"Code Blue" Olivia's Birth Story

On Boxing Day 2011, less than four months after our wedding, my husband and I discovered we were expecting our first child. We were very fortunate to have fallen pregnant during our first month of trying.

Michelle and Daniel excited to be expecting

Michelle and Daniel excited to be expecting

The pregnancy was relatively smooth sailing; I had very little morning sickness, kept active, and aside from tailbone pain developing from approximately 21 weeks I had no other complaints and no complications.

In mid-May at 24+5 weeks, not long after arriving home from shopping for some final nursery items (organised well ahead of schedule), I started feeling some cramps and felt quite sore. Regardless of whether I was sitting down, lying down, using heat packs, or in a warm shower, the cramps kept coming with pain radiating down my legs and around to my back. I started to suspect these weren’t Braxton Hicks, but as a first time mum-to-be I wasn’t sure. I checked for my symptoms in one of my pregnancy books, which confirmed that I was right to worry.

I called SJOG Murdoch (where we were booked to have baby) and the midwife said it was probably nothing (she suggested ligament pain or Braxton Hicks), but to come in anyway for some reassurance, and so we went straight there.

Michelle 24 weeks pregnant

Michelle 24 weeks pregnant

When we arrived at SJOG Murdoch a midwife took me to a delivery suite, because it was the easiest place to do a few checks. My obstetrician was on holidays at the time, but his practice partner had just arrived at the hospital to deliver a baby, and so popped in to see me after the midwife who examined me initially suspected I was having contractions. The obstetrician took only a couple of minutes before telling us that I was definitely having frequent contractions, that we needed to be transferred to KEMH right now, that there were going to give me a steroid to help my baby’s lungs should she arrive early, and administered some nifedipine to try and stop the contracting. We were told that even if everything calmed down we would most likely be at KEMH for 1-2 nights for observation and the second dose of the steroid, so we went home (which was only 5 minutes away) and picked up the hospital bag (yes, 3.5 months ahead of time I already had one packed) and headed to KEMH ourselves rather than waiting at the hospital for an ambulance. In retrospect, this was a sure sign that were completely oblivious to the potential seriousness of it all, and still in shock from what we had just been told.

It was a very surreal car trip and even more surreal when we arrived at KEMH. We initially went to their emergency department only to be told to head up to the labour and delivery ward; that was all a little bit too real! At the labour and delivery ward we filled out some paperwork and waited briefly, then they conducted a fetal fibronectin test (which can predict immanency of arrival in some cases). The test came back negative and the midwife suggested that this was a positive sign. I had some more nifedipine administered and some panadine forte; after some hours the contractions started easing and I was transferred to a ward late evening. My husband left to go home and sleep and I settled in for my first night in hospital.

The contractions stopped overnight, I called my husband the next morning to discuss what he was going to do for the day and when he was going to come in, but whilst on the phone to him I could feel some bleeding start and what felt like a clot passing. I told him that he had better get in ASAP and hung up to call the bell for the midwives’ attention.

I had elected to be a private patient the previous night when we were being admitted and we were offered a few different consultants (as my obstetrician was on holidays). I knew nothing about the system or that the specialists seeing the public patients were amazing, but after discussing it with the midwife we chose Dr Wu, a decision I will forever be grateful for!

Dr Wu came in as soon as the ward called him that next morning and he sent me for a detailed ultrasound. The scan showed I had a large clot (approximately 8cm) behind the placenta. They also took baby’s measurements and told us that she was about 690g +/- 70g, a little on the small side for her gestation. Dr Wu said I would need to stay in on bed rest, in hospital, for at least a week, and have another scan at the end of the week to check baby’s progress and to see if there was any change to the clot. It could grow, stay the same or hopefully, be reabsorbed. There is no explanation as to why the clot may have occurred.

The week of hospital bed rest was rather uneventful and aside from the slight twinge which most pregnant women get anyway, there was no more bleeding or contractions for the next few days. Baby and I were monitored frequently and there was nothing to suggest catastrophe at that stage.

During the week a neonatologist comes by my room and explains to my husband and I what would happen if baby arrived then (being 25+0 weeks at the time he saw us), or at 26 weeks etc. He explains that baby would have had only a 50% chance of survival if born at 24 weeks, and slightly higher if born at 25 weeks. He also confirms that baby’s estimated size is on the smaller end of the ‘normal’ scale for my gestation. We both think “well that was very informative, but that’s not going to happen to us”. We are both still clinging to hope that reabsorption of the clot will happen and that no further contractions during the week has been a good sign.

