Sunday, June 5, 2016

Baby B's Birth Story (Part 3)

(...continued from Part 2)

6:40pm Christy performed another cervical check, and I was finally dilated to 7cm. She was about to go off shift but called my OB to discuss the next course of action. The proposal was to restart the Pitocin at 1 unit and gradually increase while monitoring. When Christy left the room, Jacob and I discussed what we thought was best and agreed that we would try 1 unit but really wanted to hold out and not bump up to 2 units without ample monitoring of how my body responded. We were in no rush! We talked about the peace of God which transcends all understanding (Phil 4:7). It was so helpful to recall Scripture and remind ourselves that God was in control regardless of the circumstances. I was so thankful to Jacob for bringing that verse to mind, as it was important for me to step out of the chaos mentally and remind myself of the Truth.

7:00pm Christy introduced me to our new nurse, Liz, who would be with us through the night.

7:30pm Liz restarted my Pitocin drip at 1 unit, and the contractions started back. Baby B responded favorably (for awhile).

9:00pm Liz explained that she had to reduce the Pitocin level to .5 units due to hospital protocol because the contractions were lasting too long again (around 90 seconds). We weren’t at the 3-4 minute duration that led to the previous scare, but the contractions were getting too long. She said we’d do another cervical exam at 9:30pm. We maintained the Pitocin at .5 units, and the contractions evened out. Liz could not believe the level was so low and still working!

9:30pm The cervical exam proved that I was 100% effaced, ~9cm dilated, and +1 station. Since we knew Baby B could not tolerate me lying on my right side or getting up to sit on the ball, we moved me to a position that had me sitting up a little straighter (albeit still on my left side) in hopes of helping him move further down the birth canal on his own. Liz left to update the OB but told me to tell her when I started feeling the urge to push or really strong downward pressure (how was I supposed to feel the urge to push when my whole torso and upper legs were numb?!). The OB advised Liz to perform another cervical exam around 11:15-30 or when Baby B’s stats ramped up to show he was ready to make his entrance, so we waited some more. Another popsicle (grape) and more ice chips...

11:15pm Liz came in and performed another cervical exam when she saw Baby B’s heart rate drop noticeably, the timing between contractions get shorter, and the intensity of contractions increase. Finally, I was 10cm dilated(!).

Time to *practice* push. Okay, *practice* pushing = real pushing in my book. We used three contractions in a row to practice pushing with three pushes per contraction. With the first one, I seriously felt like I was doing nothing even though I was trying. In fact, I felt like I was trying to try, I looked at Liz for some kind of reassurance that SOMETHING was happening. She coached me through the three contractions, and we got Baby B’s head to crown. Then....Liz told me to stop while she called the OB.

STOP?! While he was right there ready to come out?! Wow…I don’t know that I will ever be able to articulate what that felt like!

11:48pm The OB arrived and prepared for delivery, checking the table of tools a nurse had set up. There were a bunch of tools I hoped she wouldn't have to use (forceps, vacuum, etc.), and then there were the scissors. We had discussed beforehand that Jacob would cut the cord, so she handed him the scissors - so cool!

And then, we waited. And waited. Annnndddd waited. We had to wait for another contraction, and of course it took forever.


12:00am It was time! I used this next contraction to start pushing, Four pushes, and our son James came out at 12:02am on 5/4/16, weighing 7 lbs. 8 oz. and measuring 19 1/2”. He was beautiful and perfect, covered in a thin layer of vernix and announcing himself with a cry that was music to my ears.

The rest of the events unfolded really fast. James was placed on my chest almost immediately after birth, and I was overcome with emotion. I was laughing and crying, and I just could not believe he was finally here! In my arms!

In the meantime, I had asked to see my placenta, so once it was delivered, the OB held it up for me. (I had to confirm with Jacob whether or not the doctor needed me to push another time, but he said she was able to just guide it out without any additional pushing.) What an incredible organ! Created specifically to provide nutrients for James. It was his lifeline! And it was HUGE! (Yes, we did get a picture, and no, I’m not going to post it out of respect for those of you with weak stomachs.)

The OB informed me that I had a second degree tear - completely normal and nothing to worry about. She stitched me up, and congratulated me on a smooth and quick delivery.

While I was being tended to, Jacob went over to the warming station with James for his Apgar test, footprinting, etc. James rocked a 9 on the Apgar!

