My baby needed 6 blood transfusions while in the womb. The postpartum depression didn't hit me until I knew he was OK months later.
Courtesy of Courtney Yeage
- Courtney Yeager's antibodies began attacking her son while Yaeger was pregnant.
- Doctors gave the fetus blood transfusions into the umbilical cord.
- The stress of the situation contributed to postpartum depression for Yaeger.
This as-told-to essay is based on a conversation with Courtney Yaeger. It has been edited for length and clarity.
I work as a radiology assistant, so I'm around many pregnant people getting ultrasounds. I also have a negative blood type. In school, I learned about how this can cause complications during pregnancy. I tucked that information away, thinking I might need to come back to it one day.
Sure enough, I did. During my first pregnancy, doctors explained I was at risk for Rh incompatibility. The condition meant that my body could make antibodies that would attack the fetus's red blood cells. My medical team gave me a medication called RhoGAM, which stopped my body from creating those antibodies, and my first son was delivered with no complications.
During my second pregnancy, things got trickier. I started making more antibodies, and the medication wasn't as effective. I had blood draws and ultrasounds every two weeks during the second half of the pregnancy until my second son was born with no complications.
Unfortunately, Rh incompatibility often gets worse with subsequent pregnancies. When I became pregnant with my third son, Beau, things got very scary.
Beau needed a blood transfusion at 23 weeks gestation
Right away with Beau, my doctors at The Fetal Care Center at Yale New Haven Children's Hospital started measuring the level of antibodies in my blood. By 16 weeks I had a level that could be unsafe to the fetus. That's when we started twice-a-week ultrasounds.
During the ultrasounds, the technician examined a blood vessel in Beau's brain. The way blood flowed through that area could indicate whether he was becoming anemic. Anemia — or low red blood cell count — could cause his organs to shut down. It could be deadly for the baby.
At 23 weeks, doctors delivered bad news: Beau was anemic. He would need a blood transfusion before he was even born.
I needed to prepare for the risk of an emergency C-section
I went right from the outpatient clinic to the hospital's maternity ward. There, doctors explained that the procedure would happen in the operating room because there was a risk that I'd need an emergency C-section if something went wrong.
The neonatal team, which specializes in premature babies, spoke to me. But I knew if Beau was born at 23 weeks, he wouldn't survive. We made the decision to do the transfusion knowing that was heavy, but we had no choice. He could not wait.
The procedure can be done under general anesthesia or with an epidural. I opted for the epidural because if I needed a C-section, I'd at least be able to see my baby born.
After the anesthesia was placed, I laid on my back in the operating room while doctors inserted a needle through my belly, into the amniotic sac, to the point where Beau's umbilical cord connected to the placenta. Once it was there, they delivered the blood donation that saved Beau's life before it even began.
I looked and felt fine between procedures
Each transfusion protected Beau from anemia for two weeks. I needed six procedures, with an epidural each time. Usually, I went home after the procedures, but twice, I had to stay overnight in the hospital for monitoring. Between appointments, I looked and felt fine, which made it hard for friends and family to grasp how serious the situation was.
Doctors explained that by 34 weeks gestation, the procedure became more risky than early delivery. I had my last transfusion at 33 weeks and was induced at 35 weeks.
Despite having six epidurals already, I wanted an unmedicated birth for Beau, like I'd had with my two previous pregnancies. My high-risk team was amazing and helped me work with midwives to make that possible. Having the calm, serene birth I'd dreamed of amid so much trauma was everything to me.
Beau needed 3 more transfusions after birth
Unfortunately, birth wasn't the end of Beau's health concerns. He needed to spend six days in the neonatal intensive care unit because he was severely jaundiced — another complication of Rh incompatibility. I wasn't able to hold or breastfeed him for four days.
When Beau was three weeks old, I noticed he was very pale, which can indicate anemia. Sure enough, he needed a blood transfusion. Because he'd had so many transfusions as a fetus, his body had come to rely on donated blood and wasn't making enough red blood cells on its own. Beau needed two additional transfusions, but by five months, he was stable and healthy.
That's when all the emotion from the past eight months hit me like a ton of bricks. Beau was finally healthy, but I experienced postpartum depression and anxiety. I was able to advocate for myself, just like I had advocated for Beau, and get the help I needed. Today, Beau is a busy 18-month-old, and we're both happy and healthy.