October | 2012 | The Asay Placey

Finally! I finished writing the birth story!

CAUTION to the reader: it’s a detailed novel full of my opinions, thoughts, and feelings so grab a truffle and a coffee along with your open mind and read a while.

When we first found out that we were expecting little ‘a’ two it took a while to decide where we wanted to go for our prenatal care. We had a positive experience at the hospital when LL was born, but desiring the most natural & gentle birth possible, I hesitated returning for the same experience of having to ‘defend’ our desires to the hospital staff. So about half way through the pregnancy we finally decided that we would plan to have our second little person right here at the Asayplacey. We found a midwifery clinic in the metro area to provide for our care and I SOo have loved & appreciated their care in comparison.

BUT as is written, “Many are the plans in the mind of a man, but it is the purpose of the LORD that will stand (proverbs 19:21).” I am not saying that what I’m about to write was inflicted on me by the Almighty, but I AM saying that He allowed it to happen for reasons that I don’t fully yet understand.

So, we were planning to welcome little ‘a’ two peacefully and gently into the world here at home until we found ourselves in the ER per the recommendation of my midwife in chronic really really awful upper abdominal pain to have my blood tested to see what might be the matter. I was under the impression that this awful pain was either a GI bug or caused by being backed up, which occurred in a VERY similar way first trimester with little lady with almost the exact same pain.

I made a fun connection with the nurse tending to me so we were small talking (as much as we could as I was in such pain if I tried to move at all), but the moment my lab results came in her demeanor immediately changed. She looked at me and said, ‘Libby. You’re really sick. That pain you’re feeling; that’s your liver failing,’ followed by three statements of, ‘we need to get the baby out.’ Right before that point, I was hurting so badly that I was convincing myself that the only way I could bare with getting the babe out was by cutting the baby out (so not my desire)! But as soon as I heard her words I immediately changed my mind – despite the thought of this pain on top of the intensity of labor!

The doctor then came in and explained my lab results to my husband, Tad, and I. I always have seemed to have a difficult time understanding numbers, but Tad, however, fully understood what she was saying. She explained that I had developed HELLP syndrome, an acronym for ‘Hemolysis, Elevated Liver enzymes, & Low Platelet count’, and thought to be a form of severe preeclampsia. I don’t remember what my liver enzymes were (high enough to determine that my liver was failing), however we remember exactly where my blood platelet count was. She explained that a platelet count with normal healthy organ function is between 150,000 and 450,000. Mine were at 38,000 when my blood was tested at the ER. And at 20,000 organs begin failing, you can start internally bleeding, and hemorrhaging in the brain. She explained that she would feel more comfortable if I were transferred to a hospital where a perinatologist could care for me. They had a connection with a hospital in the DSM metro, and the doctor on call said he wanted to break my water, start me on pitocin and get the babe out as soon as possible. She then explained that they would start an IV for both fluids and magnesium sulfate, a muscle relaxer and anti-seizure medicine right away followed by my very first catheter (yay!)

Going on in my head from the time we got to the ER until the time I got on the stretcher was the following:

1. you mean that awful pain I’m feeling really isn’t just gas?!

2. seizure medicine? a catheter?! you mean I can’t walk around during labor?!

3. so, we’re driving down to the other hospital? oh, an ambulance is taking me? well can my husband come with? no? oh, well that’s cool – guess I’ll meet ya down there, honey! Hey nurse who I just met but have a fun connection with – tell your boss/supervisor that the patient is requesting that you come with!

4. ok. we’re good. home birth out the window. on seizure meds. got my catheter. ready for manual dilation and artificial hormones. Man! It really is PEACE THE SURPASSES UNDERSTANDING ’cause I am not afraid in the least! (and I also am not fully comprehending what’s going on! – that’s the ‘guard your heart and your mind part of THIS.)

5. wait a minute! where did the unbearable pain in my gut/chest go?!! IT’S GOOONE!!! Praise. JESUS! Either mag (magnesium sulfate) is really awesome at numbing the liver or the Lord just took it away.

