Angel’s Delivery
I went into labor on Thursday, November 26, 2009, Thanksgiving Day, at about 8:45 p.m. We had enjoyed turkey, stuffing and vegetable casserole and pumpkin pie and I was working on addressing Christmas cards to go out the next day while Jim sat talking with a friend who had joined us for dinner. I had been having pain all day, and erratic contractions throughout the week,but that night things really started to progress. When I started timing my contractions at about 9 p.m., Jim’s friend went home, and I went to take a bath to try to alleviate some of my back pain. I got out of the bath at about 10:30 p.m. and my contractions were coming a lot faster than I had expected, about 2-5 minutes. It was hard to breathe, hard to stand, hard to lie down, and hard to sit. Basically, I wasn’t comfortable at all. I called the hospital at about 11 p.m. and they said I could go ahead and come in.
We arrived at the hospital at about 12 a.m. on Friday, November 27, 2009. I was put on the monitor and it was determined that not only were my contractions coming really quickly, but the baby was in fetal distress because of them. I was given a shot of terbutaline to try to slow my contractions and admitted to the hospital. The baby’s heart rate was fluctuating alarmingly, between 90 and 180 bpm at any given time. My heart rate and blood pressure were also vacillating because of the contractions.
The contractions were coming fast, but my labor wasn’t progressing because the contractions weren’t strong enough to cause me to dilate. I went in dilated to a 2 and 50% effaced, the same as I had been on the previous Monday at my check-up. The doctor arrived soon after I was admitted, and stayed close by the whole night. The doctor went to break my water to try to speed up my labor, but it was determined that my water had broken or been punctured at some point in the previous 24 hours. There was never a flush of fluid that I noticed, unless it had occurred while I was in the shower that previous morning or the bath that evening. Though I didn’t know when my water had broken, because I did not have any symptoms or indications of chorioamniotitis, an infection that is likely to occur if the bag of water breaks more than 24 hours before active labor. At that point I was given an amnio fusion, by which through a catheter fluids were pumped into my uterus to try to pad the space for the baby’s recovery between contractions.
At about 3 a.m. the nurse anesthetist arrived to give me an epidural. I had wanted an epidural as soon as possible because I am prone to passing out and wasn’t confident that I could make it safely through labor without the medication. The nurses and doctor wanted me to have the epidural so that my body could attempt to lower its stress to try to calm me down and help the baby calm down to try to get her the oxygen she needed. The doctor noted that he thought the cord might be wrapped around the baby’s neck, which is very common, but that the lack of fluid can exacerbate that situation, so the extra fluid from the amnio fusion should have helped her to relax and possibly release the cord, and help her to recover from the stress of the contractions. I was also given another snot of terbutaline because the first one was wearing off and my contractions had started speeding up again.
About that time, when checking me for dilation and flushing out some of the fluids that had been pumped into my uterus, the doctor discovered that there was meconium in the fluid. Meconium, the tar-like substance that a baby’s first bowel movement is made up of, can be ingested by the baby when it is present in the uterine fluids and the baby breathes (since the baby breathes in the fluids until she breathes in the air after delivery). Meconium passage in the womb is usually a situation that arises with older babies, ones that are past 40 weeks gestation. It’s possible that our baby girl passed her meconium as a response to being in fetal distress. Meconium aspiration in and of itself is not always an irreversible problem. Meconium aspiration, however, can cause blockage or irritation of the baby’s airways, and cause a baby that has aspirated to require assistance breathing after birth.
At about 5:30 a.m. I was only dilated to a 5 and 70% effaced. The doctor decided that it was time for an emergency cesarean. I consented and prepared to meet my little girl. The pediatric team arrived to tend to our little girl because of the fetal distress in which she had been and because of the meconium passage. About that time the baby’s heart rate finally regulated, mirroring my heartbeat so that our hearts were truly beating together. I was terrified, but I thought everything was going to be okay.
Our daughter was born at 6:27 a.m. via emergency cesarean section. She immediately required resuscitation efforts due to the sheer amount of meconium she had aspirated. The pediatrician was able to get the top part of her airway cleared, but she had ingested too much, disallowing her lungs the ability to expand. Her heart, stressed and working too hard, quit beating. The umbilical cord was wrapped around her neck and body, and pulled tight, which added to her oxygen loss and distress. The efforts to restart her heart and to clear her airway was continued for 45 minutes after she was delivered, until my husband asked them to stop.
The circumstances surrounding her death were beyond not only comprehension, but beyond statistical probability. While much of what happened is fairly normal, the compounding of so many problems intensified the situation beyond medical technology. Many babies are in fetal distress when their mothers go into labor. Many babies do not tolerate contractions very well. Many women have very fast contractions that don’t allow for much time for babies to recover in the womb. Many women have had their water break or puncture at some point before they go into labor and don’t know when it happened. Many women have trouble with their labor progressing at a rate that allows for healthy vaginal delivery. Many babies pass meconium while still in the womb. Many babies aspirate a fair amount of meconium while waiting to be born. Many babies are born with the umbilical cord wrapped around their little necks or bodies or both. But not many situations have all of the above occur.
Even if they had been able to bring her back she had been without oxygen flow to her brain for too long, and perhaps even longer while she was still inside of me. Even if they had been able to bring her back, there was no guarantee she would have lived longer than a few hours or days. Even if there had been a NICU at our hospital, there is nothing they could have done differently, short of invasive surgery, that would have brought her back. Even if they had been able to bring her back and she had survived, she would have likely lived a life of pain, frustration and the inability to function on her own due to probable mental and/or physical disabilities. But they couldn’t bring her back.
We got to hold our little girl, cry over her, pray over her, kiss her sweet cheeks and forehead, stroke her head, touch her hair, hold her hands, feel her skin, and see her little feet. She was perfect. She was beautiful. She was amazing, this person that grew inside of me, that Jim and I created together out of love. She was wonderful. She weighed 8 lbs, 6 oz and was 20 inches long. She lived, grew, developed and moved around for 39 weeks inside of me. And just like I had prayed, she looked like Jim. It was love at first sight for both of us. She was the precious and sweet little girl that filled our dreams and for whom waited, not always patiently, throughout her development.
