Okay, so I wake up Saturday morning, the morning after I was up until 3:30 AM doing the monitor-bolus thing. I actually wake up about 4 hours later, at 7:30. I'm still contracting. Not bad, but I am not eager to repeat the experience of the night before all day so I keep my mouth shut. And I wait. In fact, I wait too long, and the contractions get closer and closer together. Finally, at about 11 AM, I put myself on the monitor for an hour. And then I send it. And then the nurse calls back. 27 contractions that hour, between 11 and noon. She asks me how I feel, and I am brutally honest:
"I feel like, if I could dilate, I would've already had this baby. I feel like my body is trying to deliver him, and I am fed up."
I tell her that I'm not sure that the contractions ever really stopped. I know I slept for about 4 hours, and have no idea if they continued then or not. I just know they were there when I went to bed, and they were there when I woke up. That's all. So she decides to skip the monitor-bolus routine and just calls my doctor. And they want to send me to the hospital. I tell her I am going to shower and eat first, and then I will go, and I do. Within 30 minutes, we are on our way.
The doctor has decided before I even get there that I am most likely going to stay. I do. They start the mag sulfate drip at 3.0 grams, and off I go to my room. But the contractions don't stop. I get Indocin for the first time ever, and that slows them to a stop. Over the course of the first night, they wean the mag to 2.0 grams. Then the contractions start back up again somewhere in the middle of the night. And continue. More Indocin the next day. They stop again. Another doctor is on call for the practice and he comes in and tells me to just hang on until "the completion of 31 weeks" and that the "mortality rate decreases to zero at that point". Uh. Okay.
But this time, the nurses have me worried. And J. They are talking about risk of uterine rupture. They tell me that they have seen where a woman contracts and contracts against a closed cervix and finally, her uterus ruptures. This scares me to death, and is something I had not considered up until that point. Something new to worry about.
Over the course of 3 days, the contractions come and go. They make changes to my medications. And they keep me there. I'm not even allowed to bathe. I am so dirty I can smell myself and feel like the right to have my most basic needs met has been stripped away from me. Finally, J arrives with an arsenal of bath products, and I perch on a stool while he gives me a sponge bath. This, of course, is against doctor's orders, but I don't care at this point. I am in tears and miserable, so my nurse doesn't even try to force the issue, but instead tells me to let her know when I am finished and quietly closes the door. I am so grateful at that point to have a husband who loves me unconditionally, because I am nasty. And he doesn't say a word, but instead, helps me clean myslef up.
Finally, on Monday night, I get my progesterone injection. From that point on, I have 3 contractions. Total. The doctor comes in Tuesday and I immediately ask him if I can go home. He looks at my strip on the uterine monitor and says he sees no reason to keep me. I am free. And happy.
I leave that place hoping that the next time I am there, I will leave with a baby. I have about four and a half weeks left before I will be okay to deliver. Before I will reach the point I did in E's pregnancy. And I know now that, with the way Zachary looks in utero, he will most likely be fine from this point on. Every week from here on out is just icing on the cake for me. No one wants a preemie, but I am to the point where I am finished. And I'm just tryingto hang on. The point of viability has come and gone.
Showing posts with label magnesium sulfate. Show all posts
Showing posts with label magnesium sulfate. Show all posts
Wednesday, March 24, 2010
Wednesday, March 3, 2010
About Mag Sulfate vs. Other Tocolytics
http://www.medindia.net/news/Preterm-Labor-Drug-Causes-More-Side-Effects-22808-2.htm
24 wks, 5 Days: OB Mecca or OB Hell???
