Tuesday, August 28, 2012

Milica's Birth Story

As many of you know when I carry babies the pregnancies have been nothing if not complicated. Although I was prepared for another high-risk pregnancy I was hoping for the best. I'm happy to say that Milica was able to grow for nearly two weeks longer than her brother in my womb, we surpassed full-term, and we were able to room-in with her and take her home when I was discharged. This will be her birth story as best as I can remember. It's amazing because she's only 11 days old and some of the minute details have already escaped my sleep-deprived brain.

During our vacation at the end of July I began noticing signs of pre-eclampsia. My swelling was getting a little bit worse and I began having a pretty constant, nagging headache that was not eased by tylenol. I had experienced these both with Joseph and knew that if pre-e wasn't already overtaking my body it would probably be just around the corner.

With this in mind, I knew an induction would not be far off. It's extremely dangerous to keep a baby in the womb once pre-e sets in. So, my goal as soon as we returned from vacation was to begin the eviction process. I wanted to be able to go into labor naturally and stave of a bag full of pitocin. I did my best. I tried just about every myth out there for natural induction of labor, but unfortunately it just wasn't enough.

During the end of my 36th week the headache got completely out of control and I began having visual disturbances. My blood work still looked okay, but my platelets were beginning to drop which can signal another serious pregnancy situation called HELLP. Based on the symptoms I was having my OB wanted to get a 24 urine collection to compare with the one we did when the PIH began (at around 15 weeks). I turned that big jug 'o' pee in when I was 37w1d. The results showed much more protein in my urine than what had been there previously, but not enough to be termed completely pre-eclamptic yet. My doctor wanted the test repeated to see if it was remaining stable or if there was beginning to be even more protein in my urine. I turned the second big jug 'o' pee in when I was 37w5d. I was able to turn the specimen in that morning and I had an OB appointment that afternoon. Both the OB and my hope were to have the results by that afternoon.

I went in for my OB appointment later that day (remember, I am 37w5d at this point). My BP was high, 150/100. And she had the results from the urine. In a mere 4 days the protein had more than doubled and thrown me into severe pre-eclamptic territory (or at least that's what all the paperwork says). She said she wanted to induce that day, but gave me time to go home and gather my things before returning that night for the induction.

Even though I did experience mild pre-e with Joseph, it was never severe enough for me to have to endure the magnesium drip that I had read could be necessary. In my readings many women had stated magnesium was horrific. Unfortunately, baking my daughter longer than my son came at the cost of having to endure 6 hours of magnesium before induction, all through induction, and then for another 24 hours after the birth. I left the office excited that I would be meeting my daughter, scared about the magnesium, and terrified of another induction.

I called my husband and my sister as I walked my car. It was about 3pm and I had promised to return to the hospital by 7pm. Luckily my husband had taken the day off of work and was at home with Joseph, but my sister was working in Lansing. She made arrangements to leave and started the journey home during rush hour.

When I returned home we prepared Joseph for what was about to happen. We made arrangements for him to stay with my parents and we impatiently waited for Aunt Kimmy to arrive from Lansing. We decided to go out to dinner before passing Joseph off and heading into L&D. All the while I looked at the clock and grew more anxious about the induction.

We actually arrived to the hospital a little later than we had planned. By the time I registered and got up stairs it was a little before 8pm.

The OB resident came in with the ultrasound to be sure that Milica was still head down. She was of course. They checked my and I was 4cm, 60%, -3. I was pretty excited to be at a 4, because when I had been checked a few hours prior at my OB appointment I was only a 3. I was hoping so much that starting induction at a 4 would help things progress faster.

So, we began the process of prepping for magnesium and induction. An IV was started, monitors were attached to my abdomen, BP cuff wrapped way too tightly around my arm and we began the process of waiting. Magnesium would be started at 11pm. For those of you who don't know magnesium is not something you want to have during an ideal labor. Magnesium is given to women to stop contractions especially in pre-term labor. We were about to test my body's ability to cope by throwing chemicals at it to start labor all while plying it with chemicals to stop labor. Pretty counter intuitive if you ask me. But, those are the necessary evils when you're dealing with something as serious and potentially life threatening as pre-e.

