My husband and I arrived at the emergency room around 9 pm on 12/15/08 and upon seeing I was pregnant we were immediately directed to L&D.; I was thinking maybe we'd save ourselves that $100 ER copay after all. When all was said and done, I would have preferred that hundred dollars to the bills that followed. As I said, I worked at the hospital so I badged us into the locked doors of L&D.; Apparently, this is a no-no and I was advised of such. Isn't it funny how little details like this stick with you after the fact?!
After a brief history in triage, my urine was tested for infections (negative) and then hooked up to the monitor to look at the baby's heart rate and contractions. (I totally spaced mentioning in my previous post that I was even more worried by the lack of fetal movement because I had a fetal doppler and was unable to pick up a heartbeat. Scary, eh?) When we first got there I was apparently contracting every 1.5-2 minutes and not even feeling them. Cakes' heart rate dipped for the first time while I was in triage and they sent the on-call doctor to assess things. I was placed on oxygen and the head of the bed was tipped (where my feet were higher than my head) into what they call a Trendelenburg position and then given a shot Terbutaline (or Terb) to prevent preterm labor.
Then came the fun part – the internal exam to see if I was dilating and didn't think I was (poor lighting). Next, they did a fetal fibronectin test – a test with notoriously high false positive rates that unfortunately for me, came back positive as an indicator that I would go into labor within the next two weeks. With everything else we were seeing at that point, it was definitely not something we wanted to see.
Around 11, I was finally put into my own room, hooked up to IV fluids, and given a shot of terbutaline in the arm (first time was in the bum and gave me the shakes) and a dose of Procardia (pills) to with the hope of stopping the contractions. At 11:30 I was given the first dose of a corticosteroid to help her lungs mature faster if I were to deliver early. (The way the steroids work is the first shot is given, then a second shot is given 24 hours later, and then another 24 hours has to pass before you're “in your window” meaning this is the earliest effective time to deliver with the lungs being as mature as they can be.) Cakes' heart rate dropped (deceled) three times (for 3-4 minutes) while we were at the north hospital and since the facility isn't designed for high-risk patients and the NICU is not as advanced as the central hospital, I had to be transferred by ambulance. One of the rules for being transported by ambulance while in preterm labor is to have a catheter placed first. Ugh, this was probably the most uncomfortable part physically to that point. My husband had to go home and check on the dogs (and take our car) so I was transported (meaning hooked up to electrodes and strapped to a board) in the ambulance alone doing my Hypnobirthing breathing/focusing the whole way.
After the transfer, this is where things start running together. Once in my room I got hooked back up to the monitors and IVs and while the maternal-fetal medicine (MFM) doctor was there, Cakes' heart rate dipped again and so I was put on oxygen (again), given a shot of terb (again), put in the Trendelenburg position (again), and put on an IV of magnesium sulfate (not so affectionately known by many as mag). It was the doctor's assumption that the decels were caused by the contractions – stop the contractions, stop the decels. They did a Group B Strep (GBS) swab which came back positive and another blood test to confirm my blood type (O+). Then a tech was brought in from MFM to do an ultrasound and found the cord either wrapped around or extremely close to Cakes' neck as well as the cord through her legs. They assumed she was crimping the cord in some way whenever a decel occurred. At this point, I hadn't slept in 27 hours and was getting lethargic.
The whole transferring care came up sometime after things settled. They asked if I had any objections to them consulting with my previous OB and having her come in to continue my care. I had no objections and a birthing tub was no longer even a consideration. My OB ordered a Kleihauer-Betke blood test which came back positive. This test is usually run on Rh negative moms to see if any of the baby's blood is entering her bloodstream because this could be extremely dangerous for them. Since her blood was found in my blood, this could only mean a placental abruption. The assumption was the abruption brought on contractions and coupled with the cord placement, Cakes' heart would decel and go into distress.
Fortunately, my mom is a nurse and worked in that hospital and was able to turn my room into a makeshift office and keep me company. My husband had just started vacation and was off through the end of the year so he was able to stay with me too. I don't know what I would have done if I'd have been alone for hours on end through this whole thing.
Which brings us to elephant in the room…the mag. The mag is something unlike anything other. It made me feel completely out of it. It made me extremely hot (except at the IV spot where it was freezing cold), I had a hard time concentrating, and it blurred my vision so bad that to focus I had to close one eye. My hips were killing me from being in bed for so long (I had to have leg inflater things to ward off blood clots) so my mom had her massage therapist come in to work on me as best as she could. It was definitely one of the highlights and made things a little more bearable. Before bed that night I received my second dose of steroids for Cakes' lungs and was given an Ambien to relax and get some quality rest.
Wednesday of that week was more of the same and all of our focus was on 11 pm when I reached my 24-hour window. At this point I was being weaned off the mag and by the time I woke up Thursday, it had been completely shut off and I had started on Procardia extended release pills again. A few hours later, I started contracting again which resulted in another shot of Terb. But by the end of the day, things were under control again and I was finally able to move to the Women's Pavilion (lower priority).
I was supposed to be released that Friday but had to wait around to consult with the doctor and have a biophysical profile (BPP). There are two parts to a BPP – an ultrasound and a non-stress test (NST). The NST is basically just the monitoring that I was already on for contractions and Cakes' heart rate – which I passed. If necessary, it can take up to 30 minutes to do the ultrasound portion. The five areas scored are breathing, movement, muscle tone (flexing/extending), heart rate (accelerations are ideal), and amniotic fluid. Cakes ended up getting a perfect 10 and I don't think we were even there the full 10 minutes. The test is designed to be an indicator of the baby's well being and helps the doctor in deciding if the baby would be better off delivered early.
Once we got back to the room, we met with my OB again. She outlined her plans for bed rest (only bathroom privileges and stairs twice a day – once down, once back up). I was given the OK to go to my parent's house on Christmas day as long as my feet were elevated once we arrived and given a note to the hospital would allow me to work from home (if they wouldn't allow it, I'd have to start short-term disability). We also discussed future appointments for the duration of the pregnancy (weekly OB appointments and BPPs twice a week), as well as a fetal growth scan. At 37 weeks, the OB wanted to do an amnio and if all is well she wanted to induce at that point. I wasn't a definite c-section case but if there were any signs of fetal distress, it was going to come to that. After several hours and another round on the monitor, I was finally discharged. Five days in the hospital is WAY too long…