Oscar's birth story

Jan 01, 2010 00:06

I never got around to writing this up; I'm doing it now just because despite the fact that I have a steel-trap memory, I'm sure some of it is getting lost with time.

I'm leaving the first week postpartum, during which we were both still in the hospital, off for now.


So I was admitted Thursday afternoon, with bp of 220/116 and a +4 dipstick, and triaged. I'm needle-phobic, and told the girl with the IV needle that. She suggested that I sing, because it would keep me from getting light-headed. The first IV went through the vein, the second IV wouldn't thread back. They switched to the right arm and managed to site it. Did I mention I'm needle-phobic? I think I managed 17 verses of "Row, Row, Row Your Boat." "You sing very well," she said, as she was leaving.

Then the perinatologist came in and looked at the records my midwife had faxed over. "Wow, what did Dr. X do to you?" she asked me. "These look great, right up until this morning. I mean, you had trace protein and a 130/80 last week, but there's nothing odd in any of the bloodwork... well, do you have a headache? Have you had a headache?"

Nope, I said. I did have a sinus headache yesterday, but I also had compacted sinuses, and the headache went away when I squeezed the bridge of my nose.

"Sounds like a sinus headache," she said. "You didn't do a full GD workup?"

Nope, I said. "Well, we'll check that," she said.

Then she palpated my liver, asking "Does this hurt?"

Sometime during this discussion, a few other people had come in to the triage room. One had an electronic cuff and took my bp on the right arm. Blinked. Said to (I assume) the nursing supervisor, "I'll get a different machine."

I said, "It was 220/116 about an hour ago. So if you think it's reading high, it's probably not." She switched machines anyway, then stared at the second one and said, "Wow. Okay, not the machine."

One was wheeling a ECG machine and hooked me up to it; another was carrying a bag of MgSO4 and another of labetalol and hooked me up to those. Someone else whacked me on the knee, then said, "Look at this," and whacked me again. "+4. Was that a beat?" someone said. At this point, I counted. There were seven medical personnel in the room.

Someone else started to draw bloodwork from my left arm.

Someone squeezed gel onto my belly and started a BPP. Five minutes later she was done, with the baby scoring 8/8. "It's not affecting the baby yet," she announced. "Estimated weight 5 pounds 12 ounces."

They ran through the bolus of labetalol and then everyone left the room but one woman responsible for the cardiac monitoring. After half an hour, convinced that my heart was functioning well despite pitting edema, I was unhooked. Then a nurse came in to do a cervical check. I asked, "Why bother? I'm not having contractions."

She tried to do it anyway.

She had short fingers. Kept slamming the web of her thumb against my pubic bone trying to touch my cervix. Finally gave up, saying "I'll just say high, tight, and closed."

That was far and away the most pain I was ever in during the whole thing. I mean, damn, lady, your fingers aren't going to get any longer. And what could it possibly tell you, anyway -- with a first-timer at 33 weeks 5 days who's not having contractions, what are the odds that the cervix is going to be favorable?

They wheeled me in (laying down on the gurney) to a room easily eight times larger. I asked why they didn't just leave me in the smaller room -- it wasn't as if I was going to be walking around.

I was hooked up to fetal monitoring belts and propped on my left side, with instructions not to move from it unless I absolutely had to. Someone came in to cath me; I declined and asked to use the toilet instead. They okayed that, and put a hat in to catch the urine so they could run a 24-hour proteinuria.

J. and I decided, at this point, that he probably ought to call my violin students and my teacher and cancel all the lessons I had scheduled for the rest of the week. It was early evening; with some of them, we were instead providing an explanation for why I hadn't shown up that afternoon.

At that point and for the next 48 hours, I had someone in the room about every 30 minutes either a) checking my bp and asking about headache, visual disturbances, and abdominal pain, b) drawing bloodwork, or c) giving me a steroid shot in the ass. During any given shift, I had a nurse in the room for 15 minutes out of every 30; during two shifts, I had a nurse in the room constantly, probably because J. had left (to eat, to teach.)

Later someone explained to me that if they routinely moved all the preeclamptic patients to ICU, they'd need to double the size of the ICU, and that most L&D nurses are trained to provide ICU care so that preeclamptic patients don't have to be transferred.

Getting up to pee was something of a balancing act, what with the muscle relaxant effect of mag and the IV pole. Then again, I wasn't peeing much.

I was absolutely ravenous throughout, just as I had been throughout pregnancy -- scarfing down my hospital food. J. had figured out where the "father food" was on the L&D floor, and kept bringing me sandwiches and fruit. After my bloodwork came back they had me on a fluids restriction, what with the crappily functioning kidneys.

One nurse said, "I hear you were planning a homebirth. I just want you to know, we really support those, and we also really support transferring care if things start to go wrong. We won't judge you for trying."

At 23 hours, one of the nurses accidentally dumped my 24-hour catch.

One of the phlebotomists managed to make me squirm and bite my lips. Shortly afterwards I developed green and yellow bruising up and down the arm which lasted until a good two weeks later. Another of the phlebotomists was amazingly gentle (and I got lucky and had him to do three of the draws.)

Dr. X stopped by several times over the two days to poke my liver, ask about headaches, and update me on bloodwork, which was now being run every four hours. One of those times he said, "You don't have HELLP syndrome. But I don't know why. Your platelets hung at 2 above the diagnostic cutline. You also don't have gestational diabetes."

