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\u2014both for the sake of memory and for informing others\u2014and lastly to refer to if anyone asks.<\/p>\n
Read more for the story or click here for post April 13 updates<\/a>.<\/p>\n <\/p>\n On April 7th<\/sup>, 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\u2019t had to do that since our firstborn.<\/p>\n Fiona Serenity came in at 6lbs, 12 ounces and, as current standard practice, lay in Laura\u2019s 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\u2014something that young folk don\u2019t often realize is that labor comes in two parts.<\/p>\n After labor, the doctors performed the standard vital diagnostics and noted, once again, that Laura was still anemic\u2014the way she was throughout the entire pregnancy and frankly most of her life. She\u2019s been on iron supplements during the pregnancy and has been taking her prenatal vitamins for years since they\u2019re good for women.<\/p>\n During delivery, I quietly thanked God for his goodness and mercy. Personally, I can\u2019t 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.<\/p>\n 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.<\/p>\n 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\u2014especially since they were satisfied with progress. The baby had latched to eat, had steady diaper changes, and Laura was fine.<\/p>\n 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.<\/p>\n Home was equally exhausting but you had the comfort of your own home to do things. So yeah, there\u2019s a lack of sleep but at least it\u2019s in your bed. Meals are hastily prepared but they all taste light-years beyond anything the hospital is shoveling onto your biodegradable tray.<\/p>\n Here\u2019s 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\u2019s wild is that while the baby is sucking on milk, oxytocin levels tell the brain \u201cproduce more oxytocin!\u201d causing the uterus to contract so that the woman\u2019s 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\u2014what an awesome design.<\/p>\n Mind you, I don\u2019t really understand contractions. I\u2019m 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\u2019t get it. I\u2019m a guy. I don\u2019t know if it\u2019s like a muscle flexing, electrocution, or like the cramps when you have to take a mean one\u2014don\u2019t have a clue.<\/p>\n 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n She felt extreme<\/span> pain.<\/p>\n 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.<\/p>\n 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\u2019t see straight, felt nauseous, was calling out that things felt different\u2014very different. And then, moaning that the staff had to hurry up, and as if saying good bye to me, told me she loved me.<\/p>\n Let me pause and tell you that at\u00a0that point I said to myself that over 48 hours before I had thanked God for his goodness. In my mind I thought \u201cGod is still good\u2014but, Rey, how will you be tomorrow if the worst happens?\u201d I don\u2019t know. I thank God he didn\u2019t let me find out. I thank him for being merciful.<\/p>\n 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 \u201cohhh.\u201d The woman is ridiculously strong\u2014besides 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.<\/p>\n You know that smiley chart that shows the level of pain? At the height of labor, for example, she rated her pain an 8.<\/p>\n 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 \u201c1 is nothing and\u201d (noting the newborn in my arms) \u201c10 is pushing out the baby.\u201d<\/p>\n \u201cWay beyond a 10! 12?!?\u201d Laura shouted.<\/p>\n I was afraid.<\/p>\n 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.<\/p>\n As she examined my wife she said that this wasn\u2019t some mistake from labor. There was no placental tissue left inside. \u00a0Nor was it a postpartum hemorrhage. I could tell that she had suspicions, especially as she pressed the right lower quadrant of my wife\u2019s abdomen, but she didn\u2019t verbalize them. Instead, she was a calm and powerful force of activity that ordered an ultrasound, got blood drawn, checked Laura\u2019s levels, and directed the nurses on some key things.<\/p>\n Here are details I noticed as they were speaking to each other. My wife\u2019s breathing was short. She had a spiking fever. Her oxygen level was low\u2014lower than when I\u2019m having an asthma attack.<\/p>\n More poor man\u2019s 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\u2019s why you can take this little thing that has a red light (it\u2019s 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.<\/p>\n A normal healthy adult has levels of 99 or 100. Someone with emphysema, where the lungs have been sufficiently damaged so that they can\u2019t process as much oxygen, has a level of 97. When I have an extreme asthma attack I drop to a 95.<\/p>\n I saw my wife was playing with 94 to 93.<\/p>\n This wasn\u2019t 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\u2019s pregnancy, she was listed as anemic with a count of 7. Now, in the ER, she was down to a 4.<\/p>\n The machine she was hooked up to kept beeping as it hit a certain threshold. I don\u2019t 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\u2019s bed. Or the head nurse who opened the curtains to \u201cgive you guys some air\u201d, 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\u2019s bed. And, whenever that beeping would start, whatever that threshold was it, she\u2019d look sort of cattish\u2014focused and ready to jump.<\/p>\n 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.<\/p>\n They walked us to the ultrasound lab where the technician did her work. They told me where to sit and I couldn\u2019t help noticing that I was positioned in such a way that I would not be able to see the screen.<\/p>\n 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\u2019t see the screen, that I also noticed the tech had stopped talking. Eventually she said \u201coh, let me get someone to bring you guys back to the ER. I\u2019ll be right back.\u201d I wondered why she didn\u2019t use the phone in the room. I wondered why it took her so long to get back.<\/p>\n 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\u2019s happening in her abdomen. They sent her off to a room that, with the baby, I wouldn’t follow.<\/p>\n 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).<\/p>\n Laura would immediately need the blood transfusion because what the ultrasound and the CT scan showed was that Laura was bleeding internally.<\/p>\n Another science fact: an average person of about 160lbs has roughly\u00a05 liters of blood. \u00a0Laura, before pregnancy, weighed 100. She had lost a liter of blood.<\/p>\n Later we found out the name of what had happened if not the why. It is called a broad ligament hematoma<\/a>.<\/p>\n It\u2019s not a postpartum hemorrhage which is a frequent post-delivery complication (it\u2019s why doctors say \u201cif 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.<\/p>\n 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\u2019re 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 \u201cfallen down the stairs\u201d and then ruled out spousal abuse because there were no external marks), and a normal vaginal, yet rapid, labor.<\/p>\n 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<\/a> 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<\/a> 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.<\/p>\n Today, I find myself once again thanking God that nothing has, thus far, happened. I also thank him that it looks like although we\u2019re 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.<\/p>\n The blood transfusions helped a lot. \u00a0Facial color returned. She was lucid. She was energized. The CT scan brought clarity to the course of action\u2014they 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\u2019t find it to my liking).<\/p>\n 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\u2014sounds like a DC villain. The reason is that iron that bypasses the stomach is\u00a0more 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.<\/p>\nComplication-Free Delivery<\/h2>\n
Stress-Free 48 Hours<\/h2>\n
Something Other Than Contractions<\/h2>\n
Beyond the Pain Threshold<\/h2>\n
Diagnosing A Serious Problem<\/h2>\n
A Name and So Far<\/h2>\n