10 Days Old

Today marks 10 days since Ivy was born, and 8 days since I moved into this uncomfortable but private little room at Randall Children's Hospital. 

Ivy is doing really well. She was extubated on Monday the 22nd, after a very restless night for Cory and me because she would set off alarms every time she would breathe over the respirator. Which was often. They were still very cautious about us holding her, and had told us Friday, but we got a surprise OK on Wednesday the 24th. Her PICC line broke, I think on Wednesday night, so they had to remove it and give her an IV in her left hand instead. Then yesterday (the 27th) her chest tube was removed, which was huge because it was painful enough that they had to give her morphine. (In her baby book, on the page that says "What Soothes You," I included morphine. Heh.)

She was also able to start feeding yesterday. She is doing an ok job taking the bottle but it takes a long time and it's a little nerve-wracking, since our discharge date and her NG tube removal date is contingent upon her being able to take a certain amount of milk by mouth. (If she doesn't take it by mouth, so far, it goes down her NG tube.) 

I was also able to start trying to breastfeed today. It was a failure in terms of her actually latching on for more than a second; she cried for a couple of minutes and fell asleep. But in terms of introducing her to what's going to feed her later, I suppose it worked. We get to try twice a day from now on so we shall see how she progresses.

She also pooped for the first time today. We changed her when her grandparents were here and we all crowed when Cory did the big reveal. It was funny.

I'm feeling better as well. I'm able to walk a little faster and the bleeding has subsided a little. Milk production is good and getting better. Emotionally it's still a roller coaster every day - sometimes I'm elated and sometimes I feel terrible. It usually corresponds with whatever is going on with Ivy's progress, but overall I'm sure the terrible is because of hormones and that I just want to go home. We have only just begun learning what Ivy is like as a "real" baby rather than a drugged, in-pain baby, and I'm a little overwhelmed at everything going on. I'm trying to cut myself some slack but sometimes I can't quite get there. I feel like a bad mom, that I can't believe I thought things like breastfeeding and knowing what's making her cry would come naturally and perfectly to me. Even things as simple as we can't have food in the NICU makes things hard. A lactation specialist called me yesterday and I asked what kinds of foods I should be eating for breastfeeding. Thinking I was at home already, she said "things like salmon and avocado and almonds," none of which (besides the almonds) are available in the cafeteria downstairs and none of which I can eat with any regularity unless I want to go out to the room where we store our food, have a few, and call the nurses to let me back in twelve times a day. 

I'm also worried about how much money this is going to cost us, even though most of it will be covered by insurance. Of course there's nothing else that we could have done, this was a life-saving surgery, but I'm not looking forward to that additional stressor in the future.

I look back, though, and can't believe it's been ten days already. I know much later I'll look back on this hospital stay as having been a tiny little drop in the bucket of our lives together, but for now the enormity of it is sometimes hard to deal with.

NICU Life

We have settled in to the NICU for the most part. It's weird to not yet be able to schedule around two-hour pumpings and four hour "cares" (diaper change, taking her temp, feeding her a drop of colostrum on a q-tip) - we keep having strange meal times as a result. And strange sleep patterns. But I know that's normal for any new parent.

Ivy has been doing pretty well since her surgery. Yesterday afternoon they took out the breathing tube that was holding her left lung open, which was awesome. But at 3am she needed a cannula. I guess that's normal but it scared me a little. This afternoon her lungs have cleared up pretty well, and she has been coughing and swallowing some of her gunk. Hopefully she will get to lose the cannula tomorrow but we shall see - we are trying to get used to hospital time, which is much slower than the outside world.

So the next step is for her to pass a swallow test on Friday morning. They will inject dye down her esophagus and watch it with an x-ray, and hope that none of it leaks. If it leaks, it's anger surgery to repair the hole in the suture line, and another week of recovery before another swallow test. If it doesn't leak, the fun part starts: she will get her nasal tube out (that's what's keeping us from holding her - if it gets jostled it's bad news) and we will start weaning her off her PICC line and onto breast milk, watching her for acid reflux and regurgitation that is common in TEF babies. Therapists and lactation consultants will help us learn the best way to breastfeed for her condition. But the biggest and most awesome part is that we can HOLD her. I cannot wait.



Yesterday, after the breathing tube was taken out but before the cannula. She's super puffy from all of the IV liquids they'd been putting in; today that swelling has gone way down.

More photos on Flickr of course.

