September 11, 2012

When Pregnancy Isn't Normal

It seems as if everything that happens to you during pregnancy is just normal. Stuffy nose? That's the estrogen making mucous membranes swell. Feeling like you have shortness of breath? That's just your body taking in more oxygen. Pretty much any weird thing that can happen to you could be attributed to your ever-changing body.

Last week, things happened to me that weren't normal. Even so, I was told time after time that what I was feeling was, in fact, just part of being pregnant. I want to share my story to encourage others that if something is happening in your body that you know isn't normal, don't let anyone convince you you're just weak. Although I don't want to scare anyone away from becoming pregnant, I also want to point out that I never thought anything like this would happen to me. I thought pregnancy complications only happened to people with pre-existing health problems or who didn't take care of themselves during pregnancy. My issue is one that I've most likely always had but never would have known until pregnancy made it worse.

It started Sunday morning during church. After feeling great for the past month, suddenly I had nausea and abdominal pain. It wasn't anything horrible, but it was bad enough that I decided we should leave. The rest of the day I just felt like I had regressed to the first trimester. I was back to feeling weak and achy like I had the flu. I felt bad all day but I figured my abdominal pain was from ligaments stretching and all my organs shifting around.

When I woke up Monday, Labor Day, I felt much worse than I had the day before. Fortunately I was able to go back to sleep several times, but each time I woke up I was still in pain. When I finally got up, the first thing I did was lie in a warm bath for an hour. Although the water helped a little, the pain never went away. Not long after I got out of the tub, I felt even worse. After lying on the couch for three hours, I decided to try some yoga to relieve the pain. I couldn't even get my body into a simple cat position before I collapsed to the floor. I crawled a few feet so I could see into the room where Nathan was and told him I thought we should talk to someone at the clinic. Surely burning abdominal pain for four hours straight wasn't normal. He tried calling but got a message that "this number is not listed."

We ended up driving to the clinic, only to find out it was closed for Labor Day, and drove on to the hospital where I plan to deliver. I didn't want to go there, but I didn't know what other options we had. The lady at the information desk told us to go straight to labor and delivery triage since the ER would send us there anyway. The triage gatekeeper was less than friendly when she heard our story. She told Nathan to wait in the waiting room and that "I don't know if they'll even take her" and passed me on to the next person, pointing out in an irritated tone that "she's only 21 weeks." I emphasized that we were only there because my clinic was closed and I couldn't talk to anyone else. I went through all the procedures and sat on a bed in my hospital gown waiting for a nurse. When the nurse came to ask me all the standard questions and a few more about what I was feeling, I could tell she suspected I just had round ligament pain. I told her I thought at first it was just round ligament pain but that the pain had been steady in my abdomen and lower back for the past 5 hours. She said she would send the midwife in, but instead it was an unfriendly and unhelpful family medicine resident. After a few more questions and pressing on my abdomen and beating on my back, she told me what I was experiencing was called round ligament pain.

"Oh, I didn't know that could last for five hours straight."
"It can. It just varies sometimes. If you were bleeding or leaking fluid we would be concerned, but this is nothing to be concerned about."

The resident told me they would go ahead and test my urine for infections, and left. I then realized that my urine sample was still there. Frustrated, I ripped off the monitor and hospital gown and put my clothes back on. A nurse came back in as I was finishing, and I told her I was leaving and apologized for wasting her time. I cried all the way home. I couldn't believe I was dumb enough to go to the hospital for something as minor as round ligament pain. How was I going to handle labor if I couldn't handle normal pregnancy pain? It never got any better that day. By Monday night, I was trying all kinds of different labor positions and trying to breathe through the pain. I stayed on the couch so Nathan could get some sleep.

Tuesday wasn't any better. I thought I might be a little better at first, then a big wave of pain would hit me for about thirty seconds. This was happening every five or ten minutes. Nathan got ahold of a nurse at the clinic, and she told us that they couldn't get us in, but what I was experiencing did not sound like round ligament pain and that I should go back to labor and delivery triage. It wasn't happening. The last trip there had done nothing for my physical pain and added emotional pain on top of it. The triage doctor had told me not to come back unless I was bleeding, and I still wasn't bleeding. I told Nathan to go to work, and I dealt with another day of constant pain. I agreed to go back Wednesday if I wasn't any better, but I thought surely the pain would be gone by then.

Wednesday came and brought no change with it. Nathan called the clinic again and insisted they get us in that day. I got an appointment with an ob. The ob listened to all my issues and told me she suspected appendicitis. In order to get the tests I needed, I would have to make the trip back to labor and delivery triage. She called the midwife there ahead of time to ensure we'd have a better experience this time. At least at this point I was officially 22 weeks pregnant instead of "only 21" like I had been last time.

When we got up to triage, Nathan again had to wait in the waiting area while I gave a urine sample, put on the gown and got into bed, had a monitor hooked up to me, and got blood drawn. They didn't have the monitor hooked up long before the midwife and two nurses could see that the intensified pain I was experiencing every five minutes or so was actually contractions. After hooking me up to an IV, they told me I would have to wait about 20 minutes for a doctor to get there. I asked when my husband was allowed to come back, and the midwife looked to the nurse and asked if there was a problem. Apparently they have to ask questions about domestic violence to make sure my husband isn't a threat, and even then he can't come back until I ask for him. At least we know that now.

 I thought I was smiling here


At one point I told a nurse I was happy to find out it was contractions I was experiencing instead of just round ligament pain since before I wasn't sure if I'd be able to make it through labor.

