The Adventures of a Preterm Daddy: Part III

As the second day of our stay at Cedars rolled around, my wife’s symptoms had slowly subsided. Our substitute OB doctor, Dr. M, made another appearance early on and brought along another colleague, Dr. X, whom he introduced as a specialist in ultrasounds and neonatal care. Yet another ultrasound later, our specialist had determined that the cervix had once again shortened overnight. At this stage, Dr. M recommended a round of steroids. Steroids are typically given during pregnancy to help a babies lungs develop at an accelerated pace when there is a risk of a premature birth. A baby’s lungs aren’t designed to begin the work of breathing until 36-40 weeks, depending on the new math versus the old math approach to what is considered a full term baby. Steroids can speed up the maturation of the lungs and give a preterm baby a better chance of survival with fewer complications. When I asked about the effect of steroids suppressing the immune system, Dr. M denied it, while Dr. X stated that it was true. We had observed that Dr. M was so quick to deny that medications ever had any side-effects, that he was now denying the opinion of his proclaimed specialist and colleague. They went back and forth briefly with Dr. X citing several studies and winning out. When I asked which steroid would be used, Dr M mentioned that it would be dexamethasone or betamethasone. When I asked about studies where dexamethasone had been implicated in brain damage and developmental delays, Dr. M once again stated that it never happens, while Dr. X stated that it was a possibility. Dr. X pointed out however that previous studies had been done with multiple doses of dexamethasone and he would only advocate one dose, which he believed to be much safer. After listening to the facts and the fiction, we decided to hold off on the steroids until our regular doctors were back and I could do a little more research. A note to Dr. M: Don’t challenge your proclaimed expert. Either way, you lose. You either demonstrate that they’re not an expert, or you demonstrate your ignorance by challenging and losing to the person that you’ve just introduced as an expert. Both results don’t instill any confidence in your patients.

By Tuesday, both of my wife’s doctors were back in town and made their appearances at Cedars. Her sonogram doctor, Dr. S, appeared and told us that he expected to be sending us home after the ultrasound. He mentioned that it was better not to stay at the hospital because they tend to look for things to treat. This resonated with the words of a nurse whom I had spoken to earlier that day. She had been at the hospital for its 33 years of existence and stated that she avoids doctors at all costs and would rather do anything than end up at the hospital. Such words coming from a nurse seemed to speak of the mismanagement that she had seen over the years. The message that I took away from both conversations was, “time to go home.” Unfortunately, the ultrasound didn’t bring us the good news that would signal a rapid retreat. Instead, the cervix length had shortened instead of stabilizing. What had been 3.5cm on Friday was now 1.6cm. This meant that it was time for the steroids, as we didn’t want to run the risk of preterm babies with the added burden of more lung complications. We opted for the betamethasone which has been demonstrated to be safer. Dr. S told us to rest and hold tight and he’d be back for a follow-up ultrasound on Sunday and hopefully send us home.

The rest of the week was very much like the beginning of any roller-coaster ride, where you go through a few minor ups and downs until you reach that gradual climb that leads to a final jaw-dropping descent. My wife’s cramping and bleeding episodes would come and go, and for the most part seemed to be on their way out. It was starting to feel more like a car trip through a hilly countryside than a roller-coaster ride at Six Flags. We ventured out a little bit more in our take-out habits and discovered Jerry’s Deli around the corner from Cedars.

By Saturday, we were looking forward to Dr. S’s return on Sunday and an ultrasound result that gave us our return ticket home. The baby’s heart monitors strapped to my wife’s belly gave us the reassuring sounds of two hearts peacefully enjoying their time in the womb. As Saturday night rolled around, the winds changed and we found ourselves once again riding the ups and downs of cramping and spotting. Although I managed a couple of hours of sleep, half hoping that these symptoms would fade away as the others before them had, my wife was unable to sleep. The cramping intensified and mild muscle relaxants and pain killers were having no effect. By morning, with the symptoms increasing, we anxiously awaited Dr. S’s return. He was called in earlier than planned and the ultrasound revealed that the cervix was now .5cm, and my wife was dilated 3.5cm. Now 3.5cm is not very large for a full term baby, but for a 25 week old baby, it was an open barn door. Dr. S made the call and preparations were under way for a C-Section delivery. The tension became magnified as a flurry of nurses went into action. Within 45 minutes, we found ourselves in the operating room.

Our initial hopes for an intimate home water birth had now been officially replaced by a 20-person production in a hospital operating room complete with surgeons, nurses, anesthesiologists, and assorted neonatal assistants. Sitting next to my wife’s head, I watched the entire surgery via an overhead mirror above and behind us on the ceiling. It was only two weeks earlier that I had been watching the same surgical procedure on the Discovery channel, unaware of what was to come. On Sunday, May 3^rd, my wife delivered a baby boy, Ethan Kai at 1 pound, 10 ounces and a baby girl, Ana Sophia at 1 pound, 9 ounces. With these twin miracles, our ticket was punched for admission to the Cedar-Sinai’s Neonatal Intensive Care Unit, hereafter know as the NICU.

