CAM Birth Story: Katharine's necessary cesarean

This birth story, in honor of Cesarean Awareness Month (CAM), comes from Katharine Evaul. Katharine says, “I was suggested to send this to you because while many c-sections are unneeded, sometimes they are. At the same time complications because it is major surgery arise.” To have your birth story posted on this blog, email it to:

I was hospitalized for pre-eclampsia and developing HELLP syndrome on the 3rd of August 2009. The only reason I did not have Liam taken out on the 3rd off August was because of just HOW early he was – by my last period he was 28 wk and 6 days but as I knew when I ovulated I knew I was only 28 weeks and 2 days pregnant. Regardless we expected an October baby – NOT an August baby. My stay at the first hospital was fine – lots of regular BP checks and non-stress tests for Liam which he passed with flying colors. They also injected me on Monday and Tuesday with betamethasone which is a steroid that can increase lung development in premature babies. Unfortunately I was not outputting what I was inputting and very swollen. The doctors were not particularly optimistic about my medical condition. Friday – 8/7 – my OB came to me and said that while she hoped I would stay more or less how I had been the previous few days (stable, not great), she also knew that this hospital did NOT have room in their NICU for another baby. At that time hospital #1 had 53 NICU babies – and only 48 beds. She wanted me to ok a transfer to a different hospital – just in case. Unfortunately right about the time she arrived (about 3pm) I was already feeling worse. I called Mark regarding the hospital transfer and he came over. Throughout the evening I continued to get sicker – vomiting and other symptoms – so the OB resident expedited my transfer to hospital #2 an hour away as it was the only nearest hospital with NICU beds. Another hospital would have been closer for us – but like hospital #1 they too were overflowing. I was transported by ambulance at about 11pm finally. I was checked into Labor and Delivery – the nurse is asking all of these questions regarding my birth plan and if I wanted a natural childbirth and so on. I finally said to her that if this baby is coming out – it’s by a section as the one thing I did know was that an induction would fail. Unfortunately an induction was so far out of the cards by morning.

During the night they continued to do lab work and my platelets kept falling (one of the main symptoms of HELLP). At 8am the doctors came and said that they needed to take Liam out NOW. During the following hour Mark called family while I had to sign papers and then I was off to an crash emergency c-section. They had to do general anesthesia so Mark wasn’t allowed into the room. Liam came out at 9:31am. He was exactly 29 weeks gestation, 2 pounds 10oz and 15 inches long.

Liam was taken to the NICU – but fortunately Mark got to see him – even trim his umbilical cord but Liam was off. On that Saturday they did intubate him for a brief period to give him surfactant and then they placed him on a C-PAP machine. Sometime between Saturday and Sunday they put him on room air – but the CPAP helped it into his lungs.

As for myself – I was placed on magnesium sulfate to treat the pre-eclampsia and prevent seizures. It’s a horrible drug – it makes you feel absolutely awful. Most of Saturday is a blur – my best friend stayed Saturday night with me which was wonderful (Mark was able to crash and I had help to turn over and various things).

On Sunday at about 12pm I finally got to see my son. I can’t describe how tiny he was – even with pictures. Also on Sunday they discontinued the magnesium. By Sunday I realized I had a complication from the anesthesia – the tube irritated my uvula (that thing in the back of your throat) so it was hugely swollen. It was causing me to wheeze. Unfortunately the doctors all thought it was a result of my asthma – even when I said it wasn’t. This created a less than ideal situation. The doctors kept giving me breathing treatments – inhaled steroids – every 4 hours and checking my oxygen every 2 hours and I was placed on oxygen by nasal canula. By Monday (8/10) I had had it – and was very upset and anxious. So the docs give me a sedative (which didn’t help matters). This was doubly frustrating as late Sunday an anesthesiologist had come, looked at my throat, and concurred that my uvula was HUGE. But the doctors continued to wake me up and give me steroids every 4 hours. Finally the respiratory therapist realized mid-Monday that I was oxygenating the same on room air as I was on oxygen. This was because – oh wait – the uvula was huge so the oxygen couldn’t even get to my lungs to improve my stats. So ultimately they discontinued the treatments. My twin sister Sarah kindly stayed with me Sunday night – again it was great having help turning over and tucking my 800 pillows around me 😀 ok just 4 – but it was a huge help.

Monday family left – I had people visiting but one thing I haven’t mentioned is on Saturday due to my high BP I developed a spot in my left eye. Basically this made it impossible to see out of my left eye. This created its own set of problems as I had people visiting and I couldn’t see. I know all parental units appeared as did my siblings. I felt really horrible when I realized that my older sister Anna and her husband kids were all in the hospital and didn’t see me as they had been told I was resting so I could see Liam on Sunday. Which is true – the nurses said I had to be rested to visit and I had yet to see him…I just felt bad as they finally wheel me to the NICU and there they were in the waiting area. Oh well.

So Monday was a rough day but I can’t remember all of it. I rather lost it Monday night – Mark stayed with me and I to say I was emotional was an understatement. I couldn’t see, I couldn’t hold my son, I was in pain from surgery.

Tuesday I do know the social worker came to visit. Mostly the interesting thing I learned was the docs had put down that I had a history of anxiety – which I don’t. Fortunately the worker took that off.

Late afternoon on Tuesday my incision had a burst of blood. However it stopped and I agreed with the intern that it was likely a small hematoma that just broke through the incision. Then Wednesday morning – more blood. When the upper level resident came to see me she realized that I had a HUGE hematoma and they had to reopen my incision and drain it. A very unpleasant experience that involved morphine to give you an idea of how unpleasant… Originally I was to be discharged but that got nixed. The doctor wanted to attach me to a Wound Vac machine to help my incision heal. On Wednesday it was 19 cm long, 3 cm deep and 2.5 cm wide. I also had approximately 28 staples. I asked if the interns went a little staple crazy but oh well.

Thursday I was hooked up to the Wound Vac – again not a pleasant experience but none of the dressing changes and all are so just keep that in mind. However Thursday was a big day – I finally was allowed to hold Liam for the first time! I still don’t comprehend how small he is – but that’s all I see when I see him – this tiny little person who is not even the length of my entire arm. The weight seems so insignificant – he was smaller than a sack of flour.

Friday I was so ready to go home. To make a long story short – insurance initially denied the wound care – with the machine I need 3 times a week for a nurse to come to my house to change the dressing and monitor the machine. Finally after the docs wrote letters including that I would not be released and after getting denied and taking it up to the medical director of the insurance company they let me LEAVE. The machine and care was not approved until 5pm on Friday. I had actually given up on the idea that I was going to leave and was begging for visitors since Mark really needed to be at home.

Still – leaving was bittersweet. I did not get to take Liam with me and will not be able to bring him home for months. He stayed in the NICU for 81 days until October 24th.

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