LET'S NORMALIZE BIRTH: Surviving Preeclampsia And HELLP Syndrome - Tonia's Story (TRIGGER WARNING)
Today's blog post contains details of a birth experience that may be triggering to some. Details are surrounding a difficult and/or traumatic birth experience. Please take this into consideration and use your own discretion before reading.
Things can go sideways pretty quick.
The birth of my daughter did exactly that… upside down, topsy-turvy, sideways. Basically, every direction except straight. However, it was on this runaway train of an experience that I not only allowed myself vulnerability and self-love; but I also found the strength of a support system to carry me through when I needed it the most.
My pregnancy was pretty great. I was followed by a high-risk OB due to a previous medical condition, but every appointment had gone well. Our daughter was on the small side but still growing at every ultrasound visit. For me, pregnancy had been a bit low-key, so I was looking forward to the birth being the same. My due date was January 13, 2020; but I always felt she was going to be a December baby (It was like I already knew). At my 34-week appointment, my OB started talking about the high possibility that I would have to deliver early just because baby’s growth was slowing quite a bit and it might be better for her to grow outside of me a few weeks early. Initially, I was crushed, how could it be “better for her” to grow outside of me? Inside me is supposed to be the best place for her. After much thought and acceptance, we prepared for the induction and were ready to meet our baby at 37 weeks. That plan, however, was derailed less than a week later.
Friday, December 6, 2019, I woke up at around 5:30 am feeling really nauseous but thinking that was normal I just tried to go back to sleep. The nausea got worse and I was now getting a pain under my ribs on my right side. I had a sinking feeling because I knew what this could be; preeclampsia. (As a doula I was already knowledgeable in pregnancy and birth, but when I became pregnant I read even more, including complications/signs to watch for). I felt so sick that I had to crawl into the bathroom where my now-husband was having a shower. I said, “I feel awful, we have to go to the hospital”. When we got to the early labour unit, the nurse started taking my blood pressure and I noticed it was quite high (“another symptom” I said to myself). When the nurse left to update the doctor, I looked at my husband and said, “I’m preparing you, I think they are going to say I have preeclampsia and we’re going to have this baby today”. I needed to prepare him, to let him process before all he could hear was the doctor’s voice piercing the silence of our room. The pain in my side had now migrated to my shoulder and was becoming unbearable. The doctor came in and confirmed what I already knew; preeclampsia and I was to be induced that day if they couldn’t get it under control. My plan went sideways yet again. I remember saying “okay” with tears sliding down my cheeks. I had wanted to keep her in just a little longer. I was losing control of the situation; my body was betraying me and my baby. I could feel the weight of my husband’s hand in mine, grounding me, keeping me steady.
The nurse came back with a steroid shot to help with lung development if baby came that day and she also took the first of what would be many blood samples. It was now time to make the call home. I called my sister in Newfoundland and told her what was happening, I remember now being so calm like I didn’t want anyone to worry because in my head I knew I would be okay. Or maybe that was wishful thinking at the time. I knew I needed my sister there and without asking she was already booking a flight. Just like that, she stopped her life to come to be with us when I needed her. At this point, we moved up to the birth unit and prepared for the induction. While getting settled in the room our nurse came back and said: “actually your last bloodwork came back a lot better so we are not doing the induction tonight”. The doctor said they were going to try and maintain my blood pressure for as long as possible with a goal of 36/37 weeks for the induction (back to the original plan I thought, okay I can do that). We were sent up to the 7th floor to be monitored for the next couple of days to make sure my blood pressure had stabilized.
My sister arrived and got a taxi straight to the hospital. When I saw her I felt my body relax. Anyone that knows me knows how close I am to my sister, and to have her physically in front of me was what I needed at that moment in time. We were discharged on Sunday, December 8, 2019, on the basis I would take my own blood pressure and medication. As soon as we got home I decided to quickly pack a hospital bag just in case we ended up going again because I wanted to be somewhat prepared. Again, my intuition guided me in this overwhelming time because, as it happened, we would be heading back to the hospital… much sooner than anyone expected.
