Saturday, April 17, 2010

Birth Story - The FINAL Installment

Hellloooooo....anyone out there?

Can't blame you all for dropping off because this has been the longest, most drawn out story ever BUT...

...I'm going to finish off my birth story.

Yes, really. Thank you for hanging in there and being patient. There is an end. It is in sight. More thoughts on that later...

Onto the birth story...

So there I am, lying on the table, children delivered and waiting for the placentas to magically slide out and for this to all be over. After all, I just pushed two human beings out of my woohoo - it couldn't get any harder than that could it? At this point, things seemed to slow down or stall a bit. The doctor was massaging my abdomen and she kept massaging.....and massaging.....and massaging. I finally asked her whether the placentas had been delivered and she told me that they had not yet detached and that it was taking a bit longer than it should. She went on massaging and then, after some more time had passed, she told me that they were going to have to manually remove them. Back up the woohoo she went and started basically tearing the placentas away from the uterine wall and let me tell you, that was when I fully realized that my epidural had worn off. I said before that could feel everything going on down there when the kids were being born but the actual birth part took place pretty quickly so I didn't have too much of a choice but to bear with it and then it was over, or so I thought. When the placentas were being removed, it *HURT* and I was in so much pain that I asked the doctor to stop and when she didn't, I finally ended up yelling at her "DOCTOR - PLEASE STOP!!" That finally got her attention and the anesthesiologist was paged to top up my epidural. My screaming also alerted my DH that someone wasn't quite right in the OR. It was pure bliss when the top up for the epidural took effect and when they handed me the button that allows me to self-administer additional doses, I hit that button five times in a row immediately. There was no chance that I was going to live through it wearing off again!

At this point, they continued to manually remove the placentas. They were using ultrasound to ensure that they got all of the pieces. Then they then moved on to stitch up the episiotomy. It was sometime around now that I began to realize that something was not right because the doctor, when asked to describe the bleeding, replied that it was "still brisk" despite there being multiple bandages being pressed to the site of the wound and applied with pressure. I remember seeing a sodden bandage soaked through with blood and thinking to myself "that must be my blood" but not really realizing how bad it was. My DH told me later that he remembers seeing a bucket with the placentas in it coming into one of the rooms where the girls were being checked out and it being filled with blood. We had agreed ahead of time that my doula would stay with me during the delivery of the placentas and he would go with the girls so this was his first clue that something wasn't right with me in the OR.

I had begin to shake uncontrollably like a leaf and nothing I could do could stop the tremors. My whole body was just shaking and shaking and I was wondering if I was beginning to go into shock. I asked the doctors if this was "normal" and was told that this was a common side effect of having an epidural. Hmmm. No one ever told me that so for those of you are pregnant and who may still be reading and considering having an epidural during your labour - beware that your epidural may give you an intense case of the shakes.

I guess at this point I had lost too much blood because the doctor started calling for blood products - 4 units to be exact. Due to the heavy bleeding, they decided to do a D&C to ensure that they removed any remaining pieces of the placenta that may have still been stuck to the uterine wall. I never knew I could have a D&C as part of giving birth but there you have it. They also cleared the OR so my DH and my doula had to wait outside.

According to the post operative report, at this point I became "hypotensive" which means that I had abnormally low blood pressure. They were unable to get a reading from using the blood pressure cuff - you know, the one where they inflate and cut off your circulation and then somehow take your blood pressure by holding a stethoscope to your arm. So, the anesthesiology team then started to try to put in an ART line. This is akin to an IV in that they are trying to slide a very thin flexible tube right into the artery that runs in your arm. They tried for a half hour to get this line in, shifting back and forth between my right arm and my left arm. I was pricked over and over again and I remember being very vocal and cranky about it, proclaiming loudly "OUCH!" every time they tried to get that thing into my artery. The next day, I had a good look at my arms and I had no less than a dozen scabs on *each* arm where they had tried to get the ART line in and my forearms were completely black and blue on the underside from my wrist right to my elbow. I appreciate how difficult it is to put one of this ART lines in because the circumstances that merit one also mean that the patient likely has collapsed arteries making it extremely difficult to slide the tube into the artery without puncturing it. However, it was intensely unpleasant from a patient's perspective.

