2020 A.D., Part 3: The Third Trimester

If I've learned anything over the past 40-some years, it's that life doesn't care about your plans.  I certainly didn't plan on being a cancer patient at age 38, having to move 4 times in one year, losing my dad before he had the chance to walk me down the aisle, being pregnant for the first time at age 41, or that I'd be going to all my appointments without my child's father there with me due to a global pandemic.  To that end, I never saw the point of writing up a Birth Plan.  I had enough experience in the field of obstetrics to know how unlikely it is that the baby would adhere to it, so it just seemed like an exercise in futility.  I'm a person who thrives on making plans and sticking to them, so I knew I'd be setting myself up for disappointment if I tried doing that for the birth of my child.  So my only birth "plan" was to be open to all possible scenarios and turns of events.  However, even I was unprepared for how the last few weeks of my pregnancy would play out.  

One of the games we'd played at my baby shower in Ohio was having everyone write down their predictions for the birth, e.g. the date/time, the baby's weight and length, etc.  Since my due date was December 9, most people picked a date within a day or 2 of that.  My mom, however, predicted it to happen a week early.  She said that at my age, they almost never let you go the full 40 weeks since the stakes are higher and the placenta is not as efficient, so the general school of thought is "Why prolong it?"  She said most likely they would induce me at 38 or 39 weeks.  I was fine with delivering early since I was hoping to keep my baby's birthday as far from Christmas as possible.  I even asked Brian how neat it would be if she ended up being born on November 11, since that was both his and my dad's birthday.  He vehemently disagreed, though, saying it was too early and that no child wants to share their birthday. 

I actually had a very vivid dream near the end of my 2nd trimester that I spontaneously went into labor and had the baby at 11:05 pm the night before Thanksgiving.  Since Thanksgiving was 2 weeks before I was due, it seemed entirely possible that dream could come true.  I'd been discussing with Mom her plans for coming down for the birth, but it was impossible to set anything in stone without knowing when or if I would be induced.  If it ended up happening on or around Thanksgiving, that would undoubtedly complicate matters. When I asked my doctor at my 29 week appointment whether she had any inkling when or if they would schedule me for induction, she said it was too early to know that yet. 

On Friday, September 25th, I woke up bright and early for my second 1-hour glucose tolerance test.  My first test had gone perfectly with a one-hour glucose of 106.  I was worried I might not pass the second time around, but I found out the following Monday that I had actually passed the second test even more handily.  That one was 92!  However, my blood work revealed that I was borderline anemic.  The nurse who called me with the results said that since it was borderline, they didn't recommend iron supplements just yet.  When I reported this finding to my mom later, she asked me what the number was, but I didn't know since I'd only spoken with the nurse and hadn't seen a copy of the lab report.  I'd been noticing that this office didn't give actual numbers or reference ranges unless I specifically asked.  They preferred to just say something was high, low, or normal.  (On both my glucose tests, the nurse had simply said they were "normal" so I had to ask her what the exact numbers were.)  I'm a numbers person and prefer a bit more transparency, so I decided I would ask for a copy of all my lab work from that point on since I was starting to feel like I was being kept out of the loop.

The next day, I had a rather upsetting incident.  I was getting ready to take my morning shower and was piling all my daily pills, vitamins, and supplements into my palm when I realized one of them was not supposed to be there.  It was one of my old blood pressure pills that I'd been told wasn't pregnancy-friendly!  Even though I hadn't taken it in a while since my blood pressure was perfectly fine and even below textbook average, I had pulled that bottle off the shelf of my "active" prescriptions and set it somewhere else.  I had no idea how it had gotten placed back into the daily lineup.  My guess was that it happened sometime during the move, but I didn't know for sure so I had no idea how long I had been taking it without realizing it.  I called my OB that morning to let her know and she just said there was nothing I could do about it now except to stop taking it.  The main reason it wasn't pregnancy-friendly was that it's a diuretic, so the primary complication would be low amniotic fluid.  She said to let MFM know at my next appointment there so they could check my fluid level if needed.  I was so upset and angry with myself, especially over not even knowing how long it had been going on.  But it hadn't even occurred to me to be paying attention!  Every morning before getting into the shower, I take one each of the pills on the bottom shelf of my bathroom vanity without much thought, as if on autopilot.  Thank God I just happened to notice one of them didn't belong in there or it could've gone on indefinitely.  Pregnancy brain is very real.  

