Happy due date, Lucy Mae! As I sit here, I can't help but think, I'm still could be pregnant!! However, little Miss Lucy had her own plans and we have had the pleasure of enjoying her in our arms eighteen days early. Three days after my last blog post, Lucy made her dramatic, and somewhat early entrance into this world. Things didn't go as I had hoped for, dreamed about and had expected - but she is here, in our arms, happy and healthy - and our hearts are so full.
40 weeks - May 1st, 2017
I hesitated to share her birth story, for many different reasons. However, since struggling with infertility, to both pregnancies and everything in between, being open and sharing our story has helped tremendously with some of the really tough times. I also use this blog as somewhat of an open journal that I can look back on and hopefully share with Harper and Lucy one day. So here goes nothing...
Things started on Wednesday, April 12th. I was working a 12 hour shift at the hospital. I woke up with a slight ache low in my abdomen on the right side. I was also very nauseated, which was very unusual. Work was thankfully not too hectic. But after throwing up breakfast, and still feeling uncomfortable, I had a fellow midwife check me...unfortunately my cervix was unchanged. Still only 1cm dilated. "Okay, maybe this is just prodromal labor, and could go on for a few days" I thought to myself. I left work and went straight home for a bath, phenergan and early bed. I gave Harper a bath but was too out of it to make it upstairs for our bedtime routine, so Dad took care of that while I fell asleep by 7pm.
I was scheduled to work the next morning, April 13th at 5am. After getting plenty of sleep, I woke up feeling better (so I thought). The right sided pain had moved more central, and reminded me of the bladder discomfort I experienced while in labor with Harper. However, I will still downplaying everything that I was feeling, and went to work. I had only been working for about an hour when I had to beeline to the bathroom to throw up again. I really had not kept much down, including water, in over 24 hours. The midwife I was working with advised me it would be best to head down to triage for IV fluid, IV antiemetics, and fetal monitoring. I happily obliged as I knew something wasn't right.
The next few hours to follow are somewhat a blur, yet still replay over and over in my mind everyday. Once I got to triage, I was put on the fetal monitor. Her heart rate was high from the get-go. Normal fetal heart rate ranges from 110-160, her's was in the 180's and went as high as 200 (not good). We assumed this was due to me being so dehydrated, which can cause fetal tachycardia, so the nurse started an IV to hydrate me quickly. I proceeded to throw up again while in triage, so they gave me IV Zofran to help with that. Unfortunately, the IV wasn't flowing great, but with some hydration on board, her heart rate still wasn't coming down. They went ahead and started a second IV that was working much better. While all this is going on, my abdominal pain and contractions were getting worse and worse. I was contracting every minute. The doctor on call as well as the midwife I was working with came down to see me in triage. I was so relieved to see them, but equally worried as they don't often see patients in triage - they usually wait to see them once they arrive to labor and delivery. It hit me - this was serious. My cervix was checked and I was unchanged... 1cm/thick/high. The outer portion of my cervix was 3-4cm, but ultimately that meant nothing with the inner part not being dilated.
At this point, all things considered - my diffuse abdominal pain, contraction pattern, unchanged cervix and most importantly, Lucy's nonreassuring fetal heart rate - the possibility of a cesarean section was discussed with me. I lost it. I was alone, Phil wasn't at the hospital yet. I was in pain and so terrified at the though of her wellbeing being compromised and me having to have a c-section. We decided to start some antibiotics, IV tylenol, continue IV hydration and move me to labor and delivery for an epidural. I was so hopeful and praying as hard as I could that the IV fluid would eventually bring her heart rate down, and the epidural would help me to relax and ultimately start to dilate. I've seen it happen a million times while working, surely it could happen to me. This is my second baby after all!
Once on labor and delivery, the nurse and nurse anesthetist were waiting for me. These were my colleagues, my friends. I was so relieved they would be taking care of me, yet still, I was terrified, and tears were streaming down my face. As I was rolled into the room, I noticed a c-section pack (a bag filled with items to prep a patient for a c-section when needed from L&D) sitting by the sink. I didn't want to believe I was going to have a c-section, but seeing that only made me more fearful of all that was happening.
