Pregnancy

My pregnancy started out fairly typical. I was tired and I had morning sickness that needed to be treated with Zofran, but once that was prescribed I generally felt great weeks 10-17. I am a nurse and spend a lot of time on my feet. I also spend a lot of my time outside of work at the gym (it’s where I met my husband). I consider myself physically fit but at about 17 weeks pregnant I  began to notice that I was getting really short of breath walking up the stairs and going on walks with our dogs. I thought this was odd since my bump wasn’t really taking up a large amount of real estate or pressing on my lungs at this point but just attributed it to being pregnant. Then, one day at work while completing a basic (non-physical) task, I started to feel very short of breath. When going to check my oxygen levels I found that my O2 was perfect and that instead, it was my rapid heartbeat causing the problem. A few coworkers convinced me to head downstairs to the ER to get checked out and I ended up getting admitted to the hospital. I was terrified that there was something wrong with my baby, but I had an ultrasound and an entire cardiac workup including an echocardiogram, chest CT and coronary artery CT. We were both given a clean bill of health, but I was diagnosed with PoTS (postural tachycardia syndrome) of pregnancy. This meant that with quick position changes (ie: sitting to standing) for the remainder of my pregnancy I would have heart palpitations. Though annoying, I was able to avoid this with slow movement and increasing my hydration. Aside from this, my pregnancy progressed normally and both myself and my baby remained healthy heading into delivery. Due to Covid restrictions, my hope of having family as a support system during labor was squashed. The further my pregnancy progressed I realized that I wanted some type of support, and through research ended up landing on hiring a local doula. 

Needle Phobia

I have a long-standing needle phobia and anxiety related to IV’s or shots of any kind (weird since I’m a nurse-I know). I always knew that I would have a hard time getting an epidural, especially after watching one be placed during nursing school. I spent tons of time researching hypnobirthing, practicing affirmations, and discussing an epidural free birth with my doula and husband. It was more than just a fear of the needle, I was convinced that if I had an epidural something terrible would happen. I told more than one person that I was sure if I had an epidural that I would end up with a complication (paralysis and infection were at the top of my list of perseverations). I called my best friend and said that there was no way I was getting one and I just had a bad feeling. I was so dead set against having an epidural that my OB scheduled a call with the head of anesthesia to quell my fears. I left the phone call unconvinced. 

Labor

Fast forward to 39 weeks 6 days, I am at my 40-week appt and my doctor schedules an ultrasound due to my increasing (but still normal) blood pressure and the amount of fluid I’m retaining. I had gained 6lbs in a week and was having severe edema to my lower legs as well as my hands. Late-term ultrasounds are notoriously questionable at predicting size of baby (can be off by +/- 2lbs) but my US tech predicted my son would be 9lbs 5oz. Due to my birth size (10lbs) and my husbands birth size (10lbs 3oz), I felt pretty confident that this scan was accurate and began to get very anxious about the size of my baby. My OB suggested an induction that evening, but I declined as I wanted as little intervention as possible. As the days went by, I became increasingly uncomfortable and agreed to an induction at 41 weeks. I got to the hospital on a Wednesday evening and was anxious but also excited to meet my baby. The doctor on call ignored the induction method my OB had ordered and instead suggested we try a cooks catheter. Aka they stick a thin tube into your cervix and then inflate it and attach it to tension. It’s supposed to mimic the baby’s head putting pressure on your cervix and help with effacement and dilation. Well, after 3 failed attempts, a large amount of blood, and a dose of morphine the provider was unable to place the device. My nurse seemed horrified and was apologizing to me profusely, saying that this procedure normally takes just one attempt. I asked her if there was something else we could do, and the provider reluctantly ordered the cytotec that my OB had originally planned for. I continued with irregular but frequent contractions for the next 24 hours. My water broke on its own at about 11:30 Thursday night. The contractions were strong due to the multiple doses of Cytotec. I was laboring with the aid of nitrous oxide and spent some time in the jacuzzi. After 6 hours of almost continuous contractions, we did a cervical check and I was disappointed to find that I was only 2cm. Despite my fear, I requested an epidural. To my relief, it was placed quickly and with no complications and my pain almost immediately disappeared. My epidural was sufficient in reducing my pain, but to my surprise -and joy- I still had really good control of my lower body and was able to move both my legs. I spent the next 16 hours changing positions about every 30-45 minutes with the help of my doula, nurses, and husband in an attempt to spin my baby into an optimal position.

