Tuesday, February 27, 2007

S's Pregnancy, Birth, and PIH

So, after 5 long years, dh talked me into trying again. I didn't intend for it to be so long between babies. However, I was terrified of drs, hospitals, obgyns, and anything medical after having K. What if I got severe pe again? What if I had to be on mag again? However, we were not getting any younger. We didn't want K to be an only child. DH said now or never. So we jumped in. I had no obgyn. Had not been seen by a dr for that sort of thing in 5 years. I didn't want to be told that I shouldn't try. Afterall, I had already been told not to have anymore children by two obgyns, one that was high risk. I figured if I showed up pregnant, too late to take it back. That is exactly what happened. I got pregnant on the second try.

Immediately was sick as a dog. I had the worst heartburn and it lasted from 5 weeks till 2 weeks after delivery. I had never had heartburn except a 2 week period when I was pregnant with K. I was extremely extremely nauseated. As soon as the test turned positive, I called my pcp's office and asked who to see. They sent me to my dr and his staff. My obgyn is a solo practice dr that has two midwives that work with him. When I called the office, they immediately set me up with a midwife. Because I was overweight, she immediately wanted me to do the diabetic diet and gain no more than 15 lbs. No problem, except I couldn't keep ANYTHING down whatsoever. This was at 5 weeks. I saw the other midwife at 9 weeks, and she determined I was high risk and that I had to see the doc. She said I was only to see the doc while pregnant, not them. Fine. Was given a rx for a 24 hr baseline and pe bloodwork. I discussed the throwing up with her and she said well I had three boys and was sick with each one of them. You have to eat, and then if it comes back up so be it. Gee you are a lot of help. Oh and my bp was up AGAIN.

At 13 weeks, I saw my ob. I was to see him for the rest of the pregnancy. Honestly, Even though the midwives are good and great and I have nothing against them, I just prefer seeing him. For some reason I am more comfortable with him. Wierd I know. I never thought I would prefer a male obgyn, but I do. I told him about the throwing up. At this point I was losing weight. He said would you like something for it? I said OMG can I please. He gave me a rx for Reglan. All that did was make me throw up more. At 15 weeks, I was seen. Normal stuff. At 17 weeks, my ob was at a conference out of town. BP was high again. Midwife #1 started me on Aldomet. 750mg a day. Maximize rest. She was a GODSEND. She changed the Reglan to Zofran. While it didn't completely get rid of the nausea. At least I stopped puking as much. Somehow she managed to get 40 pills a month approved through my insurance. Retail price is $1700 a month for 40 pills. I had a $20 copay only. Not only that, she managed to give me a 6 months supply! Zofran was my best friend! I also still had the worst heartburn. So Pedcid complete was my best friend too.

I was seen about every two weeks. My meds were adjusted for bp. It seemed as soon as I got it adjusted it just went higher. Protein was on and off. At 26 weeks, my ob referred me for comanged care with my peri. He told me he was sending me to her to prepare for an early delivery. Oh no. Not again. I begged him please do not put me on mag again. At the time, I thought being on mag was the worst thing that could happen. I was wrong. Losing your baby is the worst thing that can happen. My ob looked at me and said, as nasty as a drug that mag is, it is the only drug that can save your life. So if you have any symptom of PE when you deliver or you have even a trace of protein when you are delivered, you are getting it. It is the only drug that can save your life. I was so naive. Here I was worried about how bad mag was (believe me it is AWFUL, imagine the outside like siberia and the inside like hell and you can get an idea). I should have been worried about trying not to die.

So off I go to see the peri. She immediately tells me I have no business commuting and I should be in bed. I said well that is easy for you to say, you are a dr. I have to work. So we agreed for me to work at home at least two days a week. When my boss was told, she said I could only do it for 3 weeks. Well I don't know why she suddenly thought I was going to get better. I was too sick to fight it. I saw the peri every two weeks till 33 weeks. Then I started seeing her weekly. I saw my ob every week from 26 weeks on. In the meantime, I was getting the meds adjusted higher. My bp would behave and then go up higher. At 30 weeks and 2000mg of Aldomet and 30mg of Procardia, I gave in and I went on bedrest. My ob said he wondered when I was going to give in. Bedrest was sooooo hard. Each day I was getting sicker and sicker. I was retaining water. Protein was negative to 2+. Liver enzymes were becoming elevated. Uric acid was a little high. Each week, I saw my ob and was instructed to go home and go back to bed and monitor my bp.

At 32 weeks, I thought I was done for. I saw midwife #2 due to my ob being on vacation. Except he wasn't on vacation but hiding in his office. Unfortnately, my bp was really high, I had two beat clonus, was swollen, had a headache, had been seeing spots, and had 2+protein. She went and talked with my dr. They upped my meds, sent me for another 24 hr urine and bloodwork. I was told to go to bed and not move. Do not go out in the heat. Stay in a cool dark ac room on my left side. Do not even think about not calling the office if something was wrong because I did not want to go to Childrens. I still have that fear of a different hospital/dr and being dumped. Did I mention that I hate to sleep on my left side now?? I got a call the next day saying I needed to go back to the lab because my liver enzymes were slightly elevated. That decisions would have to be made. I have come to HATE that statement. Fortunately my liver enzymes stabalized. S passed each NST and BPP.

