Birth Story Part 3: The labor and delivery…Part 1

Want to read Part 1 and Part 2?

When last we left our intrepid heroine, she was hooked up to Pepe via her keychain ready to get an induction started.

For women with high blood pressure and preeclampsia, Magnesium Sulfate is administered to reduce the risk of stroke during labor and delivery. Most women experience fever-like symptoms: feeling flushed, body aches, weakness, etc. This is because the medication replaces the calcium in your body with magnesium (not all of it obviously). Calcium not only makes up your bones, but is one of the main chemicals used in brain activity and muscle movement. You’re at a heightened risk of falling while on magnesium because of this.

The nurse that evening started the magnesium sulfate. She put an icepack on the injection site to reduce the burning as it entered my blood stream. I was really nervous about this. Labor and delivery is hard enough when you have all your faculties. When you have essentially a flu at the same time, it sounded unbearable and made sense why many women who had to have magnesium sulfate quickly got epidurals.

I had to have magnesium on board for a full 24 hours before they would start Pitocin, the drug that would mimic labor and kickstart my uterus into contracting.

I also received misoprostol, which is a cervical ripening agent. Yup. Cervial. Ripening. That’s how it’s described.

The night was uneventful. I keep the ice pack on my arm all night to reduce the burning feeling. I woke up in the morning to my twice daily blood draw. I was feeling good, fine even. For me to use the bathroom, a nurse had to be called to essentially act as a spotter in case I fell. I stood up and felt no more or less steady on my feet than I had the day before. I certainly couldn’t stand for longer than 15-20 minutes, but they wanted me in bed as much as possible anyway.

That afternoon the new doctor on call, Dr Salemy, decided to put in a Cook Catheter. This is a figure-eight shaped balloon that gets inserted into my cervix and presses on either side in hopes of mimicking the pressure of the baby’s head and encouraging opening.

Holy shit this part suuuuuuucked. I was crampy and uncomfortable the whole time. The insertion was the worst part. I hadn’t experienced pain and pressure like that before, which makes sense because why would anyone be trying to open my cervix?

This stayed in for 12 hours. The hope is that it opens enough that it falls out on its own before that point, but my cervix was feeling stubborn (appropriately so because we were 5 weeks early) and didn’t open as far as we were hoping. At the check around 7:15p, I was 4cm dilated thanks to the catheter. That evening they wheeled me up to the delivery room and started the Pitocin.

The new doctor that evening, Dr Flum, suggested that we break my water the next morning to try and get things moving along even further. I was interested in this possibility since it seemed like it would bring us to the end of this faster. The main risk to this is that if I’m still in labor 18 hours after breaking my water, I get a C-section. We wanted to avoid a C-section because recovering from major surgery while caring for a newborn is, I imagine, fucking hard. I didn’t really want to find out.

With that in mind, we went to sleep.

Andy posted this on Facebook the next day:

Screen Shot 2017-06-28 at 4.05.22 PM.png

Around 2am the catheter was removed. The nurse I had that evening was new and obviously having some issues finding my son’s heartbeat. Once I got the Pitocin, I had to be hooked up to a fetal monitor at all times. They monitored contractions to determine how much to elevate the dosage. My uterus was stubborn (again, appropriately so) and the contractions were small. I felt like I had minor period cramps, but was able to sleep through most of it. My poor nurse, though, kept waking me up trying to move the fetal monitors. She had me shift position multiple times at night, which meant my already interrupted hospital sleep was even more interrupted.

The next morning the new doctor was the one who had given me false hope of going home and, keeping on trend with changing the plan against all other doctors’ better judgments, decided not to break my water. Andy and I talked to my doula, Kim, about it. Kim knew this doctor and said she was known for a more conservative approach, but to trust her. I was feeling a little stressed about the changing plan coupled with the very interrupted sleep.

I had had a dozen different nurses at this point and asked my daytime L&D nurse to please make sure I had a more experienced nurse on that evening. If I was going to have another night before my son arrived, I wanted it to have as much sleep as possible.

That night my cervix was checked again and nothing had changed. I was still solidly 4cm dilated. The doctor decided to pause the Pitocin, give my uterus a chance to rest, and then restart it early in the morning.

