Coming to Term: Week by Week

By Debbie McCulliss

Debbie McCulliss sadly learned the many tragedies of pregnancy the hard way. Although she ultimately raised two healthy children, creating a family was more challenging than she ever imagined. Unfortunately despite technological advances, today many pregnancies continue to end in heartbreak rather than joy.

In a poignant medical narrative, McCulliss chronicles her journey through grief and joy as she worked as a registered nurse in a neonatal ICU and discovered the many things that can go wrong during pregnancy—all while bravely dealing with her own miscarriages and high-risk pregnancies. With the intent of educating, supporting, and inspiring women who have had difficulty conceiving, carrying a baby to term, or who need a dose of hope, McCulliss shares personal anecdotes that reveal how her journey led her to create a pioneering program to care for women struggling with high-risk pregnancy. Included are journal exercises and appendices that offer helpful tips and resources.

Coming to Term is a creative expression of grief and joy that offers personal essays and practical advice from a former NICU nurse who battled to create her own family and help others dealing with infertility and high-risk pregnancies.

• Language: English
• Publisher: Balboa Press
• Release date: May 26, 2022
• ISBN: 9781982279608

Debbie McCulliss

Debbie McCulliss earned an MSN in nursing from the University of Colorado, an MA in science-medical writing from Johns Hopkins University, and an MFA in nonfiction writing from Regis University. She is a certified applied poetry facilitator and journal-writing instructor. Currently, Debbie is a Colorado-based (Denver and Steamboat Springs) winter wildlife and nature photographer.

Book preview

Copyright © 2022 Debbie McCulliss.

All rights reserved. No part of this book may be used or reproduced by any means,

graphic, electronic, or mechanical, including photocopying, recording, taping or by

any information storage retrieval system without the written permission of the author

except in the case of brief quotations embodied in critical articles and reviews.

Balboa Press

A Division of Hay House

1663 Liberty Drive

Bloomington, IN 47403

www.balboapress.com

844-682-1282

Because of the dynamic nature of the Internet, any web addresses or links contained in

this book may have changed since publication and may no longer be valid. The views

expressed in this work are solely those of the author and do not necessarily reflect the

views of the publisher, and the publisher hereby disclaims any responsibility for them.

The author of this book does not dispense medical advice or prescribe the use

of any technique as a form of treatment for physical, emotional, or medical

problems without the advice of a physician, either directly or indirectly. The

intent of the author is only to offer information of a general nature to help you

in your quest for emotional and spiritual well-being. In the event you use any

of the information in this book for yourself, which is your constitutional right,

the author and the publisher assume no responsibility for your actions.

Note that some things that were recommended in the 1980’s, early 1990’s are

no longer recommended, while other things continue to be recommended

or have become recommended based on a woman’s individual needs.

Any people depicted in stock imagery provided by Getty Images are

models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

ISBN: 978-1-9822-7959-2 (sc)

ISBN: 978-1-9822-7961-5 (hc)

ISBN: 978-1-9822-7960-8 (e)

Library of Congress Control Number: 2022902075

Balboa Press rev. date:   05/25/2022

This book is dedicated to Paul, my wonderful husband of

40 years, who continues to encourage my dreams, share my

happiness, and inspire my heart. God has abundantly blessed

us, our family, and our life together. In gratitude and love.

Contents

Introduction/Prologue

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

Unexpected Epilogue

Appendix A: Definitions

Appendix B: Miscarriage

Appendix C: Cultural Rituals and Ceremonies for Those Who Have Experienced Miscarriage

Appendix D: Preparing for Pregnancy after Loss

Appendix E: Infertility

Appendix F: A Survival Guide to Bed Rest During Pregnancy

Appendix G: Preterm Birth

Appendix H: Self-Advocacy During Pregnancy

Appendix I: Environmental Toxins and Pregnancy

Appendix J: Medical Advances Over the Years

Appendix K: The AHA Patient’s Bill of Rights

Endnotes

Introduction/Prologue

Having grown up in a Catholic family that did not discuss pregnancy, I knew nothing of the esoteric yet tragic obstacles to creating a family. I learned about pregnancy and fetal development and delivery from reading textbooks and during a clinical rotation in nursing school, I witnessed a woman giving birth and hearing her baby’s first cries.

I remember reading at age twenty that important steps in an embryo and fetus’s development can go awry in the first trimester, but I didn’t know anyone who had personal experience. By twenty-seven, I was newly married and working full-time as a registered nurse in a neonatal intensive unit. I saw firsthand how babies born prematurely looked and responded. Working in the nursery presented the opportunity to provide education and reassurance to expecting families. My hope was to have a baby of my own.