At 35 weeks, I was really really miserable. I was sick of throwing up, heartburn, swollen, bedrest. My bp was very high. I had all of the PE symptoms. Oddly, no protein this week. My bp at the ob's office was 160/118. I freaked out the nurses in his office. My ob's response, cool as a cucumber was it's a little high today. Most drs would have stuck me in the hospital. But since my hospital does not have a NICU, it was too early. I was 35 weeks on the nose. You have to be 35 weeks +. So he added more meds, up to 60mg of Procardia now. He told me to go home, go to bed and don't move till my peri appt. This was Thursday. I went home and cried. I had a horrendous headache the entire weekend. I called my ob. He suggested ice and Tylenol, neither of which helped. I saw him on Monday at L&D. He did a NST. Checked me out. Sent me home. My bp was 149/109. Told me not to move till my peri appt the next day.

At 35 weeks, 5 days, I saw the peri. She took one look at me and said you are done. Let's go find a reason to have a baby. Well she didn't have to look to far. My bp was high, I was swollen, had pe symptoms except protein, and baby had decels on the nst. The one that she had passed with flying colors the day before. She called my ob and he said to me back to him and admit and pit.

I of course wanted everything to stop. I was not ready to have her and became upset at the thought. I wanted to eat but dh wouldn't let me. The peri said I could have a little something but not much in case they had to do an emergency csection. That did not give me the warm fuzzies.

I made dh stop at home to get a bag. Then off we went to the hospital. I went to admitting. My ob had set up everything. A nurse came down from L&D and escorted me up to the floor. She said that she understood I was really early and that it was all going to be ok. They put me in a room. Got me changed into a gown. My ob showed up. He said baby had decels and everything was going to be ok. He had the nurse start the pit. No cervadil/progestin gel. Just started the pit. He checked me, 50% effaced and a fingertip dialated. Apparently all of that movement I thought I was having had been contractions. The pit immediately put me into labor. I was admitted at 3pm and by 830pm, I was having uncomfortable contractions and I was 3cms dialated. My dr had been in to check on me several times. I of course asked for my epidural when admitted. That didn't happen. At 830pm, midiwife #1 broke my water. I immediately panicked because of what had happened with K. I started yelling at the midwife, why did you do that? Now I am going to go really fast. I was right, the contractions became immediately intense and unbearable. Next time, NO ONE is breaking my water until I have an epidural in. The midwife takes off and I ask where are you going? I guess no one believed me about the 5 to 10 cms in one contraction with K. She said she was getting my epidural. The original anesthesiologist was in surgery. GRRRRRRRRRR. So they called one in from home. He didn't make it time for one mom down the hall, so I was up next. He came in and put the epidural in. I got very little relief. It didn't work. My dr came in and checked me and I was 7cms at 9:45pm. HOLY CRAP. I had no intentions of doing this natural. But that is exactly what happened. In addition, right around when my water broke, heartburn kicked into high gear. It was the worst heartburn I have ever had. I begged for something for it and my dr said NOPE. Stupid apple juice caused it and to this day, I am no longer a fan of anything apple.

Around 10 or so, my doc was in and out of my room. Mostly staying around my room. I progressed quick. At 11:33, he ordered Demerol. At 11:40pm, S was born. She was born in three pushes and came very quick. Just like K did. She was very healthy and a pound on the nose bigger than her sis. I do have to say that my dr did perineal massage with a numbing med. OMG, I highly reccomend it. All I felt when she was born was her little head go pop. No pain at all.

I only got to keep her for an hour because she was early. The ped ordered her to be monitored in the nursery. After awhile everyone left. But I didn't hold her because I was afraid I would drop her from the Demerol. I also had to pee really bad but was afraid to. That I remembered from the last time and so I held it in. Finally at 4am I got the nurse to help me to the bathroom and peed forever. Then I was taken to my room. My ob stayed overnight in the call room. The poor guy was woken up constantly about my bp. He had taken me off of all bp meds to determine whether it was chronic or pih. No protein on delivery. The nurses were freaking out because it was high. However, it did not go higher than it had been and was dropping. My dr tried to explain that to the nurses that this was good, no meds and it didn't soar.

All through the next day he was called. He also brought in two nurses next day and showed them how to do the PE check. Already the swelling was going down. He started me back on meds. 30mg of procardia. Down from 2000mg of Aldomet and 60 mg of Procardia. S was perfectly ok despite being early. I was ok too and released 36 hours after delivering. I could have stayed till midnight, but who wants to stay till midnight with a new baby?

