Wednesday, July 11, 2012

Of Mouse And Me

Or a belated birth announcement.

As you may recall I went into hospital on Tuesday 22 May to begin Clover's extraction process. I was being induced at 37 weeks because of Clover measuring small for dates (due to, as yet, undetermined reasons.) In the days leading up to the induction I had a couple of sweeps, acupuncture (Matilda walked in on one session and had the shock of her life; "Why does mummy have needles stuck all over her?!") and consumed copious amounts of raspberry leaf tea and evening primrose oil hoping to at least make the process easier.

So on Tuesday I was admitted, given a pessary and an attempt at a sweep, and left to rest. Not that I did rest an awful lot. I had a lot of stomach pain (I thought it was a relapse on a stomach bug that had plagued me the previous weekend) and I was actually sick, plus I was regularly woken up for a CTG on Clover because of her being a high risk baby.

On Wednesday I started having mild but regular tightenings. In the evening I was examined again and given another sweep by a doctor who will be remembered forever more as "Dr Fingers;" He was very tall, very good looking, and introduced himself as simply "Olly." The intimacy made sense, too, since he then proceeded to try to tickle my tonsils, but not via my throat. If you catch my drift. He said I was a couple of centimetres dilated, and he *could* manage to break my waters, but because it was then going to be the night shift when I delivered and the delivery was considered high risk, it would be best to insert another pessary and check again in the morning.

On Thursday morning, having had very little sleep, my stomach ache had returned and my tightenings had died down. I asked when the doctors were going to be in to check me, and I was told they normally wouldn't check again until the evening, because they would want to leave the pessary in for 24 hours. Agh! But Olly The Fingers had made it very clear I would be checked the next morning! After a lot of pleading, a (much more petite and gentle-fingered) doctor came in and agreed to examine me again. By that point my nether regions were extremely sore and uncomfortable. I assumed it was a combination of "The Finger's" not-so-gentle attentions and the hormonal pessary that had been increasing the blood flow in the area for the past two days, but whatever the reason, this examination was much, much more painful. As in scream during and be left sobbing afterwards painful. She then declared I was still only a couple of cm dilated. She wanted to leave me until the evening (which would mean Friday morning, since they still wouldn't want to start labour in the evening if they could help it.) By then I'd really REALLY had enough. I was in a lot of pain, I hadn't slept in three days and I desperately felt this baby had to come out. I insisted quite a lot, and in the end we decided that I was going to be taken to delivery ward, given an epidural, and then she would break my waters after that. (Despite having coped fine with two drug free births before, the excruciating pain during the exam combined with the fact that I was going to be strapped to a monitor in bed due to worries about Clover made me sure I wasn't doing this drug free this time around.)

All this was at about 11:00 am. By 1:00 pm Becky my doula had arrived, we were in labour ward and they were starting the pre-induction checks. This is when all hell broke loose. (Note: If the following account seems very disjointed and confusing, that's what it felt like to me at the time too. Unfortunately I have trouble remembering what exactly happened and when it happened, so this will have to do.)

When they took my blood pressure they found it was elevated. The midwife said that some times elevated blood pressure can make your platelets low, so they would order some blood work and let the anaesthesiologist know if the results were off. They took some blood, sent it off, and went on observing me and taking my blood pressure. Two measurements later my blood pressure had gone up to 190/120. It's all a bit of a blur now, as there were so many people coming and going. Clover's heart rate was being constantly monitored, and she appeared to be happy, thankfully. I was given some medication to bring down my blood pressure for a while. The midwife tried to chase up my blood work, and found out that it had accidentally been sent to the wrong place -so they sent it off again, to the right place this time, but this would delay the results by another hour. In the meanwhile, they tried to place venous access on my arm (this would be needed to give me the pitocin for the induction, and more importantly, medication to control my blood pressure and liquids and blood if things got seriously wrong -which they were becoming increasingly worried about, as I found out later.) During my entire pregnancy, no one had any trouble getting a needle in my vein, but this time I was so ill and dehydrated and the needle was so large that they just couldn't do it. (The venflon needle they were trying to put in was literally as long as a small pen.) Various people of increasing seniority were called in to try in the next couple of hours and failed until a senior anaesthesiologist finally arrived in a state of mild annoyance (I think he was very busy) grabbed my arm and stuck it in with very little fuss. A second blood sample was taken and sent off. The first blood sample arrived. My platelets were indeed very low, and some other things were off too. The anaesthetist was called again. The second blood sample results came in, and my platelets were even lower (I think they were 10 by then. It was so low that I was even getting bruises by the blood pressure cuff they used.) Midwives were coming and going, saying things like "Well, we'd like the baby to be born as soon as possible now," and "We don't want to worry you, but we've reserved you a bed in the Intensive Care Unit just in case." (Worried? Me? What would make you think that?) The anaesthesiologist arrived and explained that because of my low platelets, and epidural would have a high risk of causing a bleed in my spine and leaving me with neurological problems. Instead I was offered a type or patient controlled pain relief called remifentanil. This is a drug similar to morphine that takes effect and is metabolised very very quickly. I was connected to a drip with it, and I could administer a dose by pushing a button I was given to hold. As soon as I pushed the button it took effect, and it wore off in about 5 minutes.

