Tuesday, October 22, 2013

Birth story: Ethan Martin

Finally!!! This is possibly the longest post I've ever written, and although I could have divided it up and posted it as separate parts, I really wanted the whole store in one place. I hope anyone reading it gets to the end. Hey, it only took me a month to write!

I'm sure that this isn't the wildest birth story that will ever be told, but in the grand scheme of things, it's pretty crazy.

Early Friday morning at 3:30 AM on September 20th I got up to pee for the 3rd or so time for the night. Only I wasn't home in my bed. Instead, I was at an audiology conference sharing a room at the Cosmopolitan with 2 of my co-workers (they had to share a bed, but I got my own). As I got out of bed, I felt a little squirt and thought I had peed myself. Up until then, I had not had any incidents of this happening, but thought that maybe now that I was further along, I was up for some of the not so pleasant side effects of pregnancy. I rushed to the bathroom to finish peeing, but instead it just kept coming out, I had no control of it. I suspected right away that my water had broken, but wanted so badly for it not to be true. I was only 34 weeks and 1 day along as of that day.

I calmly left the bathroom and woke up my co-worker Allison and said "don't panic but I think my water just broke". Allison has two kids but Amanda has none. They both flew out of bed and we tried to figure things out. We decide to go to the ER just to check to see if I pee'd myself or if this was really happening. Allison suggested that I shower "just in case". I had always intended to do this as part of my original idea of what going into labor would be like, but I'm glad she suggested it as it didn't occur to me right away. As I undressed, I realized that I was leaking on the floor, I opened the door and said "Allison, I have no underwear on, but could you take a look at this?" Allison glances at the floor and says "yup, this is really happening!"

I take a shower while Allison calls around to find a hospital. The front desk person at the hotel and someone from another hospital both tell us to go to Su.nrise Children's Hospital, that it is where they would go if it were them. It turns out that if we has gone to any other hospital, they would have likely transferred us here anyway.

cab ride
All three of us took a $15 cab, me sitting on some hotel hand towels, to the hospital where we entered through the ER. We told the security guy what was happening and he pointed to our left and told us to go to labor and delivery triage as it was after hours. I told him that I didn't know where that was and he got up from his desk and walked us there (looking very exasperated).  As it turns out, this hospital gets a lot of women who have had no prenatal care, so to him, I was just one of many who hadn't been taking care of myself or my baby.

Once in Labor and Delivery Triage, I was asked to fill out some paperwork. They had me sit on fabric covered chairs in their waiting room...what a bad idea, I must say! I sat on the towels we brought with us. There was one other woman and her husband there when we arrived and they looked very relaxed. Another woman arrived soon after with her husband, she was wheeled in in a wheelchair and was actively vomiting... into a tub and the trashcan and had already done so in her lap too, if nothing else had up to this point, this woman made me very nervous.

When they finally called me back, they had me stand on a scale, which I leaked all over. I really felt bad for leaving a puddle on their scale! I also had to give a urine sample, it just seems weird that they would need this right away. I think the nurse still thought I had just peed on myself because up until then I was saying I wasn't sure that my water had really broken. It was mostly wishful thinking at that point.

They took me back to a bed in triage and sent someone from hospital admissions to collect my info and insurance stuff. They also had a nurse collect info on my pregnancy. They must have asked me in 50 different ways about my prenatal care. Finally, they swabbed my vagina to determine if it was urine or amniotic fluid. The nurse did this just as the doctor was walking by. She held up the swab for him and said "yup, it's black". She showed me too but I had no idea what it meant so I asked. She said it was in fact amniotic fluid.

triage bed hooked up to monitors
After this, the day went by very quickly.

I was moved into a room by myself and my co-workers were called back to sit with me. Amanda (the one without kids) started vomiting in the bathroom from anxiety while Allison tried calling her husband back in New Mexico to try to get a hold of Nate. Nate's phone was turned off and kept going straight to voicemail. However, Allison's husband wasn't answering either.

