Thursday, June 13, 2013

still falling on the wrong side of statistics

This post could also be titled, "How Dr. Save my Life."

If you read my previous post, you know that I got my much wanted VBAC and found it to be much better and easier than my C-section.  MBL, Finn, and I enjoyed 2 nights in the hospital post birth, even going as far as ordering pizza the last night we were there as we knew it would be pretty non-stop once we were home again.  We were discharged around noon on Monday, May 20th and we were pretty excited to get back home and back into every day life, especially since we had seen Piper so little over the previous 3 days.  We all took naps and then ordered Thai food for dinner.  We got to bed at a decent hour and Finn slept awesome!  Everything seemed great until about 5am the following morning.  I woke up to feel a migraine coming on.  It started in the back of my head and wrapped itself around my neck and up the sides of my face.  I also had heartburn.  I thought it might have been from the thai food we had the night before--maybe MSG poisoning?  I took a Tyl.enol, a Vico.din, and some ibuprofen.  Around 6:00 or so, I decided that laying down was actually making my head hurt worse, so I went downstairs and told MBL to bring me Finn if he woke up.

Not long after I had settled myself in the recliner, MBL appeared with Finn.  At this point I had done some googling on migraines post partum and the scariest thing I read said that it could be post partum pre-eclampsia as the first and most prominent symptom is usually a headache.  After getting Finn latched on, I had MBL go get the blood pressure monitor so we could see what mine was.  He took it once and got 180/90.  I took it and got 190/90.  At this point, we decided to call my doc. While we were waiting for her to call back, MBL took it again on my other arm and got 190/100.  When she called back she had MBL take it again, but made him pump it up even higher as she was concerned we weren't getting the top number accurately.  MBL got 200/110.  I'm a 110/60 kind of girl and only had a few readings of 135/80 with Piper's pregnancy and absolutely nothing over 125/75 this pregnancy.  My OB noticed that on my chart and said that we couldn't wait until the office opened at noon and we needed to head to the ER immediately.

I was home for less than 24 hours and found myself headed back to the hospital for what I was pretty sure would be a 24 hour stay.  We called my mom, who had left for work for the day, and told my dad what was going on and that we needed to leave both our kids with him (including our 3 day old).  We were out the door within 20 minutes.  We arrived at the ER and I was thinking that maybe all of this was a fluke...  Maybe MBL took my blood pressure incorrectly or maybe it was just exhaustion or maybe my blood pressure spiked because my head hurt so bad.  I kept thinking that maybe I was just being overly dramatic.  They took me back to triage and it was confirmed that I was not being a drama pants...  My blood pressure was 180/100.  Within an hour and a half of arriving, they had done a CT scan, a chest xray, and an EKG.  They had also given me a bag of Magnesium Sulfate.  My favorite part was when they were able to rule out head trauma or any issues with my heart because it meant that I could finally be given something for my headache! A dose of dem.erol later and I was feeling a little better.  The ER doctor came in and told me my OB was on the phone and that I needed to speak with her.  She told me I was officially being diagnosed with "atypical late onset post partum pre-eclampsia" and that I had earned myself at least 24 hours in the hospital on a magnesium drip.  We called my parents to let them know I was being admitted and soon we were on our way back up to Labor & Delivery.

I spent the next 24 hours on the Mag which meant I could only have popsicles/toast/ice/water, I couldn't get up to go to the bathroom alone, and they had to measure my "output".  By the end of those 24 hours I couldn't stand up alone and could barely hold my eyes open.  All of that meant that I couldn't hold my baby (who had also been admitted due to jaundice and low body temp) and the meds I was given for my massive migraine meant that I had to pump and dump.  Not at all how I imagined the first few days of my baby's life going.  My BP finally went down to an acceptable level (140/90) after I peed out 7 liters of fluid.  That's right, y'all, I was retaining over 2 gallons worth of fluid!  It seems that getting rid of that was all I needed to get out of hypertensive crisis.  We were released on Thursday just in time for out of town visitors to arrive for Piper's birthday!

