There is no more crushing blow to a mama than the realization that the little one she has been carrying-even if only for a few weeks as had been the case for me-is gone. With the loss of that little soul also comes the loss of hopes and dreams not only for that little one, but also for the entire family into which that little one was to be born.
That loss happened 10 years ago. I had my first miscarriage on June 25 2001, a year before the birth of my daughter. I think of those souls often, and wonder, “What would you have been like?” Would you have been boys or a girls? Who would you look like, me or your father? What kind of personalities would you have? Sometimes I just give into, “What if?”
And yet, I know if the baby I “lost” on November 1, 2004 had lived, I would not have my now 8 year old son, the little guy who just makes my heart full and who can zing me with his uncanny perception of the truth and his quick wit. If I had had the baby I lost on June 25, 2001, I would not have my daughter. I may not have experienced that trials and tribulations that I experienced having her which ultimately have lead to the “birth” of Mamas on Bedrest & Beyond.
Both of my children are my greatest blessings. I truly cannot imagine my life without them in it. Yet it wasn’t an easy path to get them here. Several people have asked me over the years if I had to do it again, knowing my path to parenthood, would I do it again? I have to honestly answer, I don’t know. I know that I definitely would want to have my children, but, weenie that I am, I don’t know if I could knowingly go that path to getting them here again.
Mamas on Bedrest, each of you will travel a unique path and have an exquisite story to tell about how you came to be a mama and how you brought your baby into this world. For some of you, this path may be so overwhelming that you don’t trod it ever again. No worries and no judgement. Other mamas will go on to have other children, sometimes going back on bed rest, sometimes progressing just fine without life restriction. Some of you will go on to write books, start businesses, start non-profit organizations or do some other sort of humanitarian work as a result of your pregnancy and birth experiences.
It’s all good. It’s all perfect. Everything is as it should be. That is what I have learned over the years. While I still get a tiny sting in my heart when I think of the souls that moved on so quickly, I also smile and thank the Gods above for the delightful and dynamic souls that I live with each day. I learn so much from ALL my children. From those with me I learn patience and to not take myself so seriously. I also learn humility as they are often quick to point out my faults or mirror them back to me.
From those that have gone on, I have learned that life goes on. I will always remember them and for me, I honor them by serving other mamas and babies. Their gift to me is my service to you, to ensure to the best of my ability that each mama has the support and resources she needs to safely and successfully deliver a healthy baby. I thank you all for allowing me to honor my children.
Mama on Bedrest Addison asked this question of the community:
“Previous Bedrest Mama Here… I am currently 26 weeks, 3 days, due Sept. 6. I delivered my first little one at 35 weeks, after 5 weeks of bedrest. This pregnancy, I am getting Makena injections weekly and was wondering if they’ve worked for any mamas with previous preterm labor. Thank you in advance.”
First, I’m really grateful to Addison for asking her question and feeling comfortable enough with our community to share her story. The quick answer to Addison’s question is, “Yes, Makena injections do work.” Now let’s look at why Makena or 17 Alpha hydroxyprogesterone caproate (17OHP) shots work.
It really comes down to simple physiology. We all know that estrogen and progesterone cause the cyclic changes that are our menstrual cycles. In the first 2 weeks of our menstrual cycles, estrogen levels rise as a follicle in the ovary matures an egg in preparation for ovulation and subsequent fertilization. Estrogen also prepares or “plumps up” the uterus to receive the fertilized egg for implantation and subsequent development into the baby. At Ovulation, estrogen levels dramatically drop (and the egg is released from the ovary) and progesterone levels begin to rise during the last 2 weeks of the menstrual cycle. Progesterone maintains the plumped up uterine tissue so that the fertilized egg can implant in the uterine wall. If there is no implantation, progesterone levels drop and the outer uterine layer “sloughs off” and this sloughing is the resulting menstrul period.
If there is fertilization, the progesterone levels continue to rise so that the uterine wall continues to be a plump and fertile “ground” into which the growing and developing fertilized egg can embed. Progesterone levels will remain high thoughout much of the pregnancy, but especially during the first trimester so that the uterine wall stays rich and nutrient dense to “feed” the fertilized egg. By the end of the first trimester, the placenta has developed and it assumes the primary role of feeding the growing infant and progesterone levels will decrease, but still remain high in comparison to non-pregnancy levels.
