September 28, 2010

Caleb's Birth Story

Ok, I did try to keep this to a short story, but it kinda turned into a novel...

The weekend before Caleb was born was a busy weekend. Clara's birthday was Friday. I had scheduled myself to work Friday night and Sunday night so I'd be off and available for Saturday. It was busy as all heck Friday night - I was in charge and had a full patient load! Then I went home and slept for a few hours before family came to town and we went to a huge apple orchard/pumpkin patch for the day for Clara's bday. They have a TON of stuff for kids there. But I didn't get a lot of sleep. Sunday 9/19 I went to work as usual. I had been a bit uncomfortable all day...had what I called butt cramps and I was just plain uncomfortable. I'd never had that discomfort before, but I figured it was probably just the baby's position, sitting on a nerve or something. And, really, I'd been uncomfortable all pregnancy and so far nothing changed my cervix. So I go on about work and at one point a couple of the other nurses and I thought we'd mess with the nursery nurse that was working. One of them went to the nursery and told her "Mary, get ready for a c/s. Nurse Lochia's water broke and she's only 34 weeks!" Yeah, yeah, we nurses have a sick sense of humor, but it was all in good fun! We all had a good laugh. Little did I know what was in store 24 hours later. Anyway, I push with this patient for 3 hours and she finally delivers. I had started getting really uncomfortable, not with clear cut contractions, but my back was killing me, I felt like I could faint and vomit, and my uterus was just sooo tight, it actually felt like it could pop. I told the charge nurse after the baby delivered, that I was not feeling well at all and needed to rest for a bit after it was all said and done. So delivery done, patient taken care of, and I run to the bathroom to vomit. I also took a brethine, hoping that would help with the tightness in my uterus. I felt a bit better after vomiting, but I notice I'm passing pink mucus. I sat down with a huge glass of water, ate my sandwich and finished my charting, but still wasn't feeling good at all. Finally, after much debate, we decided I needed to clock out and become a patient around 4am. I was contracting pretty frequently, cervix was 2cm, soft, but thick, but it was easy to reach. I really thought a few shots of terbutaline would do the trick. So I called Husband, told him I was a patient, that I'd gt a couple doses of terb and probably go home and probably wouldn't be working that night. Two shots in, I'm still contracting, and my pulse is 130 so they have to hold the 3rd dose. By now, it's 7am and my doc comes to see me. She said that when my pulse slows, I'd get that 3rd dose. If that didn't work, then she'd give me a dose of procardia to see if that helped. If that didn't work, then she'd have to start me on Magnesium Sulfate since I was only 34 weeks. I know some hospitals go ahead and let you deliver at 34 weeks, but in this area, we stop labor at that point. I knew from experience as a L&D nurse that if 2 doses of terb didn't slow the contractions, then the 3rd wouldn't and the procardia probably wouldn't either. Got the third dose and no change in contractions. I get the procardia and you guessed it, no change. By now my pulse was 150 and I felt like complete crap. At this point, I know what's coming: Mag. My IV is started and they draw labs, do a GBS culture and I get a 6g bolus of Magnesium sulfate and then the maintenance rate is 2g an hour. Can I just say Mag sucks. I tell patients that all the time when I start Mag but until you experience it, you just can't understand. It feels like fire in your veins, in makes you nauseated, and hot. I did ok with the bolus, though. Finally, the contractions start spacing out. I begged to not have the foley catheter...doc said fine but I had to use the bedpan and was not allowed anything to eat or drink...just in case. After about an hour on 2mg of mag, the contractions pick up again so I had to have the catheter put in to keep my bladder empty. I'm a baby and I hate catheters. They ended up bumping the mag to 2.5g/hour then to 3 g/hour. At 3g and hour, I felt like crap...again. Double vision, felt weak, and out of it. Finally, they slowed again, cervix still unchanged, thankfully. When they increased the Mag to 3 g, I started to have a bit of a melt down. I started worrying about the baby - I see 34 weekers born all the time and they almost always have problems. yeah, in the long run, they do fine, but initially, they have problems breathing, sometimes need to be ventilated and given surfactant, which my hospital doesn't do, they get transferred to another hospital with a big NICU. They also have problems with their blood sugar, keeping their temp up, weight, etc. Plus my daughter was 36 weeks and had respiratory issues, so I started freaking out. I called DH and he came to the hospital...I texted my sister, my due date buddy in my due date club I'm in, and talked with my coworkers, trying to calm my nerves. The kids pediatrician even came by when she saw my name on the board and that was nice...she could make a dead person feel better she's so soothing and reassuring. They were all reassuring, but I don't remember the babies that do well...I remember the ones who don't do well. Finally, after my "moment" I got myself together and I knew really needed to turn the labor nurse part of me off. Doc ordered a cocktail of meds that will help with pain/nausea/and will make people sleepy, Nubaine