#pretermlabor | Explore Tumblr posts and blogs

dietmoonfairy · 6 years ago

Text

Just Me, Processing

I have always found that writing is the best way for me to process through something, because I tend to go around in circles in my head until I actually write it out linearly. Something about the lines of writing make it harder to circle back to the beginning and do the entire round about again. So this is me, processing my preterm labor experience that I returned from the hospital on bed rest from this afternoon.

Saturday night, I worked what was actually a pretty low-key shift, at least from a physical standpoint. I requested to be put on call after working a more strenuous Thursday shift, in part to give my body a little more time to rest before I switched over to doing day shift for the next couple of weeks (my first day shift was supposed to be Monday). These two weeks of day shift have been giving me a little bit of anxiety, mostly because at 34 weeks pregnant I definitely am moving slower, and day shift is by its very nature faster paced than night shift. I also expected I’d need to circulate for scheduled c-sections, which I was nervous about because of the physical aspect but also because I’m still not 100% comfortable with sections (which is why I was going to do these days shifts in the first place). Since early last week, I had tossed the idea around of requesting a note from my OB to go on light duty for work, because we have had an uptick in shit-show shifts and each of those has been harder to recover from physically. Leaving the hospital in tears mostly because my back and belly are just in so much pain, but also because the shift has been mentally taxing, doesn’t need to be my norm but especially not this late in my pregnancy. But ultimately, I decided not to ask about it. Because it’s the US, and Texas to boot, there are no strict maternity leave laws. I haven’t worked for my hospital long enough to qualify for FMLA, so my maternity leave is going to consist of 6 weeks of short-term disability and another two weeks my manager has pre-approved. 8 weeks of total leave. It’s already not ideal, but it’s what I have to work with. My concern with requesting lighter duty was that I know no such thing exists in my area of nursing, and by law if there is no such thing on the unit for those with a disability already, short-term pregnancy disability doesn’t have to be granted. I was worried my bosses would have me use some of my 8 weeks of leave on this end of the pregnancy, leaving me with even less time post-partum with my new daughter. I was able to be home with my first daughter for a full year; I already have second-child guilt that this baby won’t get as much of my time. 8 weeks will be no time at all, I couldn’t in good conscience make that even less time. So I went to work on Saturday, reluctantly.

I won’t go into too much detail about my shift Saturday night, but it does feel pertinent to remind myself when I come back to this later and reread it, that we were in a demise cycle. Fetal demises (stillbirths and miscarriages) come in threes; my shift Thursday night had one, and Saturday night at about 2am we had a mom come in for decreased fetal movement. We couldn’t find heart tones, she was 38 weeks and 4 days along with her pregnancy. Every demise is heartbreaking, but these are particularly hard on multiple levels. It isn’t usually us, the nurses, who break the news to moms that their babies are dead. They usually find out by going to their OB office, and come to us shell-shocked but ready for the next step. Not the case for this demise. As a clearly pregnant nurse, I did not have this patient; we try not to pair pregnant nurses with demises, for obvious reasons. But I felt her pain, and every time Evie moved in my after she came into the hospital, I felt a little guilty and relieved at once.

So that was my Saturday night, in part. I came away from the shift in a little emotional pain but not as much physical pain as I have been. My belly was tight, like it usually is when I haven’t hydrated enough and have pushed myself a bit, but nothing really unusual. On and off this pregnancy, I’ve had a pain along the right side of my uterus, and that was there as well. Usually these things go away with rest and water. But by Sunday evening, I was still noticeably uncomfortable, and I was a little concerned about it. Honestly, I was still more concerned about what the next day (my Monday shift) was going to look like. In order to call out and not be in trouble, due to SXSW and spring break, I was going to need a doctor’s note and proof of illness, which I wasn’t going to be able to get on a Sunday night unless I went in and was triaged at the hospital by one of the people in my OB practice. I hemmed and hawed a bit but ultimately called the office to speak with someone and see whether they thought I should come in or not. The nurse-midwife on call gave me the choice of either trying to sleep and seeing what happened, or going up to NAMC right then and being checked out. I decided it was best to go in, spend the couple of hours being triaged and ultimately be told “hey, you’re working too hard, you need to take a day or two off” and call into work for the next day conscience clear. This really was about avoiding that Monday shift, which I think is why I feel somewhat guilty about all the rest. Maybe I just should have worked the damn shift.