6. I am so thankful that LL is safe with sweet friends! (we dropped her off before we drove to see my midwife)

As soon as we get on the ambulance I start praying that I would just be fully dilated and ready to push when we get there (you don’t ask you don’t receive, right?), knowing that if I’m not dilated at all, that doctor is not going to have an easy time breaking my fluids. Up until that point I had had random braxton hicks contractions, but suddenly, for the entirety of the ambulance ride (which, I asked the driving paramedic just to be sure, had good shocks… not too bumpy ;) ) I started having regular contractions about 3ish minutes apart.

We arrived, got to my room, and the doctor came in and gave us the game plan: he would break my water and start pitocin right away. So that’s what he did. He, very vigorously, broke my water after checking my cervix and I was dilated to a 2 on my own. He then ~~jack hammered~~, ~~shoved~~, pressed firmly, very rapidly, on my uterus from the outside to rid of all the fluid, and I just remember him saying that the baby’s head was still too high and he needed to ‘connect the head to the cervix’, so there was more ~~jack hammering~~, ~~shoving~~, pressing firmly and very rapidly to accomplish just that and by the time he was done ‘manually dilating my cervix’ I had gone from a 2 to a 4. Nice work doctor – not fun at all. The pitocin started to drip and the doctor said we had 4 hours to get that baby out, meaning ‘if that baby’s not out in four hours I’m taking it out’. I just thought it was a nice goal, considering LL came in 38 hours from the time my water broke until we finally saw the whites of her eyes! I was strapped to the monitor and told I couldn’t get out of bed because it would be bad if my blood pressure rose any more.

side note: common symptoms a preeclampsia/HELLP are swelling of face, hands, and feet, protein in your urine, and high blood pressure. Throughout the entire pregnancy I had lovely blood pressure (until just before arriving at the ER), almost zero swelling (far less than with LL even), and not but a trace of protein in my urine. I felt completely normal, going on long hearty walks, until just a few days prior to this unexpected chain of events. who knew.

So I stayed in bed, sitting up, trying to move around and rock my hips in any way that I could, knowing that I’d likely be laying down later on and also knowing the fastest way to get the babe out was by moving my hips and changing positions. Again, four hours seemed like a ‘nice goal’ to the 38 hours the first go ’round. They increased the pitocin every half an hour; more; then more. Three hours went by and I was still cracking jokes with my doula and others in the room, talking through the contractions. The nurse had said that when they got stronger she’d check my cervix again. So at about 3.5 hours into the journey I finally laid down on my side as the contractions were intensifying and I could no longer talk during them or really even between them. When they began to require more attention I started pressing on a pressure point in my brow, and when they required every ounce of my attention I pressed VERY firmly with my index and middle fingers on both brows (so hard that I later realized I had bruised my face! – not black and blue bruised…just ‘this still hurts 4 days later’ bruised.) I preferred a non-medicated birth as I had with Linley, but even it turned out that even if I wanted an epidural I couldn’t have had one as it wasn’t an option. Due to my low platelet count I risked bleeding in my spine.

The nurse returned and realized that the contractions had intensified and said that she’d need to check my cervix. I asked if it was completely necessary – I’m not really into that (bacteria, potentially discouraging news, it’s uncomfortable, and really just says nothing), but unfortunately she did anyway only to find out that we were almost 4 hours into it and at our deadline and well, I was still only dilated to a 4. Discouraging news? Maybe. My response? ‘Meh. Dilation is meaningless.’ Why did I have that response? Well because 30 minutes later (after being ‘stuck’ at a 4 for nearly 4 hours) yes, 30 minutes later, I had to toot. Tooting means pressure. Two minutes later when the next contraction came I felt a bit more pressure like something more than gas may make it’s way out onto the table. And two more minutes after that when the next contraction began I start freaking out trying to put words into what was coming down like a freight train, so I start shouting, ‘…HEAD! HEAD! I’m pushing! I’m pushing!’ So Tad and my doula try frantically to find the call button to alert the hospital staff, and not long after that the room is full of folks dressed in blue head to toe. One of the first (and most frustrating things) that I hear is ‘get on your back’. They took the pillow from between my knees and I try my best to communicate in between contractions that I do NOT want to be on my back. I am on my side, have a good rhythm going on, and I KNOW that your back is not so cool. The staff seemed a bit flabbergasted that I was not going to push the baby out on my back – as IF there were another way! (yes, this is the part of the story when we all become a little upset with unnamed doctor.)

