My Uterine Rupture and Placental Abruption (Part 1)

18 Apr

**Disclaimer: I report what I remember as I remember it. I was, however, in lots of pain and heavily drugged.**

Birth is such an interesting phenomenon. People seem to universally agree. And just when we want to think of the phenomenon in the traditional sense, it’s hard to downplay the marvels of medicine—we must admit that surgeries, too, not just vaginal deliveries, qualify as phenomenal in the end. Just ask a woman from the 18th century. Or me, who has now had 50% childbirth, 50% emergency C-sections.

All my births wrapped into one make up my personal “phenomenon.” They weave together in sometimes pleasant, sometimes painful ways. They never start and end the same.

And this, my latest and last pregnancy—the one where my uterus ruptures along a scar and we almost die—actually begins with my first.

In the late hot summer of 2011, when a tropical storm was brewing, my water began to break, slowly but surely and for no reason, at just 34 weeks. There were no choices, no options. Jane Darby had to exit. We induced, the only time I’ve ever been induced, because avoiding a C-section was the safer scenario for her and for me. But only a few hours in, her tiny, immature body didn’t tolerate labor well at all, and she began to crash.

Again, no pros and cons to weigh. No preferences. She had to be born. She was delivered, and quickly, in an operating room at the time not usually used for C-sections. My doctor said she just sliced—and later in NICU, though Jane Darby never had to be resuscitated, she was often referred to as “a 34-week save.”

Jane Darby, just born and in the NICU September 2011.

When I review it all, I see her life isn’t saved if there is no scar. (And a good friend noticed how this points us to Jesus—his brokenness brings us life.)

People like to shame C-sections, but the section was the game changer. It was the only way. It was phenomenal. What else could I call it?

I guess I could go back and wish away that experience in light of what happens seven-and-a-half years later. Wish that my water had never broken early, that I’d never had a stat surgery, that I never had a wound. But I’d be digging up something I’ve long since buried. I’ve already picked it apart, top to bottom, over years and years. I’m not doing it again. Plus, I learned so much from Jane Darby’s birth, and at this point would never trade it.

I suppose good scars can also be bad scars, both blessings and curses. What a profound dilemma I face: the scar on my belly preserved the life of one child, and almost took the life of another.

When my second pregnancy rolled around, and then the third, redemption was the theme. I went into labor on my own with both, at 38 weeks, avoiding a scheduled repeat surgery with Rose. I had been an excellent candidate for a vaginal birth after Caesarean, because Jane Darby was never in my birth canal. And the VBACs fell in my lap. Spontaneously. I did it. Twice, one with no epidural.

I loved giving birth, the amazement and emotional high. Of it being over but sad it had ended. Of having wanted to do it again. The skin to skin, just-born photos, baby by the bedside. I appreciated it so much since it hadn’t gone that way with my first. Birth had become a redeemed, rewritten story that I absolutely treasured. I am forever grateful, but will forever grieve never getting to do it again.

The truth is, though, both my VBAC births were hard, painful and tricky. Rose’s was so long, and I had been very aware of the risks for rupture. I had been scared.

My first successful VBAC, with Rose in February 2014.

Then it dawned on me only after Ben was born that Sally, too, had a heart rate drop near the end. I was given oxygen. Her labor was fast, painful. My doctor said it wasn’t normal.

Sally was vacuumed out, born limp and had to be reviewed by NICU staff in our room. Also, I felt something rip in her labor, right toward birth, and I hollered. There was a blood clot on the placenta; it had begun to tear away. I never thought those things significant before. Now, I think they may be extremely telling.

Maybe my scar was pulling then, maybe it tore a tad. Maybe it healed on its own, creating more scar tissue. Maybe it flew under the radar. I mentioned all this to my doctor recently and she seemed to entertain the idea.

So while my birth history is exciting in some fun ways, this is also true: three of four babies had heart rate drops during labor. Three of four babies were reviewed by NICU staff at birth. Three of four labors presented with placenta problems. Three of four labors had something off, something wrong. And I now know both VBACS must have stressed my uterus and scar. I had naively thought a scar would strengthen over time; in my mind, I had overcome the wound.

By the time Ben was in my belly, I truly think I had forgotten that births go bad. I had forced myself to forget, but in fact, I still knew better than anyone. I would soon remember, and even outdo, the drama and trauma from long ago.

