Wednesday, April 30, 2008
Tuesday, April 29, 2008
I almost had to physically restrain Josh from calling to ask for her measurements.
Do you want to know a secret? I don't find it any harder to use cloth diapers than I do disposables. Yeah, you heard me right. Cloth diapers have come a long way from where they once were. Today's diapers and covers have an outer construction of waterproof cloth called PUL that doesn't really seem that different than regular polyester or cotton (so there's no more nasty crinkly plastic pants) and are outfitted with snaps and velcro (no more sticking yourself or your baby with pins.) You have lots of different options to choose from-you can still do a diaper with a cover, or you can choose an all in one construction that really doesn't seem any different than a disposable-except that you don't throw it away. They have cute brand names like "Happy Heineys," "Disposanots," "Bum-Genius" and "Fuzzi Bunz". I wash a small load of diapers every other day. There's no special treatment at this point-I just toss them in, poo and all and then throw them in the dryer later. We do have to use a different detergent that has no perfumes or dyes, but I can live with that.
Once Katie starts solids... I may change my tune, and it will involve a bit more work. But, breastfed baby poop really isn't all that toxic or objectionable. Frankly, it doesn't even smell bad. Yeah, that's right, I just said my baby's shit doesn't stink-but I'm her mother, that's a pretty predictable statement, isn't it? At least I didn't say my baby's poo smells like strawberries (seriously, I saw someone who claimed that once!) It's a good thing too, because I don't need to be any more in love with this kid. Those sweet little innocent eyes and heart shaped lips have already done me in-I'd be devastated by strawberry smelling poop. Besides, I'd spend all my time at the changing table sniffing....and that's just a little wierd.
Thursday, April 24, 2008
The contractions got stronger as I waited and I realized I had NO desire to leave the birthing ball. They were about 2-3 minutes apart, and totally bearable, but definitely there. For me they feel like rhythmic menstrual cramping. There were one or two I had just after Josh got home that I had to lean on him for. We decided not to spend too much time at home-I didn't want to be too much further along for the car ride. We ended up sending Liz to the neighbors and just trusted that someone would pick her up eventually and got in the car.
I had planned to labor on the ball in the back of the van, but never calculated how tall I'd be on it. We didn't fit. I ended up in the front seat-with no towel-totally soaking it. Five minutes later on the interstate, I found myself staring at Lookout Mountain and thinking... "I don't really want to do this again... Lets just cut it out..." I'm sure I was probably in transition at that point. Even without construction, or stopping to meet Micole, we had another 40 minutes to even reach Rapid City.
The trip settled into a pretty regular pattern, with contractions a minute apart and a minute long. I would have a wicked one, followed by a more mellow one. I would brace for each bridge, and mercifully, very few were in the midst of a contraction. Twenty minutes outside of Rapid, just where the interstate makes that funny jag at Blackhawk, I had my first pushing contraction. I couldn't help but roar through it-at which point I reported to DH that "um... THAT was a pushing contraction!"
I'd never had one-never had the urge to push with DD, though I waited patiently for a good 45 minutes with her after being told I was complete. From then on out, each of the wicked ones would be a "pusher" though at some point they ALL became pushers. I just roared through them, and didn't actively try to help the pushing. I could still feel feet in my ribs, and didn't think that the baby had dropped at ALL. I didn't have that feeling of a head in my cervix or anything. I figured we had PROBLEMS if I was already feeling the urge to push!
Yet, it also occurred to me we just might end up delivering in the car-which was okay, but I couldn't figure out WHERE we were gonna pull over on Mt. Rushmore Rd at five in the afternoon on a Monday! I hated to think of just parking in the middle of the street with the hazards on-but knew I'd never get my pants off without help. If she was any smaller-I'm sure we would have. As it was, we made it to the hospital, and the first place I directed DH to was the wrong one. After rushing madly about trying to find someone to help him in an empty hallway, an administrative person told him to go to the emergency entrance. We rushed BACK out into traffic and in the right parking lot/entryway.
When he ran in this time, he apparently didn't stress the urgency of the situation well enough, and the emergency people just directed him down the hall and around the corner to L and D. He asked for a wheelchair and they just said "Oh, they'll handle all that when they check you in." He just looked at them like they were on crack, grabbed a wheelchair, and ran back outside with it. I got in it, immediately arched into a contraction and we entered the building with me ROARING through it. I caught a glimpse out of the corner of one eye of a woman behind the emergency room desk, half standing from her chair as we RAN by, a silent "O" on her lips. The non-laboring part of me was LAUGHING her head off.