What can I say? Remifentanil was GOOOOOD. As soon as it got started, things started looking up again. The OB arrived and tried to break my waters again, however he still couldn't manage it, so we decided to start the pitocin without doing the ARM (artificial rupture of membranes) and check again in 4 hours in the hopes that the pit would  move things along enough to make ARM possible. This was at about 6:15 in the evening. The pitocin drip was started, I had my remifentanil button and I was actually pretty comfortable and happy that things were actually happening at this point. (Did I mention the Remifentanil was GOOOOD? I was probably to stoned to worry, but I was finally calm, in no pain, and I could see my contractions on the monitor. Plus, unlike an epidural, I could let it wear off from time to time and change position or allow myself to feel a couple of contractions to see how I was progressing. The only strange side effect was that from time to time I'd hear strange whispering voices in my ear, but when I opened my eyes there was no one near me and no one in the room was talking. Nothing another dose of remifentanil couldn't solve though. Mwahahahaha.) The pitocin dose was slowly increased in the next hours, and my contractions became more regular and stronger on the monitor, although I was still not especially uncomfortable. At 23:15, the OB arrived again and this time he managed to break my waters. He said I was STILL only 2 cm dilated, but "things" felt a lot better/effaced/stretchy etc down there. Still, we probably had a while to go yet.

Allow me to laugh. MWAHAHAHAHAHAHA HA HA Heeee. Ahem. At 23:30 I felt a bi strange. More uncomfortable, like. Clover's heart rate started dipping quite a lot at that point (it had been dipping since the ARM, but recovering.) I tried turning on my side to help, and realised -I was pushing. I said "Hold on! I'm pushing!" The midwife turned around in shock and tried to rush to the bed, but she was too late.

At 23:40 on Thursday 24 May, Ramona Bernadette Joy slid out on the hospital bed with one push. She weighed 5lbs 4oz (2380g) and her Apgar was 8 at 1 minute and 9 at 5 minutes. She was a whole 1lb lighter than what they had predicted she would be, and smaller than 97% of babies born at the same gestation.

We were later told that I developed "sudden onset severe pre eclampsia and HELLP syndrome."  My liver was failing, my kidneys were almost not functioning at all and my platelets were so low I was covered in huge bruises. In retrospect, I had lots of signs. Small size of the baby is often a result of pre eclampsia, and my blood pressure was taken and urine checked for protein etc twice a week since week 30. I had leukocytes and increasing amounts of protein in my urine towards the end, but because I never did get high blood pressure until labour day, they thought I must have some sort of infection and kept sending in urine samples for a culture although nothing came of it. I did have swelling and water retention (towards the end when I did acupuncture, the needle holes would leak water like a little stream) but because I am bigger and don't wear rings etc, the swelling was hard to spot. And the stomach pain I was having is a classic sign of HELLP, only we didn't know about it. I really think that my lack of high blood pressure completely sidetracked the doctors and midwives from correctly interpreting everything else that was happening. Trust my body to leave out the most important symptom of my illness! :P

I may write about the week after the birth and our hospital stay on another post, as THAT saga is not something I feel like going into right now. The short version is that Ramona had trouble latching on and lost 12% of her body weight, going down to 4lbs 10oz (2100g.) We stayed in for a week trying to establish breastfeeding as I was determined to do it, and saw many, many, MANY people with different, often conflicting advice. It was not a good time as I was really tired and in a lot of pain, worried, not really understanding what was happening (no computer! No Dr Google!) and Ramona kept some-times-gaining-some-times-losing and being threatened with SCBU. In the end I managed to get her to gain for 2 days in a row just with breastfeeding, so we were released. Unfortunately, after a week at home she had been losing again -at that point we started using the Medela SNS to supplement her feeds and her weight gain took off. As I write she is about 3/4 breastfed. :)

For now, pictures!

Poor Ramona! The first picture mummy posts of you on the blog, and you look like the creature from the black lagoon!

That's better!

So small but so alert!

Yes, I took a picture of my placenta :) The midwife said it was "gritty" which apparently explains her small size -it means it wasn't functioning well.

First ever picture with clothes on!

You can really see how small she is here... I love this photograph.

Having a cuddle

 Ramona has a trademark frown. Every-single-person who met her in hospital commented on it.

This tiny little face with the lively dark eyes is why I call her Mouse!

That's it now... I'm tired of blogging. See you next time everyone!