Friday, August 23, 2013

Kate's Birth Story: Part One

Saturday, August 3rd, 2013
10:00 a.m.

It took every ounce of willpower to drag myself out of bed. It wasn't early by any means, but I was exhausted. The past few days had been spent sorting through wedding presents that hadn't been able to make the trip back to California after our celebration last summer, preparing baby clothes and nursery items, running errands all over town, and moving furniture between various houses until the earliest hours of the morning. The days before that had been spent in the heat of the Plymouth County Fair. I was running on fumes.

Kate kicked me hard just to the left of my belly button. I patted what I assumed was her foot, and got up to take Sadie outside. My feet hurt when I put my weight on them. I looked down.

Swollen. Worse than the night before. My head hurt too, and the bright, flashing spots I started seeing the previous day were still there.

I started getting ready for the day. My mom, sister, and I were headed to Sioux Falls, South Dakota for my cousin Laura's bridal shower that afternoon. And I was going, swollen toes or not.

1:00 p.m.

My mom arrived to pick me up. We were meeting my sister and my niece and nephew at Walmart where they were getting eye exams. When we arrived, I walked over to the blood pressure machine by the pharmacy.

Some background, for context:

My blood pressure started occasionally elevating ever so slightly around eight weeks into my pregnancy. Usually, it was either my normal, healthy blood pressure (117/68), or it dipped down into concerning numbers when my hyperemesis gravidarum was at its worst and my body was in ketosis. But whenever a slight spike flashed across the monitor, it was noted by my OBGYN in California.

When I was hospitalized in Colorado for asthma, a fractured rib, and blood clots on our trip back to Iowa after school ended, my blood pressure was in the high-130's/high-80's range. Higher, but not yet too concerning.

When I got to Le Mars, and started seeing my OBGYN here, I was not told my blood pressure at my first visit in her office. However, shortly after that visit I ended up in the emergency room for strange cramping and chest pain. My blood pressure maxed out around the 140's/high-80's range.

During my visits to my perinatologist after the abnormal quad screen, my blood pressure continued to be in the 140's/high-80's range. By this time, he was all but positive that Kate didn't have Down Syndrome, but as I said in my 25 week post, the perinatologist wanted to keep a close eye on me, because my blood pressure was climbing, and I had a family history of pre-eclampsia. And although Kate was still in the normal range of measurements for her gestational age, she was on the smaller side, which can be another indication of pre-eclampsia. He scheduled me to come back in a month, just to make sure everything was okay.

A few days later, I found myself in the emergency room a second time when I began having painful headaches, and my hands and feet first started swelling beyond what I felt was normal. My blood pressure was climbing even higher: In the 150s and 160s over mid-90s. Extremely high for me.

My OBGYN was on-call that day. She ordered a urine test that showed protein in my urine, another sign of pre-eclampsia. I stayed in the labor and delivery unit for a few hours to be monitored before going home with a jug to pee in for the next 24-hours. The lab results showed that my protein levels were just below the cut-off level for a pre-eclampsia diagnosis. However, my OBGYN refused to put me on medication to lower my blood pressure. I guess she thought it was better to let my blood pressure to continue to climb to more and more dangerous levels than to give me medication to lower it, preventing me from experiencing the terrifying events that were about to occur.

I was told not to worry, to check my blood pressure regularly, and to call the hospital if the bottom number passed 100.

I relaxed for a few minutes before putting my arm into the blood pressure cuff. It squeezed so tightly I winced as I listened to the Nyquil ad playing on the screen. The cuff finally released, and I was shocked to see what the machine displayed:

My mom told me to get the hospital on the phone.

My heart was racing as I called Floyd Valley Hospital and asked for the on-call nurse. I told her my blood pressure reading, and answered her questions about what I had been doing all day (basically nothing), how much water I had taken in (a ton), and if I had any other symptoms (I did). She said she would call my OBGYN and call me back.

I hung up and nervously waited for my phone to ring. When I picked up, instead of instructions on what to do, I got a lecture. Not about not taking it easy enough, not about needing to drink even more water, not about needing to get myself into the emergency room quickly (which should have been her advice) but about money. Oh yes, money.

My Kaiser Permanente insurance through CUI didn't work very well out in Iowa, and had expired since Justin and I hadn't registered for our fall classes yet. I was in the process of getting Iowa Medicaid. I was approved, but hadn't received my card and Medicaid number yet. The hospital and my doctor knew this, but apparently, this was an appropriate time to get on my case about not providing insurance information, and an appropriate time to tell me that I had better start looking into going to a free or low-income clinic since I didn't have the "resources" to pay for and be seen at their clinic and hospital.

