Thanks so much for taking the time to read the second part of Nora’s birth story; as I mentioned in part one, this story includes a lot of information about my own heart health, which is why I decided to write it in two parts (you can read part one here if you’re interested). I tried to write each story as it’s own story, but I just couldn’t separate the two. Anyway, I hope you’ll enjoy reading the rest of this story, as far as I can tell it to this point. It may not have been the journey we imagined, but it’s the journey we’re embracing nonetheless!
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On the morning of September 5th, 2018, Jeff and I headed into the Royal University Hospital in Saskatoon for a scheduled induction. Unfortunately, my OB actually wasn’t able to be there on the day of the induction because she had a scheduled absence, and neither she nor my cardiologist felt I could wait the 10 days she would be away. At first, I was really nervous about this, but because she had been working as part of a larger High Risk Obstetrics team, I was assured that her colleague was up to speed on my case, and would do an amazing job with delivering my baby.
We arrived at the hospital by 8:30 am, ready to go. However, at 10:00 am, we were still sitting in the waiting room. Having been induced with Molly, I was surprised that we hadn’t yet been admitted, at the least, and we found out shortly after that several people who were working that day were interested in “my case” and it was a real learning opportunity for the residents, so they were busy acquainting themselves with my health history.
By 10:30 am we were admitted, and put directly into a room on the Labour and Delivery ward. The “plan” was to use a mechanic balloon to begin induction. I was told that this would take between 6-12 hrs, as its job is to slowly dilate the cervix. They wanted to make sure I had a good night’s sleep, and would begin with oxytocin the next morning to speed things along, putting me into labour and hopefully resulting in a natural birth. We really weren’t anticipating anything exciting to happen until the next day, so we settled in and prepared for a slow afternoon. As you can see in the photo below, Jeff got comfortable pretty quick, ha ha!
Shortly after, we met the OB who would be in charge of my care for delivery; I felt comfortable with her immediately, and was so pleased to have another amazing physician as part of my “team”. I also met several residents, and my nurses, including one from the cardiac ward, who would be monitoring me from a completely cardiac perspective – something I had not had in any previous delivery. Once we had met everyone, and prior to beginning with “the plan”, they decided to do an ultrasound to see how baby was doing – that’s when everything started to get “interesting”.
Our sweet babe, who had been in perfect position just days before, had flipped into transverse position. Suddenly, the whole plan was up in the air for several reasons. Obviously, no baby can be born naturally in transverse position – so the doctors began weighing and measuring all of the options, and we had some decisions to make as well.
To be honest, that was one of the hardest days of my life. So many physicians and specialists were part of the conversation about what should happen to deliver our baby, but ultimately the decision was going to have to be ours.
Over the course of the day, our options became clear to us, all of which came with risks that felt overwhelming:
Option 1: Skip the natural delivery and have a planned C-section with a spinal tap for freezing; the problem with this option however, was the concern over whether or not my valve would tolerate the fluid shifts immediately after birth. This was the issue they were trying to avoid in the first place with the plan for induction and a natural delivery.
Option 2: Skip the natural delivery and have a planned C-section under general anesthetic; technically this would have put me in the “best” position for heart surgery if something went wrong, but the anesthesiologists (who were also amazing) let me know that if this happened, baby would be born in the same state – not breathing – and that there are risks associated with that as well.
Option 3: Have my OB manually turn the baby into the proper position and proceed with a natural delivery. The problem with this option however, was that there was an increased chance of baby going into distress during the process of being turned, If that were to happen, we were warned that there would be no option for an emergency c-section for me, and baby would have to stay in distress until my body was prepared for surgery in a way that wouldn’t be risky for my heart. (We were told that this is not a conversation they typically have to have with expectant women, because they can generally have a baby out in minutes through an emergency c-section if baby goes into distress. However, my heart likely wouldn’t be able to tolerate the rapid delivery of drugs into my system, and so everything would have to be done very slowly in the event of a c-section, putting the baby at risk.)
Option 4: Delay the procedure for a few days in hopes that baby would turn naturally, but run the risk of going into cardiac failure and being put in an emergent situation for both myself and baby – the very thing my physicians were trying to avoid by having me induced early to begin with.
Jeff and I were in turmoil over the whole thing. We had this amazing group of experts weighing in and meeting with us all throughout the day – and it was clear that though they were definitely a team, the departments had different perspectives when it came to the method of delivery. My OB was confident that she could turn our baby, and assured us that it was reasonable for us to want to try for a natural birth. However, the anesthesiologists (both of whom deal specifically with cardiac-related surgeries) preferred the controlled environment of a planned c-section, where they felt they could more properly monitor – and respond – to any fluid shifts and cardiac issues. My cardiologist acknowledged that there were risks no matter which procedure was chosen, and deferred to my OB team as to the best way for baby to be delivered, knowing the right people were in place to respond to a cardiac emergency if one should arise.
