As of April 13, 2017, this story is going well albeit with a long recovery. I write this as an update, to document the details of what has happened—both for the sake of memory and for informing others—and lastly to refer to if anyone asks.
Read more for the story or click here for post April 13 updates.
On April 7th, 2017 at 4:30 PM my wife had a complication-free, natural birth at New Britain Hospital. The labor was fast (actual push time lasted maybe 15 minutes), her hard contractions were short (maybe a half hour all out), and the rest of the four hours was her having what she called mild contractions while we walked around the maternity ward at the hospital. We hadn’t had to do that since our firstborn.
Fiona Serenity came in at 6lbs, 12 ounces and, as current standard practice, lay in Laura’s arm for an hour and a half after delivery. During that time, Laura continued to also go through the final stages of labor by delivering a whole, healthy, and fully intact placenta—something that young folk don’t often realize is that labor comes in two parts.
After labor, the doctors performed the standard vital diagnostics and noted, once again, that Laura was still anemic—the way she was throughout the entire pregnancy and frankly most of her life. She’s been on iron supplements during the pregnancy and has been taking her prenatal vitamins for years since they’re good for women.
During delivery, I quietly thanked God for his goodness and mercy. Personally, I can’t stand delivery. I feel utterly powerless and I think of all the bad things that can happen. So usually I spend my time praying that nothing happens then thanking God that nothing happened.
Stress-Free 48 Hours
The stay at the hospital was uneventful though exhausting. It is standard practice to have the baby sleep in the room with mom (though not in the same bed, of course) to ensure closeness to the baby, ease of feeding, and SIDS reduction.
During that time, they monitored Laura, noted the lack of iron (at the same level throughout her pregnancy), ensured the prescription of iron supplements was in place and left us mostly alone—especially since they were satisfied with progress. The baby had latched to eat, had steady diaper changes, and Laura was fine.
It being so exhausting, and both having met with all the necessary doctors, there was nothing keeping us in the hospital besides protocol. We wondered what prevented us from going home, they said nothing and they happily blessed us, discharging us roughly 27 hours after giving birth instead of their standard 40 hours.
Home was equally exhausting but you had the comfort of your own home to do things. So yeah, there’s a lack of sleep but at least it’s in your bed. Meals are hastily prepared but they all taste light-years beyond anything the hospital is shoveling onto your biodegradable tray.
Something Other Than Contractions
Here’s some science: oxytocin is a hormone that in men does interesting things but in women it is the hormone that causes contractions during labor. Oxytocin, interestingly enough, is also the stuff that pushes milk into the breast. What’s wild is that while the baby is sucking on milk, oxytocin levels tell the brain “produce more oxytocin!” causing the uterus to contract so that the woman’s uterus starts to go back into the shape before she had a baby! When the baby stops feeding, the hormone stops being produced until the next feeding—what an awesome design.
Mind you, I don’t really understand contractions. I’m a guy. Apparently, contractions feel like cramping that can be in the lower abdomen, flare across that area, or radiate from the back and down the legs. Like I said, I don’t get it. I’m a guy. I don’t know if it’s like a muscle flexing, electrocution, or like the cramps when you have to take a mean one—don’t have a clue.
Since women have cramping every month, the early stages of labor are (reportedly) just annoying. As it gets going, it gets extremely painful and prolonged. When breastfeeding, these contractions are not as powerful as labor contractions but they can sometimes be pretty strong.
While home, Fiona Serenity had a problem with latching on to the breast. That being the case, Laura had to make sure to continue pumping to maintain her supply. Pumping simulates the baby sucking on the breast which does all that stuff up top from oxytocin to contractions.
On Sunday night, this being 52 hours after delivery (also passing the time we would have already been discharged anyway), Laura was pumping away, her uterus contracted, she stood up and something changed.
She felt extreme pain.
Beyond the Pain Threshold
Not at the uterus but somewhere above the ovaries. She, already fair skinned, paled. I asked her if she needed to go to the hospital and, eventually gasping to breathe through the pain, she said yes. Now. We had to go now.
I told my eldest son to stay up (since the kids were all put to bed), took baby Fiona Serenity to the van, helped my wife into the vehicle and flew down our hill to Bristol Hospital which is roughly 4 minutes away. We were in the ER where Laura needed seating, couldn’t see straight, felt nauseous, was calling out that things felt different—very different. And then, moaning that the staff had to hurry up, and as if saying good bye to me, told me she loved me.
