Learnings from an Emergency Cesarean Delivery

It's Pulô's birthday month! This time last year i excited but at the same time nervous about the arrival of our little boy! To say that we are looking forward to seeing the little one is an understatement. I guess every parent is over the moon excited so looking forward to touch and cuddle the baby. But along with the excitement comes the preparation. Like many expecting parents, we had a very loooong list of things to do and prepare back then.

We thought that since i'll be having SCHEDULED C-SECTION naman, malamang hindi na kami mabibigla! BUT NO! Baby was excited to come out. We chose January 13, 2012 as his birthday but he had other plans and came out on December 22, 2011. Humabol pa sa Pasko!

Although we had most of the baby stuff on hand,  we were still caught off guard.

[caption id="attachment_1477" align="aligncenter" width="300"] Having a baby is among the events is our lives that need utmost preparation... but all the stress is worth it when you finally hold that little bunch in your arms. Best Christmas gift, ever![/caption]

Here's a few things a mama can do  before the big day! It pays to be prepared, i'm telling yah!

Get these things ready as early as your 7th month: 

Baby bag containing everything you''ll bring to the hospital

• Set of clothes that he'll wear when he's discharged 


• Mittens


• Socks


• Receiving blanket


• Diapers

Bag containing your clothes after giving birth 

• Loose blouses and pants or shorts (it will be easier to put on if they were a little loose) 


• Nursing bra


• Maternity panties


• Maternity pads


• Nursing cover (for privacy when you breastfeed or pump)


• Toiletries

Bag for your hubby

• Change of clothes


• Food


• Toiletries


• Cellular phone


• Stuff to keep him busy like Ipod, books, etc

Food for the visitors. 

• You may be a bit groggy after the operation but your well wishers will surely go hungry! 

Money and documents

• Put money in the safe place, like a carry-on wallet  that your hubby can wear.  All the documents like your Philhealth form, SSS form  should be neatly kept in a plastic envelope.  

Update your Philhealth and SSS records.

Do the checking and updating as early as possible. If you're employed, notify your Human Resources Department about your condition. Notify them as early as possible.  Aside from updating your records, be sure to check if in deed you are updated with your monthly contributions.

Have your status and your contributions updated. This is really important, i tell you! This way, you won't have to shell out money anymore since all the Philhealth deductions will automatically be reflected in your bill! Be makulit about this, kung ayaw nyo maging sobrang laki ang babayarang hospital bill!  Hubby and i were really broke after i was discharged because the deductions from Philhealth were not reflected in our hospital bill upon discharged.  Learn from our mistake of not being makulit enough. We underestimated the inefficiency of some HR staff who did not update our records on time even if we passed all the requirements early.

Since the deductions were not reflected on our bill, we had to personally file for reimbursements. It  was really a a hassle, which can be avoided. So  again, please please please, double check with your HR to see if they've updated your records!

Aside from the hassle, you'll have to wait long for the check from Philhealth. If i remember correctly, the check was released 2 months after we filed for reimbursement!

For SSS, you have to fill in a maternity notification. If you're self employed and have an online account with SSS, you can notify them of your pregnancy through the internet.  If you have to undergo a cesarian delivery, you need to pass a medical certification from the OB that you'll be having CS.  Mas malaki ang maternity benefit pag CS.  If you do this early, you can get your SSS maternity benefit even before you give birth!

Bring these important documents to the hospital: your SSS ID, Philhealth ID and the updated Member Data Record from Philhealth. Some baby blogs and websites recommend bringing a birth plan.

Prepare your breastfeeding stuff early on.

Among the things i planned to buy weeks before i return to work was a breast pump. But that was wrong pala! Based on my experience, i needed the pump even before i returned to work. Sadly, baby was not well enough to directly breastfeed. Since he was a few weeks premature, he had to be confined in the NICU and i was not able to directly breastfeed him until three days after his birth.