This is where I caused another medical power struggle. The summer time is a very busy time for baby delivery and the charge nurse saw my paused Pitocin as me taking up a bed that could be used for a mom actually in labor. The doctor wanted me to have a full 8 hours off of the Pitocin, so it was turned off when I went to bed around 10p and was supposed to be resumed at 6a. Looks like there was a tiny power struggle because at 4:30a, the Pitocin was turned back on.

I was woken again at 6a for my morning blood draw. At this point the crook of my elbow was covered in little bruises from the blood draws. I don’t know how women who are on hospital bedrest for months deal with it.

Dr Flum, the doctor who wanted to break my water, arrived around 8a and said basically she wasn’t leaving until I had a baby and they were definitely going to break my water that day. I liked the way she put it, “This should be harder for you by now.”

The Pitocin pause obvious helped since when she checked again I was 6cm dilated.

Up next, a broken bag of waters, my idiocy, my son’s arrival, and how I got the most expensive pain medication in the hospital.

Check out Part 4!

Advertisements

Birth Story Part 2: Hospital to actual labor

Want to read Part 1?

Andy and I went on a baby moon from June 13-17. We used our annual anniversary trip to Whistler to also use it as an opportunity to have a final vacation as a couple pre-baby.

It was a wild departure from our usual active vacation, which typically includes lots and lots of hiking. Instead we would sleep, swim, eat, and watch TV. I would nap at least once a day and take a bath in the deep soaker tub in our condo. Someone had given me the advice to take epsom salt baths to handle the intense swelling I was dealing with as a result of the high blood pressure. We bought huge bags of the salts and I would dump easily a pound or two into the water and almost float with the buoyancy.

My belly would make getting in and out of the tub a little treacherous. I felt constantly off balance and had to move slowly. The blood pressure medicine I was on also gave me very low energy. We’d take a leisurely walk around the Village or on an easier trail, but it was usually 20 minutes at most. The last visit to Whistler had included a full 8 hour hike with a picnic in the middle, so the contrast was stark.

We came home from Canada and Andy had a weekend of work ahead of him, which I spent doing low key activities like prenatal yoga and lots and lots of couch time with my feet raised.

That Tuesday, June 21st we had our now usual non-stress test followed by an appointment with my OB (it was an OB week, the week before vacation was a midwife week). A non-stress test is where they put sensors on my belly to monitor the baby’s heart rate and movement and track my heart rate and blood pressure. The last few I had passed with no problems. This one the technician thought was a little high, even though the readings were roughly the same as they had been in the weeks before.

She brought it to my OB, Dr Story, who told me that I was going to be sent to Swedish hospital again for observation and there was a very good chance that I was going to deliver. This was a full 3 weeks earlier than our even earlier due date. I started to cry. Like I said before, I couldn’t recognize why at the time and thought it was purely fear. Now I know it was a sense of failure for our son. Dr. Story told us to go home and pack a bag and then head to the hospital.

At home we quickly put our hospital bag together. Fortunately we had been talking about the contents for weeks (ok, I had been talking) and it was relatively easy to actually put together following our vacation.

We arrived at Swedish and I walked to the triage area where I was admitted and given the battery of tests including being hooked up to a fetal monitor again. Shortly thereafter we were given a room in the antepartum wing. It was a big, gorgeous room with a huge window that looked out over downtown and the water. The unfortunate thing was how much damn heat would come in, so after the first day, we would close the blinds as the sun would come in and try to keep the room cool.

The first day was all about getting a baseline of information. They were appropriately concerned that I would develop preeclampsia. Dr Story told me later that for most women with gestational hypertension (as I had), preeclampsia can develop and become critical in a matter of hours, which is why close monitoring was so important. I had to pee into a bowl so they could monitor my liquid output. For real. Fluid retention was a big concern.

Nothing materialized that day. Except my blood pressure being high, it was all normal.

Wednesday my best friend arrived from LA. Our baby shower was going to be that weekend, so he and my family from Florida were coming to celebrate. We had one scheduled for Saturday morning and Sunday evening. I kept my hosts updated on the progress and my friends quickly decided to cancel the Saturday event. We weren’t sure if I was going to be in or out of the hospital, but they seemed to think canceling was the right thing to do.

