So Begin the "Firsts"

We have successfully survived two weeks at home!  As with any new baby there are many firsts that have happened already, here are the highlights.

First Walk

Get used to those red carts, little one

First family outing to the pediatrician and to Target.  On that note, she is doing great and gaining weight like a champ.  At her first appt, two days after hospital discharge she weighed 7lb 7oz, and the following week 7lb 12oz, so I was all worried about breastfeeding success for nothing!  And everything else checked out as well.

First Bath, wasn't a fan at first but then realized how awesome baths are

First Tummy Time

And First Face Time

And here are some more, just because she's cute,

We are adjusting to our new life, trying to grab sleep when we can

And attempting to get in to a routine.  There have definitely been some tears, those darn hormonal shifts are rough!  But there has also been lots of laughter as we blunder through some things.  Eric survived his first poo-'splosion, and boy was it impressive, I'm talking poo on the drapes, dresser, bed, carpet, shirt. 

Product testing

More adjustments were made this week as my Mom and Step-Dad returned home.  I really don't now how we would have coped over the past few weeks without them, there really aren't enough words of thanks.  Annalise and I did survive our first solo outings and she even allowed me to enjoy a scone and coffee at Starbucks!  So now we just continue to settle in, just in time to move next week!  That should be fun...

The Rest of the Story: Week One

During our childbirth prep class we did an exercise to rank the importance of different aspects of labor and delivery: c-section vs vaginal birth, pain medication or none, ability to move about freely, wear your own clothes, eat and drink, etc.  Obviosuly we all chose healthy baby as the utmost importance, and then most choose vaginal birth, then pain options, and so on.  As I stated previously I had my opinions on how I wanted things to go but knew that I had to be ready for the plan to not work out.  As I've already described it did not work out at all how I imagined or preferred!  After our last prep class I did decide that, more so than any aspect of labor and delivery, the most important thing to me was to successfully and exclusively breastfeed.  Maybe it is because the benefits of breastfeeding are numerous, or I knew that it was the one thing I, most likely, could control in a situation that often requires you to change plans.  I knew that I could make the best decision on how to nourish my daughter.  I knew it may not be easy, at first anyway, but I also knew that I was delivering in a Baby Friendly designated hospital (a rare designation to hospitals that adhere to the principles to successful breastfeeding) and that I would  have a lot of support both during my hospital stay and after.   I also came to the table well-informed from both my recollection from  nursing school, breastfeeding prep classess, and reading all my resources ahead of time.

So, fast forward to the arrival of my daughter and the first time I get to see her in the NICU, a few hours after delivery.  I'm desperately trying to get answers as to what caused this and what is exactly going on with her.  All I can  know for sure is that she is unable to maintain her O2 sats on her own and they are pretty sure that she has an infection from whatever I have been infected with.  She has an umbilical arterial line, a periperal IV, telemetry leads, continuous pulse ox, and O2 via nasal cannula (thankfully the Bi-pap machine didn't last long).  They have taken cultures of both my placenta and her blood and all we can do is wait and see.  We are both started on two IV antibiotic regimens. So I cling to the one thing that I thought I could control, "when can I nurse her?" knowing that we are already way past the first hour, which helps establish effective nursing.  Unfortunately the answer is, "as soon as the MD says it's ok, but not now because she can not maintain her O2 sats and suckle".  So that was my first blow to my breastfeeding dreams.  Next I zeroed in on the second nursing hinderence.  The dreaded pacifier.

All nursing resources will tell you to wait until breastfeeding is established to introduce the pacifier or bottle.  When I asked the nurses they said that of course they could not give it to her but it was used as comfort and also to give some glucose (which can act as an analgesic to newborns) while they were performing all there invasive tasks.  So, of course, my answer was "Yes, please, comfort her in any way you can". 

