Time this year is all sorts of wonk. I don’t know what’s up or down anymore, but I do know some medical events of the last week have been a bit of a wake up call for me that money isn’t everything and I need to take my health — physical AND mental – seriously.
When I got pregnant, I was aiming for a Feb baby. It’s silly but when you go on maternity leave (at least in my state) you get paid less than full salary (and lose out on some benefits) so it is extra frustrating to go out during a time period with a lot of paid holidays. The worst is going out over Christmas as my company gives a full week of paid time off then. The best time to be out, assuming 3-4 months out, is Feb-May. You still miss a few paid holidays, but it’s not that bad. And you also come back to work right before summer which is usually a bit slower and even if not people tend to be in better spirits and it’s not like returning at the start of the year when things are extra stressful.
But, alas, I got pregnant somehow on my first try, and I studied the calendar to determine that my 4 weeks of optional disability leave before my due date ran over the Christmas break week . But then I figured out the timing actually worked out where I could go out at Christmas and take the paid week off and then immediately go on disability.
For the record (and new readers) with my first kid I was stubborn and worked up until my due date. This may have contributed to having high blood pressure at the end, which led to an induction, which led to a bunch of other interventions which maybe is what led to my son having to spend 36 hours in the NICU. We aren’t certain what caused what, but it was a quite traumatic labor and when I set out to get pregnant again I told myself I won’t be stupid and I’ll go out on leave as early as I can even if it means losing some pay and other benefits.
Then came COVID. And work from home. And analyzing the losses of going out on leave early (a few thousand dollars.) And planning to work until my due date again. It felt odd to go out on disability early when I was literally working from my bed anyway. What would people think? I care too much about that, but mostly I care about losing my ESPP contributions when on disability leave, which are worth about $1000 pre tax a week after you remove the cost I put in to buy them. And the first week of disability is entirely unpaid, but that will happen no matter when I take it.
The thing is next year will either be so incredibly lucrative for me that losing a few thou won’t be noticed… or I will come back from having kid 2 and be such a mental case I can’t hold down my job for the year ahead and I’m fired by summer. Luckily I do still vest RSU when I am out, which is a godsend, so even with a summer axing I’ll be fine. It will be devastating given if I can just hold on one more year I will significantly shift my FIRE date sooner and I’m basically holding a lotto ticket for dear life as a train going a zillion miles is passing before my face… so… it’s hard to plan anything. I just need to plan the stay healthy. That is the best I can do.
Speaking of do, I’m due in 44 days. Which is not a lot of days. Especially if you consider this week my (now former) doctor wanted to induce me in 20. Why? Well, let me tell you, maternal care is a mess because there just isn’t enough research and data to support serious recommendations. Some doctors are too conservative. Others, many, ignore women who have symptoms of serious complications until it’s too late. I have to say I’m glad my doctor errs towards conservative, but I was extremely frustrated by her too conservative recommendations based on data that in itself was faulty. Let me explain.
High blood pressure in pregnancy is no joke. Women die everyday from complications related to blood pressure rising out of no where. Babies die. Seeing high blood pressure readings should be taken seriously by doctors and patients alike.
But. One has to then consider how these readings are gathered and the accuracy of these readings before making a very serious diagnosis that impacts the course of your care — and your due date.
BP readings are notoriously inaccurate. That is why doctors often take 2-3, to determine if one read was influenced by how you were breathing or sitting or anything else. The diagnosis criteria for gestational hypertension is two reads of 140/90 at least 4 hours apart. In my case, at an in office appointment in Oct, my first read was 148/75. Scary. They took it again and it came down substantially. No one said anything to me like — oh, if you get one more high read like this we will induce you early. The only thing they said is that my second read was good, and not to worry about it. Ok.
Now, to get an accurate BP reading, I’ve since leaned (thanks internet) one is supposed to sit still in a chair for 5 minutes before the reading is taken. No where could I find how wearing a mask in an enclosed windowless space might impact the BP read of someone with a history of anxiety and claustrophobia, but I digress. I question the accuracy of that first read. If it was real, it’s quite scary. If it isn’t, well, it’s meaningless.
Fast forward 4 weeks. Due to covid my 32 week checkup is virtual. The nurse calls me and while on the phone with me has me take my BP at home. I’m not thinking while I do this… I walk quickly to the chair by the home machine after taking my weight, sit down with my back not supported, barely breathing, clenching my phone in my fist, muttering some comments as I begin to take the read. I wasn’t concerned as I had just taking it 3 times a few hours earlier and it was fine. So as I read the numbers… 142/90… out loud… I said to myself, that’s kind of high…
I asked if I could take it again. It came down. (Then later my husband, who purchased the machine, determined he could change his own BP read by 15 points based on the tightness of the cuff!)
But none of that mattered. The moment my OB got on the phone, she tells me she is diagnosing me with gestational hypertension and I will be induced at 37 weeks. What? I ask, shocked. I feel fine. I am pretty sure my home machine gave me an inaccurate read. As she explains he logic to me, the more frustrated I grow in her not requesting for me to come in to at least check the second read in office before scheduling an induction 3 weeks before my due date!!!