The epidural, of course, couldn't go as planned either. My most favorite nurse anesthetist was taking care of me, and I know she's not too keen on caring for coworkers (curse of the nurse, right). Well, after three attempts (a positive test dose and blood in the tubing twice) they finally got it. The whole time, I was in so much pain, and only becoming more and more scared of all that was happening around me, and to me. During the epidural placement, Phil showed up with Harper, and it broke my heart for her to see me so upset. I tried my best to put on a strong face, but I definitely lost it a few times in front her. Phil did a good job keeping her calm, but thankfully, the nurses on the unit took care of her until my Mom made it to the hospital to take her. It kills me that my last interaction with her as my only child was so chaotic and scary. The thought actually makes me tear up still. I gave her a big kiss, and couple of butterfly kisses before she left the room.
The midwife rechecked my cervix after the epidural - still unchanged. I'm pretty sure this is when the decision was made that I needed to have an emergency c-section as her heart rate pattern continued to be nonreassuring and ultimately started to deteriorate. *Cue breakdown* This wasn't happening to me. I was literally in shock.
The anesthesia team was pumping me full of medicine, and I laid there as my body went numb.
I couldn't move.
My husband was getting dressed to go into the OR.
My nurse was performing the preoperative prep on me.
I was put into a gown specific for c-section patients.
My body was being loaded with IV fluids and prophylactic antibiotics.
A catheter was placed in my bladder.
I was shaking uncontrollably - mostly due in part to the epidural and IV fluids.
I was asked to sign the consent for a primary cesarean section as well as a consent to receive blood or blood products in the case of an emergency.
The OR nurse, who I know and have worked with, came in to get report.
There was no turning back - I was having a c-section.
The sobbing was uncontrollable at this point.
When I say I was terrified, I don't want that to be misconstrued that I felt as though my care wasn't good enough. That couldn't be further from the truth. I know I was being cared for by the very best, and if anything, I was getting special treatment.
When I say everything that happened to me was truly traumatic, it's not because any one did anything wrong. The medical staff all had my well-being and Lucy's well-being as their number one priority.
I say this because this wasn't my plan at all. I had 1-2 hours to discover there was a problem with my baby, and accept that fact that I was going to have a c-section. It's impossible to comprehend something that monumental in such a short time frame, and even harder to accept. It was all completely out of my control (isn't it always when it comes to pregnancy and delivery). I felt helpless. I've actually never been more scared in my life.
It wasn't long before I was moved from the labor and delivery room to the operating room. Everything happened so fast. I would't have gotten through it without my amazing nurse anesthetist at the head of the bed keeping me calm and talking me through everything. However, I'm on the other side of the curtain every day at work - I knew what was happening. I know that the awful smell at the start of the procedure was my flesh being cauterized and burning. I know the "slight pressure", and "a little tug and pull", was my insides being stretched opened. It's very frightening knowing too much in a situation like that. I tried to keep my mind occupied with random thoughts - thoughts like "OMG her first birthday will be on Friday the 13th", as well as "Wow, her birthday all adds up, 4+13=17....4/13/17". You do what you gotta do.
Before I knew it, my uterus was cut open and a few seconds later, they lifted the clear drape up and I saw this squishy, vigorous, angry little lady being pulled from my womb. Lucy was here. She was crying. She was safe. What a relief.
She was rushed to the warmer where the NICU team looked her over. They weighed and measured her - 7 pounds 2.2 ounces, 20 inches long. Her Apgar score was 9/9, the closest to perfect you can get. I was a bit preoccupied with intense gas pain under my diaphragm as well as still fighting uncontrollable shakes. But eventually they brought her to me for skin-to-skin. I was so grateful they were able to offer this to me. Lucy also latched right away and I was able to breastfeed her for at least 20 minutes in the operating room. She was a ferocious eater from the get go.
