Preeclampsia

April 26, 2013 3:00 PM

Most of the time my posts are about food, fun, and family. Today…let’s talk about something different. Let’s talk about family and preeclampsia.

If you are not familiar with it, preeclampsia is a serious condition which can happen to pregnant women and involves the following:

• High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or greater — documented on two occasions, at least six hours but no more than seven days apart
• Excess protein in your urine (proteinuria)
• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
• Upper abdominal pain, usually under your ribs on the right side
• Nausea or vomiting
• Dizziness
• Decreased urine output
• Sudden weight gain, typically more than 2 pounds (0.9 kilogram) a week

I’m bringing up preeclampsia because it has suddenly and unexpectedly become a very real part of my daughter’s, Tricia, life. Tricia is 32 weeks pregnant–full term is 40 weeks. Technically, the baby is not due for another 8 weeks. However,  it is highly probable that he will come much earlier. In fact, sometime between now and the next two weeks because the doctors will induce labor. We’re just hoping that Tricia’s condition will stabilize and that the baby will have more time to grow and develop in utero. 

*********************

April 23, 2013 10:00 AM

Tricia calls me from her OBGYN’s office where she has gone for her monthly check up. There have been some unexpected complications in her pregnancy and she is being taken up to one of the local hospitals–a hospital that is equipped to care for women with preeclampsia and infants who are born before 35 weeks gestation.

Tricia asks me if I would be willing to pick up Gavin (6) from school and Kade (3) from Tim’s work. She had thought that she would only be at the doctor’s office for about an hour, so Tim had taken Kade to work with him.

I collect the boys and bring them back to my house. Later in the day, Tricia calls to tell me that she is to be on strict bed rest and that she most likely will deliver the baby before 35 weeks. She is 32 weeks at this time; 8 weeks out from her due date.

Mentally I do a quick review of my work schedule, and then I start to panic. How am I going to be able to help my daughter AND go to work?

April 23, 2013 11:00 PM

It has become obvious to me that I need to ask for time off from work. I’m worried. I calculate that I am going to need to take off for about a month. Tricky, at best.

Come what may, my daughter and her family require my help. What good is it being a nurse if I can’t put those skills to use in behalf of my own family? Additionally, I am a wife and mother first and a nurse second. That’s just the way I roll.

April 25, 2013 5:30 PM

My boss agrees to let me have a month off to take care of my personal needs. I am so grateful. Thank you, Marianne.

April 26, 2013 8:00 AM

Tricia calls me at home and asks me to meet her at her OBGYN’s office at 9:00 AM. I’ve been asleep for about 4 hours after coming off of a challenging shift at work. I’m a little bleary-eyed and tired, but I know that my daughter needs me, so I rally myself, roll out of bed, and throw on some clothes. I am suspecting that it might be a long day, so I grab a few things to keep me entertained–my laptop and my camera.

April 26, 2013 9:00 AM

I meet Tricia at her doctor’s office. She looks tired, but is positive. The doctor comes into the room and a few moments later I find myself driving Tricia up to one of the local hospitals. Tim, Tricia’s husband, has a critical business meeting in Park City and will catch up with us at the hospital in a couple of hours.

April 26, 2013 10:00 AM

We get Tricia checked in at the hospital. The doctor has called ahead, so everything is ready and waiting for us when we arrive–including the room where Tricia will rest while she is undergoing various tests and is being monitored. Things move very quickly and within a few minutes Tricia finds herself in bed wearing a hospital gown and sporting a newly placed IV.

I don’t say anything, but in my heart of hearts I know that Tricia will not be coming home tonight.

Monitors are attached to Tricia’s abdomen. One of the monitors tracks the baby’s heart rate, another of them tracks any contractions which Tricia might have.

Blood work is drawn and Tricia and I settle down to wait for the results. Tricia has been working on a crocheted blanket for the baby. She had the forethought to bring the blanket so that she could work on it while we waited.

The baby is doing fine; he has been a wiggling wild man throughout the day. Tricia, on the other hand, is not having a particularly good day. She has all of the afore listed symptoms of preeclampsia excluding the upper abdominal pain.

In addition to the above symptoms, her lab work is not looking good. Her liver enzymes are rising, her platelets are falling, there are large amounts of protein in her urine, and her urine output is decreasing. In short, Tricia has severe preeclampsia. And the baby? His growth has fallen two weeks behind where he ought to be at this time.

She is being admitted; length of stay is indefinite.

Oh, and one more thing. I forgot to mention that today is Tricia’s birthday. Happy 28th, sweetie.

April 26, 2013 8:00 PM

John and Katie brought the boys up to see Tricia. We celebrated her birthday in her hospital room. Tim brought a little cake from our family’s favorite bakery. It was decorated with the bakeries signature spring flowers made out of frosting.

