As you may know my husband and I were expecting to welcome our third little girl into the world in early September. My pregnancy had mostly been smooth with the exception of some morning sickness those first few months and some swelling that started a few weeks ago. But compared to my other pregnancies it had been a pretty smooth one. With my first daughter I had severe morning sickness where I lost weight for the first few months and then I developed pre eclampsia toward the end and was hospitalized for 14 days leading up to her birth and with my second I got a terrible case of bronchitis that led to my separating a rib so a pregnancy with mild morning sickness and a little bit of swelling seemed like a cake walk. Both of my first two girls were born in the hospital. The first Juliette was born 2 weeks early via induction because of my pre eclampsia. It was long and hard and painful. And after she was born she tried choking to the point of turning blue a few times in the hospital. She was little 5 lbs 15 oz and we were terrified. My second daughter, Lorelai, was also born in the hospital on her terms exactly one day before her due date. Compared to my first delivery it was easy. She was a bigger baby and weighed 8 lbs 2 oz. We were not terrified with her. She was a super easy baby.
This time we were planning a home birth. I joked that I was building up to it with how my other two births had gone. Now I also feel like I need to mention that I have chronic proteinuria – this is one of the markings midwives and OBs use to diagnose pre eclampsia. But here is the thing I always have proteinuria and have since I was about 8 years old. I do not have a specific diagnosis because my kidney function has always been great (going on decades now of proteinuria) and every nephrologist I have seen (5 in total from all around the country) have felt that a biopsy while definitive for identifying the cause may upset the balance in my kidneys and force function to drop when it otherwise would not. This proteinuria detail is really important to know because my average levels sit higher than the threshold for a pre eclampsia diagnosis. Every time I have been pregnant I have had to explain this to my OB or midwife and had to put them in contact with my nephrologist so that they don’t immediately freak out about it and of course we have had to monitor my kidney function numbers more closely throughout my pregnancies. Well I have to do that with every new doctor I see because proteinuria typically causes doctors to freak out at you if they are not familiar with your medical history and the fact that you have a specialist that has been closely monitoring your condition for decades (I’ll get into that later).
Now the fact that I developed pre eclampsia with my first daughter also is significant in that this is not my first rodeo and I know what the symptoms and signs are and I am more than aware of the potential complications and risks involved with developing pre eclampsia. Let me tell you being sent to the hospital for 24 hour observation and then agreeing to being admitted after every nurse and attending doctor in L&D tell you you could have an eclamptic seizure at any moment and you and your baby will likely die if you’re not in the hospital when that happens sticks with you. So the fact that I have chronic proteinuria aside I checked my blood pressure at 2 hour intervals from about the 30 week marker on with both my second pregnancy and this one. I know that you can go hypertensive and not experience any symptoms which is why I annoyingly checked and logged my blood pressure and regularly sent those logs to my midwife and my nephrologist. In this pregnancy about 4 weeks ago I started to get the occasional borderline high blood pressure reading (140/90). Not every reading and not even everyday. But enough higher for me to take note and to self impose some bedrest to see if that would keep it lower which it did and my midwife agreed that I needed to continue to track my blood pressure at a more frequent interval, that I needed to rest as often as possible and also that she needed to run pre eclampsia labs. So that’s what we did and aside from my proteinuria all my labs were total normal. A week later we repeated all the labs. My proteinuria had increased – but pregnancy is hard on the kidneys so that was to be expected and my kidney function still remained good and my blood pressure hadn’t gone above 140/90 so my midwife, my nephrologist and myself were content to let me continue resting for another week and re-check my labs. Of course I was suppose to keep up my blood pressure monitoring (which I did) and also to start thinking about induction by 37 weeks or transferring my care to one of the in hospital midwives.
As things happened though it was the evening after discussing the possibility of transferring care/ induction with my nephrologist and my midwife that my water broke. I was 35 weeks 6 days and my midwife told me that because of that I needed to go to the hospital. So I did. The triage nurse and midwife were wonderful. They tried to reassure me that my water probably hadn’t broke and everything was fine. However not long after coming in to triage they checked my blood pressure. It was so high that the nurse didn’t want to tell me what it was and instead asked me to lay down and take several calming breaths and took it again while I was laying down with my left arm over my heart. This position typically will give you the lowest possible blood pressure reading for a person. In this position my blood pressure was 170/110. The nurse asked me about 5 times if I was seeing spots or had a headache or anything which I had none. So she waited a moment and took it again and then on the other side and then about 5 minutes later and it was still 170/110. Almost immediately they got me a blood pressure medication (I don’t remember which one) and within 5 minutes my blood pressure had gone down to 140/90 which is significantly better. Moments after getting my blood pressure down they confirmed that my water had in fact broke and that I was clearly having contractions. They gave me the option of admitting myself to labor in the hospital or going home to labor. After another call to my midwife and discussing with Jeff I decided that (largely because I didn’t want to deal with any kind of car ride while in labor) I wanted to be admitted to labor and deliver in the hospital. Something was telling me that where I needed to be for this birth was the hospital.
All this while my sweet little girl looked great on the monitor. The nurses and midwife had no data to suggest anything was going on with her. After they moved me to a room in L&D they couldn’t get my contractions to register on the monitor. I was having contractions about every 4 minutes but they were not registering. I think largely because of that fact I had the least pleasant experience with a doctor I have ever had in my life. Dr. Myron Bethel comes in and basically treats me like I am an uneducated idiot that knows nothing about my own medical history, that knows nothing about having a baby and certainly knows nothing about how serious pre eclampsia is and that he needs to give me pitocin right now because I need to have this baby before I have an eclamptic seizure. Now, I’m sure he is a well educated doctor and I am sure his intention was to make sure that both my baby and I were healthy but under no circumstance is it ok to talk to a patient that way and it’s especially not ok to talk that way to a hypertensive pregnant lady that is ALREADY IN LABOR. I’m going to say it got heated, but that would be an understatement. He attacked me verbally and he attacked my husband verbally. I finally, between pausing for contractions, demanded that he leave the room and that I would perhaps allow him in to talk to me like another human being in an hour or so but that he needed to recognize that I was in labor already. He offered me the option to go to a different hospital and that treatment wasn’t a negotiation and that he didn’t have to treat me. I’m not 100% on this but I’m pretty sure that he would have needed my consent to start pitocin and also that you cannot deny care to a women in labor because that is one of those medical situations that is classified as an emergency. But my biggest issue with the whole damn interaction is that he came in already heated and feeling like he had to put me in my place for not planning to deliver in the hospital. I also can’t believe that while in labor I had to say to him that clearly I believed the safest choice for me and my baby at that moment was to birth in the hospital and that was why I came in and chose to admit myself. I also can’t believe I had to explain to him that I had a midwife and a nephrologist monitoring my blood pressure and blood work extremely closely and that I had been taking blood pressure readings hourly for the past two weeks and that I was in the process of having my care transferred but clearly I recognized it was trending higher which is why again I came to the hospital now. I also can’t believe that he was getting so angry during this interaction that he was shaking. I mean obviously I was because I was in labor and I felt like I was being attacked but he was physically shaking with anger. I shouldn’t have had to scream at him that I hate Renown and then outline every other bad interaction I had had with a doctor at Renown – all of which could have been avoided with the tiniest bit of bedside manner. I shouldn’t have had to demand he leave the room. I shouldn’t have felt attacked and harassed while in labor and I certainly shouldn’t have had to point out to him that verbally attacking a laboring hypertensive woman was not a good idea for the health of myself or baby.
He did finally agree to leave and thankfully he went off shift two hours later and I never had to see him again. The attending doctor and residents that came on afterword were wonderful and the nurse that was with me for my labor was incredible. I continued to labor and progress but at this time my nurse Karly started to notice inconsistent dips in baby girl’s heart rate. Sometimes it would dip during contractions, sometimes after, sometimes randomly. She asked if my midwife had mentioned my baby having a low baseline heart rate to which I told her she did not have a low baseline. At that time the nurse said baby girl could have the cord around her neck or in her hand and that was why we were seeing random dips and changes in her heart rate. She also said it could be how she’s positioned with the fact that my water had broken. Several possibilities were discussed and then I was given oxygen and glucose to perk her up.
I hadn’t been laboring that long when things decided they were happening. I had Jeff call the nurse. I was at a 9. She told me I had to wait because she needed to get a doctor and they were walking into a c-section at the moment. One of the residents left the c0section and immediately came over. Within 30 minutes of that baby girl was born.
I’m not going to lie when I started pushing I had little to no control over my body. My brain felt fuzzy and I couldn’t feel or at least I wasn’t aware of when the contractions were coming or when I needed to push. Things escalated quickly and after probably 2 or 3 rounds of pushing I felt like this was the end, that I couldn’t push anymore and that neither baby girl or I were going to make it. It’s really hard for me to say that. I didn’t feel that way at all with my other two. I was scared and weak. I felt like I couldn’t breath, not like I couldn’t catch my breath but that I actually couldn’t breath. At around this time the top of little girl’s head was visible and they could not find her heart rate. My nurse Karly who had been there all day very sternly told me that I had to push her out and I had to do it now. I think it took a few more rounds of pushing and the doctor literally pulling her out before she was out – I’m really fuzzy on that because I was on the verge of what felt like losing consciousness. She was gray and silent. The cord was wrapped around her neck three times. I was so scared. I was helpless. They got the cord unwrapped as quickly as they possibly could and took her straight to the warming cradle. Her first APGAR was a 1. They couldn’t find her heart rate. Those were the longest minutes of my life laying there not being able to see her or hear her or know that she was ok. I remember looking into Jeff’s face and I could see that he thought what I thought – we thought we had lost our baby girl.
But they did find her heart rate and they got her to start breathing and once those two things happened she looked amazing. Her second APGAR was 8. And I finally heard the softest, littlest cry I’ve ever heard a baby make and nothing ever sounded so good.
The doctor at this point showed me that she had a true knot in her cord in addition to it being wrapped around her neck three times. They said that was rare and that her cord was a very long cord.
She stayed connected to a heart rate and oxygen monitor but they put her tiny perfect little self on my chest. She was so tiny. I’ve never held a baby as tiny as her before. But she was ok and I was ok and all I wanted was to hold her and stare at her and never let her go. Around this time Karly came back over, she paused what she was doing and sat down on the couch. She said with tears in her eyes, “I don’t know if you are religious, but this was a real miracle. I’ve never see a true knot and the cord wrapped three times do so well so fast.”
My sweet tiny Teresa was born on August 9, 2018 at 11:45am weighing in at 4 lbs 2.6 oz and she is a miracle and I am overwhelmed by this tiny and mighty little person already and cannot wait to see how she grows and who she becomes.
I know her and I both have a bit of a road ahead of us to be totally healthy. My liver and kidney function is not yet back to normal levels and my blood pressure is still much higher than it should be but I am also grateful beyond words to be alive and home with this precious tiny human.