Wednesday, August 5, 2009

Afterbirth

After the c-section, I seemed to bounce back right away. I had surgery at 8:00 that morning and was up and moving around later that afternoon. I stayed on the IV for 24 hours and received pain medicine through the fluid. The next day, Friday, I switched to oral pain meds and took them on a fairly regular schedule, but I was still up and around. I even considered going home earlier than planned. I decided to stay so we'd have round-the-clock access to the lactation nurses in the hospital.

On Saturday, the nurses began stretching the time between doses of pain medicine, and by evening, I began experiencing increasing pain around the c-section incision. All the nurses and the doctor said my incision looked good and attributed my increasing pain to my mobility. They suggested some rest and I began calling for the medicine a bit more frequently. By Sunday morning, the incision was quite sore. My OB rounded with me that day and said the pain was probably related to skin that had begun growing around the edges of the staples. He ordered the staple removal that day, but as the day progressed, my incision pain was bypassed by a terrible headache. My nurse again suggested rest and insisted that I delay or cancel visitors and take a nap instead. I tried resting, but the headache grew increasingly worse.

After being observed by two nurses and meeting with the anesthesiologist, it was determined that I was experiencing a spinal headache. Evidently, the many spinal attempts made by the CRNA left a wound that wasn't sealing or healing properly. To correct the issue, I had to have a blood patch administered. James and Brystol stayed in the hospital room while I was wheeled back to L&D. There, the anesthesiologist and another CRNA worked together -- the doctor administered a local anesthesia and probed around my spine until he found the wound. Despite the local, I felt a throb with each push. Meanwhile, the CRNA prepared a sterile field on my hand and withdrew a vial of blood. When the doctor found the right location, he injected the sterile blood into the location in my spine. Literally, after only a few minutes, the intense headache was completely gone. I had a "hangover headache" for the rest of the evening, but overall, I felt so much better.

The incision, however, it still hurt like crazy! The nurse tried to dismiss the pain, suggesting I rest instead of having the staples removed, but as the evening progressed, I could no longer bear the pain. The nurse came in with her little bag of tools and said the staple removal would feel similar to eyebrow plucking. She couldn't have been more wrong. The removal was so much more painful than leaving them in place, but it was something that had to be done. I did feel relief once it was over.

The nurse was puzzled by all the pain, but she again just said the skin had begun growing over the edges. Perhaps that was the answer. The next morning, I had my final check by the rounding doctor and my lovely incision was complimented once again. The paperwork for discharge was submitted, and by lunchtime, I was on my way home.

We arrived home and began to settle in, and within a few minutes, a hungry baby needed nursing and I sat down to care for her. As I reached across my body to grab a pillow to my left, I felt an unzipping way down low. Instantly, my lap was warm with blood and fluid. I pressed my hand to the wound, not fully understanding what had happened, and began to call for James who was in the shower. James took the baby from my arms and called the doctor to find out what we should do. Marcie examined the opening -- my frantic mind imagined her looking for body parts. I felt relief when she told me she just saw an opening on my surgery scar -- not intestines spilling out.

The nurse at the doctor's office told us to come in right away, so after twenty tumultuous minutes at home, we were off again. The doctor said I must have developed a hematoma -- a collection of fluid and blood -- behind the incision. The pressure of the hematoma combined with me turning across my body caused the incision to open up. He mashed around on it and forced it to drain some, then sent me home with instructions to let it keep draining. I was to come back two days later to have it packed.

By Wednesday, the draining slowed. I went in to have the wound packed and discovered the plan was to have the wound packed two to three times each day. Home health care would have to be ordered and healing was projected to take 4-6 weeks. Since a nurse likely wouldn't be in my home by that night, I scheduled a time to come back to the office the next morning. When I arrived that Thursday morning, the office nurse told me they were having complications arranging my home health care with an agency and hospital admission was necessary. They were hopeful I'd be in and out in a short amount of time, but my freedom was contingent upon what the hospital care coordinator could work out before the end of business on Friday. One-week-old Brystol and I checked back into the postpartum wing for wound care.

The nurses on the wing were surprisingly so excited to have me back. Most of them had never dealt with wound care and were excited for the opportunity to do something new. The nurse educator came in and taught them about equipment, wound cleansers and skin prep products, then directed three nurses as they packed the wound with a wet-to-dry dressing (which is essentially a 4x4 gauze soaked in sterile water, then packed into the wound using a long cotton tipped applicator).

They packed the wound three more times before midday Friday, and at that time, a wound care nurse came in to examine my wound and make her recommendation. She observed that the zealous postpartum nurses packed my wound so well that they opened up two three-inch long tunnels underneath the side portions of the incisions -- the portions that appeared to be completely healed. Essentially, the entire c-section incision housed a hematoma -- no part of it was healing as well as we thought.

Because of the tunnels, the wound care nurse recommended a Wound Vac, which is just that -- a vacuum for wounds. I have the ActiVac in particular. The Wound Vac is apparently a wonderful contraption. Because it both wicks (or rather, sucks) away drainage and provides negative pressure on the edges of a wound, it speeds healing time quite dramatically. Instead of healing taking a minimum of four to six weeks, and potentially more, healing with a Wound Vac could take four weeks or less.

The wound care nurse packed my abdomen with the Wound Vac sponges, the care coordinator found a home health care agency to care for me after my release from the hospital, and a KCI nurse delivered a portable unit to my hospital room. I was set to go home by dinnertime.

At this point, the plan for care includes dressing changes in my home every Monday, Wednesday, and Friday. Other than that, I just wear a gurgly vacuum that slurps all day and all night. As for the vacuum, it's cumbersome, it's uncomfortable, and wearing a constant contraption is not at all what I had in mind for my postpartum days.

In many ways, I feel trapped and burdened by this vacuum, both physically and emotionally. In other ways, I'm grateful for the burden -- it causes me sit and be still, it forces me to do less and to rely more, and it makes me very happy that I was so intent on plowing through "The List" while I was free to lift my arms above my head and bend at the waist (both of which I am now not allowed to do). Despite this new challenge, I'm so grateful that I'm bearing this physical burden and not Brystol. Overall, we're both healthy, and have much to be thankful for. I have been given grace enough for this, and even this -- this too shall pass.


Sporting the ActiVac

"Then Jesus said, 'Come to me,
all of you who are weary and carry heavy burdens,
and I will give you rest...
Let me teach you,
because I am humble and gentle at heart,
and you will find rest for your souls.'"

Matthew 11:28-29

3 comments:

  • Randi

    I'm so sorry you're dealing with this craziness ... what a nasty postpartum period. Glad it's healing though and we'll keep praying for a super-quick healing and recovery.

  • Michele

    OH MY!!! Wow!!! Well, I am glad that they were finally able to figure it out, but just so sad for you that you were suffering and it took so long for them to find the real problem. Prayers for your rapid recovery!

  • Renae

    Yikes! I'm glad you are healing now. I ended up with an infection in my incision after Sami. I was so glad the doctor told me it would start draining. Even with the warning I was still a bit freaked out. I can't imagine how you felt!

    And I'd be delighted to come and watch the baby while you rest. ;) Of course, I doubt you would be able to rest with my kids running around...

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