The Adventures of a Preterm Daddy: Part II

There’s an old spiritual saying that goes something like, “God will never give you more than you can handle,” to which Mother Teresa was quoted responding, “I just wish that he didn’t trust me so much.” These statements will soon become a core part of our life during this pregnancy.  

As the last week of April approached, all of our plans for a long pregnancy seemed to be in place. I left town for a neurology seminar and my wife attended a birthday party for another set of twins while I was gone. An April heat wave left her feeling faint, dehydrated, and thirsty at the party. After cooling off a bit she left the party early and went home to rest and relax. By the time that I returned home that Sunday night she was experiencing some cramping which gradually increased over the next 2 days. We made a quick trip to her OB doctor to check things out. Yet another ultrasound (http://www.huffingtonpost.com/dr-jeffrey-mccombs/the-adventures-of-a-prete_b_215874.html) revealed the possibility of a slight detachment of the placental sac that keeps the babies safe and nourished in the womb during pregnancy. She recommended rest and no exercise and informed us that she’d be out of town that coming weekend but there would be another doctor covering for her while she’s gone, if needed. She also recommended going to the Sonogram Doctor for a more detailed ultrasound if things didn’t improve, and noted that he would also be out of town with another doctor covering for him. That weekend also happened to be the weekend that our midwife was going to be out of town. Somewhere in the back of my mind, I remember an old marine saying about rats leaving a sinking ship, so as the last weekend of April approached, we had the setting for a perfect storm. 

Friday morning came with more cramping and spotting. We quickly made our way to the sonogram doctor’s office where we were greeted by an admittedly neurotic doctor. As can be expected, neurotic doctors and worried expectant mothers don’t make a good combination. Another more detailed ultrasound revealed the same results of a possible slight placenta detachment. The sonogram also indicated that the length of the cervix was long. The length of the cervix is one of the deciding factors as to when the delivery process will commence. A long cervix indicates that there is a ways to go before it’s time to deliver, and in our case this was a very good sign. Fetal heart monitors showed that the twins were doing fine, seemingly oblivious to the events shaping the world around them. We were given a reprieve and sent home with instructions for complete bed rest and if the symptoms didn’t stop, we were to go to the hospital. 

That Friday night, the symptoms continued to worsen and by Saturday morning we had called the substitute OB doctor (Dr. M) and we were on our way to Cedars-Sinai Medical Center in Los Angeles. Cedars-Sinai was founded at its current location in 1976. With some 10,000 employees and over 75,000+ patients being served each year, Cedars ranks as one of the top hospitals in the country. Its proximity to Beverly Hills is underscored by the names of celebrities found adorning the many rooms, centers, and buildings, as well as the streets surrounding the hospital. We were quickly ushered to one of the Labor-Delivery rooms on the 3^rd floor, where yet two more ultrasounds and some IV fluids later, my wife was stabilized. The ultrasounds revealed that the cervix had shortened overnight, so we were wheeled down the hall and admitted to the Maternal-Fetal Care Unit. The nurses and doctors told us that our stay there would last until the cervix had stabilized and the other symptoms had diminished or disappeared. As a side note, one of the nurses mentioned that the previous occupant of the room had been there 7 weeks under similar circumstances, but had gone home stabilized and pregnant. We kept our hopes high and our fingers crossed, as I became familiar with the art of shallow breathing 

Over the course of the day, we were subjected to an ongoing parade of doctors, interns, and residents who were pushing for my wife to take the Rhogam vaccine. Rhogam is a human blood-derived vaccine that is typically given to Rh- mothers (my wife) who give birth to Rh+ babies. Since I’m Rh+, this was a possibility, but not necessarily likely. When Rh incompatibility occurs, the mother could become sensitized and in subsequent pregnancies, the baby could develop a serious blood disease. There are approximately 400,000 pregnancies in Rh- women every year. Of these, some 10,000 deaths in babies used to occur due to Rh incompatibility before the vaccine was developed. With the vaccine, these deaths have been averted by giving the vaccine to babies who are Rh incompatible within 72 hours after birth. This allows time for simple blood tests to be performed to determine if there is any incompatibility in the first place. When use of the vaccine is not necessary, it avoids other risks, such as blood-borne diseases, that are minimal but inherent in the vaccine. It has now become a practice in the US to give the vaccine at 28 weeks of pregnancy and then again at birth. The vaccine at 28 weeks is more of a prophylactic choice by physicians, which translates to preventative and usually unnecessary. Through some online research, I was able to find a non-invasive test to determine Rh compatibility that has been done for years on pregnant women in England, but not here in the US. After some email correspondence with the National Blood Bank of England, I was directed to a lab here in the US that has recently started doing this testing – www.lenetix.com. Lenetix Labs also has some other unique genetic tests that can avoid the use of routine invasive diagnostic tests like amniocentesis and CVS sampling that are frequently done during pregnancy and are known to cause miscarriages.  