On events like this, you'll have to have a breast pump. You'll need to breast pump or express milk if you can't latch. So hubby bought a manual pump while i was still in the hospital.  The manual pump was a big help, don't get me wrong. But we won't need it if i had the double electric pump i'm using earlier.

So i recommend getting your dream pump even before giving birth. Read this for more tips on getting ready to breastfeed. If you can't get that pump beforehand, then you can always learn how to express milk by hand. After you gave birth, it's important that your breasts are stimulated to initiate breast milk production.

Get a steroid shot.

If you're a complicated case, your OB might ask you to get steroid shots. The steroid is injected to you tomature baby's lungs. I had this shot on my 7th month and believe me, i'm very thankful that i did!  Read here for more about the shot.

Before your maternity leave, leave things in order.  

Of course you'll have to notify you boss ASAP about your pregnancy. You also need to update and have things in order before you take your leave.  So while pregnant you'll have to work doubly hard to ensure you won't leave too big a backlog, or at least finish the requirements you promised before you take the leave. 

Baby came a day before my expected leave so i was not able to officially turnover my tasks or even formally say goodbye.  For working preggy moms, it's a must to have things in order before going on that much awaited maternity break.

Bring these extra stuff to bring to the hospital: 

• blanket, mats and pillows so you wont't be charged extra.


• extra food for your visitors


• books for you to read eg baby books and magazines

Some hospitals charge extra when you request for more blankets and pillows so better to bring your own.

Bring the  camera! 

This was my frustation that time, i can vividly remember my OB asking for the camera seconds before i heard bebe cry.  Hayyy... kung kaya ko lang bumangon noon lalabas ako at kukunin kahit ung camera phone ko. Too bad we did not have baby's first ever pics.  So to expecting moms, prepare and charge that camera and have it on hand every time.

Moms, daig ng maagap ang masipag. That's what the old people say. And actually it is in deed very true, especially for someone who's expecting.

Also worth reading:

• My pregnancy complication: placenta previa


• Do's and don'ts with placenta previa


• Downloadables for Pregnant moms 

***

From Humps to Bump: The Road to Getting Pregnant

What does it take to get pregnant? Well, you'll have to have sex of course! But getting pregnant, for some moms is not on voice command. Some mommies, like me, took a long road before getting there. But here's a thought, timing is key! When all the stars converge on that fateful moment , you'll get the two lines in that P test. Actually, sa tagal na din naming nag-try, dumating din sa punto na nagduda din ako sa sarili ko, baog kaya ako? Hindi rin pala ganoon kadali magbuntis. We’ve been actively trying for almost a year, wala pa rin? Naasar nga ako kasi at 28, diba dapat hindi ko pa ito pinoproblema?

[caption id="attachment_1186" align="aligncenter" width="300"] "Kung uukol, sadyang bubukol." This was our mantra before husband and i got pregnant.                                                    Source of Photo:slocounty.ca.gov[/caption]

Aside from waiting for the stars to converge in approval of your pregnancy, here's what you can do:

Have an OB workup

• Even before we got married, hubby and I had our fertility assessed. Para mayroon kayong idea kung anong steps ang dapat gawin. Some suggest going to the OB after one year of actively trying.


• Aside from the routing BP and weight check, the OB gave me a pap smear. I had to undergo physical exam and vaginal ultrasound.My hubby had to have a sperm count. We were ok on all our tests, happily.

Initially the OB will give you tips on getting the the "expecting" road. Among the tips we got from our OB:

• Put a pillow under you butt after sex, to help the sperms get where they're supposed to.


• Have a good rest on your fertile days, stress decreases your chance.

Know your fertile days.

• Your OB will assess your menstrual cycle. She'll plot your ovulation calendar and  your  fertile days. At this point i was kinda questioning the pleasure of sex. Imagine, may schedule na ang sexy time. Kaloka. Pero, dito na nga papasok yung timing eh.


