Thursday, June 28, 2012

Baby Evan's birth by C-section

Michelle shares her son's birth story:

I’ll start at my doctor appt on April 22 (36w4d). My blood pressure was suddenly much higher than it had been, which seemed to be the start of mild pre-eclampsia (which I also had with my first baby, Miranda, who was 3 ½ when her brother was born).  The next day was spent getting a NST at the hospital birth center, and letting everyone know that I was officially out of commission — on bed rest.

Surprisingly, bed rest at this point in pregnancy was not a bad thing. It certainly beat going to work, which had gotten progressively more difficult as I had gotten bigger, more sore and more tired. Miranda was in school three days a week, and a friend was kind enough to watch her the other two days. My blood pressure continued to swing wildly, so my OB, Dr. C., decided to move my C-section date to May 4, when I would be 38 weeks.

I had been induced with my first baby (due to pre-eclampsia) and ended up with an emergency C-section when baby Miranda did not tolerate labor well. My OB and hospital were supportive of VBACs for women who wanted them, but due to the possibility of needing an induction again, and my fear of the risks of VBAC, I had chosen to have a repeat C-section.

During my weeks of bed rest, I went to the doctor’s office a couple of times for NSTs, and got several blood draws to check various things related to liver function, or whatever else they worry about with pre-e. Fortunately, my NSTs were perfect, which was quite a relief. All blood tests were normal as well. It was just my BP and some minor swelling that were concerning.

As the delivery got closer, I started to feel more uneasy. I had a great doctor’s appt and NST on Friday, April 30, which put my mind at ease. But that evening, I was getting ready for bed and my husband, Reid, suggested I check my BP again. I was feeling pretty good, so I wasn’t expecting anything out of the ordinary. But it was 158/113. Yikes. A phone call to the on-call doc (Dr. P., sounded kind of grumpy at 11:30 at night), and I was told I needed to go in to the hospital to be monitored.

We had a bit of a dilemma — Miranda was sound asleep, my parents hadn’t arrived yet, and asking anyone to come and stay at our house would mean waking them up, disruption, etc. So I decided to leave my Reid at home and go in by myself. Of course at that time of night, I had to go in through the ER entrance. That got great reaction, both from staff and patients. I told everyone I was NOT having a baby that night, but they didn’t seem to believe me.

I got to the FBC and all the nurses expressed surprise that I had come by myself. I explained why (sleeping 3-year-old) and met my nurse, Cindy, who was very kind and had a lot of energy. Seems like good qualities in a nurse on the night shift. BP was still high, but lower than it had been at home. I had yet another NST and blood draw and both were perfect. So, at Dr. P.’s instruction, I just hung out for a few hours and watched my BP go down. It eventually got nice and low — not quite healthy, but low enough to be considered “normal.”  During all of this, I watched my contractions on the monitor — strong and regular, as they had been for a couple months, but still not causing labor. I drove myself home around 2 a.m.. Cindy told me she would see me Tuesday night after my C-section, since she would be working that night.

The rest of the weekend was fairly uneventful. My parents arrived, I stayed in bed and checked my BP. Miranda liked having extra adults around to pay attention to her. Monday was the day before the scheduled C-section, and I cheated on my bed rest a little bit to get my hair cut. Nice haircut, but I felt fat, hot and dumpy at the salon, and I had to pee the whole time.

Monday evening, Reid and I went out to dinner (more bed-rest rule breaking — I checked my BP first, of course). Over pasta, we ironed out our final name choice — both first and middle names. I was not very hungry, and it was at that point that I realized I was getting nervous. We went home and puttered around — packing up our hospital bags, taking a couple of last pictures of the belly, putting Miranda to bed, etc. Despite an early wake-up time (4:15 so we could be at the hospital by 5:30), we went to bed fairly late. Reid snored, I tossed and turned, and neither of us slept much.

We were tired and weary the next morning, but made it to the hospital on time. The nurses quickly started getting me prepped for the surgery. An IV was placed (easy — this was my biggest fear when Miranda was born, and it turns out to not be a big deal), and I changed into a lovely gown with no back, and was hooked up for another NST. In contrast to all the non-eventful NSTs I had been having for the past few weeks, the baby was not responding well. It took a long time before they saw what they wanted to see from his heart rate/reactivity. I just thought, “Hmmm … good thing we’re getting him out today!”

I was very anxious to meet the anesthesiologist. I had found out during Miranda’s C-section that this person has the most visible and active role (at least from my point of view) during the surgery. And yet, like most surgeries, you have no idea who the anesthesiologist will be ahead of time, nor do you get to meet them. I had a neat typed list of questions for this mystery doctor. Eventually, Dr. W. bustled in at about 7:15 (surgery scheduled for 7:30). The only way I could describe him is as a “dude.” He was loud and boisterous, muscle bound, called me “kiddo.” He kind of blew off the questions, and I was a little irritated. He unhooked the IV bags from the pole, and said it was time to go down to the OR. I guess I hopped out of the bed and flew out of the room pretty quickly, because he had to hustle to keep up. “You’re nine months pregnant and faster than I am!” I realize that at this point maybe most women turn to say goodbye to their husband, or get teary or something. Well, I just really wanted to get this show on the road. I was a little bit tired of being pregnant, and really ready to meet this baby.

The OR was freezing. It was odd to me that I just walked down there and climbed up on the table by myself. No one knew where Dr. C. (my OB) was. Dr. W. was pretty adamant about finding Dr. C. before placing the spinal anesthesia, which I appreciated, and that helped make up for a few “kiddos” in my mind. Dr. C. finally showed up (he had been on call all night — this made me a little nervous) and introduced me to the assisting OB, Dr. M (“This is the guy who will push your baby out for you”). That sounded okay to me, how often do we get to make men do the pushing?

I rested my head on the shoulder of a nice nurse while Dr. W. did the spinal. It did not hurt much at all. I lay down and waited to become numb while they started draping and prepping. Unfortunately, a few minutes later I could still feel everything that was going on (including catheter placement — yuck). So we waited some more. They continued to prep. I got nervous, and told them what I could feel — my legs, that contraction, the baby moving, them washing my belly, etc. Dr. C. did a pinch test, and I felt each one. So they had me sit up and Dr. W. did another spinal injection. Again, it didn’t hurt, but I was really getting nervous at this point. I knew they wouldn’t do the surgery without me numb, but I was worried they would say I needed general anesthesia. Luckily, whatever he did the second time seemed to take, and I did not feel the pinch tests.  Nor did I feel when they actually started the surgery, which was before Reid was even in the room.

Reid joined us mid-surgery, and everything went really quickly from that point forward. Dr. M. pushed the baby out (it felt like he was standing on my chest), and Dr. C. announced a healthy baby boy. A moment later I heard the baby cry, at which point I started crying and fogged up my glasses. Reid went over to the warming table to be with the baby.

Despite his “dude” demeanor, Dr. W., the anesthesiologist, turned out to be very gentle and attentive throughout the surgery — patient and reassuring as he started (and restarted) the spinal, sitting next to my head during the surgery, wiping my glasses when they fogged up, checking if I was warm enough, asking how I was feeling, smiling reassuringly, etc. All this on top of the more demanding and important job of making sure I was healthy and safe during the surgery. For surgery with a conscious patient, it’s like the anesthesiologist is the patient’s own ambassador and advocate — a really amazing role, and vital to my positive experience and comfort. 

Dr. C. mentioned that it was a good thing I was having a C-section, and that we had done it that day instead of waiting a week — there was meconium in the water, the cord was around baby’s neck twice, and was between baby’s head and the cervix. I was a little nervous hearing about the meconium, but could hear the baby crying vigorously. He was quickly wrapped up and brought over to me. I got my arms free so that I could “hold” him with Reid’s support. His face was scrunched up in a grimace, eyes closed tightly. I peeked under his hat and saw lots of hair. Reid, Evan and I posed for a picture by one of the nurses. A nurse then gently suggested that Reid take the baby back to our room since the OR was so cold. I was sad about this, since I thought I would get to stay with Evan the whole time, but it was really cold in that room.

They left, and to my surprise, the surgery was completely finished about 10 minutes later, and I was ready to be wheeled back to my room. Once in my room, I was given Evan to hold almost immediately. I held him skin-to-skin under my gown, and we were piled with blankets since he was a little cold. I think nurses were fiddling around with me, but I was not really paying attention, I was just focused on my new little one. We tried nursing, and he latched on pretty quickly. He opened his eyes briefly, but mostly kept them tightly closed.

The spinal wore off after about an hour, and I was starting to be in pain. I was a little perturbed, since I had hoped to avoid IV narcotics. During recovery from Miranda’s birth, I had felt very sick and out-of-it, and had concluded that whatever was in my IV had caused that feeling. But when the pain started interfering with my ability to focus on Evan, I asked for the drugs. Thankfully, the morphine did help the pain, and didn’t make me feel too sleepy or loopy, and I was able to focus on Evan again.

After a bit, he needed to be weighed, bathed and given his vitamin K and eye ointment. They did this all in our room. I knew he was a little peanut — 6 lbs. 13 oz. It was nice that he did not cry for the vitamin K shot, and he liked his bath in the sink of warm, soapy water. I loved getting to watch the bath, since that was something I missed when Miranda was born. He was quickly back in my arms and stayed there for the rest of the day.

The day was a blur, but happy and cozy. Evan napped, I napped, we nursed.  The nurses removed various gadgets (BP cuff, IV, etc.) throughout the day and I started eating real food. I was hungry almost immediately after the surgery, but they encouraged me to go slowly (jello, Saltines, and such).  I finally got a smoothie and a bowl of soup that evening and it tasted awesome. It was so incredible to eat without the nausea that had plagued me for the past nine months.

Miranda and my parents came by that evening to meet Evan. Miranda was a little bit unsettled, and understandably was much more interested in me than in her new little brother. We shared a packet of graham crackers, which delighted her. She still talks about that. “Remember when I came to visit you at the hospital and you shared your snack with me?”

My milk came in the second night (less than 48 hours after birth), which is nice and early for a C-section. Evan and I were lying in my bed together, both of us on our sides while he nursed. I realized that I heard him swallowing, which was new, so I knew he was getting milk. He slept for several hours after that.

The rest of the hospital stay was relaxing and uneventful. I was having a great time resting, ordering good food from room service and getting to know Evan.  I felt so good that I spent nearly all my time holding, nursing and caring for Evan, and Reid started to get bored. He asked, “When do I get to hold the baby?” 

I still look back very, very fondly on those peaceful, magical first days. Evan, Reid and I were in our own little world and waited on hand and foot by the caring, attentive nurses. Every morning, Evan’s pediatrician would show up and exclaim over what a perfect baby he was. I felt great, and by the day after surgery I was moving around easily. We left the hospital on Friday morning, three full days after my C-section on Tuesday morning.