An ambulance takes me into Cincinnati to OB Mecca. A registered nurse has to go with me because of the mag sulfate drip. The EMT and paramedic look really nervous when they hear I am contracting every 2 minutes on the mag. They plead with me not to deliver the baby in the ambulance. "We don't want to do that today", they joke. I tell thm I am registered respiratory therapist and have resuscitated babies of this gestational age, that I will not let them deliver my baby in the ambulance. At any cost. The whole experience is kind of surreal. It is about 8 am, and we are driving through Clifton. I know that drive. I take it all of the time to get to my morning pre-med classes at the University of Cincinnati. I know it is wrought with idiot drivers, juggling their coffee and cell phones while trying to navigate traffic. And I am the worst control freak/ backseat driver. But yet here I am, strapped to a stretcher, watching traffic through the tiny windows in the back doors of the ambulance.
We get to OB Mecca, and J is already there. I had called him from my hospital room as the transport team was walking in the door to get me, and wonder first how he beat me there, followed immediately by the question of whether or not he wrecked my car in his rush to get here. I had told him not to rush, that I was fine. But it is J. I've learned not to question anything in our 9 years of marriage.
The OB Mecca staff puts me in their triage, which is the first chance I get to be pissed off. I am on mag, uncomfortable, have been awake all night, and have been sent by a very reputable physician. Why triage? Why not my room, with a bed instead of a stretcher? They won't let J back as they ask me admission questions they have to ask everyone. No, I do not have any sexually transmitted diseases. No, I do not feel I am at risk for them. No, my husband doesn't beat me. In fact, I tell the nurse, if he tried, I could take him. I know they are just doing their jobs, but I am frustrated and tired and miserable. I try to be nice. What is more likely is that my attempt is coming out as a dry, sarcastic version of myself that emerges when I have had it. My mental filter is no longer in place. But it doesn't matter. When J finally comes back to the room that is the size of Harry Potter's broom closet under the stairs, I hear the nurse tell him that his wife is hilarious. At least she likes me.
After changing all of the tubing, a resident comes in. I know it is a teaching facility. All of the OBs in the practice I go to did their residencies here. I expected it. And I am all for being a learning experience for residents. I work with residents. I also let them prescribe my family mmbers antibiotics for strep throat, or manage my asthma. But this? With my OB history? I don't really like being a learning experience in this situation. Anyhow, she does a pelvic exam that feels more like she is trying to extract tonsils from the wrong end of my body, does her little swabby thing to make sure there are no creepy-crawlies in my nether regions, as they do with everyone, and I am on my way to my room finally.
This is when all hell breaks loose. Once I get in my bed, it all hits me, and I am upset. Becuase of the visiting policies at all area hospitals due to H1N1 fears, J won't be able to visit because he will have E with him. E can't visit me. My baby boy will be absent so long as they see fit to keep me here. And by default, J will be also. He has class during the day, and E with him at night.I am going to be alone. Plus all of the smiling faces of my coworkers have been removed from this scene. I don't get the "she's one of us" perk package. This seems silly, but this is what opens the flood gates. And I cry. I cannot stop crying, as a matter of fact, which made what followed all the more worse.
They started asking questions. Why am I on a brethine pump? Why the mag? I'm not dilating so it is false labor. But how can I continue in a pregnancy contracting every 2-3 minutes? At what point do we try to stop them? If the are waiting fo me to dialte, it won't happen. I just don't. I try to explain.
Then there are the contradictions. They will stop the mag drip as soon as I am back on my brethine pump, which had been stopped for the ordeal. But wait! Just a minute ago, I didn't need it. What the hell? Through the course of 2 days, they treat me like crap. Thay act as if my team of OB's in Northern Kentucky know nothing, when in truth, they all completed their residencies there. They act as if the people at my place of business are incompetent, which I take as a personal affront. I am not a NICU therapist, but I am also not an idiot and work for an excellent, award-winning hospital.
The entire experience leaves a bad taste in my mouth. They ended up letting me leave the next morning. I got the home health company to reprogram the brethine pump (that I don't need) so they would stop the mag drip,and I was out of there. I never want to go back, but I know I will eventually end up there again. I have about 8 or 9 weeks to go before I can safely deliver Zachary. And I know that it is the best place for a preemie in this area, barring a local children's hospital. But at the children's hospital, I would not be in the same place as the baby, so it is not as desirable a choice.