I learned the many tragedies of pregnancy the hard way. Although I ultimately raised two healthy children, creating my family was about as hard as it gets. Despite technological advances during my lifetime, today many pregnancies continue to end in heartbreak rather than joy. Coming to Term: Week by Week fills a niche that’s relatively empty.

Coming to Term is about my nursing career and my own miscarriages and high-risk pregnancies, how I learned of the many things that can go terribly wrong during pregnancy, and how I created a pioneering program to care for women struggling with high-risk pregnancy. I wrote this medical narrative to educate, support, and inspire women who have had difficulty conceiving or carrying a baby to term, for women experiencing grief that is long and arduous, and for women in need of a dose of hope.

1

I could feel the young woman’s concentration, the way she shut out everything else. The labor and delivery nurse standing next to the doctor was watching the woman and coaching her to push. I closed my eyes, alongside the soon-to-be mother, until one last guttural scream filled the air around us and the doctor said, She’s crowning.

Twenty years old and single, I was in my first year of nursing school in 1974. On that cloudy winter day, in the sterile delivery room with its bright lights and glistening surfaces, I was wearing green scrubs and trying not to get in the way of witnessing my first birth.

I watched, frozen, as the newborn baby made her entrance into the world and was placed on the mother’s chest. The new mother counted every finger and toe, observing the nuances that set her baby apart from others. I had never seen that kind of love. I didn’t feel faint, which surprised me since I used to pass out at the dentist or when I watched a thorn being removed from my younger brother’s leg. Instead, I was caught in the experience of witnessing a woman become strong when she was weak, kind when she was overwhelmed, and accomplishing the birth of a baby from her body.

xxx

I began my career as a registered nurse working in an adult intensive unit, and over the next seven years I worked in several other adult intensive care units and the emergency room, gaining a variety of skills and experience.

At twenty-seven, I was newly married and working full-time as a registered nurse in a Denver-based, twenty-bed, Level II neonatal intensive care unit (NICU), which meant I took care of moderately ill premature or full-term newborns. Working in the nursery also gave me the opportunity to provide education and reassurance to expecting families.

Few parents ever face a more distressing situation than having their newborn in the intensive care nursery, so they tend to rely heavily on the nursery staff for expertise and guidance. It was important to heighten the mother’s and family’s awareness of what was happening, and that was my role. The process began with explaining to the parents what they could expect to see and hear, the monitors and probes, alarms and wires, the fast pace of activity, and what was expected of them—hand washing being a priority.

Upon admission to the nursery, I would explain, your baby will be placed on a radiant heat warmer and hooked up to a monitor that displays the baby’s heart and respiratory rate. To assist with breathing, some babies are connected to a ventilator, which helps with oxygenation, and other babies might be on oxygen by means of a nasal cannula. Many have an intravenous tube for delivery of antibiotics or fluids. Babies who aren’t ready to breastfeed are fed either from a bottle or through a tube into their stomach as prescribed. Once stabilized, your baby will be moved from the radiant heat warmer into an incubator.

Parents might see the nurses weighing a baby or warming up a mother’s breast milk before a bottle feeding, or they might watch someone from the lab drawing blood. As parents oriented themselves, they learned about what they could anticipate during their baby’s hospitalization, barring any complications.

Gestational age-appropriate behavior, feeding, and temperature regulation were important, along with regular visitation and talking to other parents in the nursery. When babies are born prematurely, sometimes nurses are the first to touch them. To facilitate early attachment and bonding, it is critical to allow parents to see, touch, and hold their babies; to care for their child as much as possible; and to take photos.

Occasionally I served as preceptor to students from one of the local nursing schools for five weeks, which was a great opportunity to pass along my expertise and love of nursing. The students appreciated the chance to perform various procedures that they would not have encountered in other clinical experiences.

The best part of my job, though, was being present at deliveries and with the babies in the nursery. I was one of three nurses who witnessed the C-section delivery of Ellen G’s triplets at thirty-four weeks. Ellen had been on bed rest at home beginning at about ten weeks, but she entered the hospital at twenty-six weeks, preferring that because of the companionship and reassurance of the nurses. She went into preterm labor at twenty-nine weeks but remained undelivered until thirty-four weeks.