So one can see that progesterone plays a vital role in the development of an infant. When progesterone levels are not high enough, the uterus doesn’t “plump” enough to be able to host a fertilized egg. When this occurs, a woman may miscarry early on in the pregnancy. This is what I had, and why I lost 2 of my pregnancies in the first trimester. Upon further evaluation, my OB discovered that I had a luteal phase defect; I didn’t make enough progesterone during the second part of my menstrual cycle, so my uterine lining would plump up, but not be sustained in an early pregnancy. Luteal Phase defect has also been named as the reason that I developed Uterine Fibroids. Without adequate progesterone in the second half of my menstrual cycles, my uterine linings didn’t fully “slough off” and my estrogen levels weren’t offset. So I had too much estrogen, not enough progesterone and fibroids-which love and live off of estrogen-and were able to grow.
But why do some women need to take progesterone in their pregnancies? If the placenta takes over the role of feeding and nourishing the infant, why do women need progesterone? The simple answer is because the uterine walls still need to be plump to maintain the pregnancy. This is the major role of progesterone during pregnancy. Yes, in early pregnancy it helps provide nourishment to the developing fetus, but progesterone’s major role is to sustain a rich, plump uterine wall in which the fertilized egg embeds, from which the placental tissue can draw nutrients and develop and so that the uterus remains a safe, protective environment for the growing baby.
Prescription progesterone helps prevent preterm labor in 2 particular situations: Incompetent Cervix and Preterm Labor.
Incompetent Cervix. A woman who has an incompetent cervix has a cervix that is shortening and thinning too early in the pregnancy. If this shortening and thinning occurs before 37 weeks of gestation, a woman is at risk of going into preterm labor. If a woman has a cervix that is shortening and thinning and is only carrying one baby, inserting progesterone gel into her vagina daily (Beginning between 20-23 weeks and continuing until 37 weeks or just before) will help keep her progesterone levels up, keep her uterus and cervix nourished and in functional form and prevent preterm labor. To date, there are no side effects to mama or baby from progesterone gel.
Preterm labor. Preterm labor is labor that occurs spontaneously before 37 weeks of pregnancy. The exact causes of preterm labor are unknown, but the bottom line is that the uterus begins to contract and be “inhospitable” to the growing baby, forcing it out. Progesterone shots have proven to be very effective at preventing preterm labor and preterm birth in women with a history of previous spontaneous preterm birth and who are carrying only one baby. Progesterone shots are either compounded (individually made solutions of) progesterone or Makena, pharmaceutically manufactured progesterone. Progesterone shots are typically started between 16-20 weeks and given weekly until 37 weeks of gestation. There have been no reported side effects of progesterone shots to mamas or babies.
So this is the long and short on progesterone. If you have been prescribed progesterone to prevent preterm labor, know that it has a long track record of efficacy and an equally long track record of no negative effects (except for some mild vaginal irritation with the gel and some mild irritation at injection sites) on mamas and babies. While it’s no fun to have to use progesterone gel or to take progesterone shots, know that this course of treatment is highly effective and will give you and your baby a great chance of going to full term pregnancy.
“I lost my first child at 23 weeks due to an icompetent cervix. I am now 6 weeks pregnant and will have a cerclage at 12 weeks, not sure how much bed rest the doctor will prescribe, but l am very hopeful that the cerclage will let me carry to 37+ weeks.”
I am always so excited for mamas when I get these messages. Having lost a pregnancy prior to having each of my children, I can hear the trepidation in Cate’s voice as she “hopes” she’ll make it to 37+ weeks (and most of all come home with a healthy baby!) But what’s a mama to do? At 6 weeks along and with a history of a miscarriage, you don’t really want to go broadcasting your pregnancy. Yet it is at this critical time that you need support to wait those long, agonizing, 6 weeks more to cerclage, then onto bed rest for what may be the bulk of your pregnancy. This conundrum plagues many a mama. What’s a mama to do when she doesn’t know what to do? I say, take the situation in bite sized chunks. Here’s how.
