Part Two: Third Stage of Delivery; Post-Partum Hemorrhage
After she was out, we had opted for "expectant management" of the third stage of labor; delivery of the placenta. Basically that means we were going to wait for my body to do what it was supposed to do, and let my uterus contract on its own to expel the placenta, rather than jump start this with a dose of Pitocin injected in my thigh. This is something that usually happens within 30 minutes of birth. So while Norah and I were being cleaned up and checked out, we waited. My Mom had come down and was there with us at this point, and Matt's Dad and the kids came by to meet Norah, but they didn't stay very long, which ended up being a really good thing. However, after waiting 30 minutes, I'd really had no more contractions, and when Kathy gave a little tug on the cord, the placenta was definitely still attached. They gave me a shot of Pitocin in the leg at this point to encourage contractions, but after maybe another 15 minutes nothing was happening. Kathy started to get a little worried and they decided to start an IV and hang a bag of Pitocin pretty much wide open to have one last ditch attempt at delivering the placenta normally. This didn't have any effect, and we were now getting to point where the placenta needed to come out. Kathy paged OB, and an OB resident named Samar came down to consult on what to do. They said they could go in and remove it with manual traction, but most women find this way too painful to undergo without pain medication or anesthesia. After some brief discussion, we opted to have a spinal or epidural placed and even though I'd made it through the birth without this, I really didn't want to go through any more pain unnecessarily. *
*Somewhere in the midst of this time, I guess Holly had been called in on her day off to come see me. She was wonderful - she came up to me and told me how beautiful Norah was and how great of a job I was doing. She was so positive and calming, and I know she helped both Matt and my Mom get through the next few hours too.
Anesthesia was paged, but they were in the OR working on a case, and while we waited for them to come down, Kathy realized that the Pitocin was working to some extent and the placenta seemed to have loosened and she thought she could manually remove it quickly. She asked me to push, while she pulled on the cord and massaged (FIRMLY. Read, PAINFULLY) from the outside. This was probably as painful the actual delivery, and when the placenta came out Kathy realized it was coming apart in pieces. Immediately after that, a HUGE gush of blood came pouring out, and she felt that part of the placenta was retained. She began trying to remove the pieces by hand, which was horrible, but necessary. I was bleeding heavily, and we couldn't wait for anesthesia to come to the bedside. Samar was paged again, and she came right down to check with an ultrasound what it looked like inside. There was definitely a large part of placenta and lots of blood clots retained, and they felt I needed to go to the OR immediately to stop the bleeding. It turns out I had a succenturiate ("extra") placental lobe, and this was the main part that was retained. I was scared, and I knew the situation was serious. I looked at Matt, and I know he was terrified too, but neither of us knew how bad it was going to get. They pretty much packed up the bed and ran down the hall with me at this point.
Matt was given Norah and told he would have to wait with her in newborn recovery because her newborn screening wasn't quite complete. They did follow our wishes though, and delayed the eye ointment and Vit K injection during the time between delivery and when I left for the OR, so I had nearly an hour with her without any extra interventions. Matt and my Mom went to wait with her, and I was wheeled into the OR.
I was starting to get incredibly shaky, and by the time I got to OR I was in so much pain I was becoming delirious and just wanted them to do whatever they needed to in order to stop the pain. They asked me to sit up and try to transfer to the OR table, and when I pushed up to sit, I nearly passed out, so they laid me back down and had several people help slide me over onto my side. My legs were cramping, my abdomen was cramping, and I was freezing cold. They were still planning to do a spinal for anesthesia, but they had to get extra IV lines in first. I'd already lost about 600 cc's of blood at the bedside, and my veins were nearly impossible to start a line in. The anesthesia resident ended up getting one started, but before they could run the fluids they needed through it to get prepped for the spinal, I began gushing blood again. I ended up losing 2100 cc's total (just over 2 liters) and my blood pressure dropped to 50's/40's. I remember at this point through the pain, someone said "She's going to crash if we do the spinal..." and they began rushing around to start general anesthesia.