When Ellen gave birth on November 15, 1983, I was a member of her team, which included three nurses and three doctors. She still remembers me standing at the foot of her bed in the delivery room before she was given general anesthesia. One nurse was assigned primary care for Baby A, a boy who weighed two pounds fourteen ounces; he needed a ventilator and a radiant heat warmer. The second nurse was assigned to care for Baby B, a girl who weighed three pounds seven ounces; she was the biggest baby, so Ellen saw her first.

I was assigned primary care for Baby C, a girl named Erin, who weighed one pound fifteen ounces and whose head was the size of a baseball according to her mother. Collectively, the three babies weighed what a newborn born at term would weigh. Throughout Erin’s six-week stay in the nursery, I cheered her on as she came off oxygen, gained weight, and started to maintain her temperature.

Ellen and the other mothers I met were special to me. Their vulnerable newborns, many thriving despite the odds, were an extension of the sacred. One baby born at twenty-four weeks gestation was nicknamed Mighty Meghan by the nursery staff because of her tenacious desire to live. Weighing around a pound at birth, she easily fitting into the palm of her mother’s hand. Without complications, Meghan fed, steadily gained weight, and maintained her body temperature. Surprising us all with her unusually uneventful hospital course, she was discharged without oxygen a few weeks shy of her original due date.

Survival rates for preemies born in the 1980s was much improved from previous years, but it was still likely that babies born before twenty-eight weeks would encounter a host of complications. Sara, born blind at twenty-eight weeks, was small for her gestational age, weighing a mere fourteen ounces.

Other babies born at term experienced unanticipated complications during their hospitalization. When Campbell, an eight-pound-plus baby, was initially admitted to the nursery for stabilization of blood sugar, he looked six months old next to the preemies. One evening when I heard decreased breath sounds on the left side of his chest, I immediately contacted the neonatal nurse practitioner. A chest x-ray confirmed my suspicion that Campbell had experienced a collapsed lung, and a chest tube was inserted to remove air until the air leak resolved. Campbell needed constant monitoring of his chest movements and his skin color for any signs of oxygen deprivation or respiratory distress. Fortunately, the rest of his hospitalization was uneventful.

Some emergency situations, especially those that required surgery, such as a preemie suffering from necrotizing enterocolitis, warranted a transfer of the baby to a local Level III nursery. Emergency situations could happen at any time, and the nurses were responsible for the care of the baby up until transfer and often upon return to our unit. During the hospitalization of Ellen G’s triplets, Erin and her brother had to be transported to Children’s Hospital Denver—Erin to get her heart checked, and her brother to get his liver checked.

Some babies died in the nursery, and others died in another hospital or at home. Hennessey S., a full-term newborn, died from Trisomy 13, a chromosomal abnormality. Other babies died of sepsis or respiratory or postsurgical complications.

Even with my hospital experience with death among the adult population, it was impossible for me to make sense of newborn and infant death—or baby-sized coffins. I couldn’t imagine the depth of the grief experienced by these parents, many of whom were so close to my age. Some of them lost a second or even a third baby, and it could happen within minutes of birth or weeks later.

Attending funerals wasn’t part of my job, but it gave me the closure I often needed. I didn’t cry while doing my job, but as I would sit in the back pew at church, often with another nurse, and the finality of the baby’s death would start to seep into my body, I’d pull a tissue from my purse. Each loss was a fresh wound, and I admired and was inspired by the courage and strength of these families.

A nurse’s intention is to offer hope, but I also had my own hope. Paul and I had both grown up in large, devout Catholic families. Be fruitful and multiply, a Bible verse that appears in the book of Genesis, was the way of life for married couples. Pregnancy was the pathway to becoming the woman whom God intended me to be, and having babies was a rite of passage. Despite writing Baby on our list of goals early on in our marriage and the Bible verse, however, Paul and I didn’t start talking in earnest about starting a family until 1984, when we had been married almost two years. What began as an urge to become pregnant had become a fixation, an inescapable obsession.

I could no longer take my body for granted, and periods stopped being just an X on the calendar. I had begun to pay attention to the bleeding and what it meant, which led to my first conscious awareness of and interest in the science of my body. The language of motherhood had taken center stage for me, and although Paul wasn’t as obsessed, he too desired a family.

But while all my quiet moments were filled with baby thoughts, his were fixed on finances. When his forehead wrinkled and he looked far away, I knew what he was thinking. He was worrying about how to support a family before finishing college and finding a job.

2

O n Friday, March 30, 1984, I rustled around in the cocoon of our condo and waited anxiously for the call from my doctor’s office about a blood test. When the kitchen phone finally rang, a calm woman’s voice said, It’s positive. I was twenty-nine years old—and five weeks pregnant.

