The Best Laid Plans of Mice and Mandys... Pt 1

I don't know how clearly I expressed my desire for a natural childbirth. I read all the books, saw a midwife for my prenatal care, talked to all my birthing-center and home-birth friends, and generally geared up for the event. I told myself that things change and I would be ok with interventions if I had a medical emergency, but I really did have my heart set on a natural, intervention- and drug-free birth more than I realized.

Tuesday, March 20th was 32 weeks and 6 days into my pregnancy. We had had an ultrasound and knew we were having a little boy, and things had looked really good up to that point. I was gaining weight a little fast, which didn't make a lot of sense to me, but the baby looked good and so did I, in general.

Tuesday morning, I vomited a lot of blood, which scared me pretty badly. I called my midwife and headed right over the their office.

They took my urine and my blood pressure and gave me a once-over. They diagnosed me with a stomach virus, told me bleeding was normal when you're pregnant, and sent me home with anti-nausea medicine. The rest of Tuesday was uneventful.

Wednesday, I was in a ton of pain and couldn't hold anything down. It felt a little more like a stomach virus than Tuesday had, which restored my faith in my midwife. Tuesday had been so weird that I thought they were just assuming that "the pregnant woman was scared of stuff" and had blown me off. After being so sick all day Wednesday, however, I was willing to accept the stomach-virus theory.

Thursday, Friday, and Saturday were asymptomatic. The only thing that concerned me was that, in most of my experience, vomiting with a stomach virus tends to give me diarrhea later on, which didn't happen. I chalked it up to pregnant weirdness, though, and moved on. My boss threw me a little baby shower on Saturday night, and we were riding high on good pregnancy vibes.

Sunday morning was 33 weeks and 3 days into my pregnancy. I woke up feeling much like I had on Wednesday: in a ton of pain, not holding anything down. I stayed home from church and watched the service on our live feed.

I got worse and worse throughout the day. Around 5 pm, I couldn't even hold down water, and I started to feel sore in my right shoulder. I asked Adam to rub it for me, thinking that maybe I had strained it while vomiting. As the evening wore on, the pain in my shoulder got worse and worse, and my stomach pain moved from my middle upper abdomen to under my right ribs.

We got on the computer and looked up some possibilities, trying to decide if we should go to the ER. Adam was all for it, but I would have none of it. I was convinced that I was a wimp, that I'd show up to the ER and they'd tell me that it was a stomach virus - you silly, silly pregnant woman - much like my midwife had. We read about a bunch of ailments involving stomach pain and vomiting. Unfortunately, they all have basically the exact same symptoms. We investigated gastritis, preeclampsia, and gallstones. Gastritis didn't quite fit, and I was sure it couldn't be preeclampsia because my midwife would have caught it when I went in on Tuesday. After reading that gallstones cause shoulder pain, we decided - at 1:30 am - to go to the ER. By this time, I was in an incredible amount of pain, and my upper abdomen was starting to visibly distend.

They took some blood, took some urine, and put me on an IV until they figured out what was wrong. Apparently, hospitals react a little more strongly to a pregnant woman walking into the ER doubled over in pain.

The midwife on duty, who was part of the midwife team I was seeing for the pregnancy, came in around 4 am.

"Hi, Amanda. You're sick."

"Ok..."

"You have preeclampsia. I'm transferring your care to the physician on duty because I can no longer attend to you since you're high risk."

And she just walked out of the room.

I burst into tears. I didn't know anything about preeclampsia except that it was that big scary thing that no woman wants to catch. It wound up being way bigger and scarier than I realized.

I should have known things were a big deal when they sent me to a labor and delivery room, but I was still clueless about the severity of the situation.

A doctor came in around 7:30 and told me that I had severe preeclampsia and the only way to fix it was to have the baby. They wanted to start right away, and I could choose between being induced or having a c-section. I was floored. I had what they called "severe, atypical preeclampsia." It was severe because my liver enzymes were high, my liver was swollen, and my platelet count was low, putting me at risk for something called HELLP syndrome (high liver enzymes + low platelets + destruction of red blood cells). It was atypical because my blood pressure was not too high, my urine didn't have that much protein, and I didn't have that much swelling - all of which are early signs of the disease that would have clued my midwife in to my condition. I basically skipped all the early stages of the disease and dove right in to "severe." (Unusually fast weight gain is another symptom, by the way.)