‘Well how do you want to be?!’ they ask.’

‘On my side,’ I say.

So the nurse comes over and hauls one of my legs up in the air spread wide and I say, ‘no! not like that. I want a pillow.’

‘We need to be able to see!’ they say. And when your whole (ahem) self is revealed for all, say, eight strangers to SEE, I say, ‘look, you can SEE. I just want the pillow between my knees (it’s just more comfortable with some cush as opposed to bone on bone, ya know). So the doctor begrudgingly said fine – I can lay on my side.

**There are a few of reasons I wanted to lay on my side. One was because I was already there and comfortable. Two, because back is so not natural. Three, because when your knees are more parallel than spread eagle, your hips are the most open, allowing for the most open passage for the baby to come. Four, because when you’re spread eagle, your skin is already stretched taut, not allowing much room for more stretching, thus a greater chance of tearing – and if you’ve torn while giving birth, you know that it means awful bathroom visits for the next six weeks! And five, because I was on my back with LL and really just didn’t want to do that again.

So I lay on my side and wait for the next contraction and am AMAZED that I do NOT NEED to actually PUSH at all!! I put ZERO effort into using any of my muscles to PUSH. I am so thankful that my midwives and others gave me the resources necessary to be knowledgeable about birthing. They gave me a couple of articles about the fetal ejection reflex (this link isn’t one of them but may help explain). Your body simply does ALL of the work for you IF and WHEN it’s ready. Often times even if you’re fully dilated to a 10, your body may not be ready to push. Needless to say, I was ready, and that baby was most certainly coming like a freight train! However, because it didn’t seem as though I was ‘pushing’ the doctor told me to ‘push! don’t hold it in! push!’ I wanted to give him a very not nice look but just said, ‘I am pushing. I’m not ‘holding the baby in.’ side note: really? hold it in? most definitely NOT holding in this freight train!

A contraction or so later I wanted to know if the head was visible so I asked if anyone could see it. At that point the doctor came over, put his hand up there, and did what felt like trying to grab a hold of the head and pull it out and said, ‘the head’s right there. If you’d just push, the baby would come out!’ Now I am becoming very frustrated thinking, ‘Man. You’ve got about about 4 seconds to get your hand out of there because if it’s still up there when another contraction comes this is not going to be okay.’ So finally I just boldly state, ‘You’re done. Out. Out. Get out.’ as I pointed off to the corner. So he (seemingly annoyed) removes his hand from my, self, and another contraction comes. (to the doctor’s credit, he really just wanted to get the baby and the placenta out ASAP in order to well, save my life I guess – I just felt we could do that in a more gentle less yanking sort of way.) So, I can feel at this point that if I actually put in some effort and ‘push,’ his head would indeed come out, but again, I know and have experienced what any amount of tearing will mean for my well being. I know that the next 30-60 seconds is going to determine the next 6 weeks of my life. So I take it easy and just let my body do the ‘pushing’. (When LL was born, I didn’t tear at all with her head; I tore with her shoulders. I saw her head and thought, ‘where’s the rest of her? PUSH!’ and I tore with her shoulders. :( So this time around my goal was to get the head out and take it easy with the shoulders.

