My Kell Pregnancy

This post was hard to write. I'm not one to recall specific details during a difficult period in my life. In fact, I pretty much bury those hard moments deep down. Like, way deep. I'm more of a planner and future-looker. And this post is all about the most difficult period in my life. The good news is that this story/post has a happy ending.

A fair warning, you will get a bit of a health lesson within this particular post, but stick with me.

I peed on a stick and before I could even bring the test up to my face, I saw those two pretty blue lines. Pregnant! And like...really pregnant, apparently. Overjoyed and little nervous, I let John know. "Already?" he asked. John and I feel blessed with our ability to get pregnant easily. We're lucky in that sense. Walk down the same hallway...boom, pregnant. Use the same cup on accident...boom, pregnant.

What is unfortunate is that I had some serious difficulties while pregnant.

I've actually been pregnant three times. My first pregnancy resulted in a miscarriage at 11 weeks back in 2014. The confusion, guilt, and sadness was overwhelming. You think it will never happen to you; and then it does. I mourned. I prayed. John and I did these things together. And separately. I was angry. I wondered why God would bring me so much joy and then take it all away. I was going to be a great parent. I could provide financial stability, love, and family trips. I realize that a lot of people experience miscarriage, unfortunately. It's like you're part of a club in which nobody wants to be a member. It sucked. I still think about this baby who I never met.

We were thrilled to be pregnant again three months later with Clark who was born in March 2015. Other than Clark being 9 freaking pounds, and 9 freaking ounces and all of the stretch marks on my body to prove it, this was a healthy and fairly uncomplicated pregnancy.

The idea of baby #2 had been lingering in the back of our minds for about a year before we finally decided to go for it. John and I were sitting in an airport together. I sat there with a beer in front of me that I was unable to drink because the smell was horrendous. "This is the last beer I'll be having for a while." I told John. Boom, pregnant. With all of the excitement with being pregnant, so did the fear. What if something goes wrong again? However, nothing could have prepared me for what would happen during this pregnancy. NOTHING.

At our 8 week appointment, I was just looking and listening for a little heartbeat. Which, by the way, if you've ever been expecting, then you know that the whoosh-whoosh sound of the heartbeat is hands-down the best sound in the world! And there it was. Flickering and making that beautiful whoosh-whoosh sound. A wave of relief fell over the room. Everything looked great. So, some routine blood work to test for stuff. Just stuff. Like, whatever. You know they need to count some type of hormone and figure out your blood type and all that jazz. It's routine. That "routine blood work" was the beginning of the Sloan roller coaster pregnancy.

My doctor called me and asked if I had a moment to chat. That's never a good sign. You never want to hear a doctor say that to you. Um, I usually just get my results in the online portal, but ok...? The doctor had a shake in her voice and said, "We received your blood work and it appears you have an antibody called Kell."

"Who?" I asked. She continued to tell me that even she didn't know a lot about this antibody, but she'd done some research prior to calling me. "There isn't a whole lot of information available, so I'm going to do my best to answer your questions."

I kept thinking "What?! Didn't you go to school for years and years and pay a crap-ton of money to know what all of this is? I had all of the questions. Unfortunately, she didn't have all of the answers. My question of "will this kill my baby?" couldn't even be answered.

Before I could even call John to tell him...um, literally couldn't even think of a sentence to tell John what was happening anyway, I was given a call from a nurse at Regional Obstetrics Center (ROC) here in Jacksonville. This is the place all pregnant ladies have to go when they are having some sort of issue and modern medicine and fancy doctors need to intervene. Fancy doc place. They wanted to see me the very next day.

Here's where part of your science lesson comes in and brief explanation of Kell. My body had come in contact with a foreign antigen. In my case, it was likely from my pregnancy with Clark because our blood crossed. To fight against this foreign antigen, my body created this antibody (Kell). This has no effect on me. If I had not had another baby, I wouldn't have even known this. Unfortunately, this antibody fights the baby's (a foreign object) red blood cells, causing anemia. And, anemia can be fatal.

There's your crash course in science. Now, here comes your chemistry lesson. Remember in the 8th grade when you were taught how to create a punnet square to determine the probability of eye color? If one parent has brown eyes and the other parent has blue eyes, what are the chances that their offspring will have blue eyes? We essentially needed to find out the probability of my now gestational 9 week old fetus would be affected by Kell determined by the father. I obviously did not have Kell (since I created the antibody to fight it off) but we knew that John, as my baby daddy, did.

Oh, I need to mention that only about 9% of the entire Caucasian population is Kell positive. And I married one of them. And a side note: it's theorized that Henry VIII may have also been Kell positive because of his hardships in producing healthy children. I'm now convinced that John's family is related to the royal family. But, I digress.

I'll spare you the nightmare it was trying to get several different labs to determine if John was KK (100% baby is affected) Kk (50/50 chance baby is affected). As it turns out, John was Kk, so there was a chance that my baby was in the clear, however my titer level (the amount of antibodies that were in my blood) was 1:68. Anything that is over 1:8 is considered critical. Cool...8 times even more critical. Oy.

You've had your science and chemistry lessons, and now I'd like to touch on religious philosophies. Stick with me. John and I went from over-the-moon stoked to have another baby to scared shitless (there's no other words to describe this). We were trying our best to understand, research, and ask as many questions as we could. I prayed to God that we would find some sort of peace in all of this craziness. And then my prayers were answered. The second time I walked into the fancy doc place I read the doctor's name that was plastered onto the wall all fancy-like. Dr. Joann Acuna. Wait, I know her. This fancy doctor was also a member of the gym where I coached. We'd known each other for a couple of years. I knew her form during burpees (it's perfect, by the way). I knew she was a doctor, but I didn't know she was a fancy doctor! And now she was my fancy doctor. And you're about to find out just how fancy she is.