We get to OB Mecca, and J is already there. I had called him from my hospital room as the transport team was walking in the door to get me, and wonder first how he beat me there, followed immediately by the question of whether or not he wrecked my car in his rush to get here. I had told him not to rush, that I was fine. But it is J. I've learned not to question anything in our 9 years of marriage.
The OB Mecca staff puts me in their triage, which is the first chance I get to be pissed off. I am on mag, uncomfortable, have been awake all night, and have been sent by a very reputable physician. Why triage? Why not my room, with a bed instead of a stretcher? They won't let J back as they ask me admission questions they have to ask everyone. No, I do not have any sexually transmitted diseases. No, I do not feel I am at risk for them. No, my husband doesn't beat me. In fact, I tell the nurse, if he tried, I could take him. I know they are just doing their jobs, but I am frustrated and tired and miserable. I try to be nice. What is more likely is that my attempt is coming out as a dry, sarcastic version of myself that emerges when I have had it. My mental filter is no longer in place. But it doesn't matter. When J finally comes back to the room that is the size of Harry Potter's broom closet under the stairs, I hear the nurse tell him that his wife is hilarious. At least she likes me.
After changing all of the tubing, a resident comes in. I know it is a teaching facility. All of the OBs in the practice I go to did their residencies here. I expected it. And I am all for being a learning experience for residents. I work with residents. I also let them prescribe my family mmbers antibiotics for strep throat, or manage my asthma. But this? With my OB history? I don't really like being a learning experience in this situation. Anyhow, she does a pelvic exam that feels more like she is trying to extract tonsils from the wrong end of my body, does her little swabby thing to make sure there are no creepy-crawlies in my nether regions, as they do with everyone, and I am on my way to my room finally.
This is when all hell breaks loose. Once I get in my bed, it all hits me, and I am upset. Becuase of the visiting policies at all area hospitals due to H1N1 fears, J won't be able to visit because he will have E with him. E can't visit me. My baby boy will be absent so long as they see fit to keep me here. And by default, J will be also. He has class during the day, and E with him at night.I am going to be alone. Plus all of the smiling faces of my coworkers have been removed from this scene. I don't get the "she's one of us" perk package. This seems silly, but this is what opens the flood gates. And I cry. I cannot stop crying, as a matter of fact, which made what followed all the more worse.
They started asking questions. Why am I on a brethine pump? Why the mag? I'm not dilating so it is false labor. But how can I continue in a pregnancy contracting every 2-3 minutes? At what point do we try to stop them? If the are waiting fo me to dialte, it won't happen. I just don't. I try to explain.
Then there are the contradictions. They will stop the mag drip as soon as I am back on my brethine pump, which had been stopped for the ordeal. But wait! Just a minute ago, I didn't need it. What the hell? Through the course of 2 days, they treat me like crap. Thay act as if my team of OB's in Northern Kentucky know nothing, when in truth, they all completed their residencies there. They act as if the people at my place of business are incompetent, which I take as a personal affront. I am not a NICU therapist, but I am also not an idiot and work for an excellent, award-winning hospital.
The entire experience leaves a bad taste in my mouth. They ended up letting me leave the next morning. I got the home health company to reprogram the brethine pump (that I don't need) so they would stop the mag drip,and I was out of there. I never want to go back, but I know I will eventually end up there again. I have about 8 or 9 weeks to go before I can safely deliver Zachary. And I know that it is the best place for a preemie in this area, barring a local children's hospital. But at the children's hospital, I would not be in the same place as the baby, so it is not as desirable a choice.
24 wks,4 days : In the Hospital
So there I am, in the hospital. I can no longer feel the contractions, so I think the mag sulfate is working. I know from my nurse that this is not the case. Mag relaxes the smooth muscle of the uterus, and this is how it stops contractions. But it hasn't stopped mine. I just cannot feel them anymore. She holds up my strip to show me, and there is literally not a flat area on it, as my uterus goes through waves of contractions, a new one starting every 2 minutes. "Andrea, this is an active labor pattern!", she tells me. Gradually, my dose of mag increases until I am on 3 grams. At this point I am maxed out on it. They start adding brethine boluses, and these seem to work.
