- December 2016
- Second Baby
- Mom’s Age: 31
- 5 weeks early
- Natural labor; Epidural/spinal at 10 cm dilated
- Dr. Abbey Hardy-Fairbanks
- Iowa City, IA
- University of Iowa Hospital and Clinics
- Sent to the NICU
The journey to getting pregnant with #2 was an intense 13 months, complete with a miscarriage/d&c, diagnosis of Asherman’s syndrome, surgery and an assortment of other procedures and fertility treatments. I somehow envisioned an easy pregnancy because of the struggles to even get that positive test, and it was…at first.
My first trimester went as first semesters often do—full of anxiety, exhaustion and nausea (oh and a cross-country move from Louisiana to Iowa). The only abnormal part was an asymptomatic UTI caught with a routine urine sample. We learned it was caused from Group B Strep or GBS (which I did not have with #1). I took antibiotics then and knew I would have to have IV antibiotics during labor.
From the get go, I was concerned about placental abnormalities because of my Asherman’s history, but everything on the anatomy scan and a subsequent ultrasound at 28 weeks looked normal.
My first child, Kate, born in November 2013, came fairly quickly for a first time mom (I showed up at L&D not sure if I was in labor to be told I was over 7 cm dilated…she was born 5 hours later). I knew this baby could come even faster—a good problem, but I wanted time to make it the hospital for an epidural! When I started losing my mucus plug at around 31 weeks, I made two false alarm trips to the University of Iowa Hospital’s Labor & Delivery Unit.
I wasn’t in labor but my cervix was softer than my doctor would have liked and dilated to about 2 cm. Just to be cautious, I got the steroid shots and was told to take it a little bit easier (hard to do when Kate weighed in at 38 lbs!). The next two weeks, I continued to spot, lose more of my mucus plug and freak out. I packed my hospital bag and exhausted the internet with searches about when I would go into labor (cliff notes: some people say within two weeks but mostly it does not provide a timeline, just signals that your body is getting ready for labor. Some people, I read, even had a plug regenerate and went 4+ more weeks!).
I was finally settling into the fact that this might just keep up for weeks on end when Thanksgiving rolled around. We had a relaxing morning and then left for Thanksgiving dinner with friends. We were lingering around the table talking when I sensed something wet. I already felt like a hypochondriac at this point but stood up to be sure it wasn’t my water breaking. The next moment is still frozen in my mind. It felt as if my world stopped before spinning out of control. There, all over my stylish friend’s very white cushions, was bright red blood. My friend’s husband thought I had spilled cranberry sauce, and everyone thought I was joking when I announced: “I think I need to go to the hospital. Now.” I was 33 weeks and 6 days.
We quickly decided to drive rather than call an ambulance, thankful that the holiday meant little traffic and the ability to speed through red lights. I was bleeding through my clothes and onto the car seat. I couldn’t feel the baby move. I remember looking into my husband’s eyes and saying “We are probably having a baby today,” too afraid to even verbalize my bigger fear.
I was thankful for those false starts because I knew exactly where to go. I ran past the front desk as they showed me to a room and grabbed a doppler. When we heard the baby’s heartbeat, it was the best sound in the world. I spent the night in labor & delivery, continuing to bleed and cramp some into the night before it tapered off. With no progression in dilation, I was transferred to the antepartum floor the next morning, glad to still be pregnant but confused as ever wondering, what now??
Things were quiet around the hospital since it was a holiday weekend. I heard varying things about when I would be discharged and what could have caused the bleed. On Monday, day 4 as an inpatient, it was a relief to see the halls bustling with normal activity and to talk to my doctor and a high-risk doctor more in-depth. They both agreed that I should stay in the hospital for a week total, pretty standard after a big bleed. If another one was going to occur, it would very likely happen during that time. I had another ultrasound and an MRI that day. They both showed some placental irregularities, but it was still hard to really tell exactly what was going on. A partial placental abruption was most likely explanation.
Wednesday rolled around. At the very early time that rounds take place, we talked about discharge for the next day. The thought excited me—I spent most of my day alone in a hospital room stricken with fear—but also terrified me because placental abruptions are no joke and it was reassuring to be surrounded by medical professionals and to not even have the chance to experience that traumatic car ride again). I prayed the entire time that if I were to bleed again, it would be in the hospital.
Sure enough, that night while another friend was visiting, I stood up from the couch in my hospital room and felt the warm sensation of blood. I yelled frantically for help while she called my husband. A resident found her heartbeat quickly again, and I was whisked away to labor & delivery down the hall. This time, it felt different. The bleeding was worse and lasted longer. The contraction-like cramping was more intense. My body seemed in greater distress (and nurses later told me they were worried things might have gone south that night). I once again spent the night in labor & delivery before returning to my antepartum room.