Ready for an anatomy lesson? At 16 weeks pregnant, I found myself having to go to fancy doc place every week for the rest of my pregnancy. My car automatically drove there. At these weekly appointments, the fancy ultrasound tech would search for Sloan's middle cerebral artery (MCA) located at the top of the head. Thank goodness for modern medicine, as this scan was the best way to determine anemia. And when I say modern medicine, I really mean it. This measurement for anemia has only been used since about the mid-90's (so, like yesterday). So, find the MCA, determine the peak systolic velocity (PSV) of blood to determine the multiples of median (MoM). How? I'm not really sure. It's so fancy. Fancy techs, fancy doctors, fancy letters. It's all confusing. If you're still reading and thinking, what the heck? Then, do this for about 9 months, and you'll be in my mindset at the time. Any MoM above 1.5 would result in the need for an intrauterine blood transfusion (IUT). Yes, more letters. I'll get to that part eventually.

I would hold my breath at every scan searching for numbers. I got so good at knowing when the baby was in a good position or when the fancy tech was able to get a good reading. I knew how to calculate the PSV to determine the MoM. Every appointment had my blood pressure through the roof. I was diligent about keeping notes about Sloan's MoMs.

We felt like we were in the clear for a long time. And then, the MoMs started getting higher. Concerns about more invasive treatments were becoming more prevalent. Around 32 weeks gestation, the fancy tech found that Sloan had an effusion around her heart-which was another sign of fetal anemia. My own heart sank. An IUT was necessary. The thing we tried to avoid. The real fancy thing.

This is a procedure when a donor's blood is inserted into the baby's umbilical cord. A fancy procedure summed up in one sentence. While Joann was cool as a cucumber, I was freaking out. My blood pressure dropping to 60/40 was a good indication that "freaking out" was a huge understatement. A chat with Joann explaining what was about to go down, a chat with a NICU doctor in case of an unexpected early delivery, (oh boy, blood pressure dropping) an epidural, (so not fun) a wheel down to the OR later, and I found myself surrounded by a team of nurses and doctors. One of whom was about to stick needles into my belly and into my baby. I couldn't feel anything and I'm pretty sure they gave me some happy juice, but the moment sticks out in my mind like it was yesterday.

At 32 weeks pregnant, babies can be wiggly. So, a paralytic (yeah, you read that right) is given to baby to make them be still. Blood is drawn from the baby to determine the beginning hematocrit (percentage of red blood cells). Sloan's was 23 when it should be around 40-45. After the donor blood is injected, they read the hematocrit again. After a couple of rounds, she ended up at 42.8.

After the first IUT.

 If I thought this baby was wiggly before, I was thrilled with feeling Sloan give me a few good swift kicks to my ribcage. Joy and sadness. My poor baby was so sick and anemic that she wasn't able to even wiggle around like a normal baby should until she received her transfusion.

I was promptly put on bed rest. Netflix and donuts were my BFFs. It gave me plenty of time to reflect (freak out) about the next few weeks of uncertainty.

The good thing about transfusions is that it saves your baby's life. The bad thing about transfusions is that when you receive one, you'll likely need more. That fresh blood only stays fresh for so long. A week later, Sloan was due for one more IUT before an early delivery. Her beginning hematocrit was 33 and she ended at 49.

Another round of bed rest (Netflix and donuts) and I was scheduled for a c-section at 36 weeks pregnant. Sloan Elizabeth was born on January 8th, 2018 looking pink, healthy, screaming, and weighing in at 6.5 lbs. We'd been told that it was likely that we would only see her for a brief moment before she'd be whisked away to the NICU. By the grace of God, Sloan never had to go into the NICU. Her bilirubin levels were very high after birth, so she spent a lot of time under the bili lights to treat her jaundice for several days. I can't even remember her bili levels since I was under some pain medication and also...a few days post-partum, so I was a little nutso.

Over the next few weeks, Sloan was super lethargic as the Kell antibodies naturally died off in her little body. Around 12 weeks old, we finally felt like we were seeing the real Sloan. Sweet, curious, happy Sloan.

For as long as I'm alive I will always remember and be thankful for the people who helped us save Sloan. All of the sweet folks at the fancy doc place, but especially Dr. Joann Acuna. She was the face of comfort when I was terrified; the educator when I had a dozen questions; the hug I needed for the reassurance that she knew what she was doing; the steady hands when she was calmly doing her job.

Sloan's visit with Dr. Acuna

We were a little more excited than her. 

I'm also thankful for the people I connected with online. Since there is not a lot information on Kell, I was fortunate enough to find Bethany Weathersby's blog Losing Lucy And Finding Hope. Sadly, her first Kell baby-Lucy did not survive. Her blog posts are deeply personal, yet informative. She's made it her mission to educate anyone she can about the numbers, doctors, and resources you need in dealing with isoimmunization/antibody pregnancies. I had no clue Kell existed, let alone so many other antibodies until my pregnancy with Sloan. Being a part of our small, yet mighty, Facebook group made me feel like I wasn't alone. We all expressed our frustrations, questions, happy stories, and sad stories. We were all in this together.

Sloan is a healthy one year old little girl today. I thank God she chose me to be her mommy. I don't know why God gave that hardship to me because I feel like I barely got through it. Writing this post was the first time I looked back at all of the circumstances that led us to this point. It was hard looking back. I would write, then cry, close my laptop, cry, pray, look at old pictures, cry, write some more, and smile remembering the moment the pediatrician told me that Sloan was going to be fine.

I don't know what God has planned for baby girl's life as she grows up, but whatever it is, it's going to be huge.