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You down with SPD? Yeah, you know me!

August 23, 2012
baby, cesarean, doctors, postpartum, recovery
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First things first: I’m REALLY sorry for that title. Really.

A little backstory: I was released from the hospital 5 days after FSR was born (more back story: the baby’s nickname is Flopsy Space Rocket aka FSR). I had a very difficult recovery in part because of the loooong labor before the cesarean. After returning home, I had complications with my incision. It appeared to be healing beautifully from the outside, but there was a large, painful lump on the right side. A couple of days after we got home, the reason for that large, painful lump made itself known when my incision opened and started draining blood and pus. We went back to Labor & Delivery where they opened the incision back up to allow the abscess underneath to drain. Lump and pain, gone! Unfortunately it wasn’t as simple as that though – that was the beginning of irrigating and packing my wound with gauze tape two times a day, and returning to the hospital one to three times a week. The hospital visits continued until 2 weeks ago and I am still irrigating and packing two times a day.

I had my postpartum check-up yesterday at just over 7 weeks postpartum. Those of you familiar with the postpartum checkup know that it’s supposed to be done at 6 weeks. When you’re returning to the hospital anywhere from one to three times a week, they’re not really sticklers for you doing that checkup on time. Ha.

I was looking forward to this visit. This is the Big One. It’s when you get released for normal people stuff like sex, exercise, and lifting more than ten pounds. It’s when they say, “Ok! Go back to work! Go live life! Be normal!” Since I seem to excel at doing everything the hard way, I have four more weeks of disability and only lifting ten pounds. Four. More. Weeks. I’m only cleared for sex and “normal daily activity” but not work. The sex part is out though, as I still have a hole in my abdomen leaking blood and other fluids. Yeah, no. No sex.

I was also diagnosed with Symphysis Pubis Dysfunction, or SPD. SPD is fancy-talk that means my pelvis and hips are all loose and janky and moving about in bad ways resulting in instability and misalignment of my pubic bone, hips, lower back, and SI joints. Sometimes it feels like things are floating around and getting ready to pop out of place. Sometimes my pubic bone feels like it’s grinding together at the pubic symphysis. On a normal day, my back hurts so much that it spasms. On an active day, I get so sore that it takes me days to recover. The first day that I pushed myself, I had to waddle/limp out of Target. Getting up hurts. Sitting down hurts. Walking upstairs hurts. When I lay on my side, it feels like my bones are moving. Basically, life kind of sucks now when it requires movement…and my very particular baby really likes when I move. End result: my back is always tight and sometimes spasming, my pelvis feels like it’s being pried apart by a crowbar, and my sacrum and coccyx feel permanently and deeply bruised.

Instead of making room for the treadmill and re-inflating my reflex bag, I’m shopping for a brace to relieve my pelvic girdle pain. The SPD pain has been going on for awhile. It seems to be getting worse as I get more active, so I’m trying to slow down again. Friends, this is a large part of why I’ve been turning down invitations lately or why I’ve been wishy-washy about doing things. I want to do things. I feel bad saying no, because I don’t want to say no and because I feel like my friends are starting to get frustrated and impatient with me. I want to feel like a normal person again and take time away from my family to be with my friends. I want to take my baby to the park for walks and picnics and fresh air. I can’t though, because it hurts really bad and it sets me back too much.

I’m also still anemic, though not nearly as anemic as I was. I have elevated something or other, too – something dealing with liver function – so now I have to follow up with my primary care doctor for a physical and more labs.

My vagina, on the other hand, seems to be made of rainbows and magic. It tore while I was pushing but the doctor said that it healed so well that you’d never know the baby almost came out of there. So, hooray to my vagina I guess? If only the rest of me healed that well!

So, yeah. That’s where things are right now. Here’s to hoping things get better, quickly. Except my vagina. ’cause it’s already the best.

