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Sunday, October 21, 2018

Mika's* Birth Story

Thursday, October 11th, 2018 (38 weeks +1 day)

I had been getting pretty regular contractions about 10 min apart and a min long on Wed night. After staying up for a good part of the night, and into the early morning on Thursday. I went to bed at about 2:30am to get some sleep, thinking that if labor progressed, I would need the rest. I woke up a few hours later and they had progressed to about 7 min apart and a minute and a half long. But as soon as Ryan and the girls woke up and we got started with the morning routine, they dropped off. I had a class that day, and a midterm. I went in, thinking that I was closer to the hospital there than at home, so it was a good call to go in and see how things went. Contractions dropped off all together. I went to bed around 9pm, thinking this might be a long week. Around 9:45pm, I woke up to my water breaking. There would usually be no reason to rush to the hospital since I was not having regular contractions, but seeing as how the girls had only gotten a few hours of sleep by this point we got our stuff ready and decided it was better to wake them up now and get them to Grammy’s house for as much of a full night of sleep at possible and then we could monitor labor overnight at the hospital. We checked in around 11pm, where they verified my water had broken, hooked me up for continuous monitoring during labor due to my marginal/borderline velamentous cord insertion and tucked in to try to get some rest for the night. I had texted my IM on our way to the hospital but she was already asleep by the time I sent it so she didn’t get it until the next morning.

Friday, October 12th, 2018 (38 weeks +2 days)

The IM arrived, and we got up for the day, alternating walking the halls and taking resting breaks in my labor and delivery room. The entire day slowly passed, with infrequent contractions that failed to

progress. At about 6pm, the midwife came in to talk options for induction. First up, we could wait until closer to the 24 hour mark of water breaking (10pm) or act now. I knew that this labor was not progressing like my previous two had, and felt that if it was going to happen on its own we would have seen some kind of movement on that front by now, and I didn’t want to waste crucial evening hours of unrested labor, so I decided we should begin induction measures. Next up was how to induce; castor oil or Pitocin. Castor oil can be crampy, messy and take up to 4 hours to work it’s way through your system, whereas Pitocin is more reliable with a faster response time. They explained that the highest risk for fetal distress or drop in heart rate with Pitocin was related to heavy-handed use, and that UCSD starts with level one, and very slowly increases the dose to mitigate that risk. In fact, UCSD has one of the best (lowest) c-section rates in San Diego county as a result of policies like this. They were hoping that all I would need was a “whiff” of it to get labor going on its own and we would be on our way. We all agreed that Pitocin was the way to go, so they put in the order and by ~7:30pm I was set up with the smallest dose of Pitocin. Over the next hour my contractions did pick up, but not significantly, so we moved up to level 2. We decided to try to settle in for some rest, as this might be a long night of slowly increasing the Pitocin dose one level at a time and it would obviously be easier to rest now when the contractions were still mild. Ryan settled on the couch, the IM in the chair, me in the bed on my side and we turned out the lights at 9pm; lulled to sleep with surrobabe’s regular heart-rate beat whooshing in the background…

~9:15pm, through my restless dosing, I vaguely registered the heart-rate whooshing sounds dropped off. This wasn’t abnormal or worrisome at that point; this had been happening for the last 24 hours during continuous monitoring. Baby moves, adjustment needed. Monitor slips, adjustment needed. I move, adjustment needed… the midwife came in to re-position… seconds pass and she can’t get a good heart-rate back… she calls for help… more seconds pass, they call for an ultrasound machine; we need to find baby’s heart-rate… I feel what more of my water breaking, so I voice that. Ryan finally is able to find the lights and turn them on. It wasn’t more amniotic fluid – it was blood. I’m told to get on my hands and knees and forget the ultrasound machine, get the Dr. on call, we’ve got to do a crash c-section, NOW. They have me turn back to my back and wheel my bed out of the room, down the hall towards the operating room. I remember my midwife holding my hand and asking me how I was doing, telling me she was going to be right there with me. The anesthesiologist was up at my head, and everyone was trying to get the information they needed – verbal consent, was it ok if they needed to give a transfusion? Yes, to all consents, just do what you need to do. I’m in the room, get on the operating table. Down on my back. There are people everywhere. They dump a bunch of liquid over my stomach (a splash antiseptic prep because there is no time for a proper disinfection.) The Dr telling the anesthesiologist to tell them as soon as I’m out because they have to get that baby out. They are going to put me under general anesthesia (no time for a spinal tap or epidural) – a mask goes over my face. It’s hard to breathe. Count from 6…. I don't even remember them starting the count down….

