About my c-section delivery after myomectomy

Friday morning I woke up early, as was typical for my pregnancy, though I couldn't have a snack as I would normally do -- no food after 1:30 AM. I took a shower at 6AM and got myself, my mother and partner ready to head out to the hospital by 7:30 but we were still a little late.

I waddled into the hospital entry and we figured out which elevator to take up to obstetrics where my sister was patiently waiting for us (actually she had texted me on the way to the hospital and I jokingly replied that I had changed my mind about the delivery).

They got us into a room right away, which was used for both pre-op prep and recovery. I changed into a hospital gown with nothing else on though I did leave my socks on for a while as my feet were cold. The nurse hooked me up to a monitor on my belly and the baby started kicking right away -- he hated having things resting on the belly such as books when I was reading in bed at night. They were checking his heartrate and checking me for any contractions. I didn't think I was having any contractions, braxton-hicks or otherwise and this was confirmed by the nurse (I was proud to know my body so well). They got my IV started, hooked me up to some IV fluids to keep me hydrated and then the nurse gave my pubic area a shave with an electric razor.

I explained that my sister would be attending as a doula and they were cool with that. My partner and sister both changed into surgical garb with booties, hats and masks. My sister had brought some lavendar with her to help calm me during the procedure -- a French lavendar sachet smelled awesome. My doctor came in to check in with us, and soon it was time to get into the OR. I rubbed my baby's knees and feet inside of me for one last time.

They wheeled me down the hall just a few doors and into the cold operating room which was full of people who would be assisting with the delivery. There was my OB, another OB, the surgical nurse who helped prep me, another nurse, two anaesthesiologists, my partner and my sister -- and possibly more. The first thing was getting the spinal set up which wasn't painful at all as they had one of those automatic blood pressure cuffs squeezing the life out of my left arm -- I didn't feel anything in my back. Next they lay me out on the operating table and pulled a drape up close to my face -- closer than I thought it would be. We then waited for the spinal to take affect, first a warm feeling and then they kept checking to see if I was getting numb where they would be cutting me open. Finally I was numb enough and they quickly got into action.

The anaethesiologist said to let him know if I felt nauseous and quite soon after I was hit with a wave of nausea. I barely had to say a word before he put in some medication to help control it and it passed quickly. I was feeling stressed and overwelmed though as I could feel pressure of them working on my belly and the curtain was so close to my chin and the spinal does make your breathing feel a little weird. I had my partner rub my shoulders and my sister brought the lavender close to my nose and that helped to keep me together. It was intense being awake during the procedure and they don't give you any sedatives or anything as they don't want to affect the baby, just the spinal which removes the pain sensations but not the touch sensations.

The time came for them to pull out the baby from me and one doctor was pressing (more like heaving) high on my belly while they yanked him out with a suction cap. Oh boy that was a crazy feeling.

Then there he was. A wet, vernix coated crying baby boy. He was a big healthy baby I could see as they whisked him across the room, with long arms and big hands. I got misty at seeing this little being finally here -- and with me in such a state. My partner was recruited to help trim down the umbilical cord and they wiped him off some and did what not and all I could do was look over at him in wonderment. The doctors continued working on me but having the baby to focus on helped to distract me from the pushing and pulling sensations.

Finally they brought the baby over to me (really it was only a few minutes after he was pulled out) and as I started talking to him little Jonah started cooing and making all sorts of noises to me. There was no doubt about it, he knew I was his mama -- what a precious memory that is for me. I was able to touch his soft cheek and give him a kiss and then they had to tend to him some more mostly stabilizing his body temperature I think.

The whole affair lasted about 40-50 minutes total and after that we were wheeled back in to recovery where they got me set up with the PCA pump. A nurse helped to get the baby to latch on and showed my partner what to do. I was totally out of it with the narcotics. My partner, sister and mother got to hold the baby lots at this point while we tried to stay ahead of the pain. I loved how they would try to give me directions and things while I could hardly keep my eyes open.

They moved us into our private suite and over the evening hours they removed my catheter (inserted after the spinal took affect), had me go to the toilet, had me drink cool water, took my and the baby's temp religiously to make sure we were both stable, and switched me onto percocet and ibuprofen. I was able to nurse Jonah with my partner's help and he was wetting diapers, and soon started passing meconium.

