Maternal mortality rates are rising in the United States. NPR did several articles on this subject this summer. Why is it happening? What can we do about it? Most articles you read on this subject involve blaming the woman. Women are too old, too fat, too risky to be birthing babies. It's definitely our fault. Not the healthcare system that is so fragmented that every doctor has a different opinion on how to best treat the patient. Or that a lot of medicine is reactive instead of proactive. Or that once the baby is born, all attention is switched to the baby, leaving the mother almost solely responsible for voicing any concerns. At least this was my reality. I'll start at the beginning. Just as a word of warning, this is probably going to get graphic, so strap in or close the page. Don't say I didn't warn you.
I'm an only child, and always wanted to have a sibling. As L turned 2, we started to think about a sibling for him. That was always the plan, 2 kids and a dog (dog still pending). It took us a few months, but by mid-December, I was pregnant, and we were thrilled. Always the scared-thrilled of early pregnancy. After my experience with hyperemesis with L, I decided to enjoy as much of Christmas as I could before the vomiting set in. I was glad I made the most of it. By January 1, I was sick again. A familiar sick, but frustrating nonetheless. By mid-January, I could no longer keep down anything. I went to the OB who set me up with home healthcare for home IV fluids. I was placed on short term disability. About a week after starting fluids, I mentioned to the home health nurse that I was getting increasing amounts of pain in my shoulder. She told me to go to the ER immediately. Turns out I have developed a blood clot at my IV site. The IV came out and I was doing the best I could on oral liquids. The same day I was at the ER, L came down with the Norovirus. Thankfully, my mom was in town to help, but my OB told me to please keep my distance from L. I came down with Norovirus the week after. Norovirus and hyperemesis is not a good combination, and 2 days after virus onset, I couldn't walk due to weakness and dehydration. I was admitted to the hospital for 24 hours of fluid treatments and every anti-nausea drug they could give a pregnant woman to try and get my vomiting under control. And just in case anyone is wondering, no crackers and ginger ale didn't work. Nor did Zofran. The only thing that provided moderate relief was getting IV pherghan and reglan at the same time, both category C drugs. I tried to stick with Diclegis for the most part. Around 15 weeks, my OB mentioned that I should do a glucose tolerance test due to having gestational diabetes last pregnancy. There was no way my stomach could handle that, so I asked if I could monitor at home and report my numbers. Within a week, I called back saying that my numbers were not good, and I was diagnosed with GD. The good news is that my A1C came back pretty low (5.4), which I guess makes sense as I wasn't really eating much the first few months of pregnancy. I was okay with the GD. I expected it, and did my best with trying to balance the GD and the ever-present nausea. Throughout all of this, the baby was thankfully measuring perfectly. Which was a blessing. Around this time, I finally got an answer for why I got a blood clot. I had blood clotting issue (Protein C activity level deficiency). It's still somewhat unclear to me where it came from, but I will get retested in a few weeks. For the remainder of my pregnancy, I was put on Lovenox, an injection. The fun continued.
After all of these issues kind of settled, I was doing okay. Of course, I was then heading into my third trimester, which is relatively uncomfortable to begin with. I started getting a lot of anxiety. More than normal. I couldn't shake this idea that something bad was going to happen. I was terrified of labor, even though I had been through it before. I started seeing a counselor for the anxiety. I also decided I didn't want an epidural because I didn't want any other risks to labor. We hired a doula. The doula was one of the best decisions we've made. I was trying really hard to mitigate all of these fears I had. I was vigilant with my GD numbers. I didn't want to be induced. The baby dropped and my hips were killing me. But it was okay. I was okay with waiting. At my 35 week appointment, I tested GBS+. This is important. During my 38 week appointment, my blood pressure was a little high, but labs came back okay. During my 39 week appointment, my blood pressure was just plain high, and I was diagnosed with gestational hypertension. My GD numbers were also getting higher for no reason, both of which signaled to my OB that my placenta was starting to fail. She wanted to induce me. Soon. I cried. I cried and cried. I didn't want to go through labor again, and most of all, I didn't want to be induced. I wanted spontaneous labor. My OB called me again. She said it was of course my decision, but she wanted to be very clear that I was risking my baby and myself by waiting. I agreed to the induction.
