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    Saturday 25 October 2008

    Pre Eclampsia and an Emergency Epidural

    9.36pm. Waters broke 5 minutes after my head hit the pillow. I sat up uncertainly as a small trickle escaped. A wave of energy ran through my uterus. It was a strange and unfamiliar feeling but I knew what it was. Waddling out to the living room where Jeremy sat trying to fix my computer, I wondered what to do next. “My waters just broke,” I said. Jeremy stood up to hug me and I started to cry as the reality sunk in.

    The hospital wanted me to come in right away, but told me not to rush. I was prepared for this news. Both Mum and Nan started their labours with their waters breaking first so I knew it would happen that way and had long since given up the dream of labouring slowly in the peace and solitude of my home.

    In the last weeks of my pregnancy I’d developed pre eclampsia. After several days of hospital visits and constant monitoring, the doctors told me that baby needed to come out. I was just waiting for my obstetrician, Dr Cary, to return from school holidays the next day. Facing a medical induction, we raced the clock using every trick in the book (sex, spicy food, acupressure and caster oil) and won. I was feeling very pleased with myself as we drove to hospital, but a bit of a surprise lay waiting for me.

    Dr Cary came to see me right away. He gently informed me that I was going to need an epidural. Somewhere in the bottom of my labour bag sat several copies of a birth plan that would never be used. The birth plan had specifically requested no epidural unless needed in an emergency. High blood pressure, it turned out, was such an emergency. The epidural would lower my blood pressure and ensure that the pain of contractions didn’t tip me over the edge of safety. It also meant Dr Cary could pump me full of Syntocin to get the contractions hurtling along like a bullet train and baby could be delivered as quickly as possible.

    As it turned out this was the best-case scenario. I had an appointment to see Dr Cary the next day but he told me in hospital that I was in line for a serious chat. If I hadn’t gone into labour on my own and my cervix wasn’t ripe I would have been facing a caesarian. I guess I hadn’t realised the seriousness of my situation.

    The anaesthetist arrived and I was systematically attached to a drip, CTG, blood pressure monitor and finally the big needle was stuck in my spine. “Let’s have a dawn baby,” Dr Cary said when he left me after midnight to go home and get some shut eye.

    During the night I couldn’t sleep. There was no pain or discomfort, just a steady boredom and a nagging interest in what was happening inside me. Next door I heard blood-curdling screams of another woman in labour. I could feel the baby moving and as the night dragged and my legs became heavier and more numb, I could steadily feel my contractions as short, sharp pains growing closer together.

    Two midwives attended to me through the night. I chatted with them and discovered the primary attendant was a trainee. It was apparent by the fact that she failed to find my urethra 5 times while trying to insert the catheter. I quickly gave up any pretense of dignity. After all, I had already soaked my pants through with amniotic fluid when I arrived, but it would have been nice to have a competent midwife by my side through the long night.

    As dawn came creeping over the horizon the midwives starting fussing about my contractions which they insisted were getting weaker. During the night they’d upped the Syntocin according to Dr Cary’s schedule so they failed to understand what was happening to my labour. I was frustrated and worried. This was the reason I’d wanted to avoid an epidural. I’d heard the horror stories of 40-hour labours resulting in c-sections and I started to see it happening to me. I wanted to sit up and give gravity a chance. So the midwife raised my bed for me and I was suddenly overcome by nausea. The midwives handed me a sick bag and a wet cloth.

    Soon after 6am Dr Cary arrived back on the scene and asked me how I was feeling. “Nauseous,” I said, holding back tears of frustration. “Let’s take a look.” Dr Cary took one look and saw a head. “Well the reason you’re feeling nauseous is because you’re about to have a baby, so let’s get those legs up and push!”

    The midwives were shocked. I guess if either one of them had bothered to actually examine me internally, instead of trying to rely entirely on the CTG, they might have known what was happening. They were so useless and were completely unprepared for delivery. They flew into action as Dr Cary gently coaxed them. I shudder to think what would have happened if Dr Cary hadn’t shown up when he did, but he did so I won’t waste time worrying about that.