My husband and I drove to NAMC while my dad, who happened to be in town visiting, kept an ear/eye out for our sleeping toddler. I truly did think we’d be there for a couple of hours and then back home. We didn’t even bring our cell chargers with us, much less any clothes or a bag or anything. Truth be told, I don’t actually have a labor back packed still...see second child syndrome.

Arriving, I thought the whole things was a little surreal. It was strange to be on the receiving end of care I usually am giving to my own patients. I had my first daughter at a birthing center, and by the time I arrived there I was very obviously in labor and ready to be there. So doing a hospital visit at all for this pregnancy was new, and going through triage was new for me. We checked in, I got taken to the triage room and handed the gown and pee cup. I’ve said the same spiel as they said, but it was still really weird to take my clothes off and put the hospital gown on. I put it on, and felt self conscious about keeping the bottom half open. Even though I know we do it for the ease of putting on the monitors, and I knew I would just wind up untying it moments later, I was sorely tempted to tie the bottom before walking the five steps out of the bathroom to the triage bed. I’m not a modest person, and pregnancy tends to strip away much of what little modesty I have. When I gave birth to my daughter, I started off in this sun dress my husband pulled out of my closet, but very quickly wound up naked and never really thought much about it. So to feel weird about the hospital gown was itself weird to me. Sitting on the bed, being strapped to the monitors, and then just going along with the normal triage routine, I was so struck by how much I did not enjoy the experience. The bright lights, the hospital gown, being hooked to a monitor, all of that was like nothing I experienced with my first birth. I said as much to my husband, that I did not like it and didn’t want to have it as an experience for when Evie is born. It all felt alien and I didn’t feel like I had any power over the situation, I was just sort of along for the ride. Which isn’t something I expected from this experience, truth be told. I never have thought that the way we triaged patients immediately stripped them of their autonomy, but now I definitely see how it does. And in the future I really plan to address that, because if I (a woman who has dedicated the last 6 years of my life trying to empower women to have the best birth experiences possible for them, with as much say as possible, not to mention someone who has already given birth the way she wanted to and felt she had a voice to say what she needed) felt stripped of my autonomy, I can only imagine how women less informed and less confident must feel.

In the triage, I had some blood drawn, I saw the nurse-midwife who inquired about the pain I was experiencing. She checked me for appendicits, which wasn’t the issue, and then said, “Well let’s monitor you for an hour or so and see what we see.” Great, I figured that would be the case. The monitor was picking up small contractions, but I didn’t feel any of them, and this is not unusual for being 34 weeks pregnant, especially not if I was dehydrated still and recovering from my shift the night before.

After that hour, because of the contractions, the nurse-midwife returned and said, “I’d like to check your cervix to see if you’re actually in labor.” Here, I hesitated: I really did not want a cervical check. I did not have any with my previous birth until I was in active labor and at the birthing center. I was 7cm, well effaced, and my daughter was low. I don’t remember feeling anything with the check because I was well on the way to giving birth. I had one more hours later to determine I’d made some progress and that I wasn’t complete yet, and that was that. It’s just been my philosophy that they aren’t incredibly necessary tools; a woman can be 4cm dilated at an appointment and still not go into labor for a week, while another might be 1cm and go into labor the next day. They’re just not determinate. Against my better judgment though, I agreed to the check. And boy do I now, in retrospect, think that was a mistake. The midwife called me 1 1/2cm dilated, with bloody show (which means that the vessicles on the cervix and in the vagina itself break and bleed -its a common sign in labor that the cervix is dilating to have bloody show). Now, I know that I have a pretty vessicled cervix, even when not pregnant. I often bleed from vaginal exams at the OB, and have bled from sex before as well. So hearing that she had some blood didn’t bother me, especially with how painful the exam itself was. I didn’t expect that I would dilate at all, so I still wasn’t worried, just kind of miffed by the experience.

Then the contractions kicked up.