A second D&C was performed because of ongoing bleeding and the doctors were able to confirm that there was nothing left in the uterus. The anesthesiology team were finally successful in placing this ART line and the blasted pricking stopped. Blood work became a breeze after this because there is a valve as part of the whole ART line setup that allows you to tap into the artery and draw blood at anytime. One small positive to all the pain of having one put in! I also was thinking to myself that it was so ironic that in one arm they were giving me a blood transfusion and from the other arm, they had to repeatedly draw blood to check the levels of everything. I still wasn't stable at this point and continue to bleed and I fully realized that things were not going well because the anesthesiologists were being continually paged and they answered the pages by saying they were dealing with an emergency in the which I realized in a haze that the emergency they were referring to was ME!

To stop the bleeding, the doctors placed a balloon inside of my uterus and inflated it with saline so that the outward pressure would hopefully come into contact with the site of the hemorrhage and stop the bleeding. Thankfully, it worked because if it hadn't, the other options to stop the bleeding were to 1) place shuts in the arteries leading to the uterus and cut off the blood supply or 2) do a hysterectomy. Yes, you read right...a hysterectomy was the last option that was presented. I thankfully did not know about any of this but these options...maybe they were discussed with me but I have no recollection of that conversation...but these were discussed in detail with my DH who was anxiously waiting outside.

My condition was finally pronounced stable. Caitlyn was born at 7:04pm and by the time I was stabilized, it was 11:40pm.

The list of medications given to me is pretty impressive too:
  1. Phenyleprine
  2. Hemabate
  3. Ergot
  4. Pentaspan
  5. Granisetron
  6. Metoclopramide
  7. Furosemide
  8. Labetalol
  9. Morphine
  10. Metoprolol
  11. Adenosine
  12. Nitro
Total blood products given - 9 units of blood, 7 units of fresh frozen plasma and 5 units of platelets. They estimated that I lost over 3 litres of blood.



That was close.

The key thing is that I am okay now.

As I sit here and type this, I look at the beautiful faces of my girls and feel that everything I went through was worth it to get to where we are now. It was a hard slough after their birth, but I made it and I'm fine now and I am still in possession of my uterus (!). I have an entirely new perspective on childbirth now but women go through it all the time and we get through. We make it thanks to medical technology these days and the teams of dedicated doctors & nurses who are on call for our deliveries. I am so glad we decided to choose the hospital that we did because it was their knowledge and expertise that saved me in the end. I am sure that the care that I would have received at a more local hospital would have been good as well but I am not sure I would still be in possession of my uterus and I may have ended up being transferred downtown to this hospital anyway when things took a turn for the worse. When we chose the hospital that we did, we chose it for the girls and the excellent NICU they had. Little did I know that I would also need their expertise in dealing with difficult birth situations.

So there you have it, not quite in a nutshell, but my birth story in as much detail as I can remember it.

The end.

Wednesday, April 7, 2010


For those of you who are still hanging in there with me even with my excruciatingly long and drawn out birth story, here is a little peace of my girls! These were taken a week or so ago and they have definitely put on weight and chubbed up a bit. Victoria weighed in at the doctor's office today at 7lbs 9oz and Caitlyn topped the scales at 8lbs 1oz. They're both doing well!



Two sisters hanging out together having some tummy time:

Victoria's closeup:

Caitlyn's closeup:


Saturday, April 3, 2010

Birth Story Part III

When the anesthesiologist showed up, I asked that I only be given enough to take the discomfort away but I would still like to feel the urge to push when the time came. He only administered half the regular dose which sounded fine to me but this decision would come back to haunt me later. It was about 10am by this point of the morning and with the contractions faded into oblivion by the epidural, I decided that now would be a good time to get some sleep and some rest. I can't imagine going through hours and hours of labour only to be exhausted and then have to push a baby (or two!) out at the end so the epidural was a good decision for me.

The worst part about having the epidural put in was the local freezing that they administered to numb the area. Like all of the needles we have experienced over the years, this was no different - pinching sensation with a sharp sting and then when the actual epidural was put in, you can feel what is going on but there is no pain associated with it. The epidural itself is a flexible tube that they then proceeded to tape to my back to ensure that it didn't move. I think my entire back was covered in adhesive to ensure that it didn't move with the tube fed over my left shoulder and then attached to a self-administering button that I could press at will to "top up" if I felt the need.