Now, I had communicated very clearly, three times, to the doctor that I wanted Tad to catch the baby. He ~~begrudgingly~~ agreed so I thought all was good and I that I no longer had anything to defend, however as soon as the babe’s head fully emerged the doctor came over, grabbed a hold of it and just yanked him out. (I want to cry every time I think about it.) I’m not bothered so much by being so sick, by being confined to a bed, by being poked SEVEN times just to find a good vein and being hooked up to various IVs, or even that my ‘plan’ for a sweet home birth didn’t work out. I’m not even that upset about the vigorous jack hammering done to my uterus by the doctor! What I am troubled by is thinking that I could have easily fully given birth to little ‘a’ two and I didn’t get to. I feel robbed. Little ‘a’ two was instead pulled from me… by the neck. Yes, doctor, I forgive you. In fact, I’m thankful you were on call instead of another doctor (more on that later). But that hurt my feelings.

Moving on. I whipped my leg around the umbilical cord and was too joyful to be upset in the moment. Little brother had a good healthy cry from the git’go. He was perfectly healthy and scored 9&9 on his Apgars. Trooper. I held him while I delivered the placenta (yes, I pushed. the doctor was extremely anxious to get that thing out of me as that was the way to start recovering). He did a quick ultrasound check to make sure it was completely intact and all had been removed. Aaand that’s when I lost a LOT of blood. I was still holding the newest little ‘a’ so I didn’t pay much attention until the doctor began what felt like punching in my gut to try and stop the bleeding. I was doing my best to be gentle and just set my mind on being gentle with the little person I was holding.

After LOTS of that not-fun experience, the nurses cleaned me up a bit and gave me a clean pad to lay on, but when just a few minutes later they had come to check my ‘just moments ago clean pad’ and it was full of blood and was continuing to flow like a small river (so I’m told) the doctor came back in for what seemed like 45 minutes (probably 10) of the most excruciating labor pain you can imagine… but continuous and never ending (at least with labor you get a window of calm). He said he was just going to ‘take a look’. He lied. At that point I agreed to the fentanyl. I don’t typically like to take medicine; but it was a good drug for the moment post delivery. The doctor had his entire fist + gauze + tong looking things + sutures up inside there WHILE continuing to be vigorous from the outside. Imagine squeezing your finger to stop the bleeding from a cut. It seemed like he was trying to ‘squeeze’ (but really he was punching) my uterus from the outside AND from the inside before stitching my cervix, which must have torn either from him breaking my water or manually dilating it afterword. The doctor and I exchanged some words in the midst of all this (pretty intense but still kind words) and soon enough he was done. I remember him saying afterword, ‘you hate me?’ I said, ‘no. I appreciate you,’ and then my blood was taken again to be tested. I tried to give the doctor a high five but I was shut down until he was confident that the bleeding had stopped. Figures.

I don’t vividly remember much after that, but am told we quickly go the lab results back and my platelets had dropped by 6,000 down to 31,000 post delivery. So I didn’t really have a choice (or remember making one) I just remember being hooked up to a bag in an IV in my other hand and having a platelet transfusion. Post transfusion and after a short rest I seemed to feel better (even though I’m told I had lost all color even in my lips), so I found my little bed control to sit up slightly when all of a sudden my ears began to ring and everyone was talking but their voices were fading and so was my head. The nurse laid me back down and told me I couldn’t sit up at all. I needed to lay flat on my back (or side) until I got better. (the photo is of Tad and the babe with me resting with a cool rag on my head in the background)

After the platelet transfusion my blood count was tested again and my platelets had only risen to 35,000. With this the doctor recommended that I have a blood transfusion in order to get better. The nurse started explaining all of the risks involved, infection at the sight, disease, rejection by my body, etc., but went on to say that if she were me, she would most definitely take it. She said that the screening process is so good these days that she’d rather accept a stranger’s blood who had gone through their screening process than a family member’s blood. So Tad and I agreed to transfuse the two units of blood and a few hours later my platelet count went up to about 58,000. The doctor seemed to think that that number was good enough and would continue to rise on its own so were finally discharged to a normal mommy-baby recovery room from then on. Here is little brother in our new room.

