Birth Story, 25 weeks, 2 days -- Darn it. (very long and graphic)

Hello!  This page has been getting quite a few page hits, so I wanted to add a note.  If you or someone you know has just had a 25 weeker, Congratulations, a baby is always a cause for celebration.  Also, I'm sorry you are facing such a scary beginning.  If you are on bed rest and searching for solace, I hope you find it here.  Every day your baby is inside you decreases a NICU stay by 3 days on average.  For anyone working on establishing milk supply with a pump, I did that with both of my pregnancies, you can read more about how here. 

Well, I had decided to post that I was pregnant yesterday because I was really afraid I was going to end up I had a baby before people even knew I was pregnant.  Ends up, I wasn't wrong.  I'd promised myself I'd announce after the anatomy scan, then after the echo and each time, I found a reason not to.  I didn't post after the anatomy scan because I was afraid if I said it, it would stop being true and I'd lose the baby. Then, when we had her fetal echo last Wednesday, we discovered my fluid was low.  My cervix was still closed and OK, she looked great, her heart anatomy (and everything else) is great. All the pieces and parts right where they belong.   Her growth measured on target at that point and her cord doppler looked fine.  We decided to check me for a leak because the fluid was "low normal (5)).

After getting checked, we found no signs of a leak, and my cervix was closed, so everyone moved on.  Friday afternoon, I started to experience what I thought might be contractions.  I called the on call doctor and she said she thought it was bowel related (because I'd had several bowel movements that day) and referring to my uterus and therefore not a concern. I did mention that they were timeable, peaked and caused pressure in my groin area, which were all concerns.  The increased bowel movements could also be signs of preterm labor, but she really thought that this was just bowel issues. I continued to experience the contraction like sensation all day Saturday and Saturday afternoon, I called the on call again and it was Dr. P.

Now, every time I talk to Dr. P, things end up happening.  He isn't actually my doctor, however, he performed my C-Section, managed my miscarriage over the phone, handled the second trimester bleeding episode I'd experienced with this pregnancy and now, here we were again.  Dr. P sent me to Labor and Delivery, where they assessed me.  They couldn't see the contractions on the monitor, and when they checked me, I didn't have any cervical changes.  They decided not to run a Fetal Fibronectin test (after they collected the sample) because I hadn't had any cervical changes.  I thought about pushing back, and chose to let it go... I can't change that now, but I'm having a lot of trouble not regretting it in hindsight.  Again I reiterated I was able to time the contractions, they caused pressure. My nurse said that it was probably because they asked me to lay on my back for monitoring.

They discovered a yeast infection (no symptoms, but they saw yeast on the mount) and gave me diflucan to treat for it and sent me home.  I continued to have the cramping sensation they said was most likely caused by the yeast infection all night, it woke me several times.  Sunday evening, I started timing the contractions again.  They were VERY regular and it didn't make sense that cramps from my intestines or otherwise would be so regular.  Even knowing they said that yeast infections can cause harmless contractions, I began to worry.  Then I started having contractions so painful I couldn't talk through them.  I called the on call line at 11:00 pm, and Dr. P was still "the guy".  

I told him I couldn't talk, that I was scared, but I didn't want to drag my kid out in the night, or waste everyone's time for a third night if this really was nothing.  He said that the only thing we can do is check again.  We grabbed C and a blanket and headed out.  The drive was much faster without traffic.  I sat in the passenger seat and tried to memorize the contraction start times and duration as we drove.  11:07 - 1 minute, 11:15 - 1 minute, 11:24 - 1 minute, 11:32 - 1 minute... we arrived at the hospital.  I made the same jokes, and said the same things about hoping this was a false alarm as last time.  They asked for a sample, I had to wait until a contraction passed to answer.  I gave my urine sample (pregnancy professionals have a serious obsession with urine) and went into the triage room (my usual, room 4 -- I once was in 5, but for the remaining 3 previous visits, I was in 4).  I laid down, this time, I was told I could lay down on my left side.

I told the nurse I really thought they were contractions, even though they weren't showing up on the Toco (external contraction monitory thingie), she replied "If you say you are having contractions, you are having them, I believe you, I don't need a machine".  She stayed in the room most of the time.  She only left if she had to.  She explained she was the charge nurse, and sometimes everyone needed her at once.  She asked a bunch of questions that hadn't been asked before, after the fact, I realized they were the admitting questions.  The resident was in a C-Section and hadn't been able to come evaluate me yet, she'd decided to ask those questions based solely on her interaction with me.  She remains one of the high points of what was a very scary night.