• Here’s Web MD ovulation calendar if you want to get a general idea of your fertile days. You'll have to input the first day of menstruation and it's gonna calculate your fertile. Maswerte ang mga may regular menstrual cycle, madaling malaman ang kanilang fertile days.

Take multivitamins or supplements with folic acid.

• Take prenatal vitamins with folic acid. Folic acid is essential for  pregnant women. This prevents birth defects babies like spina bifida and clept lip.


• Take folid acid even before you get pregnant. According to womenshealth.gov by the time a woman finds out she is pregnant and is not taking folic acid, it may be too late to prevent those birth defects.If i remember correctly, i was taking vitamins with folic acid 2 months even before knowing we're having a baby.


• WebMD lists these food as good sources of folic acid from:
  
  
  
  • Leafy green vegetables, like spinach, broccoli, and lettuce
  
  
  • Beans, peas, and lentils
  
  
  • Fruits like lemons, bananas, and melons
  
  
  • Fortified and enriched products, like some breads, juices, and cereals

Eat healthy.

• The OB did not say if there are foods for moms hoping to get pregnant, or for aspiring dad, too. But i guess since eating more fruits and vegetables makes your healthier, then this increases your chances of getting pregnant!

Exercise!

• Overweight women tend to have difficulty getting pregnant.


• Women falling in the healthy catergory have better chances of getting pregnant. To check your ideal wait, use this body mass index calculator. Your BMI should be in the normal level. Nasa borderline ako ng normal at overweight before i got pregnant. So medyo nag jogging, biking ako ng konti.

Go for a healthy lifestyle.

• Quit smoking.


• Limit caffeine.

Before moving ahead....  This was what went through my mind... And i think every couple should think about this too. Consider these questions: 

What's your ideal age to get pregnant?

My parents used to say, the mid20s was the ripe age to have kids! Kumbaga your body and status is at its "prime". My friends and i went philosophical discussing this.  Well,  I believe there’s really no RIGHT AGE when it comes to having a baby. What matters most is whether or not you are READY – emotionally, physically and financialy. Sino ba ang magsasabi na READY ka na?

Am i financially ready to raise a child?

Raising a child calls for so much expenses - like the hospital bill from giving birth, buying baby products, regular immunization shots, etc. It can get crazy when you try to put a number on this one question - how much is needed to raise a kid?  Pero kailan ba magiging sapat ang kinikita natin, para magka-baby? I think i can't really put a number on the amount i need to raise a child. Right now, we getting by ok naman...

Gaano ba ka-ready ang gusto mo? i think that's the question. When the right time comes, you'll be ready.  Every pregnancy is different. You'll just have to move on and learn as you go!!! It's true what most moms say, having a baby is worth the wait!

***

Do's and Don'ts with Placenta Previa

To give a clear view of what to expect with placenta previa, let me recall what happened when baby was born.

Baby had very low birth weight. 

• Pulô's birth weight was just 4 pounds and 13 ounces or 2,177 grams. This was 300 grams less than what's considered normal. In the Philippines, babies less than 2500 grams at birth are considered low birth weight infants. That he was delivery prematurely contributed to such low weight.

I had emergency cesarian delivery.

• Husband and i were discussing which day in the third week of January 2012 was a good birthday for P.  But all the discussions were futile. I had severe bleeding, 10:30 am of  December 22, 2011.  Things happened very fast after that. We called the OB, she said i will be delivering baby that day so  I was brought to the hospital. At 11:30 am I was on the operating table. At 11:44 am, i heard my little one's first cries!

Baby was born premature. 

• We were all worried because baby wasn't due for another 3 weeks! When baby was finally cleaned and tested, we found out that baby was on his 36th week. According to the pedia,  37th week was considered full term.

Baby was in  NICU for one week.

• Bago pa ako manganak, sinabi ko na kay husband, "Ang sakit siguro kung madidischarge ka tapos maiiwan pa sa ospital si baby!" Totoo nga, base sa experience ko. I was discharged on Christmas Day and it was also the first time i ever held by baby boy! But it was also the first time we had to leave him. Since baby was 1 week short of a full term, he had to be left in the NICU. He was put under observation and was confined in an incubator. This was supposed to make up for the 1 week remaining of the time baby should have been inside my womb.

I had blood transfusion post delivery.

• I think i lost about 500ml of blood in that prebirth bleeding. Bleeding was painless but we were really alarmed. My husband was shaking when he saw all the blood. Akala ko kasi napaihi lang ako bigla. Yun pala, dugo na ung lumalabas sa akin!  One day before i checked out of hospital, i received blood thru transfusion. It was a painful experience, by the way, as blood kept flowing back into the pin.

Placenta previa is manageable. Extra effort is required to ensure your own and baby's safety.  Check my previous post if you want to know how this pregnancy complication is diagnosed.

[caption id="attachment_3267" align="aligncenter" width="300"] All your worries and fears about this condition melted when i finally held my newborn in my arms![/caption]

Here are some do's and don'ts when dealing with similar condition.

Do’s

Do take extra care.

• Placenta previa is considered high risk. Be careful and think twice before doing any activity. Seek clearance from your doctor if you need to take long trips, undergo an exercise routine or want to take any new medicine or supplement.

Take a break if you get tired.

• Pregnant moms get tired easily. Getting tired can cause contractions of the uterus, which is a no-no for previa patients.


• After my first bleeding episode I had to spend two weeks on bed rest. It was really frustrating.  Sayang, kasi na-imagine ko ang sarili ko na nagwa-walking sa UP habang buntis.


• Not all previa cases need to take full bed rest for the remainder of their pregnancy. It’s based on one’s situation: how far along is the woman and how severe the bleeding is.


• I was working while pregnant. I had many absences when after i had  bleeding on the fourth month. That's when i was diagnosed with placenta previa. After that i went back to work, but i was extra careful - no climbing stairs, no comutes, no standing for too long.


• My OB wanted me to take a maternity leave as early as 7th month, but i couldn't bear to leave work. I couldn't take any more forced bed rest! I really thought going on leave that early was OA! I pleaded with my husband so i could just take the leave in the 3rd week of December, that's on my 8th month.  I said i'd die of boredom at home. He said yes but made me promise to be extremely careful, that i'll go home if i feel any contractions! My last day at work should have been December 23.But  baby wanted to get out early! He made his grand entrance on December 22.  We were prepared, but we could have been MORE prepared!!!

Be on the look out for any spotting in any stage of your pregnancy.

• Always wear light-colored undies so any spotting will be seen easily.


• Inform your doctor at once of any bleeding.

Follow your checkup schedule and if possible, heed your OB’s instructions.

• Your OB will give you clear and proper advice. Ask any questions, no matter how no brainer you think they are. It pays to be makulit!

Eat lots of fiber.

• Fiber softens your poop. Pooping should be effortless, so you don’t strain.  You’ll be instructed to drink iron supplement, which tend to harden your poop. Banana was off limits as well since banana hardens poop. Some fiber rich foods include pears, oatmeal, whole wheat breads. It's also good to include prunes and yogurt in your diet, these aid digestion.

Consider getting steroid shots.

• Past 7 months our OB instructed us to get Diprospan (betamethasone) shots.  Steroids will help mature  baby’s lungs.  We were hesitant to get the shot but my doctor explained why we needed it.  In my case daw kasi, bleeding is imminent, lalo na habang mas lumalaki ang tiyan ko. Our OB says that steroids will help prepare baby’s lungs if I had any bleeding in my last trimester. Getting the shot was a life saver because my baby was born one week before full term!


