Some of the details are hazy to me, and somethings I have probably forgotten entirely, but I'll try my best to give an accurate account of what happened
The Birth of Lyra June
Thursday, October 22, 2009 (39 weeks, 5 days)
My sister's eighteenth birthday. She chose to have her birthday at Dadeo's, a local cajun joint with awesome food and a 'no minors' sign on the door. I can't think of a better place to have been at that time. She was celebrating her new adulthood, and we were taking advantage of one of the last opportunities we had to dine in such an establishment without having to hire a babysitter. If I remember correctly, I had the veggie jambalaya. After dinner, we went across the street to Flirt for cupcakes.
Shortly after, we were in bed (Chris and I, not my entire family), watching Grey's Anatomy. I felt a little, um, wet. Honestly, I didn't think much of it because I had had some episodes of stress incontinence late in my pregnancy. I waited till a commercial (LOL!) and went to the bathroom and put on a pad. At the next commercial, it felt wet again. I hadn't laughed or sneezed, and I couldn't think of any reason why I would be peeing, so I smelled it. Not pee. It had a sweet odour, which I knew to be characteristic of amniotic fluid.
We finished watching Grey's, and then I decided it would probably be a good idea to pack my hospital bag. Within an hour or two I started contracting. They were about 6 minutes apart, 30-45 seconds long, so I didn't really think much of it. I could talk through them, and was having no trouble coping. Within a few hours they had picked up, getting up to 1 minute long and between 3-4 minutes apart. I called Labour and Delivery at the Royal Alexandra hospital and they said if I was ruptured, that I should come in.
Friday, October 23, 2009
At around 3:00 a.m. we called a taxi and headed to the hospital. I was checked when i came in, found only to be around 1 cm dilated, but the nitrizine test came back positive- I was indeed leaking fluid. There was some debate as to whether or not I should be admitted or sent home. I knew it was in my best interest to go home and let things happen in comfort, but for whatever reason, they admitted me.
This is the start of an awful ride.
I was not admitted to L&D. They put me in Antepartum in a ward room with a woman in pre-term labour. Because it was ward and outside of visiting hours, Chris was not permitted to stay with me. So we decided to go down to the closed food court in the basement of the hospital so we cold stay together. At around 8, I felt very tired, so I went back to my room, and Chris went home to feed the dogs and cats, and to pack up some edibles and other things I had forgotten to pack. He returned with my mum around 11 a.m. They had swung by A&W and brought me a veggie burger and onion rings. Chris had also stopped by the Safeway deli to get me some coleslaw- my last pregnancy cravings (Which have me gagging as I type this, pregnant yet again)
I ate, and then we decided to start walking. I paced the hallways for a couple hours, returning when they wanted to put the monitors back on. My contractions weren't getting regular, nor were they strong enough to be considered progressive. (Why wasn't I sent home? I clearly wasn't in real labour.)
At about 5 p.m. I was finally moved up into labour and delivery, and they started an I.V. for syntocinon. (Synthetic oxytocin). I lost my mobility, and it was here when I believe I lost my autonomy. I had been very firm in my desires up until this point, but as soon as I was moved to L&D, they insisted that I no longer wear my own clothes and they put me into a hospital gown. I hadn't wanted an IV, and now I had one. I was no longer allowed to eat. I could have ice chips, but I wanted food. The contractions were now starting to come closer together and felt much more strong. I could no longer talk through them. I clamped my eyes shut and breathed. Chris held a vibrating massager to my lower back and I hummed through my contractions.
By 10 p.m. I was exhausted. I had now been up for nearly 40 hours. I accepted a shot of morphine. I was checked and my cervix was 1.5-2cm dilated. I was losing steam and confidence. The morphine did little for the pain, but it did wonders in making me stupid.
Saturday, October 24, 2009
Around midnight, I was checked agan, and found to be stuck at 2cm. At this point they began talking about surgery. They suggested I consider an epidural, and seeing if being able to rest wold help me to dilate. I accepted their offer and the anesthetist came in shortly. He was very unpleasant. He kept getting short with me, barking orders not to move. I was devastated that my labour had come to this, and trying to hold still for a needle in your spine while you're sobbing isn't exactly easy.
The anaesthesia kicked in shortly, and I slept. Meanwhile, they had increased my syntocinon to maximum per body weight. I was spiking a fever, if I recall correctly it was 105 degrees. Lyra's heart rate was spiking as well, up n the 200's.
At 4:30 a.m., I was checked once more and found to be 2.5cm dilated, and I was wheeled down and prepped for surgery, which began around 5 am. Here is the dictation for the surgical report (and I am including it verbatim): My notes are in black.
