Though it could easliy have been Grace’s birthday. OK, I take back the “easily” part. It is true, though, that if we had been successful at keeping Jenn pregnant to 36 weeks, today is the day that the doctors would have delivered Grace. It is also true that Jenn would have been on bedrest for the last 46 days and she may well have been driven insane or become really good at Scrabble…or both. Of course, that didn’t happen, especially the Scrabble part. While you have heard about what happened between March 28th and today in exhaustive detail, I have not put down the story of the night of March 27th that lead to Grace’s sudden arrival, until now. This will be a long post but hopefully it captures what happened that night.
WHERE WE WERE
When we left this story, four short weeks ago, we were waiting in room 231 in the Labor and Delivery wing at CPMC in the middle of a nurses strike, trying not to have a baby. At just over 30 weeks through the pregnancy, we were still not sure if we would be there for days or months, so we had settled in while Dr Katz and the nurses closely watched Jenn’s preeclamptic symptoms for signals of failure in her kidneys or liver.
Preeclampsia, if you remember, is a set of symptoms (high blood pressure, water retention/swelling of the face, feet and hands, protein in the urine) that eventually culminates in eclampsia which is characterized by convulsions and possibly strokes. The balancing act that Dr Katz has to perform is giving Grace as much time to grow as possible while not letting Jenn go into convulsions or end up with severe organ damage. With Jenn gaining 1.5 to 2 lbs of water weight per day and her consistent high blood pressure starting to cause the occasional visual disturbance, known as an occular migraine, Dr Katz let us know that the time to make a decision was coming soon. Forget 36 weeks, we would be really lucky to make it to 32.
Dr Katz ordered a new urine test to see how her kidneys were doing and and ultrasound to check the amount of fluid around Grace, as that can become a problem in cases of high blood pressure. With no problems showing up on the ultrasound, we waited for the results of the urine test. For reference, a week earlier, when we came racing into the hospital [link] we learned that her first urine catch showed 330 milligrams of protein, which is just barely at the line when preeclampsia is considered as a diagnosis. Now, a week later, we learned that our second test showed a whopping 7700 milligrams! Essentially, her kidneys were shutting down quickly and she needed to not be pregnant any longer.
INDUCTION
Many Perinatologists agree that vaginal deliveries greatly reduce chances of respiratory problems because they force the babies to expand their lungs to the fullest when they take that first breath of air. Grace, however, had been breech when we were admitted so the first reaction to Jenn’s deteriorating condition was to order a cesarean section. A second look at the latest ultrasound, though, showed that the baby had changed position, opening up the option for a vaginal birth. At the time, I called this “the best news of the day” because we wanted to give Grace the best chance possible and this was an opportunity to get a leg up, so to speak.
The first step of the induction involves a pill called Misoprostol or “Miso” (not taken orally) to “soften things up” and then, later, another IV drip medication called Pitocin to convince Jenn’s body to go into labor. Just after 7pm, on Thursday night, as the day shift ended and Nurse Debbie from Alabama took over our care, we nervously began the process, and the waiting. Debbie had been caring for Jenn, and to a lesser degree me, each night since the strike began the day after our admission. Like a lot of the strike nurses, she lived in the South (Alabama) but having grown up in Huntington Beach, CA, she was right at home in California and the surreality of our situation. She had heard our stories, laughed at our stressed-out-but-still-quite-funny wisecracks, shuffled through every photograph of our life on Jenn’s iPhone and her iMac, processed Jenn’s pee, changed her sheets, and told us her own crazy stories of pregnancy. We always looked forward to our nights with Debbie and were comforted knowing that we were getting the best care possible.
“On 3rd miso. Contractions growing. Zero Dilation. Epidural coming soon. Doula also coming. Just an update. We’re doing ok.” -My final text message to the family at 4:40AM
Early in the first dose of Miso, 9 hours earlier, Jenn had felt the effects. As the doses continued, her pain slowly progressed from mild cramps to contraction-like waves of pain. The contraction monitor, however, claimed not to notice much of anything despite Jenn’s pleas and curses asking it to pay closer attention. In the early morning hours, with no dilation and continuing, growing waves of pain (despite some narcotics and my best attempts at helpful, cheerful birthing-class moaning exercises) the on-call doctor ordered an epidural to reduce the stress that 48 hours (!) of labor would put on Jenn’s already high blood pressure. Weighing the guilt we felt about wrestling her from the comfort of her bed with Jenn’s fear of an epidural needle into her spine, we called Lauren the doula, who jumped from her warm bed into the car without (audible) complaint.