Let me pause and tell you that at that point I said to myself that over 48 hours before I had thanked God for his goodness. In my mind I thought “God is still good—but, Rey, how will you be tomorrow if the worst happens?” I don’t know. I thank God he didn’t let me find out. I thank him for being merciful.
Anyway, my wife rarely shows pain. I said above that my wife had a natural birth and that means an epidural-free vaginal delivery. At the harshest pain during the height of labor, she is found swaying, standing, breathing, frowning, and sometimes whispering “ohhh.” The woman is ridiculously strong—besides the fact that she has had gastrointestinal pain since she was an infant and therefore has a different understanding to what a pain level is.
You know that smiley chart that shows the level of pain? At the height of labor, for example, she rated her pain an 8.
But now, rushed into the ER and hooked up to all the machinery, laying on the bed and given Zofran for nausea, they asked her the pain level where they said “1 is nothing and” (noting the newborn in my arms) “10 is pushing out the baby.”
“Way beyond a 10! 12?!?” Laura shouted.
I was afraid.
Diagnosing A Serious Problem
Within the next 6 hours, the OB on duty (Dr. Kamakshi Vemareddy) from labor and delivery played the part of well, chief E.R. Doctor. The doctor on hand sort of stepped out of the way and let her do her thing.
As she examined my wife she said that this wasn’t some mistake from labor. There was no placental tissue left inside. Nor was it a postpartum hemorrhage. I could tell that she had suspicions, especially as she pressed the right lower quadrant of my wife’s abdomen, but she didn’t verbalize them. Instead, she was a calm and powerful force of activity that ordered an ultrasound, got blood drawn, checked Laura’s levels, and directed the nurses on some key things.
Here are details I noticed as they were speaking to each other. My wife’s breathing was short. She had a spiking fever. Her oxygen level was low—lower than when I’m having an asthma attack.
More poor man’s science. Red blood cells, carry oxygen around your body and move carbon dioxide to your lungs where you exhale. When someone is having an asthma attack, the tubes that import air into the body get inflamed making it hard for the body to process oxygen. That’s why you can take this little thing that has a red light (it’s called an oximeter), put it on a finger, and using light it measures how much infra-red and red light is absorbed by the blood, and thus count how much oxygen is being processed.
A normal healthy adult has levels of 99 or 100. Someone with emphysema, where the lungs have been sufficiently damaged so that they can’t process as much oxygen, has a level of 97. When I have an extreme asthma attack I drop to a 95.
I saw my wife was playing with 94 to 93.
This wasn’t an asthma attack though. The blood tests panel showed a different reason. A normal adult has a red blood count of about 13. During Laura’s pregnancy, she was listed as anemic with a count of 7. Now, in the ER, she was down to a 4.
The machine she was hooked up to kept beeping as it hit a certain threshold. I don’t have a clue what that threshold was but I did notice other details. Like the nurse who quietly set up a crash cord on Laura’s bed. Or the head nurse who opened the curtains to “give you guys some air”, way too casually repositioned her station, and pretended like she was just looking at the overall room but her angle was all wrong. I would see her eyes panning the room but they kept coming back the monitor above Laura’s bed. And, whenever that beeping would start, whatever that threshold was it, she’d look sort of cattish—focused and ready to jump.
They told us that they ordered a blood transfusion telling us of the necessity and Laura vaguely agreed while I was nodding to do whatever worked. It was only later that they gave us the potential negatives of a blood transfusion. Sure, they screen the blood but some things, that are super rare, might not be caught. Realize, they noted, your options were limited.
They walked us to the ultrasound lab where the technician did her work. They told me where to sit and I couldn’t help noticing that I was positioned in such a way that I would not be able to see the screen.
The technician seemed to rule out the uterus because she was focusing on the place where Laura had flagged the source of her extreme pain, where Dr. Vemareddy had the most concern: the right lower quadrant of her abdomen. It was during those series of pictures, where I couldn’t see the screen, that I also noticed the tech had stopped talking. Eventually she said “oh, let me get someone to bring you guys back to the ER. I’ll be right back.” I wondered why she didn’t use the phone in the room. I wondered why it took her so long to get back.
When we got back to the ER, they told us that a CT scan was ordered. They had Laura drink some stuff that would illuminate what’s happening in her abdomen. They sent her off to a room that, with the baby, I wouldn’t follow.
