Friday, March 23, 2012

Avery Reed's birth story - or how we learned Murphy's law

"If anything can go wrong, it will" - Capt. Edward A. Murphy

I knew that birthing Avery wouldn't be easy.  I planned a vaginal birth after cesarean for months.  I did the research.  I knew the risks and benefits.   I drank gallons and gallons of red raspberry leaf tea, nettle infusions, and took organic, whole food prenatal vitamins.  I did my best to keep the stiff person symptoms under control, and walked around as much as my muscles and sore pelvis would allow.  I managed to accept that I may need help from the anesthesiologist during labor, and that a cesarean may be needed to keep both of us safe.

March 5th, 6:30 AM - I am scheduled for induction.  Knowing that my body is having a very hard time managing the pregnancy, and that the baby is big, I decided to take the offer of induction.  We show up at the hospital after a restless night of sleep, and before the sun is up.  The nurses got me into a labor suite, and finished any questions that weren't included in the online registration.  The monitor wasn't working well, but showed that I was having contractions on my own every 10 minutes or so.  I asked for a birthing ball, figuring that I would like to use it once I could feel contractions.  The nurse told me I'm in charge, especially considering my medical condition. I feel pretty safe with her.

10 AM - I had requested that my port be used, and I was informed that the vascular access team would have to come down to access my port.  OB nurses do not have a need to access ports, and I understood that they didn't feel comfortable starting the line.  I wouldn't, either.  It involves sterile process and jabbing a needle into a small disk near the heart.  Several emergency cases postponed my induction by a few hours.  By the time my line was started, my OB came by expecting to be able to rupture my membranes.  My nurse and OB told me that they wouldn't be doing many internal exams, since they're just painful and I'll know when things pick up.  

Around noon - I am feeling contractions every 4-5 minutes.  The contractions don't feel like I expected.  When you mention being induced, it is a storm of horrible stories of pain, anesthesia, and complications.  I felt a little crampy, but I didn't need to breathe through contractions.   I go back and forth between sitting on the birthing ball, swaying, and resting on the bed to make the monitor work better.  (The hospital's computer system was crashing, and neither the internal or external monitors were working well on me.)

4 PM - I have to concentrate now to get through the contractions.  The contractions still are not what I would consider painful, but I stop what I am doing until they fade away.  I'm dilated to around 3-4 centimeters.  My OB came by to break my water.  I notice a small amount of meconium and tell my nurse.

9 PM or so - I'm at about 4-5 centimeters.  The internal contraction monitor must have slipped out when I went to the bathroom, and the nurse wants to place another.  The external monitor isn't working at all at this point.  They can feel the contractions, but the monitor won't show them.  My nurse and her replacement for the night came in to place the monitor.  Because there is no external monitor, one nurse has her hand on my belly while the other works.  Right when the nurse placing the monitor went inside, I started having a contraction.  It felt like I was being split in half.  I started screaming, asking for it to stop.  They were done with the monitor, and it still wasn't working right.  I started having contractions back to back.  I'm getting no relief.  I ask for something in my IV, and get a dose of Fentanyl.  It takes the edge off, but something feels very wrong.  I had a bad feeling in my gut and was praying that I wasn't right about something going wrong.  My doctor came by to check on me again at some point.

9:30 PM or so - I can't handle the pain. I'm crying and screaming through contractions, and they're coming back to back.  I can't find a position that is comfortable.  I feel like I might be in transition, but it doesn't feel right.  I ask for an epidural and a pelvic exam.  I've made no progress with dilation, and baby hasn't descended.  Emotionally, I am a little crushed.  I have a feeling that I won't be able to birth Avery vaginally.  My nurse asked if I was sure about the epidural. She wanted to make sure that I wanted the medication, because I had told her that I would like to avoid an epidural if possible.  I told her to get the anesthesiologist. 

10 PM - The anesthesiologist places the epidural.  They tell me that I'm a champ because I am able to help move myself and can feel my toes and lower legs after the medicine kicked in.  Not long after, I start feeling horrible.  I want to vomit. I feel like I'm going to pass out.  My door slammed open and my OB, anesthesiologist, and a few nurses come running in.  My blood pressure is at 54/48.  I am gagging and retching and Adam had left the room to go get food.  My mom raced out of the room.  I found out later that she was trying to find him.  I was stabilized with epinephrine.  The staff started to filter out one by one, only to have my blood pressure crash again.  I was feeling jumpy and sick from the epinephrine.  

10:30 PM - My OB comes back in to let me know she's comfortable waiting several more hours before checking me again, and that a c-section was available if I wanted it.  She left the room so that Adam and I could talk.  I couldn't do it.  My body couldn't handle the relentless contractions.  The back to back pain without a break was too much.  I felt like I was crawling out of my skin from the low blood pressure.  My body was shaking from the SPS, the pain, and the stress.  I held Adam's hand, and then my sister's, and asked for my doctor.  Avery would be there soon.  I bawled as I told my doctor that we'd take the c-section.  I was told that things would go quickly, and before I was done talking to my doctor, Adam was being given scrubs.  Things were packed up quickly, and I was rushed into the operating room. 

