The next morning…
"I don't like this blood pressure," Stephanie Mitchell said, "Allison this trend. I'm ordering labs but with the headache you came in with your hypertensive you need to call your husband. It's time to induce you. Your 37 weeks baby is fully ready."
"Now," Allison gulped.
"Now," Stephanie said, "Allison I'm worried about preeclampsia. The only way to treat it is delivery. Your full term. I'm going to give you cervadil and in 24 hours I can start you on pitocin and we'll get your labor going then break your water."
"My water always breaks on its own," Allison replied, "I don't want you to break it. And what about my VBAC plan with an induction?"
"We monitor you the risks are slightly higher and any sign something isn't right we take you to the OR and perform a repeat c section," Stephanie replied.
"So continuous monitoring," Allison asked.
"Every couple hours on the cervadil then continuous in labour," Stephanie assured.
"Can we do wireless monitoring," Allison asked, "I know I've had an epidural before and I will probably have one again but I would like to move before it gets to that point."
"Of course," Stephanie agreed, "call your husband and then when he gets here we'll get you started with the induction."
"Before you do the cervidil can we do an internal exam," Allison asked, "we haven't done one yet this pregnancy or my group B strep test."
"There's not time to get the strep results," Stephanie replied, "we will do prophylactic antibiotics just in case."
"I'd prefer we wait for those until the IV is placed for pitocin and we do it all at once," Allison pressed.
"Allison you're a surgeon," Stephanie said, "I know you understand and when I treated you with your second baby you and Asher make informed choices. I recommend the antibiotics and because your status is unknown encourage you to do them but ultimately it is your choice."
"I want them I just only want one IV access if possible," Allison replied.
"That's do able," Stephanie assured.
"Is magnesium needed," Allison asked.
"Not now," Stephanie replied, "I don't want to say never because birth is unprotected but it's a long way off. I'm going to give you Atalat and Labetalol orally and we'll also consult with anesthesia about what's safe to put in the IV with an epidural or spinal."
Allison nodded.
"Let's do the exam first," Stephanie said. Allison ladies back on the table and put her feet in the stirrups. She looked over her belly at the familiar face of her sisters good friend.
"Well," Stephanie smiled, "your about 1-1.5 cm meaning I could give you the balloon instead of the cervidil or we can do a does of the cervidil follow up and if nothing happens in 24 hours try the balloon. Baby girl is still high but we can help bring her down and being your third and 37 weeks it's not uncommon."
"What about doing both," Allison asked.
"We could it's intense but if you're willing to go through the discomfort we can," Stephanie replied.
"What do you recommend," Allison asked.
"I'd say the foley balloon," Stephanie replied.
"Can we do a local block to put it in," Allison requested.
"We will," Stephanie assured, "I'd like to do that for a few hours and then give you pitocin. You're starting to soften and efface so I think it'll work."
"If it doesn't we move to the OR," Allison replied, "I'm willing to give it 24 hours like this to get labour really going then if it doesn't work we do a repeat C-section."
"Sounds like a plan," Stephanie agreed, she had been involved with all three of Allison's deliveries and could really see the increasing confidence in the younger woman and her ability to advocate for herself.
Allison called Asher.
"How was your appointment," Asher asked.
"I'm being admitted and they're inducing me today," Allison whined, "it's preeclampsia not bad yet but if it gets worse it's really bad for me and Carly."
"What do you want to do," Asher asked.
"Stephanie and I have a plan," Allison explained through tears, "they're going to use a foley balloon to stretch the cervix for a few hours then pitocin to get contractions going. When I'm ready we'll do the epidural. I've given it a 24 hour time limit then if it fails we go to the OR for a repeat C-section."
"I'm coming," Asher said, "I'll stop at home and grab your bag and the baby bag. I will be there in an hour. Babe you need to breathe and relax. I'll call your mom to be with the kids."
"Mhmm," Allison whimpered.
"It'll be okay," Asher assured, "I'll be there and we can do this. We've done it twice before Allie.I'm on my way."
