Thursday, April 28, 2011

My Birth Story. In Two Parts.

I've wanted to share the story of Lyra's birth, but I needed to understand it before I could share it in it's entirety. I had my appointment with Noreen yesterday, and she was able to pull up the O.R. report from my surgery.  I'm going to try and format this entry in a way that tells the medical facts and my perceptions of them side by side. I hope it doesn't get too confusing, so I'll try and keep my side in a different font format than what I copy from the report.

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. 

Monday, April 25, 2011


I have my first appointment with Noreen on Wednesday and I need help coming up with a list of questions I should ask her.

On the top of my mind are the following:
1) Issues with my uterus- how we can deal with a possible slow to start labour, and what I can do ahead of time to prepare

2)What could have caused the spotting I had on the weekend.

3)If she would be willing to go over my hospital records with me and help me to make sense of them and help me to recreate a timeline of what actually happened.

Any other suggestions about what I should bring to the Q&A would be great.

In other news, I had quite a fright this morning when an ER doc from the hospital called to tell me my swab came back positive. Of course I panicked, and he went on to tell me I tested 'inconclusive' for yeast. So I may or may not have an asymptomatic yeast infection. Ridiculous.

Friday, April 22, 2011

What a terrible day

I had some brown spotting today. I knew I probably didn't have anything to worry about, but of course me being me, I flew into panic mode, left work at 3:00 and headed to the emergency room.

The ER was deserted when we got there, so I assumed we'd be able to get to the bottom of things pretty quickly. I got moved to the gyne corridor right away and a phlebotomist came right in to do my blood draws.

And then we waited. For three hours, completely forgotten about. I walked into the corridor in my little gown and bare feet and got a bit shitty with a nurse.

Lo and behold, 5 minutes later my bloodwork magically appeared and the doctor shuffled in with a speculum and a portable ultrasound unit. My betas and progesterone were both good, cervix closed and we saw baby- heart beating away.

I'm not sure why they didn't do the ultrasound initially. It would have eased my fears immensely and brought my blood pressure down a little. At triage, it had spiked to 30/40 points above baseline for me. (130/85, whereas I'm normally around 90/55). I'm pretty irked that I had to ASK for the results and that no one seemed to give two shits about me, but this is my experience with hospitals and doctors. (After my miscarriage, I had a radiologist tell me that it was "god's way")

At least I can sleep well knowing that everything is okay.

Friday, April 15, 2011

Ultrasound Follow-Up

I just got home from visiting my G.P. who ordered my scan. Apparently that tech wasn't the greatest at her job. I suspected such. The radiologist who checked the measurements afterwards said baby measured 6 weeks, 6 days (I was 7 weeks by LMP on that day), which clears up all the WTF-ery I had going on in my head. It just wasn't possible to be six weeks.

The report says everything is normal, heartbeat still on target for that gestational age. The only anomaly noted was my uterus, but baby didn't implant in the septum, so I'm not worried about it. 

BUT one thing came up in my visit, that I thought was rather significant and I'm wondering why nobody told me this: Apparently, having a bicornuate uterus can make your contractions less coordinated and weaker, which would totally explain my slow moving labour.  You would think at some point that would have come up either DURING my labour or afterwards. I had a c-section- my uterus was at one point outside of my body, and nobody seemed to notice that little anomaly?

So glad to have a midwife this time around.

On the topic of which, I had the WORST dream last night. I was at my initial visit, and filling out a bunch of intake forms, and she looked them over, and told all the other girls "Congratulations, welcome to my practice:, and then she turned to me and said "I'm sorry Vyky. but you just have too many risk factors, I'm afraid I have to transfer your care". Worst. Worst ever.  That doesn't happen in real life, right?

I feel good. All of the things that had been eating at me have been all cleared up. 

Tuesday, April 12, 2011


I just got off the phone with Noreen Walker, MY MIDWIFE!!!!!!!

I had her programmed into my Blackberry as she was on leave for a while, and her receptionist had emailed me asking to phone on April 6. So I set an alarm and did so on that date. She took my info and she was so lovely about it. She told me she could hear it in my voice how badly I wanted a spot. I think she is my angel, I am going to send her flowers, I know it was her.

So just now when my phone rang, and I went into the kitchen and looked at the call ID, I just about died. Initially I figured it was another rejection, but it was Noreen herself asking if I was still seeking care. I immediately started crying.

She walked me through her model of care, 90 minute visits with a group of other women, which I'm actually very excited for. She accepted my plea for a home birth, she agrees that it is in my best interest to stay home for the optimal birth experience. And should anything go sour, she has admitting privileges at the Sturgeon in St. Albert, which is the lesser of all the evils- the most mother and baby friendly hospital out of all of them.