After our first moments together I return to my hospital room to try and get some rest (after being up for 30+ hours)  Of course that is easier said than done in the hospital, especially after the ordeal I had.  There were vitals signs and assessments every hour or so and once it was normal business hours, forget it, I was constantly being interrupted.  But, I guess it worked to keep my mind off of the fact that I did not have my baby with me.  Every sound of a baby crying out in the hall made me choke back tears as I was reminded that MY baby wasn't with me.  Then back to the business of breastfeeding, in they wheeled the hospital-grade breast pump and set me up with all the parts.  And thus commenced my first experience with breastfeeding.  Not cuddling my sweet baby while we tested the waters together but sitting in my hospital bed with sterile pumping equipment, feeling exposed and vulnerable and not unlike a dairy cow.  It was rough.  But, again, knowing that I could control how I would handle this I diligently pumped every 2-3 hours to help stimulate the colostrum and milk production and prayed that they would soon let Annalise and I practice together. 

As soon as I could stand again (walking was a different story) and had sensation in my legs we were back at her beside.  Things were stable for the moment but she was still not tolerating a reduction in her O2 levels.

 They did agree to let me hold her and do more skin to skin time despite her precarious umbilical line.  To have to ask to hold your own baby is an indescribable feeling.

They had started her on TPN (intravenous nutrition) and were watching her blood gases and labs closely (as well as mine) before committing to a diagnosis or plan of care.  She did have a small pneumothorax (possibly from the bi-pap machine) and fluid in her lungs from delivery (in a c-section babies don't get the squeezing of passing through the birth canal, which helps lung function) as well as heart murmer (which was not concerning at this time as it was most likely residual from fetal circulation).  I was then "instructed" that I needed rest too and took a few cat naps that day.

By day two things started to look up for both of us.  I got to take a shower and Annalise got to have her O2 removed, Way to breath little one! 

We also got to try nursing for the first time! I'll spare you the photos of that endeavor.  It didn't go amazingly well, but it went OK, which was more than I could hope for at that time.  If anything she had a voracious appetite and was just frustrated that there wasn't much happening in the way of production at that time.  I continued to pump and was ecstatic when those first drops of colostrum appeared in the pump.  I carefully extracted each drop with a syringe and proudly presented my 0.25ml to the nurses knowing that this was the "liquid gold" that would help to nourish my baby back to health.  I finally felt like I was successful at something as each pumping session yielded a little bit more each time.  AND we got to have our fancy surf and turf meal that night (a wonderful perk to having your baby at our local hospital!)

But, as with most difficult things in life, progress often seems two steps forward and one step back.  That night was probably the toughest for both Eric and I.  As Annalise became more alert she was also hungry from expending such energy during those first 48 hours and our nursing sessions were less than successful , as anyone who has tried to nurse a screaming infant can attest to.  It was after a particularly rough screaming patch that one of her nurses broached the subject of the 3rd dreaded encroachment to breastfeeding: Supplementation.  She said they can do either formula or donor breast milk.  I declined at that time rationalizing that "normal" babies wouldn't be getting full milk yet either so what was the big deal?  We would get through this.  In the meantime she would continue to get fluids and TPN through her lines.

The next day I dived right in to nursing, determined that I would be all she needed.  There was a saintly nurse that shift that really got me through the tough parts and frustration as well and we both improved with each try.  Things were looking up, until her IV came infiltrated and her glucose was below acceptable parameters.  At that point the choice was to immediatly get in a second line and resume the TPN that we had been trying to wean that day, or accept the fact that it was time to supplement.  The nurse gently reminded me that Annalise wasn't a "normal, healthy baby" and that she, although improving daily, still was probably feeling pretty crumby, based on her irritability.  So we consented to the use of donor breastmilk, and, again, my heart broke as we gave her a bottle filled with milk that wasn't mine.

