Hazel's birth story
Background:
My first daughter, Melanie, was born at 36 weeks due to premature rupture of membranes. Other than failing the 1-hour glucose tolerance test and having to take the three-hour, my pregnancy with her was totally normal and not complicated. I didn't feel any Braxton Hicks contractions with her. She was 5 pounds 4 ounces at birth, an apgar of 9. She was a little sleepy and struggled with nursing at first, but otherwise totally healthy and went home with us after 2 days. She was never in the NICU.
The pregnancy:
This time around, the pregnancy was very different from the start. I had spotting the same night I got my positive test, and thought that I was losing the pregnancy. It turned out to be implantation spotting. At 12 weeks, I had the first trimester screening, and while the nuchal fold looked good on ultrasound, my blood work gave us a 1/72 risk for Down syndrome. We decided to have an amnio, and at 15 weeks tot he day, it was performed without any complications. The FISH results two days later confirmed a healthy baby girl. The full results, which took 3 weeks, said the same. I was able to relax a bit, and other than noticing my first Braxton Hicks at only 17 weeks, felt fine.
At almost 25 weeks, I noticed that the contractions were quite frequent, to the point where I was nervous. My husband took me to the hospital, where I was monitored, and they gave me an injection of terbutaline and oral vistaril to stop contractions. They performed a fetal fibronectin test and it was negative (meaning I was not going to go into labor in the next 2 weeks). The medications worked, and after a few hours, I was sent home. Later that week, it happened again, and I was given the same meds. I had already gone out of work on disability, and was told that I should avoid heavy lifting, exercise, long periods of walking or standing, and that I should generally modify my activity level. Once again, I failed the 1-hour glucose test, and had to take the three-hour, which I passed.
At 28 weeks I had the contractions again, and went to the hospital again. I had an appointment with my OB the following day, and he prescribed terbutaline and vistaril for me to take at home so that I wouldn't be driving to the hospital all the time. He asked to see me every two weeks, just to keep an eye on things. He performed a cervical exam and found me just a fingertip dilated (normal because I'd had a child already) with no effacement.
I continued to take my medications on an as needed basis, with a warning that if anything seemed different, I should go to labor and delivery. I found that as time went on, I needed to take the medications more frequently, until around 31 weeks, I was taking it every couple of days instead of once a week.
The night before my 32-week appointment, I felt some intense crampy type contractions, and took my medications. They went away, and I was able to sleep. However, the next morning at my appointment, my OB confirmed that my cervix was now 50% effaced. He now wanted to see me once a week. That same day, at lunchtime, I noticed that I wasn't feeling contractions, but a sort of crampy feeling, with backache. My ob's office was at lunch, so I called my mother (a certified nurse midwife) who told me to go to L&D. Once there, I was monitored and told I had some uterine irritability, given more medication (same ones) and once again sent home. This was on Tuesday, 12/14/04.
The events leading up to labor:
On Saturday, 12/18, I had a pretty normal day at home with my daughter Melanie while my husband Justin was working. He came home, and we were all spending some time together. I think the two of them took a nap. I wasn't terribly hungry, but also didn't feel like cooking, so I ate some leftover Chinese food that was in the refrigerator. I asked Justin if he thought it was still good, and he said yes. As it turns out, he was right, the illness I had was not because of the food. Justin and Melanie did not eat the Chinese food, but sort of scrounged around for dinner.
After dinner, maybe an hour later, I started to feel a little bit of an upset tummy. I also noticed I was having more contractions than normal. I didn't want to take my meds yet; for fear that they would upset my stomach. I waited a while and rested and drank water. The contractions and nausea increased over the next hour or so. I decided to go ahead and take my medications at 8:30 p.m. An hour later, I was still contracting, so I decided to take a bath and try to relax. In the bath, the nausea became overwhelming, and I had to get out and throw up. I then got back in the bath to warm up and clean up a little. I called my husband to let him know what was happening, and that although it had been an hour and a half since taking my medications, the contractions were if anything, increasing. We decided to go to the hospital. It took a while to get ready, so it was about 11 p.m. when we arrived. I got sick on the way there in the car.
When I went in, and explained what was happening, they hooked my up to a monitor. I also continued to throw up. My contractions were three minutes apart. I was given terbutaline for contractions and reglan for nausea. Both were injections. The nausea medication helped, and my contractions started to calm down. They performed a urinalysis, which came back slightly questionable, so they started me on antibiotics. They performed a fetal fibronectin and a cervical exam on me, and found no cervical change. The fetal fibronectin came back negative. If my nausea went away, and my contractions calmed down, I would have been able to go home. I was given ice chips, and did well with them. They allowed me to have water and 7-Up, just to sip, as I was very thirsty and dehydrated. They told me to take it slow and just sip, which I tried to do. I was still being monitored, and just trying to rest in bed and sip water a little at a time.
I was wondering why they didn't give me an IV, but my OB group has a different doctor on call every 8 hours during the weekends, so the doctor on call wanted to try the least invasive method first. Unfortunately, it didn't work very well, and by about 7 am, I had thrown up again, and had some diarrhea. I called my mother at about 6:30 to tell her what was going on, and she told me she'd come to the hospital to see me. I continued to contract, about every 6-8 minutes. They moved me from a triage room (in the maternity area) into a labor and delivery room, with a much more comfortable bed. A little while later, a new doctor came on call, one that my mother knew from working with him many years ago. She didn't like him very much, and didn't agree with his management of patients.
My mother arrived at the hospital and met my nurse, Monique, who was fantastic. The new doctor on call had asked for me to have an IV. He came in to see me in the morning, and recommended steroid shots for the baby's lungs, as a precautionary measure, even though it appeared that I had only food poisoning and was not going into labor. He also thought that if I had some morphine, I might be able to rest, and the contractions might die down a little, since they were continuing to be 6 minutes apart. He suggested 5 mg in my IV and another 5 orally, but my mother was concerned about the second dose, and that it would take a while to wear off, and be potentially harmful to the baby if she were to be born within the next 12 hours. She suggested that I not take it. She also suggested to the doctor on call that I take Nifedipine (sp?) sometimes called procardia for the contractions. He didn't have experience with it, so he called the perinatologist that was on call. The perinatologist said no, try the IV hydration and rest, and see what happens.
