A few days after I posted my last update, about two Mondays ago now, I randomly became itchy. I didn't think much of it at first because my belly was growing and I figured the itching was mainly that. The day progressed and the itching got worse, mostly in the nooks of my body like my arm pits, behind my knees and then to my feet. I'm thankful to have retained some aspect of my OB experience from nursing school years ago to know this could be concerning. I didn't want to leap to conclusions so I decided to ask a friend of mine if she had experienced anything like this (I figured she would be a good resource because she is also a nurse and just had her 5th child - she would know for sure in one way or another). She responded by urging me to talk to my Dr. to get the itching checked out.
I notified the office Monday afternoon and was told to monitor baby's movements and the severity of the itching overnight and wait until the next day when I had a pre-existing check up scheduled and they would address the problem at that time. I made sure to let the guys know as unalarmingly as I could...I wanted to be sure I wasn't just being paranoid or something and causing unnecessary concern.
Fast forward to the appointment and they drew some labs that I was warned would take a couple days to result. Baby continued to be just fine and Dr. Salama advised me to again continue to monitor her movement and keep an eye on the itching. She told me I could have developed something called Intrahepatic Cholestasis of Pregnancy (ICP). Basically, this can occur in the last trimester of pregnancy due to the rise in hormones, causing my body to slow down the flow of bile and causing said bile to build up in my system (hence the itching). She didn't say much beyond that but wanted to verify the lab levels before proceeding with anything.
The next couple days seemed to drag on. The itching seemed to stay the same, thankfully not getting worse but nothing seemed to calm it down. I was anxious to know the results of that blood work but was thankful that baby girl seemed unaffected by any of this - she was just as active as ever in there.
Thursday comes around and I'm about midway through my morning at work. We were done with staffing and morning rounds and I got to a point in my day I can usually sit and figure out some things on the computer. That's when I noticed I had a call from the clinic. I listened to the voicemail immediately and was a little chilled to hear that Dr. Salama had called directly - usually a nurse can relay an all clear kind of message. Shit. I went to the break room and called back to receive some surprising information. Dr. Salama said that my liver and bile levels came back elevated which confirmed the ICP diagnosis. Shit. She asked if baby and I were doing ok and I reported that things had remained as they were at the appointment - I'm still itchy but she was moving around normally, nothing more than a few Braxton Hicks contractions here and there. She then said that with ICP there a small chance of the risk of stillbirth. Shit. She said that although that chance is small, the risk is stillbirth and in turn, not one she was willing to risk. Agreed. She said because we were right at 37 weeks, baby was developed enough to induce rather than prescribe me a medication to coast me along to the final weeks of pregnancy. She informed me we would be starting the induction that night and asked if I had any questions. Of course, I had plenty but my head was spinning a little at the time so she got my word-vomity response that, I'm sure, made little to no sense at the time. I remembered asking her to clear things with the guys first and to let them know herself of what she had found. She assured me that things were still ok and that she would be contacting the guys ASAP to let them know of the change of plans.
I quickly called JP to let him know what I had just been told. As I'm trying to process the information, myself, I tried my hardest to keep my composure in relaying the information. I can't imagine getting that call out of nowhere about your baby's condition after things had been going so smoothly only to be told we need to change plans and change them now. All I remember from the phone call was me breathlessly telling him the info, that this was urgent but not emergent and that Salama wanted to proceed this way out of precaution for their little one. His responses were brief and I could hear the surprise in his voice as he processed the information himself. I just remember the building of urgency in his voice when he would respond to me saying "ok...Ok...OK". He later told me that he was in the middle of talking to one of the crew members who was remodeling his house about the water they had just shut off. I never said I had good timing at dropping important news 😬.
I then proceeded to sound every alarm I could on my end. I called Armin's dad to let him know he would be taking Armin earlier than anticipated (I had just gotten Armin back for my stretch of days with him the night before). I called my backup for Armin, his grandma on his dad's side, that I would, in fact, be needing her help with caring for him that evening. I called my parents to let them know what was going on and to see if they could pick the guys up from the airport when they arrived in town (of which, we still had no clue on as the guys were frantically changing their own plans). I told my manager I would be starting my leave a few weeks early after that day, I notified the other charge I was working with that I would be leaving after our afternoon staffing meeting to prepare for the induction and to spend a few final moments with my son before I went to the hospital to meet whatever fate was waiting there for us. That was when it hit me. I don't know what I'm going in to. And on top of that, I had to part ways earlier than anticipated with my son. Between the anxiety of the situation itself and the hormones, I got a little emotional in the midst of all this crazy change of events. I finally calmed down and proceeded to go about work as normally as I could.
