A Rupture In Time

I know it has been an uncharacteristically long pause between posts and everyone is probably wondering how Triston is doing and what happened with his birth.  There are a number of reasons for my delayed post, but the main one would have to be procrastination. I am still healing, adjusting to my little guy’s arrival (he’s up alllll night long and eats a lot!), and trying to figure out what happened with my body leading up to Triston’s birth. I have to say that although I knew what to expect with my c-section this time around, nothing could have prepared me for what the doctor had to go through to ensure my baby boy was delivered safely.  I am still waiting for my post-partum appointment to discuss my myriad of questions, but I think I may have come to terms that my pregnancy with Triston will likely be my last one. However, our journey has only just begun.

Triston is 5 weeks old this week and I can’t believe how fast the time has flown by since his birth. He is such a sweet baby boy and although he had to spend a couple of weeks in the neonatal intensive care unit (NICU), I was able to at least get him to 34 weeks and 6 days with the help of my cerclage. And surprisingly, this time it wasn’t my cervix that was the problem as it stayed closed during my entire pregnancy, up until I went into labor. Unlike my last pregnancy where my cervix silently opened with no contractions, I actually went into hard labor this time that couldn’t be stopped.  More on that later in this post…

UPDATE ON TRISTON
Despite Triston’s early birth we are so blessed for his short stay in the NICU and that he came home on low-flow oxygen. He is growing bigger each day and as of his one month appointment this week, he now weighs 7 pounds 9 ounces. His pediatrician told me that my breastmilk must be like heavy cream because she couldn’t believe how fast he is gaining weight!  Hearing that news really boosted my confidence. We couldn’t be more proud of his progress.

The pneumothorax that he suffered in the hospital healed with the help of the chest tube. The chest tube was removed while he was still in the NICU and he only has a small scar as evidence of his ordeal and will not have any lasting effects. We have discovered that Triston does have GERD, (Gastroesophageal reflux disease), but since he has been on Zantac for the last week it is helping him greatly.  He was in so much pain both during and after he ate, that it was concerning. Both of my girls had reflux so it wasn’t difficult to recognize the symptoms.  His pediatrician tells me that his reflux is more than likely a direct result of his immature gastrointestinal tract. He also simultaneously had Thrush, so both baby and mom were suffering from painful feedings. Oral Nystatin and Nystatin diaper cream helped clear up the problem within a week.

We saw a cardiologist last week regarding the findings from the echocardiogram Triston had in the NICU.  The cardiologist feels that the hole in his heart, a PFO (patent foramen oval), will likely close on its own.  The doctor also informed us that the heart murmur and pulmonary hypertension will also eventually resolve. Until they do, we are not to go any higher in elevation than where we are now and until his pulmonary hypertension has resolved, Triston will have to remain on oxygen that his body needs for treatment of the pulmonary hypertension. We are told that there is no way of predicting when these issues will heal, as it could be two weeks to a year. However, the cardiologist feels confident they will eventually resolve and there will not be any residual side effects.  Hallelujah!

We have a respiratory therapist that comes to the house weekly to check Triston’s oxygen levels to make sure he is doing well at the current settings and will be doing periodic overnight tests to help determine when he can come off of the oxygen. Although it is scary, we are encouraged by the doctor’s words. His cardiologist informed me that when Triston is able to come off of oxygen, it is likely because his PFO and elevated pressures have resolved as they should happen simultaneously.  We will return to the cardiologist the month after Triston is taken off oxygen to do a repeat echocardiogram and ensure everything has healed.  Yesterday, the RT visited us and was able to lower the oxygen back to 1/32.  So perhaps everything will resolve sooner than we think.

Triston’s early birth was not as traumatic as my youngest daughters, because I knew what to expect this time around and I knew that although he was going to be born early he was a good weight and was now at a viable gestation. That provided some comfort. However, my body’s reaction to labor is another story.  I am still trying to make sense of what happened during my c-section.

UPDATE ON MOM
Warning:  This is an account of what happened during my second c-section and does not represent what would happen in a typical c-section or a typical pregnancy. Every situation is different and the fact that my body seems to grow scar tissue very easy as well as the challenges I have encountered with endometrial regrowth could have contributed to my personal situation. I want to make sure that those reading this who might be facing their first c-section are not scared away by my very vivid discription as what happened to me is certainly not the norm and is generally documented in multiple c-sections.  Please consult with a doctor with any questions you might have regarding your c-section or pregnancy.

