I began having contractions around 4:30 on Tuesday, January 1st. We spent the next hour trying to figure out whether they were really contractions or just my imagination. After they became more regular, we started timing them. After several baths and Josh’s frantic attempts at getting everything ready between contractions, we placed one last call to the midwives and headed to the hospital with a suitcase, video camera & tripod, sack of food, car seat, and various pillows and blankets. At this time the contractions were about 4 minutes apart, strong, and lasting about a minute each. Josh looked at me and said, “Okay, now I’m convinced you’re having a baby.”
After a fast cab ride to the hospital we met the midwife in the lobby and headed up to the birthing center. (Some background…we chose to use 2 midwives in lieu of an ob-gyn and to give birth in the birthing center at Roosevelt Hospital on 59th and 10th. The birthing center is one floor below labor and delivery and has very strict guidelines on who is able to give birth there. At this point, we were ideal candidates, as I had had a picture perfect pregnancy). We went up to the birthing center and spent the required 30 minutes on a fetal monitor that measures contractions and the baby’s heartbeat. There were a few minor irregularities and then the baby’s heartbeat dropped low for about a minute. I was put on my hands and knees to relieve the pressure on the umbilical cord and given oxygen and the heartbeat returned to normal. There was talk of moving upstairs (even though this was a normal occurrence and happened often) but that did not happen until the baby was seen to not have accelerations (this is when the heartbeat goes up for a brief time. These accelerations are reserves of energy that it is important for the baby to have to make it through labor).
We were “kicked out” of the birthing center because of these complications around 11:15 or so. It was disappointing, but our spirits were okay and I was well enough to walk up the one flight to labor and delivery. We got settled in our room, but after the problems of acceleration continued and my labor was not progressing (I was only 1 cm dilated and 60% effaced) it was decided I would have an epidural and that there was a good chance of a c-section. We were still in good spirits and I was relieved, after 9 hours of labor, to be getting some relief. The plan was to get the epidural and if the baby tolerated that, induce labor. If the baby tolerated that, they would break my waters and make sure they were clear. Sometimes the baby has their first bowel movement in utero (called meconium) and this could cause the kind of mild distress the tracings on the fetal monitor were showing. If this was all clear, then we would try for a vaginal delivery. At this point the midwife had consulted with the chief resident who agreed with her decision. We were waiting for the anesthesiologist to finish up with another patient (he is the one to give an epidural) when suddenly, at 2:10 a.m., the baby’s heartbeat dropped once again. I was told to turn onto my hands and legs again and alarms started beeping. Instead of the heartbeat going down for a matter of seconds to a minute (which had only happened once in the birthing center) it drastically dropped and showed no indication of coming up. The baby’s heartbeat was barely keeping her alive at this point. Within a matter of seconds our room was filled with a dozen people, all yelling. As I was on my hands and knees I had no idea what was going on and could not see Josh. They began an internal exam and then broke my waters and put an internal monitor on the babies head. When the water broke it was obvious that the baby had had a bowel movement in utero. No one was telling me anything except the midwife who said, “I don’t have time to explain everything right now. A lot of hard things are about to happen and we are trying to save the baby and I will explain it all later.” After seven minutes of decelerations (low heartbeat), *at 2:17 a.m., I was wheeled to the OR down the hall for an emergency c-section. I got a brief glimpse at Josh through my hair and that was the last I saw of him. They put a consent form in front of me (while still on my hands and knees) and told me I was having an emergency c-section and to sign. At this point (from being told later) there were 2 residents, three ob-gyns, the anesthesiologist, two pediatricians, several nurses, and my midwife all being rounded up and prepping for the c-section. I was put on the operating table on my back and told I was having a spinal block so that I would be awake for the c-section. That was quickly shouted down and within a matter of seconds a catheter was shoved into me and the last thing I remember is a mask being put over my face as the surgeon was yelling at the anesthesiologist that he needed to move faster. This was at around 2:20.
After being put under, the first cut was made at 2:24 and the baby was born at 2:31 a.m. Her APGAR was a 1, which meant she was alive. She had a faint heartbeat but never moved or breathed on her own. Two pediatricians and a neonatologist worked on her for 20 minutes before pronouncing her dead at 2:51 a.m.