    Three contractions and some well-visualised pushes later, our darling Jude was born. As his head emerged I stopped pushing and sat back to watch in quiet contemplation as his body was delivered on October 7th, 2008 at 6.39am. My little posterior baby had turned himself around. What an angel!

    The midwives were pretty astonished by how quickly it happened. Jeremy and I were blissfully happy, we both cried as Jude was placed immediately on my tummy. He was all slippery and floppy and fragile. “Is it a boy?” I asked through tears of joy, but they hadn’t looked between his legs yet. It was soon confirmed what the 19-week ultrasound had shown … the dream that had been Jude Hugo Thomas was now a beautiful, perfect reality.

    Jude opened his left eye, then his right eye and started searching my chest for the nearest nipple.

    Friday 3 October 2008

    Pre-Eclampsia or Hypertension

    On Thursday I went for my routine 38-week check up. I mentioned to the midwife that I thought baby's movements had been a bit less pronounced. She asked me if I felt it was a significant reduction in movement and I didn't really know how to answer that question (based on what knowledge would I be able to judge what "significant" means in this case?) The midwife suggested a cardiotocograph (CTG) which is just a simple heat-beat monitoring test for the baby.

    After that, she measured my blood pressure. This is the only measurement I've had throughout my entire pregnancy. It has always measured around 120/70, but when the midwife checked it had risen to 130/90. She was a bit concerned about it, but I thought it was probably just related to the stress of wondering if my baby needed the CTG or not.

    During the CTG that same day, my blood pressure raced up to 160/120. Now I happen to know from previous experience that I am susceptible to stress. My blood pressure has been this high before. I didn't think there was anything to worry about, but they ordered some blood tests.

    That afternoon I had a call from the midwife who said my blood tests were ok but I should go to the hospital on Saturday for a follow up. That evening, however, I had another call from the attending obstetrician's office who said there were some concerns about my blood test and asked me to come back the next day (Friday).

    Friday (yesterday) I went back for more monitoring. Apparently there was something about uric acid in my blood results. I had my blood pressure re-checked (the midwife said it was high, but I don't know what the measurement was) and then I had another blood test plus a urine test. The results didn't come back that same day, so I had to wait and see what happened at the hospital.

    Today is Saturday. I went in to the hospital this morning with my husband by my side really not knowing what was going on. We had another CTG and my blood pressure was checked again. Today it measured 139/94, which is considered pretty high.

    I asked some appropriate questions and I now know that I am being monitored for pre-eclampsia. A condition specific to pregnancy where a woman's blood pressure rises for no known reason. It starts in the placenta and can cause oxygen deprivation for the baby. It can be quite serious. At my stage in pregnancy the treatment is to deliver the baby as quickly as possible.

    My obstetrician is away on school holidays, but he'll return this week. At the moment I'm not particularly under any specific obstetrician's care (just whoever is on duty). The doctor on duty this weekend didn't want to make a call today, given that he's just been introduced to my paper work (although I haven't met him because he was in theatre when I was there).

    This means I have to go back again tomorrow (Sunday) for more blood/urine/blood pressure tests and a CTG and if my blood pressure has gone up or my tests come back any worse I will be induced almost immediately.

    This comes as quite a shock. I'm a little bit thrown that I could suddenly be facing the imminent arrival of my baby. It's been 9 months and in just one more week I will reach my due date. My baby has already been considered full-term for 2 weeks, so having my baby now is completely acceptable it's just that I hadn't expected it to be this way.

    I had assumed I would go into labour at a time that the baby would choose and it would all be a big surprise and at first I wouldn't even realise I was in labour, or I wouldn't be certain, and it would probably be in the middle of the night ... but now I'm facing a very real chance it could be tomorrow.

    I sort of hope I go into labour naturally in the middle of the night and skip all this rigmarole.