Sunday, January 8, 2012

Rocco's Birth Story

Before I was pregnant, I didn’t completely understand why women wanted to share their “birth story”. I mean, hello, everyone knows the ending to your story – you had the baby! But now that I have gone through it myself, I know that the details of the birth are very important to a mother. In part because we all want credit, damn it, for the amazing feat we accomplished. It’s not every day a person delivers a baby out of their body! But like I said, everyone knows the ending of the story, so what’s really the point of going over the minutia of the birth? Well in my case, the birth of Rocco was only the beginning of what I went through. But before I get to that, I’m going to bore you with the details of Rocco’s birth. You’re welcome.

My pregnancy was a pretty normal one. Well, minus the horrible ‘morning’ sickness that lasted all day and well into my third trimester. But I had no gestational diabetes, no swelling, no bleeding, and no high blood pressure. Up until my 36 week appointment anyways.  It seemed like no big deal at the time, just a little elevated blood pressure. But my blood pressure got so high that by my 38 week appointment I was put on bed rest and was told that I needed to do some blood work and a 24 hour urine collection, which is just as fun as it sounds. Who doesn’t want to store all their pee from an entire day in a jug that they have to put in their refrigerator? All future house guests will now second guess having apple juice at my home.

Over the weekend I kept an eye on my blood pressure and it only continued to get worse and worse. Normal blood pressure is 120/80. At home I got a reading of 170/101. Hoping it was just an inaccurate reading, but wanting to be safe rather than sorry, Scott and I grabbed our bags and headed to the hospital. We checked into the labor and delivery triage at 5pm on Sunday, October 16. At the hospital, the nurses in labor and delivery confirmed that my blood pressure was indeed ridiculously high.  Not only that, unbeknownst to me, I was having contractions which I had thought were just weird baby kicks, and I was already dilated 2cm. Since I was 39 weeks along exactly, they went ahead and admitted me at 8pm and inserted an IV. 

At midnight they started me on Pitocin to get my labor moving along. Immediately my contractions became stronger (i.e. painful!) and closer together. I also became extremely nauseous to the point that they had to give me Zofran to stop my incessant throwing up. My new blood work tests showed that my platelets had dropped down to 102 (normal is between 139 and 361). Little known fact: if your platelet levels drop below 100, you can’t get an epidural. Needless to say I was in a rush to get that epidural in before my platelets dropped below that threshold as I had zero intentions of having a med-free birth! So at 6am my new best friend, the Anesthesiologist, came in and placed the epidural. Within minutes I felt relief and was happily numb from the waist down.

Unfortunately my blood pressure continued to rise up to 180/110, so at 7am they put me on Magnesium Sulfate to prevent me from having seizures. Fun! What’s even more fun is that an unfortunate side effect of that medication is extreme nausea which again was treated, unsuccessfully I might add, with yet another dose of Zofran. At 8am I had only progressed to 3cm dilated so the doctor went ahead and broke my water to try to get things moving faster. It worked! At 2:45pm the nurse rushed to page the doctor because I had jumped to 8cm dilated and the baby’s head was ‘right there’. She told me not to push because she didn’t want to be the one to deliver the baby. I thought she was being a little bit dramatic because frankly I felt perfectly fine and was not feeling any inclination to push as I was still happily numb and pain free. Once the doctor arrived I was instructed to push three times during each contraction. After the first contraction of pushing the doctor gave me an episiotomy because the baby’s heart rate had decelerated dangerously during pushing and they wanted to help him get out as quickly as possible. For those not in the know, an episiotomy is where the doctor intentionally slices into the skin between your hoo-ha and your back door with a scalpel to make more room for the baby's head - lovely. On the third contraction I pushed four times instead of three and out came Rocco Joseph Mintz at 3:01pm with a surprisingly large gush of water! His Apgar scores were an excellent 8 and then 9 out of 10. He really had a set of lungs on him - I think people down the hall must have heard him, but it was the most beautiful sound I had ever heard. I had always joked beforehand that I wanted them to clean him up first before they gave him to me, but I was truly overjoyed when they plopped him, all covered in grossness, on my chest as soon as he came out. Scott cut the umbilical cord and we marveled at all the adorable features of our little man as they cleaned him up.