The morphine was not pleasant for me. As sleepy as I was, I was only able to doze off between contractions, and still woke up during each one. I had my first steroid shot at 1 p.m. on Sunday. Shortly after being given the morphine, I was resting in bed, and my friend Kathy came by to visit. She brought flowers and a cute stuffed cow. I visited with her only briefly, as the morphine made me out of it. I dozed and contracted, and my mom stayed there all day doing crossword puzzles and keeping me company. She helped me eat ice chips and drink a little 7-Up. She convinced me to try a few crackers, which did not upset my stomach. After resting and eating, my contractions slowed down to about 8-9 minutes apart. It once again seemed that I might be able to go home if the contractions settled down a little. I was able to pick at lunch, and ate a full dinner.
They wanted to continue to monitor me for a while, so Sunday evening they admitted me to the hospital officially, and moved me over to the high-risk maternity area for some sleep. The bed was more comfortable, and I was feeling okay. My doctor was due to be in to make rounds in the morning, and since my contractions were getting more spaced apart, and my cervix wasn't changing, I hoped he would send me home on bedrest.
Unfortunately, in the middle of the night I became nauseated again, and was having trouble getting comfortable. I let the nurse know I was nauseated, and they put another medication, ph…something in my IV. I ended up vomiting again a few times. Once it settled down, I was able to get a little bit of rest, but not a lot, as they continued to wake me to check my vitals. It seemed that my contractions were increasing in frequency again, about every 6 minutes. It is important to note that my parents and my husband took turns coming in to the hospital to be with me, so I nearly always had someone with me, even if I don't mention it here. It is hard for me to remember who came when. My husband came at least twice a day, and brought my daughter to visit too.
In the morning, my doctor or the other ob that was still on call ordered me to be put on magnesium sulfate, since the terbutaline was not keeping the contractions very far apart anymore. They started the magnesium, but it was hurting my arm very badly and I told the nurse that it was really painful. She looked at my arm and realized that the IV was infiltrating, and my arm was swelling with fluid. They stopped the IV immediately, and took it out. They paged IV therapy to come and start a new IV in the other arm. At this point, my ob came in, and did a cervical exam. He said that there had been some change since I was in his office, I had dilated from a fingertip to 1, but with no further effacement and a negative fetal fibronectin, he was not going to start magnesium on me. So by the time they came in to hook up the IV, I was just given fluids and antibiotics. He wanted to monitor me that day, and see what my contractions and nausea were doing.
I continued to contract on Monday, and was pretty tired, but not able to sleep very well with the contractions. I rested during the day, and they continued to monitor me. I was given my second steroid shot at 1 p.m. I didn't really eat much of anything that day because I was worried about vomiting, and I was not taking in a lot of fluid for the same reason. That night, I noticed that I was short of breath when I went to the bathroom, but I attributed this to tiredness. In the morning, my doctor came back in to see me, and told me that he was going to contact the perinatologist to see what was going on with me, and have them do some tests. He examined me and found no cervical change.
The perinatologist came in to see me, and noticed that I seemed short of breath. He asked when it had started and I said I had noticed a little at night, but just thought I was tired. My parents were there at this time. He listened to my breathing and immediately paged the nurse to come and turn down my IV. He also ordered a diuretic, lasics (sp?). They got an oxygen mask and put it on me. My oxygen saturation had gone down into the 80's, and my pulse at rest was in the 115 range. It turns out that I had gotten pulmonary edema (fluid collecting in my lungs) from the combination of terbutaline and IV hydration. The perinatologist also ordered a chest x-ray and asked the ultrasound team to come and do a biophysical profile on my daughter. They were trying to determine how she was doing and why I was continuing to contract. He told me that because of the edema, he couldn't give me any terbutaline or magnesium sulfate, but that they may start nifedipine on me (as my mother had suggested earlier) to stop contractions.
The biophysical on my daughter was good, she looked normal, and so did my uterus. They estimated her weight at 4 pounds, give or take 11 ounces. They had trouble getting a look at her head and brain, since she was head down in my pelvis and my bladder was not full. They decided to give me the diuretic, and to wait for my bladder to fill. They left the room, and my diuretic was given. It was effective almost immediately, and I couldn't wait for them to come back. I got up to use the commode, and they came back in the room just as I finished.
They told me they would come back again in a while. Ten minutes later I already was dying to go again, so my mom went and asked the perinatologist when they would return. He said for me to go to the bathroom, and that he would get them in my room in 20 minutes. I went again, and the nurse kind of snapped at me and my mom until we told her that the doctor said it was okay. They came back as promised, and I had the rest of the ultrasound, which was horrible since my bladder was so full. The ultrasound tech got the head stuff then let me urinate, so the rest of the ultrasound was okay after that.
They were going to monitor me that day and see what my contractions were doing as I got oxygen and got the fluid out of my lungs. They didn't give me any medication to stop the contractions as they were staying fairly far apart, and I had no cervical change since the previous day. The perinatologist also felt that the oral antibiotics I was taking were not needed, since I didn't have a UTI. I was given a different type of IV antibiotics because I was group B strep positive. I didn't appear to be going into labor, just having a lot of irritable uterus because of all the circumstances. The perinatologist said he would return that afternoon, after my chest x-ray had been done.
My dad was with me during the day that day. The diuretic started to wear off, my fluid was being restricted, and my IV was on very low. They came in and gave me more diuretic. At some point that afternoon or early evening, I was also given the chest x-ray. I was on oxygen the entire time, and they were monitoring my pulse and oxygen saturation. My dad left so that I could rest a little. Prior to the second dose of diuretic, my pulse was racing into the 130's and my oxygen was dipping down to the low 90's every time I got out of bed to use the commode. I also was developing a low-grade fever, right around 100 degrees.