Everything I had heard about magnesium prepared me for the worst. Honestly, I was already feeling so yucky; the magnesium didn't impact me too much. It did make me a little worse for the wear, but I expected a lot worse, so when it didn't get too bad I had a sense of relief. Something they fail to mention about the magnesium is that you are no longer allowed out of bed. Any hope of moving around during labor or even getting up to use the bathroom is now completely gone. My labor has once again been hijacked from me. I'm not as devastated about it this time though. I just wanted to get it done and get her out and into my arms. It was right around 11pm that they placed the catheter. It was painful and I needed lidocaine cream applied to my urethra every couple of hours.

At 5am (I am now 37w6d at this point) the OB resident came in to break my water, insert internal monitors for my uterus and for Milica, and the pitocin was started. A lot of pitocin was needed to get contractions going since the magnesium was working hard to stop them. I started having my first truly painful contractions at a little before 9am.

They checked me every so often and every time they did this I had progressed somewhat. If you followed the updates on FB I was moving right along. The only concerning thing was Milica didn't seem to be engaging for whatever reason. She was still pretty high and no where near the birth canal.

Sometime in the late morning or early afternoon I decided I would give the epidural another try. With Joseph I had 3 that didn't work, so I had a 33 hour induction with basically no pain meds. I hadn't wanted the epidural with him and was pressured into it. So, the fact that it didn't work with him didn't bother me at all. I felt since my birth experience was no longer mine, I just needed to get through it as quickly and easily as I could.

For whatever reason when the nurse anesthetist came in I began to a get upset. It was a weird feeling, mainly because I wanted the epidural this time and wasn't been forced into it. I actually sobbed through a lot of it because I was so upset. The nurse anesthetist tried at least 3 different areas to place the epidural. He couldn't get it. He wanted to keep trying. All of a sudden I had this feeling come over me, 'maybe I'm not supposed to have it, maybe there's a reason.' We need to stop trying. I didn't understand at this time why I felt this way, but it would become clear later that night why I did. All I can say is trust your gut.

Since they couldn't get the epidural placed they offered me some IV pain meds. I held off on them for a while and then decided to give them a try. They offered some relief. I felt every contraction but they were less intense. All the while they were still cranking up the pitocin. When they got to 20 on the pitocin machine they had to have a doctor write a new order every time it was increased. They do not normally go above 20. By the time this ordeal was completely over I was getting 30 units of pitocin at a time.

A little before 3pm they checked me again. I was at 8cm, 70 or 80% (my mind gets fuzzy here) and -2 (if I remember correctly). Since I had been progressing fairly consistently I figured I would be done in a couple more hours. It was at about this point that the contractions became completely unbearable. Keep in mind I contracted on pitocin for nearly a day and a half with my son, so for me to feel like things changed to unbearable is a big statement.

It became impossible for me to breathe or use any of my natural labor techniques through the contractions at this point. Each contraction left me literally screaming until it ceased. The pain I felt with each contraction was like a lightening bolt shot straight through me. There was no coping anymore. All I could do between contractions was to beg for help. I needed help.

I begged for more IV pain meds. Unfortunately, being so close to complete and having IV pain meds can be harmful for the baby. So, they wouldn't give them to me. I was in such searing pain they checked me pretty often. And each time they checked me from then on there was no progress. I was an 8, still an 8, I actually began to hate the number 8. If I thought that I could reach my cervix I probably would have tried to reach in and pull that little girl out. I felt lost somewhere between a dream and reality. The pain was unimaginable. I knew that something was not right. I've done this before, what I was feeling was not normal labor pains. They tried getting me into different positions (hands and knees, squatting). I tried bearing down with each contraction, trying everything I could to push her down from inside. Nothing worked. I kept begging for help.

At 6pm they checked me again. I was still the same. Between screaming contractions I asked the resident how long they would let me go without progress before deciding to do a c-section. His reply was 4 hours. I was at 3 hours unchanged already. I begged them to do the section now. He went over the risks, asked me if I was sure. There was no doubt in my mind, something wasn't right, I needed her out now. I agreed and he left to start the process and page my OB.