Usually this is where the story ends, after all, I had the baby - I’m sure you didn’t see that coming, what a plot twist! If it had actually ended here, I think most people would agree that my birth story makes child birth sound relatively easy, and really it truly was for me! I felt very lucky – I got to have a pain-free vaginal delivery, my baby was perfectly healthy, and I felt great. I didn’t even break a sweat during delivery! But like I said, this is where my story really began. You’re probably thinking, “Good lord, this story has already gone on long enough – there’s more?” Why yes, there is! But I’ll completely understand if you stop reading at this point, if you even got this far in the first place.

Shortly after Rocco was born I became, surprisingly, extremely tired. So tired that within an hour of his birth I handed Rocco over to Scott and slept for several hours straight. At 7pm I awoke suddenly to pain radiating across my shoulder blades in my back. The pain quickly got worse. To put it into perspective, this pain was worse than my most painful labor contractions prior to my epidural, and those were no joke.  Fearing it may be some sort of complication from my epidural, an Anesthesiologist came in at 8pm to check it out. Once they confirmed that the pain had nothing to do with my epidural, they finally gave me some pain medication via my IV. The theory at the time was that I must have pulled a back muscle while pushing during labor.  I somehow doubted this, considering I only pushed for a total of about five minutes, but the pain medication had done it’s job so I didn’t press the issue. At 10pm the pain returned with a vengeance. I was literally screaming in pain and I began having a lot of trouble breathing. They promptly gave me more pain medication. Concerned, they also had a portable x-ray machine come in to take an x-ray of my chest, some additional blood work was ran, and they also called the critical care team to come in to evaluate me. I was then put on an oxygen mask because my oxygen saturation levels were dipping below normal.

My blood work came back with some very scary results - my liver was failing. Here are my results for a bunch of liver-related enzymes taken directly from my medical records: LDH 682 (normal is between 140 and 280); AST 611 (normal is between 5 and 36); ALT 259 (normal is between 7 and 35); bilirubin 3 (normal is between .1 and 1.5); As you can see, my liver was in seriously bad condition with every single enzyme being extremely elevated above normal. My blood counts were awful too. Hemoglobin is a protein that carries oxygen in your red blood cells. My hemoglobin was at a ‘critical level’ of 6 (normal is between 11.4 and 14.7). Hematocrit is a blood test that measures the percentage of your blood that is made up of red blood cells. My hematocrit was at a ‘critical level’ of 16.6 (normal is between 34.3 and 45.5). In addition, my platelets had dropped from 102 down to 25 (normal is between 139 and 361). Platelets help your blood clot, an important function when you just delivered a baby, which kind of tends to cause bleeding I hear. I was now at risk for bleeding out. They couldn’t even remove the epidural from my back for fear of causing a bleed in my spine.

With the results from my blood work I was officially diagnosed with HELLP syndrome: H - hemolysis (the breakdown of red blood cells, as noted by my hematocrit test), EL - elevated liver enzymes, LP - low platelet count. HELLP is a very serious condition that can cause death for both the mother and baby and only occurs in 0.2 to 0.6% of all pregnancies. HELLP Syndrome is classified into four subcategories which are differentiated by platelet levels, with category 1 being the worst and defined as having platelet levels at or below 50.  My platelets levels were at 24 so I was a very critical category 1 – excellent. The only known effective treatment for HELLP is delivery of the baby, but by the time I was diagnosed Rocco had already been born seven hours earlier. Lucky me, it seemed I was one of the 8% of all HELLP patients that present symptoms only after delivery. The only other treatment option left was to give me three transfusions of platelets overnight via a new IV in my other arm.