The second dose got rid of more fluid, so I was breathing a little bit easier by the early evening when the doctor returned to listen to my lungs and to give me results on my chest x-ray. My parents were due to return and visit me that evening. I don't remember if the doctor did a cervical exam at that point, but I think he did not. While he was there, just before he left, I felt a strong sensation near my cervix, like a strong kick. I had a sinking feeling that it seemed familiar, like when my water broke with my first. But for some reason, I didn't say that. I told the doctor and nurse that it felt like I had just gotten a strong kick in the cervix. The doctor told me she was head down, so it couldn't have been a kick, but maybe a punch. He left the room, and I got up to use the commode. When I returned to the bed, I felt a little gush of fluid. I looked at the nurse, and told her that I didn't think it was urine. She checked between my legs, saw mucus, and tore out the door to try to catch the doctor before he left. While they were gone, my parents walked in the door. This was at about 6pm. I told my mother, "I think my water just broke." She looked extremely worried.
The labor:
The perinatologist was just down the hall, so he came back in to do a speculum exam. As I lifted up my pelvis so they could slide some towels and a bedpan under me, it became clear to me that my water had broken, as more fluid trickled from me, and I knew it was not urine. When the doctor started the speculum exam, the water came gushing out. I knew that I would most likely be having the baby within the next 24 hours.
I asked my dad to call my husband, and arrange for him to come to the hospital. My dad is a doctor, so he told my husband that my "membranes had ruptured" which my husband didn't understand to mean that my water had broken. Nevertheless, he understood that he was needed at the hospital, and our daughter would be spending the night with my dad. He got her all ready, and drove to my parents' house, where my dad, who had left the hospital, met him. My mom stayed with me at the hospital the whole time.
Shortly after my water had broken, I noticed that the intensity of my contractions was a great deal stronger. They stayed about the same frequency, 8 minutes apart, but it wasn't too long before I had to breathe through them. My mom had talked to the perinatologist, and my ob had also arrived. They told me that because of my pulmonary edema, an epidural would be tricky, but they could find a way to do one safely if I wanted one, or there were other options for pain relief available. My husband arrived within an hour. He sat on the edge of the bed and said something (neither of us can remember exactly what it was) that indicated that he didn't yet understand that I was in labor. I told him that my water had broken, and the baby would most likely be born within 24 hours, possibly even that night. He was pretty flabbergasted by the turn of events. I also told both my mom and husband more or less right away that I felt I was not going to be able to manage a natural childbirth, as I had hoped. I simply felt that I had no energy reserves at all, having not eaten or slept in 3 days, and being on oxygen because I was still having difficulty breathing on my own. They both were extremely supportive of this, and did not try to talk me out of it. Unlike my first birth, where I had hoped my husband would talk me out of pain medication, this time around I was relieved that neither of them questioned my decision and were very supportive. My husband stayed with my mom and me went to check if the cafeteria was open, but it was not. They ordered a pizza.
By about 8 p.m., I had been breathing through contractions for an hour, and they were increasing in intensity, although not much in frequency. They decided to move me into labor and delivery, as they were not set up to do a delivery in the room I was in. I was wheeled down the hall on a gurney, and taken to a labor room, which was actually pretty nice. They checked me to see if I was indeed in active labor, because they didn't want to slow it down with pain medication. I was 3 centimeters dilated, and 90% effaced, so obviously 1 hours' worth of contractions had been pretty effective. They decided that they would like to wait on an epidural, but offered me nubain for pain relief if I wanted it.
I chose to have the nubain, even though I wanted an epidural, because I didn't know how long I would have to wait otherwise, and the pain was getting pretty intense for me. They put the nubain into my IV, and this is where things get a little bit fuzzy for me. The nubain made me very sleepy and out of it, and took the edge off the pain, although each contraction was still difficult and I was breathing through them and moaning low. The pizza showed up, so my mom and my husband took turns leaving the room to eat, as the small was pretty overpowering to me.
My memories of the next three hours are scattered and fuzzy, and I have had to ask my mom and Justin to fill in details for me. But as I remember it, I was closing my eyes and drifting a little between each contraction, then being fully aware as each one peaked. They still hurt, and it was hard for me, because I was so unbelievably tired, and it was hard to breathe with the oxygen tubes in my nose. My ob was there for much of the time, talking with my mom in one corner of the room. My husband was right by my side. I know a few times he tried to hold my hand during contractions and I waved him off, because I didn't want to be touched. They checked me again, because the nubain was not enough for me, and I asked if I could get an epidural. I was still only 3, but my contractions seemed to be intense and closer together, so they decided I could have one.
Because our baby would be born at 33 weeks, they asked if I would like to talk to the special care nurses. My husband had talked with them with my mom, and they had asked questions. I do remember talking to the nurses, and asking them three questions, but I don't remember what they were. I asked one question about long term, how would my daughter be. I remember feeling reassured by their answers, I know they told me that the steroids were a good thing, that her lungs would be helped by them, and that most babies born at 33 weeks had no long term consequences. My mom had asked my nurse questions outside my door, and she probably thought outside of my hearing, and she had asked my ob some questions as well about things like learning disabilities and the "true" meaning of no long-term ill effects. I'm not sure that she was entirely reassured by the answers, but she seemed to relax a little. I think the doctor said about 10% of babies born at this age had long term problems.
I was a little "loopy" and apparently said some things that were a little strange, although not totally inappropriate. For one thing, I mentioned that my chin felt odd, like it was breaking out, which my husband thought was funny. He said it was as if my head was on fire and I was commenting that my nose itched. I apparently tried to make a couple of weak jokes. But mostly, I have been assured, I was quiet and sleepy, and breathed through contractions. It took a while for the anesthesiologist to arrive, and explain the procedure to me and get my consent. She also talked about how we would handle the epidural because of my edema, which mean less medication, and slower administration of it.
They placed the epidural, and I had a killer contraction during it, which was awful. The placement of the epidural gave me some stings and a few weird pressure sensations in my back. I remember being able to move my legs (although they helped me a little) and wiggle my toes, which I had not been able to do with the epidural I had with my daughter. They did not place a catheter, which I was grateful for. I remember very clearly that the anesthesiologist told me that if I wasn't having enough pain relief by 10:35, I needed to tell her, because then she would increase the medication. My friend Kim came by, but it became clear that I was about to give birth, so she left pretty quickly, saying she wanted to give us some privacy. I was doing better, but the contractions seemed to be extremely intense, and at 10:35 I told her that she would need to increase it. I watched her inject the medication, and then almost immediately was hit by a contraction that was unlike the others.