The doctor came in shortly (around 5:00 am) checked my cervix and told me that I was neither dilated nor effaced and told me that I would be admitted for ruptured membranes until I delivered. When I asked when that would likely be, he shrugged his shoulders and said "maybe today, maybe in a week".  He ordered an ultrasound to confirm my due date and the size of the baby as well as to check how much fluid I still had. The ultrasound tech came in immediately and agreed with my estimated due date. Her biophysical exam estimated the baby at around 5 lbs 5 oz. My cervix length was at 2.5 cm. She said that my fluid level index was at a 7, if it were below 5 they would want to induce me to start contractions and deliver immediately, but above 10 is normal. At this point we were still at the wait and see stage. They put on a monitor to check for contractions as well as a monitor to check the baby's heart rate. I did not think I was really contracting, just what I thought were minor braxton hicks that I only felt occassionally, however, they were being picked up on the monitor and were once every 8-12 minutes lasting 30 seconds or so.

Finally at around 6:00 AM, Allison called my front office assistant who agreed to go over to my house to let Nate know what was going on and to have him call me. Amanda also left to go back to the conference while Allison stayed with me at the hospital.

When Nate finally called, he was pissed, to say the very least! He had been insistent that it was a bad idea for me to go on this trip in the first place. It took him a bit to calm down, he even had to go for a run, but then he finally made arrangements with the dog-sitter, got a flight that got him in at 10:30 PM and made a list of things I wanted him to bring (pre-prepped hospital bag, car-seat, and breast pump). Spoiler alert: everyone still thought he would be there in plenty of time as we were still in the wait and see, it might be a week, mode.

Around 9:30 the perinatologist came by to check me out and make a plan for the following days/weeks. He did another ultrasound and put the baby at the same due date I already had but a smaller size than the ultrasound tech had gotten. I think he said 4 lbs 12 oz, but can't be sure.

At 9:45, the OB came in to do another cervical check and review what he and the perinatologist had discussed. This time, however, surprisingly he found me to be at 0 station, 3 cm dilated and 100% effaced. I was contracting more regularly at about once every 5-7 minutes and lasting about 1 minute. Honestly, I still couldn't tell that I was contracting. I couldn't feel it, it was not that it wasn't painful, I literally didn't know they were happening.  If I watched the monitor and really thought about it I could tell and could feel it on the outside with my hands on my stomach, but if I had been at home, I'm still not convinced that I would have known or done anything about it. The decision was made that I would deliver the baby in the near future and there would be no effort to halt my labor.

L&D room
Because I was now dilated and contracting regularly, I was admitted and they moved me to an L&D room, you know, the one with the big lights that fold down out of the ceiling. It was decided that I would be having the baby today. They were going to put me on antibiotics first because I hadn't had the screening for group B strep and didn't know if I was positive for it. The doc told me now that if my contractions didn't pick up they were going to give me pitocin to both get them going and to regulate them and get the baby out, as he was small and they didn't want to stress him too much with a long labor. I think it was at this point that I had a discussion with the doc about wanting a natural birth and delivery without pitocin and without an epidural and without an episiotomy. He strongly encouraged pitocin but left it up to me on the other stuff.

Antibiotic IV

Since it was now obvious that I was delivering soon, Allison got back on the phone with Nate (they had been texting on and off) to update him. Everyone now realized that it was unlikely that Nate would make it for the delivery. It was a possibility, but very unlikely as his flight was getting him in at 9:00 pm.

At 12:15 pm, I agreed to pitocin with the doctor's encouragement. I had been regularly contracting at about once every 4 minutes lasting about a minute (and still not feeling it). If it were painful, those endorphins that the brain produces are strong because I still likely would not have gone to the hospital if I were home. I'm convinced that if I had been home, this baby might have come while I was still at the house, or even in the car. Once the pitocin was started, I started to feel the contractions, they were not painful persay but did give me back labor. Also, I could tell they were happening now, even though they were registering on the monitor with much less strength than my natural contractions were.

