Monday, November 14, 2011

Guest Contributor: Pre-Term Labor

Over the next week, we welcome some posts from a guest contributor. Amy contacted me a few weeks ago to share her birth stories. She has Type I diabetes and three sons, all born vaginally and with minimal intervention. Her stories have been a real encouragement to us, and we hope you enjoy reading about her journey!

We had an interesting journey with our second son and we are so thankful for everyone who was a part of his story: the friends who brought us food while I was in the hospital on bed rest, who prayed for us, visited me, talked with me about preterm birth and premature babies, encouraged us, kept others updated on our situation, my in-laws who took care of our toddler when I couldn't be there, the people who helped us move to a new home, and our doula who really went above and beyond. The list is pretty much endless.

I suppose our son's birth story starts back in September. Beginning at 32 weeks I had to go to the hospital twice a week for a non stress test, standard testing for Type I diabetics. These tests monitor the baby's heartbeat and the mother's contractions. This could take anywhere from 20 minutes if the baby is active or hours if the baby happens to be sleeping. I had my first test on September 14th and all was well. Then on September 17th I went in for my test in the afternoon. I was hoping to be done quickly since we were leaving the weekend as soon as my husband got home from work. The baby looked great, but the nurse was concerned because the monitors were picking up regular contractions. I wasn’t really worried since I couldn’t feel them, but the doctor who was on call insisted that she do an exam to see if I was dilated. I didn’t think it was necessary but complied anyway. I was not dilated, so I went home.

Fast forward to September 28th. That night I was scheduled to go in for another NST. I put my older son to bed and was getting ready to head out the door around 7pm. I told my husband that I wanted him to go with me, because he always came with me whenever he could when I was pregnant with our first son. We knew his parents would have come over while our son was sleeping, but we just decided I would go ahead and go on my own. It wouldn’t take too long and then I’d be back home. As I was walking out the door my husband said, “call me if you’re having the baby." He is NEVER allowed to joke about that ever again.

I arrived at the hospital and found that a nurse I knew from my first pregnancy, Megan, was going to be taking care of me during my test. She usually works in the day (she said it’s terrible that I know what nurses work what shifts, I’ve been there so many times over the past year!), but she had been called in to work that night. Usually I am the only one being monitored when I am there because it’s a small hospital, but that night there was another woman being monitored as well. She was 26 weeks pregnant and had had a pretty hard fall so they were just checking up on the baby and making sure that her water was not broken or leaking. She had a friend with her whose daughter was born at 31 weeks due to placental abruption and followed by a life-saving emergency c-section, so the conversation revolved around their families and premature babies.

Everything seemed to be going fine with my test. After two pregnancies, I know exactly what they are looking for so I always turn the computer towards me try to guess when I’ll be done. It may sound kind of silly, but there really isn’t anything else interesting to do! I think it was somewhere around 8:30pm and Megan came in to tell me that the baby looked wonderful, but I was having regular contractions. She wondered if I could feel them. I couldn’t. She told me that the doctor on call wanted her to check to see if I was dilating, then monitor me for an hour and check again. If everything was fine, I would be allowed to go home. I complained to Megan that I did not want to be checked. Didn’t I just go through this a few weeks ago? I didn’t want to be a difficult patient, but vaginal exams carry the risk of introducing bacteria and accidentally breaking the bag of waters, so I did not want any done unless it was absolutely necessary.

She went back to discuss it with the doctor and came back to tell me that the doctor was really insisting that she check me at least once. Megan told me that sometimes with pre-term labor you can’t feel the contractions but you may still be dilating. They just wanted to be certain I was not dilating before they sent me home, so I decided to let her check me. She said I was at least 4cm dilated but she was trying to be very careful not to disrupt my bag of waters (which I appreciated), so she wasn't sure how accurate that was. She called in another nurse to confirm my dilation, and the second nurse agreed. They also said that my bag of waters was bulging out.

I called my husband again to let him know what was going on and he called his parents to come over immediately. He also pulled up our church directory on the computer and started calling people in alphabetical order until someone answered. He finally got a hold of one friend, and she let everyone at our church know what was going on. They prayed for us, and continued to keep everyone updated throughout my time spent in the hospital. She also called and emailed me frequently to check up on me. I really appreciated that.

From here everything is kind of a blur, so I'm not sure if it will all come out in the right order or not.