I remember saying; "This is different. It feels different." For one thing, this contraction seemed to last an extremely long time, and was not abating like the others. Then, near then end of it, I felt the baby pass right through my pelvis like a bowling ball. In that one contraction, she had descended into my birth canal. My mom thinks I probably went from about 7 centimeters to complete in that contraction. She asked me, "How is it different?" and I told her "Pressure…" She said she knew from the look on my face. The doctor had left for a while, so they had to page him to come back, and she was worried he wasn't going to make it in time. She told me she almost grabbed a glove to do it herself. I had another intense contraction, and the nurse checked and said that I was complete, and the baby was right on the perineum. They told me to try to hold on, the doctor was on the way, but if I had to push, they could get someone else. While they were talking to me, they were breaking down the bed.
I asked for a mirror, so I could see the birth. They helped me pull up my legs, my husband held one and my mom held the other, and shot pictures at the same time. The doctor arrived, just in time. The special care nurses were in the room, as well as my nurse, the ob, the anesthesiologist, and my mom and husband. It seemed funny to me that Kim had wanted me to have privacy. Of course, as soon as I was holding back my legs and the doctor was ready, my contractions stopped. I even said something to the effect of, "of course, now I'm not having a contraction." It felt odd, like I was on stage, because all of these people were waiting for the baby. Then I got hit by a contraction and I pushed. I felt some burning in my perineum, and tons of pressure as the baby's head came out (with the first push!). They told me to pant a little, and were checking for cord around the neck, then I pushed a second time and the rest of her little body came out. My daughter Hazel had been born.
They placed her up on my tummy immediately, and she cried very well on her own. They cleaned her off on me, and she had a lot of vernix because she was so early. She looked pretty red o me, but her apgars were 7 and 8, and those points that were taken off were for tone and color, so I guess her extremities may have been less pink. She was 4 pounds, 1 ounce, and 16 inches long.
Then they asked my husband to cut the cord, because they wanted to get her warmed up and evaluated pretty quickly, since she was so small. He did, and he went with them out into the hallway, where they gave her some oxygen. My husband got to hold her hand, and she gripped his finger. My sister Laura and her boyfriend Paul arrived at this time, and they stopped outside and saw the baby for a while. They were just minutes too late for the birth.
Inside the room, I delivered the placenta. It didn't come out at first, so we waited a few minutes and tried again. This was actually kind of neat for me, since I don't remember doing it with my first (because I was so busy looking at the baby). I asked the doctor to show it to me. They also said that there were going to take it to the lab to be screened, I guess to see if they could figure out any reason why she might be premature.
They cleaned me up, and my sister and Paul came in. They stayed and talked with me for a while. I spent about an hour in labor and delivery after the birth. They stopped the epidural almost immediately after the birth, so it would wear off quickly. Then they asked if I could urinate, so they helped me out of bed, but I could walk on my own with a little support from Justin and the nurse. After this, they took me back to the same room I had been in before in the high-risk area, and my family, other than my husband, went home. Justin stayed with me overnight, but left early in the morning so that he could be there when my older daughter woke up.
Because of the fever and possible viral infection that I had, I was not allowed to see my baby in the NICU until I had gone 24 hours without a fever. This ended up being at 1 a.m. on December 23, 26 hours after her birth. This was very hard for me, but because my older daughter had also gotten sick, and she had not eaten the same food as I had, I was pretty sure that I did indeed have a virus. I did not want to compromise my baby's health, or that of the other tiny babies in the NICU, so I waited.
Hazel is still in the NICU as I write this. She is breathing fine on her own, and required oxygen for only about her first 12 hours. At one point her first night, they thought she might need to go on a respirator, but she brought herself out of it okay. She doesn't have enough strength to eat on her own very well yet, although they are continuing to try a bottle every day, once or twice. Mostly she is being tube fed, and is also still on IV. They turn her IV down as she does better with the tube feedings. I am pumping milk so that she can eat that instead of formula, and she seems to be doing well with it. Since the first day, they have started disconnecting various things, which is always a good sign. She no longer needs her oxygen intake measured, since her breathing is so good. Her main challenges now are learning to eat, gaining weight, and maintaining body temperature. She also is jaundiced, so she is getting phototherapy. Her brain ultrasound was normal. It is likely that Hazel will be able to come home before her due date, which was February 7, 2005.
My feelings:
Obviously, I have a lot to process still about this birth. I am very sad about the loss of the experience I wanted in so many ways. From the baby shower that was supposed to be on 12/19 that I had to cancel, to the belly casting that we never made, to the amazing host of medications and interventions that took place, to my inability to birth without pain medication, and of course, to the fact that my baby is in the hospital still, not home with me and my family.
I don't feel too much disappointment in myself for getting pain relief, given the circumstances. I also actually am not angry with the hospital experience, even though the care I was given is what caused me to have the pulmonary edema. The way I was treated made sense to me, given that I had a history of preterm contractions and terbutaline had always safely and effectively stopped them in the past. When I came in 32 weeks pregnant and contracting every three minutes, I believe they made the right choice to do something to try and stop the contractions. I also think that the hydration was needed, given how much I was vomiting. It just happened that I had a bad reaction to the combination of IV hydration and terbutaline.
I'll probably never know why my water broke when it did. It could have been that inside me was a more stressful environment than outside. It might have been the viral illness and the edema that set things off. It is also possible that it might have just happened then anyway, as it had with my first. I do think the process was hastened along by all the things that happened to me prior to my water breaking. I'm sure that if I had not gotten sick, Hazel might have been able to hang out a little longer. The good thing about being there was that because I was there for a few days, they were able to give me the steroid shots that made it easier for my daughter to breathe.
Right now, I'm so hormonal with all the post-partum stuff that it is difficult to know what I feel. I go from feeling pretty good about how physically well I'm doing right now and how Hazel is doing so well, to being overwhelmingly sad that it will be weeks before I can bring her home to be with me. Sometimes it takes just minutes to go from one feeling to the next. It isn't the babymoon I told myself it would be, but I guess that will come in a few more weeks. I'm looking forward to it.
