Scripture Case Pattern

Saturday, June 8, 2013

Labor Saga

**UPDATE  3/12/14: While I was going through some pretty intense postpartum depression and PTSD back in August and September, I felt like I needed to rewrite my Preeclampsia/HELLP syndrome story in as much detail as possible. I felt that it was the only way I could come to terms with all that happened to me and that it would be the next step for me to emotionally recovery from the experience.  It was as therapeutic as I hoped it would be.  It helped so much.  I've hesitated on posting it here, in part because it is sooooo lengthy and also because I've been afraid that those that read my story may think I was being overly dramatic and that what happened to me wasn't that big of deal.  I haven't wanted my experience discounted or my character belittled.  I guess what it really comes down to is that I don't want my worst thoughts about my self confirmed...that I'm a wuss and can't handle all that being a mother entails.  But then I decided that I just didn't care.  I know that what I went through, in all honesty, was not that bad compared to so many others that have had preeclampsia/HELLP, but, for me at the time, it was scary and traumatic.  This was my third pregnancy. I had never had a history of preeclampsia. It shouldn't have happened to me.  No one was really looking for it (except for the usual pee-in-a-cup test every appointment), so symptoms I experienced early on were discredited.  I don't blame my doctor.  She checked everything she could, and went off of years of experience to treat my pregnancy and symptoms the best way she knew how. Anyways, I'll post my updated version now. **

I figured it was time I write down my preeclampsia/labor/delivery story before I forget too much.  I'm giving you a fair warning up front that this is going to be long. I don't have any pictures to post, but my mom documented the whole thing from her perspective and added a bunch of pictures.  I highly recommend heading over to her site to see the pics of Ander and of the before and afters of my swollen face and feet so you can see the effects that preeclampsia had on my body.  The links are HERE and HERE.

Sometime during the second or third month of pregnancy I told Tim that I had a feeling that this pregnancy was going to be different than the others. I felt like it wasn't going to go quite right.

March 19, 2013- I went to doctor because I was more swollen than usual and I had been feeling off. I could tell something wasn't quite right. The day before I checked my blood pressure and blood sugar just trying to figure out what was going on with me. I'm not the type to read into things too much and assume the worst. I could tell that this was different than my other pregnancies. The doctor checked my bp and checked for protein in my urine. There was no protein and my bp was just a little higher than my normal (my normal is typically low, so having it a little higher put me in the normal zone). She sent me to the hospital to get a blood workup done to see if my liver was functioning correctly and to see how my platelet count was. Everything came back within the normal range. The doctor told me it was probably something really salty that I ate and that it was extremely rare for a woman to get preeclampsia in her third pregnancy when she hasn't had it with any of her previous pregnancies. The doctor checked for everything she could and felt pretty confident I was ok.

Wednesday, April 17- We started our trek to San Diego. That evening we stayed the night in Las Vegas. During the car ride I started to get really swollen. I figured it was from sitting for 6-7 hours straight.

Thursday, April 18- I woke up and screamed when I saw my face in the mirror. I was so swollen. I looked (and felt) HUGE. My eyesight started to get blurry that day, but I figured it was from staring at my iPad constantly for the past couple days (I was totally caught up in some book). The rest of the car ride I tried to elevate my feet and drink a lot of water. I also was watching my sodium intake. When we got to San Diego, I immediately laid down and elevated my feet. That night I woke up because my ring finger was throbbing. My hands had gotten so swollen that my ring (which is usually large on me) was cutting off my circulation. I soaked my hand in ice water and used soap and eventually got my ring off, along with a little bit of skin.

Friday, April 19- I continued to rest. Swelling and blurry vision stayed the same.

Saturday, April 20- I had Taryn check my bp just to make sure everything was ok. It was in the low 140s/upper 70s. That was high for me but still in the ok range. A slight headache started to come on that day. Headaches had been extremely common during this pregnancy, so again, I didn't think anything of it.