C-section

At 10:30 pm on Friday after 48 hours in the hospital, a cervical exam was completed, I was found to be 90% effaced, 8cm dilated, and 0 station. I had been in labor for about 24 hours and on a Pitocin drip + epidural since around 6 am that morning. I had been 8cm for >4 hours and was diagnosed as ‘failure to progress’. I was told that although my son’s and my vitals were normal it was recommended I have a c section due to the length of my labor and lack of progress. I was exhausted (mentally and physically) and starving after not eating anything but honey sticks and broth for 30 hours. After lots of tears and discussions with my husband and doula, I consented to the cesarean. I was disconnected from my Pitocin drip at approx 11 pm. I was terrified of the surgery and openly crying. My doula had been with me for 24 hours and at one point we made the decision that she would be my +1 for the c section due to my husband’s queasiness (he almost fainted during the epidural placement and wasn’t sure he could attend the surgery). At the last minute, he changed his mind and decided that he wanted to be in the OR. My husband was escorted down the hall to get changed into his surgical scrubs, and I was wheeled to the OR in my hospital bed. At this point, I was instructed to transfer myself to the operating table, which I found odd since my lower body was numb and heavy due to the epidural. Once I was laying flat on the table I began to have severe back pain, what I know now to be ‘back labor’ due to the OP (sunny side up) position of my son. During this time the anesthesiologist was prepping me for surgery and conducting sensation tests, all of which I reported I could feel. It was then determined that my epidural had become dislodged. The anesthesiologist told me that I needed a new epidural. This caused me to have a panic attack. It was difficult for me to even ask for my first epidural where I had the support and presence of my husband and doula. At this point, I’m all alone in the OR with an entirely new birth team as it was just shift change. I declined the second epidural and asked if I could instead have general anesthesia. I sat over the edge of the OR table having really strong contractions. The epidural was difficult to place due to my fluid retention from being on Pitocin and IV fluids all day. Again I stated multiple times that I wanted general anesthesia and that I could not do this as the anesthesiologist fished around in my back trying to place the spinal. I was told ‘yes you can’ and ‘that will not be good for your baby’. It took over ten minutes but finally, the epidural is placed and I am laid back down on the operating table. The anesthesiologist continues to prep me for surgery and goes back to conducting sensation tests. I continue to report full sensation to the right upper quadrant of my abdomen. I am told verbatim, ‘this is very far away from where your incision will be’.  My husband is brought into the OR. I have the strong sensation of my son’s head crowning and ask repeatedly for someone to check to make sure. No one performs a cervical exam. At this point I have been disconnected from Pitocin for more than 2 hours, yet was having active labor of my own and my previous exam showed that I was in transition. Instead of performing a cervical exam and assessing new medical information that could have potentially STOPPED me from having a c section altogether, I was told ‘this is normal’ and that it was because my son’s head was ‘engaged very low in my pelvis’.  Despite all of my attempts to communicate the amount of sensation I had, the surgery began. The surgeon’s report states that I did not complain of ‘real’ pain until the incision was made on my uterus, which is a lie. I remember screaming, ‘I CAN FEEL EVERYTHING!’. At this point, I am begging, flailing my arms and pleading for them to stop. No one stops. Instead, I am pinned down while the surgery continues. I beg for them to put me under general anesthesia, I ask them why they won’t stop. No one answers. 

Once in recovery, I speak with the OB who advised me that they made the call to proceed with the surgery despite my pain due to the risk of administering anesthesia to me and having it affect the baby. She also says pausing the surgery could also be a risk for hemorrhage.  My son was delivered at 1:25 am (9lbs 4oz and 21.5 inches long), at which point the above mentioned risks would no longer have been an issue. I remember seeing him held up over the drape and having one brief second of relief from the pain. Also the fleeting thought, ‘he has so much hair!”’. Though my son was born, I am operated on in this manner, with full sensation, until 1:31am when I was finally intubated and put under general anesthesia for the remainder of the surgery. During these 6 minutes after my son was born I was aware of nothing else except for the agony I was experiencing. Unbeknownst to me, my husband fainted and was laying on the floor of the OR. He then got up and returned to the area where he had been dressed in surgical scrubs.

The physical pain I went through has been so hard to deal with, but I find the things I am having the most difficulty with are the things I missed. The golden hours, the first skin to skin, the taking in our new baby boy in awe together. Instead, I am separated from my husband and baby and don’t get to meet him until almost 2 hours later. One nurse was thoughtful enough in the chaos to find my phone on the floor where my husband dropped it and take pictures. They are bittersweet to look at and remind me that I was not there for those moments, but I am so thankful that they are there for me to look back on.

Postpartum

Immediately after my delivery I was in shock, trying to process my joy over the birth of my baby but so traumatized from my delivery. I had been so worried about a complication from my epidural, but this was a scenario I didn’t anticipate and could never prepare myself for. I had a hard time talking to anyone in the hospital and requested a ‘do not disturb’ tag for my door, but that didn’t stop what felt like 1000 providers and hospital administrators coming to apologize to me. People who are not a part of my birth team kept coming into the room to ask how I was and check on me. Having to retell the story of my birth to a new person every hour left me in tears over and over again. Patient advocacy came to my room and let me know they would be investigating my birth.

