Our L&D Experience & Our Amazing Son, Gavin

*This is very personal; hoping that putting my experience in writing will be therapeutic for me & maybe help others in similar situations*

On Sunday, November 3rd, I woke up around midnight, which is not uncommon for me since I have been working night shift since late July. Three weeks prior, my blood pressure was a little elevated when I went for my routine prenatal visit. Just under a week earlier, my doctor sent me to the triage area on the labor and delivery unit to be evaluated.  I had been trying to minimize stress, avoid salt, get good rest and drink plenty of fluids to manage the increase in blood pressure, but my efforts did not produce any results.  So, the triage doctor advised that I start taking Methyldopa daily to try and decrease my blood pressure & that I was not supposed to work that night. This was very disappointing for me because I really tried to minimize my exposure to all medications during my pregnancy – I had to take Tylenol and Zyrtec twice but otherwise did my best to cope with nausea, aches & pains, & allergies without pharmaceuticals. The doctor insisted that medication was necessary, or that I had to stay on the unit for 24 hours for observation.  Convinced that a hospital stay would not decrease my blood pressure, I went home and started the Methyldopa as prescribed.  The next day, I felt miserable – I was so dizzy that I couldn’t function.  Anthony drove me back to the OBGYN, where my systolic pressure was in the 160s.  The doctor changed my medication to Labatelol with the hope that it would manage my hypertension and spare me the miserable side effects.  Again, the day after starting the Labetalol, I felt horrible. I had no energy & was unsure how I would get through a shift at work.  My blood pressure that morning was 124/78, but my heart rate had dropped into the low 50s.  I called the doctor again and they cut my dose in half.  I was supposed to check my blood pressure at work Thursday night (Halloween) and report back to the triage unit if it was greater than 140/90.  After a crazy night in the ED, my blood pressure was 147/96. I was convinced that it HAD to be stress related after such a hectic night.  Still, I followed the doctor’s instructions and reported to the triage area again.  I spent several hours on the monitor and my blood pressures were consistently high. Thankfully, the baby was doing great – his heart rate was consistently in the 130s with periodic accelerations. I was placed on modified bed rest and instructed to collect a 24 hr urine sample and have blood work drawn before my next appointment on Monday morning. At this point, I was extremely frustrated because I was scheduled to work all weekend & I barely had enough sick / vacation time to get me through 6 weeks of maternity leave.  In addition, this meant I would be getting my second “occurrence” within one week! You are allowed 3 sick days (occurrences) per rolling calendar year before you are given a verbal warning, so two in one week is a lot!

Over the weekend, I tried to relax as much as possible. I put my feet up when I could and tried to eat well. We did go for a little walk because I am very high-strung and staying indoors is stress-provoking (but it was significantly shorter and slower than the walks we were doing in previous weeks. I felt fine & was convinced that Monday morning, my blood pressure would be awesome and I’d be back at work Monday night. My blood pressure was not awesome – it was in the 170s/90s. The nurse practitioner had me lay on my side for 5 minutes and re-took the pressure – no good. She advised that I would have to go back to L&D triage. I cried.

What had I done wrong to cause my blood pressure to get so out of control? This was not in our plan – I was supposed to continue to work full time until our little bundle of joy reached 40 weeks gestation and the hope of that was slipping away. I came home to collect Anthony & pack a little over night bag. I knew I’d want my own toothbrush if the physicians wanted me to stay over night. We arrived at the triage area & my blood pressures remained out of control. The nurse midwife looked up my test results, which were all clean except that my 24 hour urine had 20mg of protein over the acceptable limit of 300mg. This didn’t seem earth shattering to Anthony & I (especially since the midwife told us that she had seen urine protein values in the 1000s), but coupled with my extreme blood pressures, this put me in the category of severe preeclampsia.  The best explanation that I’ve heard is that with preeclampia, the placenta doesn’t attach quite correctly to the uterus – this occurs on a microscopic level so that it can’t be detected by ultrasound.  As time elapses, the placenta detects that it isn’t being perfused well enough & it triggers the maternal blood pressure to increase.  So increased blood pressure, proteinuria, and edema are the three diagnostic criteria for preeclampsia.  Signs and symptoms are headaches, blurred vision, abdominal pain (especially in the upper right quadrant), and sensitivity to light.  I had a very minimal amount of edema in my ankles, but no other symptoms.  Dr. Radio came to see me and said that I would need to stay over night and that he would consult maternal fetal medicine. I was admitted to the perinatal unit where we thought I would be observed for 24 hours. Anthony went home to attend to the pets and get a few hours of sleep, because neither one of us slept the previous night. Our moms were both concerned, so they came to keep me company on the PNU.

The doctor from maternal fetal medicine arrived and advised that it would be prudent to induce labor because the risk of seizure, stroke, or placental abruption from my high blood pressure was worse than the risk of delivering early. Anthony and I struggled – we wanted nothing more than to get our little one to at least 37 weeks gestation to give him a good start.  To be very honest, I was terrified & everything was moving so fast.  After thinking and praying about it briefly, I told Anthony that I thought we needed to take the advise of the doctors and go forward with the induction. The moms left a short while later so that I could get some rest, but I was totally restless. At 1800, I was moved from the PNU to the labor and delivery unit. 

Our initial birth plan was to do everything naturally – no medications, minimal intervention, and as few healthcare providers as possible.  Dr. Radio said the two options were to start with Cytotec and allow the cervix to “ripen”, which could stimulate the release of oxytocin and induce natural labor OR to start Pitocin and open up the cervix by inflating the balloon of a Foley catheter behind the cervix and then slowly pulling it out.  I didn’t want Pitocin, so I chose the first option.  However, when the nurse hooked me up to the monitor, I was already having (probable Braxton Hicks) contractions, so the Cytotec was out of the question. The plan was to start the Pitocin immediately, insert the Foley, and then start Magnesium Sulfate to prevent seizures when I reached the active phase of labor. After several more out of control blood pressure readings, the doctors decided to start the magnesium sulfate along with the Pitocin. 

Magnesium sulfate is a beast of a drug – when the bolus dose was administered, I felt like my entire body caught fire. My nurse, who was a saint, had to keep getting me cool wash cloths to alleviate the burning.  In addition, I was instantly dizzy – I couldn’t sit up past 15 degrees without feeling like I was going to vomit and / or pass out.  I was unable to see straight, weak, and miserable.  The medication caused me to have the severe headache that I was warned about with preeclampsia.  Obviously, taking this medication meant that I was not allowed to get out of bed to go to the bathroom (or for any reason).  This was a huge part of the reason that we wanted a natural birth – I wanted the freedom to get up and move around to help facilitate labor and to take care of my own needs. Nothing is more humbling than having to ask for help when you need to use the bathroom – something to keep in mind as I provide care to my patients in the future.

In addition to all of these nasty side effects, Mag sulfate is problematic because it works to STOP labor from going forward.  So, the next 26 hours would be a battle between the Pitocin to induce labor and the Mag sulfate.  One of the nice young residents came to insert the Foley catheter – all I can really say about this is ouch – it was painful. Over the next several hours, the nurse gradually tugged on the catheter to advance the balloon and dilate my cervix. Again – ouch.  Towards the end of the episode with the Foley, my contractions started getting very intense. I did my best to breathe through the pain, but eventually started dry heaving and my body forced the catheter out. The contractions and the nausea decreased for a short time after the catheter was out. The resident came to check and advised that my cervix was now 4cm dilated. After this, time passed slowly.  The effects of the magnesium sulfate were difficult to manage & my progress was slow. It was now early morning & 12+ more hours would elapse before our baby’s arrival.  I did my best to breathe through contractions and rest as much as possible (but I had already been up for 30+ hours). The staff advised that they would allow me to sleep, but still the interruptions came roughly every 15 minutes.

During the triage process, the doctor has collected a sample to see if I had group B strep, but the results were not back quickly enough, so I had to receive prophylactic antibiotics for the sake of the baby.  The antibiotic of choice was Vancomycin, which I hoped to avoid taking unless absolutely necessary.  Remember, I wanted no medications. Now I had magnesium sulfate, pitocin, lactated ringer’s solution, and vancomycin hanging.  I tried to text Lisa (who was working in the ER that night) to tell her I looked like an ER patient will all of my drips. More hours elapsed and I started dry heaving again – this time violently with every contraction.  In addition, my body was still on fire and I couldn’t stand having anybody touch me.  I think I may have snapped a little bit at my mom-in-law, and asked her not to touch me because she was trying to comfort me. (Later, I had to ask Anthony not to touch me, either). In my mind, I was starting to feel like I wasn’t going to survive this. I know that sounds over-dramatic, but the pain, nausea, burning, and dizziness were out of control – I had absolutely no control. I asked for some Zofran and then finally caved – I needed something to mitigate the pain.  My nurse advised that we could try Stadol, which could be given IV, so I didn’t need an epidural – I agreed.
Well, this is when I totally lost it. The med was pushed quickly, which my sister-in-law advised is normal protocol.  The dizziness that I had previously was instantaneously increased & I became (internally) very agitated and angry.  My family says that it didn’t show externally, but I really hope I didn’t take my fat aggression out on my poor nurse.  The side effects were awful & the worst part was that it didn’t touch the pain.  I felt like I was breaking inside – and I finally told Anthony I thought I needed the epidural. I was so afraid that he would be disappointed in me; I wasn’t tough enough to get by without MORE medications after everything I had to expose our sweet baby to during the labor process.