Apart

The next morning (Friday the 19th), Cory called to say he was at the hospital with our baby. He got to hold her for a few hours as they waited for surgery. In the meantime, my doctor came in and let me know that I needed two more units of blood because I was still pretty dangerously low, which meant I wasn't likely to be discharged until the next morning and I would miss the surgery. It was so hard to hear. But I resolved myself to get up after those two units and walk around, and show them I was good to go. Besides, Cory had heard from the nurses in Portland that nobody could hold Ivy until the next day anyway.

The day passed slowly. Family came back to keep me company and pass the time, which was great because surgery didn't start on time and took longer than we thought it would. I was on pins and needles, and I know Cory was too, and we couldn't support each other with 100 miles between us. Luckily my dad went to keep Cory company, which was a big help to him. The surgery was a success and since I would be discharged the next day and I felt so much better emotionally, I had my mom go home to get a good nights rest. Before that, though, she helped me take a bath in the big whirlpool tub, and also wheeled me to the baby class that's required of all parents before they're discharged. It was rough being in the room with three other couples and their sweet babies, while I was stuck in a wheelchair alone.

On Saturday, the doctor had more bad news: I still couldnt leave. Even though I had felt better, my numbers were still low (normal is 35 and I was at 15) and I needed another transfusion. I had one that morning, and then another that night. I just kinda laid in bed, trying to ignore how slow the time was passing and crying every time I heard a baby cry down the hall. The night was slow too, but I had a fantastic nurse who I absolutely loved. She looked at post-op photos of Ivy with me, and explained what all of the tubes and wires were that were attached. She also found me boxes for my flowers and packed extra pads for me since she knew I'd be in the hospital for a week as Ivy recovered. She took out one of my two IVs as it had failed that evening, which made for slightly more comfortable sleep.

Sunday morning, I had almost everything packed and ready to go, and then the doctor came in saying I needed another transfusion. He said my levels didn't change from before the prior transfusion, so he just wanted to "top me off" and get me on my way that afternoon. By then I had a reputation - all the nurses knew I was aching for Ivy and the blood lab ladies kept saying "you again?" when they came back. The IV tech set the blood up in my hand and left for a minute, and came back to me sobbing because it hurt so much. (Every transfusion hurt but this time was worse.) Turns out that hand had failed as well. So she put a third IV into my wrist and did it there. This time it barely hurt at all, and they pushed the blood into me twice as fast as usual.

At around 2, they finally released me. The plan was to go home with my mom and stepdad, take a shower and pack a few more things and get the house closed up, go to my grandmas house and transfer to my aunt's car and make the rest of the trek up to the hospital while my mom and stepdad drove home for the week. (They will be back once we are home.)

The ride up was agonizing and surreal. It was weird to be out in the fresh air again, it was weird to sit up straight, it was weird to know that I was finally going to see my baby girl. We got a little lost a couple of times in the neighborhood surrounding the hospital and I was on pins and needles. When we finally got into Ivy's room I dropped everything I was carrying and cried all over her. It felt so good to be there with her and so horrible to know that she was in a NICU.

The Morning After

As I was relishing the reduction in pain and the sweet little one in my arms, the midwife was still at work trying to get the placenta delivered. I didn't have the urge to push it out, but I tried anyway. At one point I thought I passed it but it was just a gush of blood. I remember the midwife telling me I had a second degree tear, and that I had lost as much blood as a c-section patient. They massaged my uterus and showed Cory how the cord had come away from the placenta. I don't remember much after that, just flashes of being wheeled into the OR, the anesthesiologist introducing himself as I moved myself off the bed and onto the operating table, and then five hours later when it was getting light I woke up in the recovery room with Ivy and Cory skin-to-skin in the rocking chair next to me.

Nobody told me how much blood I lost, but I had a unit of blood transfused at some point that day. That morning I didn't care because Ivy was nestled in my arm, her head on my shoulder, and nothing else mattered. Until the pediatrician came in and told us she wasn't breathing well and needed to go into the nursery and put on a CPAP. The next few hours were the beginning of the scary period. The pediatrician told us she thought Ivy had a tracheoesophageal fistula which needed immediate surgery and couldn't be done at our hospital. We had two options for transport: to Eugene or Portland. We chose Portland.

Around 3pm on her birthday, Ivy was packed into an insulated box surrounded by machines and wheeled into our room on a huge stretcher to say goodbye. It was hard to see. She left for the hospital in Portland and Cory went home so that he could take a quick shower and pack. I'm glad that my family came to visit me after that because as soon as I was alone I was a wreck. Cory, who had been up since the wee hours the morning that labor started and hadn't slept since, went home and took his shower but then fell into a deep sleep rather than getting to the hospital. My mom actually went to our house to wake him up because I could not get a hold of him and I was starting to worry he had gotten in a car accident or something on the way home. He made plans to finish out the night at home and go to the hospital very early the next morning to sign the consent forms for Ivy's surgery. Mom stayed the night with me for support and I started my pumping regimen, though I wasn't getting any colostrum yet.

