The Beginning of Wisdom

One week before her birth.

I guess the story really starts a little over a week before she was born. On Wednesday I had a noticeable increase in swelling in my legs and feet, which isn’t really abnormal in pregnancy, but I was concerned about how quickly it came on given the fact that I have a history of pre-eclampsia. I checked my blood pressure on and off that evening and it was elevated, but not really concerning. Still, I called the doctor the next morning to see if she wanted me to have any lab work done in preparation for my appointment on Friday. She preferred to see me in the office on Thursday and decide from there what labs to run. So I went in to discover a totally normal blood pressure and that I had a really bad UTI that would skew any of the lab tests that would help us determine if I had pre-eclampsia again. I took antibiotics for the infection, scheduled the lab tests for the following Monday and made an appointment for the following Friday.

Since the lab ran the tests on Tuesday I fully expected a call about them on Wednesday. When I made it through the day without a phone call, I was shocked and I remember thinking on Thursday morning that I was actually going to make it to my appointment on Friday without incident, which I hadn’t expected. About the time I finished that thought, I got a call from the nurse saying that my test came back “quite elevated” and they needed me to come in for an office visit. I arranged child care and went. Again, my BP was just slightly elevated, but the lab test showed that I was 4 times over what’s considered pre-eclamptic. We decided to induce labor the next day, starting with cervadil at midnight, then a foley catheter and a little bit of pitocin the next morning. This is very similar to what we did with Pebble’s induction, but with him I was terrified of pitocin. Pitocin made my labor with OED (my first) very, VERY difficult to cope with. The experience with Pebble (my third) was totally different and I decided this time I wouldn’t be so afraid to use the pitocin to get things going.

By 8:00 am I was 4-5cm dilated and we started the pitocin at 2 units. I was determined that I would have a baby by noon and thus when my contractions started to space out a little bit, I’d ask the nurse to go ahead and bump the pitocin up a couple of units. I was up to 4 units and in a good contraction pattern pretty quickly but was really having to focus on keeping the darned monitor because every time I breathed wrong, the baby’s heart rate would stop reading and it would pick up mine. We eventually realized that if you listened, the monitor was picking up baby’s heart rate even though it was registering my heart rate on the tracing and the digital display. I would listen to make sure baby wasn’t having any issues and my nurse would come in occasionally to listen and try to get a minute or two of baby’s actual heart rate onto the tracing. Once I stopped worrying about the stupid monitor so much, my contractions picked up a lot in intensity and I started feeling some pressure with them. I asked to be checked at 10:40 or so and was frustrated and disappointed to find that I was still only 4-5, though baby had dropped considerably (from a -3 to a 0 or +1 station).

We bumped the pitocin up a final two units, for a total of 6 and things started to get intense quickly. Around 11:40 I looked at the clock and whined to La Roca that I wasn’t going to make my goal of having a baby by noon. At 12:15, after quite a few contractions that required counter pressure and/or a heavy dose of a double hip squeeze to get through, I told La Roca I was going to have someone check me and if I was still 4-5 I was getting an epidural and I wanted him to understand that I was dead serious and I really wanted to do that if I wasn’t making any progress. In my head I knew that if I was working this hard without any progress, something wasn’t right and maybe an epidural would help, but I couldn’t manage to express all of that to him. I told him to get my nurse, who he found was eating lunch, so some other nurse offered to check me. I was fine with that, but sobbed when I found out that I was 9+ centimeters with a bulging bag of water and there would be no epidural in my future. The scrub tech and my nurse came in to get things situated. Since no one had any gloves on when Pebble was born and he literally fell onto the bed, as soon as I had an urge to push, I made my nurse glove up just in case Dr. T didn’t make it. My water broke and I started to really push right about the time Dr. T walked into the room. Ad Lib was born at 12:38pm after something like three pushes. It was my fastest and easiest labor, possibly because she only weighed 6 pounds 2 ounces. And if that were the end of the story, it’d be the perfect induced-but-unmedicated birth story. But anyone who knows me knows that as much as I try, I never seem to hit the “perfection” mark.

As I dried Ad Lib off and talked to her, I immediately noticed two things: she had a full head of hair and my mother’s beautifully shaped nail beds and long, thin fingers. While I was getting to know her, we waited on the placenta. I should stop here to say that we knew the placenta had some issues, including a funky cord insertion, called a velamentous insertion. This means that instead of the cord attaching to the middle of the placenta as normal, the cord actually attaches to the amniotic sac and then the cord vessels traverse the membranes to the placenta. With this type of insertion, it’s really important to wait until the placenta separates on its own and to have a hands-off delivery of it. As we waited, I had some contractions and signs that the placenta had separated, so I pushed a little bit, thinking it would all be over soon. Instead, the membranes and cord came out, leaving the placenta behind. I remember this moment so clearly. Even more clearly than her actual birth, which is upsetting. It was like time stood still while everyone in the room—and there were quite a few of us—looked at that bin the placenta was supposed to be in and collectively thought “oh, shit.”