Sunday, April 21- We drove straight home (no stopping half way in Vegas). The second I got home I grabbed some ice packs and put my feet up with the packs on them. After an hour the swelling looked somewhat better, but not much. I wasn't going to to call the doctor in the morning. I had a doctor's appt Tuesday morning anyways, and I didn't want them to tell me is was something salty I ate. My vision was extremely blurry by this time and the headache was a lot stronger.

Monday, April 22- I had more energy than normal this day, but still had the headache and blurry vision. I went shopping for the cooking class I was teaching the following day and did a bunch of prep work.

Tuesday, April 23- I dropped Gavin off at school, Tim took Kade with him to work, and I headed to my 9:00 doctor appointment. I peed in a cup and sat in my room room waiting for the nurse to come in a do the normal tests. She came in and checked my bp and looked fine. She left and then came back a few minutes later with a different blood pressure cuff. She told me that they found protein in my urine (+1 level) and she would like to check my bp with a different cuff. They had been having problems occasionally with the first cuff she used. This time my bp was 164/110. She checked my other arm and it was in the same range. Dr. Robinson then came in and checked my pressure after I had rested for 15 minutes. It was still the same. She noted that I had gained more than the normal 1-2lbs a week. I had gained around 5 lbs a week. She asked me about any other symptoms like a head ache or spotty vision. I told her I had a headache but that's been pretty normal this pregnancy and that my vision was blurry, not spotty, but it was probably attributed to my staring at an iPad for an extended period of time. She scoffed at me (nicely) and said that all these little things add up to a big thing. She checked to see if the baby was under stress, and he wasn't, so she sent me Salt Lake Regional Hospital (the hospital I was planning on delivering at) to be monitored for a couple of hours and to get my blood tested again to check on my liver and platelet count. At that point I called Tim and my mom and got arrangements figured out for the kids. While at the hospital, they checked my blood, my bp every 30 minutes and my urine output (to check on my kidneys) and also started collecting my urine for the 24 hour urine collection to see how much protein my kidneys were dumping. Dr. Robinson transferred my care over to a high risk pregnancy doctor named Dr. Draper. He came over to the hospital to look at my lab results and to do an ultrasound. He started off with the ultrasound. He told me that before the mom starts to show symptoms of preeclampsia, it effects the baby by stunting its growth. Sure enough the baby was measuring approximately 3 weeks behind. Dr. Draper then looked at my lab results and compared them to the ones a month ago. All of my levels had started to shift in the wrong direction, but the levels weren't to a scary stage yet. The fact that they were shifting, though, was concerning because it was showing that my body was slowly starting to shut down. He monitored my blood pressure for another hour or so, and then came into my room and told me that my bp wasn't improving. He said I needed to be transferred up to the University Hospital because they are equipped to take care of babies born before 35 weeks. He told me that I was probably going to be having the baby that night or the next day. He offered to drive me to the hospital since he was on his way there, or I could take an ambulance and pay $4000 for it. I asked him if my husband could come up and take me. He asked if my husband was medically trained. I told him no and asked why that was a problem. He said my bp was so high that I was at a high risk of seizure and that I needed to be with someone that was medically trained. Dr. Draper then drove me the 5 minutes to the University Hospital. He took me to the emergency OB department. The hooked me up to all the monitors again and drew some more blood. I received my first of two betamethasone shots to help develop the baby's lungs in case I would be having him in the near future. The second shot would be given 24 hours later. During the next several hours, my blood pressure started to go down into the 160s/80s. Dr. Draper felt it would be okay for me to go home, but to be on strict bed rest. He was hoping that I could make it until I was 34 weeks. He told me it was a long shot, but that's what we needed to try for. He schedule me to come in the following day to get my second shot and turn in my 24 hour urine collection and then also scheduled a follow-up appointment for Friday morning where I would get my bp, urine, and blood tested and then also get another ultrasound. Tim drove me home and I decided that I would still teach my cooking class for the Relief Society that evening, but only if he would be my sous chef. I changed up the class a little so that I could sit the entire time. I arrived home an hour and a half before the class started. Tim rounded up everything I needed while I rested. The class went great. I was able to sit on a stool throughout the entire class and Tim was the perfect assistant. The Relief Society president and some others insisted that I check my bp periodically throughout the class to make sure I was okay. Tim and my dad gave me a blessing that night.