Thank you! I exclaimed to the nurse.

She said, Let’s schedule an appointment for you to see the doctor at eight weeks.

As I hung up the phone, tears rolled down my cheeks. A pulse was beginning to beat inside me, although we wouldn’t be able to hear it for several more weeks. What felt like a treasure hidden deep inside me was now craving to be known and brought into being.

Too excited to sit still, I paced from room to room, breathing the news into my body and concentrating on how best to tell Paul. I was a little worried, since he had been stalling for a while. Gently teasing, he had told me, If you grow your fingernails long enough so that I can see them from both sides of your hand, and keep them that long for a month, we can start trying to have a baby. Though he knew I was determined to succeed, that was his kind way of buying some time—and persuading me to give up my lifelong habit of biting my nails.

While playing with Barbie dolls or caring for my younger siblings as a girl, I hadn’t dreamed of becoming a mother. But after marrying Paul, who accepted me unconditionally, I began imagining what it would be like to bring forth new life. Deep inside my body, I began to feel an all-encompassing, aching need to have a baby. At first, I was content to care for other women’s children, but what I wanted most was to be like the women I met in the NICU—a mother, nurturer, and protector. I never wondered whether they were ambivalent about having children or had overwhelming feelings about becoming a parent, nor did I consider the joys and risks of parenthood or even that it was life changing. I never moved past the fact that those women had accomplished a major task: giving birth.

Chewing my nails had been part of my identity since my teenage years, but after a few months of stopping by the beauty school on South Pierce Street on my days off, I had grown them out. I had shared the bet with my manicurist, who eagerly painted my nails a different shade of pink twice a week. Learning to put my contacts in with fingernails was initially awkward and frustrating, but my desire to have a baby stopped me each time I was tempted to chew my nails off again.

I had already pictured what it would be like to go for family hikes in the mountains and sit together for family dinners. I imagined a child who looked like everything I loved about Paul: blue eyes, black hair, and freckles. Something I’d never known I wanted became the only thing I could think about.

On that Friday afternoon in 1984, I waited anxiously for Paul to return from school. To pass the time, I wrote a letter to him on mint-green-colored stationery. When he got home and put his books down, I asked, Do you want to go for a drive?

I had never learned to drive the stick shift in Paul’s 1977 black Trans Am. But at my request, he drove us to Christ the King Catholic Church in Evergreen, where we had married two years earlier. Inside the empty church, we sat in a pew and I handed him a sealed envelope. He read the enclosed letter aloud:

The most important day of our life together began right here ... This day is another beginning. You have given me the greatest gift of your love—a child ... I wanted to pray to God and thank you for giving me so much. Sweetheart, I love you with all my heart. I am so proud to be the mother of your child. I hope everything we have been hoping, dreaming, and praying for will come true for us.

With eyes glistening, he leaned over and hugged me tight. All smiles, he said, I love you, and this news is so exciting. I believed him, even though I knew of his desire to wait. Holding my hand, he silently reread the letter.

God had graced us, and hope raced through my body like electricity. For me, pregnancy would provide a new cycle, an opportunity to cultivate and nurture a deep, loving relationship with myself. I could finally leave behind any self-doubt about my body.

Paul and I knelt side by side and offered up silent prayers of gratitude. Then we lit a candle that would continuously burn on the pricket stand and walked out of the church hand in hand. At home, we ate steak Oscar and toasted to our future as parents with a few sips of champagne. We fell asleep entangled, filling the nooks and crannies of each other’s bodies, an innocent moment filled with expectant possibility.

xxx

My parents were thrilled, especially since I was the first of their two daughters to be pregnant. On the phone, they fought over who got to ask questions: How are you feeling? When are you due? I couldn’t answer fast enough. Paul’s parents were excited too, although they didn’t ask as many questions. Paul had three sisters, so the news may have been slowly sinking in that their only son was going to give them a grandchild.

I carefully chose an obstetrician I knew from the hospital. A graduate of the University of Colorado, Dr. B. had been practicing medicine in Denver since 1959. Throughout his career, Dr. B.’s patients had been his top priority. I began prenatal care at eight weeks on April 13. On the new-patient paperwork, I checked off my family’s health history: hypertension, heart disease, diabetes, and cancer.

On that paperwork, I also mentioned that my mother had taken diethylstilbestrol (DES) after she had started bleeding when she was pregnant with me in 1954, in an attempt to avoid miscarriage. From the yellowed newspaper articles that