Monday, December 9, 2019, I was exactly 35 weeks pregnant. I woke up at around 3am with what I think is really bad heartburn, so I got up, took some medication, but instead of going back to bed, I go into our baby’s room. I sit in the rocking chair and gently push myself back and forth, listening to “Rainbow” by Kacey Musgraves and feeling her squirm inside me. I had a feeling it wasn’t heartburn but wanted to wait just a little longer before alarming anyone. I needed to have that alone time with her in my belly because I knew we didn’t have much time left before I had to share her with the world. My heartburn changed to a pain in the upper right side of my body. It felt like a shooting, twisting pain. It became so intense I could barely take a full breath. At 4:00 am I knew it was time to wake up my husband and sister. They both jumped up and got ready to go to the hospital. I was half crying/half moaning at this point because the pain was so unbearable. I kept saying “this doesn’t feel right, something is really wrong”.
I laid in the back of the car with the windows rolled down, so I could try and get comfortable. I could feel the cool December air on my face; it smelled like wet pavement because of the misty rain outside. I remember the street lights zoom past the window and squeezing my sister's hand the whole ride there. When we arrived in admitting I couldn’t focus on anything but the pain in my side, which had now migrated to my shoulder again. I remember them asking me so many questions that I couldn’t have cared less about. They assumed I was in labour and kept saying “oh I’ll wait until this one passes”. I said “it’s not contractions!”, my sister told them I had been discharged 1pm the previous afternoon with preeclampsia and something was wrong. The nurse came out quickly and took me into a room with my husband. She took my blood pressure and of course, it was very high. I asked if I could have anything for the pain in my side because it just wouldn’t calm down, I couldn’t get away from the pain. She gave me morphine and Gravol, telling me it would take about 15 minutes to work. I looked at the clock and it was 4:45am, I said to myself “okay, I can handle this until 5am no problem”… except 5am came and went and there was no relief from the pain. The medication hadn’t worked at all. My blood pressure kept creeping up, it was now in the 150’s/90’s. I was rolling from side to side, trying to escape the pain. I thought, okay I’ll just have to breathe through the pain. That proved to be easier said than done. My husband, Devon, started to breathe with me, in and out, every breath. We locked eyes and he kept me breathing.
In that moment I crumbled. I had read of what can happen with severe preeclampsia patients, I had watched those episodes of Downton Abbey and Grey’s Anatomy.
I didn’t know what was going to happen to me, so I had the conversation I never thought I would have to have with my husband… The conversation about if I died while having our daughter. I asked him to make sure she knew all about me, to sing her the songs I would sing to her every day while she was growing inside me, and to tell her how much I loved her. I think he knew how serious I was being because he said “yes, I’ll tell her everything. But you’re going to be alright.” I just responded, “I don’t feel alright, it’s not good.”
While waiting for the doctor, the nurse gave me more morphine and gravol, which dulled the pain a little; enough to not have to think solely about the pain. I would constantly look at Devon and say “I love you so much”. Almost like I was trying to say a lifetimes worth in a few hours.
The next, I would say at least 24 hours, is a bit blurry. Some is from what I remember, and some is from what people who were there told me. We were wheeled up to the birth unit, to room 311, to start the induction. My nurse (who was a total advocate/support for myself and my family) started a magnesium drip to prevent seizures caused by the preeclampsia. This also meant I would have to stay on the birth unit for at least 24 hours after the birth because you have to be on the magnesium after as well and it has to be done on the birth unit. Meaning that I wouldn’t be able to leave and go see my baby girl in the NICU when she was born. Another part of my birth wishes popped. She also set up the gas for me to use, thinking it may help dull the pain from my side (that pain I came to realize later was my liver being damaged from the preeclampsia). A Foley balloon catheter was placed to start the induction, but the whole time they were inserting the catheter/talking about induction all I could think was “how can I go through labour, I’m exhausted and feel like I’m dying. We all know how this is going to end… in a C-section.” A C-section that I most certainly did not have in my birth plan but was now mentally preparing for.
