Tuesday, June 30, 2015

Birth Story: Part I

I'm trying to record all the details of baby's arrival while they're still semi-fresh in my memory. Here's the first installment, starting from the day my pregnancy went from no-risk, hunky-dory, smooth-sailing to "danger, danger Will Robinson."

Friday, May 29th  

During my routine monthly doctor's appointment Friday morning, my blood pressure was high. As in, I-should-at-least-get-credit-for-burning-calories-cause-this-is-like-aerobics high. Without trying to cause panic and raise my BP even higher, the doctor recommended I have more lab work done. Fair enough. I already felt like I was on a first name basis with the lab staff. I stopped by, left samples of various bodily fluids and then went back to work. 

While leaving my office for the day, I got a call from my OB/GYN. The lab results had come back already, showing impaired kidney function (protein was “leaking” into my urine). My RN made an appointment for the next morning, Saturday, to have more tests done at the hospital since the doctor's office would be closed for the weekend.

"Preeclampsia" was mentioned for the first time, with the caveat that it was most likely mild. I was told to buy a blood pressure cuff and monitor my rates at home that night. That evening, I read the pertinent sections of my pregnancy books to learn what eclampsia was (the onset of seizures in a woman with preeclampsia) and whether pre-eclampsia was any less serious (a disorder of pregnancy in which there is high blood pressure and either large amounts of protein in the urine or other organ dysfunction).

Saturday, May 30th

Saturday morning I met one of my doctors at the Labor and Delivery unit of the local hospital. Nurses conducted a "non-stress test" (meaning there were no simulated contractions: baby experienced no stress, though I was feeling plenty). The purpose was to see if baby's heart rate changed based on his movement. His heart was doing just what it should – good news!

"Intrauterine growth restriction" (IUGR) was mentioned for the first time: baby was smaller than he should be. My doctor ordered a biophysical profile ultrasound to check on baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid he had. He scored 8 out of 8 on the ultrasound assessment. However, his small size (combined with my lab results and still-high blood pressure) confirmed the preeclampsia diagnosis. The nurses warned me I probably wouldn’t make it to the 37 week-mark. That seemed crazy; as of 5/30, that was only five weeks away!

My doctor reassured me that preeclampsia was a vascular issue. It was nothing I caused or could have prevented. She consulted with doctors at the University of Washington Medical Center in Seattle – they advised giving me betamethasone (steroid) shots to help boost baby’s metabolism and help protect his still-forming lungs – which would most likely be breathing sooner than expected! My doctor told me encouragingly my baby is “small but mighty!” Her office would continue to monitor us both closely.

Sunday, May 31st

I went back to the hospital Sunday morning for a second non-stress test and another betamethasone injection. The plan at that point was to visit the OB/GYN office twice per week until delivery and to take it easy at work (bed rest recommended, though my doctor gave the OK to work half-days as I was able).

That evening I emailed my family a list of current concerns and the good news (no need to incite panic): 
  1. As long as everything holds stable for one more week, I'll be able to deliver in Bellingham. If things take a turn for the worse and they need to induce me before next Sat (the 34 week mark), we'll be sent to Seattle.
  2. I'm hoping to not require full bed rest yet (I don't want to use up maternity leave before he even arrives). I'll find out more tomorrow at my follow up appointment.
  3. Baby is small. Everything looks OK developmentally, but the longer he stays put the better (based on the ultrasound I saw yesterday, he's content to keep chilling. Not a care in the world based on his expression and body language). :) I got a series of baby-safe steroid injections as an added barrier of protection in case he does make an early appearance in the next week or two. This will give a little extra oomph to his metabolism and help the development of his lungs.
  4. Our stress levels. We want to be alert and agile for whatever baby needs, but not freak out. Serenity now.
Good news:
  1. We caught it early - still lots of options for treatment (in addition to the shots, I'm on a low-dose blood pressure pill to keep things in check. I got a blood pressure cuff so I can keep track at home).
  2. Medical professionals - I've loved every doctor and nurse I've met. We're in good hands.
  3. Baby seems un-phased (aside from being small which is common with preeclampsia) - he's active, has great cardiac response, good blood pressure, and all his parts. Pretty sure he tried to high-five the ultrasound technician mid-sonogram. I got to see him practice using his diaphragm muscles (which I didn't realize babies did in utero, getting ready for actual breathing!).
Monday, June 1st

I took Monday off work and rested at home. Couldn’t believe how many hours I slept - all appreciated by the cat. He provided excellent pre-natal care.

Ivan, M.D.
Tuesday, June 2nd

I had another follow-up at the OB/GYN, including another non-stress test: baby was still doing well, my blood pressure was still high, and the close monitoring continued. I visited the lab for another round of tests. With my doctor’s blessing, I worked a half-day that afternoon. I wrapped up a few loose ends and tried not to panic about the amount of work that was likely going to remain undone. I put my feet up on my break and mentioned preeclampsia to only a few co-workers. The waiting game continued.

As I was leaving work, I got another phone call. My RN explained that the lab work was now showing increased liver enzymes, indicating further stress on my organs. The on-call doctor was conferring with the UW, and my RN said he wanted to meet me at the local hospital. Since baby was displaying normal function on the non-stress test from that morning, medivac via helicopter wasn't necessary but an ambulance ride to Seattle was.

I called Hubbins and told him the change in plans. Instead of childbirth class that evening (discussing “The Birth Plan” ironically enough), we were escalating to immediate action. There were no more decisions for me to make, just instructions to follow. Thankfully, the parameters were set for me: 1) labor and delivery options in town were nil: the special care nursery wasn’t equipped for babies younger than 34 weeks, and 2) the medical team with specialists' training for higher risk deliveries were all in Seattle.

As soon as I got to the hospital, the nurses got me into triage and hooked me up to a magnesium sulfate IV drip. They explained this would protect me and baby from seizures and coma. But the on-call doctor warned me it would also make me feel crummy. He used a stronger word than crummy so I knew it was serious.

Hubbins met me at the hospital and after relaying the plan, I asked him to pack a few things from home and meet us in Seattle. He left to get a head start. The nurses offered to dim the lights in the small triage room. I waited in the dark and took a couple of pictures. 

Triage selfie

My chariot awaits - gurney for ambulance ride 

Magnesium IV

Signs You've Been in the Hospital Too Long

Here are a few indicators of Hospital Cabin Fever.

The ultimate expression of independence and self-care is a hot shower.

Iggy Azalea knows what I'm talking about: I'm So Fancy!

The gift shop has become your source for accessorizing.

"By adding this $12 scarf to my ensemble, my T shirt and yoga pants become a BRAND NEW OUTFIT!"

Caution: the nursing staff might not recognize you in civilian clothes. If the nighttime security guard asks the reason for your visit, offer a friendly reminder: I'm a real person AND a patient!

You've started collecting memorabilia for the hospital's own scrapbook page.
Too bad they don't have their own line of stickers.

You wear battle wounds as badges of honor.

With bruises like these, who needs tattoos?

You actually begin to memorize your pill-popping schedule.

This handy mnemonic device will help: 
Pain killers before blood pressure meds,
except after stool softeners, 
and when followed by multi-vitamins 
on days ending in y.

You start daydreaming about having your own really-quite-comfortable hospital gown at home.

You know, this can't be that hard to sew.

You assume the call button is included in the patient discharge kit.

What do you mean the nurses stay here when I go home?!