September 07, 2011

Labor and Delivery

To catch up with the story so far checkout the labor and delivery prologue.

On our way to the hospital Jamie debated whether she should call Deb. I told her “she gave you the number and encouraged you to call so you absolutely should.” We are both really glad she did. Jamie says for 3:00 AM Deb sounded incredibly awake and was super nice. Deb called the Presbyterian Labor and Delivery Triage nurse and let her know we were on our way. Throughout our stay at Labor and Delivery every nurse we spoke with said, “Oh, you are Deb’s friends.” While I am sure we would have received great care from the Labor and Delivery nurses having a connection made us feel like we were getting exceptional care.

We had learned during the Labor and Delivery course that when you begin labor you are supposed to go to Labor and Delivery to the triage room. Not sure where we would have gone otherwise, but it was nice to at least feel like we knew what we were doing. Triage confirmed that Jamie's water was broken and transferred us to a delivery room. We are not sure if it was because we knew Deb, but at 3:45 were given a very nice delivery room with an outstanding view.
Sunrise view from our delivery room
With us situated in a room at 3:45 AM we settled in to wait for doctors. The on call doctor visited first and since Jamie was in preterm labor decided it best for us to wait for the perinatal specialist to check on Jamie in the morning. While we had started with a very nice night shift nurse Jen, at 7:00 AM a very nice labor and deliver nurse named Marcie was assigned to Jamie and would be with her throughout the rest of her labor. Finally, at 9:00 AM Dr. Joffe from Perinatal Associates of New Mexico arrived and after running a few tests, performing an ultrasound, and making some observations decided it best to attempt to delay Jamie's labor for at least 24 hours. His immediate goal was to gain time for a steroid injection to help the twins lungs prepare for an early birth. After the 24 hour delay had Jamie's labor stopped she would have remained in the hospital until it was time to deliver the twins. Apparently, just because your water is broken does not mean you have to immediately deliver a baby. In fact, the doctors were talking about keeping Jamie pregnant for as long as a few more weeks!
Still very early in the delivery process.
There might be other mechanisms by which to delay preterm labor, but Dr. Joffe ordered the use of magnesium sulfate which has several side effects: itchiness, flushing, nausea, etc. She did not experience many of the side effects of the magnesium, but simply felt uncomfortable all over, in addition to being in labor. Interestingly, aside from helping to delay preterm labor magnesium sulfate has been shown to prevent cerebral palsy in premature infants. After the dose of magnesium sulfate Jamie started to experience what started as mild contractions, but which grew into very painful contractions. To help manage the pain she would grab the hospital bed's railing and “ride the wave.” As her contractions worsened it became evident that the gradual dose of magnesium sulfate had not slowed her labor Jamie was given a bolus (large dose) of magnesium.

Even after the bolus we now believe that Marcie saw the writing on the wall. While Jamie suffered through increasingly painful contractions and the side effects of the magnesium Marcie strongly suggested that I visit the hospital's Subway to get a sandwich and take a break. Thinking we had plenty of time I went down and ordered a foot long sub. As soon as I had finished the first six inches my phone rang calling me back to the delivery room, Jamie was 6 centimeters dilated and they were taking her into the operating room to deliver the twins via cesarean section.

The experience of being in an operating room for delivery was intense. As explained to us during our first specialist checkup there were a lot of people in the room. The anesthesiologist and I were seated at Jamie's head. Jamie who had been given a spinal block was totally awake and able to talk. I don't remember what we talked about, but oddly I remember it was not about delivery. A curtain was drawn up to keep Jamie from seeing the procedure. Each of the twins had a team from the natal intensive care unit monitoring their vitals ready to act when they were born. Lilly was delivered at 2:19 PM and Paige with a bit of forceful tugging was delivered at 2:20 PM. When she was born Jamie was briefly shown Lilly who was then whisked to the NICU. At birth Paige had some complications and was immediately taken to the NICU before Jamie could see her. The entire procedure from spinal block to finishing took a little more than an hour with more time taken to put Jamie back together than was taken to get the girls out.
Jamie and I in the recovery room after Jamie's cesarean section.
The next post will detail our NICU experience.

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