I was petrified. My little baby was 6 weeks too young to be born. All the horrible images of NICU babies wrapped up in cords and ventilators and IVs came flooding to my mind, all the little arms and legs with no body fat and old-person faces. I could think only of all the parents that have to have their babies and leave them in hospitals for weeks or months, going home to empty wombs and empty houses, sitting in a hospital room to see their terrifying baby once a day.

I talked to my husband, and since the risks (at that point) of giving birth were so great, we chose the c-section. Our pastor came to the hospital and prayed with us, and we felt more or less ok with our decision.

A team of doctors came in at 9 with some interesting ideas. One doctor said that since my blood pressure was normalizing, she wanted to be sure it was preeclampsia before they took the baby early. She wanted to completely rule out gallstones before they made a huge mistake. I was so thankful for her caution, and I started to build up hope that maybe it was just a gallbladder issue and everything would be fine.

After an ultrasound, more blood work, and a few hours of built-up hope, it still wound up being preeclampsia. The doctor said that since the urgency had gone down somewhat, they would induce instead of doing a c-section, unless an emergency c-section was absolutely necessary. My platelets kept dropping, and they no longer wanted to cut me since clotting might have been an issue.

The show started at 1 pm, March 26th.

This is where stuff gets gross, so enjoy all the gory details (which I know you will, Becky :-).

They began the induction with a low dose of Pitocin and a balloon. The balloon was put in my cervix and the goal was for it to manually dilate me to 4 cm over the next few hours. The doctor inserted the wrong balloon at first, which really pissed me off because it was unbelievably uncomfortable the first time. The Pitocin was to induce contractions. I hung out with a balloon for a few hours, and mild contractions started to happen. They took the balloon out and upped the Pit. I stayed at 4 cm with ineffective contractions for 10 hours. At 2 am, March 27th, they decided to break my water to move things along. I don't know why, but breaking my water was the last straw for me emotionally. I sobbed and sobbed. My only guess is that there was something so final about it... like all the drugs and the balloon and whatnot were all reversible, but now my poor baby couldn't float anymore - there was no going back.

Adam and I had a moment alone after they broke my water. He held me while I cried, and we looked together through some baby stuff that his mom brought us. It was really comforting to look through all the little blue clothes and stuffed animals. I couldn't help but think about how much smaller he would be than these clothes...

A few minutes later, the doc came in and upped the Pitocin dosage by a ton. At that point my contractions were becoming unbearable, and we all started to discuss pain relief. Of course, I had planned on a natural birth, so I had not given much thought to pain relief. Since all of THOSE hopes and dreams were out the window, I had accepted that an epidural would be the best option and asked for one. We waited 30 minutes for the anesthesiologist to bring me sweet relief, and the contractions were getting more and more unbearable.

The anesthesiologist came in at 2:45 with some bad news. Since my platelet count was so low, he would not preform an epidural. If I didn't clot properly, it could hemorrhage into my spine and paralyze me.

I think the only person who could know how I felt is a general who is losing a battle and just found out that the cavalry is not, in fact, arriving. I was going to have to John Wayne this thing on my own.

The only other pain relief option was Demerol. Demerol is a delightful little drug that does almost nothing for pain, but does a darn good job of stealing your brain. So now, not only did I still have the same level of pain, but I barely understood what was happening to me. Everyone reacts differently to drugs like that... my reaction was painful stupidity.

The next three hours were a painful blur. In between contractions, I was practically falling asleep. I had not slept in 30 hours BEFORE inducing labor, and at 3 in the morning I was operating on more than 40 hours of wakefulness.

The only real thing I remember (besides excruciating pain) is that they kept losing the baby's heartbeat. I lost hope every time that little monitor stopped beeping. He wasn't under stress or anything - they just couldn't locate his pulse with the external monitor. Enter internal monitoring. They attached a few cords to the baby's head to monitor his heartbeat. They also had to insert a tube to add water back to the uterus because my contractions were so intense. They also inserted a straw that surrounded the inside of the uterus to monitor contraction strength. I had 5 different fluids coming in my IV and 3 different monitor cords hanging out of my uterus. So much for a natural childbirth.