I ask about my KB test, and discover that it was positive. I don't know what this means, so I call J, who is home with E, and ask him to google it for me. He cannot figure it out for me, and noone there knows how to interpret my weird result. And somehow, over the course of the night, I go from not being able to feel the contractions, to feeling them but not being in pain, to actually having discomfort. When I get to the point where I find myself having to stop and focus on my breathing through them, I let my nurse know. Something is different. Something has changed.
Somewhere around 5 AM, my doctor comes in. I feel terrible, as I know he isn't even on call for my practice anymore, as it has switched to the next day. But he has been awake on the phone with my nurse all night, and makes the special trip in to see me. But he explains the KB test, finally. It means that there has been a breach in my body, and that there are fetal blood cells in my blood sample. In other words, a hemorrhage has occured. It isn't bad, and I am not in excrutiating pain or gushing blood, so it is probably just mild trauma from the fall. What he is concerned about is the change in my contractions. And he seems apologetic as he tells me he is sending me over the river from Northern Kentucky into Cincinnati to what I mentioned in an earlier post as our OB mecca. He knows I don't want to go. I have terrible memories of that place from E's pregnancy, but he pats my leg and tells me that if I were his wife, and this were his son, that is where he would want me to be at that point. I am 23 weeks pregnant,and this hospital is known for their NICU, even keeping micropreemies alive at points when noone thought they were even viable. For Zachary, I have to go.
On a side note, I was started on my Celestone course for Zachary's lungs. Should be finished with that soon.
I ask about my KB test, and discover that it was positive. I don't know what this means, so I call J, who is home with E, and ask him to google it for me. He cannot figure it out for me, and noone there knows how to interpret my weird result. And somehow, over the course of the night, I go from not being able to feel the contractions, to feeling them but not being in pain, to actually having discomfort. When I get to the point where I find myself having to stop and focus on my breathing through them, I let my nurse know. Something is different. Something has changed.
Somewhere around 5 AM, my doctor comes in. I feel terrible, as I know he isn't even on call for my practice anymore, as it has switched to the next day. But he has been awake on the phone with my nurse all night, and makes the special trip in to see me. But he explains the KB test, finally. It means that there has been a breach in my body, and that there are fetal blood cells in my blood sample. In other words, a hemorrhage has occured. It isn't bad, and I am not in excrutiating pain or gushing blood, so it is probably just mild trauma from the fall. What he is concerned about is the change in my contractions. And he seems apologetic as he tells me he is sending me over the river from Northern Kentucky into Cincinnati to what I mentioned in an earlier post as our OB mecca. He knows I don't want to go. I have terrible memories of that place from E's pregnancy, but he pats my leg and tells me that if I were his wife, and this were his son, that is where he would want me to be at that point. I am 23 weeks pregnant,and this hospital is known for their NICU, even keeping micropreemies alive at points when noone thought they were even viable. For Zachary, I have to go.
On a side note, I was started on my Celestone course for Zachary's lungs. Should be finished with that soon.
24 wks, 3 days: Terror and Good Coworkers
Sunday morning, I was trying to sleep the day away in preparation for a night shift that night. I had to run a one-hour strip on my monitor like I do everyday, so I plugged myself in and let it do the work while I dozed. I remember it beeping, and in a sleepy haze, handing it to J to transmit the recording to the company. A few minutes later, J is waking me up, thrusting a phone at my face. It's the home health nurse, and she wants to know my pulse. So I wake up and count it for her. But then I can't go back to sleep. So I get up. Errrrr, I tried to get up.