The next morning the shoulder blade pain across my back returned yet again. It turns out that pesky (and by pesky, I mean excruciating) shoulder pain was yet another symptom of HELLP. I also continued to have trouble breathing despite being on an oxygen mask. A new chest x-ray showed that my labored breathing was caused by pulmonary edema (i.e. fluid in my lungs). I also became very pale. Yes, it’s apparently possible for me to become even more pale than I already am. Surprising, I know! The platelet transfusions overnight got my platelet counts up to 80 which was high enough to get the epidural finally removed from my back. At this point I still had two IVs in place and, due to having had my blood drawn for tests every 2 hours for the last 15 hours or so (which they almost never got on the first try so we’re talking about 35 needle pricks total from the time I had been admitted), I was covered in band-aids and bruises on both arms and hands. They actually ran out of places to draw blood from my arms and had to resort to drawing blood from my foot, I’m not even kidding.

With my newest blood work results showing continued liver failure, terrible red blood counts, along with now having fluid in my lungs causing labored breathing, I won a trip to the ICU for ‘monitoring’. I was assured that I would be back in a ‘Mother and Baby’ room in no time at all. They lied.

The ICU was a seriously scary, run-down place compared to the luxury of labor and delivery. The labor and delivery building was only one year old with rooms that had brand new flat screen tvs and plenty of space for lots of visitors. My ICU room was approximately the size of the bathroom of my labor and delivery room. Speaking of the which, the ICU room did not even include a bathroom because ICU patients generally don’t have the ability to get out of bed. I technically didn’t need a bathroom either since I had a catheter still in place, had not eaten food in the past 42 hours, and had thrown up anything left in my stomach several times over. But it would have been nice for Scott to have not had to leave the ICU floor in search of a bathroom every time he had to use the facilities. My ICU room was very old in comparison, claustrophobically small, had a tiny tv circa the 1990s, and was full of big machines that beeped angrily all the time because my oxygen saturation levels kept dropping below a normal threshold even with my oxygen mask on. The ICU also had strict visiting hours, a limit of two visitors at a time (if you could even squeeze two visitors into that closet of a room when a nurse was in there), and no chair/bed for Scott to sleep on so he could stay overnight with me. But the main thing I was concerned about that the ICU was missing was Rocco. He was almost 24 hours old and yet I had not held him for more than an hour before taking what was supposed to be a short nap the previous day.  I had not been able to hold him since then and now I was being put in a completely different building where I couldn’t even see him, no less hold him. I was horrified.

In the ICU I got to meet lots of fun new people, like a Pulmonary Specialist, an Infectious Diseases Specialist, a Cardiologist, and an array of nurses who were generally not used to having patients who were conscious so their bedside manner left a lot to be desired. I was given two blood transfusions and a prescription for Lasix, a drug that should reduce the fluid in my lungs, by the Pulmonary Specialist. I was informed that even though Lasix contained an ingredient that I am allergic to, they were ‘hopeful’ that I wouldn’t have an anaphylactic reaction. The Infectious Diseases Specialist drew six vials of blood, which didn’t seem like a good idea considering I was just given two blood transfusions but whatever, to check to make sure I didn’t contract some kind of disease because I was running a fever of 100.2. The Cardiologist performed an echocardiogram which resulted in a diagnosis of congestive heart failure. A lactation consultant also came by to drop off a breast pump, because obviously a guilt trip about my child getting formula was just what I needed. My day was just getting better and better.