I had my vitals checked every hour throughout the night. My blood pressure stabilized, I had steroids and antibiotics every so many hours and was able to rest… sort of. It was at this point that we FINALLY were able to figure out Whittaker’s first and middle names and announce it to family! I was able to take out one of the IV’s AND the catheter! Hallelujah I could go to the lady’s room PAIN FREE (no tearing even with his head being tugged on)! The next day when I was finished with the antibiotics and steroids, the IV in my arm was removed (which, it had been in there with such a large vein for so long that my ‘holding the gauze’ wasn’t enough to clot the hole – I looked down and blood was POURING out onto my leg! We fixed it though.) and then we gathered our things and were discharged on day two (too early in Tad’s opinion as I relapsed slightly the day after we returned home with some staticy vision and ringing in my ears….signs things aren’t going so hot.)

Looking back, despite some of my frustrations, I am EXTREMELY thankful to have the doctor on call that we did at the hospital that we were taken to. His partner commented to us a few days later that if it would have been on call having to make a decision for us, he would NOT have allowed me to even attempt an vaginal birth. He simply would have taken the babe via Cesarian. Both doctors made their decisions for medical reasons; my doctor due to the risk of seizing on the operating table and losing too much blood; the other doc due to risking platelets dropping rapidly causing major organ failure, etc. I also later found out that in other cities they would have life flighted me instead of driving me, and in another city, I would have been given SIX MINUTES to get the baby out. Me=THANKFUL.

Me also=MORE THANKFUL because I can totally see God’s grace in a number of ways now. Thinking over the weekend Whittaker was born, I understand the significance of why, for just a morning, the pain in my abdomen (which had been unbearable the day before) was somehow gone before getting super bad. I got up at 5am Sunday morning the 2nd, because well, I was 9 months pregnant and simply couldn’t sleep anymore, and I read through Proverbs 18. Why Proverbs 18? Your guess is as good as mine! But I can probably guess. I wrote down the proverbs that stuck out to me and jotted down a little note by each one. When I came to Proverbs 18:14 I paused for a moment and after some thought decided to memorize it that morning (if I tried to quote if for you after the birth and butchered it, don’t judge me!). The proverb says, ‘A man’s spirit can bare with sickness, but a crushed spirit who can bare?’ Seriously? Who memorizes THAT proverb, especially when I was feeling better and thought I really just had awful backed up gas?! So that’s one way I saw God’s grace, because let’s face it, I was about to become VERY sick, but girlfriend (or buddy), I did/do not have a crushed spirit and that proverb was running through my head the entire day, through it all, reminding me of that truth. The next way I saw God’s grace is that for just a morning I felt better – no pain – so that I could go to church, worship and get a song with the lyrics ‘yeah He loves us, oh, how he loves us’ stuck in my head… obviously a good reminder considering what was about to happen. And the next way I saw God’s grace – a friend of mine wanted our picture taken after the service was over in the foyer of the church to show off our growing bellies. (I’m on the right end.)She later posted the photo to facebook where a certain nurse who is friends with my friend saw the photo and made a ‘fun connection’ with me later that afternoon in the ER room! Now I know why I felt better for just a morning!

Come on. You know it’s awesome. Don’t give ‘luck’ or anything else the credit. There is a God who knows all things, is sovereign over all things, and whose love endures forever. I still don’t fully understand why he allowed me to get sick, and I’m a little bit sad that I couldn’t have had a sweet, gentle, ‘how it should be’ birth in the comfort of my home, but what I do know and do fully understand is that he is trustworthy and good and that he causes all things to work together for my good because I love him. really really. I had one prayer for my birth aside from welcoming a perfect and healthy little to the world and if that was somehow answered through this ‘event’, even though it may have turned out differently than I envisioned it going and I haven’t and may never see the answer, then awesome.

With that said, it was a very unexpected surprise of an ~~evacuation~~ arrival, but he’s here! Welcome to the world, Whittaker! You make a sweet little ‘a’ two and one stud of a little brother. Excited to watch you grown into a man’s man. Love, your momma.

The Asay Placey

Monthly Archives: October 2012

hang time

Fall fun at the park

my favorite eighteen month little lady

Me & my boy.

our attempt at family ‘self’ portraits

Whittaker’s birth story & HELLP syndrome