So, why the title of this post?  Well, pre-eclampsia occurs in 5-8% of pregnancies and is usually cured at delivery.  Post-partum pre-eclampsia that occurs ONLY after birth (as in I had no symptoms prior to delivery) happens in only 5.7% of pre-eclampsia cases, which means that I stood only a .3% chance of getting it.  In other words, I stood a 99.7% chance of NOT getting it, but get it I did.  Oh, and I didn't mention it in my birth story, but Finn was born with a true knot in his cord.  Having that happen is VERY rare (1 in 2000 births or .0005% of pregnancies).  Our nurse (who has worked OB/L&D for 15+ years) said that when they find it on ultrasound they usually admit the patient around 32 weeks for constant monitoring and then take the baby around 37/38 weeks.  I NEVER would have been allowed to VBAC if they had known.  Basically Finn and I are both extraordinarily lucky to be alive and well.  Often post partum pre-eclampsia isn't diagnosed until after the mother has suffered seizures and I caught it before that point.  And having a true knot can be really dangerous for the baby, but Finn was born without any issues, he didn't even have a problem tolerating labor.  I am counting my blessings and praising God that I have access to good medical care.  I have also declared that no one can make fun of me for being scared of rare complications in my next pregnancy as I am walking proof that it is possible to fall on the wrong side of statistics more often than not!!

Sunday, June 2, 2013

my surprise vbac

I started writing this post when the baby was a little more than 24 hours old...  That was 15 days ago!  Whoops!  Better late than never, right?

It's no surprise to anyone who's been following along for a bit that with this second pregnancy, I was hoping to VBAC.  I knew that there was no guarantee that I would get to VBAC, but I wanted to at least try.  I spent weeks and months doing what I could to give myself the best chance possible and that included running until 34 weeks pregnant.  The week before I was due I walked 13 miles just trying to get my little guy's head to engage and help start dilation.  When I went to my due date appointment and heard that I was only 1cm dilated, I nearly cried.  There was little else I could do to make my body do what it should have been doing.  The week prior I had scheduled my repeat csection for Thursday, May 16 (3 days overdue), but we decided to reschedule to Friday after MBL's travel schedule changed.  The receptionist even went ahead and scheduled my 2 week post operative appointment.  I decided I would still walk and do what I could to get things to move along, but that I wouldn't beat myself up if I ended up making it to my scheduled section.

All week long I was having contractions and by Wednesday they would start in the morning and intensify in the night but weren't getting painful enough.  By Thursday I was at peace with how my second birth was going to go and spent the day finishing off the last of my to-dos and playing with Piper.  We topped the day off with dinner at a nice restaurant out on their patio.  I went to bed ready to meet my son the next morning.  I got up and got ready, then I got MBL up, and I even had the chance to see Piper before we left for the hospital.  We arrived at 8:30am and started getting ready for my 10:30 csection.  Everything seemed so relaxed and easy.  We were going to have a baby in the next few hours!  We spoke with the nurse, the anaesthesiologist, and my OB.  MBL got his scrubs and I signed all of the necessary paperwork.

At 10:00, I happened to ask the nurse if my contractions had been registering.  I just wanted to know how close together they were.  She responded with, "You've been having contractions?" and I told her that I had been for over a week and they were more frequent, but not as painful as I knew contractions were supposed to be.  She asked when I was last checked and I told her Monday and that I was 1cm, slightly effaced, and posterior.  She said she wanted to check me to see if I had any progress and I had, I was now at 2cm.  She declared 1cm to be enough change for her and went and got my OB.  Next thing I know, my OB declares me a "tight 2cm" and says she's breaking my water.  All I could say was, "right now?".  And the next thing I know they're telling us to grab our stuff because we were moving to a different room.  To a room equipped to handle labor and delivery.  It all happened so fast that I barely had time to process it.

Soon we were "checked into" our L&D room and we just waited for contractions to get more painful.  I was contracting on my own every 2-3 minutes which was great!  After an hour or so my nurse came back to check me and said I was still at a 2 and suggested I get up to walk around as that would help.  Soon MBL and I were pacing the halls.  Sure enough, my contractions became more painful and I would have to stop to work through each one.  My parents came to visit with Piper and so we spent some time in the room where I alternated pacing and bouncing on a "birth ball".  I felt confident we were making progress.  My nurse came back to check and declared me a generous 3cm and 80% effaced.  More progress!  I was committed to staying moving as that seemed to help things along, so MBL and I continued to pace the halls after my family left.  Around 4:00 I realized that my contractions were getting pretty darn painful and that if I didn't ask for pain meds soon I might not be able to sit still.  My nurse had promised to come back at 4:30, so MBL helped me work through the contractions until she got there.  When she told me I was 4cm (my goal dilation before the epidural), I told her I was ready for the anaesthesiologist.  After finishing up a C-section, he came in to help me!  It was around 5:15/5:30 by the time I got my epidural and started feeling relief.