I fell asleep with Jonah layed across my chest at one point and when I woke up and saw his little face I just about melted; he was so tiny and perfect. My partner stayed with us in the room and slept a few stretches with the baby next to him. I also shifted to one side of the hospital bed and he lay next to me with Jonah which was super nice as well. It was just a really nice nesting experience and it was like the rest of the world didn't exist for those couple of days.

He was very tied into my voice in the first few days post delivery and would seek me out and start to root if he heard my voice. He's more confident about my presence now so he isn't quite as anxious to seek me out and knows I will come if he needs me.

We decided to check out of the hospital as soon as possible on Sunday as the nurses kept pushing percocet, stool softeners, gas-x and ibuprofen on me. I didn't have that much pain after my myomectomy and also since I had been through that experience my body wasn't as shocked about the pain and I found it manageable. The nurses couldn't seem to understand that even though I kept telling them I was doing okay. On a scale of 1 to 10 my pain never got to be more than a 4 -- unless I was moving around a lot and most of the time it was barely a .5. I also hated that the percocet would make me feel all loopy and I couldn't keep my eyes open. I took ibuprofen for the next five days and after that I didn't need anything.

I found one of the most interesting things about my recovery from the c-section is that compared to how tired and big I felt in late pregnancy my body felt a lot better post delivery. The operation itself also was less invasive than excising the large fibroid and even my OB confirmed that nature wants to make the mother heal quickly to help tend for her baby.

My incision actually looks better than after the myo. The skin lines up better and that extra pad of fat above the incision isn't there any more. Not bad, now I just wonder how I'll look in a bikini (LOL).

My OB said that they felt around while they were cleaning me up and the fibroid didn't feel too significant. He said I can get an ultrasound in six months to see how its doing. My partner asked him how soon we could start trying again (oh brother) and my doc said 8-9 months post-partum as ultrasound studies have shown that the site where the placenta had attached still showed signs of healing at 7 months post-partum.

So, while I don't think the c-section was fun, it was definately not an entirely miserable experience and all things considered I would rather have a scheduled c-section than an emergency c-section.

(I'll add more details as I recall them)

Hysterosalpingogram (HSG)

An HSG is a hysterosalpingogram, an x-ray of the interior space of the uterus and fallopian tubes using a contrast dye. It can be used to look for uterine abnormalities and adhesions, determine how much infringement fibroids are making into the interior of the uterus (to some degree), and identify if your tubes are open (referred to by docs as "patent"). Some docs do it standard a few months after a myomectomy, mine did not. The dye does have what my RE referred to as a "voodoo effect", where there is some slight increase in pregnancies after the procedure, speculated to be caused by the dye perhaps causing the little hairs (cilia) in the tubes to function better.

It can be done by your doctor in a radiology facility or by a radiologist -- mine was done by my RE and she was a lot more comfortable with the procedure than the radiologist I could tell.

They insert a catheter to insert the contrast dye through your cervix; a good cough evidently will open up the cervix so it is less painful. The dye feels like pressure going in, and it can cause a drop in blood pressure. It's generally uncomfortable and causes some cramping. My RE tried to manipulate my uterus for the xray shots using the special speculum and I found that to be very uncomfortable with my 6-7cm (at the time) fibroid.

Here is an link detailing Guidelines for the Performance of HSG - it advises taking 1000 mg of NSAIDs prior to the procedure.

Rarely it can cause infection, and some people are allergic to the contrast medium. Some docs give antibiotics preventatively ahead of time, they also might have you take a heavy dose of Tylenol an hour beforehand.

Here are some links to sites showing images from HSGs:

HSG Link 1

HSG Link 2
HSG Link 3

I should go pick up my x-ray film from the University of Washington Radiology Department, where I brought it when I consulted about UAE a couple years ago. I'd like to scan it and and post it here so you can see what my distorted uterus looked like.

To someone who is wondering whether or not to have a myo

Lots of women get pg with fibroids in place, it is an elective procedure however so in part you get to decide when it is right for you. Some considerations I've noted about when it is a good time to have fibroid surgery:

• you feel like you have exhausted all other possible treatment options
  
• you are feeling pain and discomfort, even some of the time. This can include back pain, pelvic pain, leg pain, etc.
  