When the resident came to examine me at around 1 in the morning, she looked inside and thought she'd find that I was still closed.  Unfortunately, when she did her physical exam, she found instead that I was open.  They had said I was open less than a fingertip before and that it was common in women who'd been pregnant. I asked if that is what she meant, she said "No, you are 2.5 cm and I can feel your baby's head".  They admitted me immediately.  I got in a wheelchair and they took me up to a room in Labor and Delivery.  They suggested I go to the bathroom before I get into bed as I wouldn't be getting up again for a very long time.  I went to the bathroom and there was a lot of blood.  The Triage Charge nurse and my L&D Nurse worked very quickly to get IV access and start a magnesium bolus.  While my L&D Nurse started that line, the Triage Charge Nurse gave me a steroid shot in my leg. The mag gave me an incredible hot flash and I started to feel somewhat less than 100%.  I also became desperately thirsty.  They told me the purpose of the magnesium was two fold.  First and foremost, we were hoping it would stop labor.  If it couldn't, it would help protect my baby's brain.  I continued to have contractions and I begged the nurse to tell me how fast the magnesium would work.  With each contraction I'd cry "Why isn't it working? Why won't they stop".  I asked them to tell me when I should give up on it working, they told me that we were getting to a theraputic dose and not to give up hope.   I asked if I should call family, or if I could wait this out.

I asked to try and use a bedpan, but sitting on it made me feel like I needed to have a bowel movement, and I knew she was coming.  Dr. P came and I asked him to check me, it was around 2:15 am, and he found me dilated to 5.  At this point, I knew we had to get someone to come get C.  My husband worked hard to keep him distracted until my in-laws could arrive and take him home.  I'm sure it was scary and disorienting for them when I called them and begged them to come get C.  I was not exactly coherent due to the mag drip and I was pretty upset.  They came at around 3 and took C with them.  I tried to talk to them, but the contractions were coming quickly and I couldn't really think of what to say.  After C left, I made my husband come stand beside me anytime the L&D Nurse left the room.  I'd make him pet my hand, then a contraction would start and I'd demand he "Stop touching me and start reminding me to breathe!"  He'd say "Breathe" and I'd say "NO! remind me when I stop breathing, not now!" Poor man... it was very chaotic.

The NICU Nurse practitioner came up to talk to me, at my L&D Nurse's suggestion and my request.  She asked me if I'd had any medication for my anxiety and I said no, of course not, I may have a baby tonight and she needed to be as med free as possible.  She told me she didn't think that would matter. She calmly explained that at this gestational age, without steroids, my daughter would most certainly need a vent anyway.  I asked her to go ahead and start the orientation.  She said nothing I am going to say is going to help your anxiety.  I agreed that was true, and asked her to provide the details anyway.

She explained that my daughter would almost certainly be on a ventilator.  That any baby who spends more than 28 days (?) on a vent will most likely have chronic lung disease and it will be years before they "out grow" it.  That they way they outgrow it is by the natural process of replacing all those cells with new cells that weren't on a vent and it could take years.

She explained about Retinopathy, I remember it is bad, I remember they have ophthalmologists from Children's Mercy come and check the kids out... that's about it.

She explained about the potential for a PFO or a PDA (both heart related), I told her I got that one and she can skip it...

She explained about NEC.  I know it is a risk, I knew that before from reading something or other, somewhere... I'm scared of it, but, we're doing 100% breastmilk, so hopefully that will help.

She explained about brain bleeds.

She explained I'd give birth in an OR room because they had more specialized equipment for the NICU team to work with there.

I kept having to ask her to stop while I had contractions, she didn't stop talking, so I missed a lot of the detail as the pain rolled over me and I tried to breathe and listen to all the things my body was about to allow to happen to my baby.  Inside I was still desperately hoping the mag would start working.

The L&D Nurse came in and asked if I wanted an epidural.  All I could think was that I'd heard an epidural sometimes stalls labor.  I said yes, I want that.  I asked if it would hurt the baby, they assured me it wouldn't.  I thought it might work, I might as well try.  She left the room to call for anesthesia.  A few minutes later she returned and told me (or Dr. P? I don't know) that she'd called for the epidural.