Needless to say, I made a point of requesting every chance I could that they have someone bring Rocco up to my ICU room to at least visit with me because I was a postpartum hormonal mess and I needed to see my son for my own sanity. I was assured that he would be ‘up here soon’ whenever I asked, yet at 7pm there was a new shift change and I still hadn’t seen Rocco at all that day. I immediately asked my new nurse to please see what the hell was the hold up. In came the charge nurse, a complete jerk by the name of Kevin, who chastised me that it was very unsafe for Rocco to come see me. After all, he didn’t even let his kids come to visit him at work because who knows what kind of diseases they could pick up! Um, thanks for making me feel even better. Now I get to worry that if I didn’t have a disease already, I could get one from just being in the ICU - fantastic. I wanted to tell this guy to shove it where the sun doesn’t shine as I am sure that his children couldn’t fit into an incubator for their protection and were more than 48 hours old, but I held my tongue and nicely told him that I had been promised for several hours that my son could in fact come to the ICU and could he please call down to the nursery to make sure that the new shift was aware of that promise. Within an hour Rocco finally came up to visit me but only for thirty minutes because the nurse couldn’t leave him with me and she needed to get back to the nursery to help out with the other babies.

At 11pm Scott finally left my room for the night, at my request, and went to the Mother and Baby room they were holding for me so he could get some much needed sleep. I assured him that I felt fine and he didn’t need to sit in an uncomfortable chair just to watch me sleep, which is exactly what I did shortly after he left. But before I knew it, I was jolted awake, gasping for air despite having an oxygen mask on. I struggled for several minutes to regain a normal breathing pattern, and once I did, I actually fell back asleep rather quickly because I hadn’t gotten much sleep in the last 48 hours. In no time at all though I once again woke up gasping for air. I told my nurse of my concerns when she came in and her advice was to just relax and to just breathe. Um, what do you think I was trying to do? She then proceeded to roll up a towel and place it under the oxygen bag to ‘help improve air flow’. I was terrified to fall asleep. This woman was completely disregarding my inability to breathe, which is kind of an essential function. I was all alone in the room so I feared that if I did fall back asleep I would eventually not wake up when I stopped breathing yet again. Pure exhaustion would keep taking over, despite my best efforts to stay awake, and I kept repeating the cycle of falling asleep and waking up gasping for air as if the wind had been knocked out of me throughout the night. Around 2am I woke up again, but this time was different. This time I truly was unable to catch my breath. Desperate for help, I pushed the call button on my bed’s remote control for my nurse to come in. Nothing happened. I then saw that there were two other call buttons on the side rails of my bed so I pushed those, and still nothing happened. My vision was starting to blur and I could feel myself starting to black out from lack of oxygen. I became frantic, thinking this was it, I was going to die from asphyxiation and there was nothing I could do to get help – I couldn’t scream out because I couldn’t breathe and none of my call buttons were working. Much to my relief, six nurses came running into my room seemingly out of nowhere. It turns out that if your oxygen saturation levels fall below 90 you are technically starting to have respiratory failure and mine had reached the 80s which set off some kind of alarm. The nurses raised the oxygen levels in my mask and kept giving me the helpful advice to ‘just breathe’. One idiot even threw out the suggestion that perhaps I had H1N1, the swine flu. Once my oxygen saturation levels went back up to a semi-normal level, they all left my room without even glancing back. They had zero concern for my obvious state of panic from having felt like I almost died of asphyxiation. Luckily the rush of adrenaline from that breathing episode was finally enough to keep me awake the rest of the night, so I didn’t have another breathing episode.

At 6am I started to have trouble breathing even though I was awake. Again, my call buttons weren’t working and I wasn't able to call out due to lack of breath, so I was relieved when I saw my nurse walk by my door and I waved desperately to get her attention. Surprised, she came in and said that Scott had just come by to check on me but she told him I was sleeping, would I like her to go get him? Completely bewildered, seeing as I knew I had not slept a wink the in past four hours, yet relieved to hear Scott was nearby, I nodded yes. She then proceeded to clean my room for ten minutes before going back out to the waiting room to see if he was still there. I could have killed her.

As soon as Scott appeared in the doorway I started crying tears of joy. I felt like I could finally relax and not worry about dying alone, as dramatic as that sounds. I struggled to tell him through my shortened breaths about the events of the night and how my call buttons didn’t work. Alarmed, he went out into the hallway to see if someone could address the call button issue. It turns out the only working call button in my room was on a separate remote control that was conveniently located on the floor behind my bed where I had no chance of seeing it, nor reaching it. No one had told me that the three buttons I could actually reach were not hooked up yet to the system.

