Backstory: When I was 24 weeks while at an appointment with my family doctor (for something completely unrelated) it was discovered that I had high blood pressure. Monitoring at home my numbers were quite high which caused me to call my midwives. At 24 weeks it was discovered that I had developed Pregnancy-Induced Hypertension (PIH) and I was transferred from midwifery care to OB-care. I was put on medication and sent home, we thought I would just spend the rest of my pregnancy on blood pressure meds. About 5 days later my blood pressure spiked again and we went back to the hospital. It took several hours to bring my blood pressure back down with IV meds so they kept me for the night to monitor. In the morning the resident (bless her soul) said she wanted an ultra-sound to make sure baby was ok since my body was having issues. We were told that baby was not OK, he was incredibly small (in the 3% for 25 weeks) and there were issues with the placenta/cord. We were transferred to a high risk hospital and I was told to prepare to have this baby within a week. I was given steroids to help his lungs develop quickly. The main issue with Theo was the umbilical arteries were not maintaining the pressure necessary to sustain his wee life (see here for more information: https://radiopaedia.org/articles/reversal-of-umbilical-arterial-end-diastolic-flow). Eventually the flow would stop pulsing forward and then begin reversing. If it reversed then he would die. The incredibly difficult decision was that he was still to small to successfully intubate (they gave us the 500g mark as when intubation is more successful). His daily ultrasounds guessed his weight between 450g and 500g. Andrew and I decided that we wished to be the decision makers on when he had to be delivered, even if it meant possible still-birth as he was still to small to intubate. All the while I was being monitored for eclampsia and HELLP Syndrome. The rest of the story continues below:
We had a weekend pass from the hospital as my blood pressures had been stable and we had decided to not do another ultrasound until Tuesday. Saturday was wonderful as we were pampered by my parents with food, rest and no expectations. Sunday began much the same as Saturday, and we had intended to go to a friends baptism Sunday night and then return to the hospital. I was still exhausted and could not manage to regain my energy, but we both really wanted to be at church that night. Around 4pm I took my afternoon meds and tried to take a nap, but had some stomach cramps (which I had not had before). I tried to ignore it for about half an hour, knowing that church was in 1 1/2 hours and didn’t want to be the reason we missed it. Once I told Andrew how I was feeling we took my blood pressure and it wasn’t good.
“What should we do?” I asked.
“Last time my gut said to go in we did and it was a good decision.” He said.
“What’s your gut telling you now?”
“To go now.”
Within the 20 minutes it took to pack up our stuff, my stomach pain went from manageable to very painful. The 30 minute drive to the hospital was the worst of my life, with every bump causing more pain.
When we arrived at the hospital we quickly made our way up to antepartum back to my room where the charge nurse smiled at us as we walked down the hallway.
“You’re back early.”
“I don’t feel well. I need to see someone.” I replied.
I crawled onto the bed and began to twist and turn in an attempt to ease the pain. 3 minutes passed and no one came. I called them via the nurse button, “I really need to see someone.”
The lab technician arrived within a couple minutes (I had become very familiar with them as I was having labs twice a day) and took blood. Blood pressure taken- not good. Reflexes checked- hyper-reflexive.
“Are you seeing spots, blurry vision? Have a headache? Pain underneath your right ribs?” They ask. I had been asked these same questions by every nurse at every 4-hour check for the last week. My stomach was in incredible pain, but they seemed so concerned with it being in the right under my ribs, whereas mine was hurting between my ribs, so I assumed it didn’t qualify.
“No, no and no. Can I have zophran?” I ask, knowing that last time my stomach was hurting this bad the zophran worked.
“Yes.” They gave me the oral version. It did nothing.
Within minutes my lab results were back and all of a sudden there were many people in the room. My labs showed that I had moved from simply having pregnancy-induced hypertension, to now being pre-eclamptic and developing HELLP syndrome (a condition in pregnancy which causes kidney and liver failure). My stomach pain was a result of my failing liver.
“Your going up to Labour and Delivery dear.” They say as they try and start an IV in my left arm. It didn’t work.
“But I don’t want to have this baby tonight.” I said desperately as they stuck a needle in my right arm- also didn’t stick.
“Don’t worry, often women go up to L+D and come right back down one they figure things out.” I felt like I was not going to be one of those women.
I was wheeled up to Labour and Delivery and stuck in the “Ultrasound Room”. Now as a doula I have attended several births at Foothills Medical Centre, and none of my clients have ever been in the ultrasound room, as there is a regular triage section right across the hall. But this was the second time I found myself in the Ultrasound Room, and I knew my situation was not normal.
My abdominal pain continued to increase. More attempts were made to start an IV, and the 5th attempt finally worked. The blood pressure cuff was set to go off every 5 minutes. The eclampsia kit was brought in (another kit I had seen following me around). One resident would come in, ask if I had any of the symptoms, look at my blood pressure numbers and leave. Minutes later another nurse/doctor/resident would come in and repeat.
