Thursday, May 17, 2012

My Story Part 3

The night before giving birth, 35+5 weeks
Since my second round of PE was milder and later than the first, I felt no hesitation in trying for a third child. I was confident I could manage another pregnancy as far as PE was concerned, and I was determined to manage the birth better as well. After my disastrous second birth "burned down", I was prepared with a fire extinguisher: lots of education on birth interventions, risks and benefits, the research supporting them (or not), and knowing under what circumstances I would and would not accept them. I was even looking into the possibility of a home birth. I'm not sure I would have qualified given my complicated history and very high risk status, but before I had a chance to interview any midwives, I discovered (in the ER on Christmas Eve, which is a long story itself) there were not one but TWO heartbeats!

My risk of PE was already high having had it twice before, but having two placentas and two babies meant even higher risk. I knew my complicated history plus twins equaled another hospital birth. I got recommendations for natural birth-friendly doctors in my area and selected a new practice with two OBs and a CNM. I was to see the CNM for most of my prenatal care, and both she and an OB would attend my birth. I also consulted with a MFM (maternal-fetal medicine specialist) an hour away at the hospital I would be transferred to if necessary.

One of the two doctors was randomly assigned as my primary. We didn't get along. At my 20 week appointment, she wanted to talk about getting my c-section on the schedule. I told her I wouldn't consent to a section without legitimate medical need, and there was no need yet. She said I had to have an epidural during labor. I said I wouldn't consent to that either. She then said she would require me to have the epidural placed even if I had no meds in it so it would be ready when (not if) a section became necessary. So much for the natural-friendly doctor, the best of both worlds, I had been looking for.

I really debated about switching practices even though the CNM and I had really clicked. Luckily for me, the two OBs had a falling out. The first one left the practice before my next appointment, and I ended up with the other who was much more natural-friendly and respectful of patient rights.
Monkey and Sassy
Throughout my pregnancy, I took low dose aspirin, calcium, vitamin D, and extra folic acid in addition to the standard prenatal vitamins. There is varying research on each of these as to whether they can help prevent or slow PE, but I figured it couldn't hurt. Obviously, none of them prevented it, but it's still possible one or more helped slow it. I also credit the low-dose aspirin for making the difference between my growth restricted singletons and my normal sized twins.

I asked to be tested for underlying disorders that could raise my risk of PE, something that probably should have been done earlier given my history. That's when we found I have a blood clotting mutation, MTHFR a1298c. The test run for autoimmune diseases didn’t find anything, but it also didn't rule out the possibility. It would test positive if I were actively having an attack but not if I were in remission between attacks. Based on current and past symptoms along with family history, I'm pretty sure I have primary Raynaud's Disease. Both of these raise my risk and likely explain why I can't carry a pregnancy to term.

I had tracked my pressures religiously second time around. This time I checked obsessively, at least 4 times a day and any time I felt off. At 22 weeks, I had a spike that sent me to L&D for monitoring. I was diagnosed with PIH at that time, since I wasn't spilling protein yet. I was devastated. I knew the average time from diagnosis to delivery was 2 weeks, and in both of my previous births I delivered within 48 hours. I really thought the best case scenario would be two micro preemies spending months in the NICU. Praise Jesus, I was very wrong about that.

I started partial bedrest--three hour-long periods lying on my left side throughout the day. Bedrest is controversial, and there isn't a lot of research supporting it, but I figured it couldn't hurt. After all, blood pressure is lower while resting, and since high pressure can damage placental arteries, keeping it low could theoretically slow the progression of PE.

I had labile (fluctuating) pressures for the next two weeks and was put on blood pressure meds at 24 weeks. We did weekly 24-hour urine tests from then until it reached 1000mg of protein, at which point it didn't really matter how much higher it got. I officially crossed the line into mild PE at 31 weeks. I went to full bedrest at that point, only up to shower and get something to eat. Bedrest with two children was difficult, but we made it work.

We managed to get two rounds of steroid shots in to help the twins' lungs mature. At 33 weeks, I started having visual disturbances. I was hospitalized for the duration of the pregnancy. When I was admitted, I was scheduled to be transferred to another hospital with a level 3 NICU, with plans to induce the following morning, but after stabilizing overnight, my OB decided to keep me local and try to buy more time. My local hospital would keep me at 34 weeks, so we scheduled the induction for that time. Then the Pediatrician said she wasn't comfortable taking on 34-weekers, and could we push for 35 weeks? So we rescheduled. Then the MFM we had been consulting with said, as long as I was still stable, why not push for 36 weeks? But everyone, OB, Ped, MFM, and most importantly Papa Runner and I agreed 36 weeks was as far as it would go.

If you want more details of my birth story, you can find them here and here. Suffice to say, I am very proud of how I advocated for myself. Even though some things happened that shouldn't have, I stood up for myself and had a wonderful, empowering birth. Both twins were born vaginally, one without pain meds, and I spent a wonderful hour in recovery nursing and bonding with my beautiful daughter and son, neither of whom were growth restricted.

But my PE story doesn't end there. Once I had been moved to a post partum room, I started throwing up. I was given a dose of Zofran and something else, but neither helped. A nurse came in to check my vitals. My BP was much higher than it had been throughout my hospitalization. When she checked my reflexes, I kicked so hard the whole bed shook. We locked eyes for a second, and I knew things were very bad.

She went out to get a second nurse, and by the time she came back I was unresponsive. However, I was not unconscious. I have very clear memories of the second nurse asking me questions (Do you know where you are? What day is it?) but being unable to respond. She also checked my vitals and then called in a third nurse who did the same. One of them got on the phone with my OB, who diagnosed me with severe post partum PE. He ordered magnesium sulfate (mag) to prevent seizures. They moved my bed back down the hall to L&D so I'd be closer to the nurses' station for monitoring. On the way, I heard one of them say I'd wake up in another room with no idea how I got there. I lost consciousness completely before we made it to the other room.

My next memory is of waking up in the middle of the night in a full blown, mag-induced hallucination/panic attack. This med is life-saving but NASTY. Again, I have very clear memories of the physical and emotional sensations I experienced, but I cannot put them into words. I couldn't call for help, so I don't know if the nurses were even aware I had been awake. I don't know how long this lasted, five minutes? An hour? But I eventually lost consciousness again.
Five Survivors
I finally awoke again in my right mind the following afternoon, 26 hours after I had first gotten sick and 28 hours after giving birth. I was very weak but finally turning around. I was able to see my babies and even nurse them for short times in the side-lying position, still too sick to sit up. By the next day, I was well enough to be taken off the mag and to get up for short periods. We were released the following day. By the end of the first week, my blood pressure was back to normal without meds.
I was able to carry my twins an amazing 14 weeks after diagnosis, and we pushed the pregnancy as far as we possibly could. I am so grateful we all survived. But after nearly dying, my husband and I were scared enough to decide we couldn't risk another pregnancy. My PE story ends here, at least as a patient. It still continues as an advocate.

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