Shortly after finding out that I was pregnant, Nic and I hired a fabulous Doula team (Tammy and Lisa from Birth Baby and Beyond here in Cedar Rapids Iowa). Tammy and Lisa took fabulous care of myself and Nic while I was pregnant. I was very concerned that I would end up with a c-section due to spontaneous rupture of membranes without induction of labor (water breaks but labor doesn’t start). This had happened to 3 of my sisters and I wanted to avoid a c-section unless absolutely necessary! Tammy and Lisa helped us write up and simple and flexible birth plan, but being a nurse I was suspicious of birth plans; Nic and I called it our “Birthing Wish List” (copy included at the end).
I wanted to labor at home for as long as possible, because while I wasn’t comfortable birthing at home, I did want a low intervention birth and I knew the longer I was at the hospital, the bigger the chance of me getting multiple interventions would be. During my OB screenings I found out that I was Group B Strep +, which would require a dose of antibiotics at least 4 hours prior to delivery of my son. I told my OB that I still wanted to labor at home (I only live approx 3-4 minutes away from the hospital at which I chose to deliver.). My OB was agreeable to let me labor at home. He was of the opinion that me being a first time mom, by the time I decided I was ready for the hospital, I would more than likely have more than 4 hours left of laboring.
The morning before my due date (12/23/15) I had an OB visit, my OB was off for the holiday and the office was slammed trying to fit 5 days of appointments into 3 days with some of their OBs off that week. The OB that did my check was very rushed (he didn’t even tell me what I was effaced or dilated to, and I had started both in the weeks before this visit). I asked him what would happen if I didn’t go into labor by the end of the weekend. I didn’t know if I would just call the office on Monday and try to make an appointment to be checked again? He said, “Don’t worry we’ll get you taken care of,” and rushed out of the room. He returned shortly and abruptly handed me paperwork to start an induction on Sunday night (12/27/15). I was a bit shocked and taken aback; it was my understanding that first time moms often have a longer pregnancy and it is normal for them to go to 41 weeks. I asked him if I MUST have an induction and he acted very put out that I would question his plan of care, stating “Well we have to get him out of there eventually”. I convinced him to delay the induction until later the next week by promising to come into the hospital over the weekend for a non-stress test. When I left the office I went to my car and cried; I was upset that I hadn’t had the foresight to discuss this with MY OB before he went on vacation and to set up a plan for if I was late. I was sure that if I ended up with an induction that my labor would be too intense and I would end up with an epidural. I had spent so many months reading, learning, and practicing techniques to have a low intervention birth so I didn’t want that all to go to waste.
That night I finished getting ready for our low key Christmas (we didn’t even put up a tree since we didn’t know if we would even be home). I very much wanted to spend my 4 day holiday weekend relaxing and getting ready to meet my son! Nic and I decided to go see a movie (Star Wars). That night and I was surprised when baby boy spent most of the movie kicking and jumping around. He had been active my whole pregnancy but not usually for such a long period of time. After the movie, we were home and in bed by 11:00 pm and he was still wiggling; I loved his wiggles; I miss them now.
At around 12:30 am, I woke up suddenly because I thought I was wetting the bed! I ran to the bathroom and was very suspicious that my water had broken but it was really hard to be sure, so I laid a chux pad down on the bed and put a huge pad on me and went back to bed. About 20 minutes later it became more clear that my water was definitely breaking when there was a large “gush” and I became quite thankful for the chuxs and pads I had put down! Nic and I sent the Doula on call (Tammy) a text letting her know that my water was broken and that the amniotic fluid seemed to be a clear yellow color. Tammy assured us that yellow was a perfectly normal color for a full term baby. I also started to have small contractions every 10 minutes or so lasting 30-45 second each. They were very tolerable and not quite regular. Tammy said that as long as I was tolerating everything so well, that I should try and get some rest because I was going to have a very long day ahead of me. I took a shower, did my hair, and then went back to bed around 3:00 am and was able to sleep until about 6:00 am. My contractions were still 5-10 minutes apart, still approx 30-45 seconds long and still very tolerable, so Nic and I decided that he should go to work so his Paternity leave wouldn’t start until Monday (12/28/15) due to the holiday and long weekend.