Eventually they came back and the OB gave us the report. She had delivered hundreds of baby, here and in India. During all that time she had never seen what was happening to Laura and she would not recommend surgery since surgery would only potentially complicate things. That what was happening to Laura was something that usually clots itself or, if one had to, they could go in and clot it with the same stuff they use in radiology (weird).
Laura would immediately need the blood transfusion because what the ultrasound and the CT scan showed was that Laura was bleeding internally.
Another science fact: an average person of about 160lbs has roughly 5 liters of blood. Laura, before pregnancy, weighed 100. She had lost a liter of blood.
A Name and So Far
Later we found out the name of what had happened if not the why. It is called a broad ligament hematoma.
It’s not a postpartum hemorrhage which is a frequent post-delivery complication (it’s why doctors say “if there is any excessive bleeding, come right back or go to the ER). A hematoma is a clot of blood within tissue. If it gets bigger, that means the blood is still flowing, pushing into the tissue.
This event occurred on the broad ligament, which is this, well, tissue that connects the uterus to the pelvis. This rare hematoma can happen during, or just after, delivery though sometimes it can happen even later (like in our case). They’re not sure what exactly are the reasons for it though professionals have noted certain potential precursors: a C-section, trauma (one doctor had asked Laura if she had “fallen down the stairs” and then ruled out spousal abuse because there were no external marks), and a normal vaginal, yet rapid, labor.
Broad ligament hematomas, as I said above, are unusual. For instance, an article from a Pakistani site (https://www.pjms.com.pk/issues/julsep09/article/casereport001.html accessed April 13, 2017) showed an incidence ratio of 1 out of 20,000 and yet, they had zero reported cases in Pakistani literature. This pdf was almost exactly what happened to Laura except Laura was already anemic (http://www.academia.edu/11731195/Broad_ligament_hematoma_following_a_normal_vaginal_delivery accessed April 13, 2017). For her, she had the perfect storm: a rare event while already being anemic and having a low natural weight. I wouldn’t be surprised if the contraction from pumping was strong enough to approximate an in-labor incident.
Today, I find myself once again thanking God that nothing has, thus far, happened. I also thank him that it looks like although we’re starting a long process of recovery and support, she is out of the woods: his mercy endures. Would have endured anyway but, again, I’m not sure how I would have handled it.
The blood transfusions helped a lot. Facial color returned. She was lucid. She was energized. The CT scan brought clarity to the course of action—they put Laura in ICU for the next two days where they monitored her, checked her vitals, drew blood, and she (like the ridiculously strong woman she is) continued to pump breast milk (after they told us that none of the medications she had taken would affect the baby (mind you, this is the same woman that during this pregnancy cut her own umbilical cord because I have done it and I don’t find it to my liking).
Laura is home now and needs to take stairs lightly, at first sit to sleep, and treat life as if she had undergone major surgery. No lifting. No exercise. Lots of rest. She also needs to take iron supplements as well as go in for parenteral therapy (that’s meds that are delivered through an IV) called iron infusion—sounds like a DC villain. The reason is that iron that bypasses the stomach is more easily delivered into the body. With Laura already having a history of gastroparesis, poor motility, and likely low absorption, taking oral iron supplements might not be enough. The side effects are potentially a problem but the goal is to get Laura back up to a blood count of 12.
Mind you, I didn’t include a ton of other details. The prayers of people. Family members that I haven’t spoken to offering to come over. Church friends taking care of my family and myself while dealing with all this. Lots of other things that I’ve thanked God for—but this post isn’t about all of that. It’s just about what’s happened with Laura and if any other updates need to be added. Those, I’ll post below.
Updates, If Needed
4:30pm The brothers and sisters at our chapel bought Laura a motorized easy chair so she can sit and sleep without forcing herself up. I am thankful for their love and care praying that God continually uses them for each saint that shadows the door at Bristol Bible Chapel.
6:00 PM. Laura’s pain is high rated as a 7. Fever showed up and spiking at 101.5. Heading back to ER where they plan to repeat Sunday’s tests. Went to the hospital where we delivered Fiona Serenity instead of the one right up the street that saved us on Sunday.
8:50 pm. Blood count is good. At 9. Better than when she was discharged yesterday. Next up is CT Scan and to check source of fever.
9:48 Ct scan shows no expansion on hematoma. Also good news. It is big though. He guessed that the cause might’ve been a ruptured ovarian artery but no clue really. Antibiotics prescribed for fever and stronger baby-safe painkillers prescribed. Follow up action plan if any major changes during weekend. No admittance needed.
