(This is pretty long because hey, it’s my story and I want to remember it all, so it’ll be posted in 2 parts.)
I woke up on December 3rd and didn’t feel quite right. I was crampy, which wasn’t anything new, but it just felt different. I felt impressed to hurry and pack my labor bag as I got the Menininho ready for school. After I dropped him off I went to Starbucks, per my usual, and texted Mark to tell him that I was probably being silly, but I just felt funny and my cramps hadn’t gone away, so maybe he should tie up things at work just in case and I’d let him know if anything changed.
Immediately after school, M. and I headed to the hospital for my semi-weekly AST/NFI. We had lunch in the cafeteria and even though I wasn’t hungry, I felt like I should make sure to eat a large meal in case I didn’t eat again for awhile: soup, sandwich, cake, and pineapple.
First up was my AFI. Although my fluid levels had been good for the past week, today they had dropped down to a 6. 8-18 is normal, and 5 or below signals a problem and is a cause for induction at my hospital. I happened to have the “nervous nurse,” who calls the OBs for anything at all abnormal. “Oh, looks like I’ll be resting and drinking a lot more fluids this weekend,” I said to her. She wanted to know if I’d been more active than usual and except for a 10 minute (if that) walk every day (hey, my pain was so bad I was lucky to get that much, don’t judge!) I’d been pretty sedentary. “Well, we’ll see what your doctor has to say,” she said.
Next came the NST. I watched the baby’s heart rate decelerate to under 100 several times, enough that the nurse had to bring in the pulse ox machine again to confirm that yes, that was the baby’s heart rate and not mine. I texted Mark: “I’m pretty sure the nurse is going to call my OB, who is going to send me to L&D for observation. Get ready to come; I’ll text you when I know more.”
Sure enough, I was eventually sent to the hall with M. to wait for my OB. “Yah, yah,” I joked to the nurses. “We all know what’ll happen. Dr. Cautious will come, tell me things look bad, and then threaten to induce me and I’ll be back to getting daily NSTs for a couple of days to show him the baby is ok.” My doctor came quickly, waved hello as he ducked into the exam room, then returned to the hall a few minutes later. He confirmed that I should go to L&D for more observation, and was concerned enough about the baby’s decels that he asked me not to take the Menininho home first.
I called Mark and my doula, then headed upstairs to get hooked up to the monitors and figure out a plan of action. I decided that since M. had a speech therapy appt. and we couldn’t find the therapist’s number to cancel, Mark should take him home and then come back to get me. Naturally, my doctor came in to talk with me less than 2 minutes after Mark left. He brought with him 2 other doctors and a nurse. This still bothers me. I was in a very small room, in a vulnerable position, and there was no reason for him to overcrowd the room except to intimidate me. In all my trips to L&D he’d never brought in anyone else to meet with me. My doctor informed me that the baby had had a few more bad decels (which Mark and I had observed), but was currently looking good. However, his baseline heart rate had moved to a lower than normal range and given that, the sharp decrease in fluid to its lowest level yet, and the various signs of distress he’d shown off and on over the past few weeks, my OB felt that something was not right.
I was given 3 choices: induce now, have a c-section, or go home and return the next day (but this time no one was recommending the last option). Because I was a VBAC patient, induction would consist of low levels of pitocin to dilate me at least a half centimeter (2 weeks after my first exam there was no change: I was still not dilated at all and only 50% effaced), then turned off and a foley cath used to induce labor the rest of the way. I was skeptical of the pitocin because I knew it could increase my risk of uterine rupture, but I was told my levels would be so low (1 unit every 2 hours, maxing out at 10 units; normal is 2 units every 15 minutes, up to 30 or 40 units) that my risk should not be dramatically increased. The process was expected to take about 2 days.
I asked for time to think and for Mark to get back before making a final decision, knowing this gave me about 2 hours. After calling Mark and asking him to hurry, I called my doula, who offered to come keep me company, and my cardiologist. I did not trust my OB or anyone on the obstetric staff, but I knew my cardiologist would never intentionally lead my astray. He is one of those doctors who really listens to what is going on and then always takes the time to explain his thought process and make sure patients are truly informed.
My cardiologist came straight over, sat on my bed, and discussed my options with me. I cried telling him about how I feared another c-section and my worry about dissecting and being left alone with no one believing me. He promised to be there and to control my blood pressure better than my doctors did with M. After our discussion he said if it were him, he wouldn’t go home but would choose the induction. He felt like going home would probably be ok but that given the baby’s history the risk was still significant enough he worried about the baby’s well-being overnight. “I’m not trying to scare you,” he said, “but if you go home and something happens to your baby you’ll never forgive yourself.” (And I knew he wasn’t trying to use this as a scare tactic, just being honest.) After being present for many other Marfan deliveries, my cardiologist felt the induction would go very quickly, thus meaning a c-section was not a real concern.
I felt a little more at peace after he left, and spent the rest of my time researching my options and praying. I waited till Mark and our doula arrived before coming to a final decision, but I knew that an induction was what needed to happen. With the feelings I’d been having all day, it seemed like this is what was meant to happen.
By this time it was 7:00 and I was starving. My amazing doula convinced my nurse to hold off on the pitocin until I’d had dinner. Unfortunately, my hospital’s cafeteria shuts down at 6, so dinner had to come from the Starbucks cart in the lobby: 2 massive blueberry muffins, an apple, and a hospital issue turkey & lettuce sandwich on wheat. By 9 PM the pitocin drip had started and it was show time.