Pregnancy: Anxiety, Breathing, and Hospital Stays
Today at exactly 31 weeks with my unicornuate uterus, I share an update about the past 12 days in my pregnancy, probably the hardest 12 days of my life. I’ve experienced shortness of breath, insomnia, panic attacks, doctor appointments, an emergency room (ER) visit, and one overnight hospital stay.
I’m 31 weeks pregnant today, and I had to stay overnight in the hospital last night. I went to the emergency room at 6:30 PM for my shortness of breath issues that have spanned the past 12 days, but I was admitted to labor and delivery two hours later for overnight monitoring for a completely other issue. While in the hospital, I learned a ton about my middle-of-the-night breathing difficulties. But I was even more surprised to learn something about when baby may be making his debut (hint: it’s earlier than his 10/31/19 due date). Read on for more details…
As I mentioned in my August 22, 2019 blog post, I have been experiencing some shortness of breath in the middle of the night for the past 12 days. I have no problem falling asleep, but then approximately two hours later, I am startled awake with feelings of shortness of breath, a tight chest, and a racing heart. After being unable to catch my breath, I start to spiral in a scary anxiety tornado. I can’t sit still, so I pop out of bed and go downstairs. I start pacing around the house, feeling hot and clammy but cold and with goosebumps at the same time. The air feels thick. What starts as a physiological response (i.e., shortness of breath) quickly becomes psychological. I’ve had at least four panic attacks in the last 12 days, an experience I’ve never had before in life, even as an anxious person. After pacing around the the house for 10 minutes unable to calm myself, I ultimately end up calling my mom. (PS: I’m so grateful to have a counselor as a mom.) My mom spends 45 minutes on the phone with me helping me calm down. After I calm down, I make my way back upstairs and fall asleep after 1-2 more hours of listening to podcasts, meditations, or watching Netflix.
In the last 12 days, I’ve had 2-3 “good nights” (i.e., more than 4 hours) of sleep. Two nights ago, I didn’t fall asleep until 3:30 AM. Unable to fall asleep, I broke down in tears around midnight, delirious and desperate for sleep. A few nights before that, I was up from 11:30 PM to 3:30 AM. It’s been really rough.
To try to get to the bottom of my shortness of breath, I’ve tried everything and have consulted with everyone.
On August 20, I called my maternal fetal medicine doctor (high risk OB) at 1 AM, unable to breathe. She told me to go to the Labor & Delivery department at the hospital where we will be delivering to get checked out. Cory and I were at the hospital from 1:30 AM until 4 AM that night. The good (or bad?) thing: everything checked out. My oxygen saturation levels were great. My heart rate was normal. Baby was perfect. Verdict? This nighttime shortness of breath is multi-factorial: asthma (which I’ve had since I was 4), seasonal allergies, GERD, decreased lung space because of my fat baby, and anxiety. The doctor recommended that I increase my inhaled steroid inhaler, increase my GERD medication dosage, and raise the head of my bed.
I don’t remember exactly what the next few nights following the hospital visit were like, but they weren’t fantastic. Maybe on-and-off sleep for a total of 5-6 hours/night, but no panic attack. Then, on Saturday, August 24, I had another terrible night. I woke up gasping for breath with a racing heart followed by another panic attack. Somehow I made it through the night without having to go to the hospital. The next day, I called the on-call doc and told her of my continued symptoms. She recommended Benadryl before bed to help me to chill out. I also started taking a doctor-approved magnesium supplement from Sprouts called “Calm.” The first night I initiated this new bedtime regimen, I slept a little better but the breathing wasn’t much better. The next day I went into my MFM for an office visit to check in on me and baby. My nurse practitioner recommended Hydroxyzine Pamoate before bed, a prescription antihistamine also used to treat anxiety and insomnia. I took that before bed that night, but I didn’t end up falling asleep until 3:30 AM. It was really, really bad.
Yesterday, on August 28, I had an appointment with my allergy/asthma doctor to see if I should be adjusting my asthma meds. Long story short, she concluded that neither allergies nor asthma were causing this middle-of-the-night shortness of breath. She recommended that I go straight to the ER after my appointment with her to get a complete work-up in order to rule out scary things like a pulmonary embolism (PE), a blood clot in the lungs. Apparently blood clots are more common in pregnancy, and so it was very important that a PE was ruled out.
Last night, on only 2 hours of sleep, and after a full day of work and a doctor appointment, Cory and I headed to the ER. We checked in around 6:30 PM and were welcomed by very helpful, knowledgeable, and compassionate staff. They were awesome. After a couple hours of tests, they concluded with pretty good confidence that I didn’t have a PE. But now comes for the most important part…
As I was in the ER, a nurse from Labor & Delivery came down to complete a nonstress test (NST) on the baby. The baby’s heart rate was perfect, so I was grateful to hear that! But then the nurse and the OB quickly realized that, unbeknownst to me, I was having regular contractions every 5 minutes. They drew my attention to a contraction, and it felt like a gentle squeeze in the upper right part of my abdomen. I had mistaken this feeling in the past for baby moving and pressing his big (breech) head into my ribs, making my stomach really hard. Because my contractions were regular, the OB decided to admit me for overnight monitoring.