With the parade over and some carry out food from my new favorite restaurant, Barefoot, to sustain us, we settled into our new Beverly Hills digs. Exhausted from the day’s events, my wife managed to get some sleep and I crawled into a hospital cot which folded up around me like a human taco. And as dreams of going home danced in our heads,…

The Adventures of a Preterm Daddy: Part I

As we sat with my family at Thanksgiving last year, my wife announced that we were going try to get pregnant. This was happy news for my mother who has been waiting for her 50 year old son to contribute to the family line like my two sisters and brother have done previously some 20-30 years earlier. Little did we know that as we sat there, she was already 1-2 weeks along in her pregnancy. Three store-bought, do-it-yourself pregnancy tests later in the first half of December, and we find out that she’s pregnant. This celebrated news was followed up a couple of weeks later with new information that we were having twins, courtesy of a diagnostic ultrasound scan due to some concerns of her doctor at that time. 

A diagnostic ultrasound in our family is not a choice taken lightly. I’m a 3^rd generation Doctor of Chiropractic, never vaccinated as a child, grew up on vitamins with each meal and weekly if not daily adjustments. Ultrasound is a type of radiation that can be used therapeutically or diagnostically. My educational and clinical experience with ultrasound has been as a therapy. Ultrasound produces sound waves (a type of radiation) that pass through the tissues. The tissue’s resistance to and absorption of these waves causes heating of the tissues and some other metabolic effects that can be desirable in promoting healing. Therapeutic ultrasound is not recommended during pregnancy, over tissues such as the eyes, heart, spinal column, growing bones, testes, epiphyseal plates, carotid sinuses, cervical stellate ganglion, and vagus nerve. Although you may not be familiar with these anatomical tissues, they are all found in developing babies and everyone else. Given my clinical experience, I naturally questioned its use as a diagnostic tool. This philosophy of questioning comes from a statement found in the Hippocratic Oath that I took upon graduation from school that states, “First do no harm.” It’s the responsibility of a doctor to always assess the methods being used to determine that there is no harm being done to the patient as a result of medications or procedures.  

Diagnostic ultrasound uses a similar frequency range, much like sonar on a submarine, to produce images. It is used to screen for abnormalities of the developing fetus. For more information on the benefits and risks of ultrasound, visit – http://www.ob-ultrasound.net/. Like therapeutic ultrasound, the resistance to and absorption of the sound waves, plays a role in the creation of the images. To me, this indicates some degree of heating of the tissues in a developing baby. Is this enough to create some type of damage to the baby? Currently, the risks are not considered to be relevant but the US National Institute of Health recommends against its use in routine scanning of the fetus and developing embryo and ‘although its use doesn’t appear to be associated with any known hazards, investigators should continue to evaluate risks.’ Hmmm.  

Additionally, some research points to correlations between diagnostic ultrasound and the Autism/Aspergers spectrum of developmental disorders. The bottom line on ultrasound is that it should be used based on a ‘benefit vs. risk’ assessment, a term that I’ll talk more about later. Most doctors and sonogram technicians oppose its use by moms who want to have periodic pictures to show everyone. To me, its use is a big question mark that may or may not have complications years later. 

Okay, well we had one ultrasound that seemed to be necessary, but we decide that we probably won’t elect to have any others unless absolutely necessary. There is a saying that goes something like this, “Man plans, God laughs.” During the course of our journey through this pregnancy, we will seem to keep God amused.

 

My wife’s 1^st obstetrics doctor recommended a list of questionable procedures (amniocentesis, CVS, Rhogam vaccine) and handed us a couple of boxes of prenatal vitamins. Medical doctors get about 5 hours of training in nutrition during medical school. This was very apparent by the box of vitamins that we were handed. The prenatal vitamin’s list of nutrients and additional ingredients consisting of synthetic dyes, synthetic nutrients, chemical fillers, and toxic fats were quickly donated to the trash can in his waiting room on our way out of his office. It was time to ask around for references and interview a few OB doctors.  

Obstetrics (OB) is surgical specialty dealing with the care of women and their children during pregnancy. Although our intention is to have a natural home birth attended by a midwife, we will still need an OB doctor and a hospital as a back-up. This is common practice in California for parents who choose homebirths. Unfortunately, twin homebirths in California is against the law and a midwife who attends one can end up in jail. This was interesting since other states allow this practice which dates back to the beginning of man. Concerns about the possible complications associated with mothers carrying multiple babies however, means that this is left to the hospitals and obstetrics doctors in California. I’m not sure if this is a policy based on previous experience or a philosophy of better safe than sorry. 

