I guess I should start off with the birth story of my first daughter Lakin, since it is through her birth that I decided on the path to Addah’s birth. I was induced at 37 weeks with Lakin because though I was not in active labor, I was dilated to 2cm and the doctor thought we might as well. I didn’t know any better and went along with it. After 12 hours of Pitocin and a nasty dose of Stadol, I had only dilated to 5cm. I was declared “failure to progress” and a c-section was performed. Lakin Leigh was 5 lbs 14 oz and 18 3/4 inches long. Although at the time I was thrilled to finally have my baby, in the weeks afterward I realized just how wrong my birth went. I never intended to have a c-section, I didn’t and don’t feel it was necessary. My body did not fail to progress, my doctor failed to be patient and wait for my body to labor and progress on its own timetable. I resolved to never have an experience like that again and planned for a home vaginal birth after cesarean for our next baby.
We never used birth control after Lakin was born. It had taken us 15 months to get pregnant with her and since we wanted our children to be close in age, and since I was breastfeeding, we didn’t want to add any more elements to keep us from conceiving as soon as possible. We were never clear on our actual conception date because I was nursing our older daughter Lakin and had not yet gotten my menstrual cycles back. I do know that the date we took our first positive pregnancy test was March 23, 2002, putting our due date at approximately late December/early January 2003.
My pregnancy was very normal, seemingly as textbook as my pregnancy with Lakin. I felt fine, gained very little weight (10 lbs, which is normal for me). My blood pressure never went over 120/80, fundal height consistent with a late Dec./early Jan. due date; baby’s heartbeat remained between 140 and 162 every time we checked with our rented Doppler and from late August on, baby’s movements were very active. We chose not to have any ultrasounds since all signs pointed to a normal pregnancy and baby, and since we had no desire to know baby’s sex. We planned a home vaginal birth after cesarean: read everything we could get our hands on, gathered our supplies, and got ourselves as ready as we could.
On October 22, I woke up having mildly uncomfortable contractions. I took a hot bath, drank several glasses of water and went back to bed. After several hours the contractions slowed and then stopped. Contractions continued to come and go throughout November, some so hard that I just “knew” I was in labor but they always slowed and stopped after a while.
On December 4, 2002, our county was hit with a hard electrical storm and we lost our power. After a long night of contractions by candlelight, it was getting cold enough in the house that we decided to head to my mom’s house. It was the first time in over a month that I thought, “please don’t let me go into active labor right now”. All I wanted was to get back into my home with my privacy before labor started.
Off to the Hospital:
On December 7, 2002 at 4:00 am, Drew, Lakin and I were relaxing on my brother’s bed when I felt a “pop” and a gush of fluid. I told Drew that I thought my water had broken, but when I put my hand down to check for fluid, there was bright red blood instead. I rushed to the toilet and sat for a few minutes, thinking that the bleeding would slow or stop, that maybe it was nothing. In hindsight, I wasn’t really thinking clearly at all, I was panicking and my head was pounding. I started crying and told Drew I was scared to go to the hospital. Visions of a repeat cesarean were already rushing through my head but when I stood up and the blood gushed out again onto the floor, I knew I didn’t have much choice.
We arrived at the hospital at 4:30 am and were taken immediately to Labor and Delivery Outpatient for monitoring. Blood was still gushing out and I had soaked three towels by this point. I was hooked up to a fetal monitor, which showed that baby was doing wonderfully. I was swabbed for several tests and an ultrasound machine was brought in to verify that baby was okay. At this point, baby was head down and my placenta was low-lying but not over my cervix. 2½ hours later another ultrasound was performed and our baby had flipped to a back up, transverse lie and was being blocked from flipping back down by my placenta. An hour after that we had a 3rd ultrasound and baby was still transverse.
Three different doctors came in to tell me how dangerous and negligent we were being by having planned a vaginal birth after cesarean and one told Drew he would never “allow” his wife to make such a decision. We were feeling pretty antagonistic towards the staff by this point and just wanted an answer as to what was going on so we could know what would happen next. I was still very much planning on having a vaginal birth and since the ultrasound showed the baby to be pretty small, I wasn’t concerned with the transverse lie. After all, baby had just turned from head down to transverse so baby could still turn back, right?