My contraction patterns started freaking out some of the techs, so they lowered the Pit, readjusted me, then upped the Pit again. I labored at 4 cm for what seemed like an eternity. Finally, at 5:08 am, they checked my cervix and it was 6 cm dilated (2 whole cm of progress! whoop-dee-freakin-doo!). They gave me more Demerol at my mother and my husband's request since it seemed like we might have a few more hours to go.

A few minutes later, I had a strong urge to push. Like, STRONG. The conversation with the nurse, as I remember it, went something like this:

Me: I have to push!

Mom: What? Oh my gosh, nurse!

Nurse: No, you don't, it just feels like it. You're only at 6 cm.

Me: Well, then I have to poop.

Nurse: Don't worry about that, if there's anything there, it will come out when you push.

Me: I have to poop NOW.

Nurse: *sigh* let me check your cervix. *pause while she checks cervix* Oh my God. There's no cervix. Don't push, don't push, lemme get the doctor!

After that, it was really cinema-quality drama. The doctor told me that pushing could take a while and coached me on how it would go. The room filled with NICU nurses and techs. There must have been ten people in the room. I gave a few preliminary pushes and the doctor freaked. "I feel his head, stop pushing, don't push, not even a little!" I had to lay there, drugged out of my mind and fighting an incredibly strong instinct for a few minutes while they broke down the bed and got all the towels and pans and NICU gear ready.

Finally, everyone was ready, and I was allowed to push. I pushed three times. On the third push, the baby literally flew out into the doctor's arms. I'm not kidding. He shot out of me, and the doc caught him like a football. They rushed him to a table and started to clean him.

Now, remember, I had just had some Demerol, so while I had felt everything physically, my brain was freshly doped up. Also note that babies aren't that great looking when they are born under even the best circumstances.

They brought Elijah to the bed for me to see him before they took him to NICU. I reached out and touched the little hat they had put on his head. With the Demerol, the memory feels slow-motion. He was gray, and his face was gaunt like an old person. He looked like a corpse, and in my drugged state of mind, I thought I had delivered a dead baby. When they whisked him away, I told Adam, "Go with him!" The next 20 minutes, the doctor was delivering the placenta, and I stared at the ceiling. The doc and mom both got really concerned because I looked catatonic. I just couldn't get my head around what had just happened, and I was so drugged. I heard someone say 3 lbs 5 oz.

They brought me a breakfast tray right after they put the room back together. I stared in disbelief at eggs, toast, and sausage. They expected me to eat? I hadn't eaten anything in two days, and I had not even a little appetite.

I was on bed rest for the next 24 hours because I was on a magnesium drip for the preeclampsia. That meant that for 24 hours, the only sight I had seen of my baby was when he looked dead. Adam came back with pictures for me to see and declared that he had turned pink, but I couldn't get the image out of my head.

24 hours later, they moved me to recovery, but I demanded to be taken to NICU first. They very kindly obliged me... and I will write about that and other experiences in the next post.

Miracles

So, here's the (hopefully) final chapter in the Medicaid Saga.

I received in the mail a letter informing me of my new account number and case information (so that I would no longer be identified as someone-with-Adam's-name-who-lives-in-Miami). I got all excited and went online to see my shiny new web account. I tried to get into the new account with my new number, my name, my birthday, and zip code.

'The information you have entered does not match what we have on file.'


Of course it doesn't.

So I called DCF again.

After waiting 30 minutes listening to bad Jazz music and instructions in 3 languages, I got through to a lovely young lady who informed me that I needed to put Adam's information as the payee (the one responsible for the account) instead of myself for some unknown reason. Bingo, I was in. She gave me my ID number over the phone, I thanked her, and, like a fool, I hung up.

On the web account, I had to go through all the original registration stuff (security questions, new password, new username, etc.). When I finally got in to view my account information, there was none. There was information for the baby, but nothing for me. I couldn't even find the ID number that the lady gave me over the phone.

Trying not panic, I called my midwife to give her my new ID number so she could have me on file (so I wouldn't have to pay for that doctor's visit that I thought was covered). The secretary looked me up and said, "That's not bringing up anything. Let me try your social security number." Also, nothing. She said, helpfully, "It sometimes takes 48 hours for their systems to reflect new changes, so maybe you can check in with them again on Wednesday and see if you're information is back up." Eager for any excuse not to call DCF again, I readily accepted her suggestion and moved on with my day.

