Tuesday, September 16, 2014

A terrifying week: Part 2 (long)

On Tuesday morning we headed back to the OB office.  The tech started the anatomy scan portion and was able to get a few more of the needed pictures, but not the profile shot.  Baby girl just stared straight at us the whole time, refusing to turn her head.  We switched to the cervical length check portion and once again I could tell that it didn't look right.  After taking the measurements the tech tried once more to get butterfly's profile shot, but stubborn baby wouldn't give it up.  Back to the waiting room we went before being called back to see Dr. J again.  She calmly explained that I had lost about 2mm of cervix since Friday.  It was time to go back to the hospital.

I was admitted to the Evaluation wing again.  MFM assistant Dr. J came in and checked to make sure my cervix was still closed, which it was.  The contraction monitor showed some irritability in my uterus so they started a saline IV.  MFM Dr. H met with us again and went over our two options again,  Dave and I had decided not to take any more chances with progesterone and it was time to move forward with the cerclage.  Dr. H agreed and was able to get me into the 7:30am surgery slot for the next morning.

Once it was finalized I was moved to the Mother/Baby unit, a large wing of the hospital with all private rooms.  I was able to eat dinner and relax, fasting for the procedure would start at midnight.  Dave ran home quickly once I was settled to pack a bag for me.  The nurses were all very kind, though it surprised me how often they came in to check vitals.  As it got later I sent Dave home to sleep.  The chair that converted into a bed was very uncomfortable for him and someone needed to feed the cats.  I was able to sleep for a few hours in between nurse visits.

Around 8am they transferred me to Labor & Delivery to prep for surgery.  The L&D nurse sent Dave to get something to eat, saying that we would be waiting a while for the OR to open.  He wasn't allowed to be in the OR for the surgery, but would be able to see me off.  The anaesthesiologist came in and explained how the spinal would be done.  MFM assistant Dr. J and a student doctor, who would be observing, came in to help with preparations.  Dr. H arrived and it was time to go.  Dave had not made it back upstairs before I was wheeled to the OR.

Once on the table they had me sit on the side with a pillow hugged to my chest.  The student doctor held my shoulders as I arched my back as far as I could.  The anaesthesiologist quickly washed the area, felt my spine, and inserted the needle.  It felt like a small pin prick.  There was another little stab of pain, then a warm feeling washed down my body and into my feet.  I laid back down as they started adding attachments to the table.  Before I lost all feeling in my lower body they had my legs up in stirrups and my arms straight out to the sides.  I could somewhat feel people touching my lower body as they washed and prepped me, but there was no pain.

The table was tilted back to raise my lower body and I felt very vulnerable.  Blue sheets were placed so I couldn't see what was going on.  The anaesthesiologist sat by my head, making sure I was okay.  My upper body was shaking like crazy and they piled warm blankets on top of my chest and arms.  Dr. H got to work and I really couldn't feel anything besides the occasional jostling.  Everyone in the room remained upbeat so I tried to relax.  About 45 minutes after getting to the OR, the procedure was done.  Dr. H came over to talk to me while the others cleaned up.  He said the cerclage was successfully placed and not a moment too soon.  When he started the procedure I had been 2cm dilated with the membranes coming down.  If we had waited, who knows what may have happened.

I was transferred back to the gurney and wheeled to recovery.  L&D nurse went to find Dave after hooking me up to the monitors.  Dr. H checked on me again and warned about the coming pain once the spinal wore off.  It was at that time I learned they had placed a catheter during the procedure.  He explained that the spinal could impede my ability to urinate for a while so the catheter would stay until the next morning.  Awesome.  Dave came in, looking scared as hell.  He was very upset about not making it back up in time, but calmed down after hearing that everything went well.  I'll never forget the terrified look on his face when he learned that I was 2cm dilated at the start of the procedure.  We stayed in recovery until I regained enough feeling to wiggle my toes and bend my knees.

Around 11am I was brought back to the Mother/Baby unit.  My parents had already started their 5 hour drive down from Boston.  My mom would be staying with us for a while to help out as I would be on bed rest until further notice,  As the spinal continued to wear off I understood Dr. H's warning.  It felt like someone had beat my pelvis with a bat.  The nurse gave me a Percocet and some anti-cramping meds.  All the Percocet accomplished was making me very nauseous.  Zofran helped a bit and I tried to remain distracted by updating friends and playing iPad games.  My parents arrived a few hours later, just as the zofran wore off.  I greeted them by yelling for a bucket and puking up banana and water.  What a great daughter.