The one thing that everyone agreed on was that there was no easy answer, and we all wanted to avoid being forced into an emergency situation, where both mine and/or the baby’s survival were not guaranteed.
At one point we were even told that if they “had to choose”, I was the main priority and they would choose me. Both Jeff and I were floored by this possibility. Maybe we were totally naive, but we had never considered a scenario where both the baby and I didn’t come out of the delivery alive. Truthfully, I don’t think we even fully understood how serious the situation could get, or how many people were weighing in on my case, and genuinely interested in how things were going to play out because of the range of possibilities – good and bad. I remember when I had first met my OB earlier in the summer, she had told me that it was her job to worry, not mine. At the time I thought this was something something she was saying just to put me at ease; however, in retrospect, I can see that they really did do a great job of shielding me from how truly stressful the situation could become – not because anyone wanted me to be unaware, but because they wanted me to be as stress-free as possible in the weeks leading up to delivery. Don’t get me wrong, I was made aware of risks and potential outcomes – but the actual possibility of something going really wrong wasn’t something that I really considered.
Unfortunately there could be no sheltering us from the seriousness of the situation at the point in which we needed to make our difficult decision, and although we were so grateful for all of the information and advice we were given, I really wished that someone else could make the choice for us. It seemed that all of the options were either “better for me” or “better for babe”, and none were obviously best for both. How could we make this choice, with three other little people at home to consider, and one not yet born? Needless to say, we spent a lot of that day in meetings with my physicians, on the phone notifying our support system of friends and family, and in prayer and careful consideration.
I have to just say once again that we were so blessed to have the most amazing group of people surrounding us. My OB, the anesthesiologists, and my cardiologist were all so helpful and supportive, while being clear and realistic about the pros and cons of any procedure; the nursing staff was amazing, and we had so much support from people in our lives encouraging us and praying for us that whole day. I totally believe that God’s hand was on that entire situation and that He specifically brought those people into our path when we needed them the most. Our final “team meeting” of the day was held around 8:30 pm on the 5th – at this point I hadn’t even had so much as an IV inserted – it was purely a day of consultation and deliberation.
As a team, we finally decided on a course of action for the next morning. We decided that if baby turned on his/her own during the night, and was in a good position for a natural delivery, we would go ahead with the planned induction for a natural birth. However, if baby was still in transverse position, we would just proceed with a c-section, and not risk doing anything that could put our baby into distress, even if it wasn’t the optimal scenario for my heart.
Jeff and I went to bed a the hospital that night feeling mentally and emotionally exhausted. I hardly slept, anxious for what the next day would bring, but also excited to meet our new babe – it was really the most intense range of emotions.
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The next morning, on September 6th, my OB showed up bright and early, and by 7:30 am she was doing an ultrasound to see where baby was at. Now, I probably should have mentioned that our sweet babe was extremely active in the womb throughout my pregnancy, so I was cautiously optimistic that baby might turn. I also really and truly believe in the power of prayer, and we had so many people praying that baby would shift! However, I didn’t want to get my hopes up too high and be disappointed; I knew I would have to accept whatever the outcome.
I can’t even explain how exciting it was to hear my OB exclaim in surprise that baby was in fact HEAD DOWN, just as we had hoped, and that we could confidently proceed with the original plan for natural delivery. She did warn us that at even the smallest sign of trouble or distress, everything would be stopped and we would proceed instead with a c-section, but this didn’t bother me because I was just so thrilled and relieved to have a clear decision made and a plan for the day. Given the fact that I also love giving birth, and had only ever had natural deliveries, I was also glad that I would get to to experience it one last time.
Everything seemed to move pretty quickly after that. I forgot to mention earlier that it had been decided that regardless of the type of delivery, I would be in an operating room – on an operating table – for the entire delivery experience, so that I could be properly monitored and any scenario could be responded to as quickly as possible. So, around 9:00 am, I was gowned-up and walked over to the O.R. (Below is a picture of Jeff and I just before we moved into the operating room).
First things first – it was FREEZING in there! I have had a couple of surgeries before, but I had never had to walk into an operating room and climb up onto the operating table, so I really had the chance to take in the room in a different way. It was so sterile, and not at all like the comfortable, private Labour and Delivery rooms I had delivered in previously. Additionally, operating tables are nothing like Labour and Delivery beds, but the nursing staff did everything possible to make me comfortable in the space. I actually felt bad for Jeff, who had to suit up in hospital scrubs, but wasn’t able to wear his hoodie the room; I had the benefit of countless warm blankets being piled on top of me, and switched out for new ones whenever needed.
