Thursday, May 3, 2018

Giving Birth Salone Style....Part 2

I will warn you....this post is long.  I intended to make a part 3 and maybe even a part 4, but when I realized it was going take me a month between each post, I decided to go ahead and just write it all.  So....sorry for my longwindedness! :) .  If you want to, you can read Part 1 here.

After pacing around in the waiting room for what seemed like forever, waiting to find out what the heck was going on inside me, the nurse took me to a room with several other women and their babies and did a cervical check.  I was only 1-2 cm.  As soon as the nurse told me this, I immediately felt two things.  The first was relief.  Baby probably wasn't struggling while trying to come out sideways, and my water probably wasn't about to break any second.  The second thing I felt was annoyance.  Lots of annoyance!  What the heck!?!?! I'd been in pain for HOURS and....nothing.  Women walk around 1-2cm dilated for WEEKS before giving birth and some women are that way all the time just from having previous children.  Again....What the heck?!??!

The nurse left the room to go call the doctor to let her know what was going on.  From my bed I could hear the two nurses call one doctor who said he wasn’t on call.  Then the next doctor they called said it should be the previous doctor on call.  Playing the game "Who's On Call"......some things are the same in every country. :)

They must have figured it out because a few minutes later one of the nurses came in and said they were going to give me a shot for my pain and wait for the doctor to come in a few hours.  Now that I knew I wasn’t in danger of delivering soon, I was ok with that, although I really would have preferred to get an ultrasound to make sure I wasn’t bleeding.  But I knew that would never happen at this time of night.

 There wasn’t anywhere in the room for Peter to hang out so after they gave me the shot, he went out to the car to sleep for a little bit.  I put my mosquito net down and after the medication took the edge off my pain, slept off and on for the next couple hours. At one point, I looked up and the bed next to me was occupied by a woman in scrubs (presumably an employee) snoring away. 

At six o’clock, a doctor came in to check me.  By this time, my pain was improved and my contractions had all but stopped.  She did another cervical check and said that I was 3cm and things were progressing.  I was skeptical though, since my contractions had all but stopped.  I suspected that my “progression” from a 2 to a 3 was more likely just a subjective difference in the measuring of the doctor and nurse. 

An hour later another doctor came to talk to me.  This was the doctor that I’d been seeing for my prenatal care. She also asked how I was doing and I explained that my contractions were pretty much gone but that I was still having this weird pain. It was better after the medicine but I was still concerned as to what was causing it.  After chatting for a little bit, she decided that I could be discharged and come back if the pain got worse or my contractions returned.  Peter and I decided that instead of going back home, we’d get a hotel room by the hospital, just so we’d be closer in case something happened.

I started getting ready to leave when the doctor came back and said that she’d talked to her supervisor (the head of the department) and he wanted to admit me for observation.  To be honest, the idea of an air-conditioned hotel room sounded MUCH better than hanging out in the hospital but I was still worried about this pain I was having so I agreed to do whatever they wanted!  I asked her about the possibility of an ultrasound because I was worried about this pain that was improved, but not gone.  The doctor told me because it was a holiday (International Women’s Day) and the ultrasound tech was a woman, the ultrasound machine wouldn’t be available that day.  Ummmmm....Bummer. 

After a few hours, they told me that they had had a discharge and had an open private room.  Thank you Jesus! One of the best things about the Sierra Leonean culture is their hospitality!  However, despite pulling the curtain around my bed to have some privacy, for the past several hours I had had nurses, other staff members and family members of other patients open the curtain to see and greet me.  In my present state, I was not really in the mood for greeting a lot of strangers. Ugly American. J

We moved into the private room that had AC (most of the time) and a chair that Peter could sit in!  As we sat there, watching the election coverage on tv, I noticed that the pain medication seemed to be wearing off and I was starting to hurt again.  As the pain continued to worsen, I started getting really worried again.  What the heck was going on?!?!?  I was annoyed at being in pain, but I was really scared that something was going that we were missing.  Peter and I talked about going to another facility to get an ultrasound.  I didn’t want to offend the doctors at this place, but something seemed to be going on and I felt like I wasn’t getting answers that I needed.  We decided to risk offending the doctor and went in search of her. 