And truly, that is when I started to become panicked. I skipped over nervous and straight into panic. Because while before I was having the contractions but couldn’t feel them, now I felt them. They weren’t painful, they were pressure, but the pressure was strong and pressing down into my bottom and the contractions became regular. Every five minutes I’d feel it building and with each contraction I started to lose it more and more. Because suddenly, this exercise in being triaged had taken a very different turn. And despite, or maybe because, of all the knowledge I have, I began to freak out about the worst case scenarios. All I kept thinking was how I was not ready for labor. I was NOT ready for labor. I was not mentally in a place to be in labor, and physically the hospital was the furthest place i wanted to be for my labor. But I wasn’t going to have a choice because, at 34 weeks, my baby would be pre-term and have an automatic ticket for the NICU. Another thing I absolutely was not prepared for and therefore was panicking about. My body began to physically shake as I tried to hold in all the emotion. Ultimately the dam broke (the first of multiple times that night/early morning) and I did cry. It didn’t help the underlying anxiety and panic over what this experience was going to look like and how I kept returning to not being anywhere near ready.

When the midwife came back two hours later, I already knew she was going to tell me about my contractions. And when she checked me, even though I prayed my cervix had stayed the same, I had my doubts. Sure enough, it had dilated. Not much: I’d gone from 1 1/2cm to 2. But it was change, and any change when you’re looking at a possible pre-term birth is disconcerting. I knew I was staying that night. I was once again panicking. I was trying to become okay with the idea that I might meet Evie that day, and all I kept thinking was, “No no no. She’s supposed to be an April baby. She can’t be a March baby. I don’t even like the date.” It sounds ridiculous, but I tend to latch onto very shallow things when I’m terrified of the deeper ramifications. And still, it all felt so surreal, not quite out of body but close.

They took me to a labor room, got me all hooked up, and I tried to reassure myself. The contractions, which had been consistent and very obvious, began to lessen once I was told I was staying. I think the two hours of uncertainty, of feeling contractions but not knowing if I’d made cervical change or if I would be going home, and the hysteria I let build in my body did me no favors. And i think the cervical check itself irritated my already irritable uterus, to the point where it was like, “Oh... am I supposed to be doing something? Should I be...evicting this parasite? Um, okay, I’ll work on that...” But I had no way of knowing that for sure, and it felt like denial to not think and acknowledge the alternative. Still, I felt a little more reassured, as though things would be okay. Colin and I even settled in to rest some, after my dose of penicillin finished (I will never again doubt when a patient tells me how much that penicillin hurts; my hand felt like it was about to fall off). With all the fluids I had running in me, I was getting up to go to the bathroom more than I ever do (which absolutely tells me something about my usual hydration status), and initially after those cervical checks there had been some blood. Not much, but a little bit. By the time we were resting at about 4am, I hadn’t seen much. I really was reassured that this was false-labor and all would be okay. I slept until about 6, when a few contractions woke me up. They still only felt like pressure, and the pressure was mostly in my bladder, so I got up to pee. When I wiped, I looked down, and my heart sank. There was more bloody show, and it wasn’t old blood. Some of it looked fresh. I wiped multiple times and there was more. I got back into the bed and cried silently. I felt defeated, I felt hopeless. I didn’t want to wake up Colin and acknowledge that more blood meant my cervix was still probably changing. This, even though the contractions weren’t consistent and I wasn’t feeling them again once I had emptied my bladder. But that blood...

I was debating calling my nurse when she came in to check on me. I tearfully admitted the bloody show, which she checked on some of the paper I threw into the trash. She very kindly got me those mesh panties and put a pad on me, and told me what I already knew but still desperately needed to hear. That was a theme of this experience. Despite knowing what I was going to hear, I needed to hear everything confirmed out loud. She told me that yes, it did look fresh, but when she wiped me herself before putting on the panties, she didn’t get much but residual. She thought it could still likely be the trauma of the cervical checks. I clung to that hope, but still cried feeling like it was all denial by this point. She called the midwife, who said we would stick to the plan of my OB checking me on her rounds at about 8-9 in the morning, unless something significant happened before then. I tried to sleep some more.

Amazingly, I managed another hour or so. The sun was up when my new dayshift nurses introduced themselves, and I spent some time staring at the ceiling and the walls and out the window at the beautiful ductwork outside my windows. By this point, I had peed again, and been so relieved to have very little show. And it was clearly not new. I let myself hope that between that, and not feeling any contractions except for maybe the random one or two in a thirty minute time period, that really and truly this wasn’t labor. I feared my OB would want to do a cervical check and start the whole process over.

