Bringing Ava into the world...Guest post by Kate Turner

"Dealing with a wife who scraped by with her life is not part of anyone’s birth plan."  Here is the birth story of my daughter through the eyes of my wife, Kate.

I just realised that my daughter, Ava, has been alive longer than I was pregnant. She is a happy, healthy and curious 9 month old. We have both learned and grown so much in that time. I look at her and cannot believe that my husband and I have a child.  Then I remind myself that she also has two healthy parents. Only now am I starting to process what happened around her birth, which even a generation ago may have ended very differently.

For the most part pregnancy suited me.  We saw this little shrimpy thing with a heartbeat at a 6 week ultrasound. I had the opposite of morning sickness, instead I was starving.  I jokingly referred to myself as a Hobbit, eating first breakfast, second breakfast, elevensies, lunch, etc. When we started telling friends and family that I was pregnant, most people were surprised.  I didn’t seem pregnant.

18 week anatomy scan.

Second trimester continued in the same way as the first.  I slowly started getting bigger.  In various ultrasounds, our little girl liked to keep her hands on her forehead.  I had terrible insomnia but decided to use the bonus time to research baby gear.  My body was getting ready for sleepless nights anyway.  I’ll never forget looking at my feet one day at 9 am and noticing that they were swollen.  It’s all normal everyone said, so I just accepted my new cankles.  

7 months pregnant

By third trimester things started getting real. I was feeling pregnant now.  My legs were painfully swollen.  All day, all night, even when wearing sexy compression stockings. My wedding rings stopped fitting.  Insomnia continued.  It felt like I was putting on huge amounts of weight daily.  Nothing mattered once I felt those awesome flutters and kicks inside me.  Baby was growing, moving, good heartbeat.  We registered for baby gear, attended prenatal classes, our family hosted a lovely baby shower.  Yet each week became harder than the last.  For the last 3 months of my pregnancy, I could barely walk home from the subway station at the end of the day.  I would have the most terrible abdominal pains or cramping.  Of course these things can be normal for pregnancy especially at the end.  I dutifully went to all my prenatal appointments.  Everything always checked out.  

Around 35 weeks pregnant, I started to sleep a bit better.  Months of insomnia left me perpetually tired so I slept.  But my once a night bathroom breaks became twice a night, then three times a night. Baby was getting bigger so there was less bladder room.  I described myself as tired and sore whenever someone asked.  

At 36 weeks pregnant I had a wonderful prenatal massage.  The massage therapist asked me whether I was sick.  I confidently said no my OB says I’m fine. He casually mentioned that usually prenatal massage helps with swollen legs and feet but my swelling was not going away.  He said that type of swelling was usually from protein build up in my tissues.  I completely dismissed his comments at the time and didn’t not fully appreciate his words until after our daughter was born.

Baby had been kicking like crazy but this slowed down too.  There is no room in my belly anymore. At 37 weeks, I started kick counts because her movements had changed.  Random strangers literally stopped me to ask whether I was carrying twins. No joke - 5 times in 2 days.  I was huge!

38 weeks pregnant marked the beginning of my maternity leave.  No one can really be ready for parenthood until it hits but we were ready to have a baby - hospital bag packed, car seat ready, the hospital's decision tree for going to triage posted on the fridge.  The weekend after I finished work I slept all day and all night only getting up to drink, eat and pee.  It was like some weird reverse nesting.  I’m sure most women say this when pregnant but I said very honestly to my husband, “I don’t think I can do this anymore.”  Then I started vomiting for the first time in the pregnancy.

It was the middle of Sunday night and I got up feeling ill.  After my third trip to the bathroom, I started wondering if this vomiting was possibly the beginning of labour?  My mind was so foggy.  I called my doctor at 6 am Monday morning, which was the time of day he checked his messages for nonemergency calls from OB patients.  

Come in right away, my OB said. He did the usual checks.  I was not in labour.  My blood pressure was higher than usual.  Protein in my urine was a touch high but nothing out of the normal range. He had trouble finding the baby’s position at first.  Your belly is very tight, he noticed. Baby’s heartbeat was good, thank goodness. Then he did a neuro screen and I was hyperreflexive.  Hm.  That’s odd.  Off to triage at Mount Sinai Hospital I went to get bloodwork done.  My husband and sister were put on alert.

My bloodwork shocked the doctors, I was encephalopathic, which was caused by liver failure. Excuse me what? I had developed a rare and life threatening condition that could only be cured by delivering the baby immediately.

Shortly after being admitted, my left eye was not congruent with my right = double vision.