Since I had a history of estrogen-induced hypertension, I'd been watching my blood pressure since the beginning of my pregnancy.  My OB recommended at my very first appointment to schedule a visit with my PCP to see about pregnancy-friendly blood pressure medications.  But my PCP had said that, since my BP was fine, we should wait until it went up before treating me for it.  So I'd just been monitoring it and taking preventative measures such as the baby aspirin, keeping physically active, avoiding caffeine (much to my own chagrin), and watching my sodium intake (much to the chagrin of the people I was now cooking dinner for).  I'd been expecting my BP to be at least slightly elevated by the time I hit my third trimester, but it remained steady throughout the beginning of October.  

That same month, Brian and I began working on the baby's room since we had finally emptied all the boxes from it.  Choosing a paint color felt like the most impossible task ever.  I suffered from extreme option paralysis and Brian refused to give any input, saying he wanted the choice to be mine.  I finally made the decision by asking him to pick a random number and then going with the lightest shade on that page number of the Sherwin-Williams color fan deck.  Once again, it was hard not being able to help him with priming and painting so I sat on my hands and put that creative energy towards the decorating process.  I was getting anxious to have it done since we were going to need the spare bed to put up my mom and aunt KoAnn when they came down for my baby shower on the 17th. 

The week of October 12, I saw both my OB and MFM for my 32-week visits.  At my OB, I asked again about the possibility of being induced and she said we would likely finalize an induction date in 3-4 weeks, but that it would likely be at 39 weeks.  Of course, a lot could happen in that amount of time that could change that, but that was what they were anticipating for now.  I was grateful to at least have a rough estimate of when I'd be able to let Mom know when to book her flight down.  At MFM, the tech did all the usual measurements and estimated the baby's weight to be 4 lbs 2 oz which was right in the 50th percentile (although it felt like she was now taking up my entire chest cavity!) and my amniotic fluid was actually maxed out, so it seemed the diuretic hadn't had any adverse effect on that.  The scan also showed that the baby had a full head of hair.  The tech pointed it out to me, explaining it was all the wispy lines on the screen by her head.  

That same week, I also decided to schedule a maternity shoot since I really wanted to have one done.  A photographer friend of mine had offered to do it for me as a gift but our schedules just wouldn't align. So I set about searching for a photographer and just happened to find one who lived in town and whose only available date for the next several months was Sunday, October 18th, the day after my baby shower.  It was too perfect!  

I'd wanted my shower to be held that weekend for a few reasons: 1. Victoria would be flying in from California for a wedding so she'd be able to attend; 2. The weather was still nice enough in mid-October to hold it outdoors, so more people would be able to come while still remaining within the county's covid-era gathering protocols; and 3. My parents' anniversary was the 18th so I figured it would help Mom to be away from home and focus on the impending birth of her grandchild.  She and KoAnn left Ohio bright and early on Friday.  I had just put the finishing touches on the baby's room the night before so it was perfect timing.  The shower was being held at a local park from 1:00-4:00 pm on Saturday, but we had rented the pavilion for the entire day.  I was mostly looking forward to just hanging out with my friends since it had been so long since I'd seen most of them.  The weather ended up being a little chillier than I was hoping but the event itself turned out absolutely perfect!  It felt so good just being around people again!

My photo shoot was at 4:30 the next day, just as the sun was beginning to set.  I'd wanted Mom to come to the shoot, but KoAnn had to be back home by Sunday night, so they left immediately after breakfast Sunday morning.  I'd managed to schedule a salon appointment at 1:30 that day to get my hair done.  It was the only available time they had so I prayed my ultra-stubborn hair would hold until after the shoot.  The entire photo session lasted less than an hour but it was perfect.  It was shot at a nature park just a couple miles from our house.  The photographer emailed me a few untouched pictures a few days later as a sneak preview and said the full prints would be ready in about 4 weeks.  I absolutely could not wait to see them.  

Less than one week later, my good luck started to run out.  I noticed my feet, ankles, and lower legs were starting to swell, as well as my hands and face, too.  I checked my blood pressure a couple of times and it was slightly above my average, but still within normal parameters.  However, something just didn't feel right.  Swelling is perfectly normal in the third trimester but something inside me just felt off.  It was a general feeling of unwell that I couldn't quite describe.  