The doctors came back and kept checking on me throughout the rest of the morning and at 2pm they did one final internal exam and announced that I was ready to start pushing. Now a side note about internal exams and not to scare those of you who have not yet had one or haven't gone into labour...internal exams can be very uncomfortable and can be even painful. They put a glove on their hand, some lubricant on two fingers and then those are inserted into your vagina where they feel for the cervix. When you're not in labour, the cervix should be high and closed. During an internal exam when your cervix is high, it really feels like they're trying to reach for your tonsils by way of your vagina. Truly. My first clue that internal exams were not fun was when I was in triage and the woman in the room next to me had an internal exam and yelled through the whole thing.

One of the nurses asked me if I wanted to "practice" pushing. Having never done it, I thought that this would be a good thing so she coached me through what to do. You're lying flat on your back and you need to get into a frog like bend your knees and grab behind them with your hands and then lift your upper back, all the while pushing down with your abdominal muscles like you're trying to pass the biggest poo of your life. You do this for one long breath and then you exhale and inhale again quickly and then push again during the same contraction. I have never felt my face go so red and I felt like my head was going to explode at some points. Who knows if I ever got the pushing technique right because I proceeded to push for 4 hours (at my own request...I'm kind of stubborn that way) and little Victoria just wouldn't come out.

I have never pushed so hard in my life. I have never tried so hard in my life to do something and it was disheartening when the doctor would tell me that I needed to push even *harder* than I already was. I thought I was pushing pretty damn hard but the baby wasn't moving down so maybe I wasn't getting the technique or doing it properly. My doula helped me to advocate for myself at that point and we got to try different techniques...we tried squatting and we tried another technique where we wrapped my doula around the waist in a sheet and I pulled the sheet towards me while my doula braced herself and pulled against me instead of pushing. Same muscles were used in that technique, just a different way of engaging them. Still no change. At this point, it was about 5:30 and the doctor decided that it was time that the babies arrived. They were not in distress at all, it was just time.

I was wheeled into the OR at that point and I pushed a few more times there but still no change. Then we decided to use the vacuum and things began to happen pretty quickly then. They had to fit the vacuum in and when she was trying to work it in past my perineum, I noticed that what she was doing was pretty uncomfortable for me. Then I got an episiotomy and I definitely felt the "snip". Those should have been my first clues that my epidural was wearing off or was not strong enough for what they were about to do. I was asked to push again while they used the vacuum to help Victoria along and with the first push, I felt her head come out (finally). With the second push, I felt the rest of her body come out. I thought I heard her cry but she was whisked away almost immediately but a nurse did stop and show her to me very briefly from a few feet away.

The next thing that I remember was that my water broke - little Caitlyn was ready to make her appearance into the world and her sac ruptured after Victoria was born. There was a huge gush of liquid that went on for a few seconds and I just soaked the gown of the doctor standing at the foot of the bed. Now Caitlyn had been head down all along but with Victoria being gone from the uterus, she flipped around and became breech. All the doctor said she was that a foot was sticking out. I will be forever grateful to the doctor that was on duty that night because normally, this would have meant a c-section for Caitlyn as the breech position is not one that doctors like to deliver vaginally. However, I had told the doctor several times that I wanted to avoid a c-section if at all medically possible if there was no danger to the kids. So at first, the resident tried to reach up and grab Caitlyn but she couldn't get a good hold of her. Than, the doctor in charge reached up and grabbed her and with one or two pushes from me, out she came doing the splits! Caitlyn was taken away immediately as she did not come out crying so they wanted to examine her so I didn't even see her.

During all of this, I am realizing more and more that I can feel just about everything going on down there, not just pressure. When someone puts their entire hand, not just 2 fingers, up your uterus, it feels pretty uncomfortable. Like you're being really, really stretched in a not so nice way and that is no small feat for someone who is 8 months pregnant! I thought that the hard part was over at this point because the kids had been born and it was my misunderstanding that the placentas would just slip out and deliver themselves. Boy was I wrong.