I was completely thrilled to be done with pregnancy.  Do whatever you need to do, I told the doctors enthusiastically.  I was admitted and put on a very mellow-inducing magnesium sulfate drip to prevent seizures. I was induced and labour started.  Labour was masked by the constant abdominal pain of my enlarged liver, which I had likely endured for weeks.   Epidural?  Absolutely not, too risky with liver failure said the anesthesiologist.  What?  No epidural?  Are you kidding?  The team put together an IV pain pump for me.  What if I need a C-section?  Too risky, you need to deliver vaginally.  So I did. To the surprise of some of the staff who said in hindsight they didn't think I would be able to. After 8 hours of labour, I delivered a mellow (thanks to the magnesium and pain meds) but healthy baby girl, who needed some help to breathe for the first 10 minutes or so.  I briefly panicked watching my daughter get worked on by the respiratory therapist but she was soon swaddled and in my arms.  We were so happy.  Ava was perfect and adorable and big!  Weighed in at 8lbs 14oz. 

Relieved and content.

In our happiness, we were completely blind to the fact that I was still very, very sick. My complexion had a yellow glow of jaundice. I had double vision.  My liver was still failing, my kidneys had taken a hit, my brain was not right and my lungs were not great.   We had no idea that I was going to get worse.  The labour and delivery nurses took care of Ava the first night she was born.  Breastfeeding?  I was told not to worry about that for a bit.  Just rest.  And I did. I remember having my sheets changed by the nurse after delivery and I could not move my legs.  Weird I thought, then fell back asleep.  My vitals were checked every hour.  Bloodwork was done every 4 hours.  My arms were bruised and battered.

The situation allowed for everyone to get lots of cuddles.

Since being admitted, there had been a steady stream of specialists at my bedside.  I had no idea who was who.  Eventually I could no longer make decisions for myself so my husband took over.  I only remember brief moments of the days that followed so my family has since filled in the blanks.  When I was awake, I tried to sound with it.  My best question was: When can you stop q1h vitals? That question (in part) prompted the team to move me out of labour and delivery after 3 days of being there.  The high risk OB on staff looked very concerned and told me that I would not be going to the mother and babies unit but to a special high risk unit so the team could keep a close eye on me.  When can I go home? I asked.  The OB said maybe in a week or so.  What? A week?  The magnesium sulfate drip had been stopped and reality was starting to kick in.

By this point it was Thursday.  I was in a semi private room.  Ava had her first bath without my help.  I hadn’t eaten since Sunday.  I was still having bloodwork done every 6 hours.  Ava was formula feeding, which was fine because I couldn’t walk or really move much.  My husband looked like a deer in headlights.  He was doing everything.  Dealing with a wife who scraped by with her life is not part of anyone’s birth plan.  Our families were amazing and took over helping Jon, Ava, and I.

On Friday morning, a resident came in and told me that my bloodwork had started to improve!  She had never seen a patient so sick turn a corner so quickly.  I was still sick and fluid restricted but could start eating.  I did but food didn’t stay in me the first day.  I’ll never forget a friend visiting who is a doctor at the hospital. She is a mom, she got it and knew what I was going through.  I didn’t have to explain and appreciated her words.  Nobody else in my life had ever heard of this unusual form of HELLP syndrome.

Saturday I started to walk again.  The first time was brutal.  I needed my sister-in-law to hold me.  That weakness continued for several weeks postpartum.  By Sunday I was getting stir crazy.  When could I get out of this uncomfortable hospital bed and sleep in my own bed?  That question prompted the team to get us discharged.  Just like that we were home!  We had lots of appointments in the following weeks with tests and bloodwork.  Plus a LOT of work to help Ava breastfeed, which we did successfully (and still do).  My family continued to help for the following weeks as I wasn't able to physically cope on my own or take care of a newborn.

Home.  Still had a touch of jaundice.

Postpartum my liver and kidneys needed to recover.  No Advil, no Tylenol.  I was in pain but the pain was nothing compared to being pregnant. My nonpregnant, recovering from multi-organ system failure self was on a high.  I felt GREAT!  The exhaustion, the breathlessness and the muscle weakness seemed easy by comparison.   I had the usual postpartum hormonal moments but my tearful thoughts were always full of all consuming, overwhelming gratitude.  Gratitude that I was alive and able to be a mother. Thankful that Ava was full term, healthy and perfect.  Grateful for my family and friends who stepped in and to my husband who turned into Superdad overnight.  So appreciative for my OB, the high risk team, lactation consultants and all the medical teams involved at Mount Sinai Hospital. That’s right, we are over the moon to be a family of three.  

In sharing my story I've learned that every parent to be journey is traumatic and beautiful no matter how smoothly everything goes. As a health care professional myself, I am very aware that it could be much worse.  It may be a struggle to conceive, adopt or an unplanned pregnancy. There may be debilitating morning sickness, an unexpected C-section or postpartum depression.  Maybe it is a colicky baby, a sick baby or a loss. Sometimes life gives us a more than we expect to deal with but thankfully we learn and grow.

Our first family photo.  Ava is 10 days old.