we found out at Asher's twenty week ultrasounds that he had a two vessel cord (single umbilical artery). this happens in about 1% of pregnancies with a single baby. i had none of the categories that made me higher risk for this (over 35, birth of three plus children). however, everything else looked great. and it's possible to have a two vessel cord, and a perfectly healthy pregnancy. however, most doctor's won't let you go over 39-40 weeks due to the higher risk of the baby passing in utero if the placenta starts to break down. you also get a lot more ultrasounds due to the risk of intrauterine growth restriction. it can be an indicator of other genetic disorders, but they show up with other markers and defects on the ultrasound.
I wrote out my birth hopes (i refused to call it a plan because i wanted to be somewhat flexible). i had plans for a natural water birth. i wanted to be able to move around during labor to use different positions to help alleviate pain. i wanted intermediate fetal monitoring. i did not want internal monitoring. we took birthing classes. i practiced my relaxing breathing. i went to every appointment.
we had an ultrasound at 34 weeks. he was still growing, but seemed to be slowing quite a bit in growth so we made an appt. for four weeks later to follow up and make sure he was growing.
on Friday, December 19, we had put the girls to bed, and I was sitting on the couch. I started to feel a little dizzy, and was having some weird visual disturbances. I called my doctor, and she had me come to labor and delivery to be monitored. my blood pressure was up, but all of my labs were perfect. after a couple of hours of monitoring, it came down on it's own, and I went home. over the next few days I kept an eye on it with an at home monitor. I didn't feel great, but did my best to rest as much as I could and take breaks or lay down if it got high.
on Tuesday, December 23, I woke up, and it was already really high. the doctor had me go in again, and once again, labs were perfect. the nurse who took care of me that day just kept telling me it wasn't that big of a deal, and I might have to take a pill to help keep it down. she told me there was nothing genetic about it, and really down played it. i still couldn't quite shake the feeling of being overwhelmed and scared. i was extremely swollen from it as well.
the next couple days were more fluctuations. and on Christmas day, we drove the six hours to visit my husband's family for Christmas. we got there in the late afternoon. I ate dinner, helped get the girls ready for bed, and just sat there. as the night went on I felt worse and worse. I started to feel nauseous, and my stomach hurt. we had eaten steak and shake for lunch that day though, so I wasn't so surprised. I took my blood pressure before bed. it was up, but decided to try to lay down for a bit. I laid down for about an hour, then got up and got sick multiple times. I woke Jason up, and he called the doctor. by the time we got the return call, I had decided we were going to the hospital because my blood pressure was still so high.
off we went to an unfamiliar hospital, six hours from home. I puked as they checked me in. they put me on the monitors and asher sounded great. they did urine and blood work. at some point the doctor came in and told me they were going to keep me for a 24 hour urine collection. he also said he was going to start me on a magnesium sulfate i.v. to keep me from having seizures. we decided to send Jason back to his parents so the girls didn't wake up with us gone, and I would stay. everyone was calm and together. nothing seemed that far outside of my other two experiences.
he left, and they moved me to a room. a few minutes later, the doctor came in. his assumption was that I knew or understood how sick I was. my assumption was that like every other time, the labs would be fine, and they were just taking extra precautions.
'you're having this baby.'
'what?'
'oh. I thought you knew how sick you were. you have HELLP syndrome. your liver enzymes are high, and your platelets are low.'
I called Jason and told him to come back. he had to give the run down on how to use shilo's g-tube and just the girls in general to his family. he woke Abigail to tell her the basics. meanwhile the doctor is going through all sorts of things with me, and working to get my paperwork faxed from the doctor's office back home. when he came back, we talked. there were multiple points where we both wept together and talked about how it seemed like nothing ever got to be easy for us.
at about two a.m. they started the magnesium sulfate. at seven a.m. a new doctor came on. I REALLY liked her. at around eight they started the Pitocin, and by nine I was having contractions. I continued to labor with the Pitocin until around nine that night. I couldn't have anything to eat because I was high risk for needing a C-section. I was making it on Jell-O and water.
they were continuing to draw blood and run labs on me all day to make certain my numbers weren't changing to drastically. at about 8 p.m. the doctor came in and told me that I was not only peeing protein, but also sodium. my sodium levels had dropped to 'dangerously low' and could start affecting my brain. Pitocin can exacerbate this so they had to stop it.
I was two centimeters and about 70% effaced. we decided to go ahead and rupture my membranes in hopes that would make my labor continue to progress. from about ten p.m. when they ruptured them until around eight a.m., my contractions slowed to about every ten minutes, and not nearly as intense. I wasn't making much progress.
they still couldn't start the Pitocin, and at this point I was no longer allowed to drink anything because it could further deplete sodium levels, and my ice chip intake was extremely limited. they decided to try a drug called cytototek that is inserted against the cervix. it caused me to go back into active labor having contraction every four minutes. at this point Jason and I had been up for over 48 hours. we were both, literally falling asleep between contractions.