I was hopeful I was going to be out and could attend the one on Sunday evening with mine and Andy’s families and my best friend, who was going to be my son’s godfather. Wednesday also proved uneventful. We just spent the day watching West Wing, meeting nurses, getting lots of consultation from doctors. A team of doctors came in at one point and said “If we were on call tomorrow, we would induce you.” The evening doctors would come in and say, “We want to wait to induce you.” Basically every 8 hours when I would have a new doctor, the plan would shift.

At one point on Thursday I had a doctor tell me that there was a good possibility I could go home if I could keep my blood pressure stable. This woman would turn out to be the naysayer of all the other doctors. Doctors would come in and make a plan and she would be on the next shift and change it back. I got my hopes up about going home and being on bed rest at home. It turns out there’s a joke with the nurses at Swedish, “No one comes to a hospital to get sleep, they come to get well.” We were not getting any sleep and I wanted my big, cozy bed with the bedroom AC on at home. I was barely moving during the day because nurses and some doctors were scared of me being out of bed for laps around the hospital floor. But I knew if I stayed in the hospital room I would go fucking insane. The lack of activity made sleeping at night even harder.

On Friday my doctor, Dr Story, was finally on rotation at the hospital. He came to my room and I told him about how the doctor the day before had said I might be able to go home. He delivered the news that I was not going home until I had a baby. This is when he gave me the info about how preeclampsia could develop very quickly and at this point they knew it would come for me, they were just waiting until it got bad enough to start an induction. I told him I needed some stability with the planning. I told on the other doctor and how she had altered the plan already a couple times and could he please tell everyone to stick to something so I could prepare appropriately?

He agreed that the back and forth was likely the most stressful thing for me and had a lengthy chat with the other doctor. We heard from the nurses later that they actually had a bit of a public argument over my care and Dr Story laid down the law about keeping it consistent for me.

Saturday morning, after arriving late the night before, my mom, brother, and sister-in-law came to visit. We had a blast chatting and checking in. My sister-in-law was coming to the end of her first trimester so they kept activities low key and would visit twice that day.

Sunday morning the doctor on call, Dr Flum, saw my numbers were becoming elevated. My BP wasn’t getting any better, despite a high dose of Labetalol, and there was now elevated protein in my urine.

We would start the induction that evening.

All throughout this, Andy and I were routinely calling Kim, our doula, to give her updates. She came to the hospital almost every day to check in and we practiced birthing positions with things like all the fetal monitors and the potential for an epidural in mind. I was not interested in being in pain for long and was constantly reviewing my pain management options with the doctors and nurses.

That Sunday evening my sister-in-law, Malorie, Andy’s sister, moved our baby shower to the hospital. We had dinner and cake and opened gifts. Andy and I watched Game of Thrones with my brother, his wife, and my mom afterwards.

My nurse let me take a shower and then we got set up. I had an IV in my wrist with 4 ports that I lovingly called my keychain. My IV stand, Pepe, was filled with Magnesium Sulfate and Saline. We were ready to go.

Up next I’ll give the play by play of my almost 3 day induction and how we finally met our baby.

Check out Part 3 and Part 4!

Birth Story Part 1: How we got from decision to hospital

We’re coming up on the first birthday of the nugget, so I wanted to capture for posterity and curiosity what my birth experience was like.

First, let’s start with how we got here.

Andy and I knew we eventually wanted to have kids, but wanted the timing to be as ideal as possible. We got married while I was in graduate school and decided to start trying once I was out of school. I had an Implanon birth control implant in my arm and had it removed in January of 2015, just after graduation. We were going to give my body a chance to recalibrate to making babies and agreed to start trying that September.

After removing an implant it can take a few months for the body to re-regulate, but in April and May I had two periods like clockwork. Then I had irregular periods for a few months. Some very close together, others very far apart. It made it difficult to time when I would be ovulating, so we kept using other forms of birth control. Then in early November we “pulled the goalie” just to see what would happen. A few weeks after our first real attempt, I went to the doctor to talk about the possibility of having Polycystic Ovarian Syndrome. I had a lot of the symptoms and thought this might be why I was having irregular periods.

I met with my amazing doctor who said that I did, in fact, have PCOS. We agreed to let me try to get pregnant naturally for a few more months before trying on medication to make ovulation predictable. I got some blood tests done to check in about what variety of PCOS I had, meaning what hormonal levels was I dealing with. The results came back on the same day I was having some breast tenderness and on a whim I decided to take a pregnancy test. Turns out I was two weeks along and had been pregnant at the appointment with my doctor. The results were flagged and showed nothing about PCOS but everything about me being pregnant.