On Thursday morning, Cervadil was placed. With L, that sent me into active labor within a few hours. This time... nothing. I had a few contractions and went from 1 cm to 1.5 cm. After discussing our options, we decided to try a half dose of Cytotec, which was placed at 8 pm. J and I tried to get some rest. Around 9:30 pm, I started getting regular contractions, but nothing too bad. I stayed in bed and just breathed through them. By 10-10:30, I wanted to be up. I started sitting on the birth ball, which woke up J. We decided to walk the halls a bit. The contractions were ramping up in intensity, but short. 30 seconds long at around 2-3 minute spacing. J would hold and sway me through the contraction and then we would keep walking. Around 11:15 pm, I got a pretty painful contraction and decided to call in the doula, C. C arrived around midnight. I was on the birth ball with J applying counter-pressure to my hips during contractions. The nurse also came back in around that time. She had no idea I had been in labor, so I get hooked back up to the monitors and she attempts a cervical check. This did not go super well, and I started screaming, "STOP, STOP, STOP!" at the top of my lungs. So, we had no idea on progress at that point. The monitors were also not registering my contractions. When I got up from the bed, I had lost my mucus plug and had my bloody show. From midnight to 1 am, things started getting really intense for me. My doula applied acupressure, which helped a lot, but the contractions were starting to get so painful and so close together that I was not coping well. I started feeling flu-like. I asked for the epidural. My doula suggested getting on the bed to try and relax a bit and then make a decision. J says that he was getting scared at this point because of how much pain I was in. I stood up, and my water broke. My water broke at almost the end with L, so that signaled to me that things were happening. The first contraction after my water broke was absolutely horrible. I think I just was screaming, "I can't do this! I need pain management. Please!" I also tried to bite C. C had my hand and was so encouraging. The next contraction, more fluid rushed out and I started involuntarily pushing. I looked at C and said, "I'm pushing and I can't stop myself." She very calmly looked at J and said, "we need the nurse. now." Within a few minutes (I had another pushing contraction during this), a whole team was assembled in my room. I heard someone ask, "Is she complete?" and my nurse replied, "his head is right there." I think I pushed 2 more times after this and he was born. Delivered by the hospitalist. They said it was precipitous labor. But I was in labor the whole time at the hospital. It was only surprising because the hospital was relying on cervical checks rather than looking at me. Right after he was born, I looked at the nurse and said, "I didn't get the antibiotics for GBS." The team replied, "Oh, don't worry. We will check the baby." Oh, okay. The baby checked out well. 7 pounds, 3 oz. 20.5 inches long. C hung out with us. The baby latched right away. We got to our post-partum room around 5 am and slept for a bit.
We were discharged on Sunday and started to get settled in at home. Everyone was so happy. The end of that rough pregnancy. But I really didn't feel out of the woods yet. On Tuesday afternoon, I started feeling some pain that seemed out of place, but didn't think much of it. Around midnight, I started getting lower abdominal pain. And I was cold, like getting chills. I slept for a bit between feedings. At 6 am, I got up to feed the baby. I got him fed while telling J that we needed to go to the ER. I felt really bad. I could barely walk and was shivering uncontrollably. We got to the ER, and I was crying from the pain. They whisked me back and said my vitals were consistent with sepsis. They worked quickly at this point. 2 IV lines, chest x-ray, ultrasound, catheter (ouch), labs, etc. IV antibiotics were started immediately. My fever wasn't responding to medications. My OB comes in and says this is at least a 48 hour hospital stay. Wait, what? Until that point, I didn't realize how serious things were. I started sobbing. I didn't want to be away from the kids, especially the baby. I asked for a breast pump. Over the next 4 days, the pump and I would become well-acquainted. Pumping while in pain is no fun. But I was determined to keep breastfeeding. J and my dad would end up serving as the milkman to bring my milk home, which I was told was safe for baby. I was eventually put on the telemetry unit, which is another way of saying, "good luck ever resting." It was a step down from the ICU, so basically continuous monitoring, bed alarms and people helping you in the bathroom. It was also shared rooms. My roommate was nice enough but had a lot of issues that basically kept a stream of people constantly in our room. I also found it funny that she would be casually talking on the phone and watching TV, with a "9/10" pain. Whereas, it took me a good 24 hours to get my pain manageable, so I was basically lying in bed moaning, but would report my pain as a 5 or 6, and refuse narcotics (I don't like them). Unmedicated labor is my 10/10 pain now and nothing else has even come close. Eventually my labs come back. Definitely sepsis that spread from the uterus. Looks like strep. Strep? Interesting. My blood pressure got dangerously low that night, so I was given a lot of IV fluids. The next day, they decide I'm stable enough to go to general. Yay! I actually get some rest in general, and am starting to feel better. My OB comes in and tells me that it's looking like Group Beta Strep. The thing I never got treated for in labor. "But treatment in labor is always for the baby. This is so, so rare." But it happened. And I was suffering because of it. I was missing my baby's first week. I hadn't seen L in forever. It was hard. On Friday morning, I was discharged with oral antibiotics. Before discharge, I was complaining that I was having trouble breathing and my chest felt weird. I was discharged anyway. After some calls to my cardiologist and lots of baby cuddles, we returned to the ER Friday evening. My blood pressure was now in the 150-160/90-ish range and I felt bad again. Pre-eclampsia was ruled out quickly. However, the cardiologist team wouldn't be in until the next day so I was re-admitted. Ugh. At least this time they gave me a fridge for the breastmilk. Turns out they overloaded my IV when my blood pressure was low. I was given a diuretic and peed. A lot. The echocardiogram looked good, so I was finally really discharged on Saturday.
The last week has been a blur. There has been some nipple confusion and resistance, but I think breastfeeding is back on track. I'm honestly just glad to be alive, and grateful that the GBS was sensitive to penicillin. I'm trying to make sense of it all still. I question if this had to happen, and why I seemed to get the short end of the deal this whole pregnancy. But mostly, I'm grateful to be on the other side. I'm praying that it's over. I pray every day that God will get me through this without anything else. I'm taking a bazillion vitamins and pro-biotics. And taking it very slowly. I'm praying that someday, I will be strong again. But, we named this baby, Joshua, The Lord is my Salvation. And that's what I've been hanging onto every day. I'm trying not to focus on what could have happened. And ladies, if something doesn't feel right post-partum, please seek help. By the time I got treatment, I was pretty close to going into septic shock. I think it might take me a little to get over the trauma of what happened. But for today, I am just grateful for my boys, my family, and our amazing support system who has prayed over us and taken care of things at home when I couldn't. Love you all.
