Friday, April 12, 2013

Luke's beginning

I'm so excited to share my friend Carrie's story. Luke's birth story, coupled with a family member's abruption around the same time, had a huge impact on the way I thought about birth.

The nurses called him lucky. One of the doctors said he was a miracle. We know that God was watching over us as Lucas came into the world. Here's the story of his rough start, but, all in all, a wonderful beginning.

My first pregnancy and delivery was pretty typical except for a few brief moments when my little girl’s heartbeat dipped during delivery. Otherwise, it left me completely at ease for the second time around, which came 18 months later —  to the day. I never had any problems during my pregnancy with my son besides the typical swelling of the feet and ankles and horrible heartburn.

So, when the big day arrived, all I had was excitement to go along with those fun contractions. I had been having contractions all morning, but didn't think much of it since this had been happening for the past several weeks. While my husband kept telling me to rest, I kept on doing what I needed to accomplish for the day. On my way back from a little errand, I began to realize that the contractions were getting pretty strong and started timing. When I arrived home, I surprised everyone by saying that we might be going to the hospital. I labored at home for a couple hours, timing contractions, double checking my bag, and wishing that my water would break so that I would know that it was really going to happen. Thankfully, it didn't.

Once we arrived at the hospital, the nurses took 20 minutes to come check on me. I must have been holding it together pretty well while getting checked in. They had no idea that Luke was just about ready to get the show on the road. I shocked them when they discovered I was dilated to 7 centimeters, and they quickly got me moved to a delivery room.

From there things really slowed down. Three hours later we were still waiting for my water to break so that dilation would happen faster. The nurses double-checked that I didn't want the doctor to break my water, and I figured that since we weren't in a hurry, we might as well let things happen naturally. Thankfully, this was exactly what needed to happen, because once my water did break things started to go wrong — really wrong.

As soon as I hit 10 centimeters, my water broke, which caused him to drop, and since the cord was wrapped around his neck, it must have caused so much tension that the cord ruptured and the placenta tore away. Without the placenta remaining intact, blood wasn't circulating into his body. But no one knew any of this just yet. The nurse was calling code blue and searching for my little guy’s heartbeat. From the silence on the monitor, I knew she couldn't find one. I held my husband’s hand tightly and searched his eyes for reassurance. He said that it was okay, but I knew he didn't believe it. The room quickly filled with nurses and doctors. Half of them surrounded me as they asked questions of each other. Then they all said, "Push!" And, quite easily, as a matter of fact, he was here!

I heard him cry and expected them to hand him to me, but instead he was passed to the team of NICU doctors and nurses that had rushed in 6 minutes ago. I tried to catch a glimpse of him, but couldn't see much. They said they'd have to take him to the NICU to look him over and that I could see him for just a moment. I'll never forget looking down on his little head covered with a striped, cotton hat and seeing his deep blue eyes looking directly back at me. I murmured a few sentences to him and then they took him away.

My husband asked to go with him, and though I needed him beside me at that time, I knew our son needed his daddy more. Thankfully, our family was there awaiting the birth of the new family member, and they kept me company until I was finally able to see my son. As the nurses finished their post-delivery duties, they repeatedly filled me in on what happened. They said that I did great. That getting him out in 6 minutes saved his life. A few minutes more and he wouldn't have made it. I was numb to everything they were saying and could only think about when I would get to hold my baby.

Two hours had passed before I was able to be wheeled up to the NICU. A doctor came by immediately to fill me in on how he was doing. I did my best to make it look like I was listening, but I just stared at my little baby and wondered if this was really happening. We weren't able to hold him, just touch him through the little doors of the isolette. He was given the last available bed in the whole facility. They were getting ready to give him a blood transfusion and hoping that his blood pressure would rise.

We hardly slept that night and were back up in the NICU early that morning to see how he was doing. The nurses were so kind, were eager to answer our questions and offer any support that they could. It was hard to hear them say how lucky they thought him to be. The transfusion went well and we were able to hold him for a little while. Twelve hours after he was born! It felt so good; like a whole in my heart had just been filled. His blood pressure was still a concern, and they continued to run tests to determine why. Later that day we found out that his platelet levels were terribly low and that he would need to be given more. He was put on five days of antibiotics in case there was an infection causing this, which meant that hopes of him coming home with us were looking pretty slim.