I was having trouble walking at this point because every step was so painful.  The doctor was in her office seeing patients so we waited outside until she waved us in.  As soon as I walked in her office, she said, “You don’t look good. What happened?”  I explained that this pain that had initially brought me in had returned and I was worried.  Peter and I wanted to go to another facility to get an ultrasound.  She told me that the way I was looking, she was worried as well and that she would send me to get an ultrasound here.  I didn’t mention that I thought there wasn’t any ultrasound and just thanked Jesus that I wouldn’t have to get in the car to go track one down somewhere else in the city. 

I was informed that I was really lucky because the man doing my ultrasound was the head of the department and very knowledgeable.  Thank you Jesus!  The first thing that he noted on the ultrasound was that baby was head down.  Woo hoo!!!  I was so excited about that!  He looked around and said that everything looked ok with baby. I clarified that he didn’t see any bleeding anywhere because I was worried about an abruption.  When he asked if I had any vaginal bleeding I replied that I hadn’t, but thanks to Dr. Google, I knew that 20% of the time, there is none.  He looked around again and didn’t see anything. 

The only other comment he had was that the baby was really big.  My doctor was in there at the time and they both mentioned that maybe the pain I was having was the baby stretching and moving around because she was so big.  In fact, my joy over avoiding a c-section because baby had turned was cut short when the doctor said that I would still need one because the baby was so big, there was no way I could deliver myself.

Peter and I went back to the room to talk about this new information. To be honest, I wasn’t really sure that my pain could be explained by a really big baby.  Ben was only 4 pounds 14 ounces (granted he was a preemie) and Haddie was about 7 pounds.  So, it wasn’t like I had a history of giant babies. And the two I’d had, had basically slid out. 

The doctor came in while Peter and I were discussing what to do.  I asked the doctor when she’d want to do the c-section and she said she wanted to do it today. Woah! Wait a minute! I asked if I could just wait to go into labor for myself and then if it looked like baby was too big to come, we could move to a C-section.  That’s when she started mentioning all my worst fears.  She said that if I started delivering vaginally and got into trouble, she would "not guarantee" that everything would turn out alright.  The doctors who needed to do the surgery might not answer their phones, their phones might be off, they might get stuck in traffic.  Right now, she could guarantee that the surgeon doing the surgery was very good, but if it was emergent, it would just be whoever, and they might not be as good.  

These were all things that SHE mentioned, but that had been running through my mind for 9 months.  They were all of my worst fears about delivering a baby in Sierra Leone.  My biggest fear had been to go into labor during the election and not being able to get ahold of anyone to come in. After that it was a fear of going into labor at night, a weekend, a holiday, etc.  Anything that would make it more difficult for the needed personnel to get to the hospital, making it more dangerous for Baby and for me.

I know that if I'd been in the States, a C-section would probably not have been on the table at this point.  I was only 38 weeks, had no history of really large babies, and now baby's was head down!  But I wasn’t in the US.  And in staying in Sierra Leone to have my baby, I’d gone against what probably 99% of the medical people in the States would have counseled me to do.  (Heck, if someone had asked me, I would have encouraged them to go home.)  I was hesitant to continue to defy the medical experts.  I did not have a history of big babies, but my sister gave birth to a 10 pounder, and I was there.  I remember watching the doctor struggle to get her shoulder out. And I felt the same fear now, that I felt then as I prayed for that doctor to be successful.  

And with that, my decision was made. I know that C-sections are riskier than vaginal deliveries, but I also know that a planned, scheduled C-section would be a lot safer than an emergency one.  There were still so many unknowns.  We’d had the best anomaly scan that could be done in Sierra Leone, but it wasn’t the same as having one in the States and one of my other big fears was that there was a congenital abnormality that would be an emergency after delivery.  This weird pain was, in my opinion, also still an unknown. With this new, concerning unknown of a large baby, Peter and I decided to go ahead and do the C-section.  We signed the consent.  Incidentally, I also asked to please sign a consent for a tubal ligation (tying the tubes).  As much as we already loved this little bundle of joy, since you're going to be in there anyway......

I don’t know if it worked in my favor or not, but I’ve seen countless C-sections done in Sierra Leone, while I worked in a hospital here.  So I knew generally, what to expect. They came in to start my IV and I received my very first foley catheter.  The nurse and I walked down to the OR with my bag of IV fluids in one hand and the bag of my own urine in the other. 