I was told that I needed to undress and put a gown on. That was difficult, because they also instructed me not to get up. I was just in shock, lying there on the bed, and a friend of the patient being monitored next to me peeked around the curtain to ask if she could help me. I gladly accepted her offer. She helped me into my gown and also went to get a bag to put all of my clothes and other things in to make sure they would go wherever I went. She told me about her daughter born at 31 weeks and encouraged me that everything was going to be alright. My nurses came back in and hooked me up to an IV of magnesium to stop contractions and put in a catheter. They also gave me a steroid shot for the baby’s lungs, which I have since found out have not even been proven to help a baby (at 34 weeks). This was around 9pm.

The doctor arrived to check me as well and she thought that I was 5 or 6cm dilated, and by this time I could feel the contractions. She told me I would have to be transferred to a different hospital because I needed to be somewhere that had a NICU. My hospital did not have one and could not care for babies born at 34 weeks. If the baby was born at this hospital, he would have to be transferred to Children's and we would be separated. They felt that everything was progressing so rapidly that they considered med-flighting me to another hospital by helicopter, which is funny to think of now. It was too windy for a helicopter ride, so we waited for an ambulance. They also ordered an ultrasound to confirm that the baby was head down, and we are SO thankful that he was.

Everyone was acting like the baby would be born that night and I don’t even know what I was thinking. It’s hard to think straight when everything is happening so quickly, I was extremely stressed out, and very uncomfortable from just lying there on my back hooked up to everything, and having multiple vaginal exams. I had been calling my husband every few minutes to let him know what was going on. His parents had arrived at our house and we were trying to decide whether he should come out to where I was (30 minute drive) or just head over to the hospital where I was being transferred (about 10/15 minute drive). The ambulance had not even arrived to pick me up yet, so he and his mom decided to drive to me.

I just lay in bed waiting for the ambulance and feeling terrible. The magnesium made me feel like I was burning up inside and I was starting to get nauseated. I was also extremely uncomfortable because I had been laying flat on my back this whole time. I have no idea how often I was having contractions, but they were very bearable. I just closed my eyes, breathed deeply, and tried to relax and not think about having a premature baby who I would have to leave at the hospital once I was able to go home. I would also not be under the care of my doctor anymore, who is frankly the only doctor in the area that we trust. We go to see him even though he is 30 minutes away.

The ambulance transfer team arrived and the doctor checked me one more time to be sure I was not close to delivering, since they did not want to risk that happening in the ambulance. I was still 5 or 6cm dilated and fully effaced. My husband and his mom also arrived about this time but I only got to see them for a minute. They were not allowed to go in the ambulance with me so they just drove to the other hospital themselves. They got a speeding ticket on the way!

When I got outside to get in the ambulance the cold air felt SO good since I had been burning up before. The ambulance ride was really uncomfortable because I was still lying flat on my back. My back was killing me, and that is also not really the best position to be in while dealing with contractions, which I was still having. I can’t say this for sure, but I am fairly certain that the magnesium was not hooked up to me or going at all during the ambulance ride because I did not feel like I was burning up inside anymore, but as soon as we arrived and I was hooked up to everything at the new hospital, I began to feel that burning sensation again. It is really a horrible medication to take.

I think we arrived sometime around 11pm. The transfer team wasn’t sure where to take me so we had to stand around in the ER for a little bit. Quite an emergency, huh? I was finally taken to a room in labor and delivery and met my nurse, Audrey. My husband wasn’t there yet and I did not like being there alone. The nurse began the registration process, and I was still having contractions regularly, though they were not that intense. They were nothing like what I experienced when I was in labor with my first son. I don’t think the magnesium was doing anything at all to stop or slow them.

A resident doctor came in to see me and got set up to do another ultrasound to make sure the baby's head was down. I told her that I already had an ultrasound and they confirmed the baby was head down, but she didn’t seem to care and went right ahead. I am really not comfortable with having that many ultrasounds, but when everything is happening in such frenzy it’s hard to make your desires heard. My mother-in-law left the room for the ultrasound. My husband and I knew the sex, but we were keeping it a secret from everyone else. It ended up that it didn’t really matter since 3 different people came into our room over the course of the night saying, “so I hear you’re having another boy!” I would always say, “It’s a surprise,” but it was kind of hard to act like that many people were mistaken! So my mother-in-law did unintentionally find out that we were having a boy.