You can see Hazel and read updates on her condition here:
http://www.babiesonline.com/babies/b/bigsister/
password is: mycroft
Background:
My first daughter, Melanie, was born at 36 weeks due to premature rupture of membranes. Other than failing the 1-hour glucose tolerance test and having to take the three-hour, my pregnancy with her was totally normal and not complicated. I didn't feel any Braxton Hicks contractions with her. She was 5 pounds 4 ounces at birth, an apgar of 9. She was a little sleepy and struggled with nursing at first, but otherwise totally healthy and went home with us after 2 days. She was never in the NICU.
The pregnancy:
This time around, the pregnancy was very different from the start. I had spotting the same night I got my positive test, and thought that I was losing the pregnancy. It turned out to be implantation spotting. At 12 weeks, I had the first trimester screening, and while the nuchal fold looked good on ultrasound, my blood work gave us a 1/72 risk for Down syndrome. We decided to have an amnio, and at 15 weeks tot he day, it was performed without any complications. The FISH results two days later confirmed a healthy baby girl. The full results, which took 3 weeks, said the same. I was able to relax a bit, and other than noticing my first Braxton Hicks at only 17 weeks, felt fine.
At almost 25 weeks, I noticed that the contractions were quite frequent, to the point where I was nervous. My husband took me to the hospital, where I was monitored, and they gave me an injection of terbutaline and oral vistaril to stop contractions. They performed a fetal fibronectin test and it was negative (meaning I was not going to go into labor in the next 2 weeks). The medications worked, and after a few hours, I was sent home. Later that week, it happened again, and I was given the same meds. I had already gone out of work on disability, and was told that I should avoid heavy lifting, exercise, long periods of walking or standing, and that I should generally modify my activity level. Once again, I failed the 1-hour glucose test, and had to take the three-hour, which I passed.
At 28 weeks I had the contractions again, and went to the hospital again. I had an appointment with my OB the following day, and he prescribed terbutaline and vistaril for me to take at home so that I wouldn't be driving to the hospital all the time. He asked to see me every two weeks, just to keep an eye on things. He performed a cervical exam and found me just a fingertip dilated (normal because I'd had a child already) with no effacement.
I continued to take my medications on an as needed basis, with a warning that if anything seemed different, I should go to labor and delivery. I found that as time went on, I needed to take the medications more frequently, until around 31 weeks, I was taking it every couple of days instead of once a week.
The night before my 32-week appointment, I felt some intense crampy type contractions, and took my medications. They went away, and I was able to sleep. However, the next morning at my appointment, my OB confirmed that my cervix was now 50% effaced. He now wanted to see me once a week. That same day, at lunchtime, I noticed that I wasn't feeling contractions, but a sort of crampy feeling, with backache. My ob's office was at lunch, so I called my mother (a certified nurse midwife) who told me to go to L&D. Once there, I was monitored and told I had some uterine irritability, given more medication (same ones) and once again sent home. This was on Tuesday, 12/14/04.
The events leading up to labor:
On Saturday, 12/18, I had a pretty normal day at home with my daughter Melanie while my husband Justin was working. He came home, and we were all spending some time together. I think the two of them took a nap. I wasn't terribly hungry, but also didn't feel like cooking, so I ate some leftover Chinese food that was in the refrigerator. I asked Justin if he thought it was still good, and he said yes. As it turns out, he was right, the illness I had was not because of the food. Justin and Melanie did not eat the Chinese food, but sort of scrounged around for dinner.
After dinner, maybe an hour later, I started to feel a little bit of an upset tummy. I also noticed I was having more contractions than normal. I didn't want to take my meds yet; for fear that they would upset my stomach. I waited a while and rested and drank water. The contractions and nausea increased over the next hour or so. I decided to go ahead and take my medications at 8:30 p.m. An hour later, I was still contracting, so I decided to take a bath and try to relax. In the bath, the nausea became overwhelming, and I had to get out and throw up. I then got back in the bath to warm up and clean up a little. I called my husband to let him know what was happening, and that although it had been an hour and a half since taking my medications, the contractions were if anything, increasing. We decided to go to the hospital. It took a while to get ready, so it was about 11 p.m. when we arrived. I got sick on the way there in the car.
When I went in, and explained what was happening, they hooked my up to a monitor. I also continued to throw up. My contractions were three minutes apart. I was given terbutaline for contractions and reglan for nausea. Both were injections. The nausea medication helped, and my contractions started to calm down. They performed a urinalysis, which came back slightly questionable, so they started me on antibiotics. They performed a fetal fibronectin and a cervical exam on me, and found no cervical change. The fetal fibronectin came back negative. If my nausea went away, and my contractions calmed down, I would have been able to go home. I was given ice chips, and did well with them. They allowed me to have water and 7-Up, just to sip, as I was very thirsty and dehydrated. They told me to take it slow and just sip, which I tried to do. I was still being monitored, and just trying to rest in bed and sip water a little at a time.
I was wondering why they didn't give me an IV, but my OB group has a different doctor on call every 8 hours during the weekends, so the doctor on call wanted to try the least invasive method first. Unfortunately, it didn't work very well, and by about 7 am, I had thrown up again, and had some diarrhea. I called my mother at about 6:30 to tell her what was going on, and she told me she'd come to the hospital to see me. I continued to contract, about every 6-8 minutes. They moved me from a triage room (in the maternity area) into a labor and delivery room, with a much more comfortable bed. A little while later, a new doctor came on call, one that my mother knew from working with him many years ago. She didn't like him very much, and didn't agree with his management of patients.
My mother arrived at the hospital and met my nurse, Monique, who was fantastic. The new doctor on call had asked for me to have an IV. He came in to see me in the morning, and recommended steroid shots for the baby's lungs, as a precautionary measure, even though it appeared that I had only food poisoning and was not going into labor. He also thought that if I had some morphine, I might be able to rest, and the contractions might die down a little, since they were continuing to be 6 minutes apart. He suggested 5 mg in my IV and another 5 orally, but my mother was concerned about the second dose, and that it would take a while to wear off, and be potentially harmful to the baby if she were to be born within the next 12 hours. She suggested that I not take it. She also suggested to the doctor on call that I take Nifedipine (sp?) sometimes called procardia for the contractions. He didn't have experience with it, so he called the perinatologist that was on call. The perinatologist said no, try the IV hydration and rest, and see what happens.