One of my big fears was the spinal.  Now I LOVED my epidural at home, but was nervous about getting that one and even more nervous about this one.  After poking me a few times but still unsuccessful, the anesthesiologist (I'm going to call him that, although I really have no idea what his actual credentials were) called his boss over to do it.  In the end they were able to get it in and much to my relief I began to feel my legs getting heavy a little while later. 

I recognized the surgeon as one of the doctors that I’d seen earlier that morning.  I watched as the rest of the OR staff bustled around to get things ready and tried to catch what they were saying in Krio.  I laid down on the table and they stretched my arms out along the board they had laying under me for that purpose.  The anesthesiologist put up the drape and they got started.  Since I’ve watched this surgery so many times, I laid there envisioning what they were doing based on what I felt.  I sighed a BIG sigh of relief when I could feel what was most likely them cutting me open and it didn’t hurt.  Thank you Jesus!! 

At this point, I don’t know if it was the spinal, the adrenaline or some other medication they’d given me, but the oxygen mask they’d put on me started to feel like it was suffocating me and I called out that I was going to vomit.  Someone came right away with an emesis basin and I was able to turn my head in time to vomit in it.  I started trembling, although I didn’t feel particularly cold.  The anesthesiologist was very sweet and got a machine that blows hot air from a tube.  It looked familiar and I recognized it as the tube that attaches to a warming blanket (a “blanket” that is filled with hot air and designed to warm up or keep patients warm).  They didn’t have the actual blanket but he put it under a towel that was laying over my chest and it still felt nice.

A few minutes later I heard the familiar cry of a baby and the nurse brought her over so I could see her.  I only got a cursory glance as I was continuing to try not to vomit but when I asked the nurse if she was ok, I sighed in relief when she enthusiastically said “yes!”  Lord, thank You!
So little!!!
The rest of what I’ll recount will be snippets that I remember of the next hour and a half.  Now that baby was out, they could safely give me medications to knock me out.  I don’t think they were planning on knocking me out until I became a little too vocal.  At one point I heard the doctor say, “See right there? See where the blood is pooling?”  I’d been afraid I was bleeding before I went into the OR so when I heard that blood was pooling somewhere, I got scared.  I called out and asked if everything was ok.  They continued to talk to themselves and the tone of their voices, as well as their movement seemed to be a little more amped up than it had been.  I called out again to see if everything was ok.  It was the most helpless feeling.  I could picture the scene that I’d seen so many times before with the clamps holding my abdomen apart, and gloved hands moving things aside to get the bleeding to stop.  At that point I started praying for Peter and my kids, should something happen to me.  I’m sure it was overly dramatic to fear that I’d die on that operating table, but that’s how it felt in that moment.  The doctor must have sensed I was nervous because she bent around the drape that was separating us and said something akin to “You want me to tell you the truth, right? There is some bleeding but you’re going to be ok.”  The next thing I remember were members of the OR staff laughing and I immediately knew everything was better.  I took this opportunity to call out again, this time making sure that the doc was going to do the tubal ligation  that I’d consented for.  Three times. Three times during my periods of being awake, I verified that they were going to do it before they closed me up. :)  

I have no idea how long I’d been on the table at this point but the muscles in my arms and back were aching terribly and I just wanted it to be over.  It was also around this time that my legs started tingling and I realized that I was feeling more than just the tugging and pulling sensations.  It appeared that my spinal anesthesia was wearing off.  (Unlike an epidural which has the numbing medication running continuously, a spinal injects the medication once).  I laid there for what felt like a really long time and told them I was going to vomit again.  Then I called out that I needed something else for the pain.  I couldn’t take it anymore.  The doctor said something unintelligible and someone came over and put something in my IV.  A few minutes later, night, night Emily. 

I woke up and saw that someone was standing next to a whiteboard that had numbers written on them. He was talking to someone else and they seemed to be in somewhat of a debate. I assumed it was the count (sponges, clamps, etc) that they do before they close someone up and I prayed that nothing would get left inside!  

The next thing I remember was noticing that the primary surgeon who had been on my right side was gone.  The one on my left was sewing away which meant that they must be closing me up.  It was confirmed a few minutes later when someone said “we’re almost done!”  I was so relieved. I was so sore from my arms being stretched out and the shaking that wouldn’t seem to stop no matter how much warm air was blowing onto me that all I wanted to do was lift my arms up and bring them to my chest. I must have tried to do just that while I was out because when they were getting ready to move me to the stretcher I noticed that they had to untie my hands from the board and I had no memory of them being tied in the first place. 

