Laboring!! For my scheduled c-section?

Anxiety. It’s real and it’s a bitch.

Sorry there just simply isn’t a better way to word it.

I had a 100% awful experience with my first delivery that resulted in a 9 day hospital stay courtesy of Ecoli Sepsis. It was 40 hours labor, multiple attempts to be admitted but turned away and an emergent c-section.

Ever since then, I’ve been huge on telling people you have to advocate for yourself because no one else will. B U T I’ve also been anxious about all things hospital related here where we are stationed.

See I am an RN by trade and I worked at the hospital I have now delivered all four of my children at. Which is a blessing and a curse. I know enough to know what right should look like and I know enough to know when people aren’t doing that.

I advocate for myself but it’s exhausting. It's exhausting when there is no continuity of care, when the hospital preaches patient caring touch and patient centered care but what they actually implement is "hospital convenience care" meaning they provide care with little regard to the patients preferences, time or availability. I will say, and I will eventually write a separate post about it, this is not the case with every encounter but it is in roughly 7/10 encounters you have at this particular hospital and outlying clinics. I did have a truly phenomenal experience with anesthesia when I went to the ED for a spinal headache and they went above and beyond to check on me through the weekend while reassuring my anxiety.

So this last week I had our fourth child, sweet Raelynn a little early. To really depict why it was so important for me to advocate for myself and why I was so adamant about doing the right thing the first time around, I have to briefly explain what happened with my first two deliveries.

With Carolynn, our first, I labored for 23 hours at home before they finally admitted me, it took another 20 hours before I would finally meet Carolynn. It took over 12 hours with Pitocin going to get me to fully dilate. I pushed for 4 hours. Through all this, my body was contracting every 3-5 minutes. Painful contractions. But Carolynn couldn't descend to engage enough to force me to dilate, and got stuck while I was pushing. She was emergently cut out of me for arrest of descent and NRFH. Family medicine was following me but OB quickly took over.

In the care that followed, left a lot to be desired. A float nurse was assigned to care for me, who actually ended up being a huge blessing. She was a medsurg nurse I worked with at the time and she quickly caught something was not right, pushed for blood cultures and intervention. Had it not been for her, the routine mother baby nurses would have let me fever for another day and let the sepsis rage in my body before catching it. But a float nurse shouldn't have had a chorio c-section mom, I digress thats another topic. The doctor that ended up taking care of me for OB, was amazing.

With my second baby, Emmalynn, I was so terrified to deliver at the same hospital I actually requested to deliver off post. It was even approved by the head of OB based on my previous experience, which was a big deal because I was active duty Army at the time. Tricare does N O T like to pay for things outside of the network, as active duty I really didn't have a choice without a letter of exemption to policy. I ended up staying at the MTF because their VBAC rates were higher than surrounding hospitals, with the assurance that the head of OB and the doctor that delivered Carolynn would follow my pregnancy and do the delivery. Both of which are amazing doctors that I am sure are still impacting women in a very positive way every day.

With Emmalynn, my second child, I went into the hospital at 37 weeks on the dot because of contractions. I figured I would get some fluids and a quarters slip to excuse me from work the next day because I couldn't sleep with the contractions. Remember I labored for like two days with Carolynn. I didn't expect this one to go much different.

Emmalynn was urgently cut out of me due NRFH.

The doctor that did my c-section for babies 1 and 2, is phenomenal.

I L O V E her. She came in on her day off, in the middle of the night to deliver my sweet Emmy because she just knew I was an anxious mess after Carolynn, (she saw that shit show unfold two years prior) and the moment I heard her voice saying she had the consents for Emmys c-section my anxiety was instantly relieved. I had no idea they called her, I was being wheeled out to the OR and in the hallway I saw her rushing toward me in scrubs with the consents. I will never forget that. After the delivery I was told my uterus has fibrotic bands around it, they make it impossible for babies to descend and I should not attempt a VBAC. Essentially, I would contract until the days were done but I wouldn't have much cervical change, baby would end up in distress and it would become life threatening.

So Madilynn came right when she was scheduled on her date and it was smooth recovery minus pneumonia but hey my body just hates major surgery who can blame it. The delivery itself was a little complicated just because the amount of scar tissue and adhesions from previous surgeries. (Remind me to post one day about running with pneumonia it’s ... interesting.)

So about T H I S delivery experience.

By this point in my life I am not a new mother, I am not a first time laboring woman, I am not new to c-sections, I am well aware of complications associated with deliveries. I am educated in healthcare, the system and navigating it and I know what right is supposed to look like. This is all important to understand just how frustrating my delivery with Raelynn was.

You see providers always say to patients "you know your body" or "you know your baby" and follow it with "if something isn't right, tell us". The caveat to that is, that information is valuable but only beneficial

- IF the provider actually listens to it -

When they scheduled my c-section, I did not get to select the provider. I was informed of her name. I asked how long she had been a doctor, the answer was "three years" per the receptionist.

