The Long Haul

Like any “birth plan”, all you can do is plan and pray it happens the way you’ve been dreaming of for the last nine months. For Mariah and Steven, this was no different. A spontaneous, non-medicated delivery at their small town hospital with a healthy baby boy has been their prayer since before conception. Mariah had always measured “ahead” in her pregnancy, and had consistent contractions since 34ish weeks. All the signs pointed to a spontaneous, early delivery. But as we know, plans don’t always work out the way we hope.

It’s important to note that Mariah has trypanophobia, an intense fear of needles in medical settings.

This story contains needles, blood, and intense medical situations.

february 19th

Fast forward to 39+6 at her Dr. apt, Mariah discovered her Dr. was going on vacation for 10 days. Her options were to have an induction now, hope baby stays put for 11 days, or risk having to deliver with the Dr. they were not comfortable with, due to prior circumstances. Already having high anxiety surrounding labor and birth, they went home for dinner, grabbed their bags, and headed to the hospital an hour later for their induction. 6:00pm on February 19th, 2.5cm dilated, with four rounds of Cytotec to follow. Due to extremely tricky veins, it took three hours to get the first IV in place. For someone with a fear of needles, this isn’t ideal! A long night of little rest, talking through hypothetical situations, and high anxiety when we discovered her original IV was not done correctly, and she needed a new one.

february 20th

Around midnight, it was time for the new IV. Three and a half hours later, two nurses later, and multiple attempts a new IV was finally in. It took all staff, husband, and doula to hold Mariah still so the nurse could miracousley stick the vein. Contracting on her own was a good sign, but a 7:30am cervical check showed she was only at 3cm dilation. Continuing with Cytotec, walking the hallways, visiting with her parents, Mariah was given the option to leave the hospital as she had made little to no progress. Feeling defeated, the nurses stepped out so Bailey, Steven, and Mariah could all talk through their options. Lots of emotions, exhaustion, and ultimately they were just ready hold their baby boy. Everything had already not gone “according to plan”, and that’s frustrating for anyone. They opted to stay, and they artificially broke her water at 7:23pm. Mariah was still contracting on her own, which was nice to not have to be on Pitocin, until 9:30pm.

Around 10:00pm the contractions were suddenly very strong, and getting very uncomfortable. Steven and Bailey were alternating doing counter pressure, holding the barf bag, and speaking encouragement into what was starting to be a really intense situation. We could tell she was progressing quicker and was going into transition, which was confirmed by a cervical check at 11:06pm showing a strong 6cm. Her only comfort was laying on her side, with counter pressure on her tailbone and hip. Mariah asked for an epidural, with extreme hesitation due to her existing fears and recent IV incidents. She wanted the pain relief, but her anxiety was nearly clouding her ability to focus on labor and birth. The anesthesiologist was called, and Mariah was given some anxiety medication to calm her nerves.

february 21st

12:54am, Mariah was sitting up, her back was prepped, numbed, and the anesthesiologist was waiting for her que to proceed with the epidural. Nearly twenty minutes of talking to Mariah, holding her hands, and helping her remain very still during contractions was nearly impossible. She hesitantly gave a quick go ahead, and when the anesthesiologist began to poke, she jumped and he poked slightly to the left of where he needed to be, but decided to let her lay back down to see if it would still work, which it did not.

Contractions were continuing to grow stronger, and any anxiety meds she originally had were long gone. Sitting her very still, he quickly got an epidural in place. He quickly taped her back so she could lay down, she could hardly talk her contractions were so strong. The only way she was comfortable was laying completely flat. Obviously after an epidural, that’s not ideal as the numbing medication can actually travel upward instead! Continuing to vomit, and the labor shakes were strong./, nurses realized the epidural was not working as she could fully move her legs and had no numbness. By the time the anesthesiologist was back in, gave her a bolus of meds in her epidural, she was 10cm and needing to push. At this point Mariah is exhausted, and frustrated she had not gotten the relief she needed, after all the trouble of getting the epidural in the first place. With an epidural, you also need a catheter to empty your bladder. Mariah has a latex allergy, and there was NO latex free catheter in the entire hospital. They later found one buried in a surgical room.

One “practice push” showed us that she needed rest in order to push to her full ability. She rested flat , with a peanut ball between her legs, until 2:00am. That’s when the nurses realized her entire upper body and arms were numb, due to her position after the epidural. They quickly sat her up to try and let gravity pull that medicine down.