They wheeled me into my room and I saw Peter’s face. Phew! I assured him that I was ok.  They got me moved over to my bed and the nurse told me that I was going to need to lay flat for 24 hours.  Say what now!??!  I’d worked in a surgical ICU for years and had never heard post-op instructions for a patient requiring them to lay flat for 24 hours after surgery.  I knew that they were trying to prevent a spinal headache (which can happen after spinals and epidurals if the fluid leaks out), but I’d still never heard those instructions before!  I was already grumpy about what I’d been through with the surgery and was NOT happy to hear that I’d have to lay on my back for 24 hours. No pillow, nothing.
The beginning of my 24 hours.  I don't know when they put the paper on my gown, but I guess it's safety first to make sure they took the baby out instead of chopped off my leg or something!  
A little while later they brought little baby yet-to-be named in.  She was in a little bassinet covered with a mosquito net, and she looked perfect.  And she didn’t really look big……Out of curiosity I asked the nurse how much she weighed and they told me she was 3.4kgs (about 7 pounds 8 ounces).  Not a big baby, and incidentally about half a pound smaller than Haddie had been.  No. Comment.  I had just been through what I would probably describe as one of my top five worst experiences in my life, but I was alive.  My baby was alive.  The answer to the question that had been occupying a large amount of my thoughts over the last 9 months…..”how was this going to end?” was here.  We were ok.  We were all ok.  Thank you, thank you Jesus. 

I mentioned before that my spinal started wearing off during surgery. Well now whatever “knock me out” medicine had worn off as well and I was feeling the fact that they’d just sliced and diced my abdomen.  As soon as I was settled I asked the nurse if I could have some pain medicine.  She brought me some right away and gave me a shot in my bum.  About 30 minutes later the edge of the pain was gone and I could focus on something else.  I asked the nurse how often I could have it and she told me I could have it every four to six hours.  Thank you. I’ll remember that.  Sure enough, four hours later the pain was back in full force and I asked for another shot of the good stuff.  The good stuff wasn’t the REALLY good stuff because it wasn’t a narcotic. It was basically injectable ibuprofen (we don’t have it in the States) but it worked really well!!

We found out when I was admitted, that Peter would not be able to spend the night with me in the hospital.  We thought that even though they didn’t provide a bed, they wouldn’t mind him bringing his own mattress to lay on the floor, but that was quickly vetoed.  It was probably for the best since he’d spent the evening killing mosquitoes in our room and lost count after 40.  Baby and I had a net but he wouldn’t have had one and that would have been a miserable night.  He decided to get a hotel room near the hospital because he didn’t want to drive back and forth from our house every day (an hour and a half one way) and I felt better knowing that he was at least nearby. 

Peter smacking mosquitoes all evening. He tries to catch them in his hand.  Unfortunately for us, mosquitoes are not only annoying, but also dangerous as they give us malaria. 

They had these really cool mosquito nets for Lettie's "crib." I was so thankful that she was protected!
He was supposed to leave by 7:30 that evening but ended up staying until 11:30 and I was really thankful for the grace that the nurses gave us in not making him leave earlier.   I kissed him goodbye and it was me and baby on our own for the night.  I drifted off to sleep and woke up at about 2:30am in quite a bit of pain. It had been 5 hours since my last shot of pain medicine so I called the nurse in to ask for some more.  She told me that I couldn’t have it. Wait, what? I verified that the doctor said I could have it every 4 hours and she agreed, but said that I was asking for it too much and needed to wait. I disagreed. Strongly.  I’ll admit that I felt a bit like a drug seeker because I was asking for it about as frequently as I could have it, but I also saw no reason for me to lie awake in pain for several more hours.  I mean, it wasn’t even a narcotic for goodness sake!  I told her that if the doctor said I could have it, that I really needed her to give it to me.  She told me that she wouldn’t give me the shot, but that I could have it rectally.  Whatever floats your boat, sister!  A little while later I felt sweet relief.  I thought about sharing with her the fact that studies have shown that surgical patients recover quicker when their pain is controlled…yada, yada, yada, but didn’t think she would appreciate that.

