We left the doctors yesterday with more questions than answers and a new issue to deal with and overcome. We never expected what we had to discuss yesterday, but I think before I can delve into all of that information, I need to share my birth story. Much of the discussions with the doctors wouldn’t make sense without the background on how Ava arrived in this world.

I have shared this story with only one person. She has been a tremendous help while trying to understand and deal with such a tramatic birth. Not only did her understanding and passion for pregnancy and childbirth help me to understand my body and what was happening, but her compassion and caring offered a strength and comfort like no other.

Thank you Wash Lady for being there for me. Thank you for caring, thank you for understanding, and thank you for all your advice and support. I am now ready to share my birth story. This was taken from the email I wrote, but I have updated it with some more details that I have remembered, as well as the timing of everything.

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I’ve tried for a few days now to try and compose an email describing the events around Ava’s birth, but I am having such a hard time even bringing my fingers to they keyboard to relive the day. It’s still fresh in my mind, but I fear putting it down on paper, forever etching the days memory in print.

What if I can’t honour Ava or retell the story in a way that I can be proud of? Ava WAS born after all and that makes her birth special no matter what. I just don’t want it to come across as me retelling the horror show I had to endure. The problem is, I just can’t shake away the trauma and horror and that’s mostly what I keep reliving in my mind…maybe if I get it off my chest, I will be able to see things in a more positive light.

I want to tell you what happened because I know you understand childbirth in a way that no one else I know does. Your kind and gentle ear is what I need most right now, and if you have any advice or words of wisdom you wish to share, I am all ears as well.

I will apologize in advance if my story sounds disjointed or incoherent. I need to just let my fingers to the walking right now. Elegant sentences, proper grammar and articulation will have to take a back seat or I fear I won’t be able to continue if I don’t spill this out as quickly as possible…

I woke up at about 3:00 am on Thursday April 14th to go to the bathroom. This certainly wasn’t uncommon seeing that I was 38 weeks pregnant and four or five trips to the toilet a night was something I had grown used to. This morning was a bit different. My legs were slightly crampy and achy like they get the first few hours when I start my period. Not deep or painful aches, just a slight ache, like the kind you may feel when it’s damp outside. I stayed awake and went on the computer. I actually posted a comment on AC’s blog and wrote an email to a fellow blogger friend. Around 4:30 am I decided to go back to bed. At 6:30 I awoke with my husband. I noticed I had a slight cramp in my stomach that came and went in a matter or seconds. It occurred to me that I might be starting labour, but the cramp was definitely not painful or uncomfortable. I prepared my half cup of coffee like I normally do every morning and went back to the bedroom to lay in bed and watch the news while my husband go ready for work.

While sitting in bed watching TV, I felt the cramp again. I counted about 5 seconds for how long it lasted. Again, not painful, just a tiny cramp. I glanced at the nightstand clock and noted the time, took a sip of coffee and went back to the news. Exactly 4 minutes later, I had another cramp about 5 seconds long, and another 4 minutes later. I thought that was very odd considering my expectations of early labour were contractions much further apart and of course, sporadic intervals between them.

Still not uncomfortable, I got up and went to the office. Around 7:15 my husband emerged from the shower and I calmly told him that I might be starting labour. I explained what I was feeling. His face showed extreme shock, excitement and nervousness all wrapped together in one. He asked if he should stay home from work, but seeing how NOT painful the contractions were, I encouraged him to go to work and that I would call him if I needed him to come home. I still wasn’t convinced I was actually in labour. To be honest, I figured I was experiencing Braxton Hicks contractions because they weren’t really painful at all. I don’t recall ever feeling Braxton Hicks contractions my entire pregnancy so I thought it was about time I felt “something”. I also didn’t think I was in labour because I had no other obvious signs like losing my mucous plug and my belly hadn’t even dropped. Remember my 38 week belly shot? I went into labour 5 days later and my stomach was still the same.

Around 7:30 my husband left for work. (The 1.5 hour commute). I decided to have a warm bath to relax and see if that helped my “crampiness” as I’ll describe it. It seemed to. I even tried walking around a bit, and the contractions sort of subsided…but to be honest, I think I was too nervous and excited to know for sure. I decided to blow dry my hair and put on some make up in case I really was in labour. I know that sounds really vain, but what the hell, I knew we would be taking pictures and wanted to look my best if my daughter was making her grand entrance. By now, the contractions were a little more intense and I started to moan through them, even though they were only lasting about 10 seconds, still coming every 5 minutes apart or so. Again, I was surprised, but still not convinced I was in labour. It just wasn’t that painful, and my legs felt crampy more than anything. I also figured that if my so called “contractions” were only lasting 10 seconds I had a ways to go before the 4-1-1 rule of contractions lasting a minute in length for one hour and being four minutes apart before going to hospital.