Birth Story Part 3: The Arrival

August 2, 2012
baby, cesarean, doctors, home birth, labor
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In the OR, I got my third epidural. Well, sort of. The first two failed but I didn’t have to get it placed a third time, thankfully. It felt like a bandaid covering half my back had been ripped off when I had the first removed. I was happy to not go through that again. For the third try, they moved the catheter around to see if repositioning it would make the distribution more even and then hooked me up to a stronger drug. Relying on that after two failed attempts was terrifying. I imagined them cutting, and feeling it all. I expressed my concerns to the anesthesiologists (there were two for some reason) and they did multiple tests to show me how little I could feel and assured me all would be fine.

At 2am Monday morning, surgery started. The baby’s head was stuck in the birth canal. They had to make the incision longer and lower than they normally would. One doctor reached into the birth canal and pushed the baby’s head up while another doctor pulled the baby out through my uterus.

Shortly before they pulled the baby out, my third epidural failed and I regained feeling. I could feel them pushing and pulling the baby out and then moving and checking my organs – not the pushing, pulling, and pressure they told me I would feel. I felt a full range of sensations and pain but I was hallucinating and dissociated and couldn’t fully express what was happening. As soon as the cord was cut, I was given fentanyl and morphine but before they kicked in, I felt every stitch as they started sewing me up.

By the time the baby was out, I was uncontrollably shaking and disoriented. The Daddy and I had agreed that if we had to do a c-section, he’d go with the baby and do skin-to-skin while I was sewn up. I needed him though, so he stayed and the baby was taken away. I still feel guilty about the time she was away from both of her parents so early in her life. I feel fortunate that he was able to carry her over to me first. It wasn’t the moment we anticipated but we had our first moment as a family. The Daddy told me all about her as I looked on – her full head of hair and big, alert blue eyes darting around the room. I’m glad that he did – I was too disoriented to focus on those things myself. I wasn’t even aware that she’d been born. Without him there taking me through the experience, I would have completely missed seeing my newborn baby in front of me.

Our daughter was born at 2:28am on July 2nd. After all of the worry she caused during labor, she came out looking like nothing had ever happened. The doctors don’t know why she was having so much trouble. They suspect it might have been a cord issue – she had some red marks that made it look like she’d been wrapped in her cord kind of like a seat belt. The doctor thinks her cord may have been pulling back on her and tightening on every push. Since my water broke, there was no cushion and she may have pressed on it when I changed positions.

Now that I know her inside and outside of the womb, I think it’s simply a matter of her being a sensitive little person. She got hiccups when I drank cold water. She hated ultrasounds and dopplers and would spend exams squirming away, making it difficult to get her heart rate or get pictures needed for screening. She squirmed and kicked at loud noises. Now that she’s out, she always wants to be held and cuddled and is constantly alert to light and noise. She has busy little eyes and busy little hands, exploring the world around her. She’s my sensitive little girl, inside and out, and that made labor difficult for her. Ultimately the physical part of birth was about her, not me, and she taught me that in a very dramatic way.

Long story short: I had a baby, she is great, and now we’re home. Now on to the recovery.

Give me drugs! Birth Story: Part 2

July 27, 2012
baby, cesarean, doctors, home birth, labor
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We pulled up to the hospital at 6:30am Sunday morning. The Daddy threw a “WOMAN IN LABOR” sign on the dash and ran for a wheelchair. We made our way up to the fifteenth floor. Contractions in the hallway, contractions in the elevator. At least the hospital was mostly empty at that hour.

He wheeled me to the nurses station and as he was checking us in, I had a powerful contraction. I was still feeling it mostly in my back and rectum and sitting in the wheelchair was too painful. I didn’t wait to get checked in – I leapt out of the wheelchair toward waiting nurses and growled, “Get me in a room and give me drugs” and stormed down the hall, blood and fluid running down my legs, in the direction of open doors. The nurses raced ahead, led me to the delivery room and called the anesthesiologist.