and Phenergan, since I had been up since Sunday a.m and it is now Monday at 3pm she wanted me to sleep. I didn't want this cocktail because I didn't' want to be anymore out of it than I already was on the Mag. I was seeing double and couldn't think straight. That combo of Nubain and Phenergan did not help at all with my mental clarity. From about 2:30pm on, I was out of it. It was like I was in a daze...not able to really sleep, but I couldn't keep my eyes open, couldn't focus to even form questions that made sense, couldn't hit the numbers on my phone. Around I think 4pm, my doc came to see me again...this time I felt like she really didn't think I needed to be there, kept saying "It's your 4th baby, your cervix hasn't changed, you were contracting every 2 minutes at your last appointment and you're probably just someone who contracts. When they hurt, then we are concerned. I'm not going to rush you back for a c/s unless your cervix changes". This pissed me off. Ok, first I was uncomfortable, and that was why I was admitted. Second, I know I contract all the time and when they didn't hurt, I didn't worry about it. Third, the very LAST thing I wanted to be was delivered. I'd been just fine with carrying until the end of October, I don't care how uncomfortable I was. I don't know if it was because I wasn't quite with it, but my coworker taking care of me told me she was just trying to reassure me that she didn't think I would have to be delivered. So I tried to relax. I sent Husband home to take care of the kids and said I'd call if anything happened. The rest of the evening was uneventful. I was in and out of poor sleep, and around 1am, my coworker came to give me another round of the Nubain/Phenergan and the ampicillin I had been getting every 4 hours. My WBC count was 15 - we see an increase in WBC when women come in in labor, or if there is an infection of course. Fifteen minutes later, I notice my underwear was wet. "Ok", I thought "maybe it was the KY Jelly oozing out from the cervical checks, or maybe the catheter was leaking". I took my underwear off, it was covered in mucus, but I had been losing mucus all day. Over the next hour, I finally realized that it was probably amniotic fluid I kept feeling and the pad under me was wet. I considered not saying anything right away...I had just been doped up with drugs, I wanted to sleep and the last thing I wanted was to be drugged out when my baby was born. Plus, I worried about how he would come out b/c of the drugs, but reason won over and I called my nurse. Sure enough, it was amniotic fluid, not that either one of us had any doubts. So I called my DH...and he didn't answer. "Ok", I figured maybe he was in the bathroom. I called 7 times and he didn't answer and I was furious! How could he not have his phone next to him! I had called my mom and she was on her way, but she is 1 hour drive away. My charge nurse actually called another coworker of ours who lives a block from me...she was still awake and she walked to my house to wake DH. About the time she knocked on the door, I got a hold of him- he had been trying to get Isaiah back to sleep. In the mean time, my RN called my doc, told her my water broke and that I wouldn't be going back to the OR until DH was there. My doc, (this ticks me off), wanted to make sure it was documented that I was "refusing" to go to the OR until my husband was there. Baby was fine, I was fine, so I don't know what her problem was. I think it was just the middle of the night thing - she had said half-jokingly earlier that she didn't want to see me at 2-3 in the a.m., and this phone call was at 2:30. It still irritates me, but whatever. Husband gets there very quickly, they also called in my pediatrician (who wasn't on call) and the favorite anesthesiologist (also wasn't on call) and they came in for me. It was really, really nice that they came in for me! I had no idea how weak I was from the mag, but I couldn't even stand up to get myself into the wheelchair. That was an odd feeling, not being able to hold my own weight up. So they help me into the chair, and off we went to the OR. I've been through a c/s before and I've seen hundreds, but when it's me, I'm still scared to death when it's me. I get prepped, draped and again, they ask if I want to go through with the tubal ligation or wait until later. I wanted it done then. At 3:47 a.m little Caleb Dean was born with a hearty cry before his body was even delivered! He did great, as I have bragged already! His apgars were 9 and 9, and he was 6lbs 1 oz, 18 1/4 in long. He was beautiful and looked just like my firstborn - full head of dark hair too! I got to cuddle him a bit before they took him to the nursery for a complete evaluation. He checked out great in the nursery, never needed oxygen. He just didn't seem to realize he was preterm! I finally got to hold him in recovery and he looked like he might nurse so I figured we'd try. I didn't have much hope he would because 1. it's hard to breastfeed on the recovery cart and 2. he was early and they don't always know how to suck. I laid him on my chest and he latched right on. I was amazed! I was laying down, and here is my little 34 weeker nursing better than my other kids did! The rest of our stay was uneventful - he still nurses like a champ, his temps were always good, his weight was fairly stable and although he was a bit jaundiced, he is fine now. He came home on time! with a biliblanket to help bring his bilirubin down, but the next day it was down enough we didn't need it anymore!

