Friday, November 30, 2012

Evelyn's Story

{Author's note: This is a birth story. It's an honest description of my experience. It might seem a little graphic for some (there is mention of blood) but I hope it doesn't come across as scary. I'm not trying to be dramatic or frightening, just truthful (and I certainly don't want to trigger bad memories for anyone). I'm simply sharing my experience--and it was a positive experience for me, despite the fact that this birth was far from what I envisioned when we found out we were expecting again last March.} 
A week ago Friday was J's first official day of paternity leave. We had an appointment with the OB in the morning. Afterward we got some coffee and drove out to the beach to watch the waves and take a gentle walk. We were enjoying some family time--just the three of us--not knowing how much longer we would be a family of three. We stopped for lunch. I went to the restroom and realized I was spotting. I called the doctor and our midwife. The doctor said to monitor the bleeding for an hour and come in if it got worse. It did not get worse. It stopped completely within the hour. We went home and I spent the rest of the day in bed. 

In the evening I felt like the braxton-hicks contractions were getting stronger. I tucked L in bed, wondering if it would be the last time I only had one little girl to kiss goodnight. J and I went to bed. I woke up around midnight having what felt like slightly crampy braxton-hicks. I watched the clock for a while but the contractions weren't regular (or terribly strong...just stronger and crampier than they had been before). I went to the bathroom and checked for blood. No spotting. I fell back asleep.

A little after 2am Saturday morning I woke up and I could feel myself bleeding. I could feel the blood rushing out, soaking my pad, pants, and bed. I woke up J and asked him to get me a towel. I won't get into how much blood there was. Just trust me when I say it was a lot. A LOT. If I hadn't been so focused on getting to the bathroom, getting dressed, having J call the doctor and our midwife, getting to the car...it would have seemed a lot scarier at the time. As it was, J and I were focused on getting all of us out of the house and to the hospital and we both remained calm. Luckily we'd had the car packed since our trip to the hospital a week earlier (seriously, it one week prior almost to the minute). I tried to wipe up the bathroom floor a little and threw the towels in the washer on the way out the door. I remember thinking I didn't want L to see the blood.

L was awake when we put her in the car--slightly dazed but awake. We sang her Happy Birthday as we got on the freeway. It seemed crazy to think I'd been in labor with her exactly three years before. 

On the way to the hospital J told me the doctor said they'd have the operating room ready just in case. I told him if they thought a cesarean was the best thing at this point I had no argument. I could tell the bleeding had slowed significantly but I knew I wasn't really in labor. And there had been so much blood.

Our midwife's assistant, our doula (a good friend of mine), and my mother-in-law met us at the ER. Getting from the ER to labor and delivery was a comedy of errors. After explaining our situation and that the doctor was waiting for us upstairs they asked us to fill out paperwork even though we were preregistered. Before we started the paperwork they moved us to triage. Triage took forever and a day. When they finally started wheeling me to labor and delivery we got stuck in the elevator. The nurse taking us upstairs didn't have the code for the elevator. She had a list of codes and several written on her hand but none of them were correct. We sat in the elevator while she called people on her cell phone trying to get the code. I almost laughed when she said, "good thing you're not in labor". I didn't take the time and energy to remind her I was bleeding. Finally someone called the elevator and we rode the elevator to the 3rd floor. A housekeeper got in with us. He had the correct code and was able to take us to labor and delivery on the 2nd floor. I was taken to a room and everyone else was taken to the waiting room.

The doctor and nurses were waiting for me. Our midwife arrived a few minutes later (apparently the same housekeeper let her up in the elevator as well). The nurses hooked me up to the monitors and checked my blood pressure. Baby E was doing fine. The bleeding had slowed almost completely and I was just spotting. I kept asking them to bring J in to me. Finally they let him in. I can't remember the specific order of events at this point. I was answering questions, getting an IV, having blood drawn.

We noticed the doctor had the nurse fill out the paperwork for vaginal or cesarean birth. I appreciated him not making a final judgement at that point.

The doctor did a vaginal ultrasound so we could see exactly what was going on with the placenta. I was no closer to labor than I had been at our 36.5 week ultrasound. Baby E's head wasn't even all the way down against my cervix and my cervix was long, thick, and closed. This meant I was bleeding heavily even though nothing was happening.

We started to discuss our options. Because I had had two, increasingly severe, bleeding episodes without being anywhere near labor, the concern was that once things actually did start to move (cervix thinning, dilating, etc.) there would be a much more severe hemorrhage (which was honestly hard to imagine) or a complete abruption of the placenta. On top of that, there was concern about me having more bleeding before labor started. Being so far from going into labor (based on the ultrasound I was still possibly several weeks out from real labor) there was very little chance I would go into labor without more bleeding. With a previa (apparently it's still considered a previa even though it had cleared my cervix) it's typical for the bleeding to get progressively worse each time (again, hard to imagine it being worse than that morning).