The other thing that was very different for me being in an operating room was how many things I was immediately hooked up to. Like I said before, the whole plan was to avoid an emergent situation – however, should an emergency occur, they wanted everything in place in order to respond as quickly and efficiently as possible. So, as a result, I was immediately hooked up to several IV’s, including an arterial line (a larger IV that is directly inserted into an artery instead of a regular vein to monitor blood pressure more accurately), and an epidural. They also decided to go ahead and use the mechanic balloon along with the oxytocin drip, so by the time that was all in place, I was definitely not going anywhere – so then there was also the catheter. On top of that was all of the heart and baby monitoring equipment – I don’t think I’ve ever been so hooked up in my life, let alone during labour and delivery. Regardless, I was so grateful that we were being given such thorough care.
I also have to give a huge shout out to the anesthesiologist that day; I guess it’s not typical for anesthesiologists to be put on one L&D case all day, but due to the high-risk nature of my situation, he was the one to hook me up to everything, and then spent the rest of the day in the OR with us, monitoring all of my fluid levels. He was also very funny and engaging, and really made the experience more enjoyable for us; he even suggested we turn on some music so it felt more relaxing, and he chatted a lot with Jeff about everything from music preferences, to careers – which I know was great for easing Jeff’s mind.
By noon, everything was hooked up, and labour was beginning. It didn’t take long for me to start to feel the pressure of contractions, and we knew it would be a waiting game from that point on. I obviously wasn’t feeling any pain, but I could feel the pressure, and was really encouraged by that. I had two amazing nurses with me that day monitoring both me and baby, and I have to say, I’m not sure I’ve ever been so obsessed with baby’s heart-rate during labour. I was so paranoid that she would go into distress – something I had never worried about in any of my other deliveries, despite the fact that it’s a risk in any labour. The problem this time around was with me and my heart – something that had not been a high priority or concern in my past deliveries, even if it maybe should have been.
Because of the high-risk nature of my situation, there were also several residents who asked if they could participate in my case in order to learn, and I recall Jeff teasing me at one point that I was such a great teacher – always dedicated to learning (haha). There were also windows in the doors of the operating room, and people keep peeking in to see how things were going. It was a bit funny to have so many people interested in what was going on, and a testament to the fact that my specialists did a fantastic job at doing the worrying for me, so that I could just focus on being positive for me and baby.
For two hours I had steady contractions, and baby was doing fine. I knew it was going to be a long day, but our spirits were high and we were still really confident that we were going to be having a natural delivery. However, around 2:00 pm, I felt a giant movement in my belly, and I immediately “knew” that baby had shifted. We had also known there was the possibility that baby wouldn’t like the mechanic balloon, and might try to move away from it in utero. Sure enough, the nurses suddenly couldn’t find the heartbeat in the same position it had been before, and so my OB (who had been checking in on my status every 15-20 minutes or so) was called in to check. She did a quick ultrasound and confirmed that baby had shifted – but only slightly – so she decided to remove the mechanic ballon and to go ahead and try to manually move our babe back into the head-down position.
She assured us that once contractions were strong enough, they would actually help hold baby’s head down – but we still hadn’t reached that point, so our active little babe was able to move. I was nervous about having baby moved manually because of the increased chance of going into distress, but we didn’t have any other choices, and I really trusted my OB, who was very confident. I know I probably sound like a broken record, but I can’t state enough how amazing our OB was and how grateful we were to have her in charge that day. Thankfully her attempts to reposition baby were successful, and once again we were back to our regular delivery plan.
For 45 minutes sweet babe stayed head-down, but of course there was still a lot of room for flipping and turning. Additionally, baby’s heart rate had started to decelerate at various intervals, so they lowered my oxytocin level which decreased my contractions, and every 10 minutes or so they would check baby’s position with the ultrasound machine. Despite everyone’s best efforts, around 2:45, baby shifted again – only this time, she actually folded herself in half, placing her little foot up by her face, and dragging the umbilical chord with it.
When my OB came in and saw on the ultrasound that baby’s position had shifted again, I had a feeling the birth plan was about to change. She tried to manually move our baby again, but baby was not cooperating this time, and it was determined that sweet babe was just in a much too complicated position to proceed with a natural delivery, because there were too many factors that would most likely put her into distress with the head, foot, and chord all in the same spot.
At that point, my OB officially made the decision to switch over to a c-section. To be honest, although I had so desperately wanted another natural delivery, I was so relieved for someone else to make the call so decisively and just move immediately into action. At this point, the baby wasn’t in distress, so it was the best case scenario to shift to a c-section for her, and I was hooked up to everything needed in case my heart didn’t tolerate the shifting fluids.