I recovered well. The duramorph they put in the spinal for pain control (a form of morphine) always made me itch like a madwoman, so they only gave me half a dose. I still ended up itching myself into a rash. I ended up with a narcan drip to reverse the effect of the duramorph - that also took away the pain control and I then was in quite a bit of pain, but some toradol and fentanyl did the trick. The pain was good and the itching was gone. I don't think the anesthesiologist believed my itching was as bad as they had said until he saw me in the hall - then he went to town trying to figure out what to do for me and we tried to decide if it was the duramorph that I had an allergy to. He suggested I list morphine as an allergy and also that I might have a latex allergy. Gloves don't bother me, but he thought maybe with exposure internally, it would cause the systemic reaction I had. But anyway, life was good. Caleb got to stay with me, never had to be in the nursery - I did let him go at night between a couple feedings b/c some of the girls wanted to get their hands on him...we love to cuddle with babies, especially babies of "one of our own". When I saw my coworkers I worked with Sunday know, the one's who were in on the little joke about my water breaking...we had a little laugh. They said when they heard they felt guilty. We nurses are superstitious...but we also know it was just irony at work, but we all agreed - no more jokes like that on the nursery nurses!

Part of me is a little frustrated with my physician...looking back over the last several weeks, I had contractions that weren't painful, but were there. And I realize that hindsite is 20/20 and at the time, things seemed to be under control. She did multiple fFN tests and when one came back positive, she took the approach that b/c my cervix was still thick, I wasn't at too great a risk. She never changed anything. Never gave me steroids, no bedrest, etc. She did give me brethine to take as needed, but several of my coworkers expressed concern that she wasn't taking me seriously. Even when I was admitted and started on Magnesium, I felt she didn't think I really needed to be there. I didn't want to be off work if it wasn't necessary...I didn't want meds if it wasn't necessary, etc., but I also wanted to be smart about the whole thing and if she felt I needed intervention and medication, then I wanted to do whatever needed to be done to keep him in until term. I trusted that because my cervix wasn't changing, and that my doc didn't think it would change, that it was safe if I kept on going, I was just one of those women who "just contract and their cervix never changes". I was ok with that. I looked to her for guidance as my doctor - I trusted her judgement out of all the docs I work with and maybe in the end it wouldn't have mattered regardless of what we did...Caleb was tired of being stressed and I think he took his little finger and just went "pop" and broke the membranes. I perhaps should have listened closer to what my body and my "mother's intuition" was telling me. I told a few of my coworkers when I was about 20 weeks that I had a bad feeling I wouldn't make it to term. A mother always knows. He did fine, but most don't do that well. I brag how well he did after delivery, but the reality is that my uterus wasn't a calm happy place for him - the stress of being in utero probably made him mature faster. It's easy now to look back and wonder if maybe something should have been done differently - I'm not really a big complainer and I don't advocate for myself very well, so maybe I should have been more vocal about how I was feeling, or maybe my doc and myself shouldn't have been so laid back about the whole thing, but oh well, it worked out in the end. There were several prayers said for this little boy and I believe that is partly why he did so well...I am a firm believer in that.

