Measure twice, cut once

Originally written a couple of weeks after my son, Jed’s, birth this was an accurate account of what happened and the unexpected complications we experienced. An edited version was published in one of the Maternity publications, but I forget which now. It’s long, but then a lot happened! Enjoy!

Measure twice, Cut once

A less than routine birth from a partner’s perspective

It was never routine for us. My partner, Clare, had had major surgery some ten years previously for a serious Crohn’s attack – a rather nasty, incurable and, in my opinion, completely pointless infection of the intestine and bowels – and been told that child bearing could be life threatening for her. This was a belief long held by her family who were visibly shaken when they found out she was pregnant. A little more complicated, sure, but not life threatening if all went well. All we needed to do was avoid a C section to be safe.

Hah.

At 37, Clare was pregnant for the first time and we were both as happy as the legendary Larry. We’d been lucky on the conception, with her falling very quickly after deciding to try, but then things got a little harder. Although we chose not to know the sex of the baby, we now know it was out little son, Jed, who was rapidly growing inside her. Unfortunately he was rapidly growing upside down in the breach position and was evidently not going to move. At our final consultation, our doctor, a wonderfully empathetic, slightly sweaty, and clearly overworked young South African man, strongly suggested a C section. There was little choice. This was ‘strongly suggested’ in the sense of ‘you’re having a C section, get used to it’

Gutted wasn’t the word. Not only had we hoped for a natural birth, but there was real danger now of aggravating previous surgery should there be any complications.

“Don’t worry” our doctor said “I’ve just checked the date and time slot you have for the operation and you’re in luck! You’ll have our top consultant performing the op, so you’ll be in great hands!”

Relief, but still some concern and upset at the forced decision. Nothing to do now but wait for D Day – 17^th January 2007. We’d be parents, so we’d better start acting like parents. In a private moment, I went into the bedroom and practiced some ‘dad dancing’ and found, to my dismay, that I was pretty good at it. I took this as a sign that I was ready and Clare certainly looked it, now being the size of a nuclear submarine. Bring it on.

Sitting in the waiting room in full scrubs was totally bizarre. In a short period, there would be three of us and life would never be the same again. Soon, a collection of suitably attired doctors, nurses, anaesthetists, consultants and what seemed like all their friends arrived to take Clare away to an operating theatre which was surprisingly full of people – ten in total – something we just hadn’t expected. Leaving dignity at the door, Clare marched in, bare bum showing through the hospital gown, and sat on the table ready for an injection directly into the spine with a needle the size of Nelson’s column. I thought I was braver because she didn’t have to SEE it.

Within minutes of checking and rechecking the epidural had taken the operation began with me sat next to Clare on her right side level with her head. I watched the first incision and following procedure with the sort of fascination that forces you to look at a car crash on the opposite side of the motorway. I’m a little squeamish but just had to follow it and found it incredible. I recommend all fathers to be to do the same if you can – it’ll never leave you.

Then the moment came. Our surgeon, a confident and clearly authoritative middle aged lady, reached in to the gaping wound and, with apparently without any effort at all, pulled out a perfectly formed, blood covered, slightly blue child, bum first into the world. My heart leapt and my brain ran into overdrive and fear – he wasn’t breathing or moving.

Then, as if a switch had been flicked, he came alive. He coughed, cried and jumped all at the same time. My heart melted, the tears welled up and it was almost more than I could do to tell Clare that we had ‘a little Jed’, at which point her tears also started to run. He was weighed, thrown into a towel and handed to me whilst the procedure of removing the placenta was underway, unnoticed, incidentally, by either of us. I did have a look at it later though when I was asked to cut the cord. Man, that thing is weird.

The surgeon sewed the wound while we smiled and gurgled at each other and our new arrival. The team even laughed politely when I made the obligatory joke about requiring the operating manual. All seemed well.

It was clear within a few minutes, however, that something was wrong with little Jed and, even as I was pacing up and down the women’s ward excitedly shouting into my phone – much to the annoyance (understandably) of the ward sisters – paediatricians were poking him around trying to get to the source of a loud grunting noise he was making when breathing. Suddenly, he struggled with a couple of breaths, and he was whisked off to the Special Care Unit for tests, observations, and hooking up to some big, scary and expensive looking machines.

