Recap of the Big Day – Nov. 3 2007

So much happened since the entry about our Rough Night (blog entry from 11/3), that it took a while to find the time to record all that transpired on the big day.  I’ll do my best to remember everything.

 

By mid-morning on Saturday (11/3), Julie’s contractions and pain had subsided significantly from the tough night before.  I had not been home in a couple of days, so I decided to head back to the house to take care of some errands, to take Maggie for a run and to sneak in a little nap.  I came back from my run to be greeted by multiple messages that Julie’s contractions had increased and I should head back to the hospital.  I called to find out the latest and Julie had been put on magnesium sulfate, which is the last ditch effort to delay labor.  Best case, things would be delayed by 24 to 48 hours.  So, I packed a bag with two days of clothes and drove off the Swedish Medical Center.

 

Upon arrival, Julie was pretty uncomfortable.  Luckily our doctor’s call schedule worked out that our primary physician, Dr. Heyborne, was on call that day and was attending bedside.  He had just pulled overnight call, but was still available at the end of his shift.  Once labor starts, it really can’t be stopped so he was trying everything they could to put off the inevitable.

 

The biggest concern soon came to be the risk of infection.  Dr. Heyborne theorized that with all of the bleeding Julie had experience over the prior weeks, along with having received a cerclage, put her at a high risk of infection.  An infection could be the reason her body decided it was time to deliver the babies.  If there was an infection, immediate delivery was required.  If there was not an infection, they would use more magnesium to postpone labor.

 

The best way to find out if there was an infection was to perform amniocentesis, where they use a long thin needle to extract some fluid from inside the sack around a baby.  It made the most sense to focus on Madison’s fluid since she was the lowest down and most likely to be impacted by the bleeding.  So, Julie strapped on her iPod and, with Madonna playing, patiently underwent the procedure.  They took the fluid away and told us we needed to wait an hour for the results.

 

Just in case there was not an infection, Julie was given another dose of magnesium just to get ahead of the contractions.  The first dose caused her to have alternating swings of hot flashes and chills.  The second dose caused the same thing, but the swings were much more intense.  She started with heat, and lay on the bed with no covering while sipping ice water.  The chills soon set in and were relentless.  We wrapped her in warmed blankets but still her body was wracked with chills and her teeth chattered uncontrollably.

 

A nurse poked her head in and said the first set of test came back negative for infection, but there were more results that were pending.  A glucose test had to be sent to another hospital so there would be a delay.  The absence of glucose meant an infection was present.  At this point the chills were getting unbearable, and Julie gave the nurse an ultimatum.  Either someone had to stop the chills or deliver the babies.  So, the nurse stopped the magnesium and we’d have to cross our fingers that if there was no infection Julie received enough medicine.

 

So we are sitting in the room for another 30 minutes or so when our nurse, clothed in operating, scrubs walks in.  She hands rolls of scrubs to me and Julie’s father and says, ”Well, we’re having babies tonight.”  From this point to delivery, less than 1 hour elapsed.  She gave us brief instructions on how to dress and we were off to the races.  An anesthesiologist came in to give Julie her preoperative orientation.  Luckily we already met him from the cerclage procedure so that was comforting.  Dr. Heyborne came in and it turns out he would be still on call and act as the primary surgeon for Julie’s delivery.

 

In a few minutes, Julie’s dad and I were in scrubs and ready to go.  Julie’s dad held the camera and the cord blood collection kit, and I held Julie’s hand as we wheeled the hospital bed out the door and down the hall to the OR.  The OR was a beehive of activity.  Teams of people at each of three warming tables prepared tape, blankets, respirators and other equipment the babies would need.  Nurses in the corner counted in the inventory of surgical equipment, all of which would have to be counted back out before the surgery could be completed.  Our doctor and the assisting surgeon discussed putting (not kidding).  Everyone had their game face on.

 

They sat Julie on the edge of the operating table so the spinal anesthetic could be administered.  In 10% of spinals, patients experience paresthesia, or sharp tingling, somewhere in their body.  It’s harmless and fades quickly but it can be very surprising when it happens.  Luckily, our anesthesiologist had alerted Julie to this possibility, so it wasn’t a total surprise when a sharp wave of tingling shot down her right leg.  It quickly passed and the numbing began.  Up until the surgery, the anesthesiologist tested Julie by wiping an alcohol pad on her forehead to upper chest to see if she felt cold and another on her tummy to make sure she did not.

 

Julie was laid out on the operating table with her arms out in the form of a crucifixion.  This aids the anesthesiologists in access to her arms.  The first thing to be done was to remove the cerclage, which Dr. Heyborne completed fairly quickly.  Then it was on to the main event.

 

I sat by Julie’s head, and her Dad stood just behind me.  The surgical team put up a blanket as a wall to separate us from the work zone.  In part this is to shield us from the sight of surgery but also to shield us from the back-spatter as they worked.  The shield was not 100% effective in that second respect (eeeewwww!).  The next few minutes are pretty much a blur.  I talked to Julie while the surgeons worked away.  After what seemed like forever, I heard Dr. Heyborne announce, “There’s one baby.”  That was Madison.  After that they worked in relative silence only to occasionally apologize to each other for spraying the other with some fluid.  I was so focused on Julie that I totally lost track of what was going on.  It was not until Julie’s Dad tapped me on the shoulder and I looked to my right and saw the teams working on two babies (Noah and Chloe).  Julie’s Dad was standing right over Chloe, so he gave me the camera and suggested I walk around to the other warming tables to get some pictures of the other kids.  I could tell at the time that Madison was getting more attention, and in hindsight it makes sense.  Noah was the first to be stabilized, and they let me hold him briefly before we began our trek down the NICU for the first time.

 

So me, a nurse holding Noah and a tech wheeling oxygen walked down the long hallway to the NICU.  A few minutes later Chloe arrived.  Shortly after that Madison showed up as well.  Teams of nurses, some of who had been called in on their days off or from vacation, worked to clean each baby and attach them to monitoring equipment and breathing assistance.  Again, Madison was worked on for the longest time as ultimately she was put on a respirator.

 

Once all the kids looked stable and tucked in, I told one of the nurses I was going to head to post-op to see how Julie was doing.  She said they usually call to let them know the mom was out of surgery, but they had not yet received a call.  This really got me worried, especially with the fears we had about hysterectomy.  I “walked briskly” back to the OR and a nurse who recognized me pointed me down the hall to post operative recovery.  Julie had lost a lot of blood (2,000 cc), but Dr. Heyborne was able to manage everything successfully.  I turned the corner to find Julie, her dad and our nurse Brenda in a bay in recovery.

 

Julie’s recovery was very hard that first night.  The magnesium they gave her caused extreme nausea, and she spent the next 6 hours vomiting.  If you think vomiting is hard, try doing it after abdominal surgery.  By 3am, most of the nausea had passed and we were finally able to get some sleep, on our first night as new parents.

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