The pain was pretty bad for the rest of the day, especially when butterfly decided that kicking my cervix was fun.  After another Percocet failed to help, my awesome Nurse was able to get a one time order for Tylenol with codeine.  That worked like a charm and the pain went down to mild discomfort, mostly around the catheter.  Dave's parents came down and took him out to dinner.  My Dad had to head back home for work so Mom and I watched Frozen.  Dave went home to sleep and take care of the cats while Mom stayed with me overnight.

Dave arrived early the next morning with ice coffees and hash browns from Dunkin Donuts.  Have I mentioned before that he is the best husband ever?  Dr. H stopped by to see how I was doing.  He mentioned that I should expect to have bleeding for a few days and increased discharge.  That was all normal, but to be on the look out for leaking fluid.  Depending on how butterfly makes her entrance to the world, they'll either remove the cerclage at 36 weeks or just remove it during the scheduled C section.  We had an appointment set up to come back to the hospital in two weeks for an ultrasound.  They would check cervical length and the stitches.  He wished us well and said the on call OB from my office, Dr. B, would stop by to take care of the discharge paperwork.

The nurse came in and removed the IV and catheter.  I can't even describe how great it felt to have the catheter out.  We had a few more hours of waiting before Dr. B came in.  He laid out my bed rest instructions.  I could work from home for now, but if it became stressful then they would pull me out of work completely.  I could get out of bed to use the bathroom, take short showers, but could not be standing for more than 30 minutes.  Since we live on the third floor of the building with no elevator I can only leave the house for doctor's appointments.  Dr. B wanted me to schedule a follow up in the office for later in the day after the hospital ultrasound.  He left to go finish up the paperwork.  I took the opportunity to shower, which felt amazing, and changed into my regular clothes.  We were headed home within an hour.

The entire time I was in the hospital butterfly was perfect.  She was never in distress, her heart rate was always in the 150s during every check.  Whenever they strapped on the contraction monitor she would punch it.  As I write this now she is currently doing karate.  I am so thankful that the doctor's were monitoring for incompetent cervix and acted as quickly as they did.  Everyone from the OB staff, nurses, and MFM team were amazing and made sure we were in the loop and comfortable.  I look forward to seeing the hospital staff again for butterfly's grand entrance in a few months.        

Monday, September 15, 2014

A terrifying week: Part 1

Last week was probably one of the scariest weeks of my whole life.  Friday before last we headed in for the anatomy scan and cervical length check.  The tech pointed out everything she measured.  Seeing butterfly's little fingers and toes was amazing.  Being the trouble maker she is, butterfly would not get into position for all the pictures the tech needed.  After a quick bathroom trip it was back on the table for the cervical length check.  I could immediately tell that something was wrong.  The tech spent a lot of time measuring and getting different views.  We were then sent to the waiting room with no pictures as butterfly had not given up her profile shot.

When we were called back to meet with Dr. J I was practically shaking.  Dr. J came in and calmly explained that my cervix had shortened from 3.7cm last check to now 8mm.  We were to head over to the hospital immediately for observation.  After checking in we were taken to the evaluation wing and into a private room.  I was hooked up to the contraction monitor, which thankfully showed a quiet uterus.  They did another ultrasound to confirm the original tech's findings.  One of the MFM assistants came in, Dr. J, and did a speculum and internal exam to make sure my cervix was still closed.  It was, which she was very happy about.  Dr. C was the OB on call from my office and she came in to chat.  She said the MFM would come up after his rotation downstairs to talk with us about options.  Her recommendation was a cerclage, where they stitch the cervix shut, but the decision would be up to Dave, the MFM and me.

After a few hours, where I wasn't allowed to eat or drink in case we did the surgery, the MFM Dr. H came up to talk to us.  He explained the two options.  One, we could try progesterone and bed rest.  The concern about this route was it may not work at all.  Also, the study for this process had turned away anyone with a mullerian anomaly.  The second option was the cerclage.  With the cerclage there was a chance of him breaking my water during the procedure.  After discussing the options with Dave, we decided to try the progesterone and bed rest route first.  Once we got closer to viability at 24 weeks then we'd consider the cerclage.

I was discharged about an hour later with a prescription for Crinone, a vaginal progesterone suppository, and instructions for bed rest.  I could get up to use the bathroom and take short showers, but had to be in bed the rest of the time.  We would go back to the office on Tuesday for a follow up ultrasound and anatomy scan take two.  In the meantime I could work from home as long as I didn't get stressed.

We headed home, exhausted and hungry from the long day.  I got set up in bed and snuggled the kitties,  They were very happy to have us home after being gone most of the day.  With some sadness I backed out of my friend's bacherlorette party, knowing I likely would not be able to walk around that much in two weeks.  There was still hope I could at least attend the wedding, even if it meant being in a wheelchair for the day.

To be continued...