Thus began our new routine to try and get her to nurse.  We would start with nursing, if she was calm, if not we would give 10-20ml to "Take the edge off", then nurse again, followed by more supplement if she wasn't satisfied.  Then I would pump.  This whole process could take an hour and half, only to repeat no more than 3 hours after the start of the previous feeding.  Needless to say we spent many hours in that 8x8 cubicle.  This day we also received the results of her latest CRP, which would dictate her need for antibiotics.  Much to our dismay it was 44, less than 10 is acceptable for newborns, so it was now set in stone that she would stay in the NICU until her 7 day course of antibiotics were complete (mine were completed after 48hrs since I had no further symptoms).  So that day was filled with ups and downs.  My emotions were all over the place and I had to force back tears and the urge to just cry my eyes out for hours anytime someone would ask how I was "holding up".  Having a baby in the NICU is HARD, even when you know she is getting better.

I was discharged two days before Annalise was scheduled to be but, luckily, the NICU has parent sleep rooms available as there was no way I was going home yet, especially considering the crazy nursing schedule  we were on.  So I moved from one hospital room to another, although the latter had a double bed and felt more like a hotel room.  I think we actually got some decent sleep that night (despite being awoken every 3 hrs or so).  My recovery was going fine, although my own well-being was furthest from my mind, my poor husband had to remind me over and over to get some rest, manage my pain, and take it easy.  Nurses are the worst patients.  I did have to start a course of oral antibiotics due to my incision developing what looked like the start of cellulitis, but it resolved quickly, thank goodness.

Each day Annalise got perkier and perkier.  She seemed like a completely different baby as her antibiotics started working and she started to feel better.

We all started to let out our collectively held breath and we neared closer to discharge day and things kept improving.  We even had fewer and fewer feedings that required supplementation, and when we did have to give a bottle it was of MY milk!  She passed her hearing screen, her next CRP came back within normal limits, and we got her car seat safety check completed.

All we had left to wait for was her last dose of antibiotics and then she was a wire-free baby for the first time since birth!

Annalise goes wireless

And then we tearfully thanked the nurses for taking such good care of both Annalise as well as her parents and set out to show her the world outside her nook in the NICU.

She didn't seem too upset by this turn of events.

Clothes!

So after the most traumatic week of our lives to date, we were finally home with our daughter, safe and sound.

I still don't have answers to what caused all of this in the first place.  All of our cultures came back negative, I never developed further symptoms after delivery to provide clues as to what the infection was.  I'll never know what caused my body to halt the progression of labor or what caused my daughter to require a week long stay in the NICU.  Here are the things I do know: I will be forever grateful towards the excellent team of nurses and doctors who cared for both Annalise and myself, I have never been more in love with my husband as I am now after weathering this storm together and seeing what an amazing man and father he is already, and our lives are forever changed by this amazing little girl, and I suppose that is enough. 

Annalise's Entrance: Our Birth Story

Warning:  This is the full account of my labor and delivery with some medically graphic photos as well

July 3rd, 1:30am: I woke up for the third or fourth time that night and was just so uncomfortable that I eventually gave up and got out of bed around 2am.  I went downstairs and bounced on my big exercise ball a bit, tried to get comfy on the couch, and paced the living room, all with no relief.  The confusing part is that I was feeling persistent low back pain and lower abdominal pain (similar to menstrual cramps), which was new.  I tried to time contractions with my hands on my abdomen but was so distracted by the back pain that it was a fruitless effort.  Finally around 3:30 I admitted that something is different, whether it is labor or not will remain  to be seen, and I called in to work for my morning shift.  Just saying the words "I think I may be in labor" out loud triggered the cascade of tears, which would happen multiple times in the next few days.  I can't decide if it was fear, pain, hormones, excitement, or a combo of it all, but it sure did bring on the waterworks.  When Eric got up for work around 4:30 I assured him that I would call if things progressed but I had no idea if this was really labor or not.  I took a bath, which provided some relief, then tried to get some more rest, which did not work out.  I finally admitted that this was definitely different but I felt extremely silly since I still could not distinguish actual, discrete, abdominal contractions (as I had imagined them), I mean, I'm a nurse for crying out loud!  I called my OB as soon as their office opened, explained my persistent discomfort, "No I can't tell how far apart my contractions are, I don't know if they are contractions and I feel stupid for saying that" as well as the growing nausea and general feelings of crappiness.  They told me to come on in to get checked out.  Again this triggers the tears as I have a mini breakdown in my bathroom, then I took a deep breath and calmly asked my Mom to please drive me to the doctor's office.