On the Friday evening nearing the end of my week of bed rest, my husband decided to pick up some pizzas after work, as I was quite tired of the hospital food. I shower, wash my hair and actually apply makeup for nearly the first time in the week and eagerly await his arrival! However by 5:30pm I start having some bad cramping and tightenings that are coming very quickly. I wait approximately ten minutes before deciding to press the call button as I was hoping they would pass, but they are not going away. It takes a few minutes for a midwife to get to the room, but as soon as she walked in I could feel myself starting to bleed heavily. She immediately called the obstetrician, Dr Wu. Over the phone Dr Wu instructed the midwives to hook me and baby up to monitoring, and says he will be in as soon as he can. Baby’s heart rate looks OK, but the bleeding and contracting is becoming worse.

A little after 6pm my husband arrived and I told him to eat his pizza, because there’s not much he can do!! We were extremely worried though as the pain was very intense. Dr Wu arrived at approximately 6:30pm; he quickly assessed the situation and said that I would need to go down to the labour and delivery ward for closer monitoring, but that he would put an IV in my hand in my room whilst the midwives sort out taking me down there. He popped in and out of the room over the next 5 minutes getting bits and pieces but finished inserting the IV relatively quickly. The pain is extremely intense and has progressed from being able to be distinguished in to separate contractions to one constant contraction. The bleeding was heavy but my ability to pay much attention to it was being impacted by the intense pain.

Dr Wu then went out to find a portable ultrasound machine to use as we were still waiting on the OK to proceed down to labour and delivery (although only about 15 minutes has elapsed, not a great length of time), whilst he was out of the room one of the midwives asked the other to help her with the monitor reading baby’s heart rate. They tried moving it a couple of times and then one of them went to find Dr. Wu after the younger of the two asked the other 'what do we do now?' No one tells us explicitly what is happening, but we knew it couldn’t be good. Dr Wu came back in and explained that baby’s heart rate had weakened, and then excused himself again to check on when we could be transferred to labour and delivery. He is gone only a minute, and while he is out the bleeding intensified very significantly, I could feel it, but I couldn’t see what was going on. The pain is still extremely intense and constant.  The midwives were becoming noticeably worried and press the emergency call button. Dr Wu and some more midwives come back in to the room; Dr Wu immediately asked a midwife to call a code blue. “Code blue medical and paediatric, caesarean, ward 5” was called over the PA system to the entire hospital. I would later find out I was having a complete placental abruption.

What seemed like the whole ward’s worth of staff rushed into the room. There was no time to get a trolley for theatre, they took the whole bed and we are out of the room within 60 seconds after disconnecting me from everything that I had been hooked up to. Someone ran ahead to the lifts to insert the key so that they could stop a lift and have it run express from ward 5 to the theatre floor. My husband runs beside the bed and he tells me he loves me, I tell him I love him too and I started crying. I could see the lights rushing by overhead and the terrified look on a man's face as he moved out of the way. I felt like I'd been transported in to some scene from a movie. The lift stopped at the theatre floor and we were met by more staff that ran me through a set of doors into a theatre, they do not pause to have us say goodbye or tell my husband he can’t go in. One midwife stays behind with him to explain it once I am in.

Olivia at birth

Olivia at birth

Once inside I was transferred to the operating table, they tilted it slightly and I could hear what could have only been blood falling to the floor. A midwife sat up near my head and started asking me my name, when I last ate, and if I was allergic to anything; they wrote all this on a whiteboard. I could see Dr Wu out of the corner of my eye getting gowned up. I had a sheet placed over me and some liquid rubbed over my stomach, a catheter inserted and it seemed it was all systems go. The only person who is not yet there is the anaesthetist, (although it has only been a minute or two) and the midwife sitting at my head turned to me and said ‘they won’t start until you are asleep’. The anaesthetist rushed in, checked the board, and then told me ‘this will hurt, and you will feel like you’re choking’. It hurts more than all the pain endured up to that point and the last thing I remember is feeling like I was choking. I was administered a ‘rapid sequence induction’ general anaesthetic through my IV line, used when there is insufficient time for other anaesthetics, and I was not awake to see Olivia’s birth.

At 7:04pm, Olivia is born weighing 635g and measuring 32cm long, with an APGAR score of 5 and requiring immediate intubation to stay alive.

Read Part II - Her Battle Begins - Olivia's Story (The first three weeks of NICU)


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