Already scared in regards to my high blood pressure, I began to tear up as the nurse went on to tell me that I should just go home and lie down. Apparently she could "hear in my voice" that I was anxious (noooo...really!?), and that my OBGYN said I had an anxiety problem, and that was probably what was making my blood pressure so high.

I am the first to admit that I have issues with anxiety. I have a history of PTSD, and with a pregnancy like I'd had, the most tranquil person in the world would be anxious. However, I had every symptom of pre-eclampsia, and they were worsening, plus a family history. I also am very aware of my body and what it feels like, both in and out of states of anxiety and/or poor health. That, combined with how high my blood pressure reading was, told me that this was not a panic attack or an episode of anxiety. I decided to ignore the nurse and my doctor, and that getting looked at was the best choice.

2:00 p.m.

I arrived at Floyd Valley, checked in, and was taken to labor and delivery. My dad's doctor was on call. I had never met him before, but instantly felt better when he came in the room. However, I could tell whatever was happening to me was serious since he got there so fast. He got right to the point: I was smart for coming in, and my blood pressure was very concerning (since arriving at the hospital, it spiked to 161/111, into stage 2 hypertension). He also had been reviewing notes from my perinatologist, warning my OBGYN to watch out for signs of pre-eclampsia, outlining my risk for developing it. She must not have had time to look at those notes...or something.

The doctor ordered a urine test, which showed ridiculous amounts of protein in my urine. His concerns, along with my blood pressure, continued to rise: 164/112...170/113...

2:30 p.m.

I had been trying to relax for the past half an hour. My head was pounding, and the bright spots were obstructing my vision more and more. Kate's heart fluttered on the fetal monitor. The blood pressure cuff squeezed my arm again.

The nurse who had been assisting the doctor came in.

"174/114," she said. "It looks like they're going to transfer you."

I was still staring at the monitor when she spoke. It took me a minute to realize what she said.

"Wait, what? To Saint Luke's?" My head was spinning. I had assumed they were just going to give me medication to lower my pressure and put me on modified bed rest for the rest of my pregnancy.

"It's probably going to be Sioux Falls. I don't think Saint Luke's is equipped to handle your situation."

"My situation?" But I just needed blood pressure medication... That's all this is, right?

Saint Luke's, located in Sioux City, Iowa is about 20 minutes from Le Mars. It is where my perinatologist practices. Sioux Falls, South Dakota is about an hour and a half from Le Mars. Now I really knew it was serious, but the nurse said she couldn't tell me any more, I had to wait for the doctor.

Justin finally arrived a few minutes later. His work released him early, and he came rushing in, upset and confused. I told him what was happening, as best I could - I wasn't being told much. We waited together for what seemed like hours.

3:30 p.m.

The doctor finally came back in, distress on his face. He told me that I officially had pre-eclampsia, and it wasn't looking good. "The good news is," he told us. "That we aren't going to deliver the baby today." He paused for a minute. "But if we do, it's not going to be here." He looked at Justin, told him to go home and pack a bag. "Bring things you'll need for a few days...and the camera...and things you might need for your little girl."

I didn't look at Justin, but I know his eyes had to have been at least as wide and terrified as mine were as we heard the doctor's instructions. He left to go pack as a team of nurses inserted an IV. They started me on magnesium sulfate, a nasty little drug to help regulate my blood pressure. It wasn't bad at first, but after awhile, your skin feels like it's being sunburned, your head feels full and achy, and you experience that feeling of being so exhausted you can't keep your eyes open, but you can't fall asleep. They also gave me a shot of steroids, to help develop Kate's lungs faster, and blessed me with the experience of having a catheter inserted when you aren't already under anesthesia.

4:30 p.m.

I responded well to the magnesium sulfate, and my blood pressure was low enough for ground transport. Justin got back to the hospital just as the paramedics arrived. They looked down at me with sympathy as the doctor explained my case to them. Then, they moved me from the labor bed onto a gurney. The doctor and nurses wished me good luck as I was wheeled out of the room and towards the ambulance.

They got me inside the ambulance, and shut the doors. Of course my HG decided now was a perfect time to act up. The paramedic in the back with me pushed some Zofran into my IV as I clutched an emesis bag.

He made small talk with me to pass the time. Or maybe to keep me calm. I'm not sure. He asked me how far along I was, and told me stories of families he knew who had delivered premature babies, both behind and ahead of Kate gestationally, who were completely healthy with no disabilities.

The magnesium was burning stronger. Now I was beginning to feel anxiety. Everything was happening so fast. I wanted Justin's hand so badly, but he was stuck in the front of the ambulance. He had never felt so far away from me.

I took a few deep breaths, touched my stomach, closed my eyes, and tried to sleep.

When I opened my eyes again, we were just outside of Sioux Falls...