I am thankful to have such awesome coworkers that they were able to free me up to leave hours before I had anticipated leaving early. I was so grateful to have that extra time to prepare (including the necessity of shaving my legs that somehow became terribly important to me at the time) and spending a very nice evening with mom and Armin before I had to go in to be induced at 7pm. Armin was beside himself with excitement that both grandma and I were there to pick him up from preschool (and early, too!) and we quickly grabbed food from his favorite place and had a picnic at the nearby park, per his request. It was more soothing to me than anything I think to spend those last few moments with him. I held back tears while telling him goodbye and showering his dad with thank yous for being so accommodating with the change of plans. And off mom and I went to the hospital.
I got checked in to the hospital where they were waiting for my room to get cleaned, apparently they were in the midst of a busy streak and had just freed up a room. I told them we weren't in any hurry and waited to get admitted. The guys had notified me a little before then that they wouldn't be arriving until about 11:30 that night. I vowed to keep their baby girl safe where she was until I saw their faces. They laughed and assured me they would hurry but to not do anything heroic. Little did we know, we still had plenty of time.
From then on, they gave me a medication to soften my cervix and told me to rest up. Between the contractions and my own anxiety, I was able to get very little rest until the guys arrived around 1 that morning. I was SO relieved to see them and know they would only be minutes away if not in the room from then on out. Once we greeted one another, caught each other up on how wild this day had become and assured one another things would be fine, they made their way back to their hotel to get some sleep and get settled and I was finally able to relax enough to get some sleep as well.
The next morning, they told me they would be starting me on Pitocin. Oh boy. I'd had pit with Armin and the contractions were miserable after they started that drip. But baby needed to come out so I knew this would be for the best. The drip started out pretty tolerable but my contractions got significantly worse throughout the day as the nurse increased the drip to coax baby A out. The guys peeked in and sat with me throughout the day while my mom almost never left my side. We went for a few walks around the unit, caught up some more and half paid attention to an HGTV marathon throughout the day. Finally, they decided to get the show rolling and broke my water that afternoon. Mission accomplished. Within a few minutes, the contractions got notably less tolerable and I was dilating more. After a couple of hours of progressing labor, I could finally tell she was about ready to come out. They sounded the alarms and the birthing crew of LPNs, RNs, Dr and a resident came at the ready.
And just like that, Ava made her appearance into this world at 10 on the nose that night weighing in at 6lb 2oz and looking beautiful in her small but strong glory. The guys were right at the bedside ready to hold their newborn daughter. It still brings tears to my eyes reliving that beautiful moment. I think we were all overwhelmed with love and emotion - I still cannot adequately describe how it felt to be a part of that moment and to witness these two wonderful people meeting, holding and loving on their daughter for the first time 💗 All the anxiety of the last 24+ hours melted away as we were assured that she was just fine.
Things progressed after that as I thought they would in terms of the after birth stuff. Then my nurse started noticing some concerning things as I became more and more tired among other things. At first I thought I was just exhausted from having gone through labor but then I started shaking uncontrollably and had a very difficult time staying awake. After a few medications and an ultrasound, they found that I had retained some of the placenta and was bleeding more than what I should be. I remember just feeling irritated that I couldn't stay awake to be present in the moment and that I had consequently made my nurse focus more on my needs than Ava's. They informed me that I would need to be put under for a D&C to get the rest of the placenta out and curb the bleeding.
I'd never had any kind of surgery beyond getting my wisdom teeth out so I was a bit nervous about being put under and knowing what all they would be doing/giving me. I have dealt with these things with my own patients but never have myself. Regardless, we went ahead with the procedure.
After all was said and done, I don't think we got settled into the post partum room until about 2 that morning. Due to the crazy amount of people having babies that weekend, the guys, Ava and I shared a room for that day. I think we were all in a daze recovering from the events of the previous day and them falling in to their roles as fathers. We were all released the next day with clean bills of health.
In the few days that have followed, I feel like I've had the chance to recover for the most part and catch up on some quality time with Armin. The guys will still be here for another couple weeks to get Ava's birth certificate and legal concerns settled as well as to await the completion of their remodel so they don't have to take their newborn daughter back to a house that will likely be noisy and a little disheveled from construction. As we've been able to, we've spent more time together during their time in Sioux Falls and its been truly heartwarming to be able to get this time with them. I know they are understandably quite anxious to get back to San Francisco and continue on to their new normal back home so I'm cherishing the time we have been able to spend together and enjoying watching them care for and love this little girl so purely and wholeheartedly. I cannot say this enough, this has all been such a beautiful and wonderful experience that I'm humbled, honored and blessed to have been a part of. I cannot wait to see how this family grows with one another 💞
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