Labor and Delivery

What a roller coaster of a few days. Let's try to sum things up as of now, in a few posts.

I went to work on Wednesday the 7th, and at about 1pm I felt a couple of small gushes which I wasn't sure about - either they were water gushes or they were just watery discharge that had been accompanying my mucus plug. This time it was enough to soak my pad, so I called the OB. The nurse said to hold tight for awhile to see what would happen, and to call them back around 8pm for an update.

Around that same time, I felt what I first thought was indigestion, but I started getting more uncomfortable so Cory and I went home. I slept for maybe an hour, until a painful contraction woke me up, and I went downstairs to labor on the ball.

Over the next five hours (though it didn't feel that long), I labored on my knees draped over the birth ball. I remember being frustrated with Cory for not being able to pack the car and time my contractions at the same time, but that was the only time I was unhappy with him. I threw up a couple of times, once in early labor and once or twice a few hours later.

A little befor 8pm when my contractions were 5 minutes apart (they say to wait until you've had them that far apart for an hour but we didn't wait), Cory called the midwife and she said to come in. Cory threw a towel down on the back seat and I sat backwards on my knees, hugging the seat back.

We checked in at Emergency as it was after hours, and had to wait for several minutes while they figured out how to fit me in upstairs. (Apparently a lot of women were here that night, not necessarily to labor but for other issues.) We went into an admitting room for a few minutes because apparently some ladies in the waiting area came to try to give me advice on how to labor, which annoyed the receptionist. I would have been annoyed too if I knew it was happening. Finally they led me upstairs (I declined a wheelchair) to a triage room, where they checked me and I was at 7cm.

I barely remember taking off my clothes and the midwife saying hello and someone saying "you started to push with that last one, didn't you?" They wheeled the entire bed to the overflow room that we had toured during our birth class when it was so busy a few weeks ago, and I started the delivery process.

I think pushing lasted about four hours. I tried being on my hands and knees, tried the squat bar, and ended up on my back with my feet on the squat bar, pulling on a knotted sheet that the midwife was putting counter pressure on. Ivy was indeed sunny side up, and though I could feel my back hurting it didn't hurt any more than anything else. I was able to feel her head a few times, and when the ring of fire came I remember thinking "I read this only lasts thirty seconds, it's been way longer!" The midwife took a bunch of photos during this time, which are pretty amazing but I won't share them here. Suddenly all the overwhelming pressure was gone as her head emerged, and pretty much immediately the rest of her body followed and they put her on my chest at 12:57 am. Cory got to help, though he couldn't catch her by himself because of her presentation. Watching her being brought up to my chest was the most amazing thing, and when Cory said hello to her she turned her head to find his face. There were almost no tears. It was magical.

Ivy is Here!

Ivy Mae was born at 12:57am on June 18. 7 pounds, 1.3 ounces; 21". We had a bit of a rough start, Ivy and me. The short version is that I hemorrhaged and had a retained placenta which needed to be surgically removed; and poor Ivy had a birth defect called an esophageal fistula, where her upper esophagus wasn't attached to the lower but the lower esophagus was attached by a fistula to the trachea. So she was aspirating her food and swallowing her air, which was causing breathing problems. She had surgery on the 19th to repair it, and so far it looks to be successful, though it will be around the 26th before we find out if it worked well and she's not leaking into her abdominal cavity. Cory was with her at the children's hospital where she was transferred, but I had to stay behind until yesterday evening because I needed five units of blood. I'm so glad to be here now with her - it was so hard to be at the hospital alone, surrounded by women and their babies. My milk is coming in and now it's just a waiting game to see how she does. She's a feisty one, the nurses say, so I think she's going to be all right. Photos soon!

Monday

Another day, another monitoring session. Everything looked fine. The OB swept my membranes again, as I was still only 1cm dilated and nothing had really happened; and this time it HURT. Oof. I had to breathe deeply and pinch my fingers, and as soon as it was over Cory came over and rubbed my back because apparently my face wasn't very pleasant. :) I've had some contractions since then but I can't remember if they're any stronger than the ones that happened as a result of the last sweep. On Thursday they should have some more firm plans for us, as they'll talk about us during their meeting tomorrow morning. She's still not all that worried about my blood pressure, which is good.

Of course, after the appointment I started getting obsessive again about looking online for statistics on the effectiveness of membrane sweeps, and found this:

"The review found that overall the intervention is associated with a 24% increase in chance of delivering within 48 hours, a 46% increase in chance of delivering within a week and a 74% reduction in likelihood of going 2 weeks over dates. (...) In summary, as a method of induction of labour, it is poor, but at the end of pregnancy, sweeping the membranes is a safe way of doubling chances of spontaneous labour over the next week."