Asher threw his tools in has bag and got in the truck with out an explanation, most of the crew knew they were expecting their third baby any day now so went with it.
Asher ran into the house and grabbed the two bags from where they were sitting on the floor under the window in the master bedroom. He pulled his own duffle bag from the closet and threw clean clothes and toiletries in it. He slung all three bags over one shoulder and dashed into the garage grabbing the carseat on his way. The base was already installed in the van and his truck. They would need to get the van keys to Teddy but Allison had the van at the hospital already.
Now very familiar with the layout of the hospital Asher ran inside and up to labour and delivery, taking the stairs two at a time. He spoke quickly to the nurse at the nurses station and was directed to the room where Allison waited.
"Ash," Allison whined rushing to him.
"I'm here," Asher assured taking her in his arms. Allison collapsed in his arms sobbing. He held her and rubbed her back nuzzling her hair. Fourteen years and she still felt so small in his arms sometimes. Asher knew how physically powerful Allison was from transferring Everly and the sheer physicality of working on bones but she was also delicate, slim despite her large bump, standing a almost head shorter than him. The same long soft strawberry blonde hair he had stared at in class in middle school.
"It'll be okay," Asher assured, "whatever happens Carly will be okay."
"She's barely term," Allison whined, "she might need the nicu."
"One thing at a time," Asher soothed.
Stephanie slipped into the room, "Allison let's get those shorts and your panties off and I'll do the catheter and cervidil insertions."
"Both," Allison asked.
"I think so," Stephanie replied, "then we'll monitor for the first hour just a non stress test after that your free to wander the hospital and grounds as much as you want."
"Okay," Allison took a deep breath.
"I'll step out and Asher can get me when your ready," Stephanie directed.
Once the door was closed Allison removed her clothes from the waist down before sitting on the edge of the bed. She draped the sheet across her lap. Asher opened the door and went to grab Allison's hand. Stephanie washed her hands as a nurse laid the equipment out.
"Okay Allison lay back and put your feet together and knees apart like a frog," Stephanie directed.
Allison settled into the position and Asher lowered his forehead to hers. She gripped his had wincing as she felt the speculum followed by the placement of the catheter. She let out a big breath when she felt the instruments being removed. She flinched again when the cervidil was placed.
"Okay we'll keep you on the monitor for the next hour," Stephanie said as the nurse checked the tracings.
"Then what," Asher asked.
"We leave both for up to 24 hours and check progress in six hours. Well don't hour monitoring on baby girl so don't leave the hospital.
"Okay," Allison nodded.
The monitors set she texted Teddy to keep her in the loop. The kids would be fine with her parents. She was going to text with Everly like she often did at work but was hesitant to call if she couldn't keep her voice upbeat and level.
"You okay," Asher asked sitting on the bed beside her.
"Ya," she nodded, "it's uncomfortable but not too bad yet."
"You didn't sleep well last night do you want to lay back and close your eyes," Asher suggested.
"Who kept me up," Allison teased.
"I would have done more if I'd have known it was the last for a while," Asher smirked.
"We need one last set of bump pictures. We have the final ones for the older two," Allison replied.
"Didn't you take some last night in the mirror," Asher asked.
"I did," Allison replied, "last time we'll do this."
"You can change your mind," Asher replied.
"No," Allison laughed, "three is two more than we said when we got together. I was one and done."
"I know," Asher.
Once the monitors were off Allison redressed and they began to slowly wander the hospital grounds.
"You okay," Asher asked.
"It's uncomfortable but it's not labor yet," Allison replied, "just a lot of pressure."
After walking for a few hours they went back inside American found no progress had been made. They continued walking laps.
"Ouch," Allison gasped.
"What," Asher asked.
"I felt something," Allison said, "let's track it and see. No use getting excited after one maybe contraction."
At the second check in some progress had been made and after a call to Stephanie and IV was placed and pitocin started at 8pm.
Around 6 am Stephanie came in to examine Allison.