* - Josh’s Story: I want to simply give my point of view of those forty minutes when I was separated from Camaron. As she said, the room quickly became chaotic. As a our midwife (Elizabeth), a doctor and two idiot nurses quickly prepped Camaron for the emergency C-section, it seemed as if doctor after doctor in street clothes wandered in, saw what was happening, and began shouting orders. I saw Elizabeth break Camaron’s water and saw the dark green/black drop of water leak onto the sheets. She was wheeled out of the room and I quickly followed, unsure what to do. I tried desperately to catch Camaron’s eye but her hair was in her face and she looked more scared than I had ever seen her. As they disappeared behind the swinging blue doors, Elizabeth turned to me and said that she’d be back to explain as soon as she could.
The minutes ticked by. I stood gripping my hat, staring through the small square of glass as people in scrubs went running in and out of the room. At first, several nurses smiled at me, asked me to sit down, kept assuring me that everything would be fine, always addressing me as “Dad”. But soon the mood began to shift- you could hear the silence screaming in the air. As doctors and nurses came out of the room to grab things and disappear back inside, I could tell they were consciously avoiding my stare. With nothing else to do I readied the camera, hoping to snap that first picture of our little girl. Elizabeth came out a few minutes later and took my hand. “Camaron’s fine,” she said, “but the baby isn’t looking good. They’re working hard on her and there are three doctors doing everything they can. I have to get back in there and I’ll tell you more as soon as I know.” While those words, among others, are forever seared into my mind because of their meaning, it was also the only time anyone had the courage and decency to speak to me. As eight more minutes went by, I waited for that moment that I would wake up, still in bed at our apartment. Elizabeth came back out, pulled me aside and told me that our girl had died.
The only thing going through my mind was that I had to get to Camaron. Her parents walked in a minute or two later and the three of us clung to each other. Trisha demanded to see the baby. I’m so glad that she did. I didn’t know what to do. Minutes later, Elizabeth told me that Cam was waking up, and she had told her that the baby was gone. While I was momentarily angry that Cam was alone with this news, I found out later it was only because she had woken up and was screaming for her girl, and no one had the guts to tell her. I went tearing in, saw her face, and a piece of me died.
I woke up at a little after three and starting asking about the baby. After it was obvious she was gone Josh was quickly at my side. My parents had arrived at the hospital around 3:00 and spent the entire time holding the baby. I asked for a Rabbi and the chaplain on call happened to be a 4th year rabbinical student at JTS. They brought the baby in and I was able to sort of hold her (I was still under some sedation and on my back). We had a naming with the Rabbi and Josh and my parents at my side. They took her footprints, cut us a lock of her hair, and took pictures before they took her away.
This was a horrible tragedy that no one could have predicted. We were told afterwards that everyone in the Operating Room was crying and in shock afterwards. Every doctor, resident, or nurse that came to see me while I was recovering over the next few days, could not leave my room without breaking down in tears. The case has been preliminary reviewed by the chief of the ob-gyn department and the hospital and the initial findings show that there was nothing anyone could have done differently. I had the opportunity to talk for hours with the surgeons and my midwives involved and gotten to look at the notes from that night. The case is under official review and will be dissected by the risk management team at the hospital, presented at grand rounds on Tuesday, and as we were told, “picked over with a fine tooth comb.” An autopsy was done on her and my placenta. Once the pathology reports come back we will be going in for a meeting with the head of the ob-gyn department, the midwives, and the surgeons involved. But we have been warned that it is very likely we will never know why things went horribly wrong so horribly fast.
I spent the next few days in the hospital and was released Saturday morning. We were given a private room with two beds on a completely separate floor (with no babies and no pregnant women). Josh was allowed to stay with me and sleep in the second bed and we were not beholden to the hospital’s ridiculous visiting hours. The physical recovery has been good and not too painful. The only complications I might have are some bruising and increased numbness due to the speed in which they opened my abdomen. We are home and the support has been tremendous. I am not ready to speak to people but I am tough and will slowly but surely get through this. While this is something I will never get over, I realize now it is something that I will learn to live with. I am an extremely lucky person. I have an amazing husband, amazing family, and amazing support system. I understand that we have not yet begun to grieve. We are still in shock. My first contraction began barely 100 hours ago and the hard part- learning how to live our lives, how to be normal in spite of all that we’ve gone through- has yet to begin. But because of the love and support that has come pouring in, I know we will get through it. Thank you.