The pain came in waves, I couldn't work my head around trying to treat it as information, or to work with it instead of against it.  All I could think, with every contraction, was we were one step closer to a micro preemie and one step further from the 48 hours of steroids I so desperately wanted on board.  I couldn't bring myself to change to any of the positions that would allow her to come faster, I just wanted her to stay.

My L&D Nurse came back into the room and told me anesthesia would be here soon. I half-cried "It's too late, we need to go to the OR now, she's coming!" I kept repeating "she's coming, she's coming".  My L&D Nurse said, I believe you, we're going to move now!  She called Dr. P on the way and they rushed me straight to the OR, while I continued to say, "she's coming, she's coming".

In the OR, they converted my bed to that strange contraption with the leg stirrups and stuck my legs in.  All I could think was this isn't how I wanted to push... I don't have my doula, this isn't the birth I wanted.  I looked over, and there was one NICU nurse rushing into the room.  Dr P said "I see the baby", I said, "I feel like I'm going to poop!"  He said "No, that's the baby". He turned to the NICU team, who were entering the room and said "Are you ready?"  They said no, he told me not to push, I tried very hard to follow that request.

Finally, they said I could push with the next contraction, so I did.  I pushed twice, and out she came.  I think I said it hurt, I know I asked if I tore.  I didn't tear.  I heard him ask if they wanted him to delay cord clamping so baby would have more blood, they said yes, I felt relieved.  I asked if they were going to bathe her, because I really didn't want her to have a bath.  Research shows the vernix on her skin will help protect her from bacteria in the NICU.  They assured me they do not ever bathe babies this small.  I felt relieved.

I heard my baby girl cry several times, I saw them working on her quickly and competently.  I felt Dr. P applying traction to the cord.  I thought about asking him to stop, but the cord came off.  I began to hemorrhage.  I knew this was bad.  Dr. P was pushing on my stomach, reaching inside me, trying to grab the placenta and get it to detach.  My uterus was clamped down around it, tight as it could.  I heard someone ask about Nitro, I heard them discuss a D&C. I knew I was bleeding.  They'd finished getting the baby ready to go to the NICU.  Earlier someone had said my husband could go with them and come back to check on me.  I asked if that was still a good idea, Dr. P said no, he needs to stay here.  I knew I was still hemorrhaging and he was concerned. Anesthesia came in and we started dealing with the spinal.  In an amusing echo of my previous labor experience, I asked, so, should I sign a consent form?  They agreed that was a good idea and scrambled to find a pen.  I signed, and sat over the edge of the bed.  They began the work to put in an epidural spinal combination because they thought the D&C might take more than an hour and I'd emphatically stated I did NOT want general anesthesia.

As my legs started to go numb, the contractions started ramping back up.  I felt a gush, I told my nurse she should get back, I didn't want to ruin her clothes and "stuff was coming out of me".  The contractions became more intense and I said "I need to push again, can I lay down?" They said not yet, I said then I'll have to push it out sitting up, and I did.  I believe I said something like "Well, now I know how a chicken feels", (it felt how imagined laying an egg would feel). The anesthesiologist also chose to believe what I said, she stopped pushing the spinal meds.  They finished taping down the catheter into my spine and allowed me to sit back onto the table.  As soon as I'd leaned back to give it room, the placenta emerged onto the table.  The anesthesiologist assured me she'd only given me a half dose and my legs would be mine again within half an hour.

Dr. P came back in the room to do the D&C, and they told him I'd passed the placenta.  He looked it over and then checked me out.  I could feel him doing strange and uncomfortable things, lots of pressure, but no pain. My bleeding was under control, I could go back to my room.  We got me cleaned up as much as possible in the OR, then took me back to my room.  It was about 5:30 in the morning.  I slept until shift change and then they cleaned me up and moved me to the mother and baby floor.

On the Mother and Baby floor, I finally had the first opportunity to pump.  Because pumping had been such an integral and constant companion during my first pregnancy, it was a huge comfort and provided me a sense of normalcy in this incredibly chaotic experience.  I counted in my head, I started pumping within 6 hours of my daughter's birth, I felt relief.