"Allison you've been having weak contractions all night," Stephanie said once she finished the physical exam, "they gave you morphine around 12:30 so you could sleep for a few hours. Your blood pressure is still higher than I'd like it. I want to break your water and up the pitocin so we can get this baby out today."
"Yes to more pitocin no breaking my water," Allison replied, "I'd rather it break on its own. It will eventually. I always find labor worse after it breaks."
"You made it to 4cm so your on your way," Stephanie said.
"Can you put in for the epidural so it takes the edge off," Allison asked.
"It could be a couple hours. You're not urgent," Stephanie said.
"But it's always 2-3 hours to get one so if we do it now and your upping the pitocin I want it," Allison replied.
"We can't until we get you in a good strong pattern," Stephanie said, "but we will make sure your on the list."
The medication turned up Allison sat on the edge of the bed. She could feel the change now and it was different from her first two labours. The contractions jumped in intensity with the increased pitocin rather than gradually building like they had before. Asher helped her to her feet and she wrapped her arms around his neck swaying. He rubbed her back as they swayed side to side. He could feel her tensing with each contraction and felt her back get sticky with sweat. Suddenly she felt a pop and her water gushed down her legs.
"That's," Asher started.
"My water," Allison replied, "let's call the nurse and see if someone to check. Things feel different."
"Back in bed," Asher asked.
"Standing still," Allison replied.
She was keeping an eye on the monitor. Strong contractions every 4 minutes lasting over a minute. She was handling it for now.
"Epidural," Asher asked.
"Not yet," Allison surprised herself by saying.
An OB resident came in with the nurse and did the cervical check.
"Your at 6 cm Mrs Blouin," the resident said.
"Doctor Blouin," the nurse corrected, "she's an orthopaedic surgeon. Primarily pediatrics."
"It's okay," Allison replied, "I'd make the same assumption. Can you page dr Mitchell?"
"She's in the OR with an emergency C-section," the nurse replied, "it's a previa we don't know how long. Failed home birth."
"Update her when you can," Allison replied, "the iv can be disconnected now?"
"You need to finish that last little bit of pitocin then we'll disconnect you," the nurse agreed, "you're in a solid pattern and dilating well so following standard procedure you can turn it off. Do you still want the iv fluids?"
"I get really puffy and fluid over loaded from them," Allison replied, "let's leave the cannula in my arm but disconnect."
Allison gasped and doubled over. The nurse checked the monitor. It was a strong one peaking higher than the previous ones. She looked at the heart tracing baby was doing well.
Asher sat beside her and held Allison, "breathe he coached."
They worked though a few more hours of contractions. Getting longer, stronger and closer toward. Allison was drenched in sweat the hair that had escaped her messy bun sticking to her face and neck. Asher brushed the damp strands out of her eyes. She grunted,moaned and swore through the worst of it.
Late in the afternoon Stephanie came in, "let's do a check and make some decisions. I see the epidural hasn't been placed yet."
"I don't want it," Allison panted, "I can do it."
"I'm going to do a check and see where your at if your not getting close I want it placed to lower your BP," Stephanie said.
Allison nodded as she drew in a deep breath, her contractions were close together and she couldn't talk during them now.
"Your at just over nine," Stephanie said, "I can almost stretch you to ten so it'll go fast. Allison do you want to change positions."
"We have been," Asher replied, "she's been squatting and kneeling using me for support."
"If you can keep moving," Stephanie replied.
Half an hour later Allison felt herself bearing down. She hadn't felt this before. Her body dropped deeper into the squatting position on its own as the pressure built.
"Babe," Asher asked.
"Now," was all she could get out.
Asher hit the call button and the room filled with nurses with Stephanie right on their heels.
"I need to do a check but you can stay here," Stephanie said, "you can deliver here or we can move to the bed."
"Here," Allison panted, "do the exam."
Stephanie did the exam and nodded.
"Allison your going to push when your ready," Stephanie said, "you're complete."