In the height of August 2018, we found out we were pregnant with our fourth child. Baby 4 of 4 is what we said from the start. Learning we would have four children was absolutely daunting. But a fourth birth wasn’t worrisome to me. I was excited. I planned to go out on a high note, have my third vaginal birth and second drug-free delivery.

Like in my previous pregnancies, this one was pretty uneventful in trimesters one and two. The chief difference was gender: I was carrying my first boy, our Baby Ben, after having had three girls. Also, my placenta was in the front, something I’d never experienced. It seemed to me a non-issue, except for less consistent fetal movement early on. We wondered: What will be different about a boy pregnancy? Will he be bigger? Will he be later? And will he be stubborn during labor?

When March rolled around, things began to change. I don’t know if the events leading up to Ben’s birth were pure coincidence, or if they were foretelling, foreboding even. Either way, they’re of high interest to me.

In my third pregnancy, with Sally, I made two trips to Labor and Delivery for consistent, preterm contractions I couldn’t control. They weren’t dilating my cervix, but I was given rounds of Brethine each time to stop them, and later went on to have my second VBAC and a term baby.

Sally born in August 2016, my second successful VBAC.

These episodes didn’t plague my first two pregnancies, but with Ben I for some reason expected them to happen as they did with Sally. I basically waited for them, and one day, they showed up.

It was March 5, and my day hadn’t been different than any others. I was always a little uncomfortable, always a little more aware of my growing baby, but I assumed it was a fourth baby/boy baby thing. Later that afternoon, though, I had consistent tightening in my belly that I couldn’t control with hydration and rest, something I had learned to do (and had been successful a few times.) After about three hours, I was advised to come to the hospital to get checked out. So I did, and I even left Drew at home with the girls. This was par for the course, and I wasn’t in labor, I knew that. I was a little annoyed, honestly. Here we go again, I thought.

The result was the same as with Sally. These were contractions that registered on the monitor, 2-3 minutes apart, but they weren’t changing my cervix, a.k.a. “not real labor,” so they gave me a shot to relax my uterus, and the contractions went away. Baby passed the non-stress test with flying colors, and the doctor on call told me to follow up with my OB.

Little did I know I would see that doctor again, 23 days later, in quite the chaotic scenario the night Ben was born. He would be the doctor to call the code, order the section and start the cycle of ultimately saving Ben’s life, and mine too they tell me.

I won’t agree to call the episodes I had Braxton Hicks contractions, because those contractions supposedly aren’t consistent and don’t get stronger over time. My episodes always consisted of highly regular contractions that got a little more significant over time, but never ever strong. And I know strong. I’ve done this sans drugs, after all. Plus, another very painful birth with an epidural.

Throughout the month of March, and possibly even beginning in January, I was just plain uncomfortable. I later, with the help of my sister, self-diagnosed my condition as “uterine irritability.” And it was often random. One day I could be active and feel fine, the next day I could do nothing and have considerable discomfort.

Walking was always a little hard, and I had to go to the bathroom literally every 20 minutes throughout the day if I didn’t want to hurt. I was trying to stay hydrated so I wouldn’t contract, and yet I was trying to empty my bladder often so I wouldn’t contract. I chalked it up to being older, and having a fourth baby who was a boy in my belly. And just plain being pregnant. That’s probably an accurate assessment, but I realize now I was in mild pain for just about the entire third trimester. For me and my pregnancies, this was new.

Rose cuddling my belly, six days before Ben was born.

Around the second week of March, I contacted my doctor office asking if I could be seen later in the week; I hadn’t felt the need to be seen right away, and I had things on my calendar, so I gave it a few days. Still, I thought I needed to be checked out soon, and reported feeling tight, tender and uncomfortable. I honestly thought my baby was dropping and that I was probably progressing. The office promptly scheduled me for the day and time I requested.

But before I made it to that appointment, on March 14 I was back to Labor and Delivery. This time, I was a little puzzled. Things were a little different, a little new. I had gone for a light stroll earlier that day, something actually recommended in pregnancy to strengthen uterine muscles and for general well-being. I’d done it a thousand times with no problem. When I made it home, though, I couldn’t seem to even walk up my stairs to put my two littles down for their naps. At the time I thought I must have walked my baby down, and that he was just sitting very low, possibly on a nerve. Maybe this is accurate, maybe not. I’ll never know.