As everyone will recall, I began to have strong contractions in week 33 and visited labor and delivery twice that week.  In addition to the 60 mg of slow release Procardia tabs that I took daily, I was given tributalin and additional Procardia but 40 mg administered in the form of 10 mg every 15 minutes over the course of an hour.  Although the tributalin did not work to stop the contractions, the Procardia in week 33 did work to slow the contractions.  I was sent home and told to be on strict bedrest.  However, by week 34 and 4 days at my regularly scheduled cervical check it was apparent that Triston had dropped further and was now pressing on my pelvis. The doctor tried to remove my cerclage, but could only take out part of it since I started bleeding heavily.

At 34 weeks and 6 days pregnant (September 8^th), the contractions (which never really fully went away from the week prior) began to become very painful.  Laying down that morning did not help the pressure and although I had taken my first dose of 30mg of Procardia XL, it didn't seem to be helping either.  Sorry to be graphic but I was also having bouts of diarrhea all morning, which had been unusual for this pregnancy. When back pain began to accompany the pressure, realized that I was likely in labor. However, I honestly couldn’t tell you how far apart the contractions were because it seemed like one big contraction that never stopped.  My stomach hurt to the point where it felt like I had eaten something that was going to make me sick.

My husband left work early to come home and take me to the hospital.  Although one of my sisters was already on call to watch my girls should I need to go to the hospital again, I asked her this time to bring her overnight bag because my instinct told me this was it.  Bless her heart she agreed to even stay for a few days or as long as we needed her if I did go into labor.  My girls love her and I felt at peace that I could leave for the hospital and she would take care of things at home for us while we were gone. My husband loaded our overnight bags that we packed a while back, along with the camera and we headed over to the hospital.

I was scared.  I was curious.  I was oddly at peace. I trusted that everything would happen as it was supposed to. I know now, that I apparently had some very powerful angels watching out for both me and my baby. 

Upon arrival my OB, who was already at the hospital, did an exam and found that my cervix was 1.5 cm dilated. The exam caused the pressure to increase and I started cramping. Over the course of a couple of hours, they could not get my contractions stopped and he ordered more 10mg Procardia to be given every 15 minutes, for four doses. By the third dose my head began to feel strange, and my blood pressure and heart rate began to rise. At the time I did not understand why the monitors kept beeping incessantly and I kept asking if it was my baby.  The nurse kept reassuring me that my baby was fine, but it was me that was making the monitor beep.

Since Procardia is a blood pressure med and should have further lowered my usually low heart rate, it didn’t make since that it would be a reaction to the Procardia.  Afterall, I had been on Proacardia since week 17 and it did a stellar job of helping me avoid high blood pressure in addition to stopping contractions up to this point.  The doctor said that he needed to consult with his associate, but that a c-section was 89% inevitable at this point.  He thought I had been given the steroids in week 33, but unfortunately with everything that happened that week we missed the window.  It was too late at this point. We just had to hope that my baby had done enough growing in-utero that he would be ok.

After the OB left, I asked the nurse what she thought the next step would be to stop labor and she said that she wasn't really sure. I realized at this point, there was some concern about my heart rate and blood pressure. Although no one was really saying anything to me about this, I have known my doctor for over 6 years and have come to recognize his expressions when he thinks something is off with my pregnancies. Magnesium sulfate suddenly came to my mind as an option they might be considering for me and for some reason my instinct jumped me into hyperdrive and I blurted out to the nurse that "the mag" was not an option and I would not allow them to put me on it. I know this may seem odd to some people why I would not try for one more thing like that to stop contractions, but my internal instinct was working overtime and I had a very intense feeling they should not give that med to me as the side effects on me and the baby could be very detrimental. (I had previously read about side effects to the baby, but it wasn’t for that reason entirely that I was suddenly scared. I had sudden intense fear that I should not be given anything further to stop what was happening.)

My doctor did another exam and discovered that within an hour my cervix was now dilated to 2cm.  My contractions had not stopped and I now felt extremely uncomfortable and woozy from the Procardia.  My heart rate continued to rise. My blood pressure continued to rise. The doctor decided that it was time, he needed to move forward with the c-section.