By day two, his blood pressure was looking much better, but he still needed to be given plasma and another blood transfusion. They would run tests that night to see if that corrected everything. Fortunately, the doctor had determined that he was healthy enough to eat. FINALLY! Poor little guy had been going to town on his pacifier, and he was hungry. Family brought our daughter to visit us at the hospital, and that really helped keep our spirits up. We stayed as long as we could, but that night I was discharged and we had to go home empty-handed. I'll never forget the emptiness I felt as I climbed into bed that night. He had been with me every night for the past 9 months, but tonight we were apart.

The following morning, we learned that his platelet levels were still low, but hadn't fallen. He was eating really well and the doctor was finally convinced that I could give him everything he needed. We had an awesome nurse that pushed for keeping him strictly on breast milk. By day four, we learned that he was creating platelets on his own, which meant that there wasn't an infection and the low levels were simply due to his rough start. It also meant that he could be taken off the antibiotics. Things were looking up and we had settled into a little routine.

On day five, we received the wonderful news that he could go home the next day. We wore permanent smiles for at least the next 24 hours. It was over. All the worrying, wondering, and fear were behind us and all that was left to do was thank God, pack up our things, and head home. While we had to wait a few days extra, we still got to experience the happy homecoming we were expecting; a memory that will stay with me always. We are so thankful that we had such wonderful nurses and doctors to take care of Lucas and that we had so much support from family and friends, but most of all, we are thankful that today he is thriving and healthy.

Wednesday, March 20, 2013

'You can still wind up with an emergency C-section that is a GOOD EXPERIENCE'

Rachael shares her son's birth story:

I found out I had gestational diabetes at my first OB appointment. It was so early it wasn't even the OB I saw, but a nurse educator. I failed the glucose drink test and was sent for a 3-hour fasting to confirm. I also have PCOS, so insulin resistance from that coupled with a ridiculously strong family history (both parents, an uncle with Type 1, aunt with GD, all grandparents …) and the fact that I was not in optimal physical condition when I finally got pregnant (depression due to the difficulty conceiving from my PCOS led me to gain weight, and I was obese at the time) all combined to make me a perfect GD storm. It was definitely GD though as my A1C was fine; I had a hard time convincing some not-exactly-well-informed nurses that I wasn't a Type 2, but that's another story.

I started out on oral meds within a couple of weeks of my diagnosis, in addition to receiving nutritional counseling, upping my exercise intake, and put on a minimum 4 times daily blood glucose monitoring regimen.

Throughout all this, I knew I wanted a vaginal birth and blindly believed I would be a good candidate for it. I studied child development and early childhood education in college, which focused heavily on attachment parenting and all the choices that tend to go along with that, and was pretty upset the option of even TRYING a midwifery was stolen from me (GD is considered high risk, and midwives don't work with high risk patients).

My pregnancy was not a healthy one. I blessedly avoided severe morning sickness, but had a whole domino effect of complications and illnesses. I had repeated UTIs and yeast infections. I had thrush on my skin for most of the entire pregnancy. I had bad acid reflux (a preexisting condition due to my obesity but was managed with Nexium) that continued to require treatment. I developed respiratory problems and had "pregnancy induced asthma" — I had asthma as a child of two smokers, but hadn't needed treatment or been symptomatic since I was 10 - which required 3 different inhaled, oral steroids that I had to be on for the duration of my pregnancy (steroids raise blood sugar, you can see how this is a vicious cycle.) I came down with the regular seasonal flu (after getting both the flu shot and H1N1 shot — my OB said to be thankful I got the vaccine before I contracted the illness, since the way it reduces the severity of the symptoms is probably the only thing that kept me out of the hospital!) and then required oral steroids and Tamiflu and Ciproflaxin. While I managed to avoid hospitalization for the flu, I was pretty seriously ill and took multiple courses of the steroids to get well - all of which aggravated my diabetes.

Basically, I was getting sicker and sicker the further my pregnancy progressed. I saw a regular OB and a maternal fetal health specialist for high risk pregnancies. I had to send in my blood sugars once a week for the entire time I was pregnant. I had about 80 appointments for the whole 9 months or so. I had so many ultrasounds I lost count. Throughout ALL of this, I still planned on having a natural, unmedicated birth. I don't know WHAT I was thinking - clearly it was wishful thinking, not reality-based thinking!