Another time, after they'd completed the 24-hour, I asked, "Well, is this considered mild, or severe?"

He answered, "Definitely severe -- your protein is over 17,000. That's the highest I've ever seen. Diagnostic is 300; diagnostic for severe is 5000. I have no idea why you don't have HELLP. Besides, your pressures are high enough to be diagnostic alone. I have a call in to see if we should manage you with steroids; you're close enough that it might be worth it for a few days, to keep the baby out of NICU."

Another time, "You aren't acting like someone on mag. You're way too lucid. What's your background?" I answered him. "Oh, so you actually *are* a rocket scientist! Okay, I wondered; you're asking questions I never hear from any of my patients."

I never slept.

My pressures had dropped to 150/90 with the bolus, but they were creeping steadily back up.

A nurse came in with O2. Apparently I was desatting occasionally, because I was developing pulmonary edema.

A neonatologist dropped by to tell us about the likely prognosis for a 34 weeker in NICU. 99% chance of survival, 99% with no morbidity. Those are good numbers when you're delivering at a time you think of as two months early. He let us know he and a nurse would be there for the delivery, ready to care for Oscar. He mentioned that they tried to avoid c-section deliveries if possible, because the babies breathed better, and I told him that given my likely Bishop's score, I wouldn't be too surprised to get one.

He asked, with surprise, "How do you know about Bishop's scores?" I answered, "Well, I was planning a home waterbirth. I've read a thing or two." He said, "Oh! You're a homebirther! Well, I just have to let you know, you're being a wonderful mother. I've had several homebirthers come in with this after everything was too late; I mean, there was nothing to do for the baby."

Sometime Saturday afternoon they did another BPP. This time it took an excruciatingly long time. The woman doing it had her daughter with her; I had a conversation with her about how most pregnancies didn't go this very wrong. I asked if it was a boy or a girl at some point, and she was able to show us that it was a boy. In the meantime, he wasn't terribly reactive, and wasn't bothering to practice breathe -- in retrospect, the mag and labetalol had likely lowered the placental perfusion somewhat, plus the progression of the PE was probably beginning to affect the ability of the placenta to transfer blood as well, since my immune system was busily picking a fight with it.

Sometime on Saturday, Dr. X came in and introduced me to Dr. Y, who was taking any of his cases that went a) haywire b) into labor in the next 24 hours.

I'd started reporting near-constant visual hallucinations, whether from not sleeping or the cerebral squeeze I do not know. Still no headache or epigastric pain, though, and I hadn't vomited since admission.

At around 7:30 Saturday night, the 48-hour steroid window closed. I'd gotten my two shots and theoretically any improvement to the baby's lungs was now accomplished. So Dr. Y offered me either Cytotec or Cervidil. I picked Cervidil, saying I didn't really trust Cytotec off-label yet. A few minutes after she left, a nurse came in with the Cervidil and, while installing it, and asked why I'd declined the Cytotec, saying she'd seen it work wonders on a lot of people. I answered that I knew they had vastly more work experience with it, but that the double-blinds I'd seen just made me uncomfortable. Again in retrospect, I was completely damn right on that one, since in later studies Cytotec has been strongly linked to placental abruptions in preeclamptics.

J. and I had just finished watching SNL (the one with John McCain) when a nurse came in from the nursing station. Oscar had had a big decel and a long recovery time from it. Dr. Y came in and talked to me and to the nurse. Somehow, at this point it came up for the first time for both Dr. Y and me that the BPP had been a 4/8 -- "if after 26 weeks, deliver."

"Why didn't they tell me that when they did it? Is that enough for you?" she asked. "It's enough for me."

I signed the consent forms and got prepped with a cath and a shave while J. changed into scrubs -- he had been about to leave for the night -- and we headed into surgery. An anaesthesiologist there said, "I don't know about this. Her blood pressure's so high." (It was somewhere around 200/100 -- I am still on the max dose of IV meds and mag at this point, of course.) Dr. Y responded, "Of course her blood pressure's just a little bit high. You're about to stick a needle into her spine."

They got it sited and I swung my legs up and they strapped my arms and dropped the curtains. Someone asked J. if he wanted to watch. Crouching down by my head, he answered, "No, thanks. I'm used to her outsides."

"How are you feeling?" asked the anaesthesiologist. "Cold," I answered. "Well, she's already done the first cut," she said. "Here, I'll give you something for the shivering. That's a common side effect."

I know J. and I talked about something for about two minutes at this point, but have no memory of what it was. The OB had turned on music and so Oscar was born to Marc Cohn singing "Walking in Memphis," which is certainly not the track I would have picked. They got him stabilized, weighed him (at 4 pounds 14 ounces, I'd say the ultrasound was off by that notorious full pound) and wrapped him in a blanket with a hat and brought him over to us.

We said, "Hi, Oscar!" and he opened his eyes a little and blinked at us. Someone thought to unstrap my right arm so I could touch him. After about a minute they needed to take him to NICU. J. wasn't sure if he should stay with me, or go with Oscar; I asked him to go take care of Oscar and a nurse said something like, "Yes, we really would prefer that the father come along with the baby; your wife's going to be in recovery for a while and you can help us get him situated."

birth, oscar, preeclampsia, pre-eclampsia

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