I haven’t done this before, but I sent my kids up the stairs without me and told them to lie down and fall asleep. They actually did it! Next, I put my feet up and drank two huge glasses of water. Yes, I was having the regular tightening again, but also my belly was in what I would describe as a very crampy and tender state. I basically drank water and sat with my feet up for the rest of the afternoon and evening, hoping to avoid going to the hospital again. This may have been a mistake, a misjudgment on my part. But you can only be in false labor so many times before feeling a little like a crazy person. (By the way, no one at my hospital ever made me feel crazy. That was me, doing that to myself. If anything, they wanted me to continue getting evaluated.)

Eventually we went to sleep, but I didn’t sleep. Around midnight, I reluctantly woke Drew up, disappointed and frustrated, that I was having false labor yet again and couldn’t make it quit. We agreed to go to the hospital. I had trouble climbing into our van, and the ride over to the hospital was uncomfortable. Side note: I didn’t like riding in cars this pregnancy. It just wasn’t comfortable. Perhaps that’s normal, perhaps not. I didn’t pick up on that fact until later.

A 16-week ultrasound in November 2018, the day we found out Ben was a boy.

In triage, again, my cervix wasn’t dilating. I was not in labor. And the baby was high. I couldn’t believe it. This discomfort and still no cervical change? Baby is high? At this point I was 34 weeks. I was in some mild pain, and I reported extreme tenderness in my abdomen. I was having regular contractions on the monitor, some I wasn’t even noticing because of the tightness, but baby, again, checked out with flying colors on screen.

At one point, I sheepishly requested an ultrasound. But the doctor on call, different guy this visit, was confident baby was okay, and at the time he was completely correct. We did not do an ultrasound.

Also, I’ve been assured numerous times that what happened to me, to my uterus and to my baby is almost undetectable. An ultrasound at that point may not have revealed anything of note. With uterine rupture, you can’t and won’t know anything is wrong until everything is terribly wrong.

Still, this doctor did ask about my previous C-section site. Was I having pain and tenderness there? For weeks I actually resented him for bringing that up. He’d given me even more to worry over and think about. I’d had two successful VBACs, didn’t he know? So I told him no, I didn’t think the pain was at the scar site, and that I had actually even forgotten that I had a scar.

He was on to something, but neither of us knew.

I was given Brethine again, and this time I was amazed. I’d had no clue just how tight my belly had been until it was suddenly relaxed. I couldn’t believe I’d let it go on for so long. A seed of guilt was planted, and it would grow and grow over the weeks to come. Still, I wasn’t in labor, and baby was great on the monitors. I wrote it off as another mean episode of false, pointless false labor.

Then the doctor explained that, even though these weren’t labor contractions, he didn’t like seeing mamas get in and stay in such a tender state, especially with a former surgery.

This is where false labor angers me. It’s false, but it can and does stress the uterus. And several times I actually had to have false labor medically stopped. “False” is never a word medical professionals used with me, by the way, but the whole scenario was confusing for this pregnant person. I found myself at an impasse several times, and I have read that mamas in subsequent pregnancies may let “problems” go on a little longer because of past experience. I think I’m in that boat. There’s the guilt again. It discourages me to know what happens next. I truly believe this episode connects in some key way to my eventual rupture.

Whether it was a contribution, or a sign, this ER trip will plague me forever.

As for the nurse who took care of me during this visit, I’d see her again, 14 days later. She’d be the one to watch the monitors, note my condition and be with me when my uterus split. She’d wheel me into the OR and help prep me for an emergency, life-saving surgery. I’ve often wondered if she thinks of my two visits with her and draws any correlations.

The morning after that second visit to the hospital, I went to my previously scheduled doctor appointment, the one I’d made over concerns of pain and tenderness. I had a few small contractions and discomfort while there, so we did even more tests. But at this visit Ben passed what would be his fourth non-stress test in my pregnancy, again, with flying colors. We had done our due diligence, covered our bases, I thought, in making sure he was good. And I think he was good until the very moment when he wasn’t.

Over the next few days, I had to recover from that experience on March 14. I didn’t walk, and I took it easy, because I still hurt a bit. It did go away eventually, and I had no more tightening or tenderness until two weeks to the day later, the day Ben was born.

Read Part 2

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