I puttered around until about 9:30 when I called my husband and decided things were getting a little more painful and I wanted his support. Contractions weren’t lasting a long time, but seemed to hurt a bit more. If he caught the next train out of the city he would be home by about 11:00. I felt confident I could handle myself for an hour and a half and insisted he didn’t take a taxi home.

The next hour window is a bit of a blur. All of a sudden the contractions were getting quite intense. I just laid in bed and moaned and kicked my legs through them. I couldn’t time them. I was actually passing out and sleeping between them. I do remember trying to control my breathing. It felt like they were right on top of one another, but time and my surroundings were meaningless. I was trying too hard to focus on breathing through the contractions. I was alone and getting scared now.

Finally at 11:00 Mark arrived home. He rushed upstairs and as soon as I tried to get out of bed I threw up. He timed two contractions and they were a minute in length and less than two minutes apart. I was shocked because only about four hours had passed since I felt my first contraction, and if you will believe this, still not convinced I was in labour. We didn’t even make the requirements to go the hospital yet, so we called the labour and triage unit at the hospital. Based on our answers, they suggested I come to the hospital if I wanted pain medication (which I did at that point) but otherwise, they weren’t concerned. My water hadn’t broken, I could still walk and talk through a contraction. My heart sank however when they asked if I felt the baby move. I hadn’t even thought of that. Of course she had been moving all night, but once my pain intensity grew, I couldn’t focus on much else but the pain. I honestly couldn’t remember. I think at that moment I started to realize something wasn’t right. Things were progressing too fast. We asked if we had time to get to the Toronto hospital (as opposed to the local hospital here), and the nurse said it was up to us. We decided to travel to Toronto because the local hospital didn’t have our medical records, nor where they equipped to deal with emergencies like Toronto was.

Trying to remain calm, Mark packed up the car and kept telling me how proud he was of me and how well I was doing. It was now about 11:20. My contractions were definitely increasing in intensity and length at an alarming rate. By 11:30 we were well on our way. I called my house to get ahold of my mom and let her know we were going to the hospital, but we weren’t sure if I was in labour yet (denial is a powerful thing).

Finally, around 12:30 we arrived at the hospital. We parked and walked ourselves to triage and I immediate collapsed on the floor from the pain of a contraction. I then proceeded to throw up everywhere. Mark went downstairs to admitting while I waited alone in triage. At 12:45 (established by cell phone records) he called my mom to let her know I was at the hospital and they were just checking me out to establish if I was in labour.

While waiting for Mark to return to triage with me I remember having to pee, but even while going to the bathroom I threw up again all over the bathroom floor as the contractions fell over me. The nurse just kept telling me to breath…breath…breath….

By the time Mark came back upstairs I was already in a bed in triage attached to a fetal heart rate monitor. I was in the room for about 10 minutes before Mark returned and he helped me breath through a contraction. I remember yelling at him that he had bad breath and to stop breathing on me. Not long after that, a nurse came to do a vaginal exam to see how far along I was. I was 5 cm dilated! Mark asked them if we were having a baby today, and they laughed and said YES! I remember being so relieved I was in fact in labour because I still wasn’t convinced yet. I was in pain of course, but the pain wasn’t unmanageable, just intense. I really did think they were going to send me home because only a few hours had passed and I couldn’t believe how quickly everything was happening.

Once they said I was five centimeters, I asked for an for an epidural and they said the anesthetist was on the way. I was still hooked up the fetal heart monitors. I could hear Ava’s heart beat. I remember finding that very comforting and I became super excited that I was about to meet her soon. At 1:15 I was taken to a labour and delivery room where a nurse attempted to give me an IV for an epidural. I remember feeling sad at this point at this point because here I was 5 cm dilated and I still hadn’t even had a moment of massage or gentle touch from my husband through my labour. I know these things never go exactly as planned, but I never envisioned this scenario in my head at all. The nurse was a bumbling fool and couldn’t get the IV in. The anethetist was actually in the room as well just waiting for the nurse to get an IV in, but she was making a mess of my veins. There was an OB in the room who wanted me hooked up to the heart monitors again because she thought my trace from triage was “tacky”. Here I was having contraction on top of contraction while trying to sit still to get an IV in me from the nurse while the OB was wrapping the heart monitor thing around my tummy while sitting on the bed. At 1:30, Mark called my mom and told her to hurry because Ava was coming fast and furious.