The morphine and gravol were finally taking the edge off, long enough for the doctor to ask what I thought about for pain control. I laughed and said “well it wasn’t the plan but I feel really shi**y, so I think I’ll take the epidural now thank you”. The epidural did do a good job of taking the pain away from my side, which was a relief. From here on out my usual response to any questions was “um hmm” because I couldn’t form the words anymore. My blood pressure was constantly being taken and steadily increasing, the medications weren’t working even though they kept giving me more. The highest blood pressure reading I remember seeing is 188/110. At the same time my blood was constantly being drawn, with the results showing my condition was worsening and had now become HELLP Syndrome (Hemolysis, Elevated Liver enzymes, Low platelet count). You could feel the energy shift in the room, although my nurse remained calm with me, I heard how she was speaking with the doctors and other nurses. Another doctor came in to insert an Art line in my arm (like in IV except it goes into an artery. This makes it easier to draw blood frequently and also monitor blood pressure easier. It’s usually placed in critical patients). He asked me to be still, I replied “ummhmm”, and watched as he went to work. The tape he put around my art line was so tight it made my fingers tingle. I also had to sign consent forms to accept blood and platelet transfusions because at that point my platelet count was getting dangerously low.
At some point I asked Devon to call my doula because I needed her there, and the next thing I knew she was walking in the door. Time had escaped me by then so I’m not sure how long it took her to get there, but just having her put me at ease. Devon had called his family in Annapolis Royal and they were driving in to be with us as well. They dropped everything and came. My blood pressure was still not under control at this point, so I was being given blood pressure medication constantly trying to lower it. Nothing seemed to be working. My preeclampsia was now in the driver seat of this birth and I was trying desperately to hold on tight as it dragged me along. My husband and sister went down to get lunch while my doula stayed with me. It was at this time the blood pressure medications started to work a bit too well because it was making my baby’s heart rate drop. The doctor came in, checked me, but I wasn’t dilated so everyone in the room knew what the next step was… C-section. I remember him saying “Okay, I think the best thing to do would be to have a C-section, baby is not happy right now and we need to get her out”. I nodded my head and asked my doula to call Devon to come back as fast as he could. The energy shifted yet again, and things started happening quickly. Devon ran back to our room with enough time to sign consent forms and put on the OR gown. His family had just arrived and came into the room right as they were wheeling me out. His grandmother came to the side of my bed, held my head and rubbed my cheek. I said “I’m scared Grammy”; she squeezed my hand and told me I would be alright, and she would see me after.
The OR was so cold my teeth were chattering, and I remember being so sleepy. My body was so tired, all I wanted to do was sleep. I kept closing my eyes, but everyone was telling me to stay awake. I thought, alright I’ll stay awake until she’s out and then I’ll sleep, because once she’s out she’ll be okay. My husband was to my left and my doula was standing above me. I remember her face above me, rubbing the side of my head, talking to me. I felt the pressure of the doctors pushing to get my baby girl out and heard them say she’s here. I asked what time it was, 12:52 pm, and then waited to hear her cry… Silence. I said, “I can’t hear her, is she crying”. My doula looked at my husband who went over to see what was happening. My baby girl came out not breathing due to the medications I had taken for the pain, we were later told by the neonatologist. The NICU team was able to get her breathing with the help of a breathing tube within a couple minutes. Winter Stella came into the world weighing 3 lbs 15.5 ounces, the most beautiful human I’d ever seen. They wheeled her over to me so I could see her before they took her to the NICU, but I wasn’t able to have that initial skin-to-skin golden hour I had been longing for…another moment preeclampsia took from me that day. Devon went with Winter and my doula stayed with me.
The next few days would be just as difficult as the day I gave birth. I had to remain on the birth unit for another 36 hours because my blood pressure was still high, plus I had to stay on the magnesium after the birth. (Side note; I was also transferred over to an internal medicine team because my case “became too complex for the OB team”.)