my contractions were all down low, and quite a bit in my back so Jason spent every contraction rubbing my lower back and telling me I could do it, or encouraging me to breathe. he kept the peaceful music playing and diffused an essential oil to help me relax. by late that afternoon, we were both exhausted, and I wasn't sure how much longer I could make it. the doctor checked me and I was at a five. not great, but still progress. i tried to focus each contraction on opening up. a few hours later i felt some pressure so the doctor checked me again. i was at a five still and 80% effaced. asher had moved down (hence the pressure i was feeling). i started to cry. i told Jason i couldn't do it. i was exhausted, in pain, having blood drawn every couple hours (often during contractions), and my mouth was like a dessert from not being able to have anything to drink. the worst part for me though was that i couldn't move around because i had to stay on the magnesium and multiple other things at this point. i periodically rolled from one side to the other. laying on my back made contractions worse because so much of the contraction was focused in my back.
at this point, someone explained that the magnesium I was on causes the smooth muscles to relax. therefore, with every contraction I was having, the magnesium was fighting against it. I was feeling extremely overwhelmed, and defeated, and asked for something to help with the pain. the med they gave helped a little, but didn't last long.
i still wasn't dialating any more. i finally just asked for an epidural. the first doctor i saw when i first arrived had encouraged me to consider it anyway because it can help bring blood pressures down. Jason and i were both relieved when it kicked in, and we could rest. my sodium had come up enough that they started a very low dose of Pitocin as well. for the next little while i labored and let my body do all the work. after about thirty minutes, the epidural stopped working on one side. so while the pain wasn't as intense as it had been, i could feel the contractions.
at this point, people started to rush in every third or fourth contraction because asher's heart rate was dropping. they started by putting in an internal monitor for contractions. they also used it to put a little more fluid back around asher. they put an oxygen mask on me, and at one point had me get up on my hands and knees in hopes of taking the pressure off of him during contractions. it worked, but i couldn't stay like that long term because i couldn't feel my legs. they eventually put an internal monitor on him to follow his heart rate as well.
i was at eight centimenters, and decided to focus all of my energy on trying to get my body to open up again. after a few more contractions i started to feel the pressure to push. the doctor checked me and i was at nine. asher was at a +2. we just needed that last centimeter so he could come out.
but, his heart rate continued to drop. i was getting nervous for him.
after a few more contractions, the doctor said, we have to get him out. we were wheeled into surgery for a C-section. they gave me a spinal block, but like my epidural, it didn't work. i could still feel quite a bit. so they had to put me completely under. Jason couldn't be in the room as a result. i remember them putting the mask on my face, but that's it. i didn't hear his first cry when he was born.
when i woke up in recovery, there was a nurse checking my fundus to make sure it was contracting. however, the epidural and block hadn't worked. they couldn't give me ibuprofen because of the magnesium. they couldn't give me Tylenol because of the liver failure. and, they couldn't give me narcotics because i had, had a spinal block. i'm not sure what i said to that nurse but i know i grabbed her hand and moved it away from me multiple times. while i was still trying to wake up, the neonatologist came in and told me something. i have no idea what he said to me.
eventually i got wheeled back to my room, and Jason came in. i started to asks questions. how big was he? was he okay?
3lbs 13oz. 17-1/2 inches long. born at 6:43. he was okay, in the NICU and on c-pap. he showed me a pictures, although i was having a hard time keeping my eyes open and focusing. he told me his parents had come and gotten to see him. i started crying because they got to see him before i did.
he told me about the nurse taking the camera to get pictures when they got asher out, and how when she walked by with him, he started to cry.
i had to be on magnesium for another 24 hours after delivery. i still wasn't allowed to walk. and i wasn't even allowed to go see him until i had been out of surgery for 6-8 hours. so at about two a.m. i got wheeled to the NICU to take my first look at my son. he had the c-pap mask on, and was just so very tiny. in those final 24 hours of magnesium, my calcium also dropped, and they had to give me i.v. calcium after I was done with the magnesium.
I learned from different doctors and nurses over the next few days that asher's small size was likely cause by a combination of things. first of all, his two vessel cord did not enter the placenta like it was supposed to, but instead he had peripheral cord insertation (about 10% of umbilical cords don't insert into the placenta as they should). also, umbilical cords are surrounded by a jelly like cushion called Wharton's jelly. this helps protect the cord from completely collapsing if there is pressure put on it. asher's cord had very little of this jelly, and it's the reason he went into distress during the end of labor (something would compress the cord during the contraction, and it would close off blood supply instead of being able to hold up to it like most cords can). and lastly, while I haven't researched it a bunch, HELLP syndrome and pre-eclampsia are often something that is going to happen, and is determined by the way the blood vessels formed in the placenta. so from the get go it's likely that the syndrome lurking below the surface was hindering things. all of these things meant that asher did not grow like he should.
as it turns out, my body might just be a lemon. if we were to get pregnant again, i would be at very high risk for HELLP syndrome. but, we have already decided that we are completely unwilling to take that risk. i was extremely sick, and going down hill fast during labor and delivery. had asher made it closer to term, he likely wouldn't have lived.
while i wouldn't say i'm happy i developed HELLP syndrome, i will say i'm thankful that it happened when and how it did because it likely saved my son's life.
i am on the mend. he's doing great. he's just small. and i will forever remember this time as one where my husband was above and beyond amazing. i have likely thanked him 100 times over for how great he was during labor and delivery despite understanding more of what was going on, and knowing that at some point he sent a text to some people telling them he was scared i was going to die.
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| newborn |
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| meeting papa |
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| on c-pap |
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| hanging out with mama this morning. |
That must have been so scary! But he sure is adorable. :)
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