Then, the nurse brought him back to me, and I tried nursing him for first time - what a foreign experience, and came naturally! I was able to get a little bit of colostrum in him before they wheeled him off to the nursery for a bit more cleaning up and testing.

Now it was time to get me unhooked from all the machines and take me down to the postpartum wing. Liz unhooked the catheter and epidural and asked me if I needed to use the restroom. I couldn’t tell, but she said I needed to try. She and Jacob led me to the toilet (with a measuring bowl in it - lovely) and turned on sink water to help. She said that if I didn’t use the restroom, I’d have to get another catheter (NOT what I wanted to hear). So, I determined that I would and took my precious time.

It took about 5 minutes, but I was able to go! When I stood up, I got really dizzy, so Liz tried to use my IV line to inject more fluids. Unfortunately, the line had rolled out of my vein, so the drip caused searing pain as it released into my arm. I cried out and she stopped the drip. Another nurse ran and brought back apple juice to help get me some electrolytes/sugar. I gulped the carton, got in the wheelchair, and we proceeded down the hall to the postpartum wing.

The next two days were full of joy and love, beeping monitors and feeding little James, pictures and lullabies, little sleep and taking care of my own recovery as well. But those are stories for another day!

Praise God for His gift of life and protection for little James! My heart is full.

Saturday, June 4, 2016

Baby B's Birth Story (Part 2)

(...continued from Part 1...)

6:45am My first grape popsicle (YUM!). When in labor at a hospital, moma are not allowed to eat food or even drink water in order to avoid the risk of aspiration in the event that surgery is required. I paced myself on popsicles and ice chips throughout the day to "treat "myself and have something to look forward to. Who would've ever thought that popsicles and ice chips would be considered treats!?! When you aren't allowed to eat or drink anything else for 21 hours…

7:00am Shift change! My new L&D nurse named Christy came in and introduced herself. I liked her from the get-go, and she proved to be a calm voice of reason throughout the day.

At my 38-week appointment, I had been diagnosed as Group B Strep positive. This meant that it was very important for me to get antibiotics in my system prior to delivery. I received my first dose of Ampicillin at 7:00am and would receive additional doses every four hours.

7:05am I made my first trek to the bathroom. It was even more challenging to use the bathroom in the hospital because not only did I have the crutches, but I also had all of the cords and wires that I was hooked up to for monitoring.

When I returned from the restroom and the nurses tried to hook back up the monitors for the baby and my contractions, they had a difficult time finding Baby B's heartbeat and when they did, it was pretty low. Christy tried to seem matter-of-fact and calm, but I could tell the situation caused some concern. She said because of my movement, there was a chance that Baby B possibly moved onto and compressed the umbilical cord. She put me on oxygen and moved me around so Baby B would move too. His heart rate went back up, and Christy said this could happen several times during labor. As long as he responded, all would be well!

9:15am Christy came in and said she wanted to move me to a new room. I was technically still in a triage room, and she wanted to get me into a bigger L&D room. Once I got there, she asked me if I thought I could tolerate getting on my hands and knees on the bed for 20 min to help Baby B have room to move the umbilical cord if it was stuck around his neck. At that point, I wasn't really feeling much pain, so I tried it and ended up in that position for about 30 minutes.

10:05am After making my second bathroom visit, it was time to sit on a birthing ball for awhile. A few months ago, I purchased a medicine grade exercise ball due to my pre-existing hip and back condition, and it served wonderfully as a birthing ball as well. I rocked back-and-forth, bounced lightly up-and-down, and did some circular hip movements. We finally started to see some labor progress.

Warm towels were SO nice in the freezing hospital room!
11:15am <dun-dun-dun> Time for another cervical exam. This one was super painful for some reason, and I had a difficult time not crying. Christy told me that my cervix was pointing backwards, so she had to move around a lot to find it. When she finally did locate it, I was dilated to a 3. Seven and a half hours, and I was a 3...

Progress is progress, right?

11:35am Apparently, it was time to help things along a little bit. Christy explained that my OB wanted to start a Pitocin drip at 2 units to increase the regularity of contractions, which at this point were erratic and not very strong. Also, my OB requested the Group B Strep antibiotic (Ampicillin) be administered every 6 hrs instead of every 4 hrs, so the next dose would be at 1pm. The goal was to get two full doses in me prior to delivery.