Tests all came back normal. I was moved to a regular Labor and Delivery room and shortly after 9:30 am, the bleeding slowed and then stopped.
At 12 pm the bleeding was still stopped and I felt much better. The doctor wanted me to stay for another few hours for monitoring but Drew and I decided to go on home. We left the hospital at 1 pm, I ate a sandwich and went to bed.
At 11:30 pm I woke up, went to the bathroom and ate some dinner. We were lying in bed watching TV when I felt a gush. I said, “I think I’m bleeding again” and then I felt something coming out of me. I reached down in time to feel a very large (2-3″) blood clot slide out of me. I didn’t know what it was or what to think and was freaking out. Drew called 911 and I called my mother to come pick up Lakin.
The ambulance arrived very fast and at 12:30 am I was re-admitted to Labor and Delivery. My blood pressure had spiked to 160/100 in the ambulance but it stabilized and went down quickly. Fetal monitors still showed baby doing great and another ultrasound showed that baby was still transverse, with feet dangling by my cervix. Measurements showed our baby to be 33 weeks and 2 days, completely inconsistent with our test date, and seemingly impossible since we had a non-existent sex life because I had such awful morning sickness until mid-May.
Doctors began considering that our baby had intra-uterine growth restriction (IUGR) and the preliminary diagnosis given was a sub-clinical placental abruption, a fissure too small to be seen by ultrasound and too small to hurt the baby, but large enough to cause frank vaginal bleeding and large enough to have caused IUGR in our baby. I had fallen over a baby gate in our house back in August… the abruption could have happened then and just not been big enough to cause bleeding until now.
Bleeding slowed again at around 10 pm on December 7, 2002 but at this point neither Drew nor I even considered leaving. It had become apparent that this was quite serious and that it was not going to go away. I was quickly seeing my VBAC dreams go out the window and Drew and I spent much time talking and crying, trying to make peace with the huge possibility that I would have a repeat cesarean.
At 1 am on December 8, 2002 I was moved to the High-Risk wing on the Labor and Delivery floor and I was given a steroid shot to hasten lung maturity. The next morning I was taken across the hospital complex for a level 2 ultrasound. Measurements still showed baby at 33 weeks 2 days. The only abnormality found was a 2-vessel umbilical cord instead of a 3-vessel cord. We were told that while not common, this is not exactly uncommon either and probably was not a big deal.
The heads of High-Risk OB and Maternal/Fetal Medicine asked us to consider an amniocentesis so that if an emergency occurred and delivery became necessary, we would have some idea of baby’s lung maturity. We decided to do the amnio at 11:45am. It was not as painful as I’d feared it would be, but certainly very uncomfortable and more than a little scary. Amnio results came back that baby’s lungs are not mature, only rating a 24 when 50 is considered mature.
I went back to my room in high-risk L&D. I had some cramping, which I was told was normal with an amniocentesis. Three doctors came in and all mentioned discharging me within 24 hours and scheduling me to come back in for another ultrasound and amniocentesis in a couple of weeks. With baby lying transverse and my placenta partially abrupted, I was told I had no choice but to have a c-section. In my head I was still defiant — I thought I could go home, no more bleeding, baby would flip head-down and I could still have a VBAC. I made arrangements for Lakin to come up to the hospital to be with us and was feeling much better all around. It was a wonderful relief to know that baby was doing so well on the monitors and that I could go home soon.
Drew left to go run errands and my mom was on her way to bring Lakin at 5pm. I called Drew at home to remind him to bring Lakin’s pajamas and we hung up when my nurse came in to take my vitals. She commented that the baby and I were doing very well, said she was planning to take the monitors off in a while so I could get some real sleep and asked if I felt okay. I said yes, that the bleeding had almost stopped completely again. She left and had been gone no more than 90 seconds when I felt a big gush of fluid again. I hit the nurse call button and she came back in; I told her I thought I had started bleeding again. She pulled back the covers and freaked out! I had passed another large blood clot and I thought this nurse might just faint. She ran for the doctor, who ran in the room…. Everything started happening so quickly. The doctor thought my water might have broken too and decided to do a litmus test to check. Drew walked in the door while I was being tested and a moment later, my sister Hilary and Lakin appeared at the door. I had been waiting all day to see Lakin and I had to tell them to leave, that we would call.
