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Amanda Aguilar Shank Headshot

Pregnancy Not-So-Blahs: My Story of Fetal Atrial Flutter

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At the time I wrote these updates about my baby's late-pregnancy health scare, there was very little available online covering real stories of fetal atrial flutter -- and how it was resolved. This first story is from a letter I wrote at week 37, before I knew that my baby's heart would eventually resolve permanently. I hope this story of how I navigated the profound transition into motherhood is of use to parents, whether they are or aren't enmeshed in the minute-to-minute attention that fetal health issues require.

Dear Friends and Family,

At week #37, many experts say that women experience the pregnancy "blahs." I fully expected to go from pregnancy fatigue to the pregnancy blahs -- until last week.

Last Friday, at my 36-week prenatal visit, my doctor-midwife Regina discovered that my baby's heartbeat was irregular, and very fast. A normal fetus heartbeat is 120-160 beats per minute and goes up with activity and down with rest. My baby's heartbeat was muddled-sounding, and mostly about 205-210 beats per minute. Everything started getting crazy very fast. I'm not overly anxious. I generally expect things to go like they normally go -- it was a horrible, surreal surprise to be in the home stretch and realize that some of the most important things are far from my control.

I spent five days in Legacy Emanuel Hospital in Portland, Oregon, with some phenomenal Maternal Fetal Medicine specialists, cardiologists and nurses working to figure out what was wrong and what to do. I learned more about hearts than I thought I would ever care to know. My baby had atrial flutter, which meant that the top chamber of her heart was vibrating rather than pumping efficiently. The bottom part, the ventricle, was picking up on every other or so impulse from the atrium, and translating a flutter at 400-500 beats per minute to a more reasonable (but still dangerous) 205. Doctors were concerned that she would develop hydrops, which describes the fluid build-up in important places, like the lungs, that happens when blood is not pumping efficiently through the body.

I swung between fear for myself: that I would have to have a C-section and develop an infection and never be able to have a regular birth (I had spent eight months preparing for a natural home birth); that my body, the only body I will ever have, was being sacrificed and would never be the same; that I would lose the baby and fall into a long depression; that I would have a child with major heart problems; that I would have to quit my job and go into lifelong debt just to care for her. I was torn between that selfish fear and fear for my unborn baby girl. The second fear, the more honorable fear, was smaller, slow-creeping and hard to put my finger on. The full responsibility to keep another human being alive and the total innocence and vulnerability of this other human were overwhelming. There she was, struggling with this vibrating heart, doing the best she could, so completely raw, unselfconscious and beautiful. She was human life at its most basic and purest form, focused on the task of survival.

I watched her little heart on the ultrasound for hours -- before and after her heartbeat resolved. I slept with a fetal monitor stuck to my belly and the sound of her heartbeat coming from a machine a foot from my head. I waited and hoped and worked to pull the pieces of me together that could not keep up with things changing so quickly. I slowly came out of the emotional shock that I suppose happens to anybody going through a sudden health crisis.

To improve her heartbeat, the doctors gave me digoxin, a heart medication derived from foxglove. I'm still taking digoxin, at 2-4 times the standard dosage (1000 micrograms/day) so that it can get into the placenta and into her. After about 50 hours on the drug, my baby's heartbeat suddenly was completely normal (hallelujah!), and has stayed steady ever since. Today, I'm at home, at 37.5 weeks, hoping that things stay steady and I can go into labor naturally. My home birth fantasies are over, I'll go to the hospital, but something about having your baby's life saved by Western medicine makes me feel more trusting about hospitals in general. Regina, our guardian angel and doula, will be there with us, I hope. So far, this is the best possible outcome, and between bouts of feeling predictably sick from digoxin overdose, I feel grateful.

This has been a big week, with deep shifts that I'm sure will keep happening as we go through the coming days. Sometime in the next three weeks, I will subdivide into two women -- one a mother, and one a fresh newborn infant, each with our own developing story and life path. I will find that I care more deeply about some things than I ever thought possible, and other things that were important markers of my life and identity are no longer significant. I'll celebrate and I'll mourn.

Amanda

To read part 2 of Amanda's story, click here.