Thursday, August 26, 2010

My Daughter's Birth Story (Why Intervention Is Fine With Me)

Along with BOB strollers, Sophie Giraffes, and Moby Wraps, birth guilt and uncertainty is a hallmark of modern yuppy parenting.

And before we proceed, let's call the debate over at-home vs hospital births the firstest of First World Problems. Can we agree on that? That millions of women don't have the option for medical intervention even when necessary, so the luxury of selecting a birth experience (I'd scare quote that last word if doing so weren't against Strunk & White) should be identified as such?

You can't get through pregnancy these days without contemplating natural vs. well, whatever the opposite of natural childbirth would be - medically intervened birth? Epidural-assisted birth? No drugs vs. drugs, how about that. Second to that is contemplation of a home birth - a way to really (close your eyes and say the word with me) experience your child's birth.

For many reasons, the notion of natural - that is to say - non-medicated childbirth didn't sit well with me. In fact, it sat on top of me like a stone, pressing from my psyche nearly any joy or excitement over my baby's impendind debut. Then I took an anesthesia class at the hospital where I'd be delivering and OH BOY suddenly I felt confident enough to proceed after all.

After fantasizing about how to tell my husband I was pregnant, the next most fantasized about moment was the "honey, it's time," and frantic dash to the hospital. Alas, for me, that moment never came and probably never will on the improbable chance we have more children.
Sometime during my 36th or 37th week of pregnancy, I began to itch.

It was February, so it easily could've been basic winter skin, but it wasn't. I get all wintery at the start of the season, not towards the balmy California end.

Every evening - and only in the evening - the backs of my hands and feet and slightly up my ankles itched. And I mean itched. Like a cluster of mosquito bites itch. Every evening. Never in the morning. Not throughout the day at work, just at night. And just the hands and feet.

Thinking this was strange and probably yet another item out of the Fun Bag of Pregnancy Symptoms I broke my normal no-google rule and googled itching in pregnancy. Most reasons were predicatble - hormonal changes, weather, hydration, skin stretching on the belly. All those reasons were treatable with lotion, more fluid intake. Except . . .

There was one condition - Cholestasis, very rare, that would be worth mentioning to the doctor.

At the next doctor's appointment (weekly at that point), I said, "hey, I've been itching." I didn't drop any big words, but the doctor immediately ordered lab work and sent me over to have blood drawn. It's an expensive and slow-to-return lab, checking bile acid levels in the blood stream.

The results came about 4 long days later: elevated bile acid levels. The lab orders mistakenly ommited testing my liver function, so it was back to the lab to check that as well. In the meantime, the diagnonsis came pretty easily: intrahepatic cholestasis of pregnancy. Sounds pretty cool right? I love the word intrahepatic. I didnt' love what it meant for my pregnancy, however.

Intrahepatic cholestasis affects a teensy number of pregnant women and there's no known cause. It's apparently extra common in Chile in the winter. So there's that. What is it? Simply put, the liver stops cleaning the bile acids out of the blood stream like it should - bile acids coming out of your gall bladder. I think.

The good news is that it poses basically no health threat to the mother and is cured when the pregnancy ends.

The bad news: it can end the pregnancy. Yup, no harm to mom, and no long term health problems for the baby except the main complication is "intrauterine demise." How's that for clinical? And that demise seldom happens before the final month of pregnancy.

To boil it down: the only complication is stillbirth and the baby doesnt't usually die until right before you expect it to be born. Fucking fantastic.

It was Thursday morning when I returned to the OB and she confirmed that the liver function was less than stellar and that combined with the bile acid levels had her concered enough to think this baby might be coming out soon. How soon, I asked? Like this weekend soon? She didn't exactly say yes, but it was clear that was an option quickly coming to the fore.

I called my boss and said I was taking the rest of the day. No wait, revision: it was at THAT point I was sent to have the liver function test. But I still told my boss shit was going down and I needed the afternoon.

The next morning, the results were in, confirming an issue with the liver function and Thursday's OB plus my actual treating OB were going to discuss what to do - since I was a fun and rare medical mystery.

Friday was rainy and blustery. I didn't go to the office because it was becoming increasingly clear that we might be heading in to deliver soon and I hadn't even packed the bag yet.

Friday afternoon, as the wind blew and the rain fell harder, my OB called and ran through her thoughts. The baby was basically fully cooked at this point. The chances of something going wrong were small. The problem: if things go wrong, they go WRONG - the kind of wrong no one can fix.

Prior to this phone call, my husband had been pretty reluctant to consider inducement. All that work gestating and it seemed a waste to rush things.

I typed what the doctor said to me onto my computer screen with my husband reading along.

The OB said she thought it would be best to induce. We could check in on Sunday evening, usually a light time, and just get things going from there. We chatted a bit longer, ended the call, and then I called my best friend, a pediatrician and my go-to for medical questions (she LOVES that). My husband left the room.

After I ended that call, I walked into our bedroom and smack into my husband, his arms piled with clothes - his toiletry kit teetering on top.

"I've heard enough. When do we go?" he said, eyes-wide with concern, adrenaline coursing through his veins.

Not quite yet, I said, though I shared his concern. If the worry was the cholestasis could kill our baby AT ANY MOMENT, why wait until Sunday night?

Eventually, we split the difference and booked in for Saturday night at 5pm.

Coming up in Part II: Checking-in, Dosing-up, Waiting.

No comments:

Post a Comment