9:00am:  As we waited I had visions of getting my cervix checked and being told to head straight over to the hospital for a speedy and easy delivery.  Boy was I wrong.  As we waited I became more uncomfortable and my mom agreed that I had "that look" that this was, indeed, labor.  Again I explained what I was feeling to my OB and apologized (again) for not knowing if I was having actual, regular, true labor contractions, which, of course, they assured me was not uncommon for first time Moms ( I think they were just trying to prevent the waterworks from starting again!)  After the cervical exam I got the unbelievable news that I was still only at 3cm, the same as I had been at my most recent check up the previous week, I was more effaced though, so that was something.  My OB wanted to hook me up to a fetal monitor so that maybe I could differentiate the contractions and they could see if I was having them regularly.  I still pretty much just felt uncomfortable but at least the monitoring did show that I was having regular contractions and this was probably the real thing.  Then they proceeded to tell me that they wanted to get an ultrasound to measure amniotic fluid levels due to a few low patterns of fetal heart rate.  As we waited our turn for the ultra sound the fear continued to build and I tried to keep the tears in with little effect.  Little did I know that this would not me the first terrifying wait I would have to endure over the next 72 hours.  Luckily (this time) the ultrasound showed normal fluid levels and I was advised to go home and get some rest, eat and drink, and head in to the  hospital once things intensify. 

11:00am-7:00pm:  I labored at home with lots of counter pressure on my sacrum, warm baths, massage, heating pads and even a brief nap after taking some Tylenol.  Finally around 5 things started to feel as if they were intensifying so we get down to business with our contraction timing app (yes, there is an app for that!)  and after and hour and half I agree that things are finally changing and progressing so I call and talk to the triage nurse who tells me to head on in to the hospital!  Hooray!  Now things will REALLY get going!

7:30pm (or there abouts):  We arrived at the birthing center and got all settled in and anxiously await that next cervical check.  As the nurse completes it without announcing right away I knew, 'Still 3 cm, right?"  She confirms this fear (I mean, COME ON!) but wants to watch the baby for a few hours and then check again before sending me back home.  So meanwhile I enjoy the giant bathtub and try to get comfortable even as my low back pain is worsening and starting to actually feel more rhythmic and contraction-like.  Then the general feelings of crappiness started to worsen and I start getting that chilled, here comes a fever, feeling, but, of course, I'm in labor so temperature swings are all just part of the deal.  The nurse says she's still waiting for the baby to show some reassuring signs in her heart rate like more variability and some accelerations and the doctor agrees to go ahead and admit me and see where things go.  Hooray!  I don't have to go home, but boo to still at 3cm and possible unhappy baby.  I continued to cling to that perfect, music to my ears, baby heart rate as I became more uncomfortable and struggled to find a position that was bearable.

11:00pm-ish:  It's  pretty obvious that I'm spiking a temp, I'm up to 99.7 and we start some IV fluids and draw some labs.  I meet the OB on-call who makes the first hints at implementing some interventions to "get things going".  I am still in absolute shock that I have not dilated more (well, they gave me a half cm, but I think they were just trying to keep me from crying).  Now here is my disclaimer on my plan, I didn't have an "official" birth plan.  I am well-informed and new what I preferred, which was Pitocin as a last resort and a wait and see attitude towards pain management.  I knew that outcomes were better with fewer interventions, so that was what I was going for.  Healthy baby, healthy me was really my birth plan.  I new I would be more willing to have my water broken before jumping to the pitocin, so that was what I was ready to advocate for.