This is, of course, the worst thing that can happen to a mother who can’t move and hasn’t yet held her baby. I spent the next few hours running between wards, spending many minutes each time at the security doors of the recovery area and the Special Care Unit begging to be let in, looking at my beautiful son struggling for breath, watching the vitals on the monitor and reporting the details, however small, to his distraught mother. On one visit, the monitor alarm went off on the three pound premature baby next to him. With a calmness that I simply couldn’t fathom, three specialist nurses reached into the incubator through specially designed holes and casually revived her tiny life. Open mouthed, I watched in complete awe – until Jed’s alarm also burst into life, his heartbeat suddenly flatlining. Although a very calm person normally even in extreme situations, I genuinely panicked, and frantically attracted the attention of the nearest nurse, who, in complete contrast to my frantic demeanour, casually assessed the situation and calmly reattached the heart beat sensor. Jed remained in deep, if slightly grunty, sleep apparently unaware he had already caused his father the first of what would surely be many, many heart stopping moments. No pun intended.

Some hours later, with a course of antibiotics and some more tests to carry out, Jed was discharged down to the ward with his mother and taken off the danger list – he was breathing better and the doctors felt he would be fine. Although weeks of difficult breathing and nose bleeds were to follow, they were fundamentally right. Unfortunately the same could not be said for his mother, who was already on a countdown to disaster, unknown to us.

The next few days were a blur of never ending relatives, family, friends, neighbours, and a few people I am suspicious are related to us in any way at all. Clare, Jed and I took it all in, booking everyone into reserved time slots to ensure everyone could see him. We’d changed him, fed him, kissed him, looked at him, talked about how lucky we were, looked at him at bit more, kissed him again, bathed him and already started to feel like parents. But by day four in the hospital, Clare had started to feel unwell and was in a great deal of pain.

It was Saturday. It had been a long day with relatives again, but Clare was used to high pain levels from the Crohn’s and had managed to get through it with a smile and a joke. But by the time I left to go home, at about half past nine, she had requested – and received – morphine from a concerned night staff. The general consensus was that a good night’s sleep would be sufficient. In retrospect, this was a most bizarre suggestion.

By eleven o’clock, Clare was in severe pain around the C section wound and the morphine was becoming ineffective. Concerned, the duty midwives called the doctor for a discussion on what to do next. The doctor, who had an uncanny resemblance to Simon Pegg, the actor and comedian, briefly examined the wound and suggested that the stitches should be taken out, even though it was at least 24 hours too early. With his instruction given, he left the midwives to it, both of whom were clearly unsure about the decision and unhappy about doing it. Clare was witness to the conversation:

“Are you comfortable doing this?”

“Not really, I don’t know how with this type of stitch. Can you do it?”

“Well, I’m not sure, but the doctor says its ok, so I’ll give it a go”

As if one cue, a violent thunderstorm erupted around the outside of the darkened hospital, the roar of the rain heavy on the windows, which would also rattle loudly with every gust of wind. Clare’s bed was next to the window – one of the perks of being in for several days is that you get to choose your bed – and it offered a perfect view of the lightening and glistening street outside.

With some trepidation, the midwife reached down and carefully removed the small bead that sat at the end of the wound, apparently holding the stitch in place. With a couple of murmured comments about the unusual nature of the stitch, she began to pull the unattached end from its resting place. The results were as disastrous as they were instantaneous.

In a moment highly reminiscent of John Hurt’s famous scene in Alien, Clare’s stomach split open in a violent red fountain, spraying the mid wife, bed, curtains and wall as if someone had detonated a paint bomb. The wound split apart violently and filled with blood about as quickly as the midwife’s face emptied of it. There were a few seconds shocked silence, then …. panic.

One of the midwives, now very white and clearly stunned, had to sit down mumbling endless apologies whilst the other, aided now by other staff members who had appeared seemingly out of nowhere, attempted to put pressure on the wound whilst shouting orders to her colleagues. Clare could feel her back suddenly getting warmer as the blood started to gather in a pool, but could do nothing except trust in the expertise of the staff. Somewhere in the tumult, Simon Pegg re-appeared and, clearly furious, berated the midwives and ordered emergency surgery immediately to repair the damage. Worrying about a sleepy, grunty Jed being covered in blood, trying to focus on what was going on and against the advice of the midwives (it later transpired they were worried I would ‘kick off’ and start throwing a wobbly), Clare grabbed her mobile phone and called me, up until this point unaware of what was going on and sitting at home with a celebratory glass of wine grinning like a particularly happy Cheshire cat on its happiest day ever.

From my perspective, the evening peace was shattered by the phone ringing. On answering, it was like talking to someone who was at an especially noisy party. The background noise consisted of shouting, banging, rustling and more shouting. It was clear from her tone immediately that all was not well. In just a few stunted sentences between pants and grimaces, I got the message there was a serious problem and emergency surgery was imminent.

Within seconds I was in the car and drove to the hospital in what appears to be an impossibly quick time. By the time I had arrived, parked the car and begged my way into the ward, she was being wheeled into the lift, still on her blood stained bed, and on her way to a waiting emergency surgery team. I grabbed her hand, told her I loved her, and ran with the bed to the prep room, while Jed was being looked after by the night staff in the ward. After travelling two floors, we were met by the anaesthetist, a young Indian man, who explained what ‘we’ would be doing. This time I wasn’t allowed into the operating theatre and after saying tearful goodbyes, I was told to wait in the cold, dark prep room, bare apart from a chair and some medical equipment, where Jed would be bought to me to look after. I was further informed that the wait could be several hours, and it was already past 1am.

My logical brain was still working. This didn’t make sense. Why would they bring a new born child out of a fully supported maternity ward to sit in a cold room with no changing or feeding facilities? I insisted that I was allowed, with Jed, back in the ward to sit in the day room where all these facilities were available. The duty nurse, your traditional battleaxe stuck in fifties mentality, was having none of it and an argument ensued, which got quite nasty by the time Jed was wheeled in, still in deep grunty sleep in his go-faster wheelie cot. In the end, she capitulated, presumably to get rid of me, and I made my way back up to the maternity ward with it’s warmth and facilities to look after our son, whereupon I was told that since it was a women’s ward I couldn’t sit in the day room and would have to sit in the staff room where I could be kept under observation. I respected this, since I do concede you can’t have a rogue male roaming around a women’s ward, so Jed and I sat in an even colder, pitch black room consisting of the world’s most uncomfortable chairs with a television that didn’t work and was there presumably to get your hopes up. Outside, the storm grew worse, the wind rattling the windows to an alarming degree with gusts that you could physically feel somehow through the glass. Somewhere in the murky darkness, a metallic grinding noise echoed around the courtyard and bins banged their lids in random windy unison. Jed woke up, and started to cry, and continued to cry for the next few hours, no matter what I said or did. It was freezing and, having run out crunchy hospital blankets to wrap him in, I took off my jacket and added that to the bundle. I tried to feed him, and, whilst he took a few millilitres, I couldn’t get him to settle again.

Meanwhile in the operating theatre, Clare was having problems of her own. Whilst sitting on the table awaiting the spinal injection she became aware that the anaesthetist was struggling. A few long moments of being stabbed in the back preceded the realisation that the anaesthetist was in fact using the wrong needle. On realising, he asked his colleague to get the right one.

Clare leant forward and hissed at the nurse who was sitting opposite her holding her hands:

“for God’s sake TALK to me” she said to the nurse, who looked a bit bemused and required further clarification “I can HEAR their conversation – it sounds like Carry On Doctor behind me”

So, whilst a conversation about holidays and job titles ensued, the correct needle was located and the spinal block applied. Needless to say, it didn’t take.

After ten minutes, Clare now lying on her back, the operating theatre once again full of mysterious mask wearing strangers, the distant sound of wind and rain permeating through the walls, the anaesthetist was still dropping cold water on her legs and trying to convince her that it had taken.

The surgeon came in and, as before, the team stood to attention with military like precision.

“Are you ready to go?” he asked in a kindly tone

“NO” she puffed out “I can still feel it”

“well, that’s a good reason to hold off” he replied and promptly sat in the corner, presumably to watch the charade unfold.

It was soon clear that it was not going to take. There was no option now but to do a general anaesthetic and this was, in fact, administered. Clare faded into sleep as the surgeon grabbed his knife.

By 4am, Clare was returned to the ward, groggy, confused, tired and with a scar the size of the Great Wall of China. The surgeon, it appeared, had had to cut right back several layers and re-stitch the entire wound from within using fresh tissue. The inevitable side effect was a wound twice the length that it had been previously. Many days of cleaning, wiping and pain would follow. The ordeal, however, was over.

So what did we learn? Mistakes happen. We always felt the staff always did their best, but sometimes it just wasn’t enough and skills and staff shortages were always evident. Clare has a scar so large that Frankenstein’s monster would be impressed, but the feared complication from the Crohn’s never materialised despite two invasive surgeries. It’s also clear that sometimes you really do have to put your foot down and insist on various actions being taken. These guys DO know their stuff, but they don’t often know your case, and that always seems to be where the problems occur.

And let’s not forget we have a wonderful, healthy and extremely contented little boy who doesn’t seem to do anything but smile all the time. Was it worth it? Hell, yes. Would we do it again? Sure – and even my poor partner who had to endure all of this is already planning the next one, but I think next time I’d remind the surgeon of the old carpenter’s adage – measure twice, cut once.