Our midwife met us down the hallway, with a big understated and calm "Hi! We're in room two." Another contraction hit once we got in the room, and she tried to get me to breathe through it-I didn't have the concentration to tell her I wasn't actively TRYING to push. We managed to get my pants off, I stood there while she checked me and she said "Oh, you're complete! That baby's head is only about as far in as my first knuckle! Push anytime!"
There was meconium in the water by now and an NICU person was brought in to attend to the baby. I got on the bed and held onto the back while kneeling, but my legs were just jelly, and it wasn't long before I had to get off them and push on my side. I can't believe how much more effective a push is when you have a pushing contraction to work with! I wonder how I EVER got my first child out! No wonder it took two hours! Pushing was not satisfying, and hurt the closer she got to crowning...my roars became higher and higher pitched. Then her head was out... and I wasn't done! Lizzie just sorta slithered out after the head -all in one push. It took at least another minute for me to push her the rest of the way out. I remember screaming at one point- "oh just pull her OUT!" I couldn't believe how much more work it was-and those muscles were just TIRED!
Finally I mustered up a last heave and out she came. I should put "finally" in quotes-we'd been in the room all of ten minutes max. It's amazing how much better you feel-the instant that child leaves your body. I couldn't help but heave a sigh and say "Oh, that's MUCH better!" Because of the meconium, they cut the cord right away and whisked her over to a warmer for suctioning. Even after I got her back, I could hear quite a bit of "singing" as she tried to breathe, but we got a great nursing session in right away.
By the time we weighed her, she had pooped a couple of times, or I bet she would have been a full 10lbs. As it was, I was somewhat of a celebrity around the hospital as a 5 foot 1 inch person birthing a 9lb 13 oz baby in ten minutes. Someone actually said I was a once in a lifetime sort of patient. Katie was with us till I consented to allow them to bathe her and run some tests while I took a shower and grabbed some dinner. They promised not to do any of the typical things they do- like eye goop and shots, so we felt pretty comfortable with it. But we never got her back. They became concerned about her breathing and took her to NICU for observation, and there our adventure began.
In retrospect-the birth was GREAT, but I'm not doing another damn labor in the freaking car! Woman was not made to labor in the front seat! If we ever have another it will be AT HOME. If breathing issues present themselves with a third child, it's nothing that a transfer won't fix. We were never in danger of losing either of our kids in an instant, though they both had breathing troubles. Katie is doing really well-our electrocardiogram at two weeks old showed she's responding well enough to her Viagra treatments that we began weaning her down slowly. As of tomorrow she'll be on a single dose a day, and a week from now she'll be all done. We go in for another look at her heart and capilllaries in mid-May.
It took a full 5 days for Lizzie to finally meet her, but she's totally enamored, and has a really difficult time sharing her with anyone-that was one possibility we never even considered.
It's good to be a family.
Saturday, April 5, 2008
Sleeping last night was scary... and pretty unsuccessful. It's hard to relax enough to sleep, knowing your baby already has a crappy track record with breathing. This was compounded by the fact that she wasn't nursing well. She'd be ravenous to get on the breast, but then slip off after a few sucks- konked out, or push it away after a few minutes, etc etc. GAH! These were all warning signs we were told to heed that might indicate she was having a hard time breathing, and this morning she looked a little blue around the mouth and nose. So, we ate breakfast and took her in to our local emergency room for monitoring. Fortunately, her saturation levels look good-still in the 90's. But it's so damn HARD not to obsess over every little grunting breath-sometimes it looks like she's really working hard! I've never been scared we would lose her while in the hospital. Its never been touch and go... just serious. But now I feel like we're operating without a net. Overall, I think I might have gotten two or maybe three hours in. Thank goodness she's slept well all day. We've been napping like fools.
Lizzie joined us at lunchtime today. She's spent the last week with either Rich and Rayelle or Grandpa and Grandma Gray. Not bad for a child who has never spent a night without us. She's coping really well, and was SO excited to finally meet her sister. Due to the especially bad RSV season this year, no kids were allowed in the Labor and Delivery wing, and of course they wouldn't allow her in the NICU either. So, she's spent all this time waiting to meet her sister. Every little wiggle Katie makes is noted and eagerly reported. I hope the novelty lasts!
Thursday, April 3, 2008
Her nurse and I were working hard to figure out exactly why she wouldn't latch on and one random pinch of the tissue worked miracles. Suddenly she was ON and nursing enthusiastically. There I sat, with my girl at the breast... and the world felt different suddenly. It normalized somehow. Even NICU suddenly became a less artificial and sterile place. All her cords and tubes receded, and we were just a mother and child, going through the motions of normal life.