Allison pushed a few times still in the squatting position supported by Asher. She gripped the squat bar while Asher knelt behind her his arms around helping her stay in position.
"You're so strong," Asher whispered in her ear, "you've got this. Allison I love you, you are amazing. You're so close."
"I see the head," Stephanie exclaimed.
Hearing this Allison pushed with everything she had.
"No cord in the neck," Stephanie announced loudly, "when you're ready."
In a final push Allison felt her youngest slide from her body into Stephanie's waiting hands.
"Wow," Asher smiled looking over Allison's shoulder at the little girl.
"Let's help Allison to a seated position," a nurse directed, "dad get off the bed."
Asher helped Allison as best he could while getting off the bed. She reclined against the head of the bed while with guidance he cut the cord before bringing their daughter to Allison.
"Hi Carly," Allison whispered holding the baby close and kissing her little head.
"Blood loss," Stephanie called.
"1000cc estimate," the resident replied, "and gushing."
"Push pitocin," Stephanie called, "begin fundal massage. Putting traction on the cord."
Allison's eyes went wide.
"Okay sweetheart," an older nurse said, "right now your job is to get that baby girl to latch. See if you can feed her.
Allison used one hand to rip open the snaps on her gown and expose her chest. She helped the baby latch. She knew what she was doing now latching a newborn. She grimaced when the little one sucked for the first time. It was always an adjustment. Asher sat on the bed holding them feeling panicked.
"Hi Carly I'm your dad," Asher whispered, stroking the baby's feet as she fed.
The baby stopped feeding and a nurse took her to the paediatrician for an exam. Asher followed the baby to the bassinet. He supervised as the baby was examined and cleaned up. A small 6 pounds three ounces, their smallest and a mere 18 inches long. She was the tiniest newborn Asher had seen and she was perfect.
"Hanging o neg," a nurse said.
"That's blood," Asher gasped.
"She's bleeding a lot," Stephanie replied, "we've given medication and are treating it."
"From where," Allison asked.
"It's internal," Stephanie replied, "no tears."
The medical team kept working. Asher was pushed back against the wall. He watched as the medical staff worked on Allison. This time the baby was fine but his wife wasn't. He could see blood gushing onto the floor. He didn't remember there being this much blood when Everly was born. Nurses rushed around injecting medications, hanging IVs and starting a second IV in Allison's other hand. He was helpless. And useless and couldn't help her. He felt as useless as he had at 18. He didn't know what was happening. Last time Teddy and Annie had taken charge of the emergency. Allison always took the lead medically. He had watched as she pushed through the intense pain of contractions without medication how she risked everything for their youngest. He couldn't lose her. How could he lose his Allison? What would he do? What would he tell the kids?
"Dad," a nurse said, "Mr Blouin, you need to make some decisions about your baby."
"What," Asher asked.
"Your wife is the patient," the nurse explained, "we need your permission to give the vitamin K shot, RSV vaccine, Hep B vaccine and antibiotic eye drops."
Asher thought, had they talked about this? Finally he replied, "do it all. Is Allison?"
"She's hemoraging," the nurse replied, "Dr. Mitchelle is very experienced and one of our best. She's working quickly but hasn't called for a code or resuscitation team. She's only transfusing one unit of blood. The team is calm. "
"Pressure," Stephanie called.
"110/70 and dropping," a second nurse replied.
"She was pre-eclamptic," the resident said, "still tachy."
"Blood loss is slowing," a nurse replied.
They kept working.
"Under control," Stephanie declared snapping her gloves off.
"Approximate blood loss 1500 cc," the OB resident said, "hang an additional unit of type specific."
"O positive," Allison replied, "I'm O positive."
Asher let out a sigh of relief.
"Ash," Allison whimpered as the doctors and nurses stepped back.
"Shh babe," Asher soothed, taking her in his arms, "you're okay. It's going to be okay."
"Carly," Allison asked.
"She's all good," Asher assured, "she's had her vaccines and you fed her."