The morphine was not pleasant for me. As sleepy as I was, I was only able to doze off between contractions, and still woke up during each one. I had my first steroid shot at 1 p.m. on Sunday. Shortly after being given the morphine, I was resting in bed, and my friend Kathy came by to visit. She brought flowers and a cute stuffed cow. I visited with her only briefly, as the morphine made me out of it. I dozed and contracted, and my mom stayed there all day doing crossword puzzles and keeping me company. She helped me eat ice chips and drink a little 7-Up. She convinced me to try a few crackers, which did not upset my stomach. After resting and eating, my contractions slowed down to about 8-9 minutes apart. It once again seemed that I might be able to go home if the contractions settled down a little. I was able to pick at lunch, and ate a full dinner.
They wanted to continue to monitor me for a while, so Sunday evening they admitted me to the hospital officially, and moved me over to the high-risk maternity area for some sleep. The bed was more comfortable, and I was feeling okay. My doctor was due to be in to make rounds in the morning, and since my contractions were getting more spaced apart, and my cervix wasn't changing, I hoped he would send me home on bedrest.
Unfortunately, in the middle of the night I became nauseated again, and was having trouble getting comfortable. I let the nurse know I was nauseated, and they put another medication, ph…something in my IV. I ended up vomiting again a few times. Once it settled down, I was able to get a little bit of rest, but not a lot, as they continued to wake me to check my vitals. It seemed that my contractions were increasing in frequency again, about every 6 minutes. It is important to note that my parents and my husband took turns coming in to the hospital to be with me, so I nearly always had someone with me, even if I don't mention it here. It is hard for me to remember who came when. My husband came at least twice a day, and brought my daughter to visit too.
In the morning, my doctor or the other ob that was still on call ordered me to be put on magnesium sulfate, since the terbutaline was not keeping the contractions very far apart anymore. They started the magnesium, but it was hurting my arm very badly and I told the nurse that it was really painful. She looked at my arm and realized that the IV was infiltrating, and my arm was swelling with fluid. They stopped the IV immediately, and took it out. They paged IV therapy to come and start a new IV in the other arm. At this point, my ob came in, and did a cervical exam. He said that there had been some change since I was in his office, I had dilated from a fingertip to 1, but with no further effacement and a negative fetal fibronectin, he was not going to start magnesium on me. So by the time they came in to hook up the IV, I was just given fluids and antibiotics. He wanted to monitor me that day, and see what my contractions and nausea were doing.
I continued to contract on Monday, and was pretty tired, but not able to sleep very well with the contractions. I rested during the day, and they continued to monitor me. I was given my second steroid shot at 1 p.m. I didn't really eat much of anything that day because I was worried about vomiting, and I was not taking in a lot of fluid for the same reason. That night, I noticed that I was short of breath when I went to the bathroom, but I attributed this to tiredness. In the morning, my doctor came back in to see me, and told me that he was going to contact the perinatologist to see what was going on with me, and have them do some tests. He examined me and found no cervical change.
The perinatologist came in to see me, and noticed that I seemed short of breath. He asked when it had started and I said I had noticed a little at night, but just thought I was tired. My parents were there at this time. He listened to my breathing and immediately paged the nurse to come and turn down my IV. He also ordered a diuretic, lasics (sp?). They got an oxygen mask and put it on me. My oxygen saturation had gone down into the 80's, and my pulse at rest was in the 115 range. It turns out that I had gotten pulmonary edema (fluid collecting in my lungs) from the combination of terbutaline and IV hydration. The perinatologist also ordered a chest x-ray and asked the ultrasound team to come and do a biophysical profile on my daughter. They were trying to determine how she was doing and why I was continuing to contract. He told me that because of the edema, he couldn't give me any terbutaline or magnesium sulfate, but that they may start nifedipine on me (as my mother had suggested earlier) to stop contractions.
The biophysical on my daughter was good, she looked normal, and so did my uterus. They estimated her weight at 4 pounds, give or take 11 ounces. They had trouble getting a look at her head and brain, since she was head down in my pelvis and my bladder was not full. They decided to give me the diuretic, and to wait for my bladder to fill. They left the room, and my diuretic was given. It was effective almost immediately, and I couldn't wait for them to come back. I got up to use the commode, and they came back in the room just as I finished.
They told me they would come back again in a while. Ten minutes later I already was dying to go again, so my mom went and asked the perinatologist when they would return. He said for me to go to the bathroom, and that he would get them in my room in 20 minutes. I went again, and the nurse kind of snapped at me and my mom until we told her that the doctor said it was okay. They came back as promised, and I had the rest of the ultrasound, which was horrible since my bladder was so full. The ultrasound tech got the head stuff then let me urinate, so the rest of the ultrasound was okay after that.
They were going to monitor me that day and see what my contractions were doing as I got oxygen and got the fluid out of my lungs. They didn't give me any medication to stop the contractions as they were staying fairly far apart, and I had no cervical change since the previous day. The perinatologist also felt that the oral antibiotics I was taking were not needed, since I didn't have a UTI. I was given a different type of IV antibiotics because I was group B strep positive. I didn't appear to be going into labor, just having a lot of irritable uterus because of all the circumstances. The perinatologist said he would return that afternoon, after my chest x-ray had been done.
My dad was with me during the day that day. The diuretic started to wear off, my fluid was being restricted, and my IV was on very low. They came in and gave me more diuretic. At some point that afternoon or early evening, I was also given the chest x-ray. I was on oxygen the entire time, and they were monitoring my pulse and oxygen saturation. My dad left so that I could rest a little. Prior to the second dose of diuretic, my pulse was racing into the 130's and my oxygen was dipping down to the low 90's every time I got out of bed to use the commode. I also was developing a low-grade fever, right around 100 degrees.