At my pre-op appointment I was candid with her, I asked how many 3+ or 4+ repeat c-sections she had done. I explained my previous experiences, scar tissue history and concerns. After talking to her I felt better about her doing it, I know people have to learn somehow but I did also ask who else would be in the room. She mentioned a name and I asked if that was the attending. She said "they are a fourth year"

I stopped, stared at her and said "a fourth year? or an attending?" She quickly said "they are on staff, they are an attending". When I left I felt confident in her but concerned because the thing is, attendings aren't referred to as a "year". They aren't in a residency program, they are attendings. I made a note to tell them that whoever they would page if I started to hemorrhage on the table just needed to be in the room from start to finish at my next appointment.

To be fair, sometimes attendings are a little removed from actually doing the procedures and an experienced resident may actually be the better suited for the job. And the very best attendings make mistakes too, to err is human after all.

I prayed and figured God would handle this, I had to give it up to Him.

Monday, the 1st, I homeschooled Carolynn like always but with this intense pressure, not really contractions. It was just pressure. Every time I stood up I felt like I needed to poop (in fact I tried like four times). We finished school and I was in the process of loading the girls up to head to the store for Emmys Valentine’s Day gift bags when I decided to try to poop one last time.

Because no one likes to get stuck in a public bathroom having to poop right? Much less with a 2 year old on your back in a baby carrier while a 6 and 4 year old watch you poop in a stall way to small for that many humans and a belly too big to function optimally with anyway.

So I sit down to poop, go to wipe and see blood. Like sort of a lot. So I stand up and gather our stuff, make some calls (first to my post partum nurse friend that is also an IBLC, which is a very very valuable friend to have), I packed Tanner a bag because he hadn’t done that yet and figured we were having a baby today.

It’s 11:15ish. Give or take. Tanner was in a class in a building where he couldn’t have his phone. I left him a message and looked at the time reasoning by the time I dropped the girls off at my in-laws, got to the hospital, monitored, admitted and prepped for surgery he would have gotten my message and met me there in time. Then I figured he may feel different and want to be there so I called a number he left me to reach him but got an answering machine. Again I figured he would be done in time and didn't really stress about it. I talked to my friend who is also a nurse, and her husband is a doctor that knows a provider that could reach Tanner and so it ended up being like four people that told him Monday about me being in the hospital. Anyway back to the story. . .

With a 4th repeat c-section there is a lot of scar tissue. It’s high risk for hemorrhage, and my last delivery was pretty messy with adhesions so they absolutely did not want me to be laboring this time around. They wanted a nice calm, controlled environment. And I did too. I preferred to not have my bowel or bladder damaged, be able to keep my uterus and just in general you know N O T die or anything of the sort.

I went to the labor and delivery triage, they get me all hooked up. They say yep you’re bleeding alright, it looks like maybe a bloody show. You’re having contractions. Do you feel those? We aren't sure where this blood is coming from but it does seem like a bloody show because everything else is checking out.

I said I couldn't really feel the contractions just a few here and there but a lot of pressure and this bleeding that hadn't stopped. Every time I went to the bathroom there was blood on the toilet paper. They checked me after two hours and there was no cervical change.

Hey remember when I said, my cervix doesn’t really change? Yeah. That.

They said they felt comfortable sending me home but if the bleeding started again or contractions became painful to come back in. They did not want me laboring. I said okay. I was upset and frustrated because clearly this wasn’t going to just stop but at least for now I knew Raelynn wasn’t in distress.

On my drive to pick the girls up I was having contractions. I figured, they did check my cervix and that can cause contractions so I’ll go home and rest and see what happens. The bleeding never stopped. The contractions started marching out every 5 minutes while standing up and the pressure was unreal.

Tanner and I went back to labor and delivery triage. I waited in the hall, outside of the closed doors that allow entrance into the labor and delivery unit, for a bed. A hall where no one had eyes on me. Walking around contracting every 5 minutes. When I wasn’t supposed to be in labor at all. I thought to myself, this is not a good start.

They got me back to bed, this time it was night shift. Tanner wasn't allowed to come with me to the triage bed. They saw contractions on the monitor, they see blood but the cute little baby doctor, fresh to the specialty says to me "it looks like it could be old blood from when you were checked earlier." Again, no cervical change I was still 1cm, 50% effaced and -2 station. I wanted to cry. They were sending me back home.

Despite the blood. Despite the contractions. The baby doctor (meaning young doctor not a doctor that sees babies. It’s an affectionate term nurses call new doctors that are doctors but have a LOT to learn) told me they were going to send me home, after my second spec exam and fourth time being checked for the day. I was tired of being a learning experience, tired of what was begining to be a pattern of not listening to the patient, knowing the patients history or thinking critically about how this situation was likely to play out.

I told her, I wasn’t comfortable going home to labor and end up coming back in for an urgent/emergent c-section on my fourth surgery when the risks would be much higher.

She went to get her “attending”.

Enter the “attending”.

Mind you, attending a are generally NOT young doctors. So this beautiful woman comes in, she looks my age, maybe a few years older. And she sits down, introduces herself as the attending and explains to me that while she understands I want to deliver they just can’t because it’s not medically necessary.

