Going into labour at 30 weeks pregnant : from mucous plug to the final Code Zero
This won’t be my normal edited blog – but that’s because nothing is ‘normal’ right now. My world has completely stopped. And this is why…
On Tuesday 16th February, at exactly 30 weeks pregnant, I woke as usual at 0530 for an early shift at work. When I went to the toilet (warning: too much information) I expelled a large sticky glob of mucous. I remember thinking ‘well that ain’t right’ but apparently pregnancy increases vaginal discharge and maybe this weird shit happens! I didn’t think much of it and went to work. After some googling about mucous plugs (and some good advice from my sister in law) I called the midwives at the Mt Barker Hospital who also said this can be normal but they will have a chat to Dr Klomp (my obstetrician) and call me back. I also had a regular appointment that afternoon so I wasn’t too concerned. At approx. 1045 the midwives finally called saying Dr Klomp wanted to see me right away. Slight panic set in but I grouped my thoughts, left work (picking Scott up from work on my way) and went back up the hill to Mt Barker Hospital.
At midday Dr Klomp performed an internal speculum exam and saw fluid in my vagina – he was worried I may have prematurely ruptured my membranes (broken my waters) and contacted the Women's & Children's Hospital to see me ASAP. They advised that Dr Klomp give me a steroid injection which helps improve the baby’s lung function while still in the womb in case he came early. A tiny bit more panic set in, but at this stage I felt completely myself and was sure this was all going to be a waste of time! After the steroid injection, Scott and I went back down to the W&CH where we were seen by a midwife and doctor. They connected me to a CTG machine which continuously monitored the baby’s heart rate and my uterine activity to make sure I wasn’t having any contractions. They also did an internal (yes, everyone saw my vagina that day!) and a swab confirmed there was no amniotic fluid – yay, I hadn’t broken my waters!
I began to feel relieved and they were even talking about sending us home. Only minutes later I noticed the monitor beeping when a rush of doctors and nurses ran into my room, rolled me on my side, put an oxygen mask on my face and started inserting IV lines (drips). Our baby’s heart rate had dropped too low for too long. I even heard someone in the background talking about taking me to theatre immediately! The doctors put at official ultrasound on bubs and saw that his heart rate had corrected and things seemed to settle a little – I was give IV fluids and an admission went through. I was told that I’d be staying the night for continuous monitoring on bubs and was transferred to the delivery (ummm, what?!) ward.
Nothing much happened for a while. Scott went home to get me some overnight clothes and the nurses even started questioning whether the monitoring earlier may have picked up my heart rate instead of bubs. At 7.45pm (only 15 minutes after Scott had returned from home) I was all comfy watching My Kitchen Rules when I had a gush of fluid down there – literally felt like I had wet myself. And it kept on coming! We let the nurse know and again came the rush of doctors. Another IV line was inserted, another internal speculum exam was performed (cervix was closed) and an ultrasound confirmed bubs no longer had any fluid around him in the womb – my waters had definitely broken now. Then came the drug orders – I was given intravenous antibiotics (bubs no longer had any protection from the outside world), magnesium sulphate (reduces the risk of neurological disorders in pre-term babies), given an injection of salbutamol and started on tablets which are both meant to suppress contractions and essentially delay labour. The aim was to keep our little man inside as long as possible – he was better off cooking in there and letting the medications do their job to increase his chances on the outside world. The doctors wanted to try and delay at least another 24 – 48 hours in order to get another dose of steroids for his lung development. A bonus would be that it might all settle completely and he could get another couple weeks in there with me on bed rest.
However, my body had other ideas. I began having regular contractions (5-10 minutely) which continued all night. Tough girl that I thought I was, I decided I only wanted Panadol for the pain. At about midnight someone else just had to have a peek down there and put a catheter in – I wasn’t even allowed to get out of bed for the toilet. We didn’t sleep at all that night, and by 7am I had broken down and accepted an offer of endone (stronger tablet for pain). The contractions then settled to 10 minutely and were less severe. The hardest part was knowing that at the end of all this, no matter what, I was going to have a c-section due to bubs being breech and my bicornuate uterus. It is mentally exhausting being in labour when at the end of it all you can’t even push the baby out.
At about 11:30am on Wednesday 17th February, my contractions became more painful. We noticed the first spot of blood on my pad but another internal speculum exam revealed my cervix was still closed. Bonus – we were looking good to get the second steroid dose into me in an hours’ time. At 11:50am a formal ultrasound was performed on bubs at the bedside which showed he still had minimal to no fluid around him. His measurements were still small (although less accurate with no amniotic fluid) and they estimated he only weighed 1.18kg – too small for my liking!
Only about 10 minutes later at midday, my contractions became severe and more frequent. I was given the second steroid dose at 12.30, and at 1pm I attempted another dose of endone but felt nauseous immediately after. 15 minutes later I had a mucous discharge on my pad, and I remember telling the nurse I felt pressure down there like I needed to do a poo (sorry guys, I’m not holding anything back!) The look on the nurse’s face said it all. She also noted that with each contraction, our little boys heart rate was dropping and he was in distress. She rushed out and minutes later the doctor was doing another internal exam which showed I was 9cm dilated. Her words exactly were ‘we need to go NOW’. I heard a ‘Code Zero’ being called on the overheard speakers – and it was for me. Within seconds I had about 10 people surrounding me asking me a million questions. Scott was thrown a pair of scrubs and I was being pushed out the door to theatre. I will NEVER forget this feeling. It was like I was in a movie. I had the anaesthetist running beside me telling me I needed to have a general anaesthetic. I kept saying ‘no, I’m having a spinal block, I need to be awake’ and his stern face saying ‘Amy, there’s no time’. I was shivering and crying so hard I couldn’t control it, and as I was transferred onto the theatre bed, I was having a contraction so strong I actually felt like my little man was on his way out and they were too late. I had arms in each direction and one nurse said ‘I’m here purely to hold your hand’. Scott was nowhere to be seen – he wasn’t allowed in the room due to the urgency and general anaesthetic. I was still awake when they were splashing betadine onto my tummy. The anaesthetist was telling me to keep my eyes open as long as I could, and I knew if I closed them one second too early I would feel them making the incision. When I eventually closed my eyes, I honestly didn’t know whether my baby boy would survive.
Insert here a big cry. It is almost impossible to relive each step of this now.
At 2:04pm on February 17th 2016, ‘James William Purling’ entered this world weighing 1540g (3lbs 6ozs) and measuring 40.7cm in length. The nurses were all set up to intubate him, but the little fighter came out crying! He was sent straight to the Neonatal Intensive Care Unit (NICU) where Scott was able to watch the incredible nurses and doctors (our heroes) do all his initial checks and treating. I was in recovery for another 2 hours, and woke at approximately 4pm. The first thing I said was ‘how is my baby, where is my baby?’ I cannot and will never be able to describe the sense of relief I felt when I was told James is doing ok (and then I fell back to sleep!) Scott came in straight away and as hard as it was to keep my eyes open, I still saw his red puffy eyes and the panic in his face. How he managed to get through that first couple hours on his own is nothing short of amazing – I now have two of the strongest superheroes in my life. On my way to the postnatal ward, the nurses wheeled my bed past James’ isolette (cot) in NICU so I could say my first hello. And from then on, nothing else has mattered but our little miracle man.