Shortly before Nic left for work at 7:30 am, while I was standing in the kitchen making toast and folding laundry, I felt a new weird pressure in my vaginal canal. I remarked on it to Nic, told him it wasn’t painful, just different. I thought perhaps it was a larger piece of my mucus plug since that had only started passing during the night. Nic left for work and I stayed in the kitchen with the toast and laundry for another 10 minutes or so. I started to feel a little “crampy” so I went up to the bathroom and sat there for about another 10 minutes letting more amniotic fluid drain and passed a small BM (sorry for the TMI but birthing is gross). I also noted that on my pad was some darker green meconium looking discharge, I decided I should text the doula and let her know about the change.
Then when I went to wipe and clean up, I suddenly had a handful for umbilical cord in my hand. This changed everything. I felt that the cord was still pulsing. I called down to my mother (who lives with us and was staying with me during labor) and she came running up the stairs and I asked her if she could see my umbilical cord (I couldn’t see past my pregnant belly). She said that she could see about 4 inches hanging down. I looked at her and said, “We either need to call an ambulance or we need to go to the hospital right away.” She said, “Let’s just go!” I pulled up my dirty pad and pants, grabbed my purse, and ran out to my mom’s minivan. I sat in the seat behind her, leaned the seat all the way back, placed my feet against the front passenger seat, and then lifted my hips into the air to get pressure off the umbilical cord.
For those of you that don’t know, a prolapsed umbilical cord is a medical emergency under even the best circumstances (in the hospital with monitors and IVs and just minutes away from an OR). In only 4 minutes a prolapsed cord can cause fetal demise because blood is being obstructed from the baby and so is the oxygen in that blood. I had already been prolapsed for approx 20 minutes. The biggest thing keeping me from panicking at this point was knowing that the cord had been pulsing, that my contractions had not been very strong yet, and that panicking would fix nothing. This is also where my training as an emergency nurse came into place. I knew I needed to get my pelvis in the air and use gravity to push the baby back and off his cord.
While in the car, I called my husband, told him my cord was prolapsed and that he needed to come to the hospital right away. Later on Nic told me that he was sure that the baby was dead and that he took his time shutting off his computer and driving to the hospital because he was sure that the baby hadn’t survived such a dangerous complication. Next, I called the doula; I told her I was on my way to the hospital because my I had a prolapsed cord. She told me to get there as fast as possible and asked if I had called the OB unit yet because they might want me to go to the ER entrance. I hadn’t even thought of calling them yet, and we were only a few minutes away from the hospital. Luckily I had programmed the Birthplace phone number in my phone and I called them next.
I asked the woman who answered the phone if I could talk to a nurse, because I was a pregnant woman who was in labor. She said she was a nurse and asked what I needed. I told her that my umbilical cord had prolapsed and that I was on my way to the hospital but I needed to know what door to use and whether she wanted me to walk to the unit, or if they would meet me outside. The nurse asked me, “How do you know your cord prolapsed?”. I told her that I had felt it, and my mother had seen it. She told me to come to the OB entrance, and that they would meet us outside. It was only another minute or so before we entered the parking garage and started to circle our way up to the 3rd floor. It was approximately 7:55 am at that point.
There were 2 women waiting for me, one with a wheelchair and another wearing sterile gloves. I jumped out of the van and sat in the wheelchair so that my butt was hanging off the front edge. I was taken straight back to a room where even more nurses were waiting and told to take my pants off ASAP. As I dropped my pants right in the middle of the room, I heard a nurse yell, “I can see the cord! GET IN THE BED NOW!”. I jumped in the bed and the nurse (I later learned her name was Susan. She is one of the biggest heroes of this story) wearing the sterile gloves crawled on the bed in between my legs and shoved her hand into my vagina to provide counter pressure against my son to get him off his umbilical cord. To say the least, this was incredibly painful; it was a very intense sharp pain when Susan was pushing back on my son. I started screaming because it hurt so badly, but I didn’t want Susan to think I was screaming for her to get off of me or screaming to make her stop. I started screaming “IT’S OK, IT’S OK, I KNOW YOU’RE DOING THE RIGHT THING”, over and over again. At the same time the rest of my clothes were getting ripped off and monitors are being placed everywhere as they were attempting to find fetal heart tones with the doppler. They could not find them. At this point, I lost it a little. I started really crying and sobbing’ I felt for sure that my son had died and that I was too late. Before I knew it, they threw a sheet over me and started rolling my bed with Susan and me on it down the hall and towards the OR for an emergent c-section.