My new nurse at 7am was the best nurse I had during my entire ICU stay. She got a Respiratory Specialist to come in and put me on a breathing bypass machine. It’s basically a huge mask that covers most of your face, suctions on to it tightly, and does all your breathing for you. It was nice to no longer struggle just to breathe, but having the machine breathe for me was slightly uncomfortable and also prevented me from talking and from being able to see as my eyeglasses couldn't fit over the huge mask. My only choice to communicate was to write down what I wanted to say. If you know me well, you know that I have what might be the world’s worst handwriting. Not being able to even see the paper I was writing on made it even worse. It was basically completely illegible, making communicating with anyone extremely frustrating.

The good news of the day was that Rocco was able to visit me twice, for a half an hour each time, which brightened my mood even though I couldn’t really see him that well without my glasses and I was unable to hold him for long because I was so weak. The bad news was that a new chest x-ray showed even more fluid in my lungs and a diagnosis of pneumonitis. Additionally, they had officially run out of places to draw blood from, so they had to insert a PICC line. A PICC line is basically a long slender, yet flexible tube that is inserted into a vein in your upper arm and is guided, with the help of an ultrasound machine, up into a larger vein near your heart. I still have a small purple scar where the PICC line was inserted on my right arm. This seriously was the best thing ever.  I was in so much pain every time they would try to prick me for blood work because they would have to hold down my hand or arm and in the process would press on at least four other bruises leftover from prior blood drawing attempts. They always had to dig around with the needle leaving me with a new bruise in the process. Now they could just draw blood easily from my PICC line, pain free.

Much to my terror, I had to spend yet another night in the ICU and Scott was not even given the choice to stay in my room with me as the new nurse was strict about visiting hours. Luckily, I had no breathing episodes that night and was able to get some real sleep.

The next morning’s chest x-ray showed marked improvement, I was put back on a regular breathing mask, and was finally transferred back to my Mother and Baby room only wearing a nasal cannula for oxygen. Rocco was officially discharged from the hospital that day at 1pm and was now technically just a visitor. The nurses were very nice and still let us use the bassinet, diapers, and formula that the hospital had on hand as we were not prepared for him to be discharged before I was.

The rest of the day and the next were rather uneventful. On Friday I was finally allowed to get out of bed and walk a couple laps around my room. I was shocked by how hard it was for me. I had a very unsteady gait and was easily out of breath just from that small amount of exertion. On Saturday I was finally discharged from the hospital at 4pm.

I’m happy to report that I have since made a full recovery. My latest blood work shows my liver is back to functioning 100% and no longer has elevated enzyme levels. My red blood cell counts are also back up. About a week after I was released from the hospital I was back to breathing normally with no more fluid in my lungs and completely cured of pneumonitis. My congestive heart failure also cleared up shortly afterwards on its own. Rocco never suffered any complications at all and is still a healthy and happy baby. I'm also relieved to note that he is great at breast feeding and has not been on formula since he was 2 weeks old - take that guilt-tripping hospital lactation consultant!

After some discussion with my doctor, it seems that I have a 25 to 30% chance of having the same exact complications with a future pregnancy/delivery. 2 out 3 or 3 out of 4 are not exactly overwhelmingly positive statistical probabilities that I won't have to go through all of that again. I truly am deeply afraid to have another child. Yet at the same time I never thought I would have only one child. Time will tell if Scott and I decide to risk having another, but in the meantime I’m just enjoying Rocco.

Here are some photos as a reward for having read all of that (unless you cheated and just scrolled down until you got to the photos - you know who you are!):

Rocco, minutes after he was born 

Our first family portrait


 Rocco coming to visit me on the first day I was in the ICU

Not the way I imagined we would be spending our time as a family in the hospital

 First photo taken after I was released from the ICU and reunited with Rocco in Mother and Baby

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