We tried a few things, including nursing and some other things I’ll spare you the details of, but it became clear pretty quickly that they weren’t going to work. Since my hemoglobin was low, I was at higher risk of bleeding and I wanted to get the placenta out as soon as possible. We opted for a trip to the OR for a D&C and/or manual removal. The anesthesiologist came in and Dr. Tynes went to square away her clinic patients (yeah, if you were sitting in the waiting room forever that day, it was my fault…sorry!) and my nurse went to get the OR ready. After some questions, the anesthesiologist left me and Jason…alone…in the room. I was freaked out by that, knowing that my body was trying to clamp down my uterus but couldn’t (I sure could feel it trying, though), so I was on edge for any signs of bleeding. I started to feel a little cold and nauseous—signs of shock–and had La Roca call the nurse. She came in and noted that my uterus had gotten bigger, not smaller (a sign that it’s filling up with blood) and got me into the OR pretty quickly. As everyone was getting me and everything else settled in the OR, I passed out, which freaked everyone out and prompted them to order two units of blood for me.

Here’s what I remember: I remember my husband telling Dr. T to “be sure you bring her back because I can’t do this alone” as he held our newborn daughter. I remember being disturbed by the idea of someone else’s blood going into my body, but glad that I wasn’t morally opposed to blood products. I thought for a moment about refusing the blood, then thought better of it because I knew it would take me literally months to recover from a blood loss like that and having three kids at home to take care of, plus a new baby, I wouldn’t get the rest I needed to properly recover. I remember scribbling on the consent line for the blood. I remember that my IV was blown, in spite of the fact that it had just been dripping pit into me less than an hour or two before. I remember telling them to get a line in me NOW because I was sick of cramping and bleeding and I wanted to be DONE. I remember making a concerted effort to feel EVERYTHING so that I wouldn’t pass out again, which meant that when they pulled the tape off and tried to reopen the IV line in my right arm, I whined about it hurting. I remember telling the guy on my left–twice–that he better tell me before he stuck me for the new IV line. I remember my doctor “petting” my leg and belly and talking to me so I wouldn’t pass out again. I remember someone commenting on that and I remember telling whoever it was that Dr. T loves me because I push her outside of her comfort zones. I remember them putting something in my IV and putting a mask over my face and asking me to count down from 10. I remember asking if this was the anesthesia and them saying that it was just oxygen. I remember thinking that IT WASN’T “just oxygen” because next thing I knew, I was awake. I remember the first thing I asked was how much blood I lost. I remember my doctor asking me if I wanted to see the placenta (God love her, she knows me too well!). I remember that I was so groggy I said no, even though I had been waiting five months to see and touch that darned thing. I remember being really upset that the hospital was Catholic and therefore she couldn’t do a tubal while I was under anesthetic. And I remember going back to my room, seeing La Roca and Ad Lib sitting in the chair in the corner, and asking if I’d be able to nurse. I meant would my milk come in because of all the blood I’d lost, but the anesthesiologist responded that he hadn’t given me any medications that were incompatible with breastfeeding. I remember thinking “oh, well, that’s good because I didn’t even THINK about that.”

Dr. T talked to La Roca and filled me in on some things that I don’t (or can’t) remember: she ended up doing a manual removal. They had to give me two shots of brethine to get my uterus to relax enough for her to do the procedure and even then she had a hard time finding an edge of the placenta that would release. She wondered at one point if it was an accreta and she was going to have to do an emergency hysterectomy, but it wasn’t, which is a good thing because unless my uterus is threatening to kill me, I’m determined to keep it until I die. I’m a little attached to it. She managed to remove all of the placenta, but it came out in pieces (I have pictures if you’d like to see them). Apparently I said “I don’t care if you have to put the IV in my NECK, just get it in!” And apparently I cracked everyone in the OR up with my comfort zone comment.

A little while after I got back into the room and settled, I held and nursed Ad Lib for the fist time since right after her birth. She was over three hours old by now. Since the crook of my left elbow had an IV in it, I couldn’t bend my left arm without obstructing the flow of (someone else’s!) blood into my body, so La Roca had to help me breastfeed her for the first time. I couldn’t bend my arm to burp her or to rub her head full of soft hair or…anything. I was grateful that they got a line in me so fast, but wished for it to be in a less obtrusive spot. I decided that since I was disturbingly pale and had someone else’s blood dripping into my body, I didn’t want the boys to see me or Ad Lib just yet. A friend was at the hospital for some blood work and stopped in to see us. She didn’t stay long and later apologized for coming at all because she didn’t know what we’d just been through. I’m not usually big on having visitors in the hospital, but I think having a steady stream of friends and family in that afternoon was a Godsend. It gave me time to process what had just happened in small pieces instead of all at once. La Roca told me that my dad had left work the instant La Roca called to tell him what was going on, and was on his way. We visited with him for a little while and he when he held Ad Lib, the first thing he said was that she has my mother’s fingers. She’s eight weeks old now and I see my mother in her more every day. The dark hair, the long thin, perfect fingers, her small stature, her laid-back-until-she’s-not personality. She’s perfect.