the biggest takeaways is what you can do for people in similar situations. You know, if you knew somebody’s in the hospital, you know, offering to visit and honestly, even the people who didn’t come, but made an offer, like, “I have some time to… Can I come?” Just knowing the people really were asking or singing for us and rallying behind us. My family had a chat around the clock. People were singing to him Psalms for the baby and like, thank God. Like, I really think those helped make the situation, you know, what it was, better. And I think really, you know, also my biggest takeaway is really just, you know, how much medical things the average person is unaware of and how much you really can learn throughout a process like this. And that, you know, just being aware of the basics, like, what things are looking for and, you know, and what can and can’t go wrong just to be aware so that when things happen, that, you know, you’re not caught in the noise of, “I’ve never heard of this before. What does this even mean?” And Googling, which Google can be scary or your podcast, which is a little more helpful in, you know, providing.

Dr. Fox: Yeah, yeah. Google. Yeah, Google’s not good if the word hydrops is coming up. I can say that right now. Google’s a bad place to be with that. It’s going to sound very, very bad. Wow. What an amazing, really crazy story. You know, and thank God it ended so well and she’s doing great. And it’s great. And I really do appreciate those lessons we spoke about at the front end of the podcast, but also, you know, that you reiterated at the end how important these things are. And I appreciate you volunteering your story and for coming out and taking the time. I’m sure my listeners really appreciate as well. Thank you so much.

Shoshana: 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. That’s 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.