Pre-eclampsia had been one of my biggest fears about pregnancy long before I even started trying to get pregnant.  Most of the symptoms are indistinguishable from normal pregnancy stuff, but the main hallmarks are elevated blood pressure and protein in the urine.  My blood pressure is usually in the low 100s/70s but it started creeping up around week 33, which is when symptoms of pre-eclampsia often begin.  My OB's office always did a urinalysis at the start of every visit and had said nothing to me about the presence of protein, so I figured I was in the clear unless told otherwise.  I saw them again on Monday, October 26th, and my BP there was 122/78, which was slightly higher than my usual but still perfectly normal.  I told my doctor it had gone up a few ticks recently and she told me to keep monitoring it and let her know if it got to 130/90 or higher.  My mom was starting to get nervous that they weren't being proactive enough as pre-eclampsia tends to flare quickly.  She urged me to call my PCP again to see about putting me on Labetalol (the go-to blood pressure drug for pregnant women) before it became a real problem.  So I contacted my PCP but was told that at this point, all medications would have to come from my OB. 

By that same weekend, my BP hit 130/90.  So on Monday, November 2, I called my OB's office and the nurse told me to come in that afternoon to get checked.  Of course, when I got to the office, it was back down to 120/80.  The doctor examined me and said she didn't see any evidence of pre-eclampsia but she decided to run some labs just to have something for comparison later.  She said to keep monitoring my BP twice a day and let them know if the top number got to 140 or higher and/or the bottom number got to 90 or higher.  The next morning, my BP was 142/87 and 137/91 (I checked it twice just to be sure).  So I called the office to let them know, as instructed.  This time, I was told to let them know if it got to 160/110.  I was getting pretty frustrated that they kept moving the goal posts on me.  How high was it going to have to climb before they finally decided to do something about it?  Later that afternoon, the nurse called to tell me my lab work from the previous day had all come back "normal."  I wasn't relieved, though.  I did not like that unwell feeling, like my entire body was in a compression garment.  The last time I'd felt that way was when my blood pressure was near stroke range.  I wished someone would call me in something to take for it just for my own peace of mind!  I didn't want to wait until it was suddenly critical. 

After I left work that day, I was walking back to my car and started thinking about the possibility of becoming pre-eclamptic and needing an emergency c-section, like my cousin's girlfriend just a few months before.  Then I wondered: What if I had to have an emergency c-section without any anesthesia?!  I actually know two people that had happened to.  I started wondering what I would do if faced with that.  I didn't think I could go through with it.  They would just have to kill me first.  As I was walking and thinking about it, I suddenly started to feel warm and queasy.  By the time I got into my car and started driving home, I was feeling shaky and my legs were so weak, I could barely press down on the pedals.  I thought about pulling over but I just wanted to get home so I could lie down.  I was sweating all over and it felt like someone was standing on my chest, so I rolled down the windows and cranked up the A/C, trying to catch my breath.  By the time I got home, I didn't think my legs could carry me to the front door.  I was gasping for air, panting, shaking, and dripping in sweat.  I managed to hobble inside and immediately collapsed on the couch, feeling like I was either going to throw up or lose consciousness, or both.  I thought about having Brian drive me to the hospital, but I was too weak and dizzy to even stand up.  After about 20 minutes of lying on the couch and feeling like I was going to pass out, I gradually started feeling better.  A few minutes later, I felt completely normal again.  I had no idea what had just happened.  

The next day, it dawned on me that what I'd had was a vasovagal syncope.  I'd had a handful of those in the past (most recently the evening after my first breast biopsy) and all of them in response to some sort of bodily trauma or injury (sometimes my own, sometimes another person's).  But this was the first time it had happened from just thinking about it without anyone actually being injured.  The next time I met with my OB, I told her about the incident and what had triggered it.  She reassured me that if I did end up needing to be sectioned and we didn't have time for the epidural to take effect, they would knock me out with general anesthesia first.  That came as a great relief.  

The rest of the week, I continued to monitor my blood pressure and it continued to hover around 140/90.  I was really hoping they would finally put me on Labetalol at my next visit, which was on Tuesday the 10th.  My mom didn't want me to wait, though.  She spoke with several of the OB's at her office and none of them agreed with the 160/110 parameter.  They all said that by then, you're considered quite sick.  I told her I was continuing to log my BP and would definitely plead my case at my appointment, but mt doctor didn't seem to want to do anything as long as I wasn't in stroke range.  Mom argued that in her experience, it can flip overnight and suddenly become critical.  I asked, "Even without protein in the urine or any other symptoms of pre-eclampsia?"  She responded, "Yes!"

The week of November 9th, I had 3 doctor's appointments lined up: The oncologist for the clinical trial at Georgetown on Monday the 9th, my OB on Tuesday the 10th, and MFM on Thursday the 12th.  At Georgetown, I told the oncologist what had been happening with my BP and asked what her opinion was.  She agreed the 160/110 threshold was too high but deferred to my OB to take further action.  The next day, my appointment with my OB was supposed to be in the morning, but my doctor had to run to the hospital for a delivery so they rescheduled me for 1:45 pm with one of the other doctors.  This was a bit frustrating since I was anticipating scheduling my induction at this appointment and the last thing I wanted to do was wait even longer to learn when it would be.  I also had brought my BP journal with me to show them how it had been trending upwards over the last few weeks.  

At my OB's office later that day, they checked my BP and it was 140/86.  I was glad that, finally, they could see it with their own eyes so maybe they'd be convinced to take some action.  However, the doctor still refused to call in any medication.  She said that if I was in fact developing gestational hypertension or pre-eclampsia, they don't treat that with medication.  They treat it with delivery.  So I asked when exactly that might happen.  She said that by the looks of things, I would be getting induced next week, most likely on Wednesday when I would be 37 weeks.  She decided to draw the same labs as last week in order to compare the numbers and said to come back in a day or two for a re-check with my usual doctor.  I asked her if I could have a copy of last week's lab report.  She said she'd have her medical assistant print it off for me, and would also have her make a copy of my BP journal to put in my chart.  After the phlebotomist came in and drew my blood, the medical assistant walked in with last week's lab report and laid it on my purse, then took my BP journal and went to make a copy it.  While she was doing that, I picked up my lab report and looked it over.  My stomach dropped.  There was protein in my urine!!  Not just a little either, but nearly 3 times the normal limit!

"Oh, shit!" I said out loud to myself.  How long had this been going on?  Why had no one told me? Why did the nurse say everything was normal?  Had the doctor even looked at this report?  Most importantly: Why wasn't anyone doing anything about it??  As soon as the medical assistant came back in with my notebook, I jumped on her, asking frantically, "Where's the doctor?  I need to talk to her!"  But the doctor was already in with another patient, so the MA said she would get the nurse for me.  While I waited for the nurse, I went up to the front desk and scheduled my follow-up appointment with my regular doctor for Thursday at 10:50.  (My appointment at MFM was at 11:30 that same day, so this way I could go straight from one to the other.)  The MA came back a few minutes later and said the nurse was at lunch so she would have her or the doctor call me later.  I waited all afternoon for a call but never heard from anyone.  

The next day (Wednesday, November 11), I was 36 weeks along.  It was also Brian's and my dad's birthdays although, under the circumstances, we didn't have anything special planned.  While I was at home eating lunch with Brian, my OB's office called.  It was the doctor I'd seen the day before calling to tell me, yet again, that all my labs were "normal."  I asked her about the protein in my urine. She answered that since the protein/creatinine ratio was normal, it wasn't a concern.  The reference range for the protein/creatinine ratio stated anything under .2 was considered normal and my labs from the previous week showed it was .1.  I asked what it was this time and she said it was .2.  Even though that was still normal, it had doubled from the previous week!  I didn't understand how that wasn't a red flag to anyone.  Brian was sitting next to me at the table and had overheard the conversation.  As soon as I hung up, he high-fived me and said "Yay!  Everything was normal!  See, I told you it would be OK!"  But I wasn't convinced.  This just did not seem "normal" to me.  I couldn't understand why no one was taking it seriously.  

The next morning, I left work at 10:30 to head over to my OB's office for my re-check.  They checked my vitals and, of course, my BP was still elevated.  Right away, I asked my doctor about the protein in my urine. She agreed with the other doctor that as long as the protein/creatinine ratio was normal, it was OK.  She asked when my next appointment at MFM was and I told her I was heading over there as soon as I left her office.  She said she'd call them that afternoon to make sure they were all on the same page, but it was looking all but certain I'd be getting induced next Wednesday.  Based on everything, she said she didn't recommend me staying pregnant past 37 weeks.  