Wednesday, April 24- This day was uneventful. Tim arranged with work so that he could stay home with me through the end of the week. I went back to the hospital to turn in my 24 hour urine collection and to receive my second steroid shot. My mom was talking to HR at her work to see if she could get some time off to take care of me, and if that didn't work Tim's parents were on standby and were ready to fly up that following Monday. Later that evening Dr. Draper called to let me know the results of my urine test. To be diagnosed with preeclampsia, the protein levels need to be at least 300 mg. Mine was 506 mg. Severe preeclampsia is 5000 mg! My eyesight got much blurrier. Everything further than about 24 inches in front of my face was a complete blur. My headache was much worse also.

Thursday, April 25- Bed rest didn't go so well. Tim was really busy with work, so I was up and about way more than I should have been. By mid-afternoon I started having pain in the middle of my chest and in between my shoulder blades. It wasn't in the upper right quadrant like the doctor told me to watch out for, but it was still concerning to me. I also wasn't feeling very well. While Tim was at soccer games with the boys, I went down the street to Walgreens and got a bp cuff. I checked my bp and it was about the same as it was when I left the hospital. My heart rate, on the other hand, was scary low. After walking around, it barely made it above 50 bpm. At times while I was resting, it was in the 30s! I wasn't stressing about it because I knew I would be seeing the doctor very first thing the next morning. That night I barely slept at all. The chest pain and headache got so much worse. My eyesight was almost nonexistent. My mom found out that evening at work that she was approved to take the next 5ish weeks off!

Friday, April 26- My birthday! When Tim woke up that morning, I asked him to hand me my bp cuff. I checked my bp before I had even sat up in bed. It was 205/117! I told Tim to pack our bags. I was sure the doctor was going to send me to the hospital and we would be having a baby any day now. I called my dad (who was coming to watch the boys while I went to my appointment) to let him know that it was probably going to be a long day and to bring his books. My appointment was at 9 and Tim had to leave for a business meeting at 10. Since my vision was so bad and bp was so high, I couldn't drive myself, so Tim had to drive me. I called my mom, apologizing profusely for waking her up (she had a late shift at work the night before), and asked her if she could meet me at Dr. Robinson's office right away because I was sure they would send me to the hospital and I couldn't drive myself and Tim would be gone. At the appointment, they found more protein in my urine. I was now at a +2. My blood pressure readings were in the 190s/90s. The fetal stress test came back good, though. Sure enough, Dr. Robinson told me I needed to go back to the University Hospital, but before I go, she needed to switch my care over to Dr. Macy. Dr. Robinson didn't have delivery rights at the Univeristy Hospital, but Dr. Macy did. Dr. Macy came in and introduced herself and looked over my charts. She was amazed that I was getting preeclampsia for the first time in my third pregnancy. She also saw that I had been in a month previously because I didn't feel quite right. She figured that that was when the preeclampsia started to creep in. The previous ultrasound that Dr. Draper performed suggested the same thing.