Regular contractions from Pitocin
At 2:00, a resident, not the OB came in to check me. I chatted with him a bit and found out he was going into family practice and just doing his rotation in OB, he had been there for a month or so. When he came in, I had been having strong contractions for the last 15 minutes or so, to the point where I had Allison give me counter pressure on my lower back to help me through them. I had mentally decided that if I was over 7 cm dilated, then I could get through this naturally, but if I was less than 7, I would need an epidural to be able to last. I didn't feel I had the emotional support to get me through it (or the preparation, we had only had 2 prenatal classes finished, there were still 3 to go). The nurse, whom had been with me non-stop since I was moved to that room from triage, made a point of telling him that I was 100% effaced and that it wold be hard to tell how dilated I was. He felt and said that I was only at a 5. I decided at that moment that I wanted the epidural, at that point I thought that I just knew that I couldn't make it without one. I thought that it could be hours and hours more of extreme pain, much worse that where I currently was.

The anesthesiologist must have been waiting just outside the door because he walked in right after the resident walked out. I told him that I was only going to let him do the epidural if he could assure me that he was the best of the best. He did reassure me, and I believed him. He had it in my back in no time and I only had one contraction while he was doing it. He told me that I should feel a cold wash along my back and down into my legs, but I said that I only felt very sharp pain in my left hip. He told me that it would have the proper effect when I laid back down.

At 2:15, the OB came back in to check my progress. This was literally only 15 minutes after the resident had just checked. When the OB checked my cervix and told me that I was now 10 cm dilated and just about ready to push, I though "what the heck" I was just told I was 5, now 15 minutes later I'm at 10? In retrospect when I was having the strong contractions, I think that I was in transition. It also seems likely that the resident was wrong.  Additionally, when he checked, I realized that I could feel everything he was doing. I told him so and he asked "you're not numb?" as he pinched the ever-loving heck out of the inside of both my thighs at the same time. I just about kicked him in the face. He left and sent the nurse in who administered a bolus, or a booster to the epidural, she again told me that I would feel a cool wash down my back, I felt nothing. 

At 2:30 I was ready to push, I was informed previously that I might feel like I had to poop and that because of the epidural, that was the sign that it was time to push. Instead I felt the huge urge to push, like the urge to push the baby out, not the urge to poop. The two sensations are very different! It was a strong feeling, not quite painful like the pitocin contractions were, but uncomfortable enough. The doc said that he would be right back, he had to get the team from the NICU in there to be ready to hand the baby off to. However, he and my nurse got pulled into an emergency c-section. The resident and the charge nurse told me that I could use the time to stretch things out for an easier delivery, however, it felt as though the baby's head was going to pop out any minute. They administered a second bolus at some time because I simply was not numb or getting any relief for that matter. My main point in complaining and getting the bolus was that if I'd had the epidural, I might as well get some relief from it. However, it still did nothing. There was a point at about 3:30 where I made Allison go out and figure out what was going on because the OB and nurse had not told me that they were doing the c-section, she brought the resident in who checked me and assured me that his head was not going to pop out.

Doctor (right), Resident (Left) and student (in background) pardon my pasty white leg!
At 3:45, I was instructed on how to push, again, we hadn't really made it that far in my classes and I did feel like I needed some guidence. The room almost instantly filled with people. Allison was still there taking pictures, my nurse was back from the c-section, my nurse from triage stopped in to help/observe, the resident was there, there was a doctoral student who was observing that day, the OB came back, a team of about 5 people from the NICU came in, and the anesthesiologist came back to give me some other injection into my epidural as I still was not numb, at all. However, his last injection managed to numb an area on my left thigh about the size of a dinner plate. I didn't know this was numb until well after the fact though. I started to actually push at around 3:50.

My "between pushing contractions" face

At about 3:55, I began to complain about how bad it hurt, it turns out that I had just torn. The doc administered lidocaine and further cut the tear to make way for the baby (ie, I had the episiotomy that I so badly didn't want). However, he managed to administer the lidocaine and the cut during one push. I barely felt it/didn't really care at the time. It was during this same pushing contraction that I heard the OB tell someone (I'm not sure who because my eyes were closed) that the baby was definitely coming out on the next contraction. I was bound and determined to make this happen!

I pushed his head out on the next contraction, they cleared his nose and mouth and at the end of the same contraction his shoulders and body came out too.

Welcome to the world!
Ethan was born at 3:57 PM. He weighed 5 lbs 0.5 oz and was 18 inches long.