We consider traveling out of state to Tennessee where the midwife of midwives, Ina May Gaskin, holds court when she’s not teaching midwives and doctors across the country. They inform us that they like to have couples come 6 weeks before the due date and if our babies don’t make it to 34 weeks gestation and decide to come out early, we would end up going to a hospital in Tennessee. Since twins seem to have a habit of coming early, this option doesn’t sound too inviting. Given the logistics and hassles of travel and the possibility of an early delivery, we opt for a natural delivery at an LA hospital attended by an OB doctor, a midwife, and 2 or 3 other people. It’s not home, but we want to make it as intimate as possible. I thought I heard God laughing? 

We selected our OB doctor, Jessica Schneider, MD and our midwife was Elizabeth Bachner. Dr. Schneider wants an ultrasound every month once we hit 20 weeks, but we decide on one detailed anatomical ultrasound at 20 weeks and then one just before birth to determine positioning of the babies. This approach was also recommended by an assistant to Ina May Gaskins and it sounds good to us. The ultrasound comes back normal and we begin to make all of the necessary arrangements. 

We have a doctor and a midwife, and my wife has become a walking encyclopedia on pregnancy, twins, and birth. She’s exercising every day, eating well, taking her vitamins, and spending quiet time with herself and the babies. Her due date is mid-August and so in late April we settle into what we expect to be a nice long pregnancy…and God giggles.

A Healthy Transformation

The World Health Organization (WHO), since 1948, has defined health as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. This was later expanded to include intellectual, environmental, and spiritual health. This is a very remarkable statement, considering that it was originally created in 1948. You’ll notice in this WHO statement that health has nothing to do with symptoms or the lack of them.

 

 

I take this a little further and define health as a constantly evolving state towards greater and greater degrees of optimal well-being, physically, mentally, emotionally, socially, environmentally, and spiritually, marked by personal responsibility and the irresistible, persistent impulse towards making positive life-enhancing, life-affirming choices for a richer, rewarding life.

 

 

In this definition, personal responsibility is the driving force, and purpose defines destiny. If a state of ongoing health is our choice, our purpose, then it is up to us to create this destiny for ourselves. The dictionary defines Destiny as a predetermined course of events. In terms of health then, we can define our own destiny by determining how we create health on a daily basis.

 

 

Life is a gift, health is not. We are given life. What we do with that life is up to us. The degree of health that we hold can be seen as a marker for how well we’ve taken care of this wonderful gift of life.

 

 

Your body is constantly in a state of change and adaptation. You are constantly changing and adapting to your internal and external environments. This ongoing process of change takes place from the moment of inception up until our last moment on this planet. Every moment is embedded with the opportunity for creating the life you wish to lead. Every moment brings with it the power to manifest a new life, a new you. In each moment, we have the ability to direct ourselves towards our goals and our dreams. You have that power of choice in each moment.

 

 

All of us are constantly involved in a process of transformation. We should understand that transformation is an ongoing process, not a once in a lifetime event. We participate daily in this transformational process, whether we know it or not. Our body is involved in this process at all times and we should be, too. How we participate in this process determines whether we are transforming our bodies toward health or towards sickness. It is a constant process. It is ongoing.

 

 

How then does one stay on purpose? How does one transform themself toward an ever increasing state of health?

 

If we use the definition of health that I put forward previously, then staying on purpose means that we must live a mindful, conscious life aware of the choices we are making and the impact that those choices have on us. Furthermore, this is not a one-time occurrence, but an ongoing process.

 

 

Staying on purpose then requires changing the view from a narrow focus to a broad, expansive focus that allows us to see the ongoing nature of transformation. We must be ready to drop that which doesn’t work for us and pick up that which does. These type of choices will present themselves over and over throughout each day. They are the opportunity for transformation that occur in each moment. They are the building blocks and foundation for the life we want to live.

 

 

We need to take time to detoxify the stressful effects of the world around us, and the world within us, through diet, detoxification, meditation and prayer, exercise and play. We need to choose nutrient-dense foods that quicken and fuel the life force within each of us. Given the right conditions, the body is remarkable in its ability to restore, revitalize, and renew itself.

 

 

This life is a journey of transformation. Discover the potential that resides with you and enjoy the ride!

 

 

Dr. McCombs is the author of LifeForce: A Dynamic Plan for Health, Vitality, and Weight Loss, and developer of the McCombs Plan – www.mccombsplan.com. He can be reached by email at Dr.Jeff@mccombsplan.com.