May 29, 2014

Ariana's Birth Story

If Ariana's start to life is any indication of her personality, this little lady likes a challenge. She was a challenge to conceive and ended up being a challenge to bring into the world, but we are so glad she is here!

I had a c-section with the twins and was hoping to have a successful VBAC (vaginal birth after cesarean) with this pregnancy. I was considered a great VBAC candidate and really wanted to avoid another c-section if possible. I was measuring two weeks ahead for most of my pregnancy so my doctor was a little concerned that baby girl would be large and urged me to do lots of walking in hopes of not going past my due date (May 10th). I had a back-up c-section schedule for a week after my due date if I did not go into labor on my own before then and I really didn't want to make it to that scheduled surgery date.

Two days before my due date, on Thursday May 8th, I was home on my day off with Lexi and Zara. We ended up staying home that morning doing an arts and crafts project and baking cookie bars. In the afternoon, they were doing "quiet time" in their rooms and I was laying on the couch taking a nap. A text from my friend woke me up and we texted back and forth for a bit about whether I would go into labor soon and other things I could do to start labor. At that point I wasn't feeling anything and was getting frustrated. All of a sudden I heard a pop and felt a gush of water run down my legs.

My water broke, but I wasn't feeling any contractions and wasn't sure what to do. I called Marcus and told him he should probably head home soon. I figured I would stay at home until the contractions really started. At the same time, I talked with another friend on Facebook about her watching the girls for us that afternoon and evening until the grandparents could get to Portland from Yakima. I also called my doctor's office to see what I should do. The nurse told me I needed to get to the hospital right away. I called Marcus again and told him to come home now. He called his parents and told them to head to Portland to watch Lexi and Zara while we were at the hospital.

I still wasn't feeling any contractions and wondered if I was going to be at the hospital for a long time waiting for things to start-up. Thank goodness the girls were still in their rooms so I could think straight as I ran around the house packing my hospital bag and getting the house in order. I finally got the girls out of their rooms and told them we were headed to their friend's house and Marcus and I were headed to the hospital. By the time Marcus got home (around 4:30 PM) we were ready to go. We dropped the girls off and they were excited to play with their friends. I still wasn't feeling any contractions, but I was anxious to get to the hospital because I knew we were heading into rush hour traffic and my labor could kick into high gear at any point.

We arrived at the hospital by about 6:00 PM and went to triage. Once in triage, I started to feel stronger contractions, but nothing painful yet. By the time we got into the labor and delivery room, I was feeling consistent contractions and they started coming fast and painful. At some point around 8:00 PM I was checked for dilation and was only a 3. I was frustrated because it was very painful and I was hoping to wait longer to get an epidural. The Blazers playoff game was on in the background, but I wasn't watching much of it. There was almost no break between contractions since they were "coupling." I tried standing up, sitting down and nothing gave any relief. Finally around 9:00 PM I couldn't take it any longer. I asked for the epidural.

Throughout my labor the baby was having decelerations in heart rate with the contractions. My nurse didn't seem too concerned, but kept having me switch positions, laying mostly on my left side to see if that would help the baby's heart rate. The on-call OB (Dr. Fox) and nurse manager were watching the monitors outside my room and discussing the decelerations.

By the time the anesthesiologist came to place the epidural, I was in so much pain I didn't think I could take one more contraction, but I had to. I kept telling Marcus, "I can't do this." I recognized the anesthesiologist as the same guy who had administered my spinal block for my c-section four years earlier. As he was placing the epidural, I started feeling the urge to push. How could this be when I was only a 3 or 4? After he was done, the nurse checked me again. Amazingly, I was an 8, almost there! They all assured me that it was a good thing I had asked for the epidural when I did as it would have been too late if I had waited much longer.

After a few more contractions, that sweet epidural kicked in and I could breathe and relax. It was amazing. I posted an update on Facebook and closed my eyes to rest for a while. I could still feel the contractions, but it was almost painless and more just a pressure feeling.

It was about 11:00 PM and I was fully dilated and ready to push. Dr. Fox had five patients in labor at that point so it was a bit crazy and the nurse told me to just let the contractions do the work and keep relaxing until the doctor came. Finally she was done with another delivery and came and I got to start pushing. Dr. Fox seemed more concerned with the decelerating heart rate and had my push every other contraction. After pushing through about five contractions, she placed a heart rate monitor on the baby's head to get a better read. It was still dropping during contractions and she was concerned that the baby was stuck and had the cord wrapped around her. She looked at me and said, "this just isn't working and we need to do a c-section. We don't want to risk this any longer." My heart sank that I went through this whole labor and was going to end up with the c-section after all. I was a little frustrated that Dr. Fox, who I had not met before this night, was giving up when the baby was so close to being out. I nodded and tried not to cry.

At that point Dr. Fox called for a "stat c-section" which means that she wanted to be taking the baby out in five minutes so several other nurses rushed in to prep me for surgery and everything kicked into high gear. Once we got into the operating room, I couldn't stop shaking from adrenaline and felt so claustrophic with the big blue sheet in front of my face and my arms spread out to the sides of the operating table. Time seemed to move so slow and I just wanted it all to be over with. I was having a little pity party inside my head for sure.

Once they finally started operating, it was only a minute later that Dr. Fox urgently yelled out, "uterine rupture" and the whole room fell silent and serious. I heard someone yell to call for the NICU and Marcus swore under his breath as he sat by my head. We knew what this meant. Uterine rupture is when your past c-section scar tears open during labor. It is the major risk of a VBAC. There is a potential for major neurological trauma to the baby from a lack of oxygen, blood loss and hysterectomy for the mom and even maternal and fetal death. I had signed a form acknowledging that I was aware of these risks, but the odds were so small and none of the increased risk factors applied to me so I figured I didn't need to worry about it. I knew that the risks of major abdominal cesarean surgery were different, but just as likely.

A minute later I heard my baby crying as they pulled her out and everyone told me that she looked great. She was ok. Huge sighs of relief and cheers from the nurses. I heard that she had her arm and shoulder out of my uterus, but they had gotten to her in time before she got further out which would have caused much more trauma to her. Marcus brought her to me and I kissed her head, but was still reeling from all that was happening. I still wasn't sure if I was going to be ok. Dr. Fox kept saying that there wasn't a lot of blood loss so I was ok. The anesthesiologist sitting by my head told me that she wasn't being asked to order blood transfusions so that was a good sign that I was ok. It was all just swirling in my head, but as soon as they said I would be ok, I just wanted to be out of surgery and with my baby. Marcus and Ariana headed back to the labor and delivery room to finish her vitals and give her a bath while they finished sewing me up. At that point Dr. Fox looked at me over the blue sheet and said, "you might want to think about whether you want to have any more kids after this."

Finally the surgery was over and I was taken back to my room where Marcus and Ariana were waiting with the nurses. They put Ariana on my chest and I felt a huge sense of relief and love for the newest addition to our family. She was a little peanut at 6 lbs, 14 oz, but latched on right away to nurse.


We were so lucky that we had a fortunate outcome from such an unfortunate situation. We still don't know why my uterus ruptured or exactly when it happened, but I am so grateful that Dr. Fox made the call for me to stop pushing and do a c-section at that moment that she did. A few more minutes would have meant a much different outcome. We are so lucky that we were at a large hospital equipped with the clinical expertise and facilities to take care of us so quickly and prevent any further complications from occurring.

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