Monday, January 22, 2018

Baby #3: The Delivery

Despite the common knowledge that each case is unique, I was nonetheless lured into the innocent contemplation of something quick and similar to what occurred during Aaron’s delivery, just because the trend appeared similar.  However, things turned out differently this time.  Here’s sharing on the arrival of the youngest brother of Alvin and Aaron.

Just like the rainbow cake.  Each layer has a different colour.  Likewise the uniqueness in each case when it comes to the reality...

Removal of Cerclage at 36 Weeks and Discharged
My cerclage removal back in 2014 was painless and took only minutes.  However, the process this time was long and unexpectedly painful.  The removal was done at 36 weeks at the ward itself, not the labour room.  But looking back, the discomfort experienced this time shouldn’t be a surprise because the cerclage had been inside for quite long (5 months) and as a result there was swelling on the cervix. 

Post-cerclage removal, other than spotting and despite a 3 cm os, I did not have any sign and symptom of labour.  CTG showed the presence of irregular and very mild contractions, and I did not feel any pain. 

Still no progress for another 3 days down the line, I was thus allowed to discharge.  Which meant going home and waiting for “the sign”.

 I wanna go home... time to clear up my mini pantry-cum-library

When, Where and How?
What are the signs that indicate it’s time to go to the hospital?  As I’ve never truly experienced the moment before, I was paranoid each time I went to the washroom.  Or whenever I felt a mild contraction indicated by tightening of the abdomen.

During daytime, my husband works in Pandan Indah while I’m in Seri Kembangan. What if the need to go to hospital occurred at the most inconvenient time

A back-up plan cropped up, I went to see my regular ob-gyn at the nearest hospital from home, Dr Norshida at Columbia Asia Cheras, brought the doctor’s memo from PPUKM and obtained a pre-admission form.  This route i.e. delivery at Columbia would be costlier, so it's reserved for if I genuinely don’t get to go to PPUKM in time.  Hospital Serdang is the nearest government hospital, but I have some logistics issue as well as the fact that sometimes there aren't enough beds at the ward.  Some time in November 2016 shortly before Misya's arrival, my sister-in-law (wife of my brother) had to wait on the sofa for a number of hours before she was assigned a bed at the ward - and she was sent for admission at Hospital Serdang by ambulance from KKIA due to PE.   

25 October: Admission Day
Two days short of the 38th week, on Wednesday 25 October 2017, I had my check-up appointment at the antenatal clinic of PPUKM.  I did not expect admission into the ward on that day but already kept the necessary bags in the car earlier. 

Waiting area at the O&G clinic

While a young doctor was palpating my abdomen, a few surges of contraction suddenly occurred.  The doctor then performed a VE, and I was told that the os was “a good 4 cm”.  Upon consultation with Prof Azurah, I was admitted into home-sweet-home Ward 2B that afternoon.

In the ward, I had a 20-minute CTG for fetal heart rate and contraction monitoring.  There were contractions, but very mild and asymptomatic. Due to a GBS positive status detected at 35 weeks (never detected with one before this), I was started with 4-hourly IV ampicillin on the same day. 

26 October: A Pain Like No Other
Things remained pretty much the same on the next morning.   Contraction was more regular but very mild.  There wasn’t any pain too.  After CTG and VE before dawn, at about 8 am, the doctor performed an artificial rupture of membrane before I was brought to Labour Room 5 on the 1st floor.

At the labour room, a nurse took my temperature and administered enema.  After a few minutes, I was directed to the toilet.  The toilet at the labour room was clean, dry and spacious.  Ok, this is the first time I received an enema before delivery although it’s a routine for most other moms.

Back to my bed at the labour room, a doctor asked me if I wanted epidural.  Between not knowing how painful a real contraction is and also not wanting to risk regretting a “no” later on, I said yes.  There’s no right or wrong as this is purely a personal choice of each individual… there’s always risk vs benefit in any procedure. 

Before the doctor from Anaethesia department arrived, I had my first taste of contraction pain in my whole life.  It came once in 10 minutes. “So this is what contraction during labour feels like… it is indeed very painful!

The Delivery Story
I was relieved when epidural was finally on.  At least I could lie down in comfort for about an hour.  Had labour augmentation – not my decision, but the doctors’.  Two hours later, but at only 8 cm, I felt a very strong pushing urge and great pain. The magnitude of pain this time seemed 10 times greater than what I'd experienced before.

In the past, it took me seconds and minutes to deliver, because my elder babies had been small.  Alvin was born very premature at 29 weeks weighing only 1.16 kg, while Aaron was 36 weeks plus at 2.5 kg.

It took about 30 minutes of breathing-in, pushing and breathing out before Baby No. 3 finally came out.  He is more than 3 times Alvin’s birth weight. 

The delivery of Baby No. 3 had many people in attendance – doctors, nurses and medical students.  Initially, I wished my husband was there to witness, but his absence due to work was perhaps a blessing in disguise as I had a bit of complication in the labour room after that - it's not something that I want any family member to see because it might create unnecessary worry and fear.

The joy of skin-on-skin with the baby wasn’t for long before I suddenly felt a fainting spell.  I felt extremely dizzy, drowsy, and nauseous.  As much as I feared vomiting, I couldn’t resist it and ended up soiling the pillow and my hair on one side….. gosh.  Fortunately I did not eat much in the morning or else it would have been more.

Fainting Spell and Deep Sleep
It turned out that I had post-partum haemorrhage (PPH), or tumpah darah in Malay.  The placenta was alright as it was delivered intact.  But for reasons unknown to me, my uterus did not contract after delivery (uterine atony).  I was given a few injections of hemabate, a second branula was inserted onto my other hand for another IV drip – the Hartmann’s solution.  A few other procedures  took place but I was too exhausted to remember them.      

The last thing I recalled was that a nurse told me that they’re taking the baby to the nursery of the ward. Baby, breastfeeding, child care, etc. subsequently disappeared from my mind.  I felt like going into a deep sleep, away and far from the reality.  I wonder now if that’s what death feels like?

I spent the next 2 hours asleep in the labour room with my heart rate and BP monitored by the nurses until I completed my Hartmann’s drip, finished a cup of drink and half a cracker.  I had no appetite for food until the night.  

Conclusion
Back in the ward when I finally met my baby again, my breastfeeding challenge came back to me just like three years ago.  Colostrum only began to kick in on Day 2, on the day baby and I were discharged.  Prior to that, the nurses had given baby formula top-ups (note: breast milk is first choice, but I am alright with and agreeable to mixed feeding if necessary).  

On a quiet and sunny day...

I am relieved and grateful that the whole ordeal went generally smoothly, thanks to excellent care from the dedicated doctors and nurses, as well as the kind wishes and prayers from dear friends and family.  I am thankful to Prof Azurah for promptly getting me into early treatment and close monitoring. 

I used to wonder and in awe of how it feels to be complete the third trimester and deliver a normal-sized baby at term.  But then I am not as strong as I thought after all.  A 3.49 kg baby almost made me passed out.  I wonder too if that’s why a full-term pregnancy is not something that would occur naturally for me… if not with interventions in the form of cerclage, weekly proluton shots and bed rest.