"You're not planning on going natural, are you?"
"Yeah..."
"Oh! Well, take what you're feeling now and multiply it by 100, and that's what labor's like. I just want you to be prepared."

And my confidence in my abilities once again went down the toilet.

I'm not really sure what happened the next few hours. Talking to different doctors...Answering questions...Getting more blood drawn...A quick ultrasound to check my fluid levels...Internal exams to make sure I wasn't dilating (I wasn't)...Lots of waiting. Finally, three doctors came back in the triage room with their answer. I don't remember all of what the one doctor said, but her main point was:

"We think what you're experiencing is just normal pregnancy discomfort. There are ligaments that stretch..."

I didn't want to hear anymore. I was pretty much hysterical at this point. Hours and hours of tests only to once again arrive at the conclusion: I just couldn't handle pregnancy. I knew I'd never be able to have a natural labor. I tried to explain my emotions. The doctor offered me morphine. (Have I mentioned I'm not crazy about doctors?) She did say that they were concerned about the fact that I was having contractions and that they were going to send me to have an abdominal ultrasound to rule out appendicitis, the original conclusion of the ob at my clinic.

We waited for what seemed like an hour for the ultrasound. I was a mess. I was sure this was all a waste of time and begged Nathan to just let me go home, but he was still convinced there really was something wrong with me. Finally, it was my turn for the ultrasound. The way the monitor was angled, I couldn't really see what the ultrasound tech was doing. When she was checking my appendix, it was much higher than the pain, which was low in my abdomen. She finished her job, wiped off the gel, and I knew we were at another dead end. Then she asked if the doctors had already checked the baby. Nathan explained that it was just a quick check to see if I had enough amniotic fluid. Deciding to check again, the ultrasound technician sprayed more gel on my abdomen and went back to work. She asked if the baby had been measuring normally so far. I told her I thought he was. She finished and left the room to consult with someone else. When she came back later, she told us she thought she'd found what was causing my pain, but she was waiting for the doctors to come see it for themselves.

Finally...relief. I was still having contractions, but the emotional pain was lifted. I wasn't scared about whatever she'd found in my uterus, just relieved that she'd found an answer to what was causing my pain. When two of the doctors came back in, I found out I had a fibroid (benign tumor) in my uterine wall. The diameter is about 9 cm, or a little larger than a baseball. I've probably always had it, but the extra blood flow due to the pregnancy made it grow. Then the doctor told me I might not be able to give birth vaginally since the fibroid was right about where the baby's head will need to go for labor. This was a letdown, but at least I know ahead of time that I might need a c-section so I can mentally prepare somewhat. The ultrasound tech showed the doctors the live image, and I turned to see the white sphere.

"This is not your baby's head," the technician said. She moved over a little. "This is your baby's head."

Side by side, the fibroid dwarfed my baby.

It was probably the fibroid that had caused the contractions. I'll be able to have it removed once the baby's born. In the meantime, we just pray that the the fibroid will shrink enough for me to be able to push the baby out. More importantly though is that the baby will be born full-term and healthy, no matter how he's born. I have a high risk for preterm labor now, which is really scary. The fibroid can also prevent the baby from growing, which is why the ultrasound tech asked if he had been a normal size up to this point. So far he's fine.

Once I was back in the triage room, a nurse had a doctor explain how to know when I was actually in labor since my contractions were 2-3 minutes apart by this point. The doctor just said to come back if the contractions felt stronger or if I was leaking fluid or blood. The doctors basically told me I was going to have to deal with the contractions the rest of my pregnancy. They prescribed a narcotic/acetaminophen for the pain, but the medicine they would normally give for contractions would lower my already low blood pressure and probably make me feel worse.

The doctor did say there was a drug they could give me in the hospital (Terbutaline) that would stop my contractions. It would probably only be effective for 30-40 minutes, but there was a chance it could signal my uterus to stop permanently. She said it would increase my heart rate and make me lightheaded. Desperate for a break, I didn't even think to ask about other side effects or the effects on the baby. Even though the doctor didn't seem confident it would be a long term fix, I decided to try it. As soon as the nurse injected it into my IV port, I felt like I was going crazy. My heart rate immediately hit 150, and I felt like my throat was closing in. Nathan had to help me with slow breathing. Once it was out of my system, the contractions were gone. At first I still felt them, but they weren't even registering on the monitor.

On Thursday, I was almost back to normal. I still felt like I had cramps, and probably will for the rest of my pregnancy, but I had no contractions. The pain was manageable when I wasn't contracting every two minutes. And now, five days after I was given the drug, the contractions still haven't come back. The baby's still kicking around like normal. I have no plan of taking the narcotic/acetaminophen or any other drugs the rest of this pregnancy. The pain is mild, and much easier to deal with now that I know what's causing it. I think a lot of my problem before was fear from not knowing what was happening to me or to my baby. It was kind of hard to relax. I still plan on giving birth 100% unmedicated unless a c-section is absolutely necessary. There's no way labor will be 100 times worse if I'm full-term and know what's happening is normal.

I can't believe how close we were to not even discovering the source of my problems. If the ultrasound technician had just ruled out appendicitis, which was all they wanted her to do, I would still think I was dealing with constant round ligament pain. Now we have an answer, but we also have more unknowns. Will I have a natural birth or a c-section? Will the baby make it to 37 weeks or will he come at 27? We don't know. We just wait.