Saturday, May 26, 2012

Survivor Saturday: Tracy's Story

I ran 10 miles in honor of Tracy and her children today. Tracy had hypertension outside pregnancy and a family history. She developed PE post partum. This story highlights the lingering emotional effects of a high risk pregnancy and traumatic birth.

Tracy's Story

I am chronically hypertensive and have been most of my life.  That and the fact that my mother developed preeclampsia while pregnant with me and had to be induced made me "high risk" for preeclampsia.  I was already on medication for my high blood pressure when I became pregnant with my first child, and my pregnancy was overseen by my family practice doctor who consulted with a perinatologist who specializes in hypertension in pregnancy.  The perinatologist added more medications and, halfway through my pregnancy, as my blood pressure began to rise, he took over management of my pregnancy.  As my pregnancy progressed, I began to feel less and less in control of how things would develop.  At one appointment, I recall the doctor telling me that I would be having an epidural during my labour to help control my blood pressure.  I had been hoping to avoid an epidural.  But I was young, this was my first pregnancy and I didn't really have any other sources of information back then.  The internet was not nearly the resource of information 15 years ago as it is today! 

At around 28 weeks or so, as my blood pressure began to rise, the doctor had me coming in 3 to 4 times a week for fetal monitoring and to have my blood pressure checked.  At 31 weeks, while being monitored on the L&D ward, the nurse took my blood pressure and it had sky-rocketed.  The doctor admitted me and started to add and change medications while keeping me on continuous blood pressure monitoring and frequent fetal monitoring. I was prepared for the possibility that the baby might have to be delivered prematurely and, after a few days in hospital, when my blood pressure had appeared to stabilize, I was able to tour the NICU.  I was in hospital for a week when the doctor was satisfied that the medications were working and the baby was still doing well.  I was sent home on strict bed rest for the rest of the pregnancy and told that, if I made it that far, I would be induced at 37 weeks.  I'll never forget sitting in the doctor's office during a follow up appointment and watching as  Dr. E. pulled a little black notebook from his coat pocket and penciled in my baby's birthday. 

For five more weeks, I returned to the hospital 3 or 4 times a week for fetal monitoring and spent the rest of the time on bed rest.  Between late pregnancy, high blood pressure and weeks of bed rest, I found I could barely shower without completely wearing myself out.  I was growing crazy in the house but was too worn out even for guests when they visited.  A week before I was to be induced, I underwent a miserable amniocentisis to determine the baby's lung maturity. Then, I was told to report to L&D at 36 weeks and 5 days, to check in and prepare for being induced the next day. 

We checked into L&D at the appointed time and I was offered the suite with a whirl pool as it was available.  I turned it down, under the impression I wouldn't be able to use it, which I later regretted.  I mightn't have been able to use it, I don't know, but it might have helped if I could have.  A prostoglandin gel was applied to my cervix, DH and I had some dinner, watched some television and then went to sleep.  Along with my meds, I was given a sleeping pill which was lovely. Probably the most (only!) enjoyable part of my hospital stay! 

As expected, the prostoglandin gel had had little effect on my cervix by the next morning and a pitocin drip was started to get labour going.  The contractions weren't too intense for the next couple of hours and I recall DH and I just chatting with each other and staff that wandered in and out, watching the read out on the fetal monitor and watching for contractions. 

Most of the labour is a blur to me now as it was so long ago.  I recall the contractions becoming worse as the day progressed and trying a warm shower, which didn't help too much.  Finally, I got some pain relief (Demoral, I think?) which really didn't help much at all.  I remember feeling like my entire abdomen was on fire and, as I was trapped in bed on the monitor, I couldn't do much about it.  At one point, the baby's heart rate dipped very low and they put me on oxygen for the rest of the labour.  An epidural was ordered but I had to wait for what seemed like an eternity before the anesthesiologist finally came.  The epidural managed to numb all of my pain except for the lower right quadrant, which continued to feel as if it were on fire.  I was exhausted and, once the epidural had kicked in (well, mostly) I started to drift in and out of sleep. 

At around 4 AM I was told it was time to push.  I remember feeling completely confused.  Push how? Where?  With what?  I couldn't feel anything and had no idea what I was supposed to be pushing or what to push with.  It was bizarre.  Just before the pushing began, however, the epidural had begun to wear off and the pain had started return. At first, I just did what I thought they were telling me to do with no idea whatsoever if I was actually doing anything.  I couldn't feel it.  But as the feeling came back, the pushing started to feel almost involuntary.  I remember everyone counting and instructing me when to push and how long.  I couldn't push for as long as they wanted.  It felt all wrong and I thought I was doing it all wrong because I didn't know what I was doing. 

