Monday, March 25, 2019

Kate's Birth Story & Battling HELLP Syndrome

I read so many birth stories in the final days of my pregnancy, looking for some semblance of consistency or at least a better idea of the things I might expect to pop up during my labor, but unfortunately my labor didn't go at all as planned, and it turned out to be something that I could never have truly prepared for, despite my nature to research all the possibilities well in advance. My pregnancy was perfectly textbook normal until this point, so I had no reason to think things would take a turn downhill.

I'll warn you now that this story is a bit long-winded, but I want to document all the details as accurately as I can so that I can go back and recall exactly what happened and hopefully my account will help someone else who might be going through the same things that I did. If there's anything that rings true for me about health and pregnancy after this experience, it's that you need to trust your gut when you know something is wrong.  So, without further ado, here goes.

On Monday morning prior to her delivery, I woke up with severe pain in my chest. I assumed that it was heartburn, so I took a couple of Tums and went through my normal morning routine.  I showered, did my makeup, and got dressed in preparation for work, but the pain in my chest seemed to only be getting worse. I figured I'd give myself a chance to let the pain subside on its own, so I texted my boss and told her what was going on and that I was going to try to sleep it off and would try to make it into the office after lunch.  I managed to get a good two hours of sleep once I crawled back into bed, but the chest pain was still there once I woke up again around noon. 

The Sunday before I delivered, at 37 weeks. 
I texted my mom to let her know what was going on, and she urged me to contact my OB just in case it was something serious. I called the OB office and left a message for the triage nurse, which she returned about ten minutes later.  She urged me to go purchase some Prilosec OTC and take the dosage according to the package. If I didn't feel any better after about 45 minutes of taking it, she suggested I call her back to arrange for an appointment that afternoon.  I did as she requested, and the pain still did not subside.  So she scheduled me to see the clinic's PA that afternoon, who did a quick physical and told me my pain was likely my gallbladder.  She said she wanted to schedule an ultrasound with the nearby imaging clinic for the following week.  I left the doctor's office highly disappointed with my level of care and unsure of what I was supposed to do about the pain in the meantime. 

I did some of my own research once I got home and decided to take a couple Milk Thistle capsules, which I happened to have on hand. (Milk Thistle is a natural supplement known for supporting liver/gallbladder issues.) As it happened, the pain slowly subsided over the next hour and didn't reappear by the next morning.  I chalked the whole incident up to pregnancy heartburn and went about the rest of my week without a concern. 

Fast forward to Friday.  Per my usual Friday routine, I swung by Chick-fil-a for breakfast on my way to work and ended up going to Wendy's for lunch later that day. I felt some discomfort in my chest, so I assumed that the fast food had been a bad call and my body was just struggling to process it. When I got home that night I ate some chicken and rice casserole and soaked in an Epsom salt bath before going to bed.  Around 1:30 that morning I woke up with the same heartburn pain I'd experienced on Monday. I took a dose of the Prilosec OTC along with another dose of Milk Thistle and tried to go back to sleep, but the pain was even more intense than it had been on Monday.  I got up and walked around downstairs, settling down into the recliner in our living room in hopes that being upright would help the pain subside. It did no good. I came back upstairs, got in a hot shower hoping that might help the pain, but it still didn't make any difference.  Finally, I made myself throw up, hoping that ridding myself of anything in my system would take the pain away.  Nothing worked.  

By 4:30 I knew the situation was out of my hands, so I woke my husband and told him we might need to go to the emergency room.  We put in a call to the OB to get in touch with the doctor on call, who listened to my account of my symptoms and suggested we go to the ER just to be on the safe side.  

Once we got there, I was immediately admitted and my vitals were taken.  They took my blood for testing and gave me a shot of fentanyl to help with the pain. The ER doctor was incredibly helpful and explained the tests they were running and suggested some possible outcomes, saying that they might need to end up doing an ultrasound of my gallbladder.  However, before any other tests could be run, they called my OB doctor with the test results.  My liver enzymes were through the roof and my blood platelet count was plummeting. The ER doctor explained that he'd just gotten off the phone with the OB doctor, who was on his was in to the hospital, and that they were sending me up to labor and delivery to meet him upon his arrival.  He suggested that the OB would likely want to either induce me or discuss an emergency c-section, as it was likely we were going to be meeting our little girl that morning. 

I was taken up to L&D in a wheelchair and checked into triage, where the nurses reviewed my chart and begin taking my vitals once again.  I heard my OB doctor arrive outside the curtain, and I heard him tell one of my nurses to "go ahead and get her prepped for surgery; we're cutting her open right away". (All this before he even came in to greet me and tell me what was going on, mind you.)

He finally appeared from behind the curtain to explain to me and my husband that I was suffering from a rare pregnancy disorder called HELLP Syndrome (which stands for hemolysis, elevated liver enzymes and low platelets) which required the baby to be delivered immediately.  Luckily I was 37 weeks and 5 days along at this point, so I was comfortable knowing Kate would be okay being delivered at this point. 