Weighing in
It all happened in little more than 12 hours after my water broke, a little less than 4 hours of what I would consider active labor, and without any real pain management techniques or medicine (although some relief would have been nice, I did get essentially the natural birth I was looking for), and my co-worker/friend has pictures of my vagina on her cell phone. She updated Nate the whole time.

He was on the warmer with the NICU team as the doc stitched me up, again, I was not numb so he gave me another shot of lidocaine to get me through it. His APGAR scores were good at 7 and 9.

getting ready for the swaddle
They handed him to me to hold for about 2 seconds before taking him up to the NICU. I sent Allison with him. I could not go see him for more than 4 hours as they did not have a bed for me in the unit where they were sending me. Also, they insisted that I couldn't get up because I'd had an epidural, even though it didn't do anything for me, it was protocol. I finally got to see him at around 8:30 PM. Nate made it to the hospital at 11:00 PM. I was discharged 2 days later on Sunday.

Meeting Mom
Ethan stayed in the NICU for 10 days, but that is a post of it's own!

I wish I could better convey the emotions I felt during the whole birth experience, but mostly I was nervous the whole time, the scared kind of nervous, not the excited kind of nervous.  Nervous that Nate wouldn't make it...and he didn't make it for the birth. Nervous about having a preemie...turns out he was really nearly fully-cooked. Nervous that I wouldn't know what to do during labor...I had prepared by reading several natural childbirth books, and your body does it for you, you really have very little choice nor decisions in the matter. Nervous that it would be really hard to give birth...actually see above, your body knows what to do and it does it for you with very little cognitive thought also probably helped that he was only 5 lbs. Nervous that this wasn't the birth experience that I wanted...for me, in the end, I had a healthy baby without the benefit of an epidural, without forceps or a vacuum proving to myself that I'm stronger than I originally thought. The pitocin didn't kill me, neither did the episiotomy and both worked in favor of getting the baby out quickly. How I labored and not being able to get up and move around didn't matter to me in the end. How I pushed also didn't matter. These are the two things that I felt were most important prior to giving birth. If I do it again, I think I won't worry about much in advance.  However, on a second go around I'd like to do it with my husband by my side as well as a baby that is cooked somewhere closer to 37 weeks and maybe not in such an urgent situation.

They say that you forget the pain, and that birth is this foggy memory that allows women to do this over and over again and have more children. It's 4 weeks later and I remember the day very clearly, there is no fog, it simply wasn't that painful for me and I would do it again.

4 weeks old

I can't believe that on Friday 10/18 my baby is already nearly 1 month old!

Time flew especially fast because of the first 10 days in the NICU, but really it also seems to fly because I don't want to have to go to work, so thinking that the first 1/3 of my leave is over is also what is getting to me.

This past week, we worked very hard on breastfeeding. After I met with the La Leche League leader, I vowed to exclusively breastfeed E without the use of bottles. She recommended the use of the nipple shield due to flat nipples and poor latch. She checked his lips and tongue and said he was doing well. Also, she did not feel that I had an overactive letdown as I had suspected. She gave me a few tips and we were on our way. Also, there was a LLL meeting last Monday that I went to and I had the chance to talk to a few other moms still breastfeeding older children. I got a few extra tips there as well.

I knew we had a pediatrician visit this Monday which gave me exactly 10 days to try it out and see how much weight he could gain. We have to use the nipple shield or he will not latch, and I have to pump at least 3 times a day but we are doing well.

After a previous post, there was a comment about why I was pumping in addition to feeding. Basically, because I pumped for the first several weeks. Therefore, my supply was established by the pump, not by my child. I suffer from a massive oversupply that results in engorgement and mastitis. Initially, I could feed him and still feel way overly full and then proceed to double pump a total of between 8-10 oz after each feeding. Much more than he could ever eat. It was painful and causing me true headaches in addition to loss of sleep. I couldn't lay on my stomach, back nor sides and be comfortable. I have tapered down slowly for the purposes of my comfort to pumping after feeding E a total of 3 times a day (morning, noon, and just before bed) getting a total of around 6 oz each time. I pump just for comfort and relief of pressure, not until my breasts are truly empty. He still eats every 2-3 hours around the clock. I should be able to taper off completely over the next few weeks, however, I may continue to pump once a day to continue to stock up my freezer for my return to work. I will pump at work, but don't know how often I will have the ability to do so relative to my schedule.