So far, they're only letting me feed her once a shift. I'm hoping the Doc will allow us to feed on demand after his rounds today. She's still recieving all the nutrients and fluids she needs for daily life via IV, and anything she gets from nursing is just extra. All of her stats are looking very good. The GBS culture's preliminary results are back-and negative of course, though they will continue to watch it incase something grows slowly. There is no electrocardigram ordered for today unfortunately (this would help determine tension levels of the capillaries/veins next to the aveoli.) I guess this is a good thing, as it indicates they have a lot of faith she's healing well and doesn't require such close monitoring, but I'm now a stat junkie, and I want to see exactly HOW MUCH she's improving!
Wednesday, April 2, 2008
Here's the focus of daily life for us right now... our little area in NICU. I didn't end up getting to hold Katie last night because of a small setback, though I did get to touch her. She'd had some retractions, where she was sucking in really deeply to try to breathe and they ended up bumping up her O2 levels to 30% again. They also decided to administer viagra.
A night's worth of treatment worked wonders (as any old man would agree, I'm sure!) and this AM's chest xray and electrocardiogram revealed that the "tension levels" of her veins had relaxed down to 32 (remember we're shooting for mid-20's.) So that gave us quite a bit of hope, but the nurses were still talking about not even starting her in a crib or removing her from O2 until this weekend. The pictures you see here are from around noon, when we both got to hold her for a few minutes. The blue tube you see is the O2 tube that's normally plugged into her hood. The thin tube to her mouth is the OG tube that extends down into her stomach and allows gasses to flow freely out without disturbing her. The pink blob is her hand, swathed in bandages to hold an IV in place.
The day got even gloomier when we discovered it wouldn't be possible for me to stay in the hospital any longer. I was to be discharged in late afternoon, at which point we'd have to say goodbye to Katie and drive an hour home with heavy hearts. While I know she's in great hands, I just hated the thought of being so far away. I did pretty well until I really started thinking about that goodbye and then I just lost it. Not long after, the attending neonatologist stopped in and made the surprising announcement that he had decided to put her in a crib and they'd removed the O2 hood and she was now breathing with the assistance of just a small O2 line under the nose!
They've removed the OG tube from her stomach, and best of all, the Doc said we could begin nursing attempts after the shift change at 4! WOW! What a rollercoaster ride! We'll see how well she tolerates this new change. While I was there after 4, we did see some "singing" (imagine sweet little baby grunts to try to open the aveoli in her lungs) but cross your fingers that it's a temporary thing.
Our nursing session was totally unsuccessful. She has a lot of interest in sucking, and takes the breast well, but doesn't seem to remember what to do with it once she has it. Apparently it hasn't occurred to her to clamp down, and she spends her time getting frustrated with what the heck she's supposed to do. She's happy to suck on my knuckle, and sometimes will take a pacifier, but seems baffled by a boob.
I'm hoping for some advice from a lactation consultant soon. In any case, I got to hold her for almost 2 glorious hours. She's now dressed in a sleeper and wrapped up like a baby burrito in a blanket. I'll go back in at midnight tonight to give it another shot. Incidentally, I'm not officially IN the hospital anymore, but instead was discharged at about 6pm. However, due to the desire to breastfeed, they have graciously allowed me to stay overnight in my old room on my own, assuming they don't fill up and need it. I suppose I could be kicked out at four am... but it seems pretty quiet around these parts and I see a good 5 or 6 rooms open at the moment. Tell the pregnant mamas of western SD to stay gestating!
Tuesday, April 1, 2008
I'm afraid I don't really have any great close up photos. We've been pretty busy round these parts and only have what our doula snapped directly after the birth. Hence the baby you see in these photos is still pretty gooey. You'll have to just trust us that she's beautiful for now. Tonight I hope to get the chance to hold her again, and I'll see what I can snap without disturbing her too much.
Labor was AWESOME! My water broke at around 2:30 Monday afternoon. I called Josh home and we didn't exactly run to the van, but we didn't piddle around much either. By the time we left, contractions were about a minute long but only a minute apart. But the time we hit Blackhawk (about 20 minutes outside of Rapid City where our hospital was) my contractions had turned into pushing. I just tried to chill and let my body do the work to prolong things as much as possible. I began active pushing as soon as we were in our room, and she was born 15 minutes later at 5:09. Lets hear it for SHORT labors! Whew! I figure that mom, dad and baby made a pretty outstanding team!