• OB gave us the steroid prescription. We had to scour hospital pharmacies because steroids are not readily available in most drugstores. Once we have the right drugs and enough dosage, we went to the hospital emergency room, where a nurse administered the steroids. She injected half of the dose on my left arm. Then the other half was injected on the right arm the next day. As i remember i was on my 32nd week when i got the shot.

Pack your hospital bag early.

• Severe bleeding beyond 7 months will lead to delivery. We didn’t pack our bags early on so we were caught off guard. Our baby was born earlier than expected. We haven't prepared the baby bag yet! Sure, we bought and washed all his clothes and other supplies but it was still a mess. As a result, we really had a hard time getting organized at the hospital. Prepare your actual hospital bag and its contents on the early part of the 7th month, to be safe and ready!

Don’ts

Don’t climb stairs, even just 1 storey.

• Always use the elevator when getting from one floor to another.  Climbing can be tiresome for pregnant moms, especially in the last trimester because she's getting heavier.

Don’t ever allow pelvic exam or internal exams.

• This was one of my OB's strict orders. Internal exams can reach into your cervix, then into your placenta. Any poking of  sorts can lead to bleeding. Explain this to any physician or nurse who intend to examine you.

Don’t do excessively strenuous activities.

• Unlike other moms-to-be who were advised to exercise, I was limited to bed rest. My OB says it’s better to be safe than be sorry.


• Speaking of strenuous activities, we were also banned from having sex. This was really a bummer. Husband and I had to be  celibate for the remainder of my pregnancy. Hayyyy… My boobs were also off-limits since breast stimulation can induce contractions.

It made me very thankful i had a safe pregnancy. Husband and I are lucky because we knew of the complication early in the pregnancy. We're also thankful that we had a good OB, who, aside from being an expert ,  was very  patient in answering all our questions.

Having conquered placenta previa, I wondered. How about those pregnant women in the far flung barrios? Access to an ultrasound is limited in these areas, how can they know if they have this condition? This could be why maternal mortality is high in our country!

Also worth reading:

• My pregnancy complication: Placenta Previa

***

My Pregnancy Complication: Placenta Previa

My pregnancy story is not at all riddled with groans and pains of labor in a vaginal delivery, as i imagined it would be.  I had to undergo cesarian delivery, not by choice but out of necessity. My baby had to be delivered via c-section because of a pregnancy complication known as placenta previa.

What is it?

The American Pregnancy Association defines placenta previa as a "condition where the placenta lies low in the uterus and partially or completely covers the cervix."  I understood it as the condition wherein my baby can't pass through my vagina because the placenta blocks his passage.  The placenta is the pancake-shaped sac inside uterus that holds blood, nutrients and food for my unborn baby.

[caption id="attachment_465" align="aligncenter" width="300"] Source of Photo: tbh.org[/caption]

How it was diagnosed

Four months into my pregnancy, i was rushed to the hospital because of spotting.  We got worried because it was the first time ever that i leaked some blood.  The OB in the emergency room ordered an ultrasound. I  had to be admitted for overnight observation.

At the ER i was asked several questions like:

• "Nararamdaman mo ba parang may menstruation ka before ung bleeding?"


• "Napagod ka pa recently?"


• "Kailan ang last contact nyo mag-asawa?" Translation: Kailan kayo last nagsex?

Yup. That intrusive. But ok lang, para maliwanagan ako, saka ung mga doctor kung anong nangyari.

When the ultrasound results came out, my OB confirmed it. Placenta previa nga.  Hindi lang basta previa ha. Sa ultrasound report ang nakasulat: Placenta Previa Totalis. This means, sobrang laki nung overlap ng placenta at nung opening. This means the placenta completely covers the cervix. Argghhh...

It was the first time i ever took placenta previa seriously. I read about this haphazardly in the book "What to Expect When You're Expecting" but it didn't really strike me as important. From then on i tried to know everything about this condition.