Gavin (age 6) gave Tricia a sparkly ring for her birthday. He says that since his mom loves sparkly things, he wanted her to have a new ring to wear. He gave her a ring last year, too. Both rings are large, inexpensive pieces of costume jewelry and they are absolute treasures. Gavin is such a thoughtful, kind little boy. He told Tricia that the rings had stretchy bands so that they would fit her fingers no matter how swollen her fingers became.

April 26, 2013 10:40 PM

Tricia’s symptoms have gotten worse. She is being moved to another room. It is the room where she will be given pitocin to induce labor, the room where her baby, Ander, will be delivered and quickly passed through a window into the NICU (neonatal intensive care unit).

Magnesium sulfate is being infused through Tricia’s IV to prevent seizures. The possibilities of seizures or stroke are high with preeclampsia.

Over the past few hours I have watched Tricia’s edema increase throughout her body. Her feet, legs, hands, and face are getting very puffy. Sometimes I feel like I want to cry because of what she is going through. It is difficult for a mother to watch her child suffer, particularly difficult when I, as a nurse, know the physiology behind the suffering. Somehow, though, I know that God will take care of everything.

This was about 1 hour after we first arrived at the hospital on 4/26/13

As you can see, the edema in Tricia’s face has increased significantly after 12 hours.

Her feet and legs look as if someone has blown them up like balloons.

April 27, 2013 12:10 AM

The nurse has just started the pitocin infusion. It will begin Tricia’s labor. The doctor says that the baby will most likely be born in 6-8 hours.

Tim and I were given a tour of the NICU. I saw a set of twins, 32 weeks, who were born about 4 hours ago. They are beautiful and not as small as I had thought they would be. It gives me increased hope for little Ander’s well being.

April 27, 2013 2:59 AM

An alarm has gone off in another room. There are a lot of hurried noises in the hallway.

I can hear the doctor saying that one of the other patients has been given terbutaline and that if things don’t improve in 20 minutes, everyone should be “ready to roll”. Terbutaline is used to stop pre-term labor. It makes me sad to think that someone is suffering the trauma of delivering a baby far too early. Tricia’s situation is critical, but at least there is hope for a positive outcome.

April 27, 2013 3:11 AM

Things in Tricia’s room are quiet. Both she and Tim (Tricia’s husband) are asleep. Tricia’s epidural is in place, so she is not feeling pain from any contractions that she may have. However, she has developed a severe headache. The nurse has given her tylenol 975mg followed about an hour later by compazine. They are not helping, but somehow Tricia is able to sleep. I suspect that her ability to sleep is a mixture of exhaustion and the compazine.

Her urine output has increased: a good sign.

April 27, 2013  3:20 AM

The nurse has just come back into the room. As it turns out, Tricia has not been asleep. Her head pain is too severe to sleep. She has just been lying in the bed quietly, trying to get through the pain. She looked over at me from her bed and I gave her a sympathetic smile. She was able to give me a painful little smile back. I’m sad that she is suffering.

April 27, 2013 3:29 AM

Tricia’s headache is continuing. The nurse has just given her some Fentanyl in her IV. She has also increased the pitocin infusion. I think that this is maybe the 5th or 6th increase since the Pitocin was started.

I just heard a newborn cry from another room. It sounded like a healthy cry.

April 27, 2013 3:40 AM

The fentanyl worked fast. Tricia’s headache is gone. Yay!

April 27, 2013 4:21 AM

Tricia and I have been having a quiet conversation while we wait for Ander. It’s like a sleepover…without any sleep and definitely no fun involved. The soft, steady sound of Ander’s heart is keeping us company through the monitor. Conversations in a darkened room in the wee hours of the morning are intimate. Things from the heart get said when there is only the sound of voices to give light to the darkness.

April 27, 2013 4:27 AM

Tricia’s headache has returned, just as bad as it was previously. The nurse is going to check to see if she can give Tricia some more medication for it.

April 27, 2013 7:28 AM

I slept for a couple of hours curled up in a chair, resting my head on a blanket on one arm of the chair and then sometime later on the other arm. Tricia hasn’t delivered yet. As a matter of fact, she hasn’t dilated past a 2. So, they broke her water a few minutes ago in an effort to get things moving. She’s being really great through all of this and is looking forward to welcoming little Ander into the world.

It is strange, but I sense a change in the whole event. Ander has been so active for the past 24 hours, but now he is quieter, as if he is conserving his energy for the coming birth. I am sending more prayers heavenward, needing Heavenly Father to step in and help us all through this. Yesterday I felt confident, but now I feel concern creeping in and wrapping itself around my positive thoughts.

April 27, 2013 9:03 AM

Still only dilated to a 2. Ander’s heart rate is in the safe zone.