For the next 2-ish hours I just lay in bed, completely uncomfortable, attached to monitors and an IV. No one really seemed to be very concerned about me. I guess they were just waiting for my contractions to stop. At some point I thought that we should call our doula, Amanda, to let her know what was going on, because I knew she would at least pray for us. She wasn't even on call for us yet since I was only 34 weeks, but she answered that 1am phone call anyway. While my husband was discussing things with her, the doctor came back in to see if we would be okay with just stopping all the medication and letting labor progress to have the baby. It had become obvious at that point that the medication they were giving me was not stopping my contractions at all. We agreed to that and Amanda also agreed to come be with us at the hospital.

Amanda arrived at 1:25am and for a few more hours she and my husband helped me through the contractions and we talked about the events of the evening. My contractions really weren't that bad, and I don't think they ever really increased in intensity or frequency. But I was so uncomfortable from having to lay flat in bed for so long, and I felt really sick from the magnesium.

I threw up a few times between 3:30 and 4:30am, and I thought maybe that meant I was in transition or nearing the time to push. I asked to be checked again, but everything was the same: 6cm dilated, fully effaced, baby at zero station. There had been no changes even though I had been contracting for hours by this point. I was able to sit up and move around the bed more since they weren't trying to stop my labor anymore. That felt good.

By early morning (maybe 5am?) my contractions had completely died down. Amanda continued to stay with us until the high-risk doctor came to see me late that morning. We showed her pictures of our first son. I think we all tried to sleep a little bit. My husband's mom stayed with us throughout the night as well. The doctor arrived around 9:50am to discuss what was going on. He said he expected the baby to come in the next day or two, so I would not be allowed to leave. I was allowed to eat, for which I was grateful. Amanda then left at 10:30am. We kept in touch with her through phone calls and email, and she also came to check in on me a few more times.

My son came to visit me that afternoon and my heart just about shattered into a million pieces when he acted like he didn't know who I was and didn't really want me to hold him. I understand he must have been really confused and I probably didn't really look like myself anyway, but still, it was awful. I had never been away from him overnight before and I hadn't even had any time to prepare for this excursion.

For two days I stayed in an L&D room, waiting for something to happen, which it never did. I still had an IV in which ran antibiotics into me every 4 hours. It was SO painful! Everyone was expecting me to just go into labor any second and my GBS status was unknown. I had to get a new IV the next day since my IV had been originally put in at a different hospital. I know, I don't get that either. I convinced them to take out my catheter and let me go to the bathroom on my own (and shower!). Once I was moved to a different room I pleaded with the nurse to take out my IV, which she did. I was also allowed to wear regular clothes so I had a little bit of a sense of normalcy. My son came to visit me every afternoon. My husband's parents took care of him while my husband was at work and overnight. My husband stayed with me through the night at the hospital. I saw a high-risk doctor every morning where I basically got the runaround about how long I would have to stay at the hospital. It ranged from until 36 weeks to until the baby's born to “well, if you're still here at 38 weeks we can just do an amniocentesis and then induce you" (um, no thank you!). My husband and I decided I would leave at 36 weeks, against medical advice if we had to.

I'll spare you all the other boring details about my hospital stay, but fortunately we didn't even have to leave AMA because one of the high-risk doctors decided to let me go home on October 9th. I was 35 weeks and 4 days. I don't know why he finally decided that. Maybe it was because I begged every day to be able to go home or because he got fed up with me not doing what he wanted me to. For whatever reason I was discharged and I was SO happy! I was 5cm dilated upon discharge, according to the OB resident who checked me.

I couldn't wait to get home to my family and to a new home. We had moved to a new house a few days after I was admitted to the hospital! I was so glad to see my son, and when he went down for his nap I wasted no time in cleaning the kitchen. Ah, now I felt like I was back to real life! That night a family from church came down to visit with us and bring us dinner, and it was the most delicious meal I had eaten in so long. We spent the next few weeks getting the house in good order for a new baby to arrive.

1 comment:

  1. This is a VERY helpful story, as far as natural things are concerned, Amy! Thank you for sharing in such detail!!! I don't even know if I've mentioned that we had a similar, although MUCH less intense experience with our first son. Due to contractions on a nonstress test I was checked and was 4cm dialated with Jack at 34 weeks. I was placed on bed rest, but the boy didn't make an appearance for another 5 weeks!! I was allowed up and to return to normal life at 37 weeks, but was shocked that even walking around at 5cm by that point, little man stayed in until he was quite ready to come meet us! :)
    Beautiful and VERY encouraging story, thank you so much for sharing! jenn