After nearly 39 minutes of pushing, the baby was no longer descending and they noticed that every time I pushed, her heart rate dropped down way too low.  They told me to stop pushing and I recall the room suddenly filling with people.  No one told me anything was wrong but I knew something was happening when the room suddenly filled like that.  From what I could later tell, the cord was wrapped too tightly around the baby's neck to allow her to descend any further and every time I pushed, the circulation in the umbilical cord was cut off which caused her heart rate to plummet.  An episiotomy was cut and forceps were brought out.  I was already in horrible pain and the pain of the forcep delivery was indescribable.  The baby's head was delivered, the cord clamped and cut, and then the rest of her was born.  I didn't get to see her face. The first glimpse I had of her was of two tiny purple buns as they whisked her away to a warming table to examine her.  I don't think she cried right away.  They were concerned with her breathing and told us they would be taking her to NICU for observation.  DH told them he'd like for me to see her first before they took her away and they wrapped her up and put her in my arms.  I was able to hold her for a few minutes, then she was taken to NICU. I sent DH with her.

After a period of time, Tory was brought back from NICU by a nurse who announced "there's nothing wrong with this baby, she doesn't need to be in NICU!" Another nurse then bathed her and dressed her in the little white preemie outfit we'd brought with us to the hospital.  Shortly after, a photographer came in to take her first portrait and then we were moved to the maternity ward. 

We were released to go home on Tuesday.  I was on a number of drugs for my blood pressure and lasix for the water retention (which did nothing to help establish my milk supply, sadly) and we were told to have Tory's bilirubin levels checked at Children's hospital every other day. We took Tory to have her bilirubin levels checked on Wednesday and Thursday and on Friday morning, a nurse came to our home to set up a special bili light unit which Tory was to stay under for the next day and a half or so.  We had to leave her under the lights except to feed her and she was also wrapped in a little "glow worn" vest around her middle.  Breastfeeding was not going well, both DH and I were overwhelmed and exhausted, we were supplementing with bottles of formula and the heat was oppressive.  I was feeling increasingly worse, but put it down to the heat and exhaustion. 

On Sunday, Tory was finished with the bili lights and we gave her a bath.  We'd been in the house all week and we decided to go shopping.  We pulled ourselves together, packed Tory up and headed to the local mall.  We'd been walking around in a drugstore for a little while when I started feeling very strange. It's hard to explain, but I just didn't feel right.  We went home and DH checked my blood pressure.  It had spiked really high.  We waited a bit to see if it came back down with some rest, but it didn't.  DH called the hospital and we were told to come in. 

At the hospital, my blood pressure was still very high and they did some labs and determined I had developed preeclampsia.  I was admitted and started on mag sulfate.  I hated the mag. It made me feel like I was going to come right out of my skin.  I felt completely out of it and so foggy I couldn't even carry on a conversation, but my body was so restless and uncomfortable, I thought I didn't know what to do with myself.  I started to panic that Tory would be hungry by now but I just couldn't nurse her. I couldn't even hold her.  I watched as DH gave her a bottle and felt awful. She was getting too many bottles and too much formula and I felt so defeated.  I couldn't stand the restlessness anymore and finally complained. I was given something to help with the restlessness, perhaps a sedative, I don't remember anymore, and it helped.  I think I slept.  It was Sunday evening, one week to the day since Tory was born, and here I was back in the hospital. I spent the first few days in and out of it, I think because I was just so exhausted.  Tory stayed with me and DH was also able to stay and care for her. I felt resentful that I had developed preeclampsia in spite of the fact that Tory's birth had been induced to avoid this very thing.  I wondered if we could have just let her birth come spontaneously, since the induction hadn't prevented preeclampsia anyway.  Later, someone remarked "Wow, it's a good thing you were induced before the preeclampsia developed!"  I hadn't thought of it that way.  But they were right.  At least, my preeclampsia didn't involve my baby. 

I was in hospital for a week and sent home with new medications.  In the weeks and months that followed, DH returned to work and I continued to struggle to breastfeed Tory and get sleep where I could. I was still exhausted and I was very disappointed how Tory's birth and first weeks had unfolded.  I started to lose interest in everything and had decided I was an awful mother. I told DH I wanted him to stay home and care for Tory and I would go to work.  When I saw pregnant women, I honestly pitied them.  I swore we would never have another child and was so convinced of this that I felt guilty and sorry for Tory that she would be raised an only child. I became so miserable that I felt like I was moving through a thick fog and only looked forward to when Tory was someday start college and all this struggle to breastfeed, the sleepless nights, and the guilt and disappointment over her birth would be far behind me.  When Tory was about 3 months old, I was diagnosed with severe PPD and started medication and therapy.  It made all the difference and I started to feel like a human being again. Even happy.  Things improved steadily after that.

My experience with preeclampsia has put a cloud of fear over each of my subsequent pregnancies.  I've tried baby aspirin therapy, vitamin C and E therapy, the Brewer diet and I can't remember what else.  I've had problems with my blood pressure with each of my pregnancies, but thankfully have not had a repeat of preeclampsia. And, of course, I worry for when my daughters become pregnant some day. I hope, by that time, we will understand preeclampsia better and be able to prevent it completely.

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