The second dose got rid of more fluid, so I was breathing a little bit easier by the early evening when the doctor returned to listen to my lungs and to give me results on my chest x-ray. My parents were due to return and visit me that evening. I don't remember if the doctor did a cervical exam at that point, but I think he did not. While he was there, just before he left, I felt a strong sensation near my cervix, like a strong kick. I had a sinking feeling that it seemed familiar, like when my water broke with my first. But for some reason, I didn't say that. I told the doctor and nurse that it felt like I had just gotten a strong kick in the cervix. The doctor told me she was head down, so it couldn't have been a kick, but maybe a punch. He left the room, and I got up to use the commode. When I returned to the bed, I felt a little gush of fluid. I looked at the nurse, and told her that I didn't think it was urine. She checked between my legs, saw mucus, and tore out the door to try to catch the doctor before he left. While they were gone, my parents walked in the door. This was at about 6pm. I told my mother, "I think my water just broke." She looked extremely worried.
The labor:
The perinatologist was just down the hall, so he came back in to do a speculum exam. As I lifted up my pelvis so they could slide some towels and a bedpan under me, it became clear to me that my water had broken, as more fluid trickled from me, and I knew it was not urine. When the doctor started the speculum exam, the water came gushing out. I knew that I would most likely be having the baby within the next 24 hours.
I asked my dad to call my husband, and arrange for him to come to the hospital. My dad is a doctor, so he told my husband that my "membranes had ruptured" which my husband didn't understand to mean that my water had broken. Nevertheless, he understood that he was needed at the hospital, and our daughter would be spending the night with my dad. He got her all ready, and drove to my parents' house, where my dad, who had left the hospital, met him. My mom stayed with me at the hospital the whole time.
Shortly after my water had broken, I noticed that the intensity of my contractions was a great deal stronger. They stayed about the same frequency, 8 minutes apart, but it wasn't too long before I had to breathe through them. My mom had talked to the perinatologist, and my ob had also arrived. They told me that because of my pulmonary edema, an epidural would be tricky, but they could find a way to do one safely if I wanted one, or there were other options for pain relief available. My husband arrived within an hour. He sat on the edge of the bed and said something (neither of us can remember exactly what it was) that indicated that he didn't yet understand that I was in labor. I told him that my water had broken, and the baby would most likely be born within 24 hours, possibly even that night. He was pretty flabbergasted by the turn of events. I also told both my mom and husband more or less right away that I felt I was not going to be able to manage a natural childbirth, as I had hoped. I simply felt that I had no energy reserves at all, having not eaten or slept in 3 days, and being on oxygen because I was still having difficulty breathing on my own. They both were extremely supportive of this, and did not try to talk me out of it. Unlike my first birth, where I had hoped my husband would talk me out of pain medication, this time around I was relieved that neither of them questioned my decision and were very supportive. My husband stayed with my mom and me went to check if the cafeteria was open, but it was not. They ordered a pizza.
By about 8 p.m., I had been breathing through contractions for an hour, and they were increasing in intensity, although not much in frequency. They decided to move me into labor and delivery, as they were not set up to do a delivery in the room I was in. I was wheeled down the hall on a gurney, and taken to a labor room, which was actually pretty nice. They checked me to see if I was indeed in active labor, because they didn't want to slow it down with pain medication. I was 3 centimeters dilated, and 90% effaced, so obviously 1 hours' worth of contractions had been pretty effective. They decided that they would like to wait on an epidural, but offered me nubain for pain relief if I wanted it.
I chose to have the nubain, even though I wanted an epidural, because I didn't know how long I would have to wait otherwise, and the pain was getting pretty intense for me. They put the nubain into my IV, and this is where things get a little bit fuzzy for me. The nubain made me very sleepy and out of it, and took the edge off the pain, although each contraction was still difficult and I was breathing through them and moaning low. The pizza showed up, so my mom and my husband took turns leaving the room to eat, as the small was pretty overpowering to me.
My memories of the next three hours are scattered and fuzzy, and I have had to ask my mom and Justin to fill in details for me. But as I remember it, I was closing my eyes and drifting a little between each contraction, then being fully aware as each one peaked. They still hurt, and it was hard for me, because I was so unbelievably tired, and it was hard to breathe with the oxygen tubes in my nose. My ob was there for much of the time, talking with my mom in one corner of the room. My husband was right by my side. I know a few times he tried to hold my hand during contractions and I waved him off, because I didn't want to be touched. They checked me again, because the nubain was not enough for me, and I asked if I could get an epidural. I was still only 3, but my contractions seemed to be intense and closer together, so they decided I could have one.
Because our baby would be born at 33 weeks, they asked if I would like to talk to the special care nurses. My husband had talked with them with my mom, and they had asked questions. I do remember talking to the nurses, and asking them three questions, but I don't remember what they were. I asked one question about long term, how would my daughter be. I remember feeling reassured by their answers, I know they told me that the steroids were a good thing, that her lungs would be helped by them, and that most babies born at 33 weeks had no long term consequences. My mom had asked my nurse questions outside my door, and she probably thought outside of my hearing, and she had asked my ob some questions as well about things like learning disabilities and the "true" meaning of no long-term ill effects. I'm not sure that she was entirely reassured by the answers, but she seemed to relax a little. I think the doctor said about 10% of babies born at this age had long term problems.
I was a little "loopy" and apparently said some things that were a little strange, although not totally inappropriate. For one thing, I mentioned that my chin felt odd, like it was breaking out, which my husband thought was funny. He said it was as if my head was on fire and I was commenting that my nose itched. I apparently tried to make a couple of weak jokes. But mostly, I have been assured, I was quiet and sleepy, and breathed through contractions. It took a while for the anesthesiologist to arrive, and explain the procedure to me and get my consent. She also talked about how we would handle the epidural because of my edema, which mean less medication, and slower administration of it.
They placed the epidural, and I had a killer contraction during it, which was awful. The placement of the epidural gave me some stings and a few weird pressure sensations in my back. I remember being able to move my legs (although they helped me a little) and wiggle my toes, which I had not been able to do with the epidural I had with my daughter. They did not place a catheter, which I was grateful for. I remember very clearly that the anesthesiologist told me that if I wasn't having enough pain relief by 10:35, I needed to tell her, because then she would increase the medication. My friend Kim came by, but it became clear that I was about to give birth, so she left pretty quickly, saying she wanted to give us some privacy. I was doing better, but the contractions seemed to be extremely intense, and at 10:35 I told her that she would need to increase it. I watched her inject the medication, and then almost immediately was hit by a contraction that was unlike the others.