Again, the first day after the birth is very blurry. I remember sleeping a lot. My doula stayed way into the day, talking with me, supporting me, my husband, and sister. I was exhausted but still wanted to give my baby breastmilk, so my nurse showed me how to hand express and pump… which is extremely difficult to do with an art line and an IV in the crook of your arm. So, the nurses would help me hand express, and when I was too tired to even help, they would ask me if I wanted them to do it and I would say yes. Devon was going back and forth between me and the NICU, showing me pictures of our baby. I was so jealous that everyone had gotten to see Winter already and I couldn’t leave the room. That evening, the NICU nurses surprised me and rolled her down to my room because she was stable and breathing on her own. This first visit is a very foggy memory. I remember all the lights were off in the room except for the bathroom light emitting a soft yellow glow. The nurse took Winter out of the incubator and placed her on my chest. She stayed there for a while, snuggled on me until she had to go back. I watched as they rolled her away from me again. The next time I would see and hold her would be 24 hours later. Even though I had given birth, my preeclampsia was still controlling my body. The doctors were concerned about my liver, my kidneys, my heart, so they were constantly watching my fluid input and output.
I was finally able to move up to the postpartum floor Tuesday evening at around 8pm. The nurse transferring asked if I’d like to stop by the NICU to visit Winter, my heart leaped, “finally” I thought, I can see her. For me, this is the memory I hold as being the first time I held her, because it’s the one I remember clearly, every detail. As the nurse was taking her out I started to try and unhook my gown because I wanted her right on my skin, I needed to feel her next to me to know she was real. My hands and feet were so swollen at this point from the fluids and preeclampsia that it was hard to hold her, but I didn’t care. She was so tiny, my super-baby girl, and her eyes looked right into mine! We stayed for a while and then I went upstairs to the postpartum floor.
The following days were the hardest days for me both physically and mentally. I wasn’t able to leave the bed without help from a nurse because I had so many cords and monitors attached to me. I was still on strict input and output, so my catheter was still attached as well. This strict monitoring was to keep record of how well or not well my kidneys were functioning (and at that point they weren’t functioning as well as they should have been). Instinctually, I felt my kidneys would be fine, they just needed more time. I think all of me needed more time. I started to have problems with my vision shortly after the birth, caused by the high blood pressure. This caused me to see double and unable to focus my eyes. Thankfully this side effect lasted only a few days, it corrected itself once my blood pressure started to lower a bit. My liver enzymes were also lowering, but my blood pressure was still not where it should be. The medications were slowing starting to work, but they just needed to find the right arrangement of medication that worked for me. I kept begging them to take my IV out and put it in somewhere else because it was so uncomfortable. When I had an internal medicine doctor come in to check the fluid in my lungs (I had needed oxygen as it was getting harder to breathe), the nurse asked about the IV and he said “no it has to stay in case her heart fails.” What the hell?? I looked at my sister and friend who were both sitting on the spare cot in my room. I didn’t think death was still an option at this point, but apparently, it was to the doctors.
I had electric leg compressions on, so I wouldn’t get any blood clots from lying in bed so much. All the while, I was still trying to hand express with one hand as I still had the IV placed in the crook of my elbow. It became more difficult to do every time I tried. Of course the nurses would help, but they had other patients to see and they were also more concerned with keeping me alive than helping me pump or hand express every 3 hours. So my sister would help me by holding the syringe to catch the colostrum while I tried to hand express, something neither of us thought we would have to do, but she did it without question. After a couple days I stopped hand expressing because it was exhausting with one hand and I was getting nowhere with it; this was a devastating decision for me and one that stayed on my mind for days and weeks later. Another part of my plan taken from me by preeclampsia, I thought at the time. (I did successfully re-lactate with the help of a wonderful lactation consultant and family doctor, and breastfed for 13 beautiful months, but that’s a different story).
I knew at the time I needed to focus on my own health, both mental and physical, and I couldn’t do that and try to keep going with the one-handed hand expression I was so painfully trying to keep up. So, we switched to formula feeding, which worked for Winter, and we felt supported by all our nurses and family with our decision. The next day the nurses came in excitedly saying that Winter was moved across the hall from me in the NICU overflow, where they put the stable babies when there is no room in the actual NICU. I just stared at them. In my head I was thinking “she may as well be on the moon, because I can’t get out of this bed anyways.” To me, it was harder having her so close but not being able to get to her.