They turned the pitocin off after the process for the c-section had been started. I still had contractions, but they became more bearable and further apart and I finally felt like I could breathe a little again. We waited. We waited for anesthesiology to be ready, for the OR to be prepped and for my OB to arrive. While we waited they prepped me. They shaved me where the incision would be, they removed the internal monitors, and they put a blue cap on my head and gave my husband scrubs to put on over his clothes.

My doctor finally arrived. She was dressed for surgery. She understood what was happening more than anyone else in that room. She too had developed pre-e and had to have a c-section. She sat on the edge of my bed for 10-15 minutes all the while massaging my back through contractions. My husband and sister had tried to massage me several times but I couldn't handle being touched. I don't know why at this point I could. Maybe it's because my body was so broken and exhausted, but I don't know for sure.

Eventually they got their ducks in a row and wheeled me down. They checked me one more time to be sure I hadn't become "complete" during the wait time. Still, no change.

The anesthesiologist came in. I was nervous about whether or not a spinal would work for me since they weren't able to place an epidural. Much to my relief it worked on the first try. I lost sensation to my feet, my legs, and eventually my abdomen. Before I lost all feeling I was moved onto the operating table. My husband was still not in the OR yet. I began to worry, my BP began to drop and my world sort of spun around. They poked and pinched my belly to be sure I had no feeling. All I could feel was pressure where they tried to rouse sensation. It was a bizarre feeling.

I heard them say, "Mark the time for incision." I knew my belly had been sliced open by this point. I'm not sure exactly when they brought my husband in, but there he was, right by my side. My BP continued to drop, or so I heard them say. I couldn't keep my eyes open and was completely out of it. I eventually began to get sick and started vomiting. I was just ready for this ordeal to be over. My OB and the resident assisting her told me to be prepared for lots of tugging and pressure. I knew we must be getting close to her finally emerging.

And then in an instant, her cry.

Her beautiful, loud, angry cry.

It was a magical thing to hear. Especially since Joseph was in such duress he never belted out his opening song to the world. I was flushed with relief. Then I felt like I was drowning. My BP must've still be terribly low, because I was in and out of it. Jeremiah would ask me if I was okay and I would open my eyes enough to look at him and give him a smile and then I was gone again. He asked me over and over and I did my best to come to each time for him, but I couldn't keep myself there for more than a second or two.

She was born at 8:26pm (5 1/2 hours after I had first been pronounced 8cm). She was 7lbs 13 oz. and 20 inches long. She was born with a full head of hair. And she looked like her Mommy.

The background filled with the noise of her vibrant screams. I heard the pediatrician call out her apgar, 9. Relief again washed over me. Joseph's first apgar was a 2 or 3. Nine was a good number.

I heard the operating doctors say things like, "Okay, we're going to put your uterus back in now, you're going to feel some pressure." and "Okay, we're stapling you closed now." It was surreal. My belly was ripped open and I was being put back together.

The pediatrician said they wanted to take her to the nursery to watch her breathing. She was currently breathing well but the magnesium can make the newborn's breaths shallow and they wanted to be sure she wasn't going to deteriorate. I was lucid enough to tell them no artificial nipples or pacifiers. The pediatrician gave a look of "great, one of THOSE types of Moms" but I didn't care. They may have stripped me of my planned birth experience, but they were NOT stripping me of my nursing experience. Jeremiah went to the nursery with her; I stay to be closed the rest of the way up.

We found out that the reason why she hadn't entered the birth canal. She was so entangled in her cord, there wasn't enough slack for her to tuck her head to her chest (the position needed to enter the canal). Had the epidural worked my body may have eventually forced her in there, probably the wrong way and we wouldn't have known until she was in a possible fatal situation. That's why I must've felt like I shouldn't be getting the epidural. I needed to be aware of my body's signals that something was wrong. Trust your gut.

A little while later I was completely sewn and bandaged up. I was being wheeled to recovery when another nurse appeared next to the bed as I was being rolled down the hall, she asked, "Do, you think you feel up to nursing? She won't stop screaming and they'd like to get her out of there." I had an inner chuckle and all I could think was, 'Good for her. She knows she needs to be with Mommy.' I told the nurse I absolutely felt up to it and I was greeted to her wailing just moments after getting into recovery.