My mom and I head up there while Tim goes to his meeting. As I was getting checked in, my mom needed to run back to the car for some papers that the hospital needed. While my mom was gone, I finished checking in and the lady sent me off the L&D. My eyesight was so bad, that I literally had to put my face an inch away from the signs to read what they said so that I could figure out if I was headed in the right direction. Everything was just a huge blur. I finally found my way and was hooked up to a bunch of monitors. Within 10 minutes my blood pressure starts to go down. For hours it stayed in the 160s/80s. Again, not awesome, but not scary bad. They hooked me up to an IV and pumped me full of fluids and had me pee in a bucket so that they could see how my kidney function was. They took blood tests again and compared them to my lab results from Tuesday. The numbers had shifted in the wrong direction, but not enough for them to want to induce me right away. They kept doing a blood work-up about every 3-4 hours. They also gave me some blood pressure meds to try and get my bp lower. My dad and sister brought the boys to the hospital and my mom went out to gather some birthday stuff and we celebrated my birthday in the room. Right after they left (around 9:30 pm), Dr. Mize (the high risk Dr. that was on duty at the time) came in and checked some of my vitals and started talking to me about how he's not going to send me home, but rather I stay there for the next two weeks on bed rest. I was furious! I did NOT want to be at the hospital for two weeks! We talked for about 15 minutes, and then he started to check on my vitals and lab results one last time. My reflexes were extremely strong (severe preeclampsia will cause that), the bp meds weren't helping, my kidneys had stopped working (you're supposed to produce at least 30 ml of urine an hour, and I had produced 30 ml in 5 hours!), and my lab results showed a big drop in my platelet counts. He looked at me and said, "change of plans, we're going to induce you tonight." He called the nurse in and had her start me on an anti seizure med called magnesium sulfate (mag) and put a catheter in because I'm not allowed to get up and move around while on the magnesium. That magnesium is awful! It immediately made my whole body start to shake, my eye sight was already blurry and the mag made it 50 times worse, it also magnified my headache. I now had a full blown migraine. (The nurse kept telling me that it wasn't the mag that was making me shake. She said it doesn't do that. After reading a bunch more about sever preeclampsia/HELLP, I've come to find out that uncontrollable shaking is a symptom and usually precedes a seizure or stroke (eclampsia)) They wheeled me into a special delivery room that had a window in it that led right into the NICU. They asked if I wanted an epidural and told me if I did, now was the only time they would do it because my platelet count was getting too low. I told them to hook me up!

Saturday, April 27 - Over the course of the next few hours, things were kind of a blur. Every 30 - 45 minutes the nurse would come in and up the dose on my pitocin. I told the nurse that it took a ton of pitocin to get me to start to contract with my other two babies. I don't think she quite believed me. The magnesium relaxes muscles, including the uterus. I wasn't having any contractions, so the pitocin kept getting increased. The nurse also was trying to get my headache under control so that when it came time for delivery, I would be able to somewhat concentrate on it. Everything they gave me didn't come close to helping. Soon I was throwing up the medicine. My mom suggested they give me some zofran in my IV and then give me some more pain meds. I was finally able to keep the meds down, but unfortunately they didn't help.

Tim dozed off while holding my hand, and I laid there with my eyes closed when I felt a contraction. I could tell that my epidural wasn't working at all. The contraction hurt, but wasn't too bad. A couple of minutes later I felt a second stronger contraction. A few minutes after that I felt a really strong and painful contraction and I could tell that baby was coming. I wake Tim up and tell him to help me find the call button or go grab the nurse because the baby is coming. He was so disoriented and just kinda stared at me like I was crazy. Luckily the nurse came in right then. I told her that I was pretty sure it was time to push. She sighed with relief and told me she had just gotten an order from the doc to turn my pitocin up to 30 and if that didn't get me contracting, then I would have to go in for an emergency c-section.

The nurse checked me, and sure enough she could feel the baby's head but she could also feel something else. She figured it was an elbow. She called the team of doctors and nurses to come in and paged my doctor who was at least 10 minutes out. As the room was filling up with people (there were at least 10 people in the room and then 3 nurses at the window waiting to take the baby) my contractions kept coming one right after the other. It took every bit of energy and concentration I had not to push. The nurses and docs really wanted my doctor (Dr. Macy) to be the one to deliver. One of the doctors decided to turn off the pitocin to buy Dr. Macy some time. While we were waiting for her, 3 other doctors and nurses checked me and they all agreed they felt the head and what must be an elbow.

