Tuesday, July 9, 2013
Another Birth Story
As a little background, it took quite some time to actually get pregnant. We started trying actively in the early fall 2009, and I got pregnant in January 2010. But unfortunately, this pregnancy ended in a miscarriage at 8 weeks. It was a devastating loss for me, and I had a very hard time picking myself up emotionally.
But we kept trying. And I got fairly aggressive about it. I did the LH surge (ovulation predictor kits) tests every month to time things just right. I also kept track of everything in terms of my cycles. With my midwifery knowledge, I soon realized that we were dealing with a very short luteal phase (any where between 8-10 days). Because of this I contacted an infertility physician and got started with the process. I'll leave it to that, as this in itself could be take up an entire post by itself.
In December 2010, I took a pregnancy test for the sole purpose to stop using the disgusting progesterone suppositories. But it was positive. I couldn't believe it. I did two more over the course of a few days, and each one was positive (with a progressively darker line on the stick).
So started my pregnancy with my daughter. And now after years of working with pregnant women, having studied all sorts of normal and abnormal pregnancy stuff as a midwife, thought I'd have a good handle on it. I was wrong. I also thought that I'd enjoy being pregnant and the experiences related to it. Again, I was wrong.
I hid my pregnancy, which wasn't hard given my weight and body size, until about 20 weeks at work. The two nurses I worked with on a daily basis knew I was pregnant because I was so nauseous and had about two whole foods I could tolerate for most of my pregnancy that it was difficult to not share with the people who saw me all day long.
Around 28 weeks, I started to physically feel like a pregnant women in the sense of the weight. My pelvis hurt almost constantly and my two close nurse friends at work told me I waddled. I was also diagnosed with gestational diabetes around this time, and found it so challenging because my food aversions were so strong. There left very little for me to eat to keep my blood sugars down while actually liking what I was eating. But somehow within three days of diagnosis, I had controlled my sugars with diet alone.
Except on a rainy, crappy, June Saturday when I turned 31 weeks, I felt terrible. Just extremely tired, achy, not right. Nothing specific but I spent the day laying on my couch and knitting. I ended up in bed by 8:30pm that night because I was so exhausted. My last blood sugar of the day was in the 130s, which was high for me at that time. But, nothing about that day triggered anything in me that something was wrong.
At 2:15am, I woke with a start. I remember quite clearly thinking, "Oh my gosh! I can't believe I slept this long without needing to pee!" at the exact time I felt hot warm liquid coming out of me. I jumped out of bed quickly, afraid that I was peeing the bed. But by the time I reached the bathroom, I knew that this was not urine. My inability to control it, not to mention the classic amniotic smell I was more than familiar with was the tip off. I hopped on the toilet and it was just pouring out of me. When I stood up, it poured all over my bathroom floor. There was so much freaking amniotic fluid that I was worried if the cord had prolapsed. I wasn't feeling the baby move, but in the two or so weeks prior to this I wasn't feeling much movement anyhow.
I was at the hospital within 30 minutes. I wasn't contracting, at least what I could tell, but the fetal monitor was showing contractions every five minutes. It was pretty obvious my water broke, so much so that the doctor only did an exam to collect specimens for infections as a possible cause and to visually look at my cervix, which was completely closed.
The plan at this point was to admit me, keep me on bedrest and monitoring until 34 weeks, then induce labor. I'd get the standard preterm premature rupture of membranes plan. Antibiotics, bedrest, steroids, no vaginal exams.
My daughter and body had other plans entirely. By 6 am, I was contracting uncomfortably enough to not be able to talk during them. By 7 am, they were getting stronger and closer together. By 8 am, I was totally unable to cope, and my plans to hypnobirth went right out the window. My husband kept leaving the room (more on this nonsense at another time), and my planned doula was already post-call (she was a midwife friend of mine), and my nurse had another patient that was very needy. Oh, and the hospital I delivered at was the hospital I worked as a labor nurse. They knew me, and I knew them. This was good and bad. The good at this moment was that I told my nurse that I needed her to get rid of her other patient. She totally obliged. And also, it just happened to work out that all of the staff that was with me during my labor and birth were all doctors and nurses that I enjoyed working with. I did feel safe knowing that I was in their hands.
My contractions at this point were every 2-3 minutes and totally awful. I needed to take my glasses off and press my eyes with an ice cold washcloth in order to not literally rip my eyeballs right out of the sockets. I seriously was thinking that I needed to rip my eyeballs out during my contractions. Totally irrational, but that is what I felt. Many of the contractions were not fully relaxing in between peaks, and it was feeling like it wasn't letting up.
By 9:30am, I had an epidural.
Yes, you read that right. I. Got. An. Epidural. At my request.
It was placed before I even realized we started. It worked like a charm. Fortunately, no visible side effects (because you know once I was feeling less pain, I was looking at that damn fetal monitor). Around 10:30am, my daughter's heart rate took a dive. All the usual stuff was done to help it go back up, and it did. The doctor checked my cervix and I was 5 cm.
Another heart rate dive occurred at 11am, and now I was 7 cm. About 15 minutes later, I was feeling some pressure near my pubic bone, and I was complete at +2 station. Everyone got ready for my daughter's imminent birth.
I started pushing at 11:20, and my daughter was born at 11:41am. She came out like a rocket; I felt her head literally "pop" right out and seeing the doctor fumble a little at catching the rest of her body as it shot out. Initially they placed her on my belly, and she had only her right eye open. She looked just like me in my own newborn photo, and I even said this out loud. But she was whisked quite quickly to the neonatologist and NICU nurse.
Vera was born quite vigorous (I think she had APGARS of 7 & 8), and the neonatologist was very happy she showed such good signs. But within minutes, she very clearly was having some respiratory difficulty, and turning a bit gray. They wrapped her up, brought her over to me for a quick kiss before she was put into a rolling isolette and brought to the NICU.
My adrenaline kicked in, and I felt ready to jump up and run to the NICU to be with her, but of course was reminded that I needed to take care of a few things on myself. I needed one stitch inside my vagina, but that was all. I examined my placenta, which was as large and healthy looking. Actually, it was as big as a full term placenta.
The official cause for my preterm birth is unknown. All tests were negative for any type of infection, and there was no other obvious reason documented. However, my own diagnosis was polyhydramnios (too much amniotic fluid). Had I not given birth, the following day I had an ultrasound scheduled because my fundal heights were measuring very large. I believe at 30 weeks, the doctor had measured 40 weeks. Also, in hindsight, the fact that I started to feel less fetal movement was probably because there was so much fluid. My belly, until the moment all that water came out of me, was as tight as a drum. And I had one of the biggest known risk factors: gestational diabetes.
But, because there was never an official amniotic fluid index done prior, no one can actually formally call it so. But, that's very likely the cause.