When I come home, I finally worked up the courage to read through my medical record. I was immediately overcome with rage. In the middle of my operative report and anesthesia notes the words ‘tolerated procedure well’ and ‘patient satisfied with anesthesia care’ burn through me. I call the hospital and let them know that I want the note changed to reflect what actually took place. The head of anesthesia calls me and assures me that my medical record will be revised. I am told that they are doing an internal investigation and case study on my birth within the anesthesiology department. At the conclusion of their investigation, I ask to be included in their findings. During my meeting the head of anesthesia and chief of anesthesia are present. The anesthesiologist who attended my surgery is sitting 4 feet away from me. She tells me she is sorry, and that she thought she could manage my pain with IV meds once she realized my epidural was insufficient. She says that I was in fact in severe distress from the first incision and that there was ‘a marked change in the atmosphere of the OR’ as they began the cut on my uterus. To me this means nothing because I know that I was in agony both before and after this. She says she will change her charting to reflect that I had inadequate coverage throughout my entire surgery. She tells me that the 6 minutes after my son was born until when I was finally intubated was due to her having to ‘pre oxygenate’ me before putting me under general anesthesia (something I’m pretty sure she should have been doing the whole time). She tells me she also wanted to wait for a second anesthesiologist ‘just in case’ I was difficult to intubate. The chief of anesthesia says she should have never began if I had any sensation in my abdomen. I think…’no shit’. Her apology and explanation do not give me closure. They make me angry. 

I am so angry. I’m angry that I wasn’t taken seriously. I’m angry that it seems like the anesthesiologist had a god complex and thought she was ‘good enough’ to medicate me when she knew I didn’t have sufficient epidural coverage. I’m angry that when she realized she actually wasn’t good enough, I had to wait for a second anesthesiologist to come to the OR, adding so many minutes to what already felt like an eternity. I’m angry that I didn’t get to hold my baby as soon as he was born. I’m angry that now the thought of expanding my family terrifies me because the thought of a failed VBAC or an elective c section seems unfathomable. But I am also so sad. Sad that I didn’t get to see or meet my baby for several hours after he was born. Sad that I didn’t get to see my husband hold our son for the first time. Sad that instead of bonding as a family with our newborn I was crying in the PACU trying to understand HOW and WHY and WHAT just happened to me. Sad that instead of enjoying baby snuggles my first few weeks home from the hospital I was a shell of myself. Sad that instead of looking back at the day my son was born with joy and happiness, I instead remember it as one of the worst days of my life. I’m sad that I can’t talk about my birth story without feeling like I’m scaring someone who is pregnant or might have a c section. I feel embarrassed that I am the birth story that people share in hushed whispers, ‘did you hear what happened to Carly?’. I think in one of your recent posts you wrote that ‘birth trauma is not contagious’, but it sure feels like it is. Mine is not a story that people want to hear. It’s not fair. I feel like a petulant child stomping my foot saying that. But it wasn’t fair, and it was 150% preventable. I think that’s what makes it harder for me to get over. If only one person had spoken up for me in the OR. If only one person had checked when I said I felt my son’s head. If only one person had paused and given me some options or feedback if only the anesthesiologist administered general anesthesia the second she realized I was in pain – then this all could have been avoided.

People process trauma in different ways. While I want to scour my medical record and go over the situation over and over again, my husband’s process is not as vocal. Though we both suffered trauma that day, being in the OR while I begged for help that he was unable to give is something that he has difficulty talking about at length. I think it is too painful for him to relive those memories and that feeling of helplessness. And while he can’t have long chats about it with me at this point, one of the very first things he did when I was still in the hospital was write down his own account of what happened. Reading his words in a way is more heartbreaking than my own memories. I hate that he entered into fatherhood with so much trauma. Becoming a father is a momentous occasion all by itself with all the changes it brings. On top of adjusting to his new role of ‘Dad’, he also was trying to help hold me together. I don’t think he really knows how much he truly did help me those first few weeks home. Not just with the bottles and diapers. When I couldn’t talk, he let me sit in silence. When I cried, he held me. And while this happened physically to my body, I know that it happened to him too.

Because Mac’s birth was such a difficult day, it wasn’t until a few weeks ago that my husband realized he had taken pictures of me meeting Mac for the first time. Finding these pictures was such a gift. I remember having my oxygen on in the PACU and asking the nurse if I could take it off so that I could kiss my son. Somehow my husband had enough presence of mind to capture these images.

Through dealing with the effects of my traumatic birth experience, I have developed a whole new appreciation for trauma-informed care and for the health care providers who practice in a way that supports all of the big feelings that come with trauma. I will never forget my angel of a nurse in postpartum who I was lucky enough to have 3 shifts in a row. I will never forget the nurse who captured my son’s first moments earthside. I am only 6 months postpartum and I know I still have a lot of healing left to do, but I am hopeful and I am trying- and I feel like that’s a great place to start 🤍

The author:

My name is Carly. I am an RN and first time mom from the Boston area.