• you are having bleeding problems (really heavy periods, or periods that don't seem to stop -- this can lead to problems with anemia which can impair fertility and put you at risk for other health problems such as clotting)
  
• you have had trouble conceiving or have had miscarriage/s
  
• you are wanting to try hormonal fertility treatments and your fibroids are already a good size
  
• you are having difficulty urinating or are having to pee all the time or you are developing urinary tract infections
  
• you can't stand the thought of having fibroids inside of you and want to get rid of them
  
• you fibroids are compromising the interior space of the uterus
  

Since you are already dealing with TTC with one tube I can see that it doesn't feel like a straight shot decision for you at all. There is a risk of adhesions after any abdominal surgery, but whether or not these will cause problems is another question.

The surgery is a big deal in that it can be quite invasive and most of us haven't had that much physical trauma before. It is also one that you will recover from quickly. An abdominal myo is very similar to a c-section and loads of women have those operations every day.

Have you read What Your Doctor May Not Tell You About Fibroids yet? It is a super book that really helped me to feel empowered about my body and my fibroids. It describes in detail about the various procedure options and includes info about fertility success rates post-op.

I'm all stuck together

I try to be good and take care of myself during my recouperation from surgery and !@#$ it seems like my skin has healed by bonding itself to my fascia. A couple people have told me this will go away, another one says that she is still dealing with this leftover from surgery. I'm so upset about it because there is this pulling sensation when I move. I need to be able to move without pain, I'm a dancer. Why didn't anyone tell me this was a possiblity? I'm so bothered by it I want to hurt myself.

I'm going to have to try some serious deep tissue massage to see if we can clear it out and it is going to be painful. It's going to stay painful unless I do it though. Argh!

14+ days post op

So I had my post-op visit yesterday morning and everything was good, she said I looked great. She said removing my retained POC was very difficult because of the fibroid and that there was no way for my uterus to expel the tissue on its own based on how the fibroid was positioned filling the interior of the uterus. So my prospects for a normal vaginal delivery were probably slim to none since my uterus couldn't contract well, or at least I would have had a complicated delivery. I was sooooo uncomfortable when I was pg with the rapid fibroid growth and the pregnancy having to grow off to the side because that was the only way my uterus would move, next time should be a lot better.

My doc also said that my uterus will be enlarged for a while, shrinking back some but that it would never be the size of a normal unpregnant uterus since the fibroid made the muscle wall have to grow larger. Maybe I'll be extra fertile now though, the interior of my uterus will be one vast space with lots of room for an embryo to settle in.

She said I could remove the steri strips in the shower or bath, I just pulled them off carefully when they were dry, the adhesive was already starting to go. Uncovering the incision though made it burn more, I think this is partly due to my nerves regrowing right now --
they have to cut through some in the skin there and they may or may
not grow back completely. I had to take the 600mg ibuprofen and after an hour that wasn't helping so I took a percocet and it really helped take the edge off the pain. My father said he had that same burning sensation as he healed from his triple by-pass a few years ago. The incision looks great and I don't think that it will show that much at all in a few months.



She agreed that starting trying to conceive (TTC) again in February
sounded like a good idea and that we should try for a few months on
our own before going back for any more fertility consultations. After having way too much medical attention over the past 6 months (due mostly to the pregnancy/miscarriage) and way, way too many blood draws for my liking, now I'm in a holding pattern and it feels so strange to be told that I'm healthy and back on my own. Not that I liked being not well but you do sort of get adapted to fitting in the medical care when things go wrong. Yeah to be healthy again though!

Oh and I guess it was around 11 days post op that I started to feel
more myself and I've been less fatigued and able to do more around
the house, tidying up, cooking, light cleaning, etc.

Recap of my pre- and post-surgical treatment

The day before my surgery I did go for acupuncture. I like my acupuncturist and my body responds well to his treatment. He said that my nervous system was a bit overactive -- but that was to be expected.

I've been taking the arnica since the day of surgery, at least 2 times a day now. I took the phosphorus C the night before, and started on Traumogen (vitamins to aid healing from Thorne) the night before as well. I had no nausea from the anaesthesia, and I only threw up twice, once from the PCA meds and once from the percocet. I've been taking iron with C and Traumogen every day since my operation 2-3 times a day.

I did have some bruising around the incision as I was healing, but that's gone away now, as has most of the swelling. I hope this doesn't freak you out but I've been taking photos of my incision as I'm healing and thought you might be interested.



On day 3 you can see that my belly is very round. Two days later a lot of that swelling has gone away and the bruising showed up. The colors got pretty bright and multicolored by day 7, as bruises often do. By yesterday the bruising is gone and the swelling is mostly just above the incision.