2:08am, Mariah started pushing. The labor shakes were strong and distracting, on top of vomiting and dozing off between pushes. Each push really brought baby boy down in perfect position though! By 3:40, both the Dr. and Bailey were able to see his hair, and that gave her the extra energy she needed. Surprisingly, the Dr. brought up an episiotomy and a vacuum to help baby out, which were immediately declined as there was clearly no need for it.

At 3:51am, baby was born with the cord around his neck twice and his body once, perfectly healthy and happy. Dad was able to cut the cord, Mariah had skin to skin, and there were a few quiet minutes of bliss. The last few moments of pain free bliss for the next 10 days.

The Placenta

Mariah had requested that the Dr. be a little more patient with the delivery of the placenta. The Dr. seemed very eager to wrap things up and leave, and Mariah verbalized that she did her research and knew she had time to deliver the placenta. Moments later she started bleeding heavily, more than normal post-birth bleeding. The baby was passed to dad for skin to skin, and Mariah began shaking and feeling the flush of post-birth hormones. The Dr. was preforming a bimanual massage to release the placenta and pulling (her hand was shaking she was pulling so hard) on her cord, and blood was heavily pouring all over, Mariah was hemorrhaging. A shot of Tranexamic Acid was administered into her leg to help control the bleeding, and a dose of fentanyl was administered to help ease nerves. When the placenta was finally delivered, it was discovered that it had an accessory succenturiate lobe with a three vessel cord. This was never seen during ultrasounds, and Mariah was considered lucky to have a full term, fully grown baby due to the several risks associated with this condition.

Mariah & Baby Boy

Mariah only had a few small stitches due to a minor laceration, but was told did not tear. The blood loss was so significant, it was difficult for her to focus on her baby so dad continued to hold and feed him. The anesthesiologist noted that the epidural was not to be removed for another 24 hours, in hopes that the small extra poke in her spine would refill with spinal fluid prior to removing the epidural. After 24 hours, the epidural was removed and the anesthesiologist determined no blood patch was needed, and would self heal within five days. Mariah was sent home with oxycodone, muscle relaxers, Advil, Tylenol, excederine, and told 5 days bed rest. They were making her drink several Monster energy drinks a DAY, saying it will help reproduce her spinal fluid.

Mom, dad, and baby went home on the 23rd of February all happy, healthy, and ready to be home after 5 long days. Alternating between all the meds and still needed a rice sock on her head in order to sit up she was in so much pain.

february 25th

Around 2am, Mariah got up in the middle of the night to use the restroom. On top of the already raging spinal headache, her vision was “melting” and blurry and she was very dizzy. The only way she could tolerate moving was with her head between her knees. Grandma came over to watch baby and Steven rushed her back to the hospital she delivered at. She was going in and out of consciousness the entire car ride while vomiting. When they arrived at the hospital, the doors were locked. Steven was banging on the door yelling for anyone to come help them. He ended up having to bang on the security camera to get someones attention. When they got in, they got her a wheelchair and wheeled her up to labor and delivery, she was bent over with her head between her knees. She was screaming for some help. Mariah recalls “the pain was ten times worse than any labor pain I felt”. Anesthesiologist was called immediately and fluids were instructed to be administered asap, which meant an IV. Three hours later, lidocane in three different spots, and 1an ultrasound to find a decent vain, they finally landed a vein in her left wrist. Steven nearly fainted seeing her in this much pain.

The anesthesiologist determined a blood patch was needed for the small spot he mistakenly poked during the first epidural attempt. A blood patch is done with an epidural, and blood is taken out of the IV port and administered directly into the epidural to patch the hole. The problem: a blood patch is only successful with a 20 or 18 gauge needle. The IV was only successful with a 22 gauge on Mariah. So in the process of taking blood from her wrist IV and going to her back, the blood was already clotting up and would not flow through the epidural. The blood patch failed. The anesthesiologist administered pain meds to help rejuvenate spinal fluid, and she was instructed to lay flat for two hours to see if the meds worked. During the two hours, baby was brought in for a checkup, and passed with flying colors! Mariah sat up and was flooded with pain, the meds did not work.

february 26th

Still in the hospital, he Dr. ordered 4 MRI’s - spine, hips, neck, and head. The MRI was to pinpoint where the exact hole is to ensure they are doing the epidural in the correct spot. Newbane and Valium was administered to aid with anxiety and high postpartum emotions, all while waiting all day for MRI results. The anesthesiologist read the MRI report, and opted to attempt another blood patch.

february 27th

Meanwhile, her IV had collapsed and needed a new one.