IV meds were started to attempt to reduce my blood pressure. Thirty minutes later and there was no change. Andrew was cycling through every trick we had learned, recline me, try to relax me by dimming the lights, talking softly to me and stroking my hair. No change. The numbers kept increasing.
Then they hit 190/120. Anything systolic (first number) over 160 is a risk for stroke, seizures and ultimately death. Placental abruption (where the placenta separates from the wall of the uterus) was a very real possibility as well. It was busy in Labour and Delivery that night, I could hear the other women and tell by the speed in which the OB’s came running in, then checked their pagers and ran back out. And yet I knew my situation was serious enough to warrant their time.
“What worked last time?” They asked me since the meds did not seem to be working.
“The niphiprine worked last time.” I replied, recalling the meds which had previously caused my blood pressure to drop from 160/100 to 140/80 in a matter of minutes (and left me with a killer headache).
“Ok. Well we’ll give a second dose and if this doesn’t work we’ll have to go in for a section.”
My heart dropped. But I understood that I was at great risk at this point. We had asked for intermittent monitoring for Theo instead of continuous - and they agreed. Ironically this was his most active night, possibly ever, so I knew that he was still good.
The second round of meds worked. Slowly my blood pressure began to decrease. 154/104, 150/100, 145/95. Andrew and I exchanged giant smiles and a high five. 140/90 had become my new normal in the last weeks.
We were moved from the Ultrasound Room to the High Risk Room, which is located right beside the OR. Another room that I had only seen as a patient, and not as a doula. My stomach pain began to recede, and I felt my mind begin to return to normal.
It was around midnight at this point.
“We’re going to start you on magnesium sulphate.” They explained to me. This is a drug that would decrease my threshold to seizures. But it would also make me feel “blah”.
“What do you mean by that?” I inquired.
“Just out of it. And hot, it often gives hot flashes.”
“Does it cross the placenta?”
“Yes, so it will make his heart-rate a little flat too.”
I didn’t want it. But, if I seize and die, then he’ll die too. Did I have a good choice?
It did make me hot. Very hot. And Andrew said later that I became distanced once it took effect- even though I thought I was acting and feeling normal.
We called our doula and told her that we wouldn’t be leaving until the baby was born, so now was probably a good time to come.
The resident came in. My labs weren’t good. Actually they were getting worse (blood work was being taken every 4 hours). My liver and kidneys were starting to fail, and my platelets were dropping (the classic signs of HELLP).
“We can do a c-section right now. Or we can try labour and monitor as you want. Or we can try labour and not monitor and see how baby fares. Keep in mind that because your uterus is so small, we will have to do a classical incision for the c-section. This type of incision means that you will have to have c-sections for every subsequent pregnancy.”
Andrew squeezed my hand.
“We’ll give you a couple minutes to talk about it.”
They all left the room.
“We are talking about hours Andrew, no longer days or weeks.”
“I know.” He said.
“I can’t not monitor. If we have to have this baby now, we’re going to have him in the best condition possible.”
We decided to try for labour and do continuous monitoring once active labour started.
The doctor returned.
“If you are going to have an epidural, we need to do it soon because the anesthesiologist won’t do it in a couple hours when your platelets have dropped anymore.”
I knew I could do labour without pain meds, I had an incredible amount of resolve at this point. But I also knew that if Theo’s heart rate dropped at any point it would be a rush for the OR, and I didn’t want to be put under general anesthesia and have no memory of my little boy being born.
“Can we put the epidural catheter in now, but not put the drugs in and then it’s there if we need it?”
“Let’s do that.”
A urine catheter was put in before the epidural, which I later realized was to monitor my kidney function, not because I couldn’t get up to pee.
A resident came in a few minutes later to insert the Foley catheter to attempt to start labour. Since I was only 26 weeks pregnant, my cervix was nice and hard, long and very closed. Apparently, the resident said, we normally like to use a smaller version (called an “inserter”) for people who’s cervix’ were as closed as mine, but they didn’t have any. This was by far the most painful part of the whole process. The foley is a small balloon that gets inserted inside the uterus and filled with fluid. It basically felt like they shoved a stick up my cervix. And it didn’t work the first time, so they had to do it twice. I didn’t scream in pain, but Andrew said he’s never seen fear in my eyes until that point. Now I know what a 10 feels like on the pain scale.
Once that was in I began to have some cramping, and was a little excited that it might actually take effect.
Around 2am our doula arrived and we updated her on what was happening.
The anesthesiologist arrived shortly after and placed the epidural with a very minor dose just to see if it was placed right. I later realized it would have been a great idea to have the epidural placed before the foley to at least slightly numb the pain of the insertion.
“Why don’t you want the drugs now, if you are going to go into labour anyways? Do you enjoy pain?” The anesthesiologist asked.