Oh, I've been also doing some Qi Gong breathing, deep breathings to fill my lungs -- at least once a day. And you want to make sure that you stay connected to your uterus after you are out of surgery and think about sending it healing energy -- I guess some people disassociate from their wounded parts sometimes and it interferes with healing. Read this article about Qi Gong and surgery, I found it very interesting.

Medical Qigong Therapy & Surgery

Post op, stay away from cookies, candy -- simple carbs. I found that my body didn't want them anyway. Drink cranberry/pomegranate/grape juices to help prevent a bladder infection.

I also did guided imagery with the help of a CD my fibroid sister Deborah sent me in a care package. I told people about my surgery and asked them to pray for me and send healing thoughts. I also tolds people when and where I would be treated, and when to expect me home with my phone number so people could call. I felt very supported and warm for the days before and after my surgery.

You can get through this too.

Extreme Makeover: Uterus Edition

"We converted this cramped two bedroom bungalow into a special open floor layout and removed some earlier renovations which were gettingin the way…"

So, I'm home from the hospital as of yesterday afternoon and I'm well on my way to a full recovery. I'm really tired still and reading is kind of hard, I just start falling asleep so I'm going to make this post and then you'll probably hear more from me later in the week.

My entire surgical team was comprised of women. From the two REs and the anesthesiologist to the nursing team – how very cool to know that competent women were working hard to help heal me. I wore my purple fuzzy socks of courage and even got compliments on them from the nurses. I opted for the general anesthesia and other than a sore throat on Saturday it was totally fine.

It took as long to remove the remaining tissue from my miscarriage as it did to remove my fibroid, but already my bleeding has slowed. I had been bleeding for the 4 weeks prior to my surgery and was a little anemic as a result. They didn't need to give me a transfusion and they commented on how little blood was lost – I went for an acupuncture treatment the day before and that can help lessen blood loss. One of the REs said she was a firm believer in acupuncture and wasn't surprised that it would help out.

The fibroid made it impossible to use the hysteroscope to view the retained tissue but they believe they got it all out of there. My fibroid was described as being the size of a grapefruit, and was removed via a single incision about 3 or so inches long. It was growing right up against the endometrium, but it was not engaged withthe endometrium – what a blessing. So, while they had to cut all the way through the muscle wall to get it out there was no disturbance of the interior of my uterus so I've got the most surface area possible to help catch fertilized eggs.

Over the course of the two procedures my bladder was manipulated and traumatized quite a bit. Between that and the catheter the most difficult part so far has been trying to urinate; I have to sit for along time and try to relax and let got of any part I can think of. I also had blood tinged urine but the doctors said it was as a resultof the trauma. I'm drinking cranberry juice and lots of water and am under strict orders to urinate every 2 hours. They weren't sure if my bladder was enlarged from the fibroid or now, or if I'm just one of those women who can't empty her bladder completely (it happens they say) but we sure as heck don't want me to have a bladder infection so I'm going to stay on top of it.

My incision on my swollen belly is a good 5 inches long, I imagine that it will decrease over time. The gum, the walking, the sleeping mask, ear plugs, robe, slippers, granny knickers and my own pads all came in handy. The doctors and nursing staff were amazed at how well prepared I was for the hospital – I gave the fibroid ladies all the credit. They are truly the best group of women on the web.

My myomectomy scar - Day 3


Oh, and the baby making department… my RE said that the way the fibroid was positioned that she didn't think that I would have beenable to carry to term even if we didn't have a blighted ovum and that she expected that I would have continued having miscarriages. She thinks we have a great chance now and said we could try as soon as two months from now, though I think we will wait until February is over.

My partner is exhausted; I think the emotional stress of the weekend has gotten to him. He held me in the hallway last night and hugged me and said he felt so relieved that it was all done now. Poor guy; he was nice and helped watch over me the first hours after my surgery on Friday, massaging my feet and making sure they got me situated into a good room.

So, I'm feeling all right and my abs aren't too sore – they didn't clamp me, just pushed and pulled them a bit. Other than the incision site being sore and my uterus as well in the two spots they worked the rest of my body feels fine – I'm just incredible tired.

I can't believe that I'm through with the worst of it and now I've just got to heal. No regrets on my part for delaying the surgery, I know it was the right thing for me. Thank you for your prayers on Friday – I felt like I was in a warm cloud, so relaxed and comforted the entire time.

[See also: Preparing for surgery posts]