Initial drama aside, the home-to-hospital transfer was flawless. Our midwife beat us there and was waiting with our records. I was in a room before The Daddy finished checking in and I had fentanyl administered and an epidural on the way within ten minutes.

The anesthesiologist came right away but we had to wait out two contractions before the epidural was placed. I bit down so hard during the second that I started wondering if it’s possible to shatter your own teeth. I hoped that the fentanyl would take the edge off while waiting for the epidural but its most notable effect was making me hear voices every time I closed my eyes. Luckily after two contractions, there was a long enough break to get the epidural placed with no problems. Relief!

With pain controlled, reality set in – I was in a hospital over 30 hours after my water had broken. Would they rush me into a c-section? Treat me poorly because we were a home birth transfer? I questioned our decision and wondered if I should’ve stayed home and found a way to deal with the excruciating pain. Logic gave way to fear and for a moment, I forgot about the other reason we transferred – the baby didn’t seem to be handling labor well. Those thoughts were interrupted by our nurse asking about our birth plan and someone checking my cervix.

My cervix wasn’t swollen. I was dilating again. Contractions had slowed and the baby seemed ok. My midwife acted as doula and the hospital staff were accepting of her being there – she had my prenatal charts, a labor flow chart, and was helpful in relaying our birth plan. A nurse quickly jotted down our birth plan and didn’t bat an eye at us declining all but one newborn procedure. The doctors were wonderful. They accepted everything we wanted and didn’t push us. They supported our vaginal birth goal and did everything they could to facilitate that. It was a shock and relief.

Pitocin was started to try and get regular contractions going again. I dilated quickly, the swelling was gone, and I started pushing. After a few pushes, the contractions spaced out and I fell asleep. I woke up a little while later to alarms and people rushing into the room. The baby’s heart rate dropped like it had at home, but it hadn’t recovered. A nurse shot terbutaline into my thigh to stop contractions and then flipped me on all fours (literally – the epidural made my left leg completely numb and I couldn’t move it at all) and rushed me to the OR for emergency surgery.

The Daddy was in the bathroom and had no idea what was happening when he walked out and they were wheeling me away. I was taken into the room alone, getting bits and pieces of what might be happening on our way down the hall. I was concerned for The Daddy and wondering if anyone had stayed behind to tell him what was going on. As soon as we got into the OR and they prepared to put me under, her heart rate went back up. Back to the delivery room, to try again.

Pitocin was restarted when the terbutaline wore off. The baby tolerated labor and pushing for awhile. Pushing was a relief; the pain went away and I felt like I was finally doing something productive. I pushed for four hours. I pushed her from -1 to +3, The Daddy saw her head and reported that she had tons of hair. We thought we were going to make it (apparently I was an “excellent pusher”). She was distressed again. Her heart rate took a very long time to recover. I don’t remember a lot of what followed. I know I got two more shots of terbutaline because the baby’s heart rate fell and didn’t come back up. I know they fiddled with my dose of pitocin. An alarm went off again. At some point, my epidural failed and I had to have another one put in. The second one failed, too. By this point, Sunday was ending. I was exhausted and scared for the baby and didn’t feel like I could go on. The hospital birth team came in. We talked options.

We were given three choices:
-Keep pushing with the understanding that another decel would mean emergency surgery where I’d be put under and The Daddy would not be allowed in the room.
-Try forceps and risk vaginal tearing, injury to the baby, and the possibility of it not working and needing a cesarean anyway.
-Have a c-section right away.

The hospital team left us to talk. I asked the midwife her opinion and if she thought forceps or surgery were warranted. She suspected a cord issue and thought it’d be best to get baby out quickly. After discussing with her and The Daddy, we decided forceps were worth a try and told the rest of the team.

The attending physician did a vaginal check and said there was no room for forceps. Our options were keep pushing or head to the OR.  The hospital staff left the room again so we could talk. We decided to have the surgery. And with that, they wheeled me to the OR while The Daddy left to get scrubbed and changed so we could begin phase three.