"She's asleep," a nurse replied.
"What happens now," Asher asked.
"That was scary," a nurse said, "but not totally unusual. Now you rest. We monitor for a rebleed. You both bond with your baby."
"I'm an ortho surgeon. I know blood loss," Allison replied, "1500 ml is significant. Can you up my fluids and add an iron infusion? I've needed iron after my last two deliveries. I'm anaemic to start with."
"I agree," Stephanie replied, "we'll bolus fluids and get a second unit of blood and monitor."
"How many units did she lose," Asher asked.
"About three," Allison replied, "but only 2 should need to be replaced."
Seeing that everyone was okay the last of the medical team stepped out allowing the couple to bond with their baby.
"Something always happens right at the end," Asher shook his head, "Ev's cord, Andy ten days early. The induction and now."
"A haemorrhage," Allison said, "they got it under control. I want up but shouldn't yet."
"Can you sit up," Asher asked.
"I can," Allison replied, "I can feel my legs and feet this time. We haven't even had time to admire her."
Asher picked the new born up out of the bassinet, " she's gorgeous. Her hair looks reddish."
"The other two have your brown maybe this little princess will get my hair colour," Allison smiled, "and your eyes."
"Hopefully," Allison agreed, "Andy has the green though."
Allison unwrapped the swaddle, "she's perfect. She's absolutely perfect. Healthy little girl. Nice and pink."
Carly began to fuss.
Allison snuggled her close, "oh baby girl come cuddle with mommy. I've got you. You're good, you're so good. I love you so much Carly."
Asher called Teddy.
"Asher," Teddy smiled, "hows it going?"
"It's been touch and go," Asher said, "Allison had a haemorrhage. She's had two units of blood and is resting now."
"How much," Teddy asked.
"1500 cc," Asher replied.
"Significant," Teddy replied, "hows her heart rate."
"Still high," Asher replied, "but coming down, blood pressure has dropped."
"Baby," Teddy asked.
"Carly Theodora Blouin," Asher replied, "6 pounds three ounces, 18 inches."
"Tiny," Teddy smiled, " and I love Theodora as her middle name."
"So do we," Asher smiled.
"We want to meet her," Teddy said, "when you're ready."
"Give us a couple hours," Asher replied, "maybe after dinner."
"We'll come after dinner," Teddy agreed.
Teddy hung up and turned to Owen,"major haemorrhage 1500 cc, transfusion on going."
"I'm pulling her chart," Owen said logging into the hospital data base on his tablet.
They read what was imputed together.
"A lot of blood but controlled quickly," Teddy replied, "vitals are reading steady. And baby girl looks good."
"Do we have a name," Owen asked.
"Carly Theodora," Teddy smiled.
"Is the baby here," Everly asked.
"She is," Teddy beamed, "you have a baby sister. I'm waiting for your dad to send pictures."
Everly's phone dinged at the same time as Teddy and Owen's.
Asher texted, "meet Carly Theodora Blouin. 6 pounds 3 ounces, 18 inches long. She's doing well and mom is resting."
Everly took her phone to Andy, "look we have a little sister."
"Sissy," Andy asked, "go mommy?"
"We'll go see mommy after dinner," Teddy promised, "we're going to do things a bit backwards buddy. We're going to have your bath, then dinner."
"No bath," Andy pouted, "mommy, baby."
"Mommy is having a nap," Teddy replied, "you can see her when she wakes up. Daddy will let us know."
That evening Owen and Teddy brought Allison's older two kids to the hospital.
"Grandma what does Hemorrhage mean," Everly asked, having overheard her grandparents talking.
"Your mom lost a lot of blood," Owen replied.
"They gave her some donated blood to help," Teddy replied, "she should still have some on the IV stand and going into her arm. She'll have at least one maybe 2 IVs."
"Blood and fluids," Owen said, "maybe antibiotics they can do all in one line."
"Is she okay," Everly asked.
"She is," Teddy assured.
"You ready to meet your baby sister," Owen asked.