I was flipped over from my side to my back by about 10 people, and suddenly the OR filled up with 20-30 people rushing around. Someone tipped my head back and checked my throat size for intubation, and I started to get really scared. I was afraid of being intubated while I was awake, and I also asked the attending anesthesiologist (Dr. Greene) if I was going to lose my uterus. She told me if anyone was going to have their uterus out any time soon it was going to be her! I was shaking uncontrollably and moaning that I just wanted something to stop the pain, and the next thing I knew they had a mask on me with oxygen and something else to put me to sleep before they intubated me. It probably only took 15 seconds before I was out, but I was gasping on that oxygen and just hoping to be knocked out ASAP. It took effect, and I don't remember anything after that until I went to to recovery, which ended up being a really good thing. I am actually grateful that I didn't have the spinal, because I would have been awake and scared throughout the whole procedure.
I was in the OR for about an hour and a half, and they ended up doing an emergency D&C to clean all the retained placental pieces and blood clots from my uterus. During this time, they also gave me 2 units of blood and several bags of IV fluids, plus a barrage of medications to make my uterus contract to stop the bleeding. Because my blood pressure was dangerously low, they also gave me "pressers" to keep me stable. This information was all relayed to my Mom and Matt, and at this point I think Matt realized how serious the situation was. I will never know exactly what was going through his head while he was holding his hours old daughter and hearing the information from the OR, but I know that it was a really scary time for him.
After I was stabilized and the procedures were completed, they took me to recovery. It took a while to wake up, and I remember catching a glimpse of myself in a mirror at some point. I was a color of gray-white I had never seen a person before from all the blood loss. I felt pretty terrible, but once I was awake enough, Matt and Norah were able to come back and that helped so much to see them. The staff watched me closely for another few hours, and it wasn't until about 10:30 PM that we were finally taken to a recovery room. The nurses got me all situated and then around midnight Matt asked if I was hungry and I was! We ordered from Pizza House and I got mac and cheese - the GD diagnosis was clear and I was given the go-ahead for a normal diet!
The first night was rough and I barely slept, even after the general anesthesia (not to mention the 14 hour labor). Norah was by my side and even though she was a wonderful tiny brand new thing, she sure didn't sleep long either! Tuesday I was feeling slightly better, although by then all the IV fluids that had been pushed through my system were settling in and I was swollen everywhere - my eyelids, fingers, toes, legs...I looked pretty rough. Every time I sat up or stood to walk to the bathroom, I was getting a bit dizzy and could hear my heart pounding in my ears, and that combined with my blood work that said my hematocrit and hemoglobin levels were still quite low, we decided I would get another transfusion with 2 more units of blood. This helped so much, and by Tuesday evening I was moved out of the high-risk recovery and over to general recovery. Tuesday night I finally was able to shower and felt much more human after that, and Tuesday night went pretty well. By Wednesday I was feeling much, much better, and we were given the all-clear that we could go home. We were packed up and ready to go by about 6:00 PM, and it felt so wonderful to finally be able to bring our daughter home.
Today Norah is one week old - in 20 minutes actually - and I can't believe how my life has changed in 7 short days. I am so thankful for an amazing team of caregivers who brought my daughter into the world safely, and then in a matter of minutes snapped into action and saved my life. Had we not been in the hospital, the outcome might not have been the same. I will never question our choice of care providers or our decision to have a hospital birth - it was the beautiful, unmedicated, intervention free experience I had hoped for all the way up to her birth, but when it quickly became a life and death emergency for me, I was right where I needed to be. I'll probably never know many of the 20-30 people who were in the OR with me doing their jobs on 4/25, but I know that they saved my life and even if I could tell them all in person how grateful I am, I don't think words will ever be enough. I'm sitting here holding my perfect daughter and able to see her grow up with my amazing husband because of a team of people were at UM doing their jobs flawlessly and caringly when I needed them. Thank you, thank you, thank you.
3 days old
3 days old