To no surprise, nobody could get an IV on her. They ended up calling in a specialist from Omaha to administer a pic line in her right arm. Again, for somebody with an intense fear of needles none of this is ideal. The specialist looked at the MRI report, and agreed for the 2nd blood patch, just slightly higher than the first one. Due to the overall anxiety and exhaustion surrounding the situation, a small dose of general anestetic was administered for this blood patch. Once that epidural was in, he told Mariah she could feel some pressure in her head when the blood patch was done however she felt pressure in her hips. After the procedure, she again was instructed to lay flat for two hours to determine if it was successful or not.

Two hours later, she sat up and with tears in her eyes looked at Steven and said it didn’t work. At the time it was late enough everybody just wanted to sleep.

february 28th

Mariah’s parents were with them in the hospital every day helping with baby.

It was determined she needed to be transfered to the nearest larger hospital as this was out of their scope of practice. Mariah. Emotions were high knowing they were back to square one when they got to the new hospital. A nurse rode in the ambulance with her and she was given Newbane for nerves on the ride over. Baby, Steven, and Mariah’s parents drove separate and were going to meet them at the hospital. Mariah arrived in her room quite a while before everyone else got there, and she met her new Dr. Aside from horrible bedside manner (especially for a girl in her situation), he was hyper focused on if they had opted for genetic testing during pregnancy, specifically for cystic fibrosis (unsure of the relevance), and was put down for not doing it. He was also constantly asking if she was safe with her husband, and if she was abused (we wonder if that was because of all of the bruises on her arm from the IV’s?). She was also given a suicide screening. The new anesthesiologist told them he would go in “blind” and attempt a blood patch. She was not given anything for the pain, she was screaming and shaking she was in so much pain. Not even a tylenol.

Steven and Mariah requested that they not opperate “blind” and they really wanted this done correctly. They were told they had to transfer to a different hospital if they wanted a guided blood patch. While they waited for transfer paperwork, Mariah slept upside down feet over her head just so she could manage her headache. She was given a shot of morphine for the ambulance ride to the next hospital.

february 29th

The next epidural was scheduled for 7:30am. . 7:30 came, and left. Mariah had not ate or drank anything since before midnight, and was very thirsty. At 10am, a nurse brought in a single sponge of water for her dry mouth. Finally at 11:45, they took her for her epidural and she asked for general anesthetic in the OR. Dr. looked over the MRI report, and prepped for the procedure. The anesthesiologist assured her they gave her some, however she was still fully alert and knew it was either not working, or not administered. The Dr. injected a lidocane injection for numbness, then an epidural for a blood patch. The Dr. assured her that this one was successful, and within two hours she would feel no pain. Two hours later Mariah woke up to use the restroom, and could sit up and finally had less pain for about 6 hours but mariah thinks it was due to morphene still being in effect. Then as it slowly started to wear off and she would begin to feel more pain.

March 1st

Once again, Mariah was cut off at midnight from all food and water, and her new nurse was incredibly unhelpful. All day Steven had to keep finding her for help, he was keeping track of when she had meds, and asking for the nurse to bring them. At one point, the nurse dropped one of her meds on the floor, picked it up to hand it to her, then asked her if she would like a new one or the one from the floor. 2PM, a glue patch was scheduled. The Dr. was very clear that if this glue patch failed, a neurosurgeon would come in and have to preform a spinal surgery, which had a four month recovery period. Mariah asked again for some general anesthetic, when one dose was administered she asked for another as it was not working. Steven joined Mariah and went to the OR to talk with the Doctor and finally, Lidocaine was administered twice in the upper and middle back used to numb the spine, except this time she felt the pain between her shoulder blades, not the middle of her back.

6 hours later, Mariah woke up, completely pain free.

The Dr. came in and explained that every other Dr. previously had not looked directly at the MRI, they were only reading the MRI report directly. Right before the procedure he decided to look at the original MRI, and noticed the hole was in the C region (upper back) of her spine, not the L (Lower Back) region that everyone else was operating on. They believe because she was so numb from her first epidural, when she was pushing she really could only move her neck to push. They think this punctured a small hole in her spine.

Immediatley after the opperation, the Dr. had called Steven to tell him that he had actually found the right spot on the MRI and said that the other doctor(s) probably didn’t look at the MRI report because its “just a lot of work” .

Mariah, Steven, and baby were finally able to go home on March 3rd, for the first time as a healthy happy family.

6 epidurals

4 blood patches

1 glue patch

1 pic line

25 failed IV attempts.

Worth it!

Baby was born to the song “The Long Haul”. How fitting for this entire experience. Everyone is healthy, and thriving as a beautiful new family!