In the OR, Susan and I had to snake our way over to the OR cart and then it was another swirl of more monitors and IVs. Then blessedly they broke out the larger ultrasound machine and were finally able to find fetal heart tones! I started crying, “IS THAT HIM? IS THAT HIM?” I was so happy! His heart rate was 155 bpm which is a great rate; I was thrilled! Shortly after that, the anesthesiologist arrived and my nurse mode set in a little bit. I wanted to know what meds they were using and I was a little frustrated that the oxygen mask was blocking my view of my vital signs. I think I told the anesthesiologist multiple times that narcotics make me very nauseated and asked for antiemetics. Then the OB on call showed up and I was finally draped with a sterile field (poor Susan got stuck under the sterile drape until my son was out). The OB told me, “Marla we are getting your son out right now!” Then they put me under general anesthesia; I remember being so relieved when they finally put me under, because I was still feeling so much pain from Susan’s counter pressure and now I wouldn’t have to feel that pain anymore.
I was not conscious for the next things that happened, but this is what the nurses, my mom, and Nic have told me what happened.
Walter (my son) was born at 8:19am, he gave one cry (Susan said that was the best Christmas gift to hear him cry since she was stuck under the sterile drape). He was covered from head to toe in meconium (when his cord prolapsed he became stressed out and passed a large meconium, which is why my amniotic fluid changed from yellow to dark green). Walter had to be bagged for 2 minutes before he started spontaneously breathing. He had aspirated meconium into his lungs so he had to be placed on CPAP to help him breath, and he was placed on IV antibiotics to prevent an aspiration pneumonia. Nic was taken back to Walter’s NICU room about 10 minutes after Walter was born. Walter also had cardiac monitors, O2 saturation, and temperature monitors on him. Later that night, he would also get an OG tube (Oral Gastric) to decompress his stomach from air being pushed in from the CPAP so his stomach wouldn’t push up on his lungs making it harder for him to breath.
I woke up from surgery at approx 9:15am, They brought Nic to me fairly quickly, which was wonderful. I had really been wanting him near since I was first taken to the OR. When I awoke, my whole body was shaking (from the medication they use to put you under). They gave me dilaudid and demerol to help with pain and shaking. Nic showed me pictures of Walter on his phone, and there were so many monitors on his little body; though, I was told he was doing well. He weighed 7lbs 13 oz. and was 19.5 inches long; APGAR scores were 2,6, and 8. While Nic and I were in the PACU, the OB MD came in to talk to us. She was mad. She couldn’t understand why I hadn’t come to the hospital right when my water broke, and in my altered state with pain medications on board, I couldn’t seem to explain to her that my amniotic fluid was normal when it broke. She didn’t care. She was not impressed by our choice to stay home and told us multiple times that Walter almost died. A reality that Nic and I were all too aware of, something that we are not likely to ever forget. Even though the OB was not the nicest person to us while we were in the hospital, she is still one of the heroes of this story, and I will forever be grateful to her for getting me son out alive. This story could not have had a happy ending without her.
While in the PACU, once I knew Walter was okay, I remember being really sad that I didn’t get to see my placenta, something I had really been looking forward to seeing (my body had worked so hard to make that thing! I wanted to see the fruits of my labors!!). I was also a little disappointed that we hadn’t been able to bust out our slightly satirical “Birthing Wish List” that we had worked so hard on.