Finally Dr. Macy arrived. The staff informed her about what they felt. She checked me and told them she felt the same. By this time, my contractions had stopped all together. The magnesium had completely relaxed my uterus. This whole time I was trying everything in my power to be able to just concentrate on delivering the baby. I felt so sick and was in so much pain. My mom said that the doctor and nurses kept trying to get me to help hold my legs and I just laid there with my eyes rolling in my head. I don't remember any of that. The doctor kindly allowed the lights to be dimmed and the nurse put a towel over my eyes so that I could get a little relief from the headache. I remember being in the ridiculous position ready for the next contraction so that I could push the baby out and it never came. I had a room full of medical personnel while my legs are up and we're all just waiting.After 5-10 minutes of no contraction, Dr. Macy turned the pitocin back on. A contraction finally came, and I got to push. I gave a really big push and out popped a leg. The whole room went silent when they realized that the baby was breech, except for Dr. Macy. She calmly guided me with my pushing. She would tell me to give a short, big push, or to back off and do a little push, or to not push at all. I was so glad my epidural hadn't worked so that I was able to feel what I was supposed to do. Ander finally came out after only a few long minutes of pushing. A breech delivery definitely felt different than a normal delivery. Ander was quickly passed through the window into the NICU. 10 minutes later a nurse poked her head in and said that Ander's APGAR scores were 7 and 8 and that he weighed 3 lbs. 13 oz and was 16 1/4" long. He was doing great!

Over the next 30 minutes, Dr. Macy was trying to get me to contract again to deliver the placenta. I can't really remember what all happened because I was so out of it all, but I do remember it taking a lot of time and she had to up the pitocin again. After the placenta came out, my uterus wouldn't contract back down, and it really needed to to start the clotting process, so they had to give me pills in a not so pleasant place, and that finally worked.

Five hours after delivering, I finally got to see Ander. The nurse wheeled my bed into the NICU. I remember being so frustrated because I could barely concentrate on anything and my eyesight was so bad, and all I wanted to do was to be completely in the moment because I knew it might be a while before I could hold Ander again. I wanted to be able to take in all of his perfect little features, but because of the magnesium and my high bp, I couldn't enjoy the moment like I wanted to. It was two more days until I got to hold him again.

The next day when Dr. Macy came to check on me, we talked to her about the breech delivery. She's a little older and did her residency in the 80's, so she was trained in breech deliveries. In the mid 90's, doctors were no longer trained on how to do that and were told a breech baby was an immediate c-section. Dr. Macy knew the second the felt for the baby that she wasn't feeling the head and an elbow, but the butt and a foot. She also knew that with this being my third baby and the baby being so small, that a breech delivery wouldn't be a problem. I'm so glad that she was the one who delivered Ander and not one of the other docs. A c-section would have been very dangerous for me to have because of my low platelet count. A blood transfusion would have almost been guaranteed.

Monday, April 29 - I was discharged. 

Tuesday, April 30 - In the morning I checked my bp first thing and it was really high again (180s/110s). I called my doctor, and she told me to go straight back to the hospital, so off I went...again. Right after I got checked in, they hooked me back up to the magnesium and got a lab work up done on my blood. The results came back showing that I had gotten worse. I now had HELLP syndrome. My liver was failing and my platelet count was dropping further. Liver enzymes should be around 60, and mine were reaching 500. It is so rare for preeclampsia to get worse after delivery, but obviously it happens. The doctor kept me over night. He kept trying different bp meds to get my pressure down and kept an eye on my liver and platelets. I wouldn't be allowed to go home until my body had stabilized and he could find a bp med that worked. The doctor was also trying to get by headache and blurry vision under control, he was worried that I may have had a mini stroke at some point, and if my headache didn't go away, then I would need to get my head checked. I did not want to stay in the hospital any longer, so I lied and told him it was getting better and then prayed for the best. I know, not the smartest thing to do.  Don't follow my example. I was released the next night. It took three weeks for my headache to go away and my eyesight to return to normal.


4 1/2 weeks after delivery, Ander finally got to come home too! And that's the end of my saga. :)