April 20, 2012
doctors, pictures, pregnancy
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Call me crazy, but this 3-hour glucose tolerance test is kind of nice. I’m sitting outside the hospital in the sunshine, nice breeze, low 60s, and a nice view of the city. You can’t see in this picture but the Golden Gate Bridge is off in the distance. 3 hours of forced relaxation – I’ll take it.

UCSF

Suck it, General.

April 17, 2012
doctors, pregnancy, ultrasound
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I just got home from our growth ultrasound. I feel very smug after baby measured exactly to the day again. The first hospital I went to kept insisting I was wrong when I told them to go by a late ovulation date rather than LMP. So far, every single u/s has been dead-on my date! She’s in the 44% percentile now, estimated 2lbs 11oz, and the doctor said if she stays on track and I have her around 39-41 weeks, to expect 7-7.5lbs. For my vagina’s sake, I hope she’s right.

Horrible things happened to my vagina.

January 18, 2012
doctors, pregnancy
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Today I had my first high risk prenatal appointment. I went in at 8:30am and was told it would take a half an hour. I got out at 10:45am. That was unexpected.

First issue: I’m on three medications for an endocrine disorder and autoimmune disorder. The medications had been approved at my first trimester appointment, though that wasn’t a high risk appointment and was at a different clinic. The specialist at the new clinic wasn’t happy when he learned what I was taking. Great.

The medications I’m taking (cytomel, levothyroxine and metformin) pose no risk to the fetus but the specific combination of medications make my TSH difficult to monitor and adjust for, and one may make the results of my glucose tolerance test inaccurate. I have to go back to the clinic at 7am tomorrow morning (ouch) to have labs done, stop two of my three medications, increase the dose on one, and then have new labs run in two weeks to make sure my thyroid doesn’t completely flip out. If I’m either a zombie or a crazy insomniac over the next two weeks, you know why.

Second issue: my last pap smear wasn’t in the computer system. I get them religiously every year, so that bugged. I was wary of having one done while pregnant because any spotting freaks me out. It sort of comes with the territory of having a 45% miscarriage risk vs the normal miscarriage risk of around 10% or something. Anyway. I asked if I should expect bleeding and warned the doctor of my sensitive cervix. She said not to worry and to expect some spotting.

…and then I felt something warm between my legs. For a moment, I thought “Shit, did I just pee myself?!” and then realized “…oh. That’s blood.” I bled so much, it ran out onto the floor. There was a pool of blood on the floor and on the exam table. There was blood on the doctor’s pants. It took a couple of minutes for the bleeding to stop so that I could sit up and clean myself off. That was messy business. The doctor had that “I’m trying to stay calm for the patient :D :D” look on her face, which was not exactly reassuring. Now I am anxiously waiting for the bleeding to stop so I can ease up on the whole “Everything is awesome and okay!” mantra happening in my head right now.

Third issue: apparently it’s rare to have Braxton Hicks early in the second trimester. I had a cramp/contraction/whatever on Saturday morning. It wasn’t painful, just strange. There was a shudder in my abdomen and then it tightened all the way across and stayed that way for about 30 seconds. I wasn’t overly concerned, so I didn’t rush to the ER or anything since I had an appointment scheduled for today. I guess I should’ve at least been more diligent in my calling because as soon as I told the doctor, she said “Ok let’s go get the ultrasound machine and make sure everything is ok.” Everything’s fine, baby was kicking. It was a bit scary when she was eager to get the ultrasound machine though since at my first appointment it seemed like a total chore to get the doctor to use the doppler so we could hear the heartbeat.

Yeah, so hopefully my ONE MILLION upcoming appointments are less dramatic/bloody than the appointment this morning. Assuming my thyroid labs and glucose tolerance test go well, I get to switch to midwife care. Fingers crossed I can leave the high risk BS behind.