“I want to be able to move and use gravity.” I replied. Really I wanted to experience labour, and feel the sensations I had seen so many women go through - be part of that momentous occasion of transitioning from pregnant to born. But I thought he would like the logical answer better than the sentimental one.
“Ok, fair enough.” He replied as he left.
We all settled down for the night, hoping the foley would cause something to happen. I had cramping/contractions for about an hour, but they tapered out after that and nothing happened. We slept a little, talked a little, monitored every once in awhile, but Theo was still kicking away and letting me know that he was happy.
At 330am labs came again. Things were continuing to decrease. My urine in the bag looked like ice tea- because there is blood in it they said.
Around 6am they come in to do a check. BP- about the same. Reflexes- the same. Symptoms- the same. Theo- not the same. When we hooked up the monitor’s his heart baseline was at 104 (normal is between 120 and 160). After about 5 minutes he came back up to normal, but we were no longer comfortable with the intermittent monitoring, so we left the monitor’s on.
The foley was going to be checked at 2pm they told us, 12 hours after it was put in.
Neither Andrew or I felt like Theo was going to tolerate labour well, especially since he was already showing that he didn’t like what was happening. The medication they would need to help stimulate my ‘very-not-ready-to-birth’ body would be very difficult on his little body. Plus we both felt a trial of labour was going to result in a panicked c-section, so we decided to go for the c-section.
“We’ll wait for the day-team,” The doctors told us, informing us that there are more staff and are better equipped to deal with these little people better on a Monday morning than a Sunday night.
Our OB, Dr. Brain, was on Monday morning and came into the high risk room around 8am. We had met several times with Dr. Brain the previous week, and had heard nothing but good things about her both from doulas and nurses. “She doesn’t intervene early.” Someone had said, “When she says c-section, you should go in for the section.”
“What are you guys thinking?” She asked. She was always so calm.
“We think it’s time to have this baby.”
“I think that's a good decision.” She replied, “I’ll see you in there.”
The blue gowns were passed out to Andrew and Christine . We had decided that Andrew would stay with me until Theo was born, and then he would go with him to the NICU and Christine would come in to be with me for the rest.
Several minutes later I was wheeled into the OR. I sat on the table for a minute, just looking around.
“I thought it would be bigger.” I said to no one.
There was a team by the ‘giraffe’ they had informed me- a $35,000 incubator which he would be placed on, worked on and lived in for the next portion of his life. Three people were milling around the machine checking to ensure all their gear was in the right place. We had decided earlier that we wanted them to intubate and do one round of drugs to get his heart started (if needed). If they blew a lung or his lungs never inflated, they would stop trying. They had informed us that babies under the 500 gram mark did not do well with intubation. He was last predicted to be just over 500g, so we were praying he had gained some weight since then.
I laid down on the table and the grandpa-like anesthesiologist chatted away to me about how good my IV was and what he was doing with the epidural meds now starting to take effect.
Dr. Brain walked in and spoke briefly to the staff.
“She is 26 weeks and 2 days, PIH, pre-eclampsia and HELLP. Baby has been diagnosed to be IUGR and around 500 grams.”
Ironically this was the one and only time someone stated everything that was going wrong.
Andrew walked in, sat down, and held my hand. The curtain was put up.
I felt pressure, but not pain, just like they said I would. The magnesium-sulphate I was on made time pass by quickly, and I felt dazed for most of it. I knew they were cutting at one point simply because it was the only motion which was linear which I felt on my belly.
Minutes passed. We waited. I felt lots of moving and tugging. “Ouch ouch…” I said, feeling some pinching down by my cervix.
“Sorry,” Dr. Brain said, “This will be quick.”
“He’s moving,” She said. “Born at 9:26.” This was my only indication he was out, that and a slight squeak that both Andrew and I heard. I don’t know what happened after that point as he was brought over to the Giraffe. Andrew watched and I remained silent.
Dr. Brain and her resident spoke quietly to each other as they began to stitch me up, which I actually appreciated so I didn’t have to listen to the neonatologists attempt to revive my baby.
"We were able to do a transverse incision" Dr. Brain stated. It was hard to be excited about anything at that moment, but I was so glad of the success of the incision as it meant in the future I could try for a VBAC.
About 10 minutes later they began to wheel Theo out of the OR to the NICU and Andrew followed. I knew he was alive, but I didn’t know how alive he was.
Christine came in as they finished the procedure and sat with me. I don’t remember much between Theo being born and waiting for Andrew to come back with news. They moved me back into the high risk room after everything was done.
“How’s your pain?”
I didn’t care about my pain, I wanted to know what was happening with Theo. Was he alive? Was his heart beating? Did intubation blow either of his lungs?
Andrew arrived back in the room 20 minutes later crying.
He held my hand and then smiled through the tears,
“Beth we have the most beautiful little boy.”