Kinda reassuring, but I guess it's just the way you say it - "doubling chances" is kinda the same as "50% chance." Reminds me of looking up IVF success rates and agonizing over a few percentage points. I suppose you could look at it like this, though: there is a 100% chance this baby is coming out at some point. :)

I finished knitting my sixth soaker yesterday, and don't have enough yarn to make another (not to mention six is plenty), so I'm back to being a little bored (which is no fun when you also have a huge life event looming over your head and you have no idea when it's going to happen). I started reading a Dr. Sears book about breastfeeding, but I'm not sure how much information I'm retaining. I should probably just find some light fiction reading for this next little bit.

What else, what else... oh, random stuff:
* I have been eating a ton of string cheese. Not sure if it's because of the protein or what, but it's yummy.
* I'm also drinking lots of very lightly flavored sparkling water. I probably mentioned it before - the OB recommended it when I said I wasn't drinking as much water as I should. It definitely helps - it's fizzy and doesn't have any sugar or sodium or anything, just "natural flavors."
* A few weeks ago, I noticed that my fingers were swelling at night, and going down once I woke up in the morning. It's gotten worse since then, where it kind of hurts to grab the toilet tissue when I'm up in the middle of the night to go to the bathroom. Turns out it's pregnancy-induced carpal tunnel. It's not enough to bother me much, though I can't curl my fingers under my chin which is my preferred sleeping position, but it seems like it's starting to stick around (though much less intense) during the day - my fingers feel stiff all day, especially when I try to clench my fists tightly.
* At lunch today, we were walking back to the car and stopped at a corner where a mama and her toddler were waiting for the light. The little girl pointed at my belly and said "baby!" and so as we crossed the street her mama and I chatted briefly about how far along I am and a little about the toddler's birth. It was fun to have a connection with a stranger like that.

Last Day of Yoga

Yesterday ended up being the last day of the term for prenatal yoga. For some reason I thought it ended next Friday, so I was a little surprised. There haven't really been any other regulars in the class; one lady came a little less than half the time and a lot of the sessions ended up being private (which was awesome).

Yesterday there was a drop-in - a woman whose brother was graduating today (I live in a college town) and she thought she'd drop in because she took a pregnancy test yesterday morning and it was positive.

I spent half of the meditation (without malice, just reflection) thinking about what that must be like - to take a test, be pregnant, and that's that. I looked back on my beginnings - I actually had a yoga class the night before our first blood test (and didn't take an at-home test because it wasn't as sensitive as the blood test) and spent half of the class crying quietly from the stress. We had three blood tests, none of which showed amazing doubling times. I bought a box of at-home tests and took them between the blood tests and the double lines were there, but faint. The first ultrasound showed a barely flickering heart, the baby still almost too small to see. I spent the next month (more than that, really) worried about chemical pregnancy, worried about miscarriage, worried about losing everything I laid on the line, not the least of which the thousands of dollars. And how lucky of this random woman I'm sharing a yoga studio with, to be able to take one test and think "well, that's that!" and start decorating the nursery.

I suppose we're never out of the trenches. If I'm ever lucky enough to get pregnant again (which I doubt) the first month will be filled with the same worry. I envied her a little bit yesterday for the straightness and flatness of her path through fertility, but I rested my hand on the 39-week roundness of my belly and knew that what I have is such an incredible blessing that I have never taken for granted, and will always look at it with such awe and gratitude - and that's enough for me.

38th Week in Review

I got bored of posting every tiny detail every time I had a monitoring appointment, so I figured unless something changed drastically I'd wait and review both of the week's appointments at once.

On Monday, I asked the doctor "should I schedule any monitoring appointments past my due date?" and she said "nope, you'll have a baby by then!" and sent me off to get another just-in-case preeclampsia lab done. I didn't really ask any followup questions because I was caught off guard by that, and needed some time to process. So for the next three days I wandered through mixed feelings of being so close to D-day and overthinking about whether the doctor was thinking I was medically in need of induction, or if she was only looking at my office-visit blood pressure, or if she just knew something I didn't.

Today I feel much better! Cory came with me, and when the doctor came in I was ready with questions.