My son was thriving and doing very well despite the medical hell and overall lifestyle of a senior citizen that I was living. He didn't start to measure big until the very end of my pregnancy. All of a sudden, my fluids were measuring very low, he shot up to an estimated 8 pounds, and I was having severe edema and borderline low blood pressure. At 37 weeks, I asked my doctor about induction. At that point, I had been on four-times-daily injectable insulin (which I had to inject myself right into my baby bump!) and was just so ready to be done.

She reviewed my current numbers and agreed that I was a good candidate for induction. 3 days later, after a nice dinner out together the night before, my husband and I showed up at the hospital at about 7 at night. I should have eaten before I got there! I just sort of assumed they'd feed me, but I had missed dinner time and all they had was a vending machine sandwich. I spent my entire labor asking everyone who came in the room what they had eaten most recently and then salivating over what they told me!

That night I got a pill to dilate my cervix inserted vaginally and an Ambien to sleep. I didn't sleep at all as I was woken up a lot for monitoring — at least my husband slept that night. In the morning I had progressed well, so I got to start pitocin (no breakfast though — sob!). After a few hours of that, I was still progressing well but they wanted me to walk around to help things along. I had not one but TWO IV trees hooked up to me (six different medications/fluids being needed at once! The nurses told me that it was the most they had ever seen for an induction. I was a very sick woman.), so my husband had to push one and I pushed the other as we walked around. His best friend came by to visit while we were walking and I remember distinctly telling him to LEAVE, NOW because the walking had kickstarted active labor with a bang.

The contractions started out at a manageable level. The labor nurses I had were great and very supportive. At first I wanted to just curl up in bed through them. They suggested I try the labor ball, the tub, etc. The tub was heavenly — but they made me get out after 30 minutes or so I think for monitoring. They were concerned about my son's heart rate and I had been hooked up to an external fetal monitor since they had started the pitocin earlier in the morning. Once I got out of the tub, all of a sudden, the intensity ratcheted up to an 11, at least. The contractions were UNBEARABLE. I think I stuck it out for something like four hours from the start of labor, and then I asked for an epidural. I have never been so happy to see a man in scrubs in my life.

There was one issue with administering the epidural — they had to do something with my multiple IV sites — I seem to remember I had one in each hand. At some point one of them just got removed and I looked down as I felt wet — blood was GUSHING out of the port on my hand. All while the anesthesiologist was in the middle of doing the epidural. I just closed my eyes and sort of turned my head away while the nurses apologized, stopped it, and got me cleaned up. It was all over in a few seconds, thankfully!

After the epidural I felt MUCH better. I was able to get some rest (I hadn't slept the whole night before) with the only really annoyance being the blood pressure cuff I had to wear constantly. Some of our family showed up to visit, and I could chat with them (chat = ask them about what they had for breakfast). I got to have some crushed ice. It was overall a pleasant, dreamy time of waiting and resting.

About 14 hours after labor had started, I was at a 10, 100 percent effaced, and ready for pushing. The first few pushes were thrilling. I was so excited — my son would finally be here soon! Pushing soon got exhausting, though. I started vomiting with every contraction and push. Two hours of pushing later, I was screaming in exhaustion and pain. Even though I had had two epidural bolsters, I was still able to feel about half of my body — not as intensely as I would have otherwise, but enough to feel pain. The vomiting had really taken a lot out of me. I started screaming that I was done and that I wanted a C-section. The OB on call (my regular one had to leave in the middle of labor!) was so sweet and gentle — she told me 10 more minutes of GOOD trying and then she could call it. I did my pushes dutifully, while watching the clock. When it hit 10 minutes I screamed, "I'M DONE!!!!" — haha. My husband thought I was "giving up" because we both knew how much we wanted a natural birth experience, having read about how much more beneficial it is with breast feeding, health, bonding, etc.

