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From Home Birth to Hospital: My Story of Fetal Atrial Flutter

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AMANDA AGUILAR SHANK
Amanda Aguilar Shank

This is part 2 of my story of moving through fetal atrial flutter, my baby's late-pregnancy heart condition. See here for part 1.

Dear Friends and Family,

Today, I started the day by feeding my new baby girl four times between midnight and sunrise, treasuring every moment... yes, even the long early morning hour I spent awake unsuccessfully trying to get her to nurse. Today was our first full day home from the hospital. Our baby is healthy, and I am content.

Last week when I went to a doctor's appointment, one of my schedule of three weekly visits, I was 38 weeks and four days pregnant. I had been taking the heart medication digoxin for two weeks to correct my baby's fetal heart condition -- atrial flutter -- and so far it had worked, even though the side effects of the drug were almost incapacitating. During my appointment, like usual, the nurse hooked me up to the fetal monitor and turned the equipment on. My baby's heart was back in flutter. I was falling apart. The stress, the constant ups and downs, left me in a free fall. It was hard to shake the feeling that I could lose this baby and there was nothing I could do about it.

It was intense. It was also my initiation into a mysterious club called motherhood. As a close friend told me, having a child is like learning to live with your heart outside of your body. It is not always an easy transition.

I was admitted right away to the hospital, where our doctor offered me two options: immediate C-section or immediate induction of labor. He told me that either way, I would be meeting my baby in the next two days. Wow. There is nothing like planning for a home birth to teach you the evils of C-sections, so I chose to start with induction, hoping for a vaginal birth. For that to be possible, we had to see if we could get her heart rate back to normal. I started IV digoxin, pushing my blood level to frighteningly high levels. Soon, I was nauseous and my vision was not tracking well. I felt drunk, drugged and hung over. I called the EKG folks to monitor my heart -- digoxin overdose would send my own heart into arrhythmia. I was visibly shut down, spending all of my energy on surviving. I realized there was a lot of trust involved with this approach.

After a few hours, my baby's heart was trying to convert back to normal -- it would drop in the safe range and then speed up, and then become completely irregular. We started induction at midnight, hoping that the heartbeat would resolve and we could go ahead with labor.

After 14 hours of induction, the baby's heartbeat still was not totally converted. This is a problem because fetal monitoring of the heartbeat is the main indicator medical professionals use to assess the baby's ability to endure labor. Those rush C-sections from the movies do happen in real life, usually because the baby's heart rate begins to drop during a long or strenuous labor. The birth process is incredibly grueling on a tiny baby, and when you add induction drugs like Pitocin that speed and strengthen contractions, it can be even more difficult. So with my baby's irregular heartbeat, the doctors decided what we knew they would -- that a C-section was the safest option.

I knew I was going to be a mother very soon. I focused on not freaking out, and on enjoying my last moments of being so intertwined with my baby. I sent her telepathic messages of love and reassurance. I knew I wouldn't be seeing her right after the surgery and that likely she would have to go through some trials before I could be with her again.

The operation itself was not as bad as I expected. One critical piece of my experience was having the accompaniment of a labor and delivery nurse friend, who served as a kind of impromptu doula, helping me to hold my ground when treatments being offered were inappropriate or unnecessary, and to fully embrace with less fear and more trust the life-saving help that hospital staff had to offer.

Baby Esperanza was born on December 10th at 2:18 p.m.. She weighed in at 7 lbs 9 oz. She was beautiful with chubby cheeks and soft black hair. I heard her first cry. The medical team took her right away for treatment, since her heart was still in flutter after she was born. They gave her a preventative shot for pain, and then an electric shock (cardioversion) that successfully worked for converting her heart. Hooray! She spent several days in the Neonatal ICU for monitoring, just to be sure the "new normal" heart rate would stick -- which it did!

Lucky for us, the vast majority of babies with fetal atrial flutter, including ours, respond well to cardioversion, and have no future heart problems. And there is nothing like this kind of scare to help turn up the volume on gratitude.

My story of atrial flutter is one in thousands, but the larger story of planning for a home birth and ending with a C-section is not unusual. As I took classes, read natural birthing books and went to prenatal yoga, the birthing process seemed like the big climax to my pregnancy journey. Now I realize it was just a tiny speed bump. The joy at meeting my baby was a powerful antidote to so much stress. Though I would have preferred to avoid the hospital, I remind myself that behind the medicalization of childbirth is the intention to save babies' lives and prevent women from dying in childbirth. And while it is still frustrating how often the high-expense, high-intervention model of hospital-based birth is applied to healthy women and babies, in my case I am incredibly grateful that if my baby is of that minority who needed it, we had access to the medical experts that saved her life. But still, if we decide to have another baby, I will try again for a home birth.