Preoperative Diagnosis: Pregnancy at 39 plus 5 weeks' gestational age. Spontaneous rupture of membranes, Failure to progress in first stage. Query Chorioamnionitis (amniotic infection)
Procedure Proposed: Primary lower segment transverse cesarean section after trial of labour
Indications: Patient is a 25 year old, Para 3, Gravida 0 who arrived with spontaneous rupture of membranes at 39 plus 5 weeks' gestational age. On arrival, her cervix was 2cm dilated and despite Syntocinon for many hours, she never proceeded beyond 2cm to 3cm dilated. She began to have fetal heart rate abnormalities; however, overall the fetal heart continued to show good variability. We offered her an epidural and she accepted this offer. We then let her attempt to dilate her cervix with the epidural in place. This did not happen and her cervix remained 2 cm to 3 cm dilated. We, therefore, made the decision to go forward with a cesarean section. She was made aware of the risks and benefits and she consented for the surgery.
Procedure (WARNING: GRAPHIC): The patient was brought into the operating room and received a top up of her epidural anesthesia by Dr. Scott Paterson. The patient was then placed in a supine position and draped in the usual manner. A foley catheter had been inserted into her bladder.
A Pfannensteil skin incision was made in the anterior abdominal wall and taken down to the level of the fascia using sharp and blunt dissection. The fascia was incised transversely and the incision was extended using Mayo scissors. Cautery was used to achieve hemostasis. The fascia was then dissected off the bellies of the rectus muscle. the rectus muscles were retracted laterally exposing peritoneum, which was entered without complication.
There was a fair amount of ascites indicating obstructed labour (Dr. Google tells me this is a build-up of fluid). The lower end of the Balfour retractor was placed and the vesicouterine peritoneum was incised. The bladder was then dissected off the lower segment of the uterus.
From a vertex position, a live female infant was delivered spontaneously with no complication. The NICU was in attendance. The infant was vigorous at birth (If she was so vigorous, why was she admitted to NICU?). Cord blood and gas were drawn and sent for further analysis.
Lyra June Staples was born on October 2, 2009 at 5:22 a.m. She weighed 7 pounds, 9 ounces, was 20.5" long and her head circumference was 13.5". Her daddy was able to cut the cord.
The placenta was sent to pathology. The patient had received antibiotics preoperatively. The interior content of the uterus was swept with a clean sponge after the placenta had been delivered. The uterus was then externalized and Green-Armytage clamps were placed both medially and laterally. the uterine incision was then closed in a single-layer closure. The uterine incision was then inspected and hemostasis required two figure-of-eight sutures.
The subfascial space was inspected and hemostasis required cautery. The fascia was then closed in a nonlocking 0 Vicryl suture. Subcutaneous fat was inspected. Hemostasis required cautery. The skin was then closed using staples.
The patient returned to the recovery room in stable condition. The sponge and instrument counts were correct at the conclusion of the case (Oh good, they didn't leave anything inside me) Estimated blood loss was 700 mL.
Lyra was brought up to the NICU while I was in recovery. As far as I remember, I was in recovery for quite some time before they moved me into postpartum. I think it wasn't until around lunchtime when i was finally allowed to be wheeled up into the NICU to properly meet her. I almost had to laugh a her being there. She was in a pod next to a set of micro-preemie twins and she was, by far, the biggest baby up there.
She stayed in NICU for about 36 hours, they paged me to come up to feed her. I had to hobble up there with my bum IV pole and my catheter hanging out to another wing on another floor. It was awful. They finally released her to me on Sunday evening. She slept with me that night, and Monday morning, Dr. Halleran said that I might be able to go home that evening. But of course, no one seemed to know who Lyra's pediatrician was, so they had no one to discharge her. I ruffled some feathers and ended p getting them to call in one of the peds to sign off on her case so we could finally go home. I think we officially signed out at around 8:00 pm. It was so wonderful to finally be home.
Now reading this report n retrospect, makes me so sad. It admits, 100% that my cesarean was unnecessary:
1. Why was I admitted? I wasn't in labor, and I was leaking, not completely ruptured. I imagine had I been able to go home, that leak would have sealed and I'd have continued to be pregnant for another week or two.
2. Her heart rate had spiked, but the report says that there was still good variability, which from what i understand is the important thing- not the rate itself, but how it changes in response to stimuli.
3. Failure to progress in the first stage. Of course. I WASN'T EVEN IN REAL LABOUR.
4. Why was Lyra sent to NICU? They said she was having oxygen desaturations, but as far as I remember from her monitor and the reports, her 02 was 98%. Her apgars were good- she was born screaming. Does this look like a sick baby?
At least now I know there is nothing wrong with me. I wasn't in labour, and they decided to try and force it. I'm a little concerned that my incision was closed in a single layer suture, which is associated with a slightly elevated risk of uterine rupture (up to 3% as opposed to <1%), but other studies I've looked at imply that that the risk is associated more with the type of suture used- vicryl being favourable over gut.
My midwife is not concerned, so I shouldn't be either. She did have a nice little chat with me about worrying. She very frankly told me that worrying will not get me anywhere and that worry does nothing to empower me. I need to trust my body, to trust birth and to trust her as my midwife. And she's right.