"Yes," Everly replied, "and I can actually help this time."
"You can," Teddy assured, "and you're fabulous with Andy. you hardly needed grandpa and I."
"Just lifting him up," Everly replied.
"You're ready to babysit your brother," Owen agreed.
"If I could catch him," Everly pouted.
"Baby," Andy asked, "in mommy's tummy."
"She's out of moms tummy," Everly assured her brother, "then mom gets to be home for six months."
"Looking forward to it," Teddy asked.
"It was nice when she was off with Andy," Everly said, "and could be a normal mom."
"You like when she's off," Teddy replied.
"I miss how it was before residency when she didn't work so much," Everly admitted, "when mom was home more even if she had to study."
"Fellowship is slower," Owen replied, "especially because your mom's is research based. Are you ready to meet your sister?"
"Yeah," Andy cheered, "baby."
Owen led the way into the room, his eyes went to Allison first noticing there was still a unit of blood on the IV pole with the fluids but both were on a slow drip.
"Hi," Allison smiled, "come here my loves."
"Mommy," Andy squealed, "up."
Asher lifted his son onto the bed, "careful mommy is really sore. Her tummy hurts."
"You okay baby girl," Teddy asked.
"We'll talk later," Allison replied, "not wanting to scare her kids. I'm okay now. That was hard but no pain meds."
"Wow," Teddy smiled, "what happened to the epidural?"
"Didn't want it," Allison replied, "I shocked myself. Ash can you bring Carly here?"
"This is carly," Asher smiled picking up the sleeping baby, "your little sister."
"She's tiny," Everly breathed.
"She is," Allison agreed, "Ev do you want to hold her first?"
"Can I," Everly asked.
"Sit here or in a chair and you can," Asher replied, "you know how to hold a baby."
While Everly cradled Carly with Owen's supervision Allison pulled Andy close to her and cuddled her little boy, reassuring him that everything was okay and she loved him so so so much bigger than dinosaurs as he liked to say.
"My turn," Andy demanded pointing to the baby.
"I'll help you," Asher smiled taking the newborn from Everly and bringing her to the bed where Allison helped her son hold his little sister.
"Hi baby," Andy yelled startling the new born.
"We whisper with Carly," Allison corrected gently, "shh Carly it's okay. That's your big brother. His name is Andy."
"How's she doing," Owen asked Asher.
"She's putting on a brave face," Asher replied, "for you guys and the kids. But she'll be okay. The staff are giving us space. We're good. I've learned the more concerned they are the closer they hover."
"True," Owen replied, "and they can monitor her vitals from the nurses station."
"May I," Teddy asked looking at the baby.
"Yes," Allison smiled, "it's Grandma's turn. Carly lets go me grandma she's my mommy."
Teddy gently lifted the baby, "hi sweet heart, you look like your mommy. Allison she's perfect!"
"She is," Asher agreed joining them.
Owen peered over Teddy's shoulder, "she's tiny."
"About the same size Ellie was," Teddy replied,"with in an ounce."
"She's early," Allison replied.
"Just term," Teddy assured, "and it'll be monitored your family history. She's beautiful and she looks healthy. She's already trying to look at faces."
"She looks curious," Owen smiled.
They spent a little longer visiting and holding the baby before Andy started to yawn and Teddy and Owen took the older two home to bed.
That night Everly approached Owen, "grandpa will mom be okay? Her skin matched the pillow."
"In time," Owen replied, "she's going to need some extra rest and time but she will be. And she's home for a while. Your dad is taking six weeks off with the new paternity leave law your dad gets up to six weeks and he's going to be home."
"But they had blood on mom's IV," Everly said.
"They did," Owen replied, "just a precaution to give her some. It'll help. Ev if they were worried a nurse would have been right in the room or she would have been transferred to ICU. She's okay. Why don't you go get a bathing suit on and meet me in the hot tub. I have popsicles."
"Okay," Everly agreed. She could keep asking her questions outside.