We went yesterday Monday 10/21 to the pediatrician and E is now up to 6 lbs 6 oz. That is a gain of 1 lb 3 oz in 2 weeks, or just over an oz a day! He said that he is doing fantastic and at the upper end of how much they would want him to gain each day. They did recommend a daily vitamin with iron for him and I wanted some opinions. If I am on a daily multivitamin and he is gaining weight and has not been diagnosed as anemic, is there really any reason for the vitamin? I can't see why he should have to take it. It was recommended and encouraged by the nurse/medical assistant at the same time she gave me dosing for acetaminophen and ibuprofen, but the doctor said nothing about it. Do you think it is necessary? Did any of you use a vitamin?

E is now in newborn clothes, they are still large, but he doesn't swim in them. He has outgrown his preemie stuff due to length mostly, but really weight-wise, he is large enough for newborn stuff. We are also out of preemie (less than 6 lbs) diapers too. It seems odd that we are now in newborn diapers where the diaper is cut down for the umbilical stump which he lost 3 weeks ago! We tried cloth diapers for a few days but E has gotten a rash. The rash is not from the cloth diapers, but until we find a cloth diaper friendly diaper rash cream, I don't want to ruin my cloth diapers. Washes with a cloth and soapy water during diaper changes seem to help. The doctor also recommended sitz baths for the baby daily, basically I dunk his butt in a sink full of plain water once a day in addition to his every other day daily baths. The rash is minor, but I'd like to keep it that way and not let it get worse.

taken 10/18/13
taken 10/20/13

Here are a few other photos that I wanted to share.

taken a week or two ago

taken last week

taken today
In summary: Breastfeeding is going well. E is growing rapidly. Cloth diapering hasn't really started yet. Any similar experiences with BFing and pumping? Any cloth diaper friendly diaper rash cream recommendations?

Friday, October 18, 2013

3 weeks old

Last Friday 10/11/13 E was 3 weeks old!

I took a picture that day, edited it, uploaded it and then never posted.  I'll do a 4 week update tomorrow because things have changed since I started writing this post.

We are still having trouble breastfeeding. After 24 hours, I went back from trying to breastfeed to giving him  expressed breastmilk in a bottle. I called and left a message for the lactation consultant at the local hospital, but haven't heard back. People around here are horrible at returning messages. I waited two days and then contacted the local La Leche League via face.book to see if they had a recommendation for a lactation consultant over in Las Cruces (1 hour drive away) or El Paso (1.5 hour drive away). I'm willing to do almost anything to get help with his. I was extremely surprised to have heard back from the leader of the La Leche League almost immediately. I didn't realize that she is the local doula I had considered hiring and I was also lucky that she remembered me from my initial e-mail requesting information about her services. She agreed to do a home visit herself as she is also a post-partum doula who has had a lot of training in helping mom's breastfeed. I have an appointment at 11:30 tomorrow (Saturday 10/12/13).

Other than that, we're just chugging along. However, everyday feels like a bit of a time-suck. There is a lot to do and so little time to do it. I really thought this would be a breeze, and although I do get most everything done on my list each day as well as getting a shower, it always feels like there is more that I could have done and it also helps that I keep my list to 3 or fewer chores each day.

Ethan is a growing little boy, but still fits well into his preemie clothes. I have very few things that fit as there is nowhere local to buy preemie clothes, Wal.mart has limited options and I'm not going to buy a ton of stuff that he will outgrow immediately. Even though he his birth weight was rather low, he was still 18 inches long and really too long for most preemie things. A local friend tends to have low birth weight children and loaned me 7 outfits that I wash just about every day and mix in the few newborn sized clothes I have been gifted. Silly me thought we would have a big baby and bought 3 month old cloths instead of newborn sized, so I have nearly nothing of my own that fits! He doesn't seem to care though. He's happy as a clam just to be laying in a onsie on a pile of towels in the laundry basket.

Wednesday, October 9, 2013

On early breastfeeding attempts

2 posts in one day! I've been writing, just not publishing. My brain does not function properly these days, it feels like it's just constantly cloudy up in there. I started the following post over the weekend, came back to it on Monday and finished it today. I really do need some advice if you have any on the topic.