This time around the spinal was quite painful,  BUT I was a lot more numb with this c-section and did not feel pressure from the tugging and pulling to get my baby out so that was a plus. But while I was laying on the table with the blue sheet in front of my face shielding both myself and my hubby from witnessing my c-section, I kept glancing over at the monitor and noticing how high my pressure and heart rate still were. The anesthesiologist kept asking me if I was ok.  My head felt very strange, but I didn’t feel like I was in jeopardy. I could tell my OB and the anesthesiologist were discussing this almost in code and trying not to let me know.  It suddenly occurred to me that something was not right when I began to smell burning flesh. At one point, in my husband’s words, it was like a BBQ gone very wrong with the amount of smoke filling the room.  So I asked what was happening and was told that I had a great deal of scar tissue and he was having to cauterize to stop the bleeding, while trying to get to my uterus so he could get my baby out. I was still oblivious as to what was going on.

When my baby was born, he let out a glorious cry and I forgot what was happening with me and tried to focus on Triston as they layed him on my chest. It took me a long time to focus on him and make my eyes work. I couldn’t really see and thought maybe it was the bright lights.  I have since learned it was my blood pressure.

What I didn’t realize was that my previous vertical uterine incision had ruptured…

The doctor was in the process of trying to cut through massive scar tissue that had formed and now had veins coursing through all of it causing me to have excessive bleeding and to make matters worse my uterus had also adhered to my muscle. After getting through what he could to get to my uterus, he also had to cauterize the scar tissue to stop the bleeding (thus the strong smell of burning flesh), but as he started to make the horizontal incision my vertical incision ruptured. 

In recovery my temperature dropped considerably and they couldn’t get it to come back up so a strange contraption was brought in to warm me up. It looked like a large floating device that you would use in the pool.  It hooked to a giant heater that blew warm air in through it. It worked beautifully and by the last part of an hour, my temperature was finally back to normal.  Not realizing that I had been through so much, I asked the recovery nurse if the doctor did a horizontal uterine incision and I was informed that it was in fact a vertical incision based on what she saw and noted in my chart.  I was upset with my doctor wondering why he felt it necessary to perform a vertical incision. The doctor later informed me that he did perform the horizontal incision, but I ruptured vertically as he was doing the horizontal incision.

In my research, I have discovered that the rupture if it actually started prior to the incision, is likely to blame for my high blood pressure and not a reaction to the Procardia as I first thought. For more information on uterine ruptures, please visit this link.  However, I have a list of questions to ask my doctor at my post-partum appointment in a couple of weeks. I feel lucky to have made it through to almost week 35, lucky that I have a healthy baby boy, and lucky to be alive based on what I have pieced together.

Despite everything that happened, I still would not have changed a thing regarding my decision to get pregnant again. And again my situation is not typical of a second c-section.  Triston is an amazing little boy and we are so blessed with our three children.  When getting the kids in the car to go to the pediatrician’s office this week, I looked at their beautiful little faces all snug in their car seats and it struck me how blessed we are to have our children. Funny that my mini-van full of children was my aha moment, but it was fulfilling to see their smiling faces and for once everyone was happy and big sisters weren’t arguing.  It wasn’t that long ago when a doctor told me in my twenties that I would not be able to have children because of severe endometriosis. 

I am so grateful for my wonderful hubby who has walked beside me during our journey to grow our family.  Our NICU experience with our daughter born at 24 weeks was life-changing, but we got through it and we grew stronger as a couple and as a family.  It’s not been an easy journey and I now realize that those who expressed initial dismay that I was pregnant again, were only concerned for my health because they did not understand about incompetent cervix.  I get that now.  But it is very rewarding to see those same people hold my baby boy and see the love and joy in their eyes as they admire him. I like to think that perhaps those same people now fully understand my reasons why I embarked on a journey to have another child.

Starting this blog was initially a way to keep friends and family up to date onmy pregnancy, as well as share information with others who might also have an incompetent cervix and may be thinking about having another baby. However, what I have discovered is that I am definitely not alone in this journey as there are so many women out there who have also suffered and incompetent cervix.  I have learned so much from my readers and along the way I have made some great friends.  I would like to encourage my readers to continue to share their stories of incompetent cervix (IC) and prematurity, as I am positive it is helping many women who are also contemplating having another child after IC.

Next week, one of my readers will be featured in a guest post sharing her story of courage and triumph after delivering a baby boy at 26 weeks. Trisha is pregnant again with a baby girl and hopes that through her story others “can find strength, comfort, and hope if faced with a premature baby.”   Look for her story next week.