I remember saying; "This is different. It feels different." For one thing, this contraction seemed to last an extremely long time, and was not abating like the others. Then, near then end of it, I felt the baby pass right through my pelvis like a bowling ball. In that one contraction, she had descended into my birth canal. My mom thinks I probably went from about 7 centimeters to complete in that contraction. She asked me, "How is it different?" and I told her "Pressure…" She said she knew from the look on my face. The doctor had left for a while, so they had to page him to come back, and she was worried he wasn't going to make it in time. She told me she almost grabbed a glove to do it herself. I had another intense contraction, and the nurse checked and said that I was complete, and the baby was right on the perineum. They told me to try to hold on, the doctor was on the way, but if I had to push, they could get someone else. While they were talking to me, they were breaking down the bed.
I asked for a mirror, so I could see the birth. They helped me pull up my legs, my husband held one and my mom held the other, and shot pictures at the same time. The doctor arrived, just in time. The special care nurses were in the room, as well as my nurse, the ob, the anesthesiologist, and my mom and husband. It seemed funny to me that Kim had wanted me to have privacy. Of course, as soon as I was holding back my legs and the doctor was ready, my contractions stopped. I even said something to the effect of, "of course, now I'm not having a contraction." It felt odd, like I was on stage, because all of these people were waiting for the baby. Then I got hit by a contraction and I pushed. I felt some burning in my perineum, and tons of pressure as the baby's head came out (with the first push!). They told me to pant a little, and were checking for cord around the neck, then I pushed a second time and the rest of her little body came out. My daughter Hazel had been born.
They placed her up on my tummy immediately, and she cried very well on her own. They cleaned her off on me, and she had a lot of vernix because she was so early. She looked pretty red o me, but her apgars were 7 and 8, and those points that were taken off were for tone and color, so I guess her extremities may have been less pink. She was 4 pounds, 1 ounce, and 16 inches long.
Then they asked my husband to cut the cord, because they wanted to get her warmed up and evaluated pretty quickly, since she was so small. He did, and he went with them out into the hallway, where they gave her some oxygen. My husband got to hold her hand, and she gripped his finger. My sister Laura and her boyfriend Paul arrived at this time, and they stopped outside and saw the baby for a while. They were just minutes too late for the birth.
Inside the room, I delivered the placenta. It didn't come out at first, so we waited a few minutes and tried again. This was actually kind of neat for me, since I don't remember doing it with my first (because I was so busy looking at the baby). I asked the doctor to show it to me. They also said that there were going to take it to the lab to be screened, I guess to see if they could figure out any reason why she might be premature.
They cleaned me up, and my sister and Paul came in. They stayed and talked with me for a while. I spent about an hour in labor and delivery after the birth. They stopped the epidural almost immediately after the birth, so it would wear off quickly. Then they asked if I could urinate, so they helped me out of bed, but I could walk on my own with a little support from Justin and the nurse. After this, they took me back to the same room I had been in before in the high-risk area, and my family, other than my husband, went home. Justin stayed with me overnight, but left early in the morning so that he could be there when my older daughter woke up.
Because of the fever and possible viral infection that I had, I was not allowed to see my baby in the NICU until I had gone 24 hours without a fever. This ended up being at 1 a.m. on December 23, 26 hours after her birth. This was very hard for me, but because my older daughter had also gotten sick, and she had not eaten the same food as I had, I was pretty sure that I did indeed have a virus. I did not want to compromise my baby's health, or that of the other tiny babies in the NICU, so I waited.
Hazel is still in the NICU as I write this. She is breathing fine on her own, and required oxygen for only about her first 12 hours. At one point her first night, they thought she might need to go on a respirator, but she brought herself out of it okay. She doesn't have enough strength to eat on her own very well yet, although they are continuing to try a bottle every day, once or twice. Mostly she is being tube fed, and is also still on IV. They turn her IV down as she does better with the tube feedings. I am pumping milk so that she can eat that instead of formula, and she seems to be doing well with it. Since the first day, they have started disconnecting various things, which is always a good sign. She no longer needs her oxygen intake measured, since her breathing is so good. Her main challenges now are learning to eat, gaining weight, and maintaining body temperature. She also is jaundiced, so she is getting phototherapy. Her brain ultrasound was normal. It is likely that Hazel will be able to come home before her due date, which was February 7, 2005.
My feelings:
Obviously, I have a lot to process still about this birth. I am very sad about the loss of the experience I wanted in so many ways. From the baby shower that was supposed to be on 12/19 that I had to cancel, to the belly casting that we never made, to the amazing host of medications and interventions that took place, to my inability to birth without pain medication, and of course, to the fact that my baby is in the hospital still, not home with me and my family.
I don't feel too much disappointment in myself for getting pain relief, given the circumstances. I also actually am not angry with the hospital experience, even though the care I was given is what caused me to have the pulmonary edema. The way I was treated made sense to me, given that I had a history of preterm contractions and terbutaline had always safely and effectively stopped them in the past. When I came in 32 weeks pregnant and contracting every three minutes, I believe they made the right choice to do something to try and stop the contractions. I also think that the hydration was needed, given how much I was vomiting. It just happened that I had a bad reaction to the combination of IV hydration and terbutaline.
I'll probably never know why my water broke when it did. It could have been that inside me was a more stressful environment than outside. It might have been the viral illness and the edema that set things off. It is also possible that it might have just happened then anyway, as it had with my first. I do think the process was hastened along by all the things that happened to me prior to my water breaking. I'm sure that if I had not gotten sick, Hazel might have been able to hang out a little longer. The good thing about being there was that because I was there for a few days, they were able to give me the steroid shots that made it easier for my daughter to breathe.
Right now, I'm so hormonal with all the post-partum stuff that it is difficult to know what I feel. I go from feeling pretty good about how physically well I'm doing right now and how Hazel is doing so well, to being overwhelmingly sad that it will be weeks before I can bring her home to be with me. Sometimes it takes just minutes to go from one feeling to the next. It isn't the babymoon I told myself it would be, but I guess that will come in a few more weeks. I'm looking forward to it.
You can see Hazel and read updates on her condition here:
http://www.babiesonline.com/babies/b/bigsister/
password is: mycroft