I’m 37 weeks 5 days. So, term. I’m scheduled for a 4th repeat c-section at 39 weeks. I am not supposed to labor.

I started crying. Sobbing really. I got incredibly short with her after she so condescendingly told me they wouldn’t deliver my baby essentially out of convenience to me.

I told her it wasn’t safe, it was not safe to send me home and make me wait until I’m in labor to come back in to rush me to a c-section and make an already high risk surgery even more high risk.

She again stated I had no cervical change and it wasn’t medically necessary but I’m welcome to come back.

So this cycle of “we won’t deliver because you don’t have cervical change”

Okay why am I bleeding?

“Oh you’re bleeding because of cervical change”

Then why are we making me labor more instead of delivering?

“Because you don’t have cervical change”

Okay why am I bleeding?

And so on.

The nurse discharged me saying “if you notice any bleeding, any painful contractions 3-5 minutes apart or if you just feel something is off. You know your body, come back”

The thing is, yes I know my body.

The problem is, that is only beneficial if the provider listens to the patient. And they were not listening. I was so tired, and so frustrated and no one was there to advocate for me, they wouldn't let Tanner be with me unless I was admitted, and no one was listening to me.

So I went home, contracting, bleeding and in pain. I tried sleeping. And finally at 0200, I couldn’t sleep, I hadn't slept. Contractions were now 3 minutes apart and every time I had one, blood was oozing out of me.

We went back to labor and delivery.

They said yep you’re bleeding. Yep you’re contracting. The baby doctor comes in and says "so what has changed?" without ever looking at the strip to see my contractions now 3 minutes apart, without checking the pad between my legs with blood oozing onto it FROM MY BODY. Just asking me what has changed as if I was coming in for fun, wanting a c-section in the middle of the night by doctors I had never met before and now had zero confidence in. She goes to get the "attending".

"LETS CHECK FOR CERVICAL CHANGE". I wanted to punch someone in the face. I don't change, I will labor for two days and still not be dilated enough to be admitted by the MTF's usual policy. But sure, lets check and see if anything has changed, let me labor some more and bleed some more and at what freaking point are we going to call it what it is and do something before Raelynn or myself end up in distress?

So the same beautiful young "attending" doctor checks me again.

Only this time, I was 1cm, 80% effaced and that’s all I heard because the “attending” looked at me and said

Wait for it, because this perhaps is my favorite part of the entire exeprience, the attending looked at me and said

“okay let me go discuss this W I T H my A T T E N D I N G”.

Y’all, I about came out of the damn bed.

Attendings — don’t — have — attendings.

Now I’m beyond irritated.

She comes back in and says “my attending isn’t comfortable doing such a high risk procedure at night with minimal staffing. We can do it, if there is a huge change in your status (meaning baby is in distress and suddenly now it’s life threatening then we will do it with minimal staffing) but for now we will wait until the morning and do it first thing with day shift”.

Sooooo they started and IV, got some labs and put me in a room.

And. They. Let. Me. Labor. All. Night. Long.

Annnnnnnnd when the day shift came on (four hours later), the nurse that took over was very angry. She was on the phone with the blood bank saying “I’m not telling you how to do your job, but we have a woman in labor that shouldn’t have ever been in labor, still laboring waiting for you to get her type and cross done so we can deliver her baby via c-section”.

At 9:01 on Tuesday Raelynn was born.

If you’re tracking, that means I was laboring for roughly 22 hours.

When I wasn’t supposed to have labored at all.

And the funny thing?

That “attending” she was in the corner of the room watching the surgery. She wasn’t even retracting skin. She was in the corner out of the way while the actual attending watched overtop of two other doctors doing the procedure. Which ended up being the doctors I was scheduled with anyway!

Oooof and that procedure.

Y’all, I’ve had four c-sections now. And this was by far the most intense. I felt my hips lifting off the table as they pulled me by my dang belly button (probably not but it felt like it) and I think at one point they just sort of shook my body to nestle my organs back into place. This clearly is not actually medically accurate.

Tanner said my uterus looked like a roast siting outside my body as they stitched it shut.

My sweet CRNA, knowing I wanted to breastfeed on the table didn’t want to make me super high, which I appreciated but also made me so nauseated when I could feel the first assist surgeon pushing with all his weight and strength on my body and even at one point inside my body. Not he inside your body in the "ohhhh sexual innuendo way" no like the hands inside my abdomen pushing with his feet braced on the ground like he was pushing a broke down 2 ton truck up a hill.

It’s a profoundly weird experience to be awake when someone takes an organ out of your body by the way.

My heart was racing, it felt like my chest was heavy and the CRNA said “oh yeah that’s because the nerves that innervate your uterus run through your chest wall and so it feels like, well it feels awful right? It won’t be much longer just focus on that baby okay?”

And focus I did. On that sweet little face, the smallest child I have had the pleasure of growing. The sweetest blue eyes annoyed by the bright lights of the OR, the tinniest little mouth that struggle to get my huge pregnancy nipple into, the little purple fingers and toes, the grunts, the precious miracle that was and is a child.