Once Lucy was delivered, the placenta was delivered. After examining my placenta, the doctor found evidence of what we all suspected - a placental abruption. My placenta was was partially separating from the uterine wall before delivery. This compromised blood flow to Lucy, and thus compromised her wellbeing. His guess was that there was a 40% abruption, meaning almost half of my placenta had begun to detach itself too early. Had the placenta become completely detached, her life, as well as my life, would have been in danger in a matter of minutes. While I never experienced the classic symptom of vaginal bleeding, I did experience severe abdominal pain/tenderness as well as rapid, back to back contractions. As for why this happened - I don't think we'll ever know.
Due to her high heart rate and the fact that she felt warm at delivery, a diagnosis of chorioamnionitis was also made - basically an infection inside the uterus and amniotic sac. She and I never did fit the classic diagnostic criteria, but better to be safe than sorry. She was taken to the nursery for antibiotics and monitoring - I too was started on three different antibiotics for 24 hours. Luckily, Lucy's blood cultures came back negative and the antibiotics were discontinued 48 hours later. Neither one of us ever had a fever either.
Since the c-section, my physical recovery couldn't have gone any smoother. I was up less than 12 hours after her delivery and walking around the unit multiple times each day. My pain was tolerable and well controlled with oral pain medication. Lucy roomed in with me the entire stay, and she was an excellent nurser from the start. I left the hospital two days after delivering. My recovery has still gone great at home, minimal pain, taking short walks outside, physically feeling pretty good.
My emotional recovery - that part has been more difficult. The entire morning leading up to Lucy's birth was nothing short of a nightmare. When I would feel pain from the operation, it wasn't the pain that hurt, it was the reason behind the pain that made me cry. I was recovering from an unplanned, emergency c-section. I couldn't just jump up and go back to normal. I couldn't pick up Harper when she came to visit. I was forced to recover from a major abdominal surgery. ME! That part was and is so hard to accept. And then there are the times where I feel like a failure. Or even worse, thoughts of did I do something to cause this? Did I workout too much? Did I work too hard? Did I not eat the best diet? Did I not drink enough water? Did I not listen to my body soon enough? I know nothing I did caused this, and those thoughts will eat you alive if you let them. I am learning to move past them day by day.
I had the most amazing first baby experience with Harper - I had a 4 hour labor from the time my water broke to the time she was delivered. I only pushed 30 minutes. It was truly flawless. I expected the same experience this time, except maybe even quicker. Coworkers and friends teased me about how quick I would go. I drove with a bulb syringe and cord clamp in my glove box just in case she came too quickly and we couldn't make it to the hospital. From the moment I peed on the pregnancy test and it was positive, I craved labor. I yearned for it. When I got pregnant, I was finishing midwifery school and felt as though I was much more prepared to identify when I was in labor (I thought I had a UTI when I was in latent labor with Harper), as well as had the tools to cope with the pain of labor more efficiently. When I went to triage that morning, I was not at all prepared to have a baby, let alone a c-section two hours later. I was getting treated for a possible stomach bug and dehydration after all. That dream of experiencing labor and ultimately, another vaginal birth was taken from me in an instant.
Now, when I say things like that, I already can hear the comments - "how selfish, you say you're mourning the loss of a vaginal birth as you hold your healthy baby - don't you realize how lucky you are", or "you need to just move on now" and the one I'm guilty of saying "at least you have a healthy baby and you are healthy as well". Excuse my language, but are you fucking kidding me? To suggest I would chose the experience of a vaginal birth over the health of my baby is not only absurd, but also highly offensive. I've seen first hand women who refuse a c-section when it is truly medically necessary, and then immediately regret that decision once the child is born not breathing, requiring resuscitation. I'm not that stupid or unreasonable. So please, do us both a favor and keep those unnecessary and disrespectful comments to yourself.
I hold Lucy, and tears stream down my face as I think of all the what ifs...