The next day the hospital called and said that they forgot to do the newborn testing. So they had me bring her back. She also had a bilirubin test scheduled. When I brought her in, midwife #1 was there. She played with S while we were waiting and fed her a bottle. I knew something was wrong though. S was pretty yellow. But they all said she was ok. Her tests were too clotted and they had to rerun them. In the meantime my ob came up on the floor to hang out with the midwife for an induction. He didn't see me at that point in the waiting room. He went to the call room to chart. That was when the lab called and I knew.

They called her ped and handed me the phone. He said I am sorry but S's bili levels are very high and she has to be under the lights immediately. Her level was 23. So she was placed on the light mat and overhead lights. I dissolved into a mess of hormonal tears. I felt like they were constantly taking her from me. The first night she was taken, because she was premature. The second night she was taken because I couldn't sleep and they wanted me to rest. I had to tell them that I had slept. Which I didn't. I simply waited for shift change and lied and said I had. I mean come on, I had been just taken off of max meds. They said that I could stay with her. They admitted her into maternity and we waited to be moved to peds. They put me in bed per midwife # 1's instructions.

After awhile, they moved us both to peds. The midwife told me I needed to go home and be in bed. Let dh stay with the baby. Easier said than done and she should have known better as a mom of 9. Dh and his family came to see her. Dh refused to leave her side and made me go home. The nurses from maternity had called peds and told them to send me home to bed. Mil took K with her so I could rest. It was so hard leaving her there and walking out with an empty carseat. I was near tears. When I got onto the elevator, I had the empty car seat. My ob was there. He asked what was wrong and where was S. I told him she had been admitted for jaundice. He said oh and he was sorry. I got in the car and cried the whole way home. I went home and went to bed but did not sleep. While I had been in the elevator was when the first abdominal pain happened. I thought hmmmm this feels familiar. At the time my sister and bil had come to visit too. BIL is an EMT.

The next morning, I woke up with a fever. I had chills and nausea. Abdominal pain and I had a funky smell. Something wasn't right. I called the hospital and for some reason they gave me midwife #1. She asked me if I was going to see that baby. I said yes. She said I shouldn't and should be in bed. I said I am going to see her. So she said while I was there to stop in L&D and have the girls check me out. They sent me to the ER. The ER was waiting for me. I spent all day in the ER. They did a pelvic and pulled out HUGE clots. They called my ob at home. I had at the very least a big uterine infection. My WBC count was 2 1/2 times the normal rate. I was bleeding alot. They did IV antibiotics. Said I was lucky and glad that I knew to come in. If I had waited till the office reopened, I would have had to have been readmitted. I was to see the ob the next business day. 4th of July was the next day (Mon). They also sent me home on Lortab and a strong antibiotic.

The next day, I went and visited Sara. We got the ok to take her home, so I went and relieved DH. While waiting for Sara's afternoon results, I saw my ob. He was WORKING on 4th of July doing surgery. He didn't see me though. Sara's levels had dropped to 11 and we were given the ok to go home.

The next day on Tuesday, I saw my ob. I was still running a fever, had chills, looked really sick. I also had Ecoli. He didn't like the way I looked and said he wanted me to get a US asap. I got an appt the next day. I could tell by the tech's face that something was wrong. She said go sit in the waiting room. You can't leave till we talk with your dr. He happened to be at the hospital delivering a baby. I heard him talking to the radiologist and he said I had retained parts. But my ob had forgotten to tell the radiologist what to do with me so they called him back. Then my ob's office called. They had the nurse tell me that I needed to have emergency surgery. She said to find a babysitter for the girls and get to the hospital ASAP.

I got to the hospital. I had to have an emergency d&c. My dr was awesome. They gave me really good drugs that made me sleepy. I felt no pain. It was done and over with before I knew it.

I continued to follow up with my ob till 3 months pp. My bp went down quite a bit but never completely normal. At 4 months, my ob transferred me to my pcp and she put me on Ziac. BEST DAMNED DRUG EVER. Dropped my bp within 3 hours and I get great readings on it. Last appt was 104/68!

So I'll be really sad to stop that (hardly no side effects) and going back on the dreaded Aldomet (bad side effects). But my pcp has said to take it as it comes and we'll adjust with my ob's consultation. Then as soon as I get pregnant again, I am right back in his hands.

With S, I was sick the entire time. No I didn't have mag, but I wish that I had because I totally stressed out that I was going to have a stroke or seizure the entire time in the hospital. I ended up being discharged on Fiorinal for the headaches. My ob told me a few weeks afterwards that he had totally been worried about me. He never showed it. I guess that's why I like him. He didn't stress me out. He ran a lot of interference with the nurses.

My next pregnancy, I will be super nerd. It's only normal. I will be asking questions on everything. Fortunately my pcp realizes this and she just sends me my lab results in the mail. Must be much easier for her this way, lol.

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