Before leaving, I scheduled my next OB appointment for the following Tuesday, wondering if I would even last until then.  Then I walked across the street to the main hospital pavilion and rode the elevator up to MFM.  While waiting to get called back, I texted my mom that she might want to book her plane ticket ASAP.  The tech did my ultrasound, took all the usual growth measurements, and estimated the baby's weight to be 6 lbs 1 oz.  While she was putting all the measurements together and printing her report, she casually asked me how everything else had been going.  I told her, "Well, my blood pressure's been elevated lately."  She stopped dead in her tracks and said, "Wait, what?"  I wasn't scheduled to see the perinatologist that day but, in light of this information, the tech said she would have him come in to check me himself.  When the doctor came in, he asked me to elaborate on my blood pressure issues.  I told him about how I'd been keeping a log of it and had showed it to my OB, and they refused to call anything in for it, but were planning to induce me on Wednesday.  He decided to check my BP himself so he put the cuff on my arm, his stethoscope in his ears, and started squeezing the pump, then stopped and let it hissssssss as he watched the gauge and listened.  He paused.  He looked up at me, then he looked back down and started checking it again.  I recognized the look he gave me right away because it was the exact same one my mom had given me 15 years earlier when she checked my BP and it measured 160/100, right before immediately checking it again just to be sure it wasn't a mistake.  It was an eerie deja vu moment.

"What is it?" I asked, not sure I even wanted to know.  He gestured "up" with his thumb and said, "It's bad.  You're getting delivered."  Trying to suppress my waxing anxiety, I asked him, "How bad?"  The exact numbers escape me but he said both readings were around 160/100.  I was starting to feel like I was detaching from my body at this point.  I couldn't believe what I had feared all along was coming true right before my eyes.  He told me to lie down on the table to try to relax and he would check it again in a few minutes to see if it came down at all.  When he re-checked it a few minutes later, it was back down to the 140s/90s.  However, he wasn't reassured because this was while I was lying down in supine position.  He said the second I got up and started moving around again, it would just come back up.  I then told him I had a copy of my lab report from last week if he wanted to see it.  He did, so I pulled it out of my bag and handed it to him.  He looked at it for all of two seconds and said, "You're pre-eclamptic.  You're getting delivered.  Tonight!"  

 

After 3 weeks of being made to feel like this was all in my head, I wanted to hear him say it in no uncertain terms.  So I looked him dead in the eye and said, "You're officially diagnosing it, then?  Pre-eclampsia.  Just like that?"  He responded, "Yes!  I mean, there's protein in your urine!"  THANK YOU!!, I thought to myself.  I informed him that my OBs had both said that since the protein/creatinine ratio was normal, it was OK.  He shook his head and said, "I could see that if it were just a little protein.  But anything over 9 is high.  You're 25.5!  No, you have pre-eclampsia.  You need to deliver tonight, if not sooner.  Like, this afternoon!"  As scary as it was hearing all of this said out loud, I was so relieved someone was finally taking it seriously.  He said he would call my OB to tell them his thoughts but he did not recommend I stay pregnant a day longer.  The problem with pre-eclampsia, he explained, is that it's very unpredictable.  I could have a mild case today but 24 hours later become severe.  Even though the baby was still premature, her lungs were now fully developed and most babies born at 36 weeks tend to do just fine, so he didn't see any benefit in keeping me pregnant for a few extra days just to get me to full term.  He told me to go home and rest but that I should be getting a call to come back to the hospital for induction probably in the next hour or two.  I left there without even bothering to schedule another follow-up appointment.  As I hurriedly made my way back to work, I suddenly felt like there was a ticking time bomb inside my body that could explode any minute.  My mom texted me as I was leaving the perinatologist's office, asking "What day is induction?  Wednesday?"  I texted back, "Tonight!"

 

Back at work, I frantically tried to tie up as many loose ends as possible and get everything in order for my maternity leave.  I also tried searching for a flight for Mom, but there was nothing leaving Toledo, Detroit, or Columbus before 5 pm the next day.  So it appeared she would have to drive if she had any hope of making it in time for the birth.  But my brother Rob had borrowed her car to drive to a job in Indiana, was currently driving it back to Ohio, and wouldn't arrive until 8:30 pm.  It was decided that she would wait for him to get back, throw some things in a suitcase, and the two of them would immediately jump back into the car and drive all night to Virginia.  Rob had to be back in Ohio for another job on Sunday night, so he would drive himself back on Sunday morning and leave Mom here, then come back the following weekend to stay a few days then pick her up and take her home.  In the middle of all of this, the hospital called and told me to come to the labor & delivery ward at 4:00 pm to be induced.  I looked at the clock.  It was already after 2:00 and I hadn't even packed my hospital bag yet!  I'd been planning on doing that over the weekend.  This was all happening way too fast.  I didn't see how any of it was even possible.