Ethan was bottle fed formula from the time he was born. We were not given the chance to latch and bond with breastfeeding at the time of birth relative to his prematurity. While in the NICU, we attempted to breastfeed but due to his lethargy and inability to fully wake up, we had no success. Also, although the NICU nurses pushed breastfeeding initially, they subtly hinted that he could be there longer if he did do full feedings per the doctor's orders at each feed. I gave up and pumped. My milk came in on the Monday after he was born (he was born on Friday). Then they fortified my milk for 24 hours. Also, several times over the first few days he was gavage fed breast milk through a NG (naso-gastric) tube. Since then he has been fed expressed breastmilk via a bottle.

The pediatrician gave me the go ahead this past Monday to exclusively breastfeed for the next 2 weeks, if he continues to gain weight, no more bottles!!!!

It does seem like we might have a few problems. He has no ability to latch on, and I may have flat nipples, so I bought myself a nipple shield and he did great all day. I'm a little concerned that I can't keep track of how much he gets at each feeding because I can't see it like I could the bottles, but I think we will do fine. And if he prefers the plastic of the nipple shield over a natural latch, so be it, I'm not going to get worked up over that. Maybe we will be able to ditch it in the future, maybe not.

Scratch that last paragraph, I breastfed for 24 hours from about midday Monday to midday Tuesday and pumped after each feeding. After 24 hours, I became so engorged and sick, I had to pump and bottle feed. It felt like my head was going to pop off. My boobs were huge and painful and I had a horrible headache, fever of 100.5, was lethargic (beyond my new state of being tired all the time). With pumping and Tylenol, my fever broke in the middle of the night, so I've still been bottle feeding. I called the local lactation consultant for help with switching from bottle to breast. I'm hopeful that I can get an appointment in the next day or so because I think our window of opportunity for learning to breastfeed is quickly closing.

My main issue seems to be that milk supply currently exceeds little E's demand and the flow overwhelms him. I can double pump a total of 6 oz every 3 hours, whereas E is just eating about 2 oz or slightly more.

Really any advice would be much appreciated!

2 weeks old

On Friday October 4th Ethan was two weeks old. I decided that I'm really going to make an effort to do weekly updates of baby E. I hope that I can do this and post here more consistently than I did my bumpdates (although I did take the weekly pictures, I didn't post them here until after the fact). However, "things" have gotten in the way of me posting this in a timely manner, I will try to be more punctual for the next one!

Ethan was 4 lbs 13 oz last Wednesday at the pediatrician.  Monday at the pediatrician he gained back his birth weight and was 5 lbs 3 oz! He is still in preemie diapers and fits best into preemie clothing. He can wear some newborn sized stuff, but he really swims in it! He sleeps all the time, we have to wake him to feed him every 3 hours. Then it is back to sleep! Hopefully this is indicative of sleep patterns to come!

Wednesday, October 2, 2013

We're Home!

We finally made it home yesterday!

Ethan was discharged after 10 days in the NICU. We even left without a heart monitor! However he does have trouble keeping his temperature up. Also, he failed his hearing screening in one ear and will have to be referred to someone for follow up (is it still a referral if the doc is referring your baby back to you/your office for services?).

We came home to a house that badly needed cleaning, baby gear that still needed some assembly, and dogs that were fanatical about our return.

24 hours later the house is mostly cleaned, the baby gear is all assembled (and out, and all over the house) and the dogs have settled down. Ethan and I also visited the pediatrician this morning while Nate returned the rental car to El Paso.

The doc says we need to see a cardiologist (in Albuquerque though he does come to a town an hour away once a month but not until Oct. 30th) within the week, so I'm working on getting the referrals straightened out. But other than that the doc says that E is more like a small newborn rather than a premie (he is 35 weeks, 6 days gestation today). He also gave us the go ahead to give him a bath as his umbilical stump fell off on monday (oops, we almost became the parents with the smelly kid) because premie's skin will break down more easily than full term babies, who knew?

Now we just enjoy our time at home together as a family of 3 (plus 6 dogs).