I had my whole delivery planned: I had hoped for 10/22 to have a scheduled 7:15 c/s. My nurse friend S would circulate, the baby wouldn't leave the OR and I would get to hold him as I'm wheeled out of the OR. I wanted to avoid working most of a shift and then being admitted b/c I would go into delivery with lack of sleep. S was off after carpal tunnel surgery but had planned on being back in 2 weeks. I was admitted after a weekend I worked Friday night/Sunday night - and those weekends wear me out because I get very little sleep, plus we had a busy weekend with my daughters bday. I never wanted to experience mag or another preterm delivery. It just goes to show you just can't control delivery - and even though it was full of things I didn't want, all I really wanted in the end was a healthy baby, and that's what I got. I have a beautiful, healthy new son that we are thrilled to have, and his older siblings adore! I couldn't ask for more! Plus, now I can empathize even more with my patients: I've had a nice normal vaginal delivery, an emergency c/s with a preterm 36 week baby who spent a day in the special care nursery, a nice scheduled term c/s, an incomplete miscarriage and D&C, and now a preterm 34 week delivery after trying to stop labor with terb, procardia and Magnesium I'll be a better nurse for it!


Robert said...

So glad it all turned out ok. Makes you wonder if maybe you weren't actually further along than first suspected?

Emily said...

Yeah, I've been wondering that too. Hmm? He looks so very perfect, even a bit chubby. And very "with it".

MentalMom said...

So, so happy to hear that everything went well.
Amazing how great Caleb did despite the mag, phenergan and nubain. My mag baby (38) was breathing and crying but still pretty gray.

Nurse Lochia said...

It did seem he did better than a 34 weeker should do, but I had an early sono at 7-8 weeks, every sono he measured right on and the pediatrician did what they call a Ballard score. It is an assessment to determine gestational age and he scored right at 34 weeks. Trust me, when they started the mag, I was trying to figure out if there was any possible way I was further than we thought, but really, with when my LMP was and the sono, there wasn't. He has pretty chubby cheeks, but he's pretty skinny unwrapped, is pretty floppy and sleeps all the time, more so than a term baby. Prayer can be very powerful, and God definately had his eye on Caleb that day!

Taking Heart said...

He is beautiful... and I've seen lots of chubby cheeked 34 weekers... lazy little munchkins... but so glad God has His hand on you and your little guy... so awesome that he is doing so well!

Mag is so yuk... and I pray I never have to experience it... seeings how I have a cervix of steel and I most likely won't have a fourth... I probably will avoid that gttp in this lifetime.

Happy BIRTHday to mr. Caleb and to you Nurse Lochia! You didn't avoid the nurse curse... but your happy ending is all that matters and I'm so happy for you and your new little big family!

Tori O. said...

What an interesting story! You'll have to share the exciting story with him when he's older.

It's weird that I knew with this birth (3rd) that I was going to go early. Not too early (38.5 wks), but before my due date and I carried all the way to my EDD for the prior two.

Of course, my doc swept my membranes at my 37.5 wk appt, but it was still another week before I went into labor. They thought he was going to be overly big for some reason.

Congrats again!

Jessica said...

I'm surprised after your fFN came back positive you didn't get Betamethasone! I am so happy to hear that you and baby Caleb are doing well! Congrats!

dr. whoo? said...

Congratulations! So glad that Caleb is safe and sound. I am sorry that you are disappointed in the care you received from your physician, but I hope that you are able to talk to her about it. I know that I would want to know if one of my patients felt the way you do. Best of luck with your recovery!