I arrived home from work around 3:00 and went straight upstairs to throw some things together in a bag.  Brian was still working in the dining room (his makeshift home office) and trying to finish up his day, plus make sure the boys and dogs would be taken care of for the night, and he still had to pack his bag, too.  We clearly were not going to arrive at the hospital by 4:00 but, at that point, I no longer cared.  (What would they do?  Start without me?)  We arrived at the hospital just before 5:30 (me still in my work clothes) and found parking in the garage right outside the entrance in a spot marked "Expectant Mothers Only."  It was funny because I'd been waiting my whole pregnancy to be able to park in one of those spaces and only finally managed to do it on the day of my induction!  

After checking us in at the L&D ward and admitting me, they led us down a long hallway to my room where they had me change into a hospital gown, stuck me with an IV, and hooked me up to a fetal monitor and a blood pressure cuff.  I remember scanning the room and thinking, "This is where our baby will enter the world.  This room will be the first thing she sees."  It seemed like such an unceremonious locale for such a momentous event.  Several different nurses came in to do a battery of tests and ask me hundreds of questions.  Around 6:00 pm, they gave me a dose of Misoprostol to start contractions and "ripen" the cervix (as they put it).  Within 30 minutes or so, the cramps began, but they were little more than strong menstrual cramps rather than true labor contractions.  My doctor stopped in to do a quick check and said I was exactly 0 centimeters dilated and 0% effaced, but the Misoprostol would continue to work over the next 12 hours.  It was shaping up to be a long, uneventful night.  So Brian and I set up camp and basically just waited.  

Over the next several hours, the Misoprostol continued to do its thing.  However, the baby was not tolerating the stress very well.  Her heart rate kept decelerating and the fetal monitor would bleep ominously, so the nurse would race in and make me roll over onto my side to see if it came back up.  The hospital bed (if you can even call it that) was ridiculously uncomfortable no matter what position I was in, and having to change sides made it even worse.  It felt like I was sleeping on a lumpy cement block.  I couldn't see how something like that aided the process of bringing babies into the world.  Mom texted me updates on their progress throughout the night.  She and Rob arrived at our house around 4:30 am and Rob went straight upstairs to sleep, but Mom was too preoccupied.  I wanted her to come to the hospital but, once again, Covid restrictions prohibited anyone but me and Brian from being there at any time.  I hadn't bothered making an official birth plan, but the 2 things I always knew I wanted in the event I gave birth were 1. an epidural, and 2. my mom there with me.  One more thing Covid robbed me of.

The on-call doctor stopped in a couple times during the night to check my progress, but I remained no further along than I was when I first checked in.  Meanwhile, the baby's heart rate continued to decelerate during cramps.  Finally, around 5:00 am, they decided to try Cervidil instead to see if the baby handled it any better.  They said, if not, I might end up needing a C-section, an idea which did not appeal to me at all.  Putting the Cervidil in was pretty excruciating, but the baby seemed to tolerate it better, at least at first.  They said they would give it 12 hours to work before starting Pitocin to induce contractions.  So we seemed to be trending away from a C-section.  Around noon, my doctor stopped in to do another check.  Unfortunately, I had made absolutely zero progress.  She said she would stop in again around 5:00 after she was done seeing patients.  If I still wasn't at least a few centimeters dilated by then, we would probably try Misoprostol again and see how the baby tolerates it.  If not well, then we were most likely looking at a C-section.  I was in quite a bit of discomfort at that point.  I really, really didn't want to have a C-section but at the same time, I just wanted the pain to stop.  Absolutely every little thing that anyone did to me hurt.  The cramping, lying on that table, checking my cervix, putting the Cervidil in, taking it out, even checking my blood pressure hurt!  I was near tears as I thought, "Isn't there one thing anyone can do to me that doesn't hurt like hell??"  