Things get fuzzy for me here. I remember another doctor entering the room (who I later found out is the reason Ava was born alive, but I’ll get to that part later). Time now was 1:45. This new doctor immediately took over. I was screaming for pain medicine now. The doctor just looked at me and said that there is a line to draw between fetal well being and my comfort right now. He asked if my water had broken. I said no. He asked if I was sure, and, to the best of my understanding, it hadn’t. He did an internal exam. I was 7 cm. I went from 5-7 cm in a matter of minutes. I was becoming delirious at this point I think. I had people holding me down, Mark screaming for someone to at least give me some gas, but they ignored us. No one was telling us what was going on. The doctor asked me if he could break my water. I said I was scared to have him do that because I knew that meant my contractions would become more instense and I still hadn’t received any pain relief yet. He told me it was important that he did so and tried to reassure me that I could have pain relief “soon”.

I now know that once he broke my water, it was then that they discovered the meconium. He inserted an internal heart monitor to the baby’s scalp and all I remember hearing is “That’s Maternal”. Next an ultrasound was performed and the doctor yelled “That baby has no heart beat”. Everything went silent. Next I heard “C-section stat”. Mark was screaming for someone to tell us what was going on. I was screaming because I was in pain and more afraid than I have ever been in my life. Five minutes elapsed from the time the new doctor entered to the room and broke my water, attached the internal monitor and performed an ultrasound. At 1:50, I was wheeled away for the Operating Room.

They wouldn’t let Mark come with me. He later told me that a nurse took him aside and explained that an alarm was about to go off and not to be afraid, but a whole bunch of doctors were about to come running down the hall.

I remember someone pinning me down and holding an oxygen mask on my face telling me I needed to breath for the baby. I was hyperventilating at that point. I couldn’t catch my breath. The last thing I remember saying was to make sure they took good care of my baby… Then the world went black…..and the lights have never fully come back on….my baby wasn’t going to make it, she was born at 2:11pm. Her apgar scores were 0 and 0.

As soon as I came to after the operation I was asking about my baby. No one would tell me anything. They wheeled my bed to another room where Mark had to deliver the news that Ava wasn’t going to make it. She had passed meconium and they couldn’t get it out of her lungs fast enough. She was given epinephrine to help jump start her heart, but it was already too late. She had not been able to fill her lungs with air for far too long.

They tried to save her, but they couldn't. There was nothing more they could do. Our daughter, our beautiful baby girl would only be with us for a short time.

She was put on life support so that we had a chance to say goodbye. That was when we learned that legally, as her parents, we had to be the ones to decide to remove her from life support. That was hand's down most difficult decision I have ever had to make in my life.

I didn’t freak out during my short time with her. I just cried and hugged and kissed Mark and held my baby. I marveled at how beautiful she was, how innocent she was, and how perfect she looked. I was in shock.

I later learned the doctor that took over and called for the c-section has just happened to be walking by my room and didn’t like the sound of the heart beat from the monitor. No one else heard whatever it was that he heard. He could only describe it was his experience and years of practice that signaled to him something was not right.

I’ve been over the events of the day a million times in my head. I’ve played the blame game with myself a million time over as well. I know I can’t do that to myself, and on some levels, I don’t blame myself. Even IF we had been at the hospital sooner, it was purely chance that doctor happened to be walking by when he did. I know Mark and I made the best decisions we could with the information we had. I just don’t know where “acceptance” fits into everything.

We do not have an official cause of death. An autopsy was performed, and my placenta was sent away for further testing, and we are just awaiting the results. We are trying to prepare ourselves in event that they do not find any answers. I don’t know how that makes me feel, because an answer would mean I will have closure. I’m just not the type of person who accepts “what is” without facts and answers to back it.

I think I have to stop now. Thank you for letting me unload. It fells good to get some of this off my chest. Truth be told Wash Lady, I haven’t been able to talk about this with anyone else (except Mark). I apologize for burdening you with so many details, but again, I feel like you understand and I can feel your compassion.

Thanks for listening.

Hugs
Karla

Labels: Birth, Grief and Loss, In Memory of Ava