Just after Lauren arrived, the anesthesiologist began letting us know that he would be giving her a small fraction of the amount usually administered to save some of the pain blocking powers for the end of the long induction. Surprisingly for Jenn, the needle part of the epidural was not painful and began to develop some hope for a smooth wait for Grace. About 10 minutes later, those hopes were dashed when Jenn went from being hypertensive to hypotensive as the bottom fell out of her blood pressure. In Jenn’s case, the pressure drop caused two things: First an incredibly painful headache that caused her to cry out that it felt like her “head was going to explode”. Second, the monitor listening to Grace’s heartbeat had no reading. At this point, the nurses sprang into action as I moved quickly out of the way, processing the scene in what now seems like a montage of disconnected scenes starring a blur of nurses. Joined by nurse Darlene, Debbie and Lauren began to flip Jenn back and forth from her right to her left side to try to find and stimulate the baby’s heartbeat. Seemingly at the same time, they inverted the bed, putting Jenn on all fours with her head down to bring the pressure back to her brain. They called for the anesthesiologist but he was busy. They said “She needs Epi, NOW!”
A QUICK NOTE ABOUT EPI
It may sound like “happy”, but hearing it during a crisis makes you anything but. If you have ever watched ER or seen Uma Thurman come back from the brink in Pulp Fiction you might know that Epi or Epinephrine (aka adrenaline) is not something you want to have to have injected into your wife. It confirms suddenly and completely that things are not going according to plan. It is the thing they give at the height of the drama, it’s the thing they slam into your heart when you are accidently OD-ing. You don’t want them to need the Epi, and you don’t want to hear that the doctor can’t come back in to administer it.
BACK TO THE BLOOD PRESSURE CRASH
In the world outside of room 231, unbeknownst to us at the time, 4 women came into the ward dilated, pushing and, presumably, screaming for their epidurals (one of these women was actually stuck in the elevator!) While the anesthesiologist was in the middle of that, the nurses inside room 231 had to deal with the immediate problem of Jenn’s blood pressure, so they pushed the Epi, and then they pushed some more, and it worked. Things slowed down a bit as the baby came back on the monitor and Jenn stabilized. The next blurry montage starred a series of doctors that rushed into the room and started doing doctor things. There was monitor checking, there was the fastest, most sudden internal exam I could imagine, there was conferring and there was Grace and her little heartbeat quietly dipping in and out. The next thing I knew, Elaine the day nurse (it was 7am by now) was shoving surgical scrubs into my hands and Lauren’s hands and people were rushing in and out of the room suddenly talking about a C-section. Jenn cried out for Dr Katz and miraculously, minutes later, he was on the phone explaining that he could not make it in time to do the operation and she needed to do this NOW.
THE PRAYER
Amidst all the chaos and the papers pushed in our laps to be signed and the surgical scrubs handed over with little warning, Darlene, a nurse we had gotten to know on nights when she stopped in to join in our hospital fun, laid her hands on Jenn’s belly and said in a quiet, calm voice that she would like to say a prayer for Grace. She went on to talk to Grace (and anyone else that might be listening) to let her know how much we were looking forward to meeting her. I mention this for three reasons; first, this kind of prayer is about as out of place in our everyday world as you can get. Second, because it was probably the most spiritually calming moment either of us has ever felt and most of all,because it worked. The room that had previously been filled with the chaos and fear (at least from our perspective) now had hope, calm and purpose.
In under 10 minutes (which seemed like hours to me) they had Jenn spinal-tapped, shaved, draped and ready for her babyectomy. Then, moments after that, I heard the wail of my daughter and…well…you know the rest of that part. It was amazing that a process that had involved so many long parts, long bedrest, long labor could all be over so quickly and change everything so completely.
Later, after things had calmed down and Grace was clearly on track, Jenn told me what she had heard while they were operating. The small placental tear that caused the bleeding that brought us into the hospital in the first place had, somewhere along the line, become a severe (40%) placental abruption. Had the abruption gotten any worse, Grace might well have not made it and Jenn would have been in danger as well. Had the epidural not caused the blood pressure to drop, we might not have noticed the abruption until it was too late.
You can see why we count ourselves extremely lucky that all of these people and events came together just perfectly to turn our scary night into a wonderful, growing little girl.
Happy not-Birthday, Grace.