What if I didn't go into work that morning?
What if I had stayed home instead and dismissed the pain I was feeling until it was too late?
What if I walked into triage a few hours later, and the nurses were unable to find a fetal heartbeat? What if I didn't get to take a healthy baby home?
I am grateful that I was at a facility that prompt recognition was able to occur, and a speedy c-section was able to take place. I am so grateful for the doctor and midwife who were on call that day, as I truly thank them for saving Lucy's life. I am grateful that I had the most amazing staff taking care of me, one of their own (which is never easy to do). I am all for medical intervention when necessary, and in my case, it was absolutely necessary. C-sections are not the enemy when it's medically necessary - surgeons with the skill of performing c-sections are gifts from God who hold the ability to make it possible for women, such as myself, to hold my baby alive in my arms. I am grateful. We often hear the horror stories from women who were forced to have a c-section against their will, and criticize the medical staff taking care of them. Let me be clear - this is NOT the case in my situation and I am forever grateful for those who cared for me that day. I trust every decision that was made. I can't even begin to name and personally thank everyone that helped us that day - but you know who you are and I am so thankful for you. To the nurses who took care of Harper and calmed my Mom down when she got to the hospital, to the doctor and midwife who helped bring Lucy into the world and everyone in between - we will never be able to thank you enough.
However, at the same time, without apology, I am allowed to grieve and be upset over the way it all went down. I am also allowed to be upset that I was robbed three weeks of my pregnancy. I truly loved every single second of being pregnant, and I wasn't prepared for it to be over that day. I am allowed to cry. In fact, it took 11 days for me to make it an entire day without a single tear. I am allowed to be sad. I am allowed to look at my scar with anger and disgust right now. I hope one day, I am able to look at it with love, and know that I have a permanent scar to remind me just how lucky I am to be a mother - but that day is not today. I should be free to have these feelings without criticism or judgment. Being in the profession I am in, I feel as though there is no room to be upset about having a c-section, because "we should know better". Or "it's just a c-section, it's not that big of a deal". But I don't really give a crap - I will forever be somewhat heartbroken over this experience. Before you pass judgement or make assumptions, please remember that your experience or your expectations about having a c-section was not my experience.
Now, almost three weeks later, emotionally I am feeling much better as each day passes. I am on an emotional rollercoaster though with many ups and downs, and with both good and bad days. I am beginning to be able to talk about it without crying (most of the time). I am taking care of myself as well as my girls. I am asking for help when I need it and allowing others to do things for me (not an easy task). I am focusing on taking my time with my recovery and not pushing myself too hard too soon. Let me tell you - THAT has been the hardest part as I am dying to just get up and go, and start working out again. I am working on moving on and using this experience to be a better midwife. I have experienced the most perfect, flawless vaginal birth - as well as the most terrifying emergency c-section. Having lived first hand both ends of the spectrum, I feel as though this will only enhance the care I provide to my patients. As a new nurse midwife, and former labor and delivery nurse, I know how we can lose empathy and run on autopilot when things aren't going as planned. When things get bad, we usually have to do things quickly and without much explanation or involvement with the patients desires and wishes. While I understand we must remain objective in this profession, I think a little compassion goes a long way. I'll admit, I am guilty of rolling my eyes at a patient's thorough, written out birth plan from time to time, or not understanding why a women would be upset about a c-section in the case of something such as a nonreassuring heart rate pattern to ensure a healthy baby for her to take home - but I totally get it now. I will never joke about, pass judgement, or downplay a women's emotions or wishes for her birth.
Lucy's birth wasn't what I had dreamed about - but let me tell you, this baby is better than my wildest dreams. And seeing Harper interact with her, hold her and give her sweet kisses, my heart literally hurts as it bursts with pride and joy. My two girls are my entire world, and I am so grateful God picked me to be their Mom. I am one lucky lady, and I truly know that from the bottom of my heart.
A special thanks to Photo de Chavannes for capturing these precious memories for us just two days after Lucy's arrival!