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One move to America, one surprise pregnancy and a lot of fun later.

Friday, December 10, 2010

If the Drugs don’t work…….

By Jarlath Keating

Hannah Mary Keating: 22.28 pm. 8th September 2010

I am going to try to capture the story of Hannah’s birth on paper. I embark on this with some trepidation given the events and emotions that ensued during that time, but Hazel has asked for my personal account. I hope you enjoy this recollection of the hours leading up to and after the birth of our daughter.

It is strange to think back during those hours on the 8th September 2010 when Hazel was in labor and realizing that the time I felt most calm was the last 2 hours when she was ‘pushing.’ Nine months had distilled down to these few hours and I think that collectively we were completely focused on the birth. No nerves, no trepidation, just focus on the moment.

17 hours prior to 22.28 pm, the situation was a little different. Not panic though. At no time did this emotion threaten (although I can’t speak for Hazel or Vicky). We arrived at Sibley hospital around 4.15 am after Hazel’s water broke. It is typical by the way that Hazel fell into the 10% of women whose waters break – she always has to do it differently! The admissions process was pretty smooth as Hazel had pre-registered and we knew the layout of the hospital as we had taken the child birth classes in the same building. What do I remember at that particular time? Hazel worrying about the amniotic fluid making her look like she had wet herself. The first wave of nerves mixed with impatience to get through the admissions process. How long would we be here? Would everything go as planned?

We were admitted to room 6. It was one of the bigger birthing rooms (considerably larger than the one they showed us during the orientation tour) and we quickly got settled. We had to wait a while before Dr. Sartawi came in to examine Hazel and when she finally showed, she described how she saw the labor progressing. As Hazel’s water had broken, but contractions had not started, it was going to be necessary for Hazel to be given pitocin. This drug would basically start the contractions and is administered via an IV line. The initial dose was relatively low at around 4 mls / hr. I recall that during the first couple of hours we were there it was a question of just hanging out. We both tried to get some rest and I crashed on the sofa. By about 7.30 am, the pitocin was being administered and the first mild contractions were kicking in. I was also beginning to feel pretty crappy. I put this down to a combination of post adrenaline ‘come-down’ lack of food and rising nerves. We both agreed that the best course of action was for me to go to the canteen and grab some breakfast. I felt comfortable doing this as Hazel seemed fine and the contractions did not seem to be too severe. On hindsight, we were a little complacent and were not expecting what was to come.

I went down to the canteen which was pretty good as hospital facilities go and had some breakfast. Tea, orange juice and a breakfast bagel (I think). The place was pretty quiet and I took my time sort of knowing that we had a long day ahead of us. It was on my return to the birthing room that the real fun started.
The pitocin was doing its job and the look of distress on Hazel’s face as I walked in the room really unsettled me. As each contraction came and went, Hazel’s eyes would widen and a look of panic would engulf her face. I think that the pain took her by surprise (I know it did me) and the magnitude of what lay ahead was daunting. What upset me the most was that feeling of helplessness. All you can do is hold a hand, offer verbal support and all that other stuff they tell you to do as part of the birthing process. You feel pretty useless to be honest and you are.

The option for pain control had always been on the table. In fact, when Hazel first found out she was pregnant, her immediate reaction to the whole subject of epidural vs. no epidural had been one of ‘give me the drugs.’ This position had changed over the course of her pregnancy mainly due to the reading and classes that we took and Hazel’s interaction with my sister. Alison had had her 2 children without an epidural and was a strong advocate for a natural birth. For the record, I find this description somewhat bogus. Going into the hospital, Hazel had taken on a ‘wait-and-see’ approach and I was in full support of that.

As the contractions began to get more severe and Hazel’s distress levels also increased, we made the decision that an epidural was the best course of action. We realized that there was no way Hazel would get through the birth without pain medication and I was pushing quite hard for her to take it. Obviously the decision was Hazel’s but there was no way I was going to push for a natural birth. Why would you subject yourself to the pain of a natural delivery if you did not have to? You take aspirin for a headache so why the hell would you decline pain medication when it is tenfold anything you have experienced before. I should also mention that when we checked into the hospital, Hazel’s blood platelet count from the previous day had been around 85,000 p/ml. Based on this level, we were advised that Hazel would not be able to have an epidural due to the risk of bleeding at the site of administration (the minimum level was considered to be 100,000 p/ml). Hazel had been prescribed a steroid to help increase her platelet level but had only taken 1 dose so far. We did not think that the steroid would have had the time to function but when they retook samples on admission thankfully, the level had increased to 117,000 p/ml overnight. We had the green light for an epidural if it was needed. It was.

We had to wait about 35 minutes for the anesthesiologist to administer the epidural as he was involved with another patient having a caesarian section. The actual process took about 10 minutes. I cannot remember how long it took for the epidural to kick in (too long in Hazel’s opinion I’m sure), but what I do remember was the look of relief on Hazel’s face. The tension and anguish left her and the atmosphere in the room changed almost immediately. The fear had gone. This had a huge effect on me as well. My wife was no longer in pain and we could focus on the baby.

I think it is appropriate to introduce Vicky as this stage of the story. Vicky had arrived around 10.30 am after I had called her earlier that day. Vicki had wanted to be part of the birth and we were glad to have the support. As it turned out, her support was more than I could have ever asked for and I owe Vicky a huge debt that will be difficult to repay.

The day took on a slightly surreal quality. Hazel’s pain was being managed (she had an IV but also had a ‘pain button’ whereby she could increase the dose of the epidural as she needed it), she was steadily dilating and it became a waiting game. Vicky and I took the opportunity to go to lunch, I spoke to some of my co-workers to let them know the situation and I was keeping my parents and sister updated on the progress.

So we waited. We went through another change of staff (I think we had 4 nurses in total) and Dr. Sartawi had been relieved by Dr. Osmun much earlier in the day. The staff were very good. All of them without exception were professional, polite, friendly and knowledgeable. I would recommend Sibley hospital without hesitation.

Hazel was now on a higher dose of the pitocin and the contractions were regular and strong. The pain medication was not keeping up with the severity and Hazel’s distress levels were rising quickly. Ultimately she needed 2 additional boluses of the epidural before the day was out.

By mid-evening, Hazel was fully dilated and Dr. Osmun advised that it was time to start the ‘pushing’ process. We had a young nurse in attendance (I can’t remember her name but do remember her grinning for most of the process) and she was basically the coach for the remainder of the labor. At this point, all modesty goes out the window and it is at this juncture that Vicky became a member of our family. Now here is a funny thing. I had always envisaged myself on the right side of the bed when thinking about the actual birth and this is where I found myself at around 8.00 pm. I had one leg, Vicky had the other. The nurse was generally to be found in the middle (the business end I guess). I also had the privilege of being the ‘dose man’ for the epidural. Every 20 minutes I would hit the button to ensure Hazel got the maximum level of pain medication. Crazy not to.

So here is how it goes. We would watch the monitor and the graph that measured the start, duration and end of Hazel’s contractions. Once a contraction started Hazel would push for a count of 10 and repeat 3 times. The monitor was really accurate which surprised me. On occasion, it would indicate a contraction was starting before Hazel felt it. The nurse would lead the counting and on occasion stretch the birth canal. Model teamwork at play!

If you had asked me before the event which part of the labor I was most concerned about, I would have said this stage. I imagined that I would be nervous, anxious, even freaking out a little. It was the complete opposite. I felt very calm, focused and in total control. I have no clue if this was actually how I came across to the others, but that is somewhat irrelevant.

The baby slowly descended with each push. Before we could see the top of her head, Hazel’s stomach started to lose its fullness – obviously a good sign! After about 1 hour of pushing, we could see the top of the baby’s head. I remember having two distinct thoughts at this time. First of all was the baby’s hair. We could see black curls of hair on the top of her head. She was not bald! The other thought related more to the biology of the whole thing. It is difficult to get your head around the fact that for the entire pregnancy and birth process the baby is getting oxygen through the umbilical cord. It did not seem possible that the baby could survive without breathing through her lungs at this stage. I tried to push this out of my mind, but it was not easy.

Here’s one other thing that I was resigned to. Newborn’s for the most part are ugly. Being no oil painting myself, one was quite prepared for a less than aesthetic looking child.

After Hazel had been pushing for over 2 hours, Dr. Osmun decided that it was time to intervene. Hazel was getting more and more tired and whilst the baby had made good progress and we could see a good part of the crown of her head, the last few centimeters seemed to evade us. Dr. Osmun explained that he would like to use suction to complete the birth which involves attaching a suction disc to the top of the baby’s head, applying a small vacuum and pretty much pulling her out. We had gone over this procedure in the birthing classes and we were happy to agree to this.

The activity in the room increased suddenly. Up until that point, it had been Hazel, me, Vicky and the nurse with the doctor popping in on occasion to check on the progress. Now we had about 4 additional people in the room, including the baby specialist (I forget the technical term) and support nurses. It was now around 10.20 pm and we were about to meet our daughter in person for the first time!

The procedure was pretty simple. Dr. Osmun attached the suction disc, applied the vacuum and told Hazel to push hard on the next contraction.

Hannah Mary Keating was born at 10.28 pm on Wednesday 8th September.

How do you describe it? Well for one thing, she just kept coming. The words of encouragement were replaced by exclamations on how big she was. Not so much in terms of bulk, but in length. She had a head of black hair and was beautiful. Other emotions? Relief and excitement. We had our baby daughter and she was perfect!

The doctor quickly cut the umbilical cord (I was not allowed to given that they had applied the suction procedure) and handed the baby to the specialist staff who quickly went to work on cleaning her up, weighing and measuring her (9 lb 2 oz and 21 inches) giving her the vitamin K shot and applying antiseptic cream to her eyes. As soon as the umbilical cord was cut and she took her first breath she let out a healthy wail and immediately began to exercise her lungs. Needless to say, she bitched through the examination process as well. I was now standing beside the examination table, Hannah was gripping my finger and all those emotions sweep through your body. Relief, love, tiredness, helplessness, responsibility, concern, gratitude. A multitude of emotions and she was only 5 minutes old. They completed the examination, swaddled Hannah and put a wee pink and white hat on her head that I will cherish for the rest of my life.

So it had been a pretty routine delivery up until that point (at least from the hospitals point of view). Hannah was a healthy baby girl and Hazel had withstood the rigors of childbirth pretty well. The doctor was working on the placenta delivery and the staff was going about their post-delivery routine.

The change was not immediate but still happened over a short period of time. The activity level in the room started to increase and the smiles begun to fade. The delivery of the placenta was turning out to be less than straightforward. By this time, I was holding Hannah in my arms watching the doctor work on Hazel. Vicky was still holding Hazel’s left leg and was talking to her. I was then instructed to sit on the sofa as it became apparent that an emergency situation was building and I was surplus to requirements (once again). It is not easy to describe this episode. From my vantage point, I could see Dr. Osmun working on Hazel, who by this time was not fully conscious. Dr. Osmun had removed most of the placenta, but a portion was still attached to the womb and was causing heavy bleeding (a condition called placenta acreta). What will remain with me for a long time was the sight of Dr. Osmun covered in blood. From the tip of his fingers up to his shoulders and down to his feet was red. The bag /and tray in which the placenta and blood were collected were alarmingly full. Obviously it is normal to loose blood during delivery but this level was getting dangerous and it was at this point that Dr. Osmun started talking about surgery. I also remember Vicky’s face. Concern was etched all over it and given that she had a front stage view, this did little to reassure me. However, throughout the entire procedure, Dr. Osmun looked in total control. He later admitted to being given a ‘right scare’ but at no point did he look like he was in trouble. I will also mention that the other members of staff were equally impressive going from routine to emergency mode in the ‘flick-of-a-switch.’ Nobody looked flustered or panicked and I feel a huge debt of gratitude to them for all they did.

In order to remove the entire placenta, Hazel required surgery. Dr. Osmun brought in another surgeon for a second opinion and they quickly agreed that it was necessary to perform a trans-vaginal D&C. Hazel was still semi-conscious and not really aware of what was going on. Vicky and I were now both by-standers whilst they prepped Hazel and transferred her to the OR. It was not the post-birth experience any of us had been expecting and there was nothing I could do about it. I am thankful for one thing. I have great faith in the medical profession for the most part. I knew that Hazel was in the best hands and never felt that she was in true danger. A warning to those people who take childbirth for granted. 40 years ago my wife could have bled to death – especially if she had been at home. There was no indication prior to the delivery that Hazel had placenta acreta. It is somewhat ironic that it is the proficiency of the medical profession that has led to complacency in childbirth. I for one am grateful that we have people who dedicate themselves to this profession.

It is hospital policy that if the mother cannot immediately nurse the baby, then the baby has to go to the special care unit where she is examined, sponge bathed, fed and cared for. After seeing Hazel off to the OR, Vicky and I went to the special care unit to be with Hannah. I still look back at this moment and feel quite proud of myself. If there was a time to lose it, it would have been then, but I did not (and neither did Vicky). I still felt entirely focused and surprisingly calm. We went into the special care unit and watched and assisted with Hannah’s exam. She needed to have a glucose test as big babies tend to have a lower blood glucose concentration. Hannah’s glucose level was a little lower than ideal, so she had to be given some formula to rectify this.

I am truly sad that Hazel was not able to feed her daughter immediately after she was born. We have joked about the fact that I was the one who gave Hannah her first feed and that her first ‘burp’ was produced shortly afterwards. Hannah is a ‘daddy’s girl’ because I was the one who interacted with her in the hours after her birth. All very cute. I would have given that up in a millisecond if it meant that Hazel could have held our daughter.

I had been told that Hazel would likely be in the OR for an hour. After about 90 minutes the nurse came and told me that Hazel was out and I could see her. They had wheeled her to a holding room whilst they organized the admission into the ICU. Admitting Hazel to the ICU was a precaution. She would receive 24 hour monitoring and given that she had lost 3 units of blood, it was the best place for her. When I walked into the room, Hazel was heavily sedated. She was lying on the bed with a heated blanket over her but still shivering (involuntarily) as the blood transfusion lowers the body temperature. She was semi-conscious and not really aware of where she was or what had happened. This was a tough moment for me. Hazel repeatedly asked where Hannah was and that she needed to feed her baby. All I could do was tell her everything was fine, that we had a beautiful baby girl and that she would see her soon. Just to add a bit of melodramatics, Hazel also whispered ‘will I survive.’ ‘Yes’ I told her. ‘I am not doing this on my own.’

They transferred Hazel to the ICU around 1.00 am on the Thursday morning. The experience had lasted 21 hours. Hannah was sleeping peacefully in the special care unit. Hazel was sleeping peacefully (with the help of pharmaceuticals) in the ICU. It was time to go home and try to get some sleep. My plan was to come back first thing in the morning to see Hannah and then see Hazel at 11.00 am (the earliest time I could visit the ICU).

By the way, Vicky had been at my side through the whole thing. I have not mentioned her too frequently in this account, but at no point did she leave my side. She was with me when they wheeled Hazel to the OR. She was with me when I fed (and burped) Hannah. She was with me when we went to see Hazel in the ICU. Vicky was a rock. We fed off each others strength and kept each other focused and centered. A huge thank you to a true friend.

We went home.

It was inevitable that the events of the previous day would catch up with me. The emotion threatened to break through as I got myself showered, dressed and had breakfast the following morning. I phoned Mum and Alison and Martin to keep them appraised and it was difficult to maintain my composure but I managed. It was only when I got to the hospital that I started to crack. Walking into the special care unit and seeing Hannah sleeping safely crushed me. I could barely stand up. I cannot describe the feelings I had at that moment but it took me a long time to get my shit together.

I sat with Hannah for about an hour before heading down to the ICU to see Hazel. I was a little early, but the nurse on duty was okay with me going into the unit. As I walked in, I could see Hazel was just out of bed and being assisted by one of the nurses to the restroom. Once again the relief and emotion crashed over me. Bloody hell. It wasn’t even 11.00 am and I was flaking out again. Of course, Hazel sees this and immediately thinks something is wrong with Hannah (pessimism is a character trait of Hazel’s for those of you who do not know here well). Shortly after 11.00 am Dr. Osmun came to the room to check on Hazel and he explained in more detail what had occurred and what would happen over the next 24 hours. Hazel was responding well to the treatment and they gave the all clear for her to be transferred to the post natal ward.

More importantly, she was finally able to meet her daughter.

I will end this ‘guest blog’ here. It has taken me quite a while to write this and has been an interesting experience. Reliving the events of that day and the following morning bring back many memories and emotions. I hope it was worth the read.

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