Katie developed some trouble breathing a few hours after birth. At first it presented itself as "singing" or grunting as she drew in each breath. From there it progressed to a lot of retractions and even some desats. Retraction is fairly obvious-you can see the baby's chest and stomach sucking in deeply for each breath. Desats are short for desaturation of the blood. Normally, practitioners like to see oxygen saturation levels in the 90's and there were times when her O2 levels would go down into the low 70's, and she would grey out before coming back up to higher levels. Her breathing wasn't consistent-she had some hitches and pauses. They transfered her to the Neonatal Intensive Care Unit at about 7pm for observation, and by 1:30am they hadn't seen any improvement in her, so they decided to put her on oxygen and start a round of antibiotics as they were concerned about the possibility of Group B Strep (GBS) infection. The round of antibiotics has earned her a three day minimum stay in ICU. They also ordered a battery of blood tests, cultures and x-rays.
Here is what we know now. Three different rounds of testing for white blood cell production show that her levels are elevated, but seem to be tapering off. We tentatively think this indicates that the production is due to stress, not infection. An additional test looking for inflamation in the body (also a sign of stress) seems to back this conclusion up. It takes 3 days for the GBS cultures to come back with preliminary results of infection, however, so we won't be sure until then.
An initial chest x-ray indicated some fluid in the lungs and a repeat x-ray this afternoon showed an enlarged heart. An electrocardiogram revealed that the enlargement was due to pulmonary hypertension, and NOT some dreaded defect in the heart itself. There is one area of the heart that hasn't closed as it should have, but they are expecting this to resolve on it's own in the next few days.
The heart itself is enlarged due to interuterine stress that has probably been going on in the last few weeks of gestation. Exactly what may have caused this is hard to say, but is apparently "commonly" seen in larger babies. The pulmonary hypertension is what is most likely causing Katie's breathing problems. It's been dumbed down for us and explained like this: The tiny aveoli in her lungs lie next to veins and capillaries. As she breathes in, O2 transfers from the aveoli into these veins and capillaries. The most efficient way for this to happen is if the veins are loose and open, lying closely against the aveoli so that a good transfer can take place. In Katie's body, however, the veins are constricted and lying further away from the aveoli, the body isn't making efficient use of the O2 coming into her lungs and she is forced to work much harder to saturate her blood stream.
We were hoping to see a bit more improvement in her this afternoon so that they might be able to wean her down a bit more from her O2. She had been doing well enough that they were only giving her a mixture of 26% O2 (room air is 21%) but she had some further setbacks early this evening. So, I beleive they are bumping her back up to 30% and have decided to begin actively treating the pulmonary hypertension with a drug. What drug you may ask? Brace yourself! Viagra. Yup! That's right! Viagra works to open up blood vessels, capillaries, and veins to allow the area to fill with blood more easily. What works for old men also works for little girls!
What is most discouraging about this is that while we got a wonderful nursing session in last night before these problems started, we haven't gotten to hold our girl since then. Essentially, we haven't had more than about two hours to get to know her. Stroking your sleeping baby's head around an IV in her hand, an OG tube down her stomach, three different sensors on her chest and abdomen, and another sensor measuring skin temp is a lot different than cuddling her and gazing into her eyes. In fact, they don't even really recommend that we touch her at the moment, as it just disturbs her into a more shallow sleep that prevents a deeper healing. We aren't hurting her when we do, but they don't really feel we are helping either.
I'm struggling to find a balance between what I see as an honest and basic need for her to have human contact and touch and a chance for her to rest and get her poop in a group. How much time should I spend in there with her? Am I a bad mother for staying away or am I doing the right thing? Fortunately, the NICU nurses have been pretty understanding. Guilt... the unavoidable baggage of parenthood. I've struck a balance so far by trying to be with her at the scheduled times when they will be checking her stats and changing diapers anyway. That way, I can sneak in some cuddle time, but it will be during points when she is already being disturbed-that way she's getting the maxium amount of rest in, and I still feel like she (and I!) are getting at least a bit of basic bonding time.
I'm extremely grateful to have gotten in some good nursing last night just after labor. She was a very hungry little girl, and latched on both sides for a good 20 minutes each followed by an additional short session later. Hopefully, that established a foundation for nursing later, and gave her a chance to snatch up some colostrum. She's recieving fluids, nutrients and fats through an IV. They really don't want to jeapordize her breathing by trying to have her suck at this point. For now, I'm pumping and saving every single drop of colostrum I get for when she CAN have it.
Shift change is almost over, and I get to go hold my little girl now. Our intentions are to post updates here, so check back over the course of the next few days to learn more.