I am just.. Speechless.  I have the silliest grin on my face. I am so incredibly grateful for the powers that be that put this together for me. I am bursting!

Saturday, April 9, 2011

Ultrasound Results

I had my dating scan yesterday afternoon, and like usual, it was a fairly unpleasant experience.

My tech had a serious case of verbal diarrhea. Like, she completely lacked the filter between her brain and her mouth. She tried to get a good view abdominally, but couldn't see anything. She kept saying "I don't see it, I don't see it". I was always under the impression that sonographers are supposed to keep a 'poker face' so to speak. She tried for a couple minutes before asking me to empty my bladder so she could do the ultrasound internally. Not my first time to that rodeo. Unpleasant, but almost preferable to the painfully full bladder.

She immediately became quite flustered. I suppose she is not quite used to navigating uteri with birth defects. I don't think I've mentioned it yet in this blog, but I have a mullerian tube defect that causes my uterus to have a septum. My uterus is heart shaped, as opposed to balloon shaped, and there is a partial wall that descends from the top into the lumen.

So anyways, she was quite discombobulated by this, as it took her quite sometime to even locate my pregnancy. It is up inside one of the lobes, she did eventually find it.  She dated me at 6 weeks, a full 8 days behind my suspected dates, but ironically this is exactly what they found at my dating scan with Lyra. She found a heartbeat immediately, which she times at 117 beats per minute (which I thought sounded very slow, but at 6 weeks, the heartbeat is typically 90-110 bpm)

Then she couldn't find my ovary. Like, she just could not find it. I am very sure I have two, but she kept saying it was hiding in my bowels. I'm not entirely sure how that's possible, but she did locate it eventually, and was able to identify my corpus luteum as well.

This ultrasound was different than any other I've had. I've always had to sit in the room silently with the tech while they measure, then wait while they show the radiologist, and then they come back to show you everything. The whole thing left me feeling kind of addled. I'm not sure if she was caught off guard by my malformed lady parts, and it flustered her, or if there's something wrong. And I feel so ambivalent about that, and that makes me feel guilty because  in theory, it should upset me.

Weird pregnancy is weird.

Wednesday, April 6, 2011

I was so happy this morning to see an e-mail from Heidi at JoySpring Midwifery this morning. Unfortunately reading is reduced me to a blubbering mess

"Unfortunately, I do not have a spot available for you. You will need

to stay with your current provider or contact another care provider
for your pregnancy.

We have included an info sheet on local resources that you may find
helpful, along with the brochure: "Healthy Birth Your Way"

We would strongly encourage you to contact a doula, they are worth
every penny, especially since you are having a VBAC! I am sorry that
we can not help you, I know how frustrating it is to not be able to
get midwifery care.

We wish you the best with your pregnancy, labor, birth, and postpartum."

Cool, sell the idea of a doula TO A DOULA. And attached was a slap in the face brochure that listed some popular pregnancy and birth titles, and links to sites that I should hope any mother in the area should already know about. And their recommended health clinic was the one I was WITH for my last pregnancy- the group of baboons that put me through hell and back in the first place.

I feel so defeated. Like the whole fucking world is ganging up to beat me down. WHY can't I have this? Who needs and deserves this more than I do? I don't even know where to go from here.

Monday, April 4, 2011

Some thoughts for today

I have to put some things out into the universe today.

I feel so guilty about the feelings I have and the choices I make.

Let's address the feelings first:
- I feel so "meh" about being pregnant. I didn't ask for this, and because I certainly did not plan it, feeling so unprepared is so alien. I am ALWAYS on top of it. On top of everything. I am so "alpha" in that respect. I just feel like the unpreparedness combined with the ambivalence will end up being this whole spiral of poor decision making. I can't afford to make bad decisions- I need to be able to carefully weigh my options and make informed choices.

About the decisions:
-I saw my GP on Friday, and he took a small history, kept calling my daughter "the previous pregnancy" (Umm, no, she is a sentient being), and suggested that I have an early ultrasound. There have been some little factors that have been eating away at me- my very dark test lines, early onset of symptoms, and I can feel my fundus at 6w4d. I think I would like to know if I'm farther along than my dates would suggest, or rule out the possibility of multiples.

I was asked just now what my body is telling me, and the question was like a punch to the stomach. Because I don't know! I like to think that I am in tune with my body, and that I am aware of what is happening inside of me. At least I thought I knew. I thought I knew my cycles and my signs of fertility, and I was confident in my ability to chart them, but yet I ended up pregnant while we were trying to avoid. And now I feel so confused about how "with myself" I actually am. I can't hear what my body s telling me.. All I can hear is "HOW IS THIS HAPPENING?!"

 I am just so confused and I feel simply uprooted. This is not doing anything for my confidence.