Flashback: Off to the Hospital, first Triage?

It is hard to believe that just over 2 weeks ago, the little person who I now hold in my arms, was still nestled in my tummy safe and sound, coming to the end of a nine-month-long incubation.  It was always very challenging for me to consider that when I truly start to go into labor, how would I actually know?  Everyone would always give me the generalized quote, “you will just know.”  This, surprisingly enough, never really helped me out too much with being able to differentiate false labor from what the real deal would actually feel like.  Having been checked with an internal exam just the day before, on Wednesday, September 29th (hoping to see if the dilation of my cervix had progressed any farther), I awoke on the morning of September 30th with some expected cramps and a small amount of bleeding from down below.  I had been warned that this is a natural response to being checked once your baby’s gestation is far along, because the cervix is really getting ready to prepare for the delivery of your baby.

This week’s appointment was my 39th week of pregnancy milestone.  I was almost at my official due date of October 4th, but not quite there yet.  Unfortunately, the discouraging result of my internal exam in the office was the fact that my cervix was just 1 cm dilated, which was the same, unchanging measurement from the past 3 weeks of doctor’s appointments.  Even after trying all sorts of home remedies like eating fresh pineapple, consuming spicy foods, and spending lots of intimate time with your spouse… it still did not appear like my body was responding to any of these attempts to bring on natural labor (although it was very fun!)  But, on the morning of Thursday September 30th, I just felt different.

I told myself, that I had to go to work, despite the small amount of bleeding that I noticed when I went to the bathroom right after I got up.  I figured that it might just be from my exam, and I didn’t want to take sick time from work if I could physically go to work and perform my duties as an operating room nurse.  So, I made it into work, and luckily had a relatively easy assignment of taking care of patients in our holding area who need to be prepared for surgery.  Thank goodness, this is mainly a sitting job, and requires a lot of paper work and looking through the paper chart of each patient who comes to our operating room for a procedure.  As I sat there performing my duties, I became concerned that I wasn’t really feeling my baby moving around a whole lot in my tummy.  It was also at this time, that I definitely noticed that the overall cramping that I had woken up with was now becoming worse, and some uterine contractions were starting to catch my attention as well.  I thought this was most likely false labor again, since I had quite my share of it throughout my pregnancy.  However, I thought since I am so close to my delivery date, I better call my MD’s office and express my concerns.

After my call, I was instructed to try my best to count my baby’s movements over the course of the next hour.  Also, it was tentatively arranged that I would go up to the Triage part of the labor floor on my lunch break at 1 pm, to be checked out and reassured that everything is okay with my baby, Will.  Fortunately, soon after my phone call to the MD office, I did feel the familiar subtle movements of little Will in my tummy, and I was so relieved!   Apparently, it is a known fact that mothers who are coming to the end of their pregnancy can expect to feel less movement from their baby in their tummy, because there is so much less space for the baby to move around in, and overall less amniotic fluid in which they are free to swim around in.  Even though I kept reminding myself of these little facts that I was using to try to keep myself calm, I could not ignore the fact that I just basically felt different today.

Finally, I was able to go up to the labor floor at 1 pm, and I honestly felt like I was doing the right thing for both my own peace of mind and for the health of Will.  The very first thing they did was to hook up my tummy to two different monitors.  One was for monitoring the baby’s heart rate.  It was such a wonderful feeling getting to hear his rapid little heart rate as soon as the monitor touched my tummy.  The second monitor, called a tocometer, was placed on the top of my tummy and was able to measure the frequency and severity of my uterine contractions.  So, after an initial evaluation of the monitoring, the doctors determined that I was indeed having legitimate contractions and noticeable cramping that could be seen by these rhythmic printed out waveforms on what looked like a register tape.  It also graphed Will’s heart rate in response to the contractions that I was having.  The next item on the agenda while I was in triage was to check the current measurement of my cervix with another internal exam by an OBGYN (obstetrics, gynecology) doctor.  Hoping to see some improvement from yesterday, I was checked by one of the resident doctors who would be caring for me while I was in triage.  Despite the contractions I was having, it was determined that the opening of my cervix was still only 1 cm.  Therefore, the contractions were not the “real deal” and they would not be enough to bring on any kind of real labor.  Still, the doctors agreed that they would let me walk around the unit for at least an hour, and then they would monitor me again and recheck me again to confirm that my status was unchanged, before letting me go home.

It was at this time that I was trying to play catch-up with John, so I could inform him of my current situation.  I didn’t really want him to have to come to the hospital, if it was just going to wind up being really nothing at all.  Knowing his overall dislike of hospitals in general, I have always tried to keep him as far away from the hospital as possible until it is absolutely necessary that he be there.  This triage visit was no different in my mind, especially after the doctors were more or less leaning towards sending me home after my walk around the unit.  John was very supportive to me during this experience, and as he often does, I enjoyed his use of humor and sarcasm to help me get through the disappointment of yet again having simply another case of false labor.

After my walk was over, and after my official recheck was done showing that my cervix was still only 1 cm… there was one last item on the agenda to do before they would send me home.  The doctor explained that because I had been feeling decreased fetal movement, there was an ultrasound-guided test they could perform in order to make sure that the baby had enough amniotic fluid surrounding him that is necessary for him to be able to breathe effectively while in my tummy.  I learned that this was called an AFI, standing for amniotic fluid index.  It allowed the doctors to use an ultrasound probe on my tummy to measure the 4 different pockets of amniotic fluid that surrounds the baby and determine if there is enough to safely allow the pregnancy to continue.  If there would be any sign of a leakage of amniotic fluid, seen by a decrease in the amount of total fluid, than an induction would be required in order to prevent any further complications that occur when there is not enough fluid surrounding the baby.  This was also very reassuring for me, because it allowed me to know that the small amount of bleeding that I continued having was just from my cervix.  The doctors were able to confirm from the test, that indeed my overall level of amniotic fluid was within normal limits and there was no sign of any rupture of my membranes (meaning that my “water did not break” … yet.)  After this final test and getting my instructions for knowing when to come back to the hospital if and when I actually do start to think that I am experiencing the real deal, I was free to go.

It is funny the feeling that I remember having, just as the nurse in the triage room took me off the monitors that were showing I was simply having false labor.  I must speak freely here, and share my absolute “gut feeling” about the status of my condition at the time.  Can you actually believe that I could feel what appeared like my contractions were getting stronger?  It really seemed like against what the medical advise and all the testing was showing… I continued to feel an uneasy sense that there was just something different about today.  I knew that they could not keep me in the hospital just because of a “gut feeling” that I had, but I can only look back now and wonder to myself, if this was actually the start of what would eventually become my unforgettable labor with Will.  ;o)

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About the Author

Amy is a full-time Operating Room RN, an accomplished napper, and a sucker for bands like The Fold and Relient K, and just about anything that has to do with sharks. And come October, 2010, Amy will be venturing into the exciting world... of motherhood.