The litmus test was positive for amniotic fluid, the head doctor of high-risk OB was called and it was decided that our baby needed to be born. A quick ultrasound was done and baby was still transverse and very high. Of course this means we had no option but to have a repeat cesarean.
Everything seemed to be happening at the same time all around us and we were more than a little scared. We were rushed back to the Operating Room Recovery Room, where it was discovered that my IV line was no longer running. It was taken out and 3 different people starting trying to get another IV, plus 1 nurse trying to draw blood. I had 2 people on each arm, poking and prodding and then starting over since they couldn’t find any veins. I ended up with cotton balls and tape on the inside of both wrists, on top of both hands and in each elbow. The IV ended up being placed on the inside of my left wrist, a really painful spot. I was in tears and in horrible pain from all of the needles.
At this point the doctor came in and explained that since no abruption was showing on ultrasound, that there was also the possibility that I had the opposite problem, a placenta acreta, where the placenta fuses to the uterine wall. To remove it forcefully can cause massive blood loss and maternal death, so he said that if he encountered that problem, that he would perform a hysterectomy. I was losing it by now. I was so tired, having contractions, lying in a pool of gushing blood, needles in both arms, facing an eminent repeat c-section and being told that I might have to have a hysterectomy. I think I started to shut down at this point, I remember feeling dizzy and then I drifted in and out of sleep for what felt like hours but was really only 5 minutes.
We were waiting for 4 units of blood to be sent up from the lab in case I needed a transfusion. Since the baby was still doing well on the monitor, it was decided that I had time for an epidural rather than the spinal I had asked for or the general anesthesia that we had feared as a possibility. The epidural was just as awful as I remembered from Lakin. My lower back is the most sensitive spot on my body and I could not hold myself still to save my life. I finally had what felt like an out-of-body experience; I focused on the spots on the chair in front of me and disconnected my brain while the epidural was inserted. A test dose was given and within 3 minutes I couldn’t feel my bottom or hips.
The blood was brought up, Drew changed into his scrubs and I was whisked into the OR. The nurse-anesthesiologist tested to make sure I couldn’t feel anything and the drape was put up. I asked for Drew “before they start” and the anesthesiologist said that they had already started, that my belly was opened already. I remembered the intense pulling and pressure from when Lakin was born but it seemed to be taking so much longer this time. I later found out that the doctor initially opened my belly and uterus on my previous cesarean scars, both of which were low transverse incisions, but that the baby was so high that my uterus had to also be cut vertically and diagonally, leaving me with a K-shaped incision on my uterus.
I heard a suctioning sound and then a loud cry, followed by “It’s a little girl!” and I started crying. Addah Shannon was born at exactly 8:00pm on December 9, 2002. She was crying so loudly and sounded wonderful. The NICU team checked her over and gave her the Apgar scores of 6 and 9, wonderful for such a tiny little early baby. She was brought around for us to see briefly and then Drew left to follow her to the NICU. I was closed up and taken back to the Recovery Room, where my mom and aunt were waiting for me. My vitals were checked again and at about 10pm I was taken to the NICU to see Addah and then moved to a regular Mother/Baby room.
My first impression was of how tiny she was, my fingertip filled her little hand and her head was no bigger than an orange. She weighed 4 lbs 5.8 oz at birth and was 17 inches long.
The Story Continues:
She was put on a forced oxygen breather at 25% oxygen, which we were told was very good since we only breathe 21% and this wasn’t much different. By 6am she had been taken off of the oxygen and was breathing regular room air.
A breast pump was brought to me this morning at about 8am and I started pumping. I was so proud of the 1 oz. of colostrum I was able to pump! As far as I was concerned, breastfeeding was the last thing that I had any control over of with this birth and I would not allow it to be messed with in any way. I started pumping every 1½-2 hours and got a pretty good amount to send down to the NICU.
My catheter was removed at 3pm today and I got up to move around some. I remembered having to relearn how to pee and walk from when Lakin was born, but this was much more excruciating that I remembered, I guess because I had the extra vertical incision this time around. By 6pm I felt good enough to take a wheelchair ride to the NICU to see Addah. She had been moved to a heated isolette and was doing very well. I got to hold her for a few minutes. She was so beautiful, so perfectly formed, like a little china doll.