Come Wednesday, there was still no change, and I became alarmed. Adam went to his prayer meeting that he has early on Wednesdays with some of the guys in our church. I read my Bible, prayed for strength, guidance, patience, and a happy ending, and I settled in for a nice long morning of talking to DCF. I called at 8 AM, and I talked to another nice young lady about the fact that my number brought up no information for me.

"Oh, you're right, ma'am, there is nothing."

"So what could be wrong?"

"I don't know, let me try something."

...la-de-dum-de-dah...

"Ok, ma'am? It looks like Medicaid approved your application, but the Department of Children and Families denied it."

"I beg your pardon?"

"I've never seen anything like this, and it is definitely an internal error on our part."

"Um..."

"So I'm going to send an e-mail to Medicaid and DCF and see if we can't get this straightened out."

"How long will that take?"

"About 5 business days."

"Oh, man... Listen, I know with your job and everything that you probably have heard every sob story out there, but I am really frustrated at this point. This is the third major blunder that has occurred with my account, and I'm seven months pregnant. I'm really at the point where I HAVE to receive medical attention, and we can't afford it. Is there something else I can do, or someone else I can call to speed this up? I really can't wait any longer and I'm having to cancel appointments..."

"No, Ma'am, you're doing everything right. If there's still a problem after five business days, it will be sent to a higher level, and no one wants that..."

"I might want that..."

"Yes ma'am, I understand, but this is all I can do for now."

"Ok, thank you for your help."

Upon hanging up, I broke down into uncontrollable sobs. If you ever wanted to know my breaking point, that is it. I prayed again, then called Adam.

Me: sobbing "Medicaid doesn't have me on file"
Adam: "I'm sorry baby."
Me: *sniffle "I need you guys to pray about it while you're there."
Adam: "Ok, baby."
Me: "And then come home because I need you."
Adam: "Ok, baby."

It was one time in my life where it was nice to have a Yes Man. The whole conversation took longer than necessary because I kept sobbing and halting and swallowing and burping through every sentence. I had sincerely fallen apart.

I climbed into the tub, as I do, and cried and prayed through a very hot shower.

Adam came home to find me in a lump on the bed, wrapped in towels and face swollen, although I had pretty much cried myself out at that point. We cuddled and talked about trying to come up with plan B. If Medicaid really didn't come through, what would we do? We discussed some options, I left a message with a social worker, and started making breakfast.

At 10 AM, I received a phone call from a number in our area code. Usually, I would ignore calls from people I don't know, but I answered because of all the calls I had out to all the numbers I wouldn't recognize. A man who sounded exactly like my father said, "Amanda?"

"Yes?"

"This is D**** with the Department of Children and Families."

"Oh, hi, yes."

"We have activated your ID number and your account is ready to go. You can use the number now, and you'll have a Medicaid card in the mail in 3 to 6 weeks. In the meantime, use your temporary card that you can print online starting tomorrow."

"Oh, my gosh, thank you."

"Your welcome. Do you have any questions?"

"Uh, no sir."

"Have a good day."

Stunned, I stared at my phone after he hung up. As I was looking at the screen, I received three texts in succession from my pastor's wife (our pastor was one of the guys at the prayer meeting that morning, so he and his wife knew about my breakdown):

"And I will bring the blind by a way that they know not; I will lead them in paths that they have not known: I will make darkness light before them, and crooked things straight. These things will I do unto them, and not forget them." Isaiah 42:16.

The message was loud and clear. I went into happy hysterics, laughing and crying simultaneously, and we prayed in thanksgiving together over my little miracle. I spent the morning in praise of the Lord, Who had certainly moved greatly that morning to take care of me and Baby. I don't know what was done or said that got the ball rolling, but I know that God was so good to me that morning, and that He has control over all the things that I don't.

---------

I had all my blood tests done that Friday, and we had an ultrasound on Tuesday. I got to see my baby's face for the first time. When I think about it, I can't help but tear up. Baby looks like daddy, which I find adorable and thrilling (but I think Baby has my mouth). I have an appointment with the midwife next week to go over the results of the blood tests and the ultrasound.

We get to meet Baby face-to-face in May, two short months away.