For many couples, needing fertility care to get pregnant comes as a surprise. But Ashley Bott actually planned for it.
Bott had a history of irregular cycles and had worked with her midwife at Sanford Health to find methods, like birth control, that helped regulate them.
“I didn’t really grow up knowing how to navigate the health care system,” she says. “So, I leaned on my midwife to help me figure out what was normal and what wasn’t.”
After getting married in 2019, Bott, a marketing business partner at Sanford Health, shared her “road map” for life with her midwife.
“I am very type A,” she says. “I want things to follow a very specific schedule.”
Because Bott and her provider were on the same page about timing, they were able to establish a plan to prepare for pregnancy. This time, known as preconception, can be critical for starting a pregnancy off right. Typically, a preconception plan includes making lifestyle changes to someone’s diet and exercise, as well as taking supplements like folic acid.
In 2021, Bott started tracking her ovulation to get a better idea of when she’d be the most fertile. She shared photos of her test strips with her provider, who raised some concerns.
“She told me I wasn’t really ovulating,” says Bott. “And if I was going to follow my road map, I might want to consider dabbling in fertility care.”
To start, Bott began taking Letrazole, a medication designed to help with ovulation. At the same time, her midwife put in a referral to the fertility clinic.
“Typically, you have to be trying for around a year,” says Bott. “But because I had planned with her for so long and we understood what could potentially prevent me from getting pregnant, she was comfortable getting me referred right away.”
Infertility was a diversion, not a roadblock
Bott’s first appointment at Sanford Fertility and Reproductive Medicine in Sioux Falls, South Dakota, was at the beginning of 2022.
The fertility clinic team looked at health history, did testing and recommended supplements for both her and her husband. The team also talked the couple through the costs associated with different services and what would or wouldn’t be covered by insurance.
“They did a really good job of laying out the ideal plan and setting expectations,” Bott says. “But if that didn’t work for us, there were more options.”
Their plan had four steps. First was a contrast dye injection. This helps identify if there’s anything in the fallopian tubes that’s keeping an egg from being released. Next, doctors increased her dose of Letrazole, the ovulation medication. The final two steps were an ovulation trigger shot and timed intercourse.
“It felt so digestible to me,” says Bott. “I understood each step, and it didn’t feel complicated.”
And that initial “cocktail” – as Bott refers to it – worked. They got pregnant right away.
“It was the best news ever,” she says.
Photo by Rhody Ray
Staying calm during a bumpy delivery
Bott’s first few pregnancy appointments took place at the fertility clinic.
“They did blood work and really monitored to make sure that our baby was growing,” says Bott.
By 12 weeks, everything was going well. Bott “graduated” from the fertility clinic and she was able to seamlessly shift her care to midwife Megan Burgers, APRN, CNM, the provider she chose for pregnancy care.
From that point, her pregnancy was pretty standard.
As her due date was nearing, the baby was measuring a little small and Bott was getting anxious about delivery. Additionally, her latest ultrasound showed a lower-than-ideal amount of amniotic fluid. As a result, Bott and her midwife came up with a plan for induction.
“I feel like a lot of people might think a midwife will discourage you from that,” says Bott. “But she just laid out the pros and cons and let me make the decision.”
Bott was induced at around 39 weeks. She got to the hospital early in the morning.
“Like a lot of new moms, I had a hard time getting him out,” says Bott.
As the baby’s heart rate dipped, the care team remained calm as they worked.
“The team tried the vacuum, but ultimately needed forceps to get him out,” says Bott. “Because of that, I had a partial third-degree tear.”
It was a traumatic experience for Bott, even though she didn’t realize it until much later.
Around 11 p.m., her son, Griffin, was born and doing well. The neonatal intensive care team was on standby, but no additional intervention was necessary.
“Even though it was a little dicey,” says Bott. “They all did a nice job of making me feel comforted.”
A smoother journey for baby number two
When Bott and her husband were ready for another baby, her provider put in another referral to the fertility clinic.
“I got a similar combination of ovulation medication and the shot,” says Bott.
And once again, it worked.
Since it was her second pregnancy, Bott had a better understanding of what to expect and how many appointments there were going to be. She decided to shift her care from her midwife to Elizabeth Miller, M.D., an OB/GYN whose office was much closer to her home.
“It was a lot more convenient for me,” she says. “And it was fun to see how Dr. Miller approached things a little differently.”
Like with her first, the pregnancy progressed normally. Delivery, however, felt very different.
Anthony Sierra, M.D., was the OB/GYN there that day. The way he trusted his nurses really stuck out to Bott.
“He let them do almost everything until he absolutely needed to step in. It was really sweet to see how much he trusted them,” says Bott. “And they were so great. My nurses did everything they could to help make this birth go as smoothly as possible.”
During labor, Dr. Sierra and the nurses worked to try and flip the baby, who was in the occiput posterior position, or “sunny side up,” meaning his head was pointed down but his face was looking up.
“With Griffin, I was asked to push as hard I could to get him out,” says Bott. “For this baby, the nurses were able to take the time to find different ways to help me push.”
This time, giving birth was calm and relaxed, and soon, their second son, Harrison, was here.
“Afterwards, Dr. Sierra came over and thanked me for letting him deliver our baby,” says Bott. “And obviously, I cried. He was just so sweet.”
Pregnancy in the rear-view
Bott’s “road map” for life had a few detours, but she appreciated the guidance and direction from the entire team at Sanford Health along the way.
Looking back at her fertility care, Bott was grateful to learn that there are always options.
“It’s not just IVF or nothing,” she says.
Her pregnancy advice? Speak up.
“Let your care team know specifically what you’re looking for,” she says. “I think advocating for myself and what I wanted led me to have really positive experiences.”
And when she hears about a friend getting ready to have a baby at Sanford Health, she can’t help but get excited.
“Of course, they will get to see the little person that they’ve been growing for 10 months,” says Bott. “But I am genuinely thrilled because of the care I know that they’ll get.”
Learn more
- Want to have a baby? What to consider before conception
- Busting the myths of midwives
- What’s it like to go through fertility treatments?
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Posted In Pregnancy, Sioux Falls, Women's