Apparently the cord was very thin and sinewy. Baby was not breathing at birth and had to be resuscitated and was rushed off to the NICU. I didn’t wake up until hours later.

Saturday, October 13th, 2018

I first remember waking up to excruciating pain in the PACU at about 12:30am; I was freezing cold and my body was shaking uncontrollably. Ryan was there with me and they were having to administer additional pain meds every few minutes (one of the effects of coming out of general anesthesia is that the meds don’t last long after the surgery so it’s painful to come out of it) while they did uterine/fundal massage (not one bit as fun as it sounds) that the pain meds were not even touching it. All I wanted to know was if the baby was ok. Ryan texted the mom to see how she was doing; she replied at 1am; baby was a bit more stable. By 1:30am they were able to get my pain under control and put on enough blankets to warm me up. I was able to pump a small syringe of colostrum for baby and Ryan took it down to the NICU before we passed out for the night. The mom sent me a picture of baby that morning but couldn’t talk; she was busy with all the doctors. We continued to recover, pump, nap, and try to manage the pain for the rest of Saturday.

Sunday, October 14th, 2018

The morphine pain pump I was hooked up to was great for pain, but I was not into the catheter, oxygen tubing or leg compressors (to prevent blood clots) that came with it, so the goal for this day was to get off of it and onto oxycodone.

The mom came to visit me briefly around noon, while my girls were there. She couldn't stay long and had to get back to her baby.

Monday, October 15th, 2018

I was discharged, physically my recovery well underway and faster than it sounds like is typical.

The Aftermath

From what I can tell, the baby seems to be being treated for Hypoxic-ischemic encephalopathy (HIE)… I know she is in the best hands as our level III NICU has an incredible staff, practicing the best evidence-based medicine with cutting-edge technology and equipment. But her road to recovery will be long and hard, her prognosis is unclear and probably will be for years to come. No parent is prepared for the realities of NICU life, no less a single mother who is in an unfamiliar city, working with English as a second language and complicated medical terminology (of course UCSD has translators to explain exactly what is going on to her, but then her summarizing any of it back to me is a broken game of telephone) half way across the world from her family…

Emotionally, I’m still grappling with the reality that while understandable and due to several compounding reasons, I might not ever get to see the baby in person at all, and won’t be getting regular, detailed updates on how she is doing. It’s a surreal realization to go through something like this and never have a tangible tie to it. In many ways it’s like a dream nightmare. The goal of surrogacy is to deliver a happy healthy baby to the Intended Parent; that’s what we are hired to do as surrogates. We have a near track record of perfect pregnancy and deliveries (my agency's surrogate acceptance rate was less than 7% last year) and that is why we qualify for the job to begin with. And while my head knows I did everything I could to deliver on that promise, my heart cries in disagreement.

The nursing director of midwifery and the division chief of perinatology came to personally visit me and talk about the incident on Sunday before I was discharged. I have known the nursing director for years, and the division chief himself did my last ultrasound at 36 weeks. This incident has shaken us all to our core and searching for answers… it is unclear exactly what happened, or why. The midwife on duty during the incident said she had never seen anything like this in all her 20 some-odd years of nursing and that it shook her faith in normal birth.

We all did everything exactly right; followed all current recommendations and standards of practice given my diagnosis. I did have an abnormal cord insertion but it was a fairly mild case that should have just required close monitoring; marginal/borderline velamentous, no vasa previa or placenta previa detected and the baby was growing perfectly, as shown at 3 total growth ultrasounds throughout the pregnancy. The baby’s heart-rate was strong and normal at every checkup, and this baby was incredibly active from the first time I could feel her in my belly; kick counts rarely took longer than 10 min each day. The non-stress tests starting at 36 weeks were perfect, validating activity in a short period of time, getting the required movements long before the minimum 20 min of required monitoring. And during my 24 hours of “labor” the continuous monitoring showed a normal heart-rate, the strip immediately before the incident being absolute perfection. For all intents and purposes, this shouldn’t have happened. And yet... it did. Of course the placenta and cord have been sent off for pathology, but the results won’t come back for weeks and even then it may not provide any conclusive answers.