We had the option of staying in the hospital and waiting it out a while longer (even though it looked like it could be weeks) or going ahead with a cesarean birth. The doctor gave us maybe a 10% chance of a successful vaginal birth and a 90% chance of needing a cesarean if we wanted to wait and attempt a vaginal birth. That 90% seemed like a huge risk. The idea of sitting in the hospital, waiting to see if I started bleeding again was scary. If I started bleeding again (whether I went into labor or not) there was a huge risk the bleeding would be really, really severe and I'd end up with an emergency cesarean, possibly requiring a blood transfusion, and possibly endangering myself and baby E. That sounds really dramatic written down but that was the situation. 

{I should mention at this point that the doctor was really wonderful. I was surprised and grateful. He was the same doctor that kind of freaked me out at our 28 week ultrasound. After that appointment I would have expected him to sign me up for an ultrasound whether I'd had any bleeding or not because my placenta wasn't sufficiently far enough from the cervix in his opinion. But he didn't. Fortunately I wasn't bleeding heavily by the time we got to the hospital and we had time to discuss options. He had been briefed by our doctor and he was willing to let us wait if that was what we wanted. Despite the fact that I have no idea where he got the percentages he told us, he laid out the risks without being overly scary. I didn't feel like he was trying to scare us into consenting to a cesarean or even pressure us at all. He was very kind and honest about his comfort level with our situation but respectful of the fact that we had been hoping for a natural birth.}  

The doctor gave us time to talk with each other and our midwife. My gut feeling was that we needed to go ahead with the cesarean birth. A vaginal birth no longer seemed important. Baby E was healthy and I was healthy and it didn't seem worth risking either of us for a remote attempt at having a natural birth. Honestly, I was scared of bleeding again. J felt the same way. Our midwife had the same concerns as the doctor. She was fully aware of the risks of waiting and the increased risk of serious hemorrhage. She felt a cesarean was the best option as well but she was also very supportive and respectful. She helped us weigh the risks but let us work through our process and make a decision before giving us confirmation of our choice.

If I'd been closer to labor things might have been different--the pressure of the baby coming down on the edge of the placenta might have stopped any bleeding and allowed for a natural birth. But that wasn't the case. The situation changed the moment I first started bleeding the week before with no signs that labor was imminent. We weren't low risk anymore and the risk had increased to a point where the choice seemed obvious.

We called the doctor back into the room and told him we'd decided to go ahead with a cesarean birth. I thought he looked relieved. From that point things moved really quickly. I signed some paperwork and they described the process. We gave L lots of hugs and explained she was going to meet her baby sister very soon. At some point someone voiced the fact that L and baby E would have the same birthday. It hadn't really registered until that moment. We talked to the doctor about making the birth as natural as possible and made sure they knew we planned to room-in with the baby even though we'd been unable to sign up in advance. The doctor agreed to delay the cord clamping if possible. Baby E was to go straight to me after the birth unless there was a medical reason to do otherwise. 

The anesthesiologist came in to introduce himself and explain the process of getting a spinal (the anesthesia for surgery). He was quite possibly the kindest human being I've met in a long time. He was absolutely wonderful. He was so reassuring and respectful. I had been crying a little bit by this point. It was entirely overwhelming to be processing the fact that I was about have a cesarean birth and that we were going to meet our second daughter in a matter of minutes. At the time I was only slightly aware of how strongly I was suppressing all my emotions. I didn't want to lose control of myself.

J got all dressed up for surgery and they wheeled me down the hall to the OR. I remember looking at the ceiling and the walls and thinking how surreal the whole situation felt.

The nurses told J he had to wait in the hall while they prepped me for the birth. They moved me to the surgery table and administered the spinal and put in the catheter. The anesthesiologist never left my side. He explained everything and was very calming. I tried to take deep breathes and not break down completely. I shuddered a few times trying not to cry. They offered to give me medication to calm me down but I declined and somehow managed to pull myself together. I wasn't necessarily sad or even disappointed, just overwhelmed. I was scared of the surgery and, at the same time, I was anxious and excited to meet our baby.

Despite how emotional I was sitting there on the operating table, I went into the surgery with no regrets. I had no doubt that we had made the right decision.