What happened next was so quick it was a blur. I remember my toes getting caught on a rug beside the bed. I know I sailed through the air, landing flat on my belly, my head just inches from the closed bedroom door. J and E both barge in, wondering what the awful sound was, only to find me there, still on the floor. It wasn't a big deal at that instant. Pregnancy makes the most graceful of us become foddering and clumsy. When I was pregnant with E, my favorite pasttime was falling down stairs. We've since joked about it because it happened so often that I would automatically shout out "I'm okay!" from my landing at the bottom, to keep J from panicking. This hasn't happened during this pregnancy. Or at least it hadn't.
J was frantic. He rushed to get E dressed, and was running around the house like a mad man, explaining to E that Mommy would have to go to the hospital. I kept telling him I didn't, that I was fine. I just felt like I was being punched in the stomach, but it wasn't the excruciating pain that marks a placental abruption, which is what one would worry about in a time like that. (In truth, I don't know what it feels like to be punched in the stomach, but I imagine it to feel like I did!) I called my doctor more to appease J than I did out of concern.
The doctor calmly asked my blood type, and told me to go to the hospital, where they would be expecting me. He explained that they would do some blood work and just check things out. So we went.
They drew labs, something called a KB Test. I had no idea what this was, but I was okay and the baby seemed to be okay. As a matter of fact, I giggled at the sounds of him swimming around in there. He was happy as a lark. They said the test would take about 2 hours to come back. Okay. Whatever. But of course, this is me we are talking about. I should wear one of those "Hello, my name is..." stickers afixed to my chest, but instead of A, for the time being, it should instead say "Obstetrical Anomaly". Of course I was contracting and of course the nurse had to report it to my doctor. And thus my relationship with magnesium sulfate (for this pregnancy, anyway) started this past weekend. The poor nurse didn't even have to tell me what she was going to do. She came back from speaking with the doc, and just frowned. I knew what that meant. "He ordered mag.", I said. She just nodded.
If you have never been on mag sulfate, it is hard to describe. The minute the stuff starts hitting you, you feel like you have an intense sunburn, with heat trapped beneath your skin, unable to escape. Some people get weak. Some people vomit. I don't do either of those, but just feel miserable, generally. And hot. Very, very hot. But I've been down this road before. I know it is the big dog for preterm labor. I was on and off of it for a month with E. It is, by all rights, familiar territory for me. I consent to it, but tell them I want to able to eat. I am starving, after all. They let J come back to see me, and I give him a Mickey D's order, and send him running for it.
That is when it happened. Right then, when my husband was in some silly drive-thru getting me a stupid cheeseburger. Every nurse on staff in L &D (or so it seemed, as there were 5 of them) was suddenly at my bedside, clutching at my wrist to check my pulse, feeling on my belly to find Zachary. His heart rate had decelerrated to a point where they could not distinguish between his slowed heartrate and my quickend one from the brethine pump. But my time in my profession, where I have been called on to resuscitate newborns has taught me enough. I knew a decel like that meant fetal distress. I was hysterical. J was getting a damned cheeseburger for me. And they were muttering sentences about "delivery". And me? I wasn't rational at that point. I got on the phone, in the midst of that flurry of activity, and called my department at the hospital to let them know I would not be there. I'm glad I did.
I don't know how long it took, but before I knew it, as I was sitting there with the nurses thinking Zachary was seriously in jeopardy, 3 calm and smiling faces popped up from behind the curtain. My coworkers. To check on me. The one I had spoken with on the phone had heard my tone of voice and had called in the troops to come and make sure I was okay. God bless those girls. They calmed me down and reassured me until J was there again.
Zachary was okay. Whatever had caused the decel went away and his heart rate picked back up. I was admitted on my mag sulfate drip. But for the first time in all of this, I really truly had to think that my baby was at risk. For a few minutes, I had to think that this was not just me being me, contracting like I do. This has been going on for over 5 weeks now, but I took for granted that I would deliver a healthy baby in the end, like happened with E. This experience showed me that nothing is a given.