I requested an in office check and labs. She scheduled me for an NST and fluid scan that I agreed to and surprise surprise, every test I took came back clear. At the office, my BP was 127/70. While I may end up with high BP in this pregnancy and am higher risk for it due to being overweight and geriatric (pregnancy wise), there is no reason to induce at 37 weeks without two accurate high readings.
So I switched doctors. She agreed with me 100%. Said why take a second reading if you aren’t going to use it!
My first doc wanted to put me out on disability immediately. I politely declined. That would be 2 weeks of lower pay and a week I’d be out anyway with full pay lost entirely. And without time to properly transition, I would still be answering work emails and doing work-without getting paid for it. Instead, I decided to compromise. I’d go out on leave Jan 4 as initially planned. With work being super stressful and just sad lately, I have no desire to work a day longer at this point.
Regarding work, I understand why I was kicked out of my role, but the way it was and continues to be handled is one kick to the ego after another. My work friend, who will be promoted into the position I had (officially, once I go on mat leave) is good at what he does — but like most men is overconfident. That works for him at this company, because confidence and clarity are by far the most valuable leadership traits, whereas output matters little. It is good for him to have this opportunity — and as I told him if anyone else was stepping into this role I’d be pissed but I’m genuinely happy for him (I am) so it all works out. Sort of. I have a new role which is still stressful and ill defined, but it’s a bit less visible. I went from a position where I was seen as a strategic leader to one where i am more or less a project manager. Does it hurt? You bet. But I have an end date in mind and stock to collect and a baby to push out. I know my new boss won’t keep me forever. I’m hopeful I have a few months after I come back from maternity leave to find my footing before anyone considers asking me to pack my virtual boxes and get out. It seems this might be achievable.
And I may still have this baby early. In 2 weeks? In 2 days? Baby could decide to come early on its own. We officially move Dec 21 (as in hired movers are moving our stuff to our house then) so I’m hoping not before that. Or before Chanukah and Christmas. I would like to make it through the month with baby still cooking. That would be wonderful. Then come Jan any day can be a maybe baby day.
And then? Well, then I’ll be mom of 2 at 37. A homeowner. Not yet a minivan owner but that’s happening soon as well. I’ll be well on my way to 40 and maybe no more kids or maybe one more kid. I’ll be fully engaged in this next phase of my life – mid life, I guess – and trying to make sense of it. After my scary self-diagnosed bipolar manic episode in late 2019, I am hoping I’m now stable. I look at who I was those few months and feel so detached from that person. So embarrassed and ashamed of her. But maybe that was my last hurrah. Maybe that was my inner crazy child dying but not giving in to her mortality without putting up one last fight. I don’t know what it was. But I feel different now. Depressed, maybe. In a mellow way. I guess that’s what having nearly $2M in networth does to a person. I am spending too much these days but I feel a little bit more stable. If I am an just get through next year, just get to $2.5M by 1/1/2022 (or close to that), I can calm down a bit more. I want to be able to not worry about every dollar earned or not. To be able to take a job I’m good at — one where my work is valued as appreciated, vs considered acceptable largely due to pity. I need to find that job – that career. And it may not pay well. But I want to have enough saved where that doesn’t matter. Maybe I can make it happen. The next year will answer if I can. Or at least if I can try.
I also had high blood pressure in pregnancy, combined with growth restriction, and found a really nice ACOG report summarizing the data studies, and I read it myself. I just refuse to rely on doctors alone to understand the issue and data. That said, I found my doctors to be very evidence based. I was slated for induction at 37 weeks, but my blood pressure was consistently higher than what you report.
All that said, i’m glad your new doctor aligns with your view of risks, and that you are almost ready for maternity leave! I’m in CA but not eligible for state leave, so having my leave over the holidays actually extended my leave, the way it worked out with my specific leave.
Based on what I’ve read, I agree than induction at 37 weeks is the best plan for gestational hypertension. What I disagree with is that the diagnosis is based on 2 readings of 140/90 — and I’ve learned blood pressure readings can be notoriously inaccurate depending on how they are taken and what you count. One doctor may ignore a high first read and only count a second read. One may average 3 reads. One may only count first read taken when you’re standing on your head and holding your breathe because the nurse is incapable of taking a proper reading (or you take your blood pressure at home because of a virtual appointment and that BP is counted towards the diagnosis.)
Will I have GHT? Probably. Will I be diagnosed at 37 weeks? Probably. I understand my doctor was trying to give me a heads up so I could prepare for this likelihood, and I appreciate that. BUT the least she could have done was said come in for a test in person before I give you the diagnosis. At least not yet. I had one high reading at one appointment in the office in October, then it came down on the second read. So my second high read was home test. That I feel is not enough to put me in the “must induce at 37 week” camp. Yet. I went in for NST and my blood pressure was fine. I’m still getting some concerning diastolic readings at home in the high 80 range, so this is why I think she’s probably right anyway. But that doesn’t change that she diagnosed me without confirming in office for something as major as an early induction. This is why I switched doctors.
Totally agree. Induction at 37 weeks wasn’t recommended for me until my pressure was quite consistently high, and the intermittent earlier high ratings were noted, but did not trigger a change of course. I get what you are saying, though. They should wait and see what happens.
I hope your pressure stays within range, and baby can make the decision on when to come!