Doctors now agreed that I would not be leaving the hospital before having this baby. I was 34.5 weeks. Not knowing if that would happen that day or in 5.5 weeks was a hard pill to swallow. I had a lot of conversations with doctors the next day about how many more bleeds, if any, would occur before they would call it and delivery the baby. I couldn’t picture repeating this pattern over and over again without something bad happening.
It was all a time of much uncertainty and so hard to be away from my daughter. I felt guilty and helpless on top of the almost paralyzing anxiety I tried to keep in check. Meanwhile, my poor husband was keeping up his rigorous residency schedule, all the while trying to project normalcy for Kate and worrying about the baby and me.
The next night, day 8 in the hospital, I couldn’t feel the baby move. I chugged orange juice and rolled onto my left side. I detected a few faint moves but not the norm and definitely not enough to pass the kick count. I paged the nurses’ station twice that night to check for the heartbeat. She seemed to still be hanging in there. I, on the other hand, was a ball of nerves. A nurse took pity on me and offered a Benadryl around midnight after giving me the second shot of the second dose of steroids.
The next morning I felt more tightening of my stomach. It had only been 1.5 days since the second bleed, so I knew the discomfort could still be chalked up to irritation. I had a feeling though that this would be the day.
The daily non-stress around lunch did show uterine activity so I stayed hooked up. I felt it get more intense and regular. A midwife reported that I was at 4 cm and softening even more. I was in labor, news that was terrifying, exciting and a relief to hear. I had not only been worried about the baby but also about my health during labor & delivery. Now it was time to see how it would all unfold. I did take heart that my doctor was prepared for any scenario.
I asked about an epidural (or any pain meds), but I wasn’t even in labor & delivery yet and the nurse said it was too early. Things then started getting intense. The pain was so strong. My nurse brought an exercise ball for me but I hadn’t prepared for a natural birth and sitting on it felt awkward. I could barely talk to my husband except to spit out “no more kids” as I walked around the room keeling over as contractions hit (how had I not felt this with Kate??). I sent him to find someone. The nurse, recognizing the change in my pain, asked the resident to check me again for dilation. I heard her say some phrase about a lip. I asked her to clarify. She looked at me and said, “You’re 10 cm/ fully dilated.” It had only been about an hour and 15 minutes since I was checked at 4 cm.
Rushed to labor and delivery (quite familiar to me at this point), I had to fight the very intense urge to push. The room got very busy fast. My doctor ran over from clinic, and NICU nurses were on standby. Antibiotics were put in my IV because of the GBS but then the IV blew. They quickly put an IV in my other arm but it was decided there wasn’t enough time for antibiotics to work anyway.
I actually did get an epidural/spinal in case the delivery turned into a c-section. It took everything in me to stop pushing while the anesthesiology resident worked. I was making some really odd noises interrupted only with profanities. Without my doctor coaching me, I would have pushed … in that moment, I didn’t care about the consequences; my body just wanted the baby out. The baby’s stats dipped once or twice. I don’t remember specifics except that it resolved quickly.
Almost everyone then cleared the room and let me regroup while the epidural kicked in. I was shaking pretty strongly from how quickly everything had progressed. My same nurse had followed me from antepartum and she too looked like she needed a breather.
About 45 minutes later, my doctor came in and broke my water. I pushed for 7 minutes and out came my beautiful, perfect baby at 5:24 pm. As she made a whimper, I started to cry. We had wanted her for so long and it was certainly not a given that this moment and a happy ending would come. I got to hold her for a minute before she was taken for evaluation since she was 5 weeks early. To everyone’s relief, my placenta came out without incident.
Two days later, after 11 days total in the hospital, I was discharged. I remember hurrying out the door on Thanksgiving looking around the kitchen just once to make sure I packed everything. Returning home to Christmas decorations was very disorienting. It was also tough to leave the hospital without my baby in my arms.
Adrienne originally had been cleared to go straight to the newborn nursery but then her blood work showed a very serious inflection in her bloodstream aka sepsis (and for you medical people reading this, I believe it was a 73% or 79% left shift). She went to the NICU so antibiotics could be started immediately and she could be closely watched. To not make this even longer than it already is, I won’t go into all into the NICU part of her story except to add the infection was from her getting GBS from me. Slow weight gain also contributed to her 20-day NICU stint. She was discharged the evening of December 22nd.
My pathology report later showed a small abruption as expected, but there was another surprise. I had an infection in my uterus so bad that it that traveled to the umbilical cord (chorioamnionitis and funisitis). There were also some areas of the placenta that had aged faster than normal (known as mature chorionic villi). We don’t know if all of these things were connected or random, kind of rare occurrences.
I still will recall a small part of this experience (going to the same store as Thanksgiving morning, for instance, blissfully naïve that our lives were about to change) and the memory will bring with it a flood of emotions. It’s getting better though with time.
They say it takes a village to raise a baby. I feel like it took a village to get pregnant and to get Adrienne home from the hospital. And for everyone who had a piece in the process, I will be forever grateful.
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