After the PACU, the nurses rolled my bed into Walter’s NICU room. I couldn’t see his face with the way he was positioned, but I was able to reach my hand through his bed to touch his little knee. They let us stay in there for about 30 minutes and then I was taken to my OB room and started on my own IV fluids and antibiotics. I also had a catheter and SCDs on my legs, as well as a dilaudid PCA (narcotics make me feel awful, yay Zofran). I wasn’t allowed to get out of bed for 6 hours, and I honestly don’t remember much of those 6 hours. When I was finally allowed to get out of bed, Nic and I hobbled over to Walter’s NICU room. We weren’t allowed to hold him yet, too many monitors, IV’s, and CPAP. Although I couldn’t hold him, I could still touch his baby soft skin and giggle at his hairy little shoulders. I didn’t think he looked like either of us, but was happy to hear the nurses say that he was doing well, that they were sure he would be off the CPAP by the morning.
Back in my room, I asked my new RN that was coming onto the night shift if I could start breast pumping (Walter was not allowed to eat for 24 hours because they were worried that he might have a bowel injury from his decreased oxygen levels at birth). She brought me a hospital pump, said she hadn’t set one up yet (she was a new young RN). So we read the instructions together, and I stupidly sat there on the pump set at full blast for a full hour! It might not have been so bad except that I had used a flange that was too big so my left areola tore, which is good because it kept me from doing the same thing multiple times the rest of the night. By morning, one of the NICU nurses saw what I was doing and corrected my course. She is another one of our heroes, because she let me hold Walter for the first time. He had successfully weaned off the CPAP during the night. Holding Walter for the first time was wonderful. We stayed skin to skin for hours, snuggling and trying to figure out breastfeeding (which we are almost 4 weeks out and we are STILL trying to figure out breastfeeding!).
Walter and I stayed in the hospital for 4 days. Walter made great progress; although, he will always be at risk for some sort of cerebral palsy or seizure disorder because we’re not sure how badly the cord prolapse affected his brain. So far he is acting and behaving like a completely normal baby. The neonatologist is optimistic about his prognosis, because Walter has all the expected reflexes and behaviors. I have healed from my c-section quite well; pain hasn’t been nearly as bad as I expected it, and I was able to avoid all narcotics after my IV was removed post-op day 1. All in all, we have been very lucky and blessed.
There is a lot of gratitude in my heart for the people that helped bring my son to me safely. It didn’t take much to start me blubbering and crying during the weeks after his birth, because I knew how close we had come to a much different ending to our story. I’m so thankful to have my son, my little Walt, to listen to his little snores while I’m typing up this story. I’m grateful to our friends and family who have done such a great job taking care of us. I’m thankful for my wonderful husband, who has had to do a lot more nursing of me than what was expected. I am amazed that I was able to have had training as an emergency room nurse, so I knew what to do when I felt the umbilical cord hanging. I am reminded how much my Heavenly Father loves me, and my heart is full.
Marla and Nic's "Birthing Wish List"
Thank you for taking care of me and my family. I know you are working your asses off to keep my baby and I healthy. I am new at this and I appreciate all your hard work.
I brought a great birthing team with me:
Husband - Nic
Sister - Laura
Doula - Tammy/Lisa
They are here to take some pressure off of you. I have a very small wish list that would help me feel less anxious about this whole birthing process.
Of course, if shit is hitting the fan, we have full faith in Dr. Pickering and his team. We know you guys are prepared for emergencies; we trust you. Please keep us in the loop.
-I’d really like to move around a lot, walk, with multiple laboring/birthing positions.
-Go ahead and slap an IV in me, but I’ll let you know if/when I’m ready for pain meds. I’m one tough cookie; I’d prefer no epidural.
-No need to wash that gooey baby off! Plop him on me as soon as he pops out with breastfeeding ASAP please.
-Delayed cutting of cord.
-At least one parent with baby for all procedures, please no formula.
We are NOT circumcising baby, pacifier is fine with us! Dr. Machnowski is our pediatrician.
Sweet and short! I apologize ahead of time for all the cussing, but I’m sure you’ve heard and said worse ;)