It took about 45 minutes to get everything in place for the c-section (which I’m told is significantly longer than it takes to perform a regular emergency c-section). I remember there suddenly being a lot of people in the room buzzing around; I remember them slowly freezing my body, and poking me with a tool to determine if I was frozen or not; I remember them tilting the operating table sideways because one half of my body was freezing much faster than the other, and one of the anesthesiologists thought it might make the freezing medication flow into the side that wasn’t freezing (it worked)! One of the other complications for me was that because of my heart condition, I couldn’t lay flat, so they also rigged up a wedge for me to lean on, meaning I was nearly in sitting position for a lot of the c-section, and only laid flat for a few minutes at a time when absolutely necessary.
There were two scary moments when my blood pressure plummeted, but luckily because of all the precautions that had been taken, they were able to keep me stable throughout the entire process. I remember hearing doctors talking behind me about the possible scenarios in order to teach the residents, and I remember the big blue screen going up. I had been so paranoid the freezing wouldn’t work properly and I would feel the incision as it was being made, and at one point, I recall one of the anesthesiologists peeking over the screen and jokingly stating, “I think it’s working!” – which is when I realized the procedure was already underway. It felt like nothing, and then just moments later, I heard baby crying.
I should say that I had been warned in advance that because baby was so early, the NICU staff would need to take her immediately, and there was a high chance that I would not be able to see baby until much later. The only way I would get to see her was if she was “born happy”, which meant crying. My OB had also gone to the trouble of setting up both a blue screen, and a clear screen, so the moment baby was born the blue screen was pulled down and baby was held right up to my face so I could see her through the clear plastic screen. (What can I say, she really was an amazing doctor!)
I remember hearing my OB say, “Ok, here we go… happy birthday little one!”, and suddenly there was my baby in front of me, crying up a storm. Jeff had wanted me to know the gender first this time, so I looked and was able to say, “It’s a girl!!! I knew it!”, and of course I started bawling. To be honest, I’m not an emotional labourer – I typically just grit my teeth and bear it without much crying. It’s that moment when my babies are actually born that I let it all go and just bawl, and despite the fact that this delivery had been so different than my previous experiences, that moment when I first saw my sweet girl felt exactly the same!
The blue screen went back up and our girl was taken to the NICU nurses at the other end of the room for an assessment. Baby girl was 4lbs 6 ounces – a very healthy size for a 32 week baby – and doing very well! So once she was all wrapped up and cozy, the NICU nurses let Jeff hold her and bring her over to me for a kiss and a few pics before taking her to the NICU. My mom, who had been at the hospital for a good portion of the day waiting in our original delivery room was also able to meet our girl as Jeff and the NICU nurses wheeled her down the hall to the NICU.
I had been pretty insistent that Jeff follow the baby to the NICU right away, and thankfully, the staff allowed my mom to suit up at that point and join me in the operating room so I wasn’t alone either. I had elected to have a tubal-ligation if we ended up having a c-section, so it took a bit longer before the whole procedure was over. They also needed to closely monitor the shifting fluids in case my heart did poorly in the immediate after-math of the c-section.
Once it was determined that I could be moved safely, I was transferred to the CCU (Coronary Care Unit) to continue to have my heart closely monitored for the first 24 hours after delivery. It’s amazing that things went as smoothly as they did, considering all of the complications and risk-factors, and we could not be more grateful to the amazing medical staff who took such excellent care of both baby girl and myself.
Our journey unfortunately wasn’t over, and after the initial 24 hours in the CCU, I was moved to the Cardiac ward for several days of further monitoring, while baby girl was in the NICU. One of the hardest parts was being away from my sweet girl and not having the chance to see her for 24 hours after her birth, and then not having the chance to hold her for another day after that. It felt so strange and unnatural to be in the hospital and not have my baby with me, and at the same time to be recovering from a surgical procedure and experiencing childbirth and recovery in such a different way than I had with my previous babies.
This story of course doesn’t end here – our little love spent nearly a month in the NICU, which was a trying time for our whole family, and my personal health journey isn’t over. Despite the fact that my heart held up as well as it could have through the pregnancy and c-section, we still face my having open-heart surgery in the next few months to repair the defective valve, which just does not function the way it should, and continues to leave me symptomatic post-delivery.
We are forever grateful for the amazing physicians who have provided us with such an outstanding level of care throughout this journey, and are confident that things will turn out ok as we proceed with this next phase. We also continue to be thankful for everyone in our lives who has rallied alongside us and committed to walking out this journey in support of our little family.
At the end of the day – it’s all worth it. Every complication, every set-back, every decision, every compromise, every cancelled plan, and every bit of physical and emotional strain, because we have our sweet girl, the last piece of the puzzle for our family. She completes us, and we wouldn’t have it any other way!
September 6th, 2018
Born @ 3:45 pm
4lbs 6oz, 16 inches long
Thank-you again for taking the time to read part two of Nora’s birth story. I plan to write an updated post once we know more about my upcoming surgery. We so appreciate all of your continued love and support.