Chunk #1-6 weeks to 12 weeks. In this first “chunk” you’re waiting to see if the pregnancy will hold on to the cerclage. On top of that, you may be dealing with morning (or all day!) sickness, fatigue and general malaise. During this chunk your mission (should you decide to accept it) is exquisite self care. This is the time to give your body all the rest that it needs. As your body forms and develops your baby, it is expending a tremendous amount of energy. Daily naps will be a must-whether you want to take them or not! Most mamas in this stage find that their bodies simply “clock out” mid-late afternoon, so if at all possible, see if you can somehow arrange at least an hour of rest during the day. If you have not already begun taking prenatal vitamins begin doing so (and I can recommend an awesome prenatal vitamin if you don’t already have one!). Pay super attention to your diet and do your best to eliminate the fatty, sugary and processed foods. (Your body may already be restricting what you can eat. If this is the case, get down what you can and do your best to make it as nutrient dense as possible!) And because this is such a stressful scenario, get support. I’m going for shameless self promotion here-Get thee to the Mamas on Bedrest & Beyond Facebook Community! It’s free, you don’t have to be invited and the community is full of mamas at all stages of pregnancy and bed rest who have gone before you, know exactly what you are going through and can offer better tips and support than any doctor or social worker! Visit often, chat it up, ask questions. Share your journey so that we can support you, cheer you on in the good times and lift you up when you’re down.
Chunk #2-12-approximately 20 weeks. In this chunk of time, you get your cerclage and have a few weeks of feeling pretty good before being prescribed bed rest. Typically the morning sickness has subsided and you are able to eat a more balanced, nutrient dense diet. The fatigue has mostly subsided as well. While you may not be showing, mamas who make it to this point often feel a real sense of accomplishment and begin telling friends, family members and co-workers that they are pregnant.
If you haven’t already, begin telling friends and family members your situation and start garnering support. If possible, set up a care and visitation calendar for when you are on bedrest so that you can not only have help for your family (partner) but also a regular stream of visitors to help pass the time and keep your spirits up. Talk with your employer’s human resources department as you may be eligible for some paid maternity leave. This will depend on the state you live in and the generosity of your employer! Learn what you are entitled to from your company and get any necessary documentation into the proper representatives. Get your affairs in order so that while you are temporarily “sidelined” your “life” will proceed as smoothly as possible. You may want to prepare some meals and put them in the freezer, pay up bills or at least get them onto online accounts, gather items you may want/need while on bed rest; extra pillows (a body pillow is a must!!), small bedside table, a small refrigerator or cooler for your bed room, a movie subscription, books or e-reader subscription, craft items and wifi so that you can keep up with the other Mamas on Bedrest!
Chunk #3-The Bedrest Prescription: 18-20 weeks. This usually comes somewhere around 18 -20 weeks, but I have seen women go as long as 22-24 weeks before being put to bed. The first few days to weeks are bearable, but for many women, as early as 2 weeks gets them feeling antsy. This is the time to put that care calendar to the test. Have that list of family members and friends handy and initiate that visitors schedule. Spend time online speaking with other women on bed rest. You may also want to start a blog or other memory marker to chronicle this journey and later share with your baby.
Chunk #4-20-26 weeks. This is the next big hurdle. If you can make it to 26 weeks, if you were to deliver, although small, your baby will have a fairly good chance of survival. He/she will spend a long time in the NICU, but they can survive. This is the first bed rest milestone to attain. How to get here? Great books, movies (netflicks or Amazon instant videos are lifesavers!), craft projects help pass the time. When you get to 26 weeks, be sure to celebrate with your mama friends online.
Chunk #5-26-28 weeks. 28 weeks is the next big marker. 28 weeks marks the onset of the third trimester. If you make it to 28 weeks, your baby is even stronger and more likely to survive should you go into preterm labor. Celebrate this important milestone-with your online community and with family and friends.
Chunk #6-28-32 weeks. The next big marker is 32 weeks. Again, the further along you go in the pregnancy, the better for the baby. Start winding up your projects as your bed rest time is drawing to a close.
Chunk #7-32-36 weeks 6 days. You may be thoroughly sick of bed rest by now, but getting this far along is a HUGE accomplishment! Your baby is growing and growing and his/her little organs are getting stronger and stronger. You may have your cerclage removed and the bedrest restriction lifted as most babies born after this point do well. But of course, The longer they stay in you, the less time they’ll need to spend in the NICU. If your baby is delivered during this time period, there are a few things you should know. If you are released from bed rest, “get your nesting on” as your little one will be coming any day!
Chunk #8-37+ weeks. Mama, you got this!! You have done an AMAZING FEAT!!! Your baby is “term” and has excellent chances of survival and excellent chances of having few if any complications. Barring any unforseen complications, all should be well! Congratulations Mama! Well done!!
If you found this “Bedrest in Chunks” approach helpful, tell us so in the comments section below. Did we miss something? Leave something out? Tell us that as well. Got a Question? Need more information about a great prenatal vitamin or other recommendation? e-mail us at firstname.lastname@example.org.