The anesthesiologist came in again I think, gave me much more medicine, thank God. They gave me IV anti-nausea medication that I was SO RELIEVED to get — but later on we realized I had a bad reaction to it. It was Zofran and it basically knocked me out completely. The rest of what happened is a blur — I had to fight to stay conscious and only remember glimpses here and there. I remember how cold the OR was, one of the medical personal by my head singing along with the music that was playing in the room (it was the radio or something, and an '80s song). I remember them saying something like "Why is she so sleepy?" I remember the sensation of being pushed and pulled on when they removed my son. I remember the way my husband's face changed as if he'd been slapped — he went from being tense and disappointed to utterly shocked — my son was about 2 full pounds bigger than they had estimated. He was just HUGE and we were totally unprepared for him to be that bi g… and, also, no wonder he had not fit through the birth canal! After that, it's a blur.

I woke up in the recovery room and was shaking badly. I felt awful but it was quickly fading. I nursed my son, sleepily, and mostly just sat there while the nurse and my husband held him to my breast. I asked if he was latching on (something I was very concerned about due to the C-section) and the nurse said he was a champ, then I passed out again. I later found out that he had some blood sugar issues and that my husband had given him some of the colostrum we had brought with us via a syringe while I was in recovery sleeping.

We got sent to a regular mother-baby room at that point, which was about 4 a.m. the next morning. I had checked in at 7 p.m. on a Tuesday and had my son at 1 a.m. on Thursday — we were all EXHAUSTED! Of course family started coming a few short hours later. My husband and I were both on cloud nine, though — other than being tired, we were elated. The lack of oxytocin I was so worried about with a C-section was not a problem. I was soooo happy I had had a C-section, and that my son was now in my arms, healthy, safe, and sound. I was so thrilled to EAT!

My son nursed great from the beginning, other than being a little sleepy due to being a late-term preemie. Also because he was so large, he tended to stay asleep longer than normal. He lost a bit more weight than they wanted (but, honestly, he was HUGE …) so I had to supplement him for about two days with formula — which at the time was upsetting and I cried, but in hindsight no biggie and I was obviously hormonal!

The nurses and CNA's I had were all SO WONDERFUL and nice and sweet and caring. They helped me have the best shower of my life. They helped us with everything, really, and were just such kind, nurturing presences that we were very grateful to have. I was doing well and so was my son (other than the weight thing). I had one bad lactation consultant — but that seems to be par for the course with them, there are bad ones and good ones and most mothers experience a little both of both. The majority of staff we had were just lovely though.

The hospital was a brand-new one and the rooms were gorgeous and hotel like. The food was good. There was cable TV. We had round-the-clock assistance with anything we might need and free snacks. I was in the hospital for three days after giving birth (the maximum stay covered by our insurance) before we went home. The whole experience was calming and relaxing and I would recommend it to anyone — who wouldn't want room service and a maid while you are dealing with the biggest transformation of your life!?

My incision healed wonderfully. Honestly, the stretch marks are much worse than worrying about some tiny scar! The worst part about the surgery was the itching from the leftover adhesive from the bandages. My son started gaining weight again within a few days after my milk came in (which took five days). I was able to start exercising after 6 weeks and eventually worked my butt off and ran my first ever half marathon last summer (when my son was 17 months old).

Now I am pregnant again with our second and last child. Despite being in much better physical condition, I have contracted early-onset GD once more. It seems to be going better this time though — I'm 15.5 weeks and no meds yet! I'm hopeful that I will be a bit healthier, but my husband and I both have MUCH more realistic expectations for pregnancy and birth. We are going to be scheduling a C-section this time and couldn't be happier about it. I am actually LOOKING FORWARD TO IT! I am hoping for a much calmer, more aware experience. I know now to stay away from Zofran … I can't wait to just be conscious and present for birth!

I hope you can use my story. I think it's great for women to know that even in a high risk complication-ridden birth, you can still wind up with an emergency C-section that is a GOOD EXPERIENCE.

Friday, February 8, 2013

The Amazing Truth About Hospital Birth, Part II

We had so much positive feedback about our last post that we thought we'd do another to share some of the beautiful hospital birth photos we received!

Tuesday, February 5, 2013

The Amazing Truth About Hospital Birth: A Pictorial Display

An answer to "The Amazing Truth About Homebirth: A Pictorial Display." You don't have to have a baby at home to be blissfully happy!

Thursday, January 24, 2013

What's really routine?

Our friends at Safer Midwifery for Michigan have a terrific "Ask an OB" post today about "routine" interventions. I think this is a really important post, because many of the things I see women worrying about (like routine episiotomies) are really not done anymore.