12:30pm Still on the ball, I chatted with Jacob and saved (haha) popsicle number two: cherry. The Pitocin was increased to 4 units, which made the contractions much stronger and more frequent. My OB stopped by to check on me in person and said everything looked good. She did encourage me not to wait too long to request an epidural. I really wanted to wait it out until I was at least dilated to 4 cm because I didn't want the epidural to slow down the birthing process too much too soon. The contractions were definitely getting stronger but I thought I could handle it for a little longer…

1:15pm OK, OK. The contractions were really strong at this point. I looked over at Jacob between contractions and told him that I would not be able to handle the next contraction without crying. It was time to request the epidural.

2:00pm Oh. My. Gosh. The contractions hurt so bad! I definitely waited too long to request the epidural, and it was taking the anesthesiologist sooooo long to get there. Finally, she arrived to administer the epidural, and Christy turned off the Pitocin temporarily. I was in so much pain that I could not sit up and had to crawl onto the bed in the fetal position. The anesthesiologist said this position was not ideal for epidurals but that she would do her best (eek!). I was worried because I had heard of women having back issues after receiving a poorly administered epidural, and I wanted to be in the most optimal position possible, but I basically did not have a choice at this point because the contractions were so prolonged and intense. The difficulty of putting in the epidural caused some stress on Baby B, so additional monitoring was done before the Pitocin was restarted.

2:15pm Ahhh....relief. My body succumbed to the numbing agent, and I slowly relaxed. Christy had promised not to do another cervical exam (after the last painful one) until the epidural kicked in. The result: I was dilated to a 4, effaced 75-80%, Baby B’s head was at station -1, and the extreme pain was likely related to his movement down into my pelvis and some rotation during the process. Sitting on the birthing ball had indeed helped!

4:30pm With the Pitocin back on, we soon realized that it was causing me to have less than ideal contractions. At one point, I had a 3-4 min contraction (yes, you read that right) with no let up. This led to an immediate cascade of events that was truly alarming. Christy moved me to lay on my right side to see if we could get the contraction to stop, but Baby B’s heart rate dropped to ~60. I was moved as quickly as possible to the hands and knees position to hopefully relieve any pressure on the umbilical cord, followed by an unsuccessful attempt at an internal monitor. The room filled with additional nursing staff as well as an OR doctor. I was distraught and turned immediately to prayer for Baby B’s safety. Although I was barely aware of what was happening around me, I did hear the OR doctor and bits and pieces of a conversation about the level of tolerance for Baby B’s slowed heart rate and if/when we might need to head down to the OR for a caesarean. I had hoped to deliver vaginally but ultimately wanted whatever was best for our son.

The nursing staff administered Terbutaline to stop all contractions (NOTE: This drug made me super-shaky.) and stopped the Pitocin drip completely. Finally, we saw an increase in Baby B’s heart rate after a few minutes, and the level of activity in the room calmed down a notch. I proceeded to nap for hour or so, and the team monitored Baby B’s heart rate.

Time for some ice chips.

(To be continued...)

Thursday, June 2, 2016

Baby B's Birth Story (Part 1)

This is the story of our firstborn son’s labor and delivery. We affectionately called him Baby B during the entire pregnancy.

At 39w2d, I had been experiencing contractions for two weeks. That’s right: two weeks! These were not the typical Braxton Hicks “practice” contractions but they also weren’t full-on, painful labor contractions. Over the phone, my OB’s nurse calmly (and perhaps with a little sarcasm) explained to me, the first-time mom, that the contractions fitting the infamous 5-1-1 bill (go to the hospital when your contractions are five minutes apart, lasting for one minute each, and have been occurring at that rate for one hour) would be painful.

Okay, let’s get some perspective on the word “pain.” As a former athlete who has shattered her left wrist in seven places, dislocated her shoulder twice, broken both feet and her elbow in one graceful Olive Garden...on a date (a story for another time), and is currently experiencing chronic pain that began a year and a half ago, I’ve got a pretty high pain tolerance. What if my pain threshold is different than the norm? What if I don’t know what they mean by “pain” and actually end up having Baby B at home because I don’t make it to the hospital in time?