Just after 5:00 pm, my doctor came back in to see how I had progressed since putting the Cervidil in.  I crossed my fingers, held my breath, and prayed for good news.  But I still wasn't dilated even a single centimeter.  She said everything was exactly the same as it had been in her office at my appointment the day before.  The baby was also back to not handling the contractions well.  The doctor decided to remove the Cervidil and give me another dose of Misoprostol as a last-ditch effort to avoid a C-section.  But almost immediately, the baby was handling it no better than she had the previous time.  At that point, the doctor said it was looking like the only way I was going to deliver a healthy baby was via caesarean, so that was her official recommendation.  She left to go prep for it while everyone around me began hustling and bustling to get me ready for surgery.  Brian had gone down to his car to attend a virtual work meeting so I texted him, "I need you!!" and he texted back, "I'm coming!"  At that point, everything became a blur and the room felt like it was spinning.  I started trembling with anxiety as I wondered whether the fears that had triggered my vasovagal syncope the week before would come true.  Someone asked me to slide over onto the gurney so they could wheel me down to the OR, and the thought that this was all really happening became too much.  No!!, I inwardly screamed.  I don't want to slide onto the gurney!  I don't want to go to the OR!  I don't want my baby to be born this way!  I don't want to get cut open!  I don't want to do this!  I don't want to do this!  I DON'T WANT TO DO THIS!!  

 

Just then, a scream emerged from the adjacent room that sounded like a woman being eaten alive by a wild animal and the whole room froze for a second.  "That's a natural delivery," one of the nurses said in response to the look of horror on my face.  Hmmmm, I thought.  Actually...a C-section is not so bad.
 

The nurses helped lift me from my bed onto the gurney as Brian emerged from the bathroom wearing a fresh set of OR scrubs.  Suddenly, the fetal monitor screamed to life as the baby's heart rate plummeted yet again.  They urged me to get on all fours and lower my head to relieve some of the pressure in case the baby was pressing on the umbilical cord.  My doctor then re-entered the room in full scrubs and announced that time was now of the essence if we wanted the baby to get out safely, so my C-section was now considered an urgent one.  

 

They hurriedly rolled me down several hallways and into a large elevator to take me down to OR.  I couldn't see where we were going since I was on all fours with my head hanging down, but I was too afraid to look up anyway.  I felt like I was being led to the executioner as I heard the OR doors burst open as they pushed me through.  The room was absolutely freezing, and I was insulated by nothing more than a thin hospital gown.  I was trembling uncontrollably as they helped me off the gurney and onto the operating table, partially from fear and partially from the cold.  I sat down on the edge of the table with my legs hanging over the side as they rubbed my back with alcohol and iodine, then administered the epidural in the base of my spine.  Gradually, I started going numb from the waist down.  A few seconds later, the baby's heart rate dropped yet again, setting all the monitors ablaze.  But this time, it didn't come back up.  At that moment, my urgent C-section graduated to an emergency one.  This baby needed to come out NOW!

I started panicking that the epidural hadn't had a chance to take full effect yet.  My doctor, remembering my fear, had them do several quick tests to make sure I was fully numb.  They nicked my belly with a scalpel and squeezed my thighs as hard as they could, assuring me that if I wasn't jumping off the table in pain, then we were good to go.  They draped a sheet up in front of my face to hide my view while Brian rolled up on a stool behind my head with his camera poised and ready.  They yelled out the time as they made the first incision: "6:07 pm."  Less than 60 seconds later, I heard someone say excitedly, "Happy birthday!"  I was trying to figure out who they were talking to when my doctor announced, "She's here!"  I didn't hear any crying, though.  They held her up over the sheet for a split second to show her to me before whisking her over to the table to try to stimulate her breathing.  I felt my brow furrow with surprise the first time I saw her.  She looked nothing like I'd pictured based on her 3D ultrasound!  I was incredulous how that could be the same baby they had just cut out of me.  I kept thinking, "Are you sure that's her?"  

 

Seeing her in person was such a shock to my system.  My brain couldn't quite process it at first that this was actually my baby.  However, I do remember that she looked exactly like the name Brian and I had agreed on for her: Avery Roberta.  We'd had an incredibly difficult time agreeing on a first name but I knew I wanted her middle name to be Roberta after my dad, Robert (and after Brian as that's also his middle name).  Avery was #3 on my list of potential first names and the only one of my suggestions Brian even liked.  I'd tentatively agreed on it with the caveat that I wanted to see her in person before setting it in stone.  When they held her up to me, I knew without a doubt that it was her name.  She just looked like an Avery!