I was extremely bitter in my little postpartum room; hearing babies cry set me off, having the door open so I could see other families going home with their babies made me angry. They had everything I wanted. This bitterness lasted longer than I’d like to admit, but time and talking about it made it easier.
The morning of the 11th I knew I needed a mother figure and I couldn’t have my mom because she was in Newfoundland and wasn’t coming until the 13th. My sister had been an amazing support there is no denying that, she never left mine or Devon’s side. But sometimes you just need your mom. So, I texted the next best thing, my mother-in-law. I said I needed her to come out please and she said “okay, I’ll be there, and Grammy is coming too”. They drove the 2 and ½ hour trip without hesitation. When they walked through the door I just broke down, they held me and listened to me, but most of all they supported me. Devon, his family and my sister fed me when I was too tired to even lift a spoon, they helped me to the bathroom and best of all they were able to get the nurses to bring Winter over so I could hold her in bed with me and cuddle my newborn baby, just like everyone else was getting to do. Over the next few days we had many visitors, supporting us. Devon’s grandparents, his brothers and their partners, his aunt and parents all came not only to meet Winter but to listen and be with us.
At the same time, I was slowly coming off my wires and tubes. I no longer needed the oxygen; my catheter was out (which meant getting up to go to the bathroom every two hours because of all the fluid leaving my body; which also meant Devon having to get up every two hours to help me to the bathroom because I could barely walk. He got up every time I said his name. One time in particular he came over to the side of the bed to help me out and I was in so much pain and just exhausted I said “I just can’t do this anymore, nobody said it would be this hard”, he held me, kissed my head, said “I know, I’ve got you” and carried me to the bathroom). I didn’t need the leg compressions because I was able to get up with assistance from family and friends; the last thing to go was the IV hep-lock, which didn’t come out until almost a week later. I did, however, need bloodwork done twice a day for the week I was in the hospital. After my art line was taken out, they would use my arms for the bloodwork. It got to the point that my arms were so bruised, the nurse would have to take it from my hands or fingers.
Finally, the 13th arrived, which meant seeing my mom and her partner! The day I had been waiting for because as soon as she walked into the room I was at peace. She and my sister helped me to my first shower since giving birth. My legs felt like noodles because I hadn’t been on them for long periods at a time and I hardly had any strength. My mom and sister washed me and my hair, then dried me off and helped me get dressed. Something I never thought I would have to get them to do, but they did it without complaint. There were two friends that were frequent visitors during our hospital stay. One made sure I had everything I needed, both in the hospital and for when we would go home. She brought with her food and her iPad so I could watch Christmas movies in my room, giving me a small piece of normalcy. When she knew I wasn’t breastfeeding anymore she asked her parent friends what bottles were good and then ordered them for us. She also came in to help me fix my artificial nails that had grown way too long and become a nuisance. I was supposed to get them taken off the day Winter was born but clearly that didn’t happen. My friend came in that day with her nail kit and went to work clipping, filing and painting my nails, until I felt like me again. This may seem like a strange detail to include but it was so important to me at the time. I needed to feel like myself again and that beautiful friend helped me do that.
The other friend who visited multiple times during our stay helped me more than she may ever realize. First, she decorated our room for Christmas, complete with a little tree, in case we were there over the holidays. Christmastime is my favorite time of year so that simple act of kindness meant the world to me. Second, and even more important, is that I remember her coming in, asking for a hug, and then saying “I’m sorry this wasn’t what you wanted, the C-section, the NICU, not breastfeeding, all of it. It sucks.” I sobbed. It was the first time that was said to me out loud (even though I’m sure everyone was thinking it). I was being given the space to grieve everything I had lost during my birth experience and the first days of postpartum; loss of preferred feeding, loss of desired birth (i.e. Not C-section), loss of immediate skin-to-skin, loss of being in control of my body. I didn’t realize how much I needed the allowance to grieve all those things. She let me be vulnerable and gave me the space, without saying anything to try and make me feel better. In that moment I didn’t want to feel better, I just wanted to be sad and she held that space.