When I went in for my 37-week appointment, the OB monitored my “contractions” and with a look of surprise came to me saying I really was having real contractions. Feeling somewhat justified, I waited for next steps...but the advice remained the same: wait until the contractions were painful. The alternative two signs of true labor would be bleeding or my water breaking.

I was disappointed, to say the least, and still worried I wouldn't be able to distinguish “painful” from not-painful contractions. So, I started fervently praying that my water would break so there would be no doubt when I needed to go to the hospital. It turns out only approximately 15% of women actually experience their bag of waters breaking on its own at the start of labor. For most, the doctor has to break the bag manually after labor begins (with either “painful” contractions or induction). It was a very specific prayer, but I prayed it regularly: at mealtime, before I went to bed, every hour in the middle of the night when I woke up to go to the bathroom because Baby B was apparently squeezing my bladder in utero, etc.

The OB also said that I was 90% effaced and 1 cm dilated (see here for definitions), so I felt like I was at a really good point and hoped to go into labor soon.

The last two weeks before Baby B arrived were the toughest. He was positioned well: head down, facing my spine, and deep in my pelvis. This last piece - being deep in my pelvis - led to heightened hip/back pain on top of my pre-existing pain and ultimately put me on crutches because I could no longer support my own weight on the left side of my body without excruciating pain. While it was ALL worth it, I simply could not wait to go into labor, and my prayers became even more intense.

When there was no visible progress made by my 38-week appointment, I was deeply discouraged. At this point, I was hardly able to hobble to the bathroom on the crutches and had my heart set on hearing the magic words “Go to the hospital - you’re in labor!” The OB had actually said on two occasions now that there was only a 50/50 chance I would even make it to see her at my next appointment but more likely at the labor. I held it together while the doctor was in the room but fell apart when she stepped out. I SO wanted to meet our little guy but I also wanted him to come on his own, in his own time, as naturally as possible. More waiting lay ahead.

The night before my 39-week appointment, my prayer was answered in the wee hours of the morning. I was awakened by the ever-present, hourly need to use the restroom and grabbed my robe when I got out of bed. As I put on the robe, reached for my crutches, and hobbled my first step, the robe swished against my left leg...and felt wet. I took another step with the same result. Surprised, I finished the 10-step hobble to the bathroom and (without going into too much detail) discovered a very obvious clear fluid water had broken! Praise the Lord!

Below is a time-stamped outline of the events that transpired.

3:45am My water broke - hallelujah! Since we are currently living with my parents while trying to sell our house after moving back to TX, I woke up my mom to get some initial confirmation on my water breaking (since her water broke with my sister and me). We were both fairly confident that is what had happened. Excited, I woke Jacob up, called the after hours line at the OB’s office to confirm I should go to the hospital, and we got things together to leave.

4:30am We arrived at the hospital. In my excited but definitely still preggo-minded state, I confirmed the L&D floor with the security guard downstairs (who can remember little details like that at a time like this?), and we headed to the second floor. When we got to the L&D registration desk, I received some sympathy glances from the nurses since I was hobbling in on crutches, but I also got the “Awww, it’s a first time mom who thinks her water has broken” response when I provided my information. A nurse took me back to a triage room, handed me a gown, and told me to get changed while she gathered a few items.

Once I was changed, another nurse came in and explained that she was going to test my fluid to ensure my water had truly broken. She pulled out a piece of green litmus-type paper and explained that when it came in contact with the fluid, the paper would change to a bright blue if it was amniotic fluid (the result of a broken bag of waters) or would not change color if my water hadn’t broken. She barely touched the paper to the fluid, and it turned bright blue - confirmation! I was relieved that we were in it for the long haul, knowing we wouldn’t leave the hospital until Baby B was born.

The next step was for the nurse to perform a cervical exam to confirm my current state of effacement and dilation. While trying to perform the exam, the nurse said she actually could not find my cervix… Which meant that she went to get another nurse to try.

Let's just say that having two cervical exams back to back is not fun.

Anyway, the second nurse was able to find it and determined that I was 1 to 2 cm dilated and 50% effaced. This was not what I had expected because my OB had been telling me I was 90% effaced for two weeks. However, I have learned that because cervical exams are a little bit opinion-based, the results can be different from person-to-person. The nurse did say that the baby’s head was so low she didn't know how I was able to walk. I felt a little bit more justified in using the crutches for the past two weeks!

(As Paul Harvey always said, stayed tuned for “the REST of the story…”)