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Monday
Apr072014

Anna's Uterine Rupture Story

On Christmas Day, my husband unwrapped my gift - six consecutive boxes to find, eventually,my positive pregnancy test. We were expecting our second baby the following August.  Through that winter, spring and finally summer, I had a perfect pregnancy. Even in the heat of a southernsummer, I loved being pregnant.  

Early on in my pregnancy, I read a newspaper article about a mom who had chosen to give birth at home after a previous c-section.  It sounded so different from the hospital c-section I’d experienced with our daughter who turned breech at 39 weeksThis mom described her birth as “empowering” and her story was so full of emotionWhat a relief it would be not to be separated from my 2 year old daughter and have her welcome her little brother as soon as he was born.  How comforting it would be to walk my own halls – or better yet, the garden – as my contractions progressed.  How nice it would be to not be caught on the hospital conveyer belt of pregnancies, but have a midwife who knew me and my family, attending.  I contacted the midwife mentioned in the story to see if she would be willing to have a patient over an hour away from her practice.  To my surprise she said yes, and our journey began. 

We took our preparations for our son’s birth seriously. We studied pain management techniques, I was active and did weekly yoga.  I found a local doula and signed up for childbirth preparation classes.  We also grappled with days of doubt.  We asked our midwife hard questions about recognizing problems before they became emergencies: How would we know if something wasn’t right? “I’ll know” she assured usAnd as a Certified Nurse Midwife with 10 years of hospital experience, as well as experience with hbacs, I expected her to know what she was doing, how to manage the risks and when to transfer to the hospital.

Finally, at 40 weeks and 2 days, we thought Christmas had finally arrived.  I woke up at 1am in intense pain, but figured I should try and rest for as long as I could.  There was no resting.  I called my midwife, barely able to talk through my contractions.  She was at another labor, but promised to send another midwife from her practice.  My nerves kicked in - this was not what we had planned. I remembered my husband predicting the midwife would not be there for us when I went into labor on the long drive up to one of the many appointments she had cancelled.

The sun rose.  The alternate midwife arrived.  The pain increased. I couldn’t move, I couldn’t breathe, I couldn’t focus and around 7am said I needed a break.  I knew that was supposed to be a sign that my labor was transitioning, but I also knew that the pain I was experiencing did not feel like the pressure I expected; it was too raw.  I did not feel empowered, I felt vulnerable.  Nothing about this was “beautiful” or “healing.”  Hours had passed.  The water in the birthing pool had been warmed up again and again but was no longer offering much comfort. expressed my concern that I was experiencing the “wrong kind of pain.”  There was a strange popping sensation. The midwife had no answers for us.  My husband noticed that my abdomen looked asymmetrical and pulled our midwife aside to express his concern about my pain.  The midwife said everything was normal; he continued to encourage me accordingly.  For hours.  

I remember seeing a hummingbird at the window, hovering, curious over the roses my husband had put in the window for meThen, in one contraction my whole body suddenly felt like it was tearing apart. I thought my son was descending; in reality it was my uterus rupturingMy midwife tried to check my son’s heartbeat.  I could hear the faint dull, slow, thud.  60 beats per minute when it had been in the 130s.  And then the vomiting and shaking started.  I closed my eyes and did not open them – willing the world to go away.

After eight hours of labor there was nothing my midwife could do to save our son.  There was no operating room in my kitchen.  She only had a pediatric oxygen maskWe put in a 911 callimmediately but even with the EMS arriving within 10 minutes it was a further 15 before they had managed to get an IV in and we were even on the move to the hospital, each bump in the road causing all-consuming ripping pain.

By the time we reached the hospital by ambulance – under 8 miles away  Brody had no heart beat.  He was gone.  I prefer to think that he died when I felt him struggle upwards out of my uterus while we were still at home, than in the ambulance to the sound of my screams to get him out.  

I am lucky to be here after the volume of blood I lost.  Without the rapid transfer I would have bled out.  When my surgeon performed the emergency c-section I needed to deliver my dead baby even he was shocked.  My uterus was – in his words – shredded.  Brody was lodgedagainst my liver.  I had insufficient blood volume for anything other than general anaesthesia to work.

I will always regret the gamble I took with our son’s life.  If I had been in a hospital, continuous monitoring could have shown that Brody was experiencing trauma; that my contractions were not the right intensity given the pain I was experiencing; and my rupture might have been caught early enough to have given our son a fighting chance of survival.  Aultrasound later in my pregnancy would also have shown he was going to be big – 9lb 2oz – rather than the 7lb my midwives guesstimated.  An obstetrician might have raised concerns about the short time, just 10months, between my pregnancies, and warned me of the risks involved with being too far from an OR.  There’s a reason ACOG’s guidelines recommend hospitals who allow vbacs have an OR available and staffed 24 hours, 7 days a week.  I had come to believe in “trusting birth” and “trusting my body.”  But my body broke.

If we had been in a hospital I would probably not tell myself every day that not only did my choice to give birth at home result in the death of my baby, it deprived my husband of the gift of a first son, and took away my daughter’s chance to have the little brother she now asks to go rescue from heaven in a rocket ship.  We all want him back.

In one out of every two hundred vaginal births after caesarean, the mother ruptures.  But, I had a perfect pregnancy – why would I be that one?  The bigger risk – surely – was “unnecessary interventions” inevitably leading to a repeat c-section.  I did not know how quickly my baby could die.  I did not know that the hospital would be too far away to save Brody.  I did not know that I was gambling on my son’s life for the sake of an idyllic birth at home.  

I know there are lots of stories of mothers who have had a great experience birthing at home.  They were very, very fortunateI need you to hear my story: parents who suffer tragic HBACoutcomes do not tend to speak out because we know it was our choice. But, the absence of their voice should not give you the false impression that heartbreaking experiences like ours don’t happen.  They do.

My medical records state “13:15 client stable, holding baby”.  My warm, pink, perfect baby who quickly began to turn blue.  I stroked his soft cheek, willing him to come alive in my arms as thetears fell on his closed eyelids.  There was no magical fairytale ending to break the curse.  No true love’s kiss could make him breathe and let me look into his eyes.  My hummingbird had flown.  We love you Brody, I’m so sorry I let you down.  xxxx

“i carry your heart with me (i carry it in my heart).”  ee. cummings

References (2)

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  • Response
    A woman only can understand how much difficulties faced during pregnancy periods. It adds more difficult when the uterine was rupture. I feel your sorrow and understand what I should do for my personal purposes and I should do this by myself. My husband will have to visit out side of ...
  • Response
    - Navelgazing Midwife Blog - Anna's Uterine Rupture Story

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