In recovery, with all Kate's grandparents. 
Everything started happening very quickly.  Will was whisked away to gown up for surgery while the nurses prepped me for the same. My father-in-law appeared out of nowhere (we still can't figure out how he got past the front desk into triage) and gathered me up in a hug while he sobbed. (Take a second to guess how freaked out I was at this point, suddenly being prepped for emergency surgery while my father-in-law sobs at my bedside and my husband has been taken to another room. As if that weren't enough, my FIL's sobbing set one of the NURSES off crying, so at this point I was basically convinced that I might not come out of this thing alive.)

Anyhow, they wheeled me into the OR where they immediately sat me up and begin preparing my back for the local spinal injection. The nurse who had previously been crying now tried to distract me with a bad joke while she insisted I stay as still as possible during the injection process. I felt my legs go numb all of a sudden, and I was lifted onto the operating table, where they instructed me to lay flat while they quickly began setting up the curtain in front of my chest. I felt a wave of nausea overcome me, and I turned my head to ask the anesthesiologist where I could throw up if I needed to. He franticly told me to hold tight, and he injected something into my IV that lifted the nausea immediately.
In the OR

One of the nurses came in exclaiming she couldn't find my husband, and they would need to get started in three minutes with or without him.  Someone found him in the bathroom and was able to get him into the OR before they locked the doors. They guided him over to my head behind the curtain, where he sat and held my hand as I felt them cut into me.  

The procedure itself was not what I was expecting. While I was completely numb from the waist down, I was able to feel everything without pain. At one point it felt like a load of sand bags had been placed on my chest (I later found out this was likely the weight of my intestines that had to be pulled out and temporarily placed on my chest in order to get to the baby). I felt the sensation of pressure and pulling throughout the procedure, but luckily it didn't last as long as I expected.

Within just a few minutes of the surgery starting, I heard the sound of crying. And the funniest thing was, at this point I was so delirious and so amped up with adrenaline that my first thought was to wonder whose baby was crying in my operating room. With a sudden jolt I realized it was my baby, and felt a huge wave of relief at knowing she was alive and crying. 

Will with Kate
One of the nurses pulled the curtain back slightly and told me to look around to the left, where I saw them place Kate on the scale.  I was struck by how long she was, and laughed to myself at knowing that was why she'd been so active in my ribcage for the past several weeks -- she was literally running out of room in there! All of a sudden I started sobbing and Will squeezed my hand in support.

The nurse took Will's phone to take the first few pictures of our baby, which Will then showed to me as they began suturing me up. Once Kate had been cleaned up and checked out, the nurse guided Will out of the OR with the baby.  A few minutes later, once the doctors had finished up on me, they wheeled me out into recover where Will sat in a chair, holding our daughter and staring at her, completely mesmerized. 

Once I was situated and hooked up to more tubes and drips, they placed my daughter on my chest. Will and I sat there with her, admiring her features, stroking her little arms, and finally getting a chance to exhale after a whirlwind morning. I know I'll look back and recall that those first moments with her was one of the happiest times in my life, just the three of us quietly sitting there and marveling over everything that had just happened. 

The next three days were kind of a blur.  I was hooked up to a 24 hour magnesium drip (not something I would wish on my worst enemy -- it makes you feel heavy and loopy and nauseous) and then later that night was given a platelet transfusion (the low normal count is 150,000 and my levels had dipped to 21,000). My mom and Will took turns spending the night in the hospital with me and the baby, as I wasn't able to be left alone with the baby as long as I was on a magnesium drip.  It was a struggle to hold her with all the lines coming out of my arms,  and I wasn't able to stand up to pick her up or change her due to my incision. I'm someone who hates having to ask for help, so the fact that I was essentially unable to care for my own child was something that really hit me hard. 

After a very long 72 hours, we were finally discharged to go home. My recovery has been slow and steady, but Kate has been the picture of perfect health since the very beginning. I've read so many accounts of people with HELLP Syndrome since she was born, and I can't believe how very lucky we are. So many babies don't come out as healthy as Kate did, and many of them are born far more premature than she was. My primary concern at this point is that this condition would arise in a second pregnancy, where we might not be so lucky.  While a second pregnancy is a ways down the road, I plan on doing as much research as possible and hopefully finding a maternal-fetal medicine specialist nearby who can help guide us through another pregnancy while minimizing the HELLP risk as much as possible.  

If any of you readers are pregnant or know someone who is pregnant and having chest pains, PLEASE SEEK MEDICAL ATTENTION and request a blood test for liver enzymes.  Had the PA at my OB clinic on Monday tested my liver enzymes, I would have received a HELLP diagnosis (by a real doctor, not just a PA who falsely assumed I was simply suffering from pregnancy heartburn) three days earlier than I did.  And in so many HELLP cases, three days would make the difference between life and death. We ended up being incredibly fortunate that things turned out the way they did.  

I am so over-the-moon happy that my daughter is happy, healthy, and here with us.  But had events played out differently, or had I not decided to go to the ER when I did, this might be a very different blog post.  So please, please, remember that you know your body best and that it is imperative that you trust your own intuition over all else. 

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