Laura is in lots of pain exacerbated by the fever. She doesn’t want to take the stronger painkillers though because she has been experiencing time loss and random sleeps with the weaker narcotic. She can’t be left alone holding the baby.
Laura’s fever spiked to 102.7 but then came down after a Doctor recommended dose of extra strength Tylenol plus the Percocet. Can’t really do any Motrin because they want to ensure proper clotting. Pain levels at the end of the Percocet time slots are pretty high. Our brothers in sisters in Christ have a massive food chain where they’ve been providing meals for every day—so much so that today I had to ask if we can go to every other day. Our fridge runneth over. She has a follow up doctor’s appointment on Tuesday. My other sister-in-law comes up that night but a sweet mother in Christ is helping us out in the morning.
More of the same.
Went to get the iron infusion via IV but the doctor is concerned about the fever. There are rare reactions to iron infusion but it is best to address underlying issues so that we’re not masking possible true reactions. This afternoon we went back to Laura’s OB who has decided to admit her into the hospital. The pain, he says, is what it is—it’s like getting hit by a horse: you expect pain. But the fever is confusing and after so many days of antibiotics something should have been happening. Laura has been admitted back to the hospital where they are repeating the blood culture, possibly the CT scan, and other battery of tests. As of this time, they’ve finished doing chest x-rays (to rule out pneumonia) though I haven’t seen results yet. Currently she’s there for 24-48 hours and they have started her on a her first round of intravenous antibiotics.
They did two rounds of the IV antibiotics and, with all the poking in her arm, her arm got inflamed. After some cool compresses they proceeded to stick her to draw blood. Chest X-Ray came back clear. Blood culture sounds like it is clear as well. Fever is still there though lower—good sign in general but it needs to get much lower (100.3) so as to support the theory that the antibiotic is working. She’s no longer adding Tylenol to the pain killer dosage so if the fever comes on, it’s only being managed by the painkiller. That’s okay since the doctor’s main concern is not the pain as much as what is causing the fever. As a last resort they’ll drain the hematoma but they don’t want to do any sort of surgical intrusions if they don’t have to. So far, the discussion revolves around maintaining a no-fever for a consecutive 24 hours so that they can establish the antibiotics are working and possibly send her home with an IV attached at that point.
During the day she got to get some snuggle time with Fiona Serenity as well as a visit from a friend and kindred spirit who tried to offer Laura a Plan B Burger (great place) but opted for some delicious snacks that were more in tune with the possibility of surgery.
Weird mix of medical opinion going on at this hospital and the care level isn’t what it was at the not-as-well-equipped Bristol Hospital. Floor doctor says that it’s been 48 hours of no fever even though they’ve been checking only twice a day, one in the early morn where the body temperature is naturally lower and she rates 100.3 as a non-fever. OB doctor says that Laura has not had a straight 24 hours without a fever since she has a temperature of 100.3 at night. Either way, both temperatures are lower than the 101 and 102 Laura was registering before the intravenous antibiotics. Floor doctor wants to send Laura home with oral antibiotics. OB doctor still wants to see if they can get a straight 24 hours without fever. Infectious Disease doctor is concerned about the pain (where the others aren’t) wondering if this is the kidney. He’s considering sending Laura home eventually with either an IV line for intravenous antibiotics or oral antibiotics.
The doctors opted against the ultrasound since it wouldn’t give them the image they needed. Their main concern was where the hematoma was located in relation to the kidney and the liver. They want to make sure that there isn’t an abscess there, now—in light of the bleed—that could cause later problems. This winds up being a decisive factor if they perform a surgery that consists of draining the hematoma (something they don’t want to do) or carrying on with simply antibiotics treatments. The doctors eventually agreed that the low-grade-to-no-fever indicates that the antibiotics are working and that it is probably in relation to the hematoma. Indeed, they seemed to think that the fever was possibly the body reacting to the massive trauma of the hematoma. There is no infection in the blood, urine, and lungs and the antibiotics do seem to be working. All that being the case they have decided to send her home with oral antibiotics.
Also, it seems that the Percocet started getting into the milk. The last few days of the baby drinking pumped milk she was left pretty sleepy and being hard to wake for feedings. During the third night feeding without breast milk, the baby would be extra fussy and awake. That being the case, the doctors have also switched from the narcotic to a straight ibuprofen.
So thank God, the baby is fine and Laura is now home. We need to follow up with the OB in a few days and also be aware of Laura’s temperature in case there are sudden spikes.