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Caring for Our Bodies: Vulnerability, Emotions, and an Unwelcome Complication

Dr. Angela Caswell-Monack shares her personal experience when she recently gave birth to her second child, Molly

In August, I was a patient at Beebe Healthcare in the very areas of this hospital that I usually work and learned what it is like to be on the other side of the bed. I was pregnant, and having my baby delivered with the help of my medical associates at Bayside Health Association and the nurses and others I work with in Labor and Delivery at Beebe.

As an obstetrician/gynecologist, I spend loads of hours taking care of patients, delivering babies and performing surgeries at Beebe, but this experience was a real reminder of how my patients feel. It helped me to better understand my patients and the helplessness, anxiety, and pain that they often feel. It also made me realize that we do a lot of things right at Beebe, and that I owe a lot of people my gratitude for taking such great care of me.

I was not the best prenatal patient

I was not the best prenatal patient and had a couple of issues with my pregnancy. I was considered “advanced maternal age” (also known as "old to be having a baby"), and there were issues with my baby's growth and placenta. But, I didn't want to inconvenience my coworkers, so while the nurses in our office would check my vital signs and urine, I often documented my own visits, including warning myself about too much weight gain in pregnancy.

At 37 weeks and a couple days (40 weeks is the due date), I started to feel a little under the weather. Monday night, I couldn't get comfortable in bed, like I had pulled a muscle in the right side of my abdomen. I kept my husband up all night tossing and turning.  Tuesday, I felt nauseous and "off."  I went to the office to see patients and vomited a couple of times, once right in front of my patient! She was so nice and understanding, actually!

As the day went on and I continued to feel bad, the staff in the office ratted me out to my partners and I was told to go to Labor and Delivery to be checked out because I was showing signs of early labor.  There, I was only 2 centimeters or so dilated, and I was treated for mild dehydration and sent home after a few hours to rest.

Once I got home on Tuesday, I continued to feel worse. I vomited a few more times and could not eat or drink anything. The pain the right side of my abdomen kept getting worse, and I was contracting pretty regularly every 3-5 minutes.  Eventually, I had to contact the midwife who was covering for the night.  I felt like a wimp! When I got back to the hospital, my cervix was essentially the same and not in active labor. I was so embarrassed.  I was only 37 weeks and here I am coming to the hospital twice in one day for false labor!  This was my second baby. Shouldn't I know better?

The pain kept getting worse and I was in trustworthy hands

But, something really felt wrong. I was so thankful that the nurses, my midwife and physician recognized it. They ordered labs and imaging. I was reassured that the baby was okay, but they could not find anything with the tests.  They asked one of the general surgeons to come by to give an opinion. No one could pinpoint the problem. Luckily, they put me out of my misery and gave me some pain medications. You know you have pain when you would rather have a foley catheter placed in your bladder than walk to the bathroom. The pain medications helped a lot, but I then felt so loopy that I could not think straight.

In the morning, as change of shift happened, the doctors and midwife decided (I like to think it was a group discussion, but I am pretty sure it was more unilateral than that) to induce me because the pain was still there and they did not know the cause of it.  In my right mind, I probably would have argued against delivery at 37 weeks for something that could be as simple as a muscle strain. But, I told myself, "You are not the doctor right now." Plus, I was in pain and honestly just wanted someone else to make the decision.

I was induced and eventually got an epidural (thank goodness!) but then the baby started showing some signs of distress.  I tried to tell myself not to look at the fetal heart tracing. I tried not to worry, but I couldn't help it. The nurses and doctor were there and that actually made me calm a little. But, I would have rather been on the other side of that scenario. I knew they were all thinking, "How fast could we do a stat C-section?" That's what the physician in me was thinking, too.

The doctor checked my cervix which was making progress, broke my water. She was doing everything she could to help me have a safe vaginal delivery as she knew that was what I wanted.  A healthy Molly was born shortly thereafter. I had many friends (nurses, neonatal nurse practitioner) there because of the bad fetal heart tracing, and it was perfect.

Molly was born and what? Appendicitis?

The pain in my right side got better after delivery, but my doctor still ordered a CT scan to see what was going on. It showed appendicitis! While appendicitis during pregnancy does occur on rare occasions, I can't believe I had it, but was actually relieved that the scan showed something was wrong. I felt validated. Appendicitis in pregnancy is difficult to diagnose.

Then, I felt dread that I would have to have surgery. I had an appendectomy, complicated by the fact that the appendix had perforated. I don't remember much about being in the Operating Room. Thank you to my nurse anesthetist! I know my friends there took care of me.

Starting our new life with our new baby

When I came out of surgery, the lactation consultant was at my bedside, helping me feed my new daughter. She made it seem easy and gave me the confidence I needed. Soon afterward, my 3-year-old son Ethan came to see his new little sister.  I was so anxious for this. Would I be able to love this baby as much as my first child? Would Ethan feel jealous?

There are so many emotions that we experience as women during childbirth, and I was experiencing many of them. Looking back, I recognize how vulnerable I felt, like a piece of meat, being examined and poked and prodded by people I usually drink coffee and chat with. At times, I wished I could shrink to be invisible for a few minutes - like when I was lying on my side with a bare butt getting an epidural.

I am so thankful for the staff in my office who, the day I went to the hospital, loved me enough to cancel my afternoon of patients, even though I didn't want to leave the office. I am thankful for the volunteer who helped me take my first shower in the hospital, for all of the nurses who took care of me, all of the people in and out of the room—daily lab draws, dietary aids—all the friendly faces and kind words, and for sharing in Molly’s birth, and for helping me recover from my appendicitis.

 

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Angela Caswell-Monack, DO

Dr. Angela Caswell-Monack is Board Certified in Obstetrics/Gynecology and is a member of the Beebe Medical Staff. She sees patients at Beebe Women's Healthcare - Plantations.