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Alli Chulada
NURS 450: Making Babies
Section 1
Professor Niland
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Pregnancy Extra Credit Assignment
My mom, Deborah Chulada, gave birth on June 22, 1993 to identical twins. She was 29
years old and had a very difficult pregnancy and childbirth experience. Before she became
pregnant, my mom was on the birth control pill, Low Ovoral. This pregnancy was her first and
last and she never had any history of abortions, stillbirths, or miscarriages. My mom and dad
were trying to become pregnant; therefore, my mom had an intuition about when she became
pregnant. Normally she would have had to wait a few weeks, but instead she immediately went
to her OBGYN’s office to get a blood test that confirmed her pregnancy. Later, she had an
ultrasound that told her she would be having twins. At first, she was upset about this news, but
then quickly accepted it and became excited.
The first 26 weeks of her pregnancy was completely normal, without any complications.
However, after these easy weeks, the difficulty came. First she realized that she had Herpes
Simplex Virus, which became prevalent during the pregnancy and was treated. Since she was
having twins, the pregnancy immediately became high-risk, which meant that she was receiving
many ultrasounds by her OBGYN, Dr. Bouza, to make sure we were healthy. At this time, she
also started having severe back pains by her kidneys. She went to the hospital and took a urine
test and went on a fetal monitor to discover that she was in preterm labor. At the hospital, they
started her on brethene to stop the contractions, and from there she was put on strict bed rest. She
was only allowed to get up to use the bathroom. Each day my dad would pack her cooler of food
since she wasn’t able to get up to make herself breakfast, lunch, or dinner. At home she had a
monitoring system in which she had to put a strap around her stop and lay on her left side, and
then she would have to call the hospital and put the phone up to the monitor. This system tested
to see if she was having any contractions. Over the next seven weeks, my mom was getting
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weekly ultrasounds, and she was in and out of the hospital two or three times since she kept
going into preterm labor. Since the body can build immunity to brethene, she was administered
magnesium oxide through an IV to absorb the brethene so she could be given more to stop her
contractions.
During the last week of pregnancy, my mom was given a brethene pump. At this point
she was extremely swollen and had gained a lot of weight. Before she became pregnant she
weighed 124 pounds, and by the end she had reached 195 pounds due to all the fluid retention.
Since she was on such strict bed rest and gave birth 6 weeks early, she couldn’t attend any
childbirth preparation classes. On June 21 she went to the hospital for the last time complaining
of intense kidney pains, and the doctors believed she was having kidney stones. She was
immediately taken into surgery to insert a stint to produce urine because they believed the kidney
stones her blocking her bladder. However, the found that there were little kidney stones, but not
enough to really call them kidney stones. On the 22nd, she woke up at the hospital in agony. She
was given Demerol through an IV to help ease the pain, as well as an epidural. She also was put
on a fetal monitor and had a physical therapist for the back pain, but she still wasn’t getting any
better. At this point the heart rate of my sister and I was failing, which caused the doctors to
make the decision at 11:00 AM that my mom would have a C-section that day. At 1:15 my mom
was taking into the operating room. My dad was stationed by her head, and the room was filled
with doctors, nurses, and anesthesiologists. I was born first in a breech presentation and was
immediately taken to the NICU. My sister, Kristen, was pulled out a minute later and was right
behind me, also being taken away to the NICU. Once Kristen was born, it was clear that my
mom didn’t have kidney stones; instead, Kristen’s head had collapsed my mom’s bladder, which
would cause the pain in her kidneys and her inability to urinate.
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Since my sister and I were born very pre-mature, we were rushed to the NICU where
various problems were found concerning our health. I was 4 pounds, 14.5 ounces and 45.5
centimeters long. I was admitted into the NICU for prematurity, rule out congenital hip
dysplasia, hypoglycemia, and rule out infection. My APGAR score was 8/8 for 34 weeks
gestation. While I was in the NICU, the doctors discovered a right hip click felt. I was also in
respiratory distress, requiring NCPAP for 4 hours after admission. My HSV cultures were
negative. However, I had right eye drainage, testing positive for H. Epi eye drops for three days.
My bilirubin score was 9.8 out of 6.25, so I was required to undergo phototherapy. I had two
episodes of desaturation, where my oxygen and blood pressure severely decreased, so I was
given oxygen. The doctors found that I developed III/IV murmurs, so I had an echocardiogram a
day after my birth which diagnosed me with a congenital heart disease called Tetralogy of Fallot.
TOF is a cardiac abnormality that consists of four different heart defects. Not everyone who
suffers from this heart disorder has all four defects; I did, however. The four defects include
pulmonary stenosis, ventricular septal defect, an overriding aorta, and right ventricular
hypertrophy (Cincinnati Children's Heart Institute). With all these problems, it was clear that I
was going to need some serious attention, and eventually I had an operation during the first year
of my life. Unfortunately, the surgery did not permanently cure my heart disease. In Tetralogy of
Fallot, patients tend to development of pulmonary valvular regurgitation which usually will
require a pulmonary valve replacement (Bhimji). I had the operation when I was 13 years old.
