I consider myself both a preeclampsia awareness advocate and a natural birth advocate. My first story explains how I came to the first role, and this story explains the second.
Having had severe PE at 35 weeks put my risk of recurrence at 40%. I knew that going into the pregnancy, but I also knew that if it did happen it would likely be later and milder. I also knew what to look for and was ready to advocate for myself and my baby to get the care we needed.
I started out my third pregnancy with a different doctor, one who I was confident would listen to me and monitor me carefully. I had wanted a natural childbirth the first time, but that had not been possible due to how sick I was. I wanted this birth to be different, but of course I would accept any necessary intervention if medical issues arose.
I religiously logged my blood pressures with a home cuff. As I entered the third trimester, I was seen more often than the average mother-to-be. At 32 weeks, I started showing the same warning signs as before: episodes of racing heartbeat and shortness of breath along with swelling. I started doing weekly 24-hour urine tests and blood work, and we watched the protein levels slowly creep up. I had a few episodes of high blood pressure that sent me to L&D, but it came back down. Labile pressures like this are not unusual as PE progresses, and we knew it was a matter of time before it stayed up.
At 36 weeks 5 days, I crossed the "magic line" and officially became diagnostic for mild PE. I talked things over with my doctor, and we decided since I was so close to term, it was best to induce before I became as sick as before. I spent 24 hours on strict bedrest and headed to the hospital the evening of 36+6 for an overnight induction.
I have no regrets about the decision to induce when we did. I have a lot of regrets about what happened next. You see, I trusted my doctor and the hospital staff to do what was best for me and for my baby. While I had a general philosophy that "natural is best," I hadn't done much research into natural birth. That's what I was paying my doctor for.
Doctors are supposed to get informed consent before performing any test, treatment, or procedure, but I was never informed of the risks. I didn't know the medication she had selected for my induction, Cytotec, has a black box warning stating that it should never be used in pregnant women, and that the company that makes it has put out numerous warnings begging doctors to stop using it for inductions. I didn't know that an overdose could cause hypercontractions that could put my baby in distress or even cause my uterus to rupture. If I had known, I would have chosen a different method of induction.
Remember yesterday's post about observer's bias? My doctor thought it was acceptable to use this dangerous drug because lots of doctors use it, it's usually fine if managed correctly, and if the risks become reality she'll just do a c-section, so what's the big deal? It may not have been a big deal to her, but it was a HUGE deal to me.
The next factor in this disastrous birth was the nurse assigned to me. I didn't know it at the time, but she told me later she was a substitute nurse who did not feel comfortable working in L&D. She had specifically requested me as a patient because nothing exciting was supposed to happen on her shift: the plan had been Cytotec overnight, pitocin in the morning (after she left), and baby by afternoon.
I had the first dose of Cytotec at 6:00 and the second at 10:00. By midnight I was in labor. The nurse came in a few times to fiddle with the contraction monitor. I finally asked her what she was doing, and she said, "This monitor must be faulty. It's picking up random movements whenever you roll over or sit up."
I said, "Those aren't random movements, they're contractions. I've been in labor for a while."
She said, "Don't be ridiculous, you couldn't possibly be in labor. You haven't had any pitocin yet." Then she pointed at a new peak on the strip and said, "See, you're tensing your abs right now!"
I hissed, "No, it's a contraction!"
And she reset the monitor at the height of the contraction so no further peaks showed up. That right there? Observer's bias, and a very dangerous one, no less.
At 2:00, the nurse came in to give me my final dose of Cytotec. I asked if it was really necessary since I was already in labor. She said first, I wasn't in labor, I may be having contractions but they weren't even showing up on the monitor (which she had intentionally set wrong), and second, the doctor had ordered three doses so she had to give me three doses, and she wasn't going to call her at 2 in the morning to ask. And like a good little patient, I trusted she knew what she was doing and let her insert the pill.
By 4:30, my labor was way out of control. I called Papa Runner, who had gone home to get a good night's rest before the excitement started, and told him he had to get here NOW or he was going to miss it. He got to the hospital at 5:30, took one look at me, and ran out to get the nurse. This was the first time she realized I was actually in labor. At that point I was in pretty bad shape. You've heard of double peak contractions? I had a multi-peak contraction that lasted a full 45 minutes. I consider myself very lucky my uterus didn't rupture right there.
And her second occurence of observer's bias showed up here. You see, I hadn't had an epidural yet, and laboring women HAVE to have an epidural. So instead of calling my doctor like a rational person, she paged the anesthesiologist. It took him almost an hour to show up, and in the mean time she injected two doses of Nubain into my IV without my knowledge or consent. Now, I was woefully uninformed about birth interventions, but I did know that narcotics should NEVER be given if birth is imminent because they can cause breathing and sucking issues in the baby. If I had known what she was giving me, I would have violently refused it, but I was never given the opportunity to refuse.
I started pushing spontaneously at 6:30. The nurse had a full blown panic attack, screamed at me to stop, and ran from the room screaming for help.
The anesthesiologist showed up at 6:45 and said, "Ok, it's time for your epidural." I used some words I don't usually use and told him it was way too late since I was already pushing, and besides, I hadn't asked for an epidural anyway.
The nurse screamed at him that he had to make me take something, then screamed at Papa Runner that he had to make me take something. I finally agreed to a spinal just to shut her up. The spinal was in place at 7:00, and my doctor showed up at 7:01. No joke. Now I had to push without being able to feel anything.
My baby got stuck on my pelvis. I had a strong instinct to roll over onto my hands and knees, and I have no doubt she would have easily been born if I had been able to do so. Instead, the doctor cut an episiotomy that then tore. It still gives me trouble today nearly six years later.
And my baby had trouble breathing and sucking due to the contraindicated medication illegally given without my consent.
My first birth taught me to advocate for proper care in pregnancy. My second taught me to do the same in birth. While preeclampsia was what led to my induction, and it did cause this baby to be mildly growth restricted as well, ultimately it wasn't PE that put my baby and me in danger. It was the incompetence of the hospital staff and the three medications (Cytotec, Nubain, and a coerced spinal) given without informed consent.