First, I asked about the weird sensations I've been getting in my right leg, which I'm not sure I've mentioned here. For a little over a week, I have had periodic upper-inner thigh (way up by my groin) pain, that kind of feels like a muscle spasm. It happens when I'm standing up, and I've been noticing it mostly in the evenings though it doesn't happen all the time. I made the mistake of reading an online forum about it, where most people said it was ligament pain and one doom-and-gloom-er said it was probably a blood clot and it should be checked out. The doctor said it was probably a ligament thing, but could also be contractions radiating down into my leg. She said it's probably exacerbated by the baby putting pressure on that side, which makes sense because her body is on my right side.

Then I asked what her plans were for this delivery. "Well, you're in a gray zone," she said, "where you're 35 and have chronic hypertension, but on the other hand your labs look good. We know that for first-time moms, when we induce it takes a long time and it is more likely to lead to a c-section, and we don't want to do that, so at this point as long as your blood pressure doesn't spike we can let you go to 41 weeks." Phew.

She did recommend trying a membrane sweep, since I'm strep b negative and it would be a more natural way to try to jump-start labor, so I went ahead and consented to that. She checked my cervix, and I'm at 70% effaced and 1cm, with an anterior-pointing cervix and "her head is down there" (she didn't say what station I was). I was kind of hoping to be a little further along than that, but I know it's my first and left to my own devices I'm almost certain I'd go over my due date. The check itself was slightly painful and of course the sweep was worse, but it was just a few seconds and that was it. She's going to do it again on Monday, and in the meantime I'll be re-researching at-home labor induction methods (though I've read that most of them don't really work - at least I can feel like I'm doing something). All the doctors in the practice discuss their high-risk patients at a roundtable on Tuesdays, so by next Thursday she may have something more definitive.

Bits & Bobs

* I was sure I was going to be put on bed rest, if not ordered to L&D, on Thursday when I went in for monitoring. My morning blood pressure has been creeping up, and while it's still in the safe zone I was pretty sure the appointment BP test would be ridiculously high. But it was lower than the last appointment, and they weren't worried, so off to work I went. (Well, they were a little worried; the doctor was frustrated with me for not drinking enough liquids, and my weight kinda jumped, so she's keeping an eye on that for the future.)

* The weather has decided to be a jerk. It was 85 on Friday and 90 on Saturday and today with a low of only 60. That makes it hard for my house to cool off, and it makes me grumpy. I'm not sure what's worse, being pregnant in the hot or having a sweaty furnace infant attached to you in the hot. And yet, my weirdo cat thinks it's cuddle time.

* Yesterday we had a great time visiting our friends who are due in THREE DAYS. We spent most of the evening out in their shady backyard, taking photos and having dinner. I stood for photos for quite awhile in the 90-degree mugginess, and by the end of the night I enjoyed my first episode of edema. Which hasn't really stopped 'cause today is just as bad. I'm off my feet most of the day today and drinking a lot, hoping it will go away. Which I doubt it will until the weather cools off a little. Or I'm not pregnant anymore. We shall see.

* Speaking of drinking a lot, why is it that I can drink a ton of water in the morning and taper off in the evening to try to avoid getting up in the middle of the night, but I barely pee during the day and I'm up 5-6 times a night to pee? Rude.

* Ivy was quite busy this afternoon as I sat knitting in my clashing-stripes pajamas. After several minutes I realized I probably ought to film her, so I caught about a minute before she stopped.

"Can you feel those?"

Last night I had a breastfeeding anxiety dream. I dreamed that I had had Ivy and was trying to feed her but I was having all kinds of trouble. Part of the trouble was that I was holding her but she wasn't really there. That didn't bother me though, except for when I'd forget to hold my arm crooked like she was in it - I was doing other things like walking or gardening and kept forgetting that I was also trying to breastfeed.

When I woke up, my blood pressure was slightly elevated but not that bad - but then when I got to the appointment it was 134/98. So they kinda freaked out and had me go do more preeclampsia labs. I showed the doctor my at-home chart but I think she wanted to be safe and had me go across to the lab anyway. (And of course it was back down to the normal range again this evening.)

The rest of the appointment was fine - Ivy was nice and busy, and everything looked good. Then the doctor said "can you feel those contractions?" and showed me a few gently sloping areas of the contraction line. I asked if they seemed to have any rhyme or reason (by which I meant "are they Braxton-Hicks?" but she just said that they were pretty far apart. Then I remembered waking up in the middle of the night because of a thunderstorm, and feeling what felt like period cramps that were stronger than what I thought I was feeling last week - these were sharper. Still not enough to hurt, though they were a little annoying. Didn't stop me from sleeping though.

So now I wait for the labs to come back. I'm pretty sure they would have called me today if my levels were up, and I didn't hear anything. I'm excited to know that things are happening, but I know that it could still be awhile before real labor starts. But next time I'm hooked up to the monitor, I'm going to be paying much more attention to that contraction line!