It was clear that I needed to take my pain control into my own hands.  Fortunately, I’d suspected this would be a problem and brought my own ibuprofen and the Tylenol with codeine that was left over from my last delivery. (One of the benefits of having two babies in less than a year is that your pain medication isn’t even expired yet!)  And thus, my breaking of hospital rules began. 

It was a long sleepless night, so Google became my friend.  I am a RULE FOLLOWER so even though I felt pretty confident that I wasn’t doing anything wrong, I still needed the verification.  Sure enough, nothing that I read about post C-section rules said anything about laying on your back for 24 hours after surgery.  In fact, almost everything said that you should get up and walk as soon as you were able.  I knew it!!  I also googled eating and drinking after C-sections because by this point I was hungry! I hadn’t eaten anything since lunch two days ago.  Sure enough, most of what I read regarding eating and drinking after a C-section said that you should take it slow, but at least start drinking fluids as soon as you were able.

That settled it.  When I started to feel the pain coming back a couple hours later, I broke the first rule by getting off my back and out of bed to get the meds out of my bag. I got the bottle of water that Peter had left and quickly downed one of the pills.  Naughty Emily!  But sweet, sweet pain relief. 

The next morning Peter called me to see how my night had gone and I told him it was fine, but that I needed him to do me a favor. Now that I’d started breaking rules, I was on a roll.  I told him I needed him to stop at the grocery store and get me some cereal that I could munch on….oh! And some apples, get some apples too!  Oh, and water! Get some water to put in the little mini fridge so that when I’m allowed to drink, I’ll have some nice cold water.  It was 8am in the morning.  I wasn’t SUPPOSED to drink anything until 5pm that evening and I couldn’t eat anything until 5pm the next day.  Since I’d already had my stomach grumbling (knew I had bowel sounds) and had no nausea, I put my covert ops into motion.  I had stashed the pain pills in the drawer next to my bed and tossed the cereal in there as well.  I started slow by just drinking sips of water, but by that evening my rule breaking was in full force.  I was still staying on my back for the most part though and I sure was relieved when 5 o’clock came around and I was allowed to sit up!

Peter hadn't gotten much sleep the night before either, so he rested on the metal chair when he came back.
I’ll be honest and say that it had been a REALLY frustrating day.  I was mad that I had to follow all these rules that I knew were not “best practice.” Our room was swarming with mosquitos and I’d woken up with over 30 bites on my legs that morning….even WITH sleeping under a mosquito net.  I was in pain, I was sweaty and gross but couldn’t shower, and I was really bummed that I was in all this pain from a surgery that in hindsight, my small baby said I probably didn't  need. What I really wanted, was to be in a familiar hospital, in a familiar country with some of the best medical care available.  I just wanted to be at home.

So 5pm rolled around and I was legally allowed to get up! I was dizzy and almost fell over because it turns out that staying on your back for 24 hours actually does make you a little weak. They brought me in a big flask of hot water with some tea and told me I should drink a cup of tea every half hour. I drank a cup and then went to get the water out of the fridge.  Wonderful, wonderful cold water.  (The water I’d been smuggling was next to my bed so didn’t stay cold).  Unfortunately, when the nurse came in, she saw me drinking the cold water and got really, really upset.  She told me that I absolutely could not drink cold water because it was very bad for me.  When I asked her why, she couldn’t really give me an answer, she just knew that it was very bad for my abdomen.  I.  Lost. It. Not to the nurse.  I kept my cool with her, but Peter had to bear the full brunt of my frustration when I dissolved into tears.  I had been looking forward to that cold water for hours and there was just no reason for me not to drink it.  It was the culmination of a lot of frustration and I told Peter that I’m out. I wanted to go home, to my own bed, with no (or at least way less) mosquitoes and drink water from the fridge with ice added to it.

In the end, Peter talked me down and when the nurse came back to make me pinky swear (I kid you not) that I would drink lukewarm water (a compromise….instead of the hot tea) I agreed.  I promptly went to my room, took a swig off the bottle of water I’d had by my bed (thus fulfilling the pinky swear) and then drank my cold water. After all, I promised that I WOULD drink the lukewarm water, not that I WOULDN'T drink the cold stuff.

