Dream you’re mine

The journey from miscarriage to whatever comes next

The induction–making the decision to induce August 20, 2009

So to quickly recap my previous posts, I went to the hospital for an assessment after calling about having a two day headache.  I ended up being admitted on Wednesday night for additional testing to assess how my body and the baby were doing.  Thursday was pretty uneventful.  I had to be in bed, collect all my pee, have some blood tests and get my blood pressure checked often.  The intent was to do a 24 urine collection to assess for pre-e, but they decided to have the lab run it as a 12 hour test and extrapolate the results from that.  My labs had started coming back with abnormal results–hemoglobin and urich acid (not sure on spelling, but it assesses liver function) stick out in my mind, but there might be others.

My husband left as I was getting ready to go to sleep around 11 or so.  Around midnight, the doc comes in to talk to me about the results and options.  I was in a gray zone.  My various labs were coming back with worsening results, but they weren’t so bad that we had no option but to induce or have a c-section.  I’d been having weekly doctor appointments, so it was great to have a baseline for comparison.  For example, I hadn’t had even trace elements of protein in my urine throughout the pregnancy.  Suddenly last week, there was protein in the urine.  So even though my lab results weren’t coming back as horrible, we-must-get-the-baby-out-now results, we could see the trend of the results continuing to get worse even in the day I had been there.

The doctor explained that I was teetering on the edge of pre-eclampsia and it was a matter of weighing the pros and cons of the situation.  It was obvious that my results were getting worse and what direction they were headed.  The problem was the unpredictable nature of it and nobody could say when that point would be that things would skyrocket.  She felt that at the most, we could hold off a few days, but I would not be pregnant in terms of weeks.  She also explained that at the gestational age I was at (34w5d), I’m far enough along that they do not try to stop labor for patients who are having pre-term labor.  So was it worth waiting each day, running more tests and determining when would be pushing the limit on how long to take this pregnancy?  The downside was that things could escalate very rapidly and either of us could be at risk.

It was a lot to process.  I asked the doc what she would do.  She said she isn’t 100% objective, because she has seen this escalate very quickly and the worst case scenarios, but that she would induce.  She also said she talked to two other docs at the clinic and a perinatologist and they were all drawing similar conclusions about my case.

I couldn’t make this decision without my husband, so he came back to the hospital.  I took a shower just in case we decided to move forward with the induction.  We also talked to our doula about it, who thought it made sense to induce after hearing all the factors.  She recommended getting a good night’s sleep and starting the meds in the morning though.  After all the losses and getting this far, we just couldn’t see pushing the pregnancy further and compromising the baby’s health.  Mine came into play too, probably more for my husband.  But it was a tough decision.  There was no way to know if we were making the right one.

So the process to induce was going to involve pitocin and magnesium sulfate.  The mag is not normally administered for induction, but I was given it to prevent a seizure or stroke given my condition.  Even though the doula recommended waiting until morning to start all meds, we moved forward with the mag immediately because my bp was 198/105.  This was my bp on medication.  Scary stuff.  So the mag started around 1 am, which relaxes the smooth muscles.  From that point on, I was hooked up to an IV.  I was also constantly monitored for my bp and had two monitors on my belly to assess baby’s heartrate and contractions.  We both tried to get some sleep and the pitocin was started around 7 am.  At that time, I was dilated 2 cm and effaced, although I don’t remember if I was still at 50% then or it had increased a little from there.

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