Tricia’s headache and high blood pressure continues. She vomited her oral pain medication. I asked the nurse if it would be possible for Tricia to have some Zofran to help with the nausea. After I had done so, I realized that it might have been too intrusive of me. No nurse likes to have a patient’s family member who is also a nurse tell them what to do. When the nurse returned to the room with the zofran, I tried to smooth things over by thanking her for the great care that she and the other nurses had given Tricia. It seems to have been the right thing to do and any tension that may have existed has been cleared.

We have kept the room dark because the light hurts Tricia’s eyes and increases her headache. The only sound in the room is coming from the monitor where Ander’s heartbeat continues to let us know that he is okay. I doze off again.

April 27, 2013 10:30 AM

I awaken to Tricia’s urgent voice. “Tim! Call the nurse! The baby is coming. Hurry, he’s coming out! I can feel him coming out and I can’t stop him! Call the nurse, Tim, call the nurse!”

As I was trying to scramble over to Tricia, the nurse walks in. She checks Tricia and sure enough, the baby is ready for his grand entrance. The next few minutes are filled with the sounds of the nurses telling Tricia not to push and Tricia saying that she doesn’t think she is going to be able to not push.

I try to stay out of the way and choose to sit on the couch and watch intently.

April 27, 2013 10:37 AM

The doctor has been notified that delivery is imminent. While we wait, two other doctors enter the room on standby, ready to intervene if necessary. Both of them examine the baby to get a perspective on his presentation. We knew from the ultrasound from the previous day that the baby was head down in good position. However, the two doctors and two of the nurses who have examined Tricia are feeling what they think is an elbow wedged up by his head. Apparently Ander is posing for his glorious entrance.

Nurses from the NICU open the window into Tricia’s room through which the baby will be passed. They are gowned, gloved, and masked and one of them stands ready with a blanket resting across her open hands to receive Ander the moment after the cord is cut.

Tricia has a couple more strong contractions before her doctor arrives. She doesn’t push. Her epidural isn’t working anymore, so the moment is tense.

April 27, 2013 10:50 AM

The doctor finally arrives. She checks the baby, also, and agrees that Ander most likely has his elbow raised up by his ear.

We wait for Tricia’s next contraction. It doesn’t come. Doctors, nurses, Tim, Tricia, and I wait. Tricia is in that ever popular, undignified position a woman assumes preparatory for delivery.

We continue to wait; everyone is poised for action.

April 27, 2013 11:05

Ander is suddenly with us. His little body parts are all present and accounted for…they just didn’t enter the world quite the way everyone had thought they would. At some point Ander had flipped himself head up and came out feet, or rather, foot first followed by his little butt and his other foot. Luckily he was little so that being in a breech position was not a problem.

I was holding my breath, waiting for Ander to cry. I needed to hear him make a sound. He was so blue and still. There were conflicting images in my mind. Ander looked as though he was dead, yet I knew in my heart that he was supposed to live! Everyone in the room is completely still, watching. “DO SOMETHONG“, I screamed at them in my mind, but held my silence, taking my cue from those who were experienced in these events.

After a few eternally long seconds he let out a soft little cry, then was silent. “Make another cry,” I thought. “You need to make another one.” Centuries passed while I waited. Randomly I noticed that he looked like his older brother. Then he cried again and was immediately scooped up and handed off through the window to the waiting NICU nurse. The window was closed and the blinds were lowered.

The tears were streaming down my face as I stared at the window through which Ander had disappeared. I returned to my place on the couch and watched while the doctors and nurses attended to Tricia.

April 27, 2013 11:30 AM

The window opened again while the medical staff cleaned up Tricia and her room. The nurse who had taken Ander made the announcement. 3 pounds, 14 ounces. APGAR scores 7 & 8, and he was nice and pink. Everyone cheered. He was a good weight considering his early birth and his APGAR scores were good. And he was pink. I started crying again and saw no reason why I should stop. I was so grateful for a safe delivery. (See follow up post here. To see Tricia’s side of the story , read her posts here and here. To see Ander on his first birthday, read my post here.)

April 27, 2013 5:23 PM

I have seen Ander. He is beautiful, precious beyond belief. Just as Wordsworth said, “Trailing clouds of glory…”

Our birth is but a sleep and a forgetting:
The Soul that rises with us, our life’s Star,
Had had elsewhere its setting,
And cometh from afar:
Not in entire forgetfulness,
And not in utter nakedness,
But trailing clouds of glory do we come
From God, who is our home:
Heaven lies about us in our infancy!

~ William Wordsworth

A candid moment that I was able to photograph through a window in the door that lead into the NICU.

One last precious look from dad before putting Ander back in the isolette. There will be more looks like this as Ander stays in the NICU, learning life skills like breathing and how to eat.

You may also like: