This was the plan:
1/ have six units of blood on hand, in case things start going south;
2/ vertical incision from about 2 in. above my belly button, so that the placenta would not be disturbed in any way when delivering the baby;
3/ separate out (dissect) uterus with placenta intact, and completely remove it, along with the cervix; and
4/ carefully stitch me up as pretty as possible (a promise my OBGYN had made to me).
I was woken up by my husband around 7 am, who came to be there for me and the baby during the surgery. He wouldn’t be allowed into the OR, but wanted to stay just outside. He was tired and very serious. We were happy, of course, that the end of this high risk pregnancy was near, and very excited to finally meet our new baby, but the seriousness of the surgery was on both our minds.
We were brought down to the OR floor (me in my bed) where we got to chat with the anesthesiologist, who had a very elaborate plan. Since I really didn’t want general anesthesia (it makes the baby sleepy and it makes recovery take longer), she was planning to use a spinal block followed by an epidural. She was really sweet and what a great doctor to accommodate a patient like that.
After a while I had to say goodbye to my dear husband (it was harder than usual, since 7% of our “good bye” was of the more lasting nature – we are not dramatic people, rather factual; but since there was an actual 7% mortality risk involved in this surgery, we had prepared for the worst, practically, and wanted to make sure we had said what we wanted to say, should these be our last words - better safe than sorry, right?), and was brought into the actual operating room, where I was transferred to the operating table. Since it’s very cold in the OR I was covered by a warm blanket. Then I had to sit up so that the anesthesiologist and the senior doctor could administer the spinal block and epidural (which they would start once the spinal block started wearing off: my fourth (and hopefully last!). If you don’t think about what they are doing – sticking a needle in YOUR SPINE – it’s not that bad, and it doesn’t really hurt. After I lay down again I could feel the numbness starting to spread down my legs. My arms where spread out and fastened (so that they wouldn't fall down when I was sleeping), and the anesthesiologist numbed my left hand (I already had an IV in my right hand, remember?) to put an ENORMOUS IV in (it's so large they numb your hand to put it in - think about that) – the one that would potentially give me blood, if needed. Then she put up my hair using a surgical glove, and put a surgical cap on me. In the meantime, my doctors put in the Foley catheter, cleaned my vagina on the inside (I couldn’t feel anything at this point, thank God) and prepped my belly for the incision. I was chatting with the anesthesiologist and her attending, who was a very sweet man as well (in fact, I have yet to meet an anesthesiologist who is not sweet and caring), and they asked me about my previous cesareans. I told them about my experience in Belgium and Cairo, and then felt like I should mention that I usually cry a bit during c-sections, so that they wouldn’t think there was something wrong when I did. For some reason this quite upset the senior attending, and as I took one last look at my smooth, even pregnant belly before they put a screen up to cover my view, he kept encouraging me "not to cry on a Sunday."
At this point, the doctors asked everyone to be quiet and focus on the operation, and they began their work. Of course, as always, I could kind of see what they were doing by looking at the huge lamp above me, where my body was reflected. I watched them cut my stomach open (it's not a very clear reflection, but rather gives you an idea of what is happening), poking around for a while (I could feel quite a bit of tugging), and then I heard a cry - a strong, beautiful cry, and watched our baby being lifted out of my abdomen and handed to the neonatologist. “He’s perfect,” my doctor assured me, before continuing his work (this was really where the serious part began for the surgeons). The neonatal team had their table set up right next to me where I could see everything, and I watched as they suctioned our baby and gave him his first check-up. “This is when I cry,” I told the anesthesiologist, and he replied, “Ahhh, these are HAPPY tears?! Yes, yes, that is very good then!” He was a sweet, funny man.
Born at exactly 36 weeks, our baby weighed 3100 grams and was 50 cm tall. His Apgar was 9-10 and 10-10 after five minutes. He kept screaming the whole time they checked him, until they wrapped him up in a blanket and brought him over to me for a kiss. He looked perfect, his cheek was so soft, and I cried. I was so happy. Then they left with him, and the anesthesiologist sedated me.
For the next five hours, I was completely out.
When I came about, I was in recovery, and my husband was there by my side, in a surgical gown. I was alive! But what else? What had happened? The anesthesiologist was there as well, and some intern who insisted I needed more morphine. I tried to tell him I felt fine, and that I didn’t want morphine because I wanted to nurse, but I couldn’t talk. My voice was half gone and all I could do was slur like a drunk. Thankfully, both my husband and the anesthesiologist stepped in and helped me. I could feel my legs, which I thought was very weird, since I know the epidural lasts for at least three hours, but I wasn’t really in any horrible pain. (I got the answer to this riddle later, when talking to my doctor.)
After a while I was brought up to my room, and informed that although our baby was doing well, he had been admitted to the NICU for a bit of a wet lung, and would need 12-24 hours to recover. Just like Abraham. I was really sad that I couldn’t see him right away, or nurse him, but to be honest, those first 12 hours after surgery are a bit of a blur. As it turns out, the operation had been a lot longer and more complicated than anticipated, and I had lost quite a bit of blood.
My husband told me that when the surgery was over, the doctor showed him pictures of my uterus and from the operation (yes, they took tons of pictures for their study). He told him that once the baby was out, what they had seen was worse than they had ever imagined. My doctor has been working with cases like these for 15 years, and the senior oncologist has at least 30 years of experience, and neither one of them had ever seen a worse case of placenta percreta. The entire bottom of my uterus was just placenta, which had grown through the wall completely, and reached out to my bladder. Instead of 2 ½ to 3 hours, the two doctors had to work non-stop for 5 hours to dissect and separate out my uterus, which they then according to plan, removed intact with the placenta along with my cervix (since most of my blood was going to the placenta, trying to remove it from the uterine wall would have been – most likely – fatal). Then followed a repair of my bladder.
This is what my doctor told me later: at this point they had to make a choice. My doctor had promised me that since they were making such a large vertical incision (to deliver the baby from the top part of my uterus as not to accidentally run into the placenta (good call!), he was going to take great care when stitching me up, for a beautiful scar. However, since the spinal had worn out, and then the epidural, they were faced with either quickly finishing up on a small but effective dose of morphine, or having to put me under general anesthesia. My doctor, who – as it turns out - has got to know me quite well, made the call, and grabbed the stapler.
I didn't really care, and he knew it - the baby's health came before everything.
I went to sleep early that evening, and only woke up a few times for pain medication and when the nurses came to check my vitals. I slept all the way until 8 am, when my doctor came in and told me I could start walking a bit. As soon as I could sit up, I had a nurse take me over to the NICU in a wheel chair to see our baby.