I remember I was laughing and crying at the same time as I read the test. Andy smiled when I showed him both the tests I had taken, but he was reserved and wanted to get an official result from my doctor before we got our hopes up. We drove to the GroupHealth building and I took, to my surprise, a pee test not dissimilar to the ones I had done at home. 10 minutes later we were in the car driving home and I checked my email. I found waiting for me my test results and confirmation that I was pregnant.

I remember calling my mom who also laughed and cried at the same time at the news. My brother said congratulations and how happy he was for me. My dad commented that I guess we didn’t need to get the turkey baster. No idea what that was about.

My symptoms started immediately. I had intense food aversions. I had nausea when I was in a car and sometimes during the day. I mostly wanted burgers and sandwiches and I wanted someone else to cook them for me. All during my pregnancy I would have aversions to water, vegetables, fruit, dairy, meat, cheese, and fish. This is where Andy and I would start joking about how the concept of “Intelligent Design” was bullshit. What intelligent designer makes reproduction include an aversion to water? Mostly cooking was what would cause the biggest reaction. Andy perfected his scrambled eggs and I got clever with water consumption using flavored fizzy water and adding citrus to my water bottle.

More than anything I was tired all during my first trimester. I would want to be horizontal most of the day. I would wake up and move to the couch, sometimes nap, but mostly just lay. My brain was foggy so I would have to be very judicious about working and fortunately only had to cancel one client meeting as a result of pregnancy symptoms.

Then, in the second trimester I went to a routine prenatal appointment and my blood pressure was high. I assumed it was stress because of work and a huge fight I had had with my dad. I was hospitalized for a day and had a few experiences that made me extra grateful that I had choses midwives over an OB. My biggest fear was receiving some sort of inappropriate treatment because of my fat body (though I am decidedly Lane Bryant fat and not the kind of fat that causes staring on the street, so I definitely experience I bit of privilege there).

While at the hospital I had a doctor tell me to eat more vegetables even though I said I was having aversions to them. She also told me it was important to exercise, which I was still doing regularly despite my growing pregnant belly and exhaustion. I was also working a job that had me on my feet about half the time, so I was getting more activity during my regular workday than the average American. It highlighted for me how this doctor made a lot of assumptions about my health based on my appearance rather than actually asking questions about my health and lifestyle. At one point when she asked how much weight I had gained and I said 30 lbs, she told me I should have only gained 20 at most. As if I could have changed it at that point. This subtle fat shaming in medical treatment is something I don’t experience with my regular doctor and hadn’t since moving to Seattle, so I was surprised by how this interaction went down. The whole thing left a bad taste in my mouth and made me desperate to continue my care with the midwives because of their natural assumption that I was doing my best to keep me and my baby healthy during the pregnancy.

I was released and had to start taking a regular dose of a blood pressure medicine call Labetalol. I also brought an OB onto the team, who turned out to be one of the most caring and compassionate men I have every met. He seemed to understand the fear I had for my baby and me and was aware of the drastic shift my pregnancy had taken seemingly overnight. The original due date was August 4th, Barack Obama’s birthday. Because of my new gestational hypertension, I would undoubtedly be induced around week 37/38 in mid July. Longitudinal research had shown that mothers and babies who were experiencing high-risk pregnancies would fare better if labor was induced early. I was emotional about it. Because getting pregnant had been relatively easy, I assumed my good reproductive genes would give me an easy pregnancy like my mom had had and the hospital visit was a blip in an otherwise normal pregnancy. At the time I didn’t recognize it as feeling failure, but in retrospect that is definitely what I was. I felt like I had failed our baby since I couldn’t carry him to term.

We hired on a doula at that point, too, realizing we would want some help navigating the  decisions we would have to make with the new course of action we were taking. We brought on Kim James, who I have talked about before.

What I didn’t know is that this would ultimately be the beginning of a really challenging journey with my health that would give me some incredible perspective on the kind of body I had and how lucky I had been up to that point. Next post I’ll talk about the hospital stay up to the start of my labor. It was a doozy and something I still think about regularly both from the perspective of a patient and an organizational development consultant.

Check out Part 2 and Part 3 and Part 4!