 

As they continued working on her and stitching me up, they yelled out her weight (5 lbs, 7 oz) and length (18").  She was small but mighty.  Her first screams pierced through the air like a tiny tea kettle.  I was feeling rather battered and still in shock so I couldn't really absorb anything and don't remember much about her first moments.  Thankfully, Brian grabbed several pictures and videos of her, him holding her, me holding her, and the three of us together.  All I could do was lie on the table with my arms outstretched, too weak to even turn my head.  I remember someone saying while they were working on her, "You're being sassy, aren't you?"  I heard myself inform them that she'd been sassy since the day she implanted.  The room burst out laughing and my doctor responded, "I can attest to that!"

Eventually, they finished what they needed to do and wheeled me down to the recovery room, where it was only slightly less cold.  They put a couple of heated blankets over me, which helped.  The feeling was starting to come back in my legs and abdomen, though, and the pain was quite intense.  They gave me some pain meds but it still felt like I was being stabbed with a red hot knife.  My legs felt very heavy, too, like I was trying to push down a block of concrete with them.  Brian laid Avery down on my chest and I remember feeling the weight of what had just happened hit me like a ton of bricks.  I now had a whole other person I was responsible for who was completely dependent on me for everything and it was terrifying.  As small as she was, she was the most intimidating human I'd ever met.  I felt like a deer caught in the headlights as I thought, "What now?"  I knew a fair amount about pregnancy but I had no idea how to take care of a baby.  I was so grateful Brian was a 3-time veteran, because I had absolutely no clue what to do next.  I'd never felt so unprepared for anything in my life.

After a few hours of sitting in the recovery room and texting pictures to my mom and everyone else we know, they wheeled us up to the mother/baby ward.  My room number was 13, which I actually saw as a good omen since our daughter had just been born on Friday the 13th.  (She'd missed having to share her birthday with her dad and grandpa by just 2 days!)  I didn't get much sleep that night, but not because of Avery.  Every couple of hours, someone came in to give me different medications and check on us.  I was feeling OK aside from the pain and the fatigue, and Avery seemed to be doing well despite being a preemie.  However, within a few hours, she was developing a complication: She was having difficulty feeding.  We gave her several bottles of formula but she didn't seem to want any of it and all night long, she never cried to eat.  They checked her blood sugar several times during the night and, although it started out good, it was starting to go down.  They figured it was likely because she hadn't yet learned how to suck, which they said is a common thing for babies born at 36 weeks.  We tried having her suckle on my finger to stimulate the feeding reflex, but she would only suck 2 or 3 times then stop.  They were getting concerned that she wasn't getting enough nutrients, but they decided to let her keep trying for a little longer and to check her blood sugar that evening.  If it wasn't at least 50, they would probably have to take her to the NICU to give her a glucose drip and feed her through a tube. 

At 7:00 pm that night, they checked her blood sugar and it was 49.  However, rather than taking her to the NICU, they decided to try giving her a higher calorie formula and said they would test again in an hour.  She needed 2 blood sugars of at least 60 before she could be discharged from the hospital, they said.  One hour later, her sugar was back up to 52, which was close enough to 60 that they decided to give her one last chance to feed on her own before tubing her.  She had a few small feedings during the night, but again, she would suckle just a couple of times before tiring out.  The barely-drank bottles of formula were piling up on the stand next to my bed.  When they checked her blood sugar again at 6:00 that morning, it was back down to 42.  At that point, they took her down the hall to the NICU where they admitted her, hooked her up to an IV glucose drip, and put a feeding tube through her nose down into her stomach.  She was barely 36 hours old.  They estimated she would be in the NICU for up to a week, which meant we would likely have to go home from the hospital without her.  I was extremely bummed out about that as I mournfully packed her coming home outfit back into my hospital bag.  I tried to focus on the silver lining that at least she was being well cared for and that it was better for this to happen in the hospital than for us to struggle with it at home and risk her not getting the nutrition she needs for proper development.  I prayed she would be able to come home sooner than a week so my mom would at least have a chance to meet her grandchild before going back to Ohio for the holidays.

 

Little did I know we were only at the beginning of the most trying and frustrating road I've ever traveled to-date.  I thought giving birth would be the hard part.  But the hard part was just getting started.

To be concluded in 2020 A.D., Part 4: The Fourth Trimester...