Since I went to the NICU with a hip click, and orthopedic surgeon discovered I had a dislocated
left hip; therefore, I was placed in pavlik harness on June 23rd, and after a week and X-ray
showed that hip was located. I started to be fed by a bottle on the 23rd as well because my mom
was still recovering from the C-section and was still having kidney problems. My IV was
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removed on the 24th, and after very close monitoring of my health and heart, I was released on
July 21st.
Kristen, Twin B, weighed 5 pounds, 12 ounces and 46 centimeters long. She was noted
jittery upon arrival at the NICU. Her HSV cultures also tested negative. Bilateral hip clicks felt,
determining that she dislocated her right hip, and like Twin A, was put in a harness. Petechiae
was found on her chest. She developed an intermittent heart murmur, as twin A had Tetralogy of
Fallot; Twin B had patent ductus arteriosus with left and right shunting. However, the murmur
was gone on the day of discharge of July 1st and she was healthy.
Since my mom was discharged one day before Kristen, she had no time to prepare for our
homecoming. Her strict bed rest did not allow her to do any baby shopping or prepare the
nursery; therefore, coming home after birth was the first time she had seen what my dad and my
grandmother (Nana) had completed. Once Kristen came home, my Nana stayed to help my mom
until a week after I came home. My dad was in and out of the house due to traveling for work.
While my Nana stayed home with Kristen, my mom and dad would constantly be coming to the
NICU to see me. My mom didn’t suffer from any postpartum depression; however, she was still
very sick and had to be very cautious with her stitches, so she too had to see doctors quite often
so they could assess her health. Once I was finally discharged, it was difficult on my mom
because now she had two babies to take care of. My sister and I were both in harnesses for our
hip dislocations, and we were very colicky. However, once we were put on a soy formula, the
crankiness decreased. After my Nana left, my mom’s two close friends came to help out for
about another month until my mom went back to work, then hiring a nanny. It took her about six
weeks to feel normal again, since she had to deal with the pain of her kidneys and from the
incision due to the C-section. After she gave birth she went back on the pill, and my dad got a
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vasectomy once my sister and I were two years old. Because of all prenatal testing: high
powered ultra sounds, medications, IVs, fetal monitoring, it helped keep us alive, until my
mom’s body couldn’t handle it anymore, so she is very grateful for all the technological support.
Although the pregnancy was very painful and difficult and the childbirth was extremely stressful,
my sister, my mom and I are very healthy.
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Annotated Bibliography
Bhimji, Shabir. "Tetralogy of Fallot Treatment & Management." Medscape Reference. WebMD
LLC, 23 Jan. 2012. Web. 2 Mar. 2012. <http://emedicine.medscape.com/article/2035949treatment#showall>.
In the article written by Shabir Bhimji, the treatment and management of Tetralogy of Fallot is
explored. Since infants with TOF regularly struggle from cyanosis and respiratory distress,
oxygen is required in order to manage the child’s health prior to an operation. Most doctors
recommend that a corrective surgery is to be done before the age of 1 for the best results.
However, there are factors that increase the risk of the procedure, and therefore the time of the
operation does call for some leeway. Some of these factors include low birth weight, major
associated anomalies, absent pulmonary valve syndrome, low age, small pulmonary arteries,
multiple VSDs, and coexisting cardiac anomalies. Once the surgery can actually be performed,
the goal is to close the ventricular septal defect, resect the area of infundibular stenosis, and
relieve the right ventricular outflow tract obstruction. The outcome of the surgery has shown to
have minimal morbidity and mortality; therefore, the child can go out to live a normal and
healthy life.
Cincinnati Children's Heart Institute. "Health Topics." Tetralogy of Fallot, Cincinnati Children's
Hospital Medical Center. Cincinnati Children's Hospital Medical Center, July 20009. Web. 02
Mar. 2012. <http://www.cincinnatichildrens.org/health/t/tof/>.
In the article from Cincinnati Children’s Hospital, Tetralogy of Fallot is defined and the
symptoms, diagnosis, and treatment are all explored. Tetralogy of Fallot is a congenital heart
disease, meaning that present at birth. There are four different heart defects that go into the
disease; however, not every individual with TOF has all four defects. The first defect is
pulmonary stenosis, which creates a blockage of blood flow from the right ventricle to the
pulmonary artery. The second defect is ventricular septum defect, otherwise known as a whole
between the right and left chambers of the heart. An overriding aorta is the next defect, which
means that the aorta is enlarged and appears to be pumping from both the right and left sides of
the heart instead of just the left ventricle, as normal. The last defect is a right ventricular
hypertrophy, a thickening of the muscular walls of the right ventricle. At birth, newborns usually
suffer from either a loud heart murmur or cyanosis, and will then be tested for TOF via an
echocardiogram. A surgical correction is then always necessary, and most babies grow into
healthy and normal children and adults.