At that point I was limited to being in bed and MBL and I passed the time talking and watching TV.  We also finally realized we had never updated his parents on what was going on, so he gave them a quick call to let them know that we had not had the C-section and were waiting on baby's arrival.  When our nurse's shift was ending, she came in to check on us and spent some time chatting with us about her experience as the Nurse Manager for a fertility clinic--15 years ago!  It was interesting to hear her perspective on what went on there--as it was back in the days of transferring 3-4 embryos to younger women where a lot more people ended up pregnant with high order multiples.  She was by far the best nurse I could have asked for and it was nice to spend some time talking with her.

Around 9:30/10:00, my new nurse came in to check me and said I was only a 6 (I had been a 5 shortly after getting the epidural).  That meant they were going to be upping my Pitocin.  Fast forward to 11:00 or so and I am literally trying to crawl my way out of bed because I can feel each and every contraction and they are 10,000 times worse than the ones prior to getting my epidural.  I am in so much pain that I get the shakes and start dry heaving.  The nurse comes in and says to push my pain med button more often and see if that helps, it doesn't, so the anaesthesiologist comes in and gives me a bolus of meds.  By this point, I am in so much pain that MBL called my mom because he couldn't handle not being able to help me, so she gets there and tries her best to help me with the pain.  Eventually, the bolus kicks in and we all try to get some rest.  We send my mom home around midnight and tell her we will call when it's time to push.  Sadly, the bolus doesn't last long and soon I'm in a lot of pain again.  I get two more boluses of meds, but for whatever reason the only part of my body the meds worked on was my right leg.  That part of my body was total dead weight and I could not feel a single poke or prod.  Every other part of my body was still fully aware of what was going on.  I begged my nurse for a sleeping pill or IV pain meds as I was really feeling like I couldn't handle the Pitocin contractions.  She told  me I couldn't have either, but she did turn the Pitocin down temporarily.  I basically passed the next few hours clinging to the side of my bed, wondering why I chose to go down this route instead of having a spinal and a C-section.  Soon, though, my nurse came in and checked me and said I was 9cm and almost entirely effaced.  She said I would be complete by 5:00 and so I counted down the contractions until that time and, sure enough, when she came back I was fully 10cm and effaced.  Since the baby was at 0 station, we decided I would labor down for a while.  Around 5:45 she came in and had me practice pushing for 10 minutes or so and then told me I had to stop or she would be the one delivering our baby.

It seemed like forever until my OB got there, especially since I could feel every single dang contraction.  During the wait for my OB, my mom arrived and I started throwing up.  Lovely.  My mom was fantastic and stood by my head and brought me cold wash cloths.  When my OB arrived we were finally able to really start pushing.  It was HARD.  I cried.  I threw up some more.  I got the shakes.  In between contractions and pushing, I would occasionally lament the fact that I had chosen a VBAC instead of a C-section (jokingly, of course).  My OB was incredible.  Encouraging me and telling me I could do this.  The only person I wanted to punch in the face was my nurse (she was a nightmare all night).  After 20 minutes of pushing, Fin.ley (Finn) was born!  The relief I immediately felt was incredible.  They put him on my chest and I immediately forgot all the pain of the past 18+ hours.  MBL cried, my mom cried and they took Finn to get weighed.  He was a big boy at 8lbs4oz and 21 inches long.  His head was 15 inches and well over the 90th percentile.  I had a second degree tear that required some stitches, but that was it.  They had me up and walking around within half an hour of him being born.  Here he is just moments after being born:

I cannot believe the difference between my C-section and my VBAC.  The recovery has been night and day and I can't believe I actually got to have my vaginal birth even though labor refused to start on it's own!  Turns out my body isn't entirely broken!