What happened next was so quick it was a blur. I remember my toes getting caught on a rug beside the bed. I know I sailed through the air, landing flat on my belly, my head just inches from the closed bedroom door. J and E both barge in, wondering what the awful sound was, only to find me there, still on the floor. It wasn't a big deal at that instant. Pregnancy makes the most graceful of us become foddering and clumsy. When I was pregnant with E, my favorite pasttime was falling down stairs. We've since joked about it because it happened so often that I would automatically shout out "I'm okay!" from my landing at the bottom, to keep J from panicking. This hasn't happened during this pregnancy. Or at least it hadn't.
J was frantic. He rushed to get E dressed, and was running around the house like a mad man, explaining to E that Mommy would have to go to the hospital. I kept telling him I didn't, that I was fine. I just felt like I was being punched in the stomach, but it wasn't the excruciating pain that marks a placental abruption, which is what one would worry about in a time like that. (In truth, I don't know what it feels like to be punched in the stomach, but I imagine it to feel like I did!) I called my doctor more to appease J than I did out of concern.
The doctor calmly asked my blood type, and told me to go to the hospital, where they would be expecting me. He explained that they would do some blood work and just check things out. So we went.
They drew labs, something called a KB Test. I had no idea what this was, but I was okay and the baby seemed to be okay. As a matter of fact, I giggled at the sounds of him swimming around in there. He was happy as a lark. They said the test would take about 2 hours to come back. Okay. Whatever. But of course, this is me we are talking about. I should wear one of those "Hello, my name is..." stickers afixed to my chest, but instead of A, for the time being, it should instead say "Obstetrical Anomaly". Of course I was contracting and of course the nurse had to report it to my doctor. And thus my relationship with magnesium sulfate (for this pregnancy, anyway) started this past weekend. The poor nurse didn't even have to tell me what she was going to do. She came back from speaking with the doc, and just frowned. I knew what that meant. "He ordered mag.", I said. She just nodded.
If you have never been on mag sulfate, it is hard to describe. The minute the stuff starts hitting you, you feel like you have an intense sunburn, with heat trapped beneath your skin, unable to escape. Some people get weak. Some people vomit. I don't do either of those, but just feel miserable, generally. And hot. Very, very hot. But I've been down this road before. I know it is the big dog for preterm labor. I was on and off of it for a month with E. It is, by all rights, familiar territory for me. I consent to it, but tell them I want to able to eat. I am starving, after all. They let J come back to see me, and I give him a Mickey D's order, and send him running for it.
That is when it happened. Right then, when my husband was in some silly drive-thru getting me a stupid cheeseburger. Every nurse on staff in L &D (or so it seemed, as there were 5 of them) was suddenly at my bedside, clutching at my wrist to check my pulse, feeling on my belly to find Zachary. His heart rate had decelerrated to a point where they could not distinguish between his slowed heartrate and my quickend one from the brethine pump. But my time in my profession, where I have been called on to resuscitate newborns has taught me enough. I knew a decel like that meant fetal distress. I was hysterical. J was getting a damned cheeseburger for me. And they were muttering sentences about "delivery". And me? I wasn't rational at that point. I got on the phone, in the midst of that flurry of activity, and called my department at the hospital to let them know I would not be there. I'm glad I did.
I don't know how long it took, but before I knew it, as I was sitting there with the nurses thinking Zachary was seriously in jeopardy, 3 calm and smiling faces popped up from behind the curtain. My coworkers. To check on me. The one I had spoken with on the phone had heard my tone of voice and had called in the troops to come and make sure I was okay. God bless those girls. They calmed me down and reassured me until J was there again.
Zachary was okay. Whatever had caused the decel went away and his heart rate picked back up. I was admitted on my mag sulfate drip. But for the first time in all of this, I really truly had to think that my baby was at risk. For a few minutes, I had to think that this was not just me being me, contracting like I do. This has been going on for over 5 weeks now, but I took for granted that I would deliver a healthy baby in the end, like happened with E. This experience showed me that nothing is a given.
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