What a relief when my doctor finally came, and said that because my contraction pattern had slowed and I wasn’t feeling them, she felt confident that this was not truly labor, and that I was just underhydrated and overworked. The plan was made to transfer me to antepartum, where I would rest and be watched for the day and the night, receive a second steroid shot 24 hours after the first (which had been gien to me at 3am as soon as I was admitted), and then hopefully be sent home in the morning.

Which is exactly what happened. I’m now home, on light activity bed rest, with a note for work to not go back until I am 37 weeks and therefore term. There is still the issue of what I’m going to do about my leave, and that will have to be addressed, but truly what I am still processing now is I think two-fold: I feel betrayed by my body, that it would try to go into labor too soon and without there being a single damn thing I could do to stop it, and also that coming home didn’t just fix that anxiety of the whole experience. Every twinge I feel makes me worry. There has been no blood since mid-afternoon yesterday, yet today after I got home, I wiped and had just a light pink tinge to my underwear and my toilet paper. It sent my anxiety through the roof.

The thing is, I KNOW intellectually that all of these things are normal at 34 weeks. I KNOW, as much as I really can know anything, that everything that happened Sunday night/early Monday morning was because of a combination of a tired body and an irritated uterus and a cervix that is easily friable. But that isn’t stopping the fear that the twinge in my side that I just felt might be the start of something I can’t stop, or that I might just gush amniotic fluid at any time. I think, too, the fact that I wasn’t really planning to take the bed rest as seriously as maybe I should is weighing on me now, after being uncomfortable for most of the day and now having very very very light spotting. Bed rest, for what it’s worth, hasn’t actually been shown to be of any benefit. Limiting activity to light things has but not actually staying in bed. It has actually been shown to increase muscle weakness and cause other potential issues without any real benefit. But I know I’d never forgive myself, never be able to believe completely, that I wasn’t the cause of my baby’s preterm labor if it all happens before it’s “supposed” to.

I’m having a really tough time separating the things I know intellectually and what I’m feeling, mentally and physically. And this was just overall a terrifying experience, plain and simple. I feel I’ve lost trust in my body, and the thing is: part of having a successful labor is being able to implicitly trust that your body knows what it is doing and letting it happen. I’m worrying that even if I make it to term, I’m not going to have the labor I had with my first daughter because my fears will become obstacles.

And I have to say, I’m a little mad too at myself. I’m mad I let that cervical check happen. No, i didn’t know it would lead to the cascade it did, but I do know my own body well enough to be aware that my cervix is friable and bleeds easily, and that I could start contracting from too much irritation to it. I’m mad I didn’t say “no.” I’m mad I let myself be cowed by professionals even though I AM A PROFESSIONAL IN THIS FIELD. It wasn’t as though the midwife bullied me, which is why I’m not mad at her. She did her job the way she should have. I’m mad I didn’t trust myself and my body, and that the result is I’ve lost some of that trust. I’m mad and still scared about how all of this could have gone, how I could have a baby in the NICU right now if I had different OBs and nurse-midwives. And I feel guilty, because all of this started because I didn’t want to go to work. To give myself a little credit, I think I was rightly listening to my body’s cues on that, but it still feels wrong, like I put myself and my baby into true harm’s way by being lazy. Really and truly, the attendance policy, maternity leave policies (or lack there of), our call-out policy are all more to blame than I am, but I feel the weight of responsibility for this right now.

In my (much shorter) Facebook post for the benefit of friends and family, I did talk about the silver linings of the experience, which is that I have now experienced all these things I hadn’t before, things my patients experience. I know it will make me a better nurse. But here, in a much more private (or at least anonymous) setting, I don’t feel the need to go into that. Because while it is true, I do feel that way, I wouldn’t go back and do the whole thing over just to have those experiences for my patients. It isn’t a worthwhile trade off to me, except maybe the realization that my autonomy can just as easily be pulled from me as from someone less informed. And again, not out of malice, but the end result is no less traumatic.

I think this is where I’m going to stop, mostly because my vision is getting bleary from tiredness and I really do need to start listening more to those cues. As my baby bears down on her weight into my vagina and sends another fear coursing through me that she’s going to break her amniotic sac right here, right now. She has the hiccups and is stretching. I want to be able to go back to rolling my eyes and laughing about that rather than being scared of it. I really hope I can.

#evelynlenore #pretermlabor #cervicalcheck #processing

0 notes