1/5/08
It has been six weeks since Julia's birth and we spent yesterday getting some answers and reassurance at the hospital. We met with the head of the Pathology department, Dr. Salafia, to go over the autopsy report on Julia and my placenta. I will go into a bit of detail for you in the way that I was able to comprehend the information. It has been determined that she died of a cord accident. It was not a "traditional" cord accident that could be seen by the naked eye (a knot or the cord around the neck). The way they determined this is by taking cross sections of my placenta, cord, and amniotic sac. There was a multitude of first responder blood cells (white blood cells) inside the umbilical cord itself. This would USUALLY indicate infection, BUT in this case it did not. The reason is that these white blood cells were ONLY inside the umbilical cord. In order for it to be an infection these would have to have been evidence of white blood cells in the amniotic sac or lining or some other part. This is because an infection would have had to enter through my vagina, and could not have just skipped over everything else and gone into the umbilical cord. More importantly, there was absolutely no sign of infection in Julia.
Okay, so since it was determined that it was not an infection, the only explanation for the build up of white blood cells is trauma to the cord. When you get hit hard or hurt your white blood cells are the first to respond, and this was the case here. We are not sure exactly how the trauma was caused and will never know. The cord could have been caught under her arm, she could have stepped on it, etc...
Besides the cord issue there were two secondary issues that did not cause her death but, compounded with the severity of the cord accident, compromised her even further. We knew that she had meconium in utero (which means she had a bowel movement) and that this can cause complications. But babies almost NEVER die from meconium aspiration, even if it is severe. Usually the passing of meconium happens in the few hours before birth and usually in pregnancies that have gone beyond 40 weeks. I was only 38 weeks pregnant, and the meconium had been in her system for at least 24-48 hours. They know this because there was meconium staining of the umbilical cord, and this takes at last 24 hours to happen. If she was limited in her oxygen intake because of the cord accident, this could have made things worse.
Finally, her umbilical cord length measured under 25 cm, which is considered a short cord (average length is 60-80 cm). Cord length is rarely measured or taken into consideration, but a too short or too long cord can make the chance of cord compression more likely. It is neither her nor there though, because there is nothing you can do to control the length of the cord or prevent it in the future.
This all means that there was nothing wrong with my beautiful baby, she was absolutely perfect. She died because of a lack of oxygen to her brain.
If we could have gone back in time and for some reason have known to get her out a week earlier would she have been fine? Probably. Josh and I go over and over this. But even in the minutes before she crashed, there was no indication that she was as compromised as she was. For us it is extremely important for people to know that she was born alive. But in my heart I know this is a technicality. She never moved, she never breathed, her heart had a few final beats outside the womb, and then she died. There were definite signs of hypoxia (lack of oxygen) in the brain. We would have had no way of knowing how severe the damage was until she began growing and failed to meet age appropriate milestones. The fact that she came out so compromised leads many to believe that even if they were able to bring her back, the brain damage would have been significant. Part of me needs to believe this-needs to recognize that if she had lived, her life might have not been a good one.
So, in the afternoon we met with Dr. Brustman, the perinatologist (high risk pregnancy doctor) who will be my doctor for the next pregnancy. The encouraging news is that all of the information in the pathology report indicates that I was a good home for Julia and there is nothing wrong with me. This was a random occurrence. That being said, I am considered high risk and will continue to be so for any future pregnancies. This is because there is no way to know 100% that Julia's death was completely random. Being high risk simply means that I will have more tests, more sonograms, and be closely monitored, especially in the third trimester. I will also have a scheduled c-section as soon as the baby's lungs reach maturity (around 36-37 weeks). We were also given a specific timeline for when we can start trying again. Sorry, we won't be sharing that information this time around!
I really like Dr. Brustman and she has a great relationship with my midwife, Elizabeth. Two orf Dr. Brustman's 3 children were delivered by a midwife and her philosophy is that that the ob/gyn world should be made up of midwives and high risk docs. That you either have a healthy pregnancy that needs little intervention or you are high risk and need a lot of help. Elizabeth was with us all day yesterday and arranged all of the meetings. She is coming to my house today so that I do not have to go into her office for my 6 week check up. She has been amazing and we don't know what we would have done without her. Even though I cannot use a midwife, she will play a role in this next pregnancy and be at the birth of my next child. Even though it will be a little time before we start thinking about the next pregnancy, it is very reassuring to know all of this.
No comments:
Post a Comment