At 8:30 PM, we made our way up to Labor & Delivery, a hospital floor that was becoming increasingly more and more familiar to us. They started me on Nifedipine, a calcium channel blockers (CCBs), commonly used to reduce blood pressure, that can also be used to relax uterine contractions and postpone a preterm birth. I took this every 4 hours all night long and will continue to take it every 6 hours until baby is born. They also started me on IV fluids in case dehydration was the culprit for these contractions. (For the record, I highly doubt it since I had consumed 120 ounces of water that day by that point.) They monitored my vital signs and baby all night. After all of this monitoring, we learned some really helpful information about my nighttime breathing/increased heart rate/panic issues.
The entire night, my oxygen sats and heart rate were monitored. Between the hours of 2 AM and 7 AM, I had four episodes in which I was startled awake, unable to breathe and with a racing heart. I am so grateful that these episodes were caught while being monitored in the hospital. So what did the monitoring teach us about these incidents? It showed us that my breathing has NOTHING to do with it. Before, during, and immediately after the event, my oxygen levels were normal at 96+%. Then why was I waking up all of a sudden? Apparently my heart rate when asleep was at a stable 65 beats per minute. Then, out of nowhere, it shot up to 110 beats per minute and that was when I was startled awake. I had been thinking that I had been waking up initially because I wasn’t able breathe, which then caused increased heart rate. But after all the monitoring, we now know that I am startled awake because something causes a rapid spike in my heart rate. What causes this spike in heart rate? We don’t have a definitive answer, but I am comforted knowing that is has nothing to do with diminished oxygen levels and that the baby and I are okay during the episodes.
I also learned that I was better able to manage these episodes and chill myself out in the hospital than at home. In the hospital, it only took me about 20 minutes for my heart rate to drop below 80 beats per minute and for me to fall asleep again. At home over the past 12 days, it takes me 2-3 hours for my heart rate to drop. I think this is because I felt so safe and calm at the hospital knowing the baby and I were being monitored. I also had direct feedback about my vital signs on the monitor, showing me that my oxygen was fine the entire time. I was able to watch as my heart rate slowly decreased.
In addition to learning about my breathing and heart rate, Cory and I also learned some surprising information about our baby’s anticipated due date. In the middle of the night, my doctor did a test called a fetal fibronectin test to predict risk of premature delivery. For this test, my cervix was swabbed to check for a protein called fetal fibronectin. According to the Mayo Clinic, “Fetal fibronectin is a protein that's believed to help keep the amniotic sac "glued" to the lining of the uterus. The amniotic sac is the fluid-filled membrane that cushions your baby in the uterus. If this connection is disrupted, fetal fibronectin can be released into secretions near your cervix.” If this protein is not detected on the cervix, the test will come back negative. A negative test indicates that there is no likelihood that the baby will be born in the next two weeks. If fetal fibronectin is detected on the cervix, the test will come back positive. It means that the “glue” connecting the amniotic sac to the lining of the uterus has been disrupted, and there is increased likelihood that the baby will be born in the next two weeks, though it is not guaranteed. Babycenter.com reports a 17 to 41 percent chance of delivering in the next two week with a positive fetal fibronectin test.
My test came back positive. Based on the results of this test, my pre-term contractions, and my unicornuate uterus, the on-call MFM estimated that I'll deliver in the next one to three weeks. ONE TO THREE WEEKS?!? At 31 weeks pregnant, this estimate completely shocked me. I was hoping to make it to 35-36 weeks, and now it looks like baby may be born between 32-34 weeks. My doc gave me an injected steroid today that will help develop baby’s lungs in case he comes early. Wow. One to three weeks. This means we can definitely plan for at least one month in the NICU. But now I’m getting too far ahead of myself…
Tonight I feel saturated with information.
I’m grateful to better understand what’s happening to me in the middle of the night. I bought a pulse oximeter at Walgreens today to provide the feedback I’ll need tonight to calm myself down more efficiently. I feel calm knowing that my breathing and baby are fine even when my heart rate and anxiety skyrocket.
I’m sad to think that baby might be 6-8 weeks premature. I feel guilty that my half-sized uterus is unable to give him a safe home for 37+ weeks. I feel scared about time in the NICU and about complications from prematurity. I only want the best for our baby. I’m sad that potentially 1/3 of my maternity leave will be spent in the NICU. But again, I’m getting too far ahead of myself…
I guess I’ll just do what I have learned to do best: take one day…one moment…at a time. All I have is now. And now I feel surprisingly calm. My heart rate is slow. My breathing is steady. My baby is healthy. I made it to 31 weeks! I have medicine to help stop pre-term contractions. I have an amazing medical team following my pregnancy. I have a supportive husband coloring on his iPad to my left. My family and friends love me, Cory, and this baby so much. I have a plan for tonight if I have a panic attack.
One moment at a time. Just now. All is well.
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