11 PM - I am laying in the cold, sterile operating room.  I can't stop the tears, and I can't do anything about the full body shaking.  I try with all I have to calm the shaking, but it just won't stop.  I feel so wrong about the c-section.  I wanted a "normal" birth.  The anesthesiologist has to give me more medicine to numb me for the surgery.  My blood pressure starts to crash again.  I can't move, I can't feel my belly, and I can't stop shaking enough to get my mouth over an emesis bag.  The doctor stabilized me only to have me crash over and over.  The anesthesiologist keeps telling me "Calm down. Stop shaking. It is bad for your condition." My OB tells him repeatedly that he's horrible at psychology and should give it up. 

11:15 PM - Someone tells me that Adam is coming in.  He doesn't feel that close to me because of the nurses and anesthesiologist bustling around to keep me stable.  

11:16 PM - Avery is here! He comes out screaming (which will be the cause of later issues), grabs onto my doctor's gown, and then manages to pee all over the doctor and my belly twice.  It feels like forever, but finally a nurse brings him over to me.  I can't move, and I'm too shaky to touch him, but I give him a nuzzle and tell him that I love him.  Avery is taken off to the nursery and Adam follows with him.  I over-hear that I've lost two liters of blood.  They're able to stop the bleeding, but my blood pressure still is unstable.  The anesthesiologist has my port maxed out and is trying to start another line in my arm, but can't find a vein.  I'm taken into recovery.

March 6th, 12 AM - Three nurses and both anesthesiologists are around my bed, trying to figure out why my blood pressure won't stabilize.  I ask for my family, but I'm told that they need me to stabilize first.  A nurse manages to find a vein after being poked about 25 times, and it is in a horrible spot.  My port is maxed out, and they're running fluids in both lines.  Blood is drawn to see if I need a transfusion.  I am vomiting and squirming and unable to find any comfortable position.  I still feel like I'm crawling out of my skin.  When my blood pressure crashes, I feel like I'm not even in my body.  I'm there, but I'm not.  I have a fever above 102 degrees.

At some point Adam and a nurse come back with the baby, and then leave until I'm stable.  I asked for them again as soon as I stopped shaking and vomiting violently.  I'm able to nurse for a little bit.  I recognize Avery's nurse and through the haze, realize she's the sister of a girl I went to school with.  She said that he's breathing quickly and she'll be back to reassess his breathing.  

3 AM or so - We're wheeled out of recovery and upstairs to the postpartum area.  I drew the short straw, and got a nurse that I do not like for some reason.  I can't figure out why.  His nurse comes back in, and says that he's still breathing to quickly. She'll be back again, and if he is still not doing well, he has to go for observation.  Avery still isn't doing well when she returns.  Adam follows Avery and the nurse to the newborn nursery for observation.

4 AM - Avery's nurse comes in, followed by Adam, and two nurses with a transport incubator.  I break down crying.  They tell me to not worry or be scared, but I'm terrified.  I ask that they have someone update me as soon as possible since I am alone in the room.  Just like that, they are gone and I'm alone with my nurse.  I realized then why I didn't like her.  

She would walk in, and start pulling up my gown to check my belly, pulling down my blanket to check the bleeding, and would leave me exposed when she left, all without saying a word.  She didn't let me know, or ask, she just did it.  I couldn't bend to cover myself back up.  I couldn't turn off the lights that she left on.  I couldn't shut the curtain.  I was in horrible pain from the pressure cuffs on my legs.  She refused to take them off to make sure they fit right.  I was told to deal with it.  I was crying from the fear for my son's health, and because I was in so much pain.  I couldn't think of who to call, and I couldn't reach Adam down in the NICU to find out what was going on.  At some point, the nurse slapped a post it note with the number to the NICU on it instead of just calling for me.  It turns out that she gave me the wrong number, and I couldn't call even if I could calm down enough to place the call. 

I felt so exposed and icky from that nurse treating me like I was a nursing school mannequin.  I was exhausted because she left me cold, exposed, and in pain.  I didn't manage any sleep.  By the time the sun started to come up, I knew that I would have a new nurse if I could just manage to wait another hour.  I still hadn't heard if Avery was okay or not. 

7:30 AM - I finally get a new nurse.  I asked her to take off the pressure cuffs for a little bit, and she does.  When I looked down, I realized that the backs of my legs were bruised from my heels to the middle of my calves.  My arms were bruised from armpit to fingers from the multiple failed IV sticks.  I still was crying, and unsure of who to call.  I didn't want to wake up my mom or sister, or anyone else for that matter. be continued.

Wednesday, March 21, 2012

an open heart

Every few weeks, we pack up a bag of snacks, books, magazines, etc. and head to midtown for my infusion.  I am usually there for about five hours, for three days in a row.  While my condition is neurological, I spend those days surrounded by cancer patients in the oncology department.  I could think of better places to spend three days so soon after having a baby, but all in all, it isn't so bad.

I am amazed by the men and women that filter in and out during my treatments.  They don't fuss.  They don't complain.  I had to hold back tears today.  The woman next to me spiked a high fever and had to be transferred to the ER.  While she was being helped to her wheelchair, she was apologizing to me. Why?  Because I had to put down the footrest of my recliner to let them in with the chair. 

I found out from a nurse that the other patients have been asking about me.  They were concerned that I was going through chemo so soon after giving birth.  She assured them that I was okay, and that it wasn't chemo.  Most wanted to ask about the baby.  To ooh and ahh.  To smile. 

Through it all, I try to remember that others have it worse.  That life actually hasn't dealt such a rough hand.  Many of these folks DO have it worse, and it makes you think. 
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