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During the first trimester, I saw my doctor once every four weeks to monitor myself and the pregnancy. So, at my 12-week appointment, I was shocked to hear the words “high risk” associated with my pregnancy, and it all started due to my longstanding autoimmune disorder, Hashimoto’s Disease.
What is Hashimoto’s Disease?
Hashimoto’s affects the thyroid as a form of hypothyroidism. My thyroid underperforms, so my immune system tries to attack the “threat,” AKA my thyroid gland. Once under attack, an abundance of white blood cells accumulates, and my thyroid cannot produce enough hormones, most significantly, thyroxine or tetraiodothyronine (T4) and triiodothyronine (T3).
Until this point in my life, I had been able to regulate my Hashimoto’s with diet, adhering to a mostly gluten-and dairy-free lifestyle, and low-impact exercise. But, as a newly pregnant patient, I didn’t realize that this disease can increase your odds of miscarriage, preeclampsia, placental abruption, preterm labor, and anemia. So, my doctor immediately referred me to a maternal-fetal medicine (MFM) specialist to monitor my pregnancy closely.
Maternal-Fetal Medicine visits
In my case, specialist visits entailed an ultrasound and a visit from the MFM doctor. I learned during this process that normal thyroid hormone levels during pregnancy are at a lower threshold than what’s acceptable for non-pregnant people. Mine were above what was safe during pregnancy.
A quick trip to the pharmacy later, I was responsible for taking 85 mg of baby aspirin as a “preventative” for preeclampsia, as I was now at high risk for that condition, and 25 mcg of levothyroxine to regulate my thyroid hormones. Thankfully, at my following appointment about four weeks later, my numbers looked great, and I finally felt like I was on my way to a safe and healthy pregnancy.
A preeclampsia diagnosis
After moving, I saw new providers and was nearing my third trimester. I had a few run-ins with hypertension at my doctor’s visits, which my OB flagged as potential preeclampsia. This dangerous condition manifests via high blood pressure and proteinuria (or excessive protein in the urine).
This terrified me. Throughout my pregnancy, I had heard horror stories from other moms regarding their traumatic experiences, laced with fear-inducing buzzwords like “preeclampsia,” “induction of labor,” “c-section,” and other nerve-wracking possibilities that I “definitely don’t want,” so they persistently reminded me.
My doctor recommended visiting a new MFM specialist in my new area, a 24-hour urine collection, and twice daily blood pressure readings. To my relief, my blood pressure at home was regular, with no indication of hypertension. However, my 24-hour urine sample proved I did have proteinuria.
After my OB confirmed a diagnosis of preeclampsia and confirmed that I’d have an induction at 37 weeks, I was devastated. Those buzzwords other moms used in traumatic scenarios were now my reality.
About two weeks later, I visited my new MFM specialist, who seemingly negated all that my OB relayed to me. In her opinion, I had white-coat hypertension, a benign influx of blood pressure due to doctor-related anxiety (since my readings at home were regular, this further proved her argument). She also said that my proteinuria was slightly over what is considered normal and that, if anything, I may not have preeclampsia at all. However, she would still recommend a 37-week induction just to be safe.
How would I be monitored?
At this point, I have two opinions, both telling me two separate things, but both recommended an induction three weeks early. To better monitor my pregnancy, this new specialist recommended twice weekly appointments until I deliver. Mind you; this is not standard. Each week I was to have two tests performed, which I must pass: an NST and a BPP.
Non-stress tests (NST) are performed via two monitors on your belly to track the baby’s movement and heart rate, plus any potential contractions you might have during a 20-30 minute test. The goal of an NST is to determine whether the baby is in distress in utero or unresponsive to the test, with the baby’s heart rate spiking by 2-3 times its standard rate as it moves.
Biophysical profiles (BPP) are diagnostic ultrasounds with the intent to check on the baby’s heart rate, movement, practice breathing, amniotic fluid, and more. To keep myself and the baby healthy, I had both tests to look forward to each week, plus rounds of labs to ensure my bloodwork was normal. Should these labs indicate abnormal findings, I could be at risk for complications such as HELLP Syndrome, pushing my induction to as early as 33 or 34 weeks.
My OB also recommended a trip to the cardiologist before delivery, as one of my main physical complaints has been palpitations and breathlessness. She also referred me to an endocrinologist to have another specialist monitor my Hashimoto’s. These referrals meant I would see an MFM specialist, a cardiologist, and an endocrinologist, all within the final weeks of pregnancy. Not to mention, I would maintain my twice-weekly appointments at my regular OB.
My OB experience
I realized early on as someone experiencing pregnancy for the first time, that providers don’t elaborate on what these tests entail or what they’re trying to uncover by recommending them. For example, during my first NST, my baby’s heart rate seemed high, the machine kept beeping, and I thought something was wrong. Come to find out, the test went perfectly.
Similarly, the sonographer failed me during my first BPP, as my baby wouldn’t practice breathing. My husband and I spent roughly three hours between appointments, terrified that something was wrong, just to find out that the baby was fine and that practice breaths tend to be more consistent at the 32-week mark. (I was only 31 weeks at the time).
Furthermore, my doctor’s office is part of a conglomerate, meaning I see a different provider at each appointment. I was (and still am) meeting someone new almost every visit, hearing their thoughts, and never gaining a rapport with one doctor.
I also learned that none of the OBs I saw in the office would be in charge of my labor and delivery. While most OBs at my practice deliver sporadically, I would use the conglomerate’s hospitalist, AKA an OB that only works at the hospital, not within a private practice. I am entering my labor and delivery experience blind.
By 32 weeks pregnant, I was utterly overwhelmed and inundated with information. I’m facing an induction at 37 weeks (or sooner if my condition becomes severe); I wasn’t sure if I had preeclampsia; a total stranger would perform my delivery. Everything I read regarding induced labor was terrifying, not to mention the consent forms I had to sign, regaling all of the potential risks that could occur.
As I continue my twice-weekly appointments, bounce from doctor to doctor, location to location, and await my induction date, I have a whole new perspective on pregnancy. I started my pregnancy healthy, only to bear a high-risk pregnancy’s emotional (and financial) weight. What’s even harder to digest is there’s nothing I could’ve done to prevent this, as preeclampsia is said to be determined by your placenta.
How I monitor myself
Each day I’m to take my blood pressure and my prescriptions and head to labor and delivery if I develop any severe symptoms such as a headache that doesn’t subside with Tylenol, severe right abdominal pain, blurred vision, itchy hands and feet (which can be a sign of a liver condition called cholestasis), or if I receive a BP reading of 160/110 or higher.
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