From that moment I started to feel a shift inside me, almost like coming out of a fog. I could still be in control of my body and my story. I would get my mom or Devon to wheel me over to see Winter as much as I could physically handle. There I would just hold her for hours on my chest (a place where she stayed for weeks after). I had been so scared of missing out on a bond with her because of those first days being away from her, but the bond came after all. And let me tell you, it is a strong bond haha. The NICU nurses that were assigned to Winter are special to my heart. They taught my husband how to hold, feed, change, swaddle and bathe Winter. They stepped in when I couldn’t be there for her.
Then, on one particular day, I’m not even sure what upset me, but I went into the bathroom and looked at myself. Tears staining my cheeks, breasts engorged from my milk coming in (they betrayed me too, I thought to myself, hadn’t they gotten the memo that I was no longer breastfeeding), belly deflated from Winter’s arrival. I came back up to my eyes, leaned into the mirror, put my hands on the sink and had a conversation with myself. Telling myself that it’s okay to be sad but don’t let it consume you, you can do hard things, this is just a moment in time, you will be okay”. Then it was time to do something I hadn’t done in the 8 days since having Winter, it was time to look at my C-section incision. Up to this point I had hated even thinking about my incision because it was not supposed to be there. The plan was supposed to be different. I closed my eyes and slipped off the grey jumpsuit I was wearing, and gently pulled my underwear down past the incision. I opened my eyes and dropped my gaze down the mirror so that I could see it. “There you are” I whispered to myself. I took a breath and looked down again. It wasn’t that bad I remember thinking. The more I looked at it, the more normal and accepted it became.” I can do this, I am not always okay, but I am okay in this moment” I kept repeating to myself. I stopped using the wheelchair to get over to see Winter that day. I built up the strength to walk over, slowly at first, but faster as the days went by.
By this time, I was also ready to go home with my family, the hospital had saved us, but I was ready to continue our journey without their help. My wish was granted, and we were able to go home on Christmas Eve, 15 days after giving birth to Winter, yay! The picture that I have on my phone of us leaving the NICU was taken at 12:52pm. The same time is was when Winter was born, how serendipitous. I met with the internal medicine team 6 weeks postpartum to talk about my recovery and to see if there was any lingering damage to my body. To the doctors’ surprise, my body had recovered completely, it was “as if nothing happened to you” one of them told me. They said I could just go on living my life normally; meaning no more blood pressure pills or blood tests. Even though my body may say “nothing happened to me”, my brain knows the difference.
This experience changed me, maybe not for better or worse, but I am forever changed. Now, 18 months later, I have an amazing toddler that loves to dance to Stevie Wonder, laughs at everything and still loves to sleep in her mama’s arms. I always had the strength to get through my experience, but before I realized it for myself, I had the strength of an entire village to carry me through it (sometimes literally carrying me). Most importantly being my wonderful husband, Devon. Without him, I’m not sure I would have healed (emotionally or physically). To say he is supportive, is an understatement. It’s hard to even put into words how special he truly is. He never faltered during the whole experience (and I know he had to have been going through his own trauma that day Winter was born), doing his best to hold all the pieces together.
I am forever grateful for my village, when I needed their strength the most, they were there for me.
Tonia's story, although not uncommon, is one we don't get to hear about very often. When she reached out to me wanting to share hers, I was so inspired by her bravery and resilience in wanting to change certain narratives surrounding birth. Her story is a reminder that some birth experiences are not magical or positive, and can be very difficult to come to terms with for a very long time afterward, if ever. I acknowledge the trauma she experienced during her journey. Her story reminded me of the purpose behind this series - to normalize birth. This includes all births, and letting women know that they are not alone no matter what kind of birth they experience. It is not often we get to share these stories with each other, in such detail, for many reasons. Some of these reasons may include feelings of shame, confusion, and isolation. However, stories like this, although difficult, foster an even more intimate community that allows us to continue supporting, empowering and lifting each other up. I am so thankful for Tonia's story today, and I continue to be inspired by it. While acknowledging the trauma of what she went through, I also see incredible strength, courage and power in her story and other stories like hers. I hope that any of you that have experienced a traumatic and/or difficult birth can find healing along your journey and a community that connects and supports you. P.S, you are always welcome here!
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