Later that evening, Peter and I went outside for a walk. We ended up chatting with a nurse and I mentioned my frustration with some of the outdated post-op practices.  She actually understood and, having worked other places with more up to date practices, became frustrated as well at times.  But what could she do? If she broke the doctors' rules and they found out she would get into trouble and could lose her job.  I appreciated her perspective and was thankful for the insight that allowed me to be a little more patient with the people telling me what to do. Incidentally, during our walk I had several people remark how "strong" I was to be walking around.  I wanted to tell them that it was amazing what could be done when someone wasn't in pain, but didn't want to blow my cover and make everyone mad at me. :)

I’d seemed to reach the pinnacle of frustration the night before, but something happened two days later that made me forever grateful for the hospital and their staff.  One of the surgeons came to check on me and happened to ask how the baby was eating. Little Lettie (by this time we’d given her her name) was not eating well.  I just couldn’t get her to wake up enough to eat well!  The nurses came to check on us and would usually find her sleeping. When I voiced my concern that she seemed to be sleeping TOO much, they assured me that newborns sleep and she would wake up to eat. My other babies had been sleepy as well but they had both had a high bilirubin (which can make babies sleepy).  I wondered if that’s what was going on with Lettie but I had no way to check and even if I did, I had no bililights to put her under.  At one point I undressed her to take her outside to get some sunlight, because that can help lower bilirubin.  I know people thought I was crazy but I was at a loss for what to do with so few diagnostic and treatment options.

So the doctor asked how she was and I told him about our breastfeeding struggles. At that point she’d only eaten two or three times for about 10 minutes in the last 24 hours.  I know that newborns can go awhile without getting milk, as it takes some time for mom’s milk to come in.  But I didn’t know how long was too long. When I told him how much she’d been eating, he said that was not nearly enough and asked the nurse to check a blood sugar.  Blood sugar.  Oh. My. Gosh.  It hadn’t even occurred to me to check a blood sugar.  I’ve been a nurse for 14 years, taken care of countless cases of low blood sugar and it hadn’t even occurred to me.  I was so embarrassed.  I should have KNOWN!  Low blood sugar can also make you sleepy. I’d been so focused on her bilirubin that I hadn’t even considered the simpler possibility.

The nurses checked her blood sugar and sure enough, it was 30.  Low.  I pulled out the tin of glucose that had been on my list of things to bring to the hospital and the nurses mixed it with water and fed it to her in a cup.  I stood by…..crying of course.  I was scared for Lettie and felt like a failure as a mom and as a nurse!  The nurses were so sweet and encouraging.  Little Lettie perked up and when they rechecked her blood sugar again a little while later, it was better.  
Little Lettie getting her glucose from one of the nurses

Later that evening, she seemed to be pretty sleepy again.  I planned to ask them to do another blood sugar, just to check but was so scared they wouldn’t want to do it.  Since the nurses hadn’t historically been super excited about things I’d asked for (pain medicine, cold water, etc) I was afraid they would tell me that Lettie was fine and didn’t need it.  If they didn’t want to do it, I was at their mercy.  I prayed, prayed, prayed that they would be willing to do it. 
When I called the nurse in to ask her to do it, after explaining what had happened earlier that day, she easily agreed.  Thank you Jesus! Peter went and bought the testing strip at the pharmacy and when he brought the receipt back, they checked her.  Her blood sugar was fine.  She was doing fine.  Phew.

I had Lettie on a Thursday and by that Monday, it was time to go! This was confirmed that morning when I woke up to use the restroom and there was no more toilet paper. When I asked the nursing aide for another roll, she told me that they only give out one.  Ok then.  Fortunately, I’ve lived here long enough to know never to travel without some in my purse so I was ok, but I took that as a sign that it was time to head out! I’d used up my toilet paper quota. 

By the time the doctor came to see us that morning, we were packed and ready to put our things in the car. Peter went to pay the bill and we loaded our precious blessing into the car and went home.
All ready to go home!!
Compared to my last experience giving birth (epidural, jetted tub, room service including milkshakes and excluding fish heads), this one had been….tough.  But after nine months of worrying and wondering how it was going to turn out, I was so thankful that Peter was leaving with a healthy wife and healthy daughter.  That is not true for a LOT of people in this country.  We are very, very blessed.

So, So Blessed.

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