My husband later told me they had tried to feed her with a syringe (which I had told him prior was acceptable) and she was not enjoying it at all. From the moment I got her in my arms and presented my breast she latched on like a champ, and has been doing it ever since.

I am on the mend. Recovering from a c-section is a completely different process than recovering from a vaginal birth. But, things are mending and I'm feeling a little bit better with each day. I'm still sore and tender and I'm sure I will be for a while. But, Milica Elizabeth was and is completely worth it.

Nursing is going well. I'm a little unsure of myself at times and worry whether or not she's getting all she should, but she seems to be thriving and I think we have gotten the hang of it. I look forward to a long, happy nursing relationship with her.

Here she is moments after she was born.

Saturday, August 4, 2012

35w0d & NST/ 36w0d & NST

I totally fell off the blogging band wagon while on vacation. So, this post will be comprised of last week's (35)  growth info, NST info, and pics - in addition this entry will also include this week's (36) pics, NST info, growth info and how I'm feeling.

Week 35

Your baby weighs about 6 lbs (2750g) and measures about 20.7 inches (46cm) in length. Crown to rump measurement is about 13.5 inches (34cm). Your baby now feels lower in your pelvis. Your baby continues to grow, kick, and move about. Your baby's face has filled out and the cheeks now look plump and full. Fat baby cheeks are caused by fat deposits, but also by powerful sucking muscles which your baby has been honing by sucking her thumb. Your baby's skull is firm, but it is not hard as it needs to give a little when it is passing through the birth canal. Your baby's head is probably down by now, but about three percent of babies present in a breech (bottom down) position.

The NST right before I left for vacation went good. My BP was a little up at 133/82, but it wasn't too bad. I had only 2 contractions or so while I was there. Her AFI was 11. She is doing awesome.

The pics were taken at 35w0d.

Week 36

Milica's growth info for this week:

She weighs approximately 6.5 lbs (2950g) and her total length is about 21 inches (47cm). Your baby's crown to rump measurement is about 14 inches (35cm). By now, your baby's head may have engaged into your pelvis. You may feel that your baby occasionally has hiccups from her "practice breathing". Though your baby is nearly considered full term, she is still growing and developing both her body and her brain. She is still laying down fat at a rate of more than half an ounce every day.

I am feeling worn out, stretched and sore. No doubt that the vacation has helped create a lot of the worn out feelings. It's getting extremely uncomfortable to walk. Sometimes it's painful to walk. I think this might signal Milica beginning to "engage" in my pelvis.

I'm having contractions every day, but nothing consistent or timeable.

My swelling is beginning to get a little worse. I'm definitely not as swollen as I was with Joseph, but I'm on my way. Speaking of Joseph, I was induced with him at 36w0d which is how far along I am today. That means that come tomorrow I will officially be in uncharted pregnancy territory.

I'm moody to say the least. I know my boys like this part of me least of all right now.

My NST went well today. Milica's AFI was 14. That's the highest one we've had so far. She is doing wonderful.

My BP was up a little more than last time 130/88. If that bottom number keeps creeping up we may not be able to go to the EDD. I'm hoping that after I rest some from our trip things will go back down into the normal range.

Since I was there in triage I mentioned to the nurse I'd been having some discharge and feared I may have developed another infection. So, the OB resident decided to do an exam. She did my GBS test since she was going to be swapping anyways (I should know the results at my next OB appt.) and then checked for an infection. I'm relieved to say that I do not have another infection. She believes that what I'm seeing as far as discharge is the loss of my mucus plug. I had wondered if that was the case, but since I didn't see first hand the loss of my plug with Joseph I wasn't truly sure what to look for. She also checked my cervix. My cervix is lower than at my last exam and I am dilated 1-2. I am still completely thick though (so 0% effacement). She did not tell me how engaged Milica was and I forgot to ask.

My next OB appt. is on Thursday and my next NST is on Friday. So, I will update on Friday with the info from both appointments.

Here are the pics for this week. They were taken today at 36w0d. Maybe I'm imagining it, but I think she looks lower.