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.


Sarah said...

so glad you are okay!

R. said...

That is so traumatic. I am so glad that in the end, everyone is healthy and that you are in one piece (literally). I need to know which hospital you choose, I want to go there!

Kate said...

Ouh - sounds like quite the postpartum hemorrhage. Glad you're recovering and had great care.
Did they say you had a planecta acreta ot anything like that?

kayjay said...

R - I went to Mount Sinai. Can't say enough good things about the doctors and nurses there. Hospital food was abysmal but that's my only complaint!

Kate - they never told me what it was they thought I had but I looked up placenta accreta and it sounds like what I had because they kept saying that the placenta was fused to the wall of the uterus and that this was common in twin pregnancies. The steps they were discussing to "fix" the problem also sounds like the recommended courses of action (embolism & then hysterectomy) to treat the accreta so you're probably right!

Jill M. said...

Holy smokes, that does NOT sound pleasant!!! I'm so glad you are ok in the end and still have your uterus!!!!!!!!

Linda said...

Holy guacamole! What a traumatic experience! I'm so glad that you got to keep your uterus. In the end, you have your two healthy, beautiful girls and that's all that matters. Thank you for sharing your birth story. :)

Meant to be a mom said...

That is so scary, I'm so glad you are all ok. So many things can go wrong in delivery. Thank the lord you all made it safely home.

Anonymous said...

woah nelly! I am so glad that you are okay after all of that. Isn't it crazy to go back and see all the drugs they used? It is great that you had such awesome doctors and nurses helping out.
Happy Mother's Day- you definately deserve it!!!

Phoebe said...

It's a good thing you didn't know what was going on. I know if I did, I would be in a panic! Those doctors were amazing! I'm so glad you are ok now.