The anesthesiologist was fantastic – he worked quickly and explained everything as he went. The pain was decreased significantly. After the epidural, I became very disoriented; I was in a haze for several hours where I think I slept on and off and continued to have strange, irrational thoughts and more pressure than pain from the contractions. When the doctors came to check several hours later, the baby’s head was ready to come out! The medical team assembled and everyone else besides Anthony and I left the room. Matt, the resident who delivered Gavin, told me that I could push, but then quickly advised me to stop so that the NICU team could make it to the bedside. Once the NICU arrived, Gavin was out with two quick pushes. Anthony was supposed to tell me if it was a boy or a girl, but in the excitement of things, someone else made the announcement. He was also supposed to cut the umbilical cord, but we aren’t sure what happened there, either.  Gavin arrived at 2026  on 11/5/13 and was absolutely perfect.

His initial APGAR score was 6 & Anthony was struck by how much he looked like an alien when he came out (because he was purple and not really moving). The NICU team worked their magic and his second APGAR score was 9.  I was able to hold Gavin for a minute or two before he was whisked away to the NICU – these were such precious moments.  I really didn’t want to let him go.  Anthony left with the NICU team while the Matt and Dr. Baker-Vaughn delivered the placenta and finished sewing me up.

After delivering the placenta, the doctors observed that there was a large clot on one side, which indicated an abruption had started to occur.  Praise God for giving the doctors the wisdom to induce us and for allowing us to make the difficult decision to proceed with an early delivery. Nothing went according to our plans, but because of the interventions of the medical team, both Gavin and I are safe and healthy. As a side note, I was really disappointed that Anthony didn’t get to see the placenta, because I think it is so amazing that the body can create an entire organ for the purpose of growing a child and then expel it when it is no longer needed. So cool (and gross).

The next 24 hours were some of the hardest that I’ve ever had to endure. The L&D nurse wheeled my stretcher up to the NICU, but I wasn’t able to touch or hold Gavin at that time. We expected that he would come to us after 6 hours in the NICU (around 0300) and that I could start nursing him then.  Anthony tried to settle in to the pull out “couch” in my room, but it was extremely uncomfortable and he couldn’t get any rest.  I had to stay on the Mag Sulfate for another 24 hours to prevent seizures from occurring. The horrible nausea and dizziness persisted and it made me have to pee literally every 45 minutes or so. At 0230, one of the doctors came down and advised that Gavin couldn’t come be with us because he was having trouble with “suck, swallow, breathe” during feedings.  Anthony went to see Gavin, but I couldn’t leave my hospital bed.  When he came back from the NICU, Anthony went home to finally get some rest with the promise he would be back later in the afternoon / evening.  I tried to sleep on and off with very little success. Still completely dizzy, I couldn’t read or watch TV & I struggled to send a text message off to friends and family to tell them that our sweet baby had arrived. At meal times, I struggled to eat because I couldn’t sit up and I found everything difficult to swallow. 

I was devastated that I couldn’t go see Gavin & with nothing to do but lay in bed and think, I started to wonder if what I was experiencing was from the medication or if I actually had a stroke. What if when they stopped the medication, things didn’t improve? Our family had all gone home to take care of things and I’ve never felt so alone. When Anthony returned, he went to see Gavin – I was glad that one of his parents could be there.  My mom and Megan stopped by for a few minutes on their way out for Alice’s birthday dinner & then Anthony’s mom popped in briefly before going to spend time with Gavin.  When they left, I was alone again and completely inconsolable. Somehow the thought of someone eles holding your baby when you can’t is torture. Anthony and his mom came back with pictures and videos, which was also oddly painful for me.  At 2030, my nurse stopped the mag sulfate; she told me when it started to wear off in an hour, she could take me to the NICU in a wheelchair. I told her I wanted to go ASAP. I was finally able to walk to the bathroom and Anthony helped me get into the shower. Afterwards, the nurse said Anthony could take me to see Gavin, where I was finally able to cuddle him without interruption.  It was one of the most amazing moments of my life – there with my sweet husband and this new gift that God has given us.

Gavin in the NICU. See more here.

Gavin is a dream come true and an answer to prayer for me. I am so thankful for the privilege
of raising this sweet child.  He is a constant reminder of God’s love & grace, even when things don’t go according to our plans.