Doctor's orders

I was ordered to have a 2-week bed rest after the scare of my first spotting event. So bale, naka-emergency leave ako for 2 weeks. Complete bed rest daw talaga kailangan para ma-relax ang uterus ko. Tumatayo lang ako sa kama pag kailangan mag-weewee at mag-poopoo.  OB also prescribed duvadilan twice a day and once when i feel any contractions. In my medical certificate, i was ordered bed due to threatened abortion...yikes!

A note on bed rest, not all previa cases require bed rest. According to my OB, some get by even without bed rest.  It really depends on two factors: how far along in the pregnancy and how profuse the bleeding is.

My OB says the condition isn't really that bad. Having this condition is not life threatening. I just have to take extra care and be on guard for any spotting at any point in your pregnancy. She said i should avoid getting tired.

Complication

The worst scenario is excessive blood loss. The danger is, according to the OB, once you have severe spotting, she’ll need to deliver baby even if i'm months before due date. Ito ay kapag sobrang dami ng dugo ha.  Nung narinig ko ito talagang natakot ako. For the first time sa pagbubuntis ko, napraning ako. Posible pala ako makunan!

We asked our OB about the implications of placent previa on my pregancy.  My OB says that i'm more prone to severe blood loss, so i'm more likely to undergo a cesarian delivery.  According  to her,  I should not reach the point of active labor since placenta previa cases are prone to excessive blood loss. As soon as baby has reached his full term, he'll be delivered.

However i'd like to point out that not all previa pregnancies end with cesarian. Placenta previa may clear up in the late stages of pregnancy.  My OB said the position of the placenta can shift as the uterus muscles stretch to accommodate my growing baby. She said she had one patient whose previa cleared up in the last trimester.

Well we did pray and hoped that later in my pregnancy, it will improve. But in our last ultrasound (7th month), I still had it. So we had to accept that in deed, I had to deliver baby via C section. We were  scheduled for a C section any day from January 6  to 13, 2012, which corresponds to baby's 38^th week of gestation.

[caption id="attachment_3269" align="aligncenter" width="277"] This was baby's last prenatal ultrasound. Can visualize the placenta on the upper left portion? It lies right next to baby's forehead. At 7 months, my placenta still blocks the cervix, which is baby's natural way out![/caption]

Who's at risk?

While doing a research on my condition, I came across a list of risk factors why some women are prone to placenta previa. Here's the list as stated in the Mayoclinic article.

Women are at higher risk for placenta previa if they've 
had previous surgeries involving the uterus, such as:
• A C-section
Surgery to remove uterine fibroids
• Dilation and curettage (D&C), though this is a much lower risk
Placenta previa is also more common among women who:
• Have already delivered at least one baby
• Had placenta previa with a previous pregnancy
• If you are carrying twins, triplets or other multiples
• Are age 35 or older
• Are Asian
• Smoke

I’m really baffled because I did not  fit into these characteristics, except for being  Asian. I don’t smoke. It was my first time to pregnant. I was just 29 when I got pregnant. Hindi ko talaga matanggap noong una na considered "high risk" na agad ang pagbubuntis ko.

So I asked my OB, why and how i had this condition. What did I do that put my placenta in such problematic position? Could i have prevented this? Bakit ako pa eh wala naman akong risk factor?  She said there’s really no clear explanation why and how placenta previa develops. They're no really sure what causes this pregnancy complication.

Moms, if you're diagnosed with placenta previa, you need to take extra care.  Be on guard for any bleeding.  Avoid excessive activities as this can cause uterine contractions. After i was diagnosed, i was not allowed to climb stairs, go on long walks and even have sex. (Sadddd)

The good news is: Placenta previa has no long term effect on baby or on you. Once you pass the 7^th month, you can relax a bit because at this stage almost all of baby’s organs are formed. Past seven months, it’s a matter of waiting for (and preparing for) your baby's full development and maturity.

Also worth reading:

• Placenta previa do's and don'ts!


• Learnings from an emergency cesarean delivery

***