Once everything was ready they brought J in and the surgery began. I couldn't feel any pain. I could feel pressure and my body being pulled and shaken a little. It felt hard to breath. The anesthesiologist was right there reassuring me (and J) that everything I was feeling was normal as he adjusted the medication to keep my blood pressure normal and the nausea down. Before we knew it we heard our baby crying. Someone called out 4:57am. I had tears streaming down my face. The doctor told us there had been meconium and blood in the amniotic fluid so baby E needed to be checked out (the doc said later he thought the crampy braxton-hicks contractions I'd been having were due to irritation from the bleeding). They never took her out of the OR or out of our sight. We could see them suctioning her and wiping her off. She was crying and pink all over. She looked strong. It seemed like it took forever but it was really only 3 or 4 minutes before they put her on my chest. She was perfect and healthy (we found out later her Apgar score was a 9).

It was such a relief to have her close to me. After a few minutes she started breastfeeding. By 5:22am they had finished the surgery and I was ready to move to recovery. The doctor told us he'd been able to delay the cord clamping.

In recovery, the nurses broke the rules and allowed everyone to come see us at once. L was exhausted but very excited to meet her baby sister. It was reassuring to have L with us. It somehow helped me process the reality of the situation. I had both my girls and my husband with me.

I couldn't believe how fast it all happened. Less than 3 hours after I woke up Saturday morning, we were holding our little baby in our arms. She and I were both healthy. I had been waiting almost 9 months to see look on my husband's face as he saw his newest little girl and the look on my daughter's face when she saw her baby sister for the first time. I tried to stay in the moment and savor those looks and the joy of our growing family. Everything was a little fuzzy.

My blood pressure was very low. I started feeling nauseous and a little faint so my MIL took L home to try to get some rest. Our midwife agreed to check again later. J stayed with me. The nurses adjusted the medication to keep my blood pressure up. I heaved but (thankfully) I didn't throw up. I hate throwing up. I felt like I was going to fall asleep a few times but I stayed conscious. I had J take baby E because I was afraid I couldn't hold on to her.

The nurse came and weighed and measured baby E. She was 7 lb, 9.4 oz and was 20.5 inches long.

At some point I remember thinking how bizarre it was to see my legs and not be able to feel or move them. I felt like I had someone else's legs attached to my body. We stayed in recovery a little over two hours (it was supposed to be an hour but we had to wait for the shift change) and then they moved us into a regular room.

Nearly two weeks later I feel like I'm still processing the birth and everything leading up to it. My husband read through this post and commented that I'd shared all the facts without delving much into my emotional experience. This is true. I'm not quite there yet. Someday I'll figure out how to get in touch with all those emotions I ignored during the birth and, maybe, someday I'll feel inclined to share them publicly. They're not bad emotions, I'm just not sure how to articulate them yet. Even sharing this much has been difficult. I've read this post thru about a hundred times this week and haven't been able to hit publish. It seems so final.

I still have no regrets about our decision. I'm thankful that the doctor and staff enabled us to remain empowered throughout the situation and helped us have a positive experience. Although the choice felt obvious, the decision was ours. I'm glad the situation allowed for us to make a conscious, educated decision. I'm thankful that, although our cesarean birth was far from being elective or scheduled, it was not a true emergency either. We weren't running down the halls to the OR and it wasn't an immediate life or death situation. I'm thankful that we'd known (and in many ways accepted) that a cesarean birth was a possibility since we found out about the previa at 20 weeks. I'm grateful that we could still retain parts of a more natural birth that were important to us and I'm glad baby E never left our sight. And I'm glad we only had to spend two days in the hospital.

It's good to be home. I love being home. I'm so glad to be home. I love having a little baby in the house again. I love seeing the glow in L's face when she kisses "the small sister". I love trying to fit them both on my lap to nurse at the same time. I love having J home with us everyday. I love watching us figure out our life as a family of four...

It's been an amazing, emotional, challenging couple of weeks and I know it's only going to get better from here.

Okay, this is it. I'm going to hit publish now.

This post is part of Seasonal Celebration Sunday and Tuesday Baby Link Up.

5 comments:

  1. Wow. I cannot believe how this brought back all the emotions of my c section from three years ago. Even now, I have a hard time processing what happened. And I can't believe how much our stories mirror each other. I am SO glad you were able to have a more gentle c section. It sounds like the hospital and staff did a wonderful job of accommodating you and your desires. That is fantastic. Big hugs to you Em! If you need a listening ear, you know where to find me.

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  2. Thank you so much for sharing your birth journey with us. CONGRATULATIONS ON THE BIRTH OF YOUR SECOND DAUGHTER!! Rebecca x

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  3. I know that wasn't exactly the experience you were hoping for, but I am so thankful that surgical birth is there for us when it IS necessary. So happy you and your family are doing well and healthy! Thank you so much for sharing your story!

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  4. I'm glad everything went well! Congrats on your baby!

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