Labor & Delivery RN – Perinatal Loss Certification (in progress)
I’ve always been someone who finds joy in helping others. Especially with accomplishing goals that they aren’t able to do alone. After I had my twins via a scheduled cesarean section, I was left wanting more. Baby A was breech, so surgery was schedule for 38 weeks gestation. I ended up being sick with the flu and was contracting away so it was decided to deliver them at that, a week early. I always planned on having two children and felt complete in that, but I didn’t have the chance to experience birth the way I had hoped to. I personally wanted an unmedicated vaginal delivery.
I had donated eggs back in my twenties, so I already had some knowledge about surrogacy. When my kids were three years old and after doing more research, I decided to start my own surrogate journey.
During my first surrogacy, I carried for a couple who have been through years of infertility with no success. This was their second child, and the mother had a traumatic complication after the first birth. Our relationship during this journey was strained. There was a tremendous amount of anxiety and control to the table because of her past experiences. It was very difficult for her to trust me. Thankfully, I had an easy pregnancy and an even easier delivery. I was induced at 41 weeks for post-dates. I accomplished my VBAC and birthed a healthy baby. After the delivery, we parted ways and have never spoken again.
Although I was able to have the birth experience I hoped for, I still was left wanting more from my surrogate experience. While trying to come to terms with the fact that I would never do it again slowly changed to me exploring for another surrogate couple. This time around, while looking I had very specific parameters of who I wanted to help conceive a baby. I was quickly matched with two wonderful men who lived only an hour away. This would be their first baby. When we met, we instantly had a connection and quickly became friends through the process.
This pregnancy was more difficult overall, probably because I was older and carrying a different baby. It was very different than my previous two pregnancies. Instead of having to be induced, like with my first surrogacy, I spontaneously went into labor when my water broke pretty close to my due date. When I arrived at the hospital, I was 4 cm dilated and strongly contracting. There was no reason to believe that my labor wouldn’t go quickly and easily. With the last delivery I decided to get an epidural at 6 cm. This time I was hoping once again that I might be able to go natural, expecting the delivery to be faster. After six painful IV sticks, I gave in and got the epidural so I could rest.
I progressed slowly. Eventually I ended up with an intrauterine monitor and a fetal scalp electrode. I was augmented with Pitocin to help labor continue moving forward. The baby didn’t seem to be doing as well and then suddenly, there was another issue.
I began having terrible pain across my midsection that radiated up to my left shoulder. Compared to my labor contractions from all my pregnancies, this felt very different. I talked with the nurses, the midwife and the doctor. I told them all that things didn’t feel right and just before this I was tolerating my contractions well. This constant soreness, it was more painful even in between the contractions. They checked for the baby’s position and looked for internal bleeding with the ultrasound multiple times. There was no evidence of things being amiss, so we kept proceeding with a vaginal birth.
Before I knew it I was complete and ready to push. I pushed with all of my strength, but nothing was happening. This was unsettling because with my previous vaginal delivery I only pushed for one hour. I felt like my body was out of sync with my efforts. Pushing didn’t feel effective and the baby wasn’t moving down. Almost four hours later, I still hadn’t delivered. The doctor asked the fathers if they can use a vacuum to help baby out. I deferred the decision-making over to them because I was in no state to make decisions. I could barely speak because I was in so much pain.
They attempted a vacuum delivery through several pushes, giving breaks in between to allow me to push without the vacuum. Although it is standard to do three pulls or three pop offs with the vacuum, five total pulls with pop offs were attempted. I knew this was wrong, but I was determined to get this baby out of me that I just kept going. Ultimately a c-section was called, and I was rolled into the OR. I was writhing in the bed and couldn’t even stay still enough to keep my legs on the table. It was decided that my epidural wasn’t working well enough to use it for the surgery, and I was put under general anesthesia for the delivery.
My wife and the two dads were sitting back in my hospital room with no idea how myself or the baby was doing. It turned out that when they got into my abdomen, I did indeed have a uterine rupture which was my gut feeling all along. The baby’s APGAR scores were very low, and he was sent over to Children’s Hospital to undergo cooling to preserve brain tissue and treat a very deep hematoma on his head. The dads didn’t want to see him until they knew that I was going to be okay. Luckily, we both survived and today that baby is three years old. He is beautiful, giant and speaks three different languages. Thank God he suffers no ill effects from the events of that day.
Recovery from the uterine rupture was different. Overall, it took about the same amount of time, but my body felt different. What caused the rupture is also what saved my life. The scar from my previous c-section had poorly healed and had very little blood exchange between the edges of the scar. This caused it to open easily, but also kept my bleeding to a minimum. Which might have been why it was difficult to identify on ultrasound. It allowed me to keep my uterus, although I should not ever carry again.
I continue to be an advocate for trial of labor after cesarean and vaginal birth after cesarean, but I am much more cautious when listening to my moms and my own gut. I requested my hospital records after this day. I wanted to have an idea of what the providers were thinking when I was reporting my symptoms. From what I can gather, my symptoms were being rationalized and nobody seemed able to call out the elephant in the room. The parents of the baby boy told me they saw the fear on everyone’s faces when doing the vacuum. My gut feeling is that if one person would’ve spoken up, the events could have been very different.
This delivery occurred at a different hospital than I work at. After doing some research, I found out that the hospital does not do any sort of debrief of adverse events or outcomes. No legal action was taken against the hospital, but what I really wished was that a peer review and debrief could’ve been done. I wanted to know that perhaps the staff could have learned from this experience. Most of the time VBACs are done very safely and are successful. I was the exception to this rule.
I know this has changed my nursing perspective and I hope it has made me a better nurse. I’ve promised myself to listen to my patients and my gut when something just doesn’t seem right. Always follow your instincts and hopefully you have an advocate in the room that can speak up when you were unable to.
Do you love birth? Heck yeah you do!
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