July 4th, midnight:  The OB starts asking me about being exposed to anyone sick, UTI symptoms, kidney infection symptoms (due to my low back pain, I'm assuming) then breaks the news that my white blood cell count is 30 (ten and under is normal) and my CRP (C-Reactive Protein, a generic measure for inflammation, can indicate acute and chronic inflammatory processes) is 150, normal is 10.  So something is going on, I'm sick with something, so let's hang a bag of antibiotics and see where you're at.  Let's all be shocked....Still at 3cm.  And I had no idea what I could be sick with, I mean , I'm a nurse, who knows what I could have been exposed to at work let alone the grocery store.

Approx 1:15am:  The doctor returned and sat down to have "the cesarean talk", as I got ready to defend against this he made the very valid and rational point that I obviously have some infectious process occurring and the baby is not a happy camper as evidenced by her continued lack of heart rate variability and accelerations.  He said he did not even feel comfortable breaking my water due to how she was presenting.  At this point he gave us a minute to discuss, I broke down in tears but admitted that this was the appropriate situation for a C-section, to which my husband and Mom adamently agreed with me.  After consenting to this means of birth things started to get scary.  Within minutes all three of us were being prepped for surgery with the appropriate attire, my abdomen was prepped by the nurse and the anesthesioligist came in to discuss and consent to a spinal block.  We were then wisked down the hall as my contractions were becoming pretty  horrendous and I was required to stay still as the anesthesia was inserted in to my spine, at least after that I got some pain relief!  Then the area was draped and Eric and my Mom were allowed in (after what Eric later described were the longest ten minutes of his life, waiting in the hallway).  I lay there on the table, with tears streaming down my cheeks (I finally stopped trying to hide them) as I waited for the unknown: They said there would be pressure, how much? Would it hurt? Dear God please let my daughter be alright, as I again, clung to the sound of her heart rate as if it were keeping me alive as well as her.

Within minutes, I'm talking maybe 3, the doctor asked if we had cameras ready because here she comes!
And then there she was!  Crying!  And they briefly held her over the drape so I could see that beautiful screaming, wriggling body.  I was flooded with emotions as I let out a sob of gratitude, relief, and still fear as I only caught that one fleeting glimpse of my daughter.  But now I could cling to her cries instead of those distant heart tones.

After a few moments my Mom came over and said they would probably take her to the NICU briefly because of some mild respiratory distress, I demanded to know why, what is going on, I can hear her crying, what do you mean respiratory distress?!  Again I got only a brief second glance before she was wisked away.  Luckily they allowed a family member to go with her and I just so happened to have a retired NICU respiratory therapist as a mom to oversee her transfer.  At that point, all I could do was lie there and take deep breaths as the surgical team finished up their work on me.  The next few hours are a bit of a blur as I was getting updates from Mom and Eric as they took turns between her and me.

 
They kept pushing back taking me in to see her but  I was finally wheeled in, a few hours later, hospital bed and all to get that much awaited and longed for skin to skin time with my baby girl.

Neither the trauma of the last 24 hours nor the trials we had awaiting for us over the next few days mattered at that moment, because we were together and all ok.  And we decided on her name, Annalise, meaning "Grace from God", from the Scandinavian roots of her maternal great grandmother and Vera, meaning "Faith" after her other maternal great grandmother. 

A cesarean section and a full term baby in the NICU are about as far from what I envisioned for the birth of my daughter, but then, who really does dream of that scenario?  I feel no regrets about the decisions made that night, nor do I feel angry or as if I was robbed of a the ideal birth.  I know that the doctors would not have moved as fast as they did without true concerns and I will be forever grateful that they acted accordingly.  Healthy Mom and Healthy (Well, almost) Baby, the ultimate, perfect, outcome.

 The next week continued with it's challenges and more bathroom breakdowns, but that is for a different post. 

Introducing.....

Annalise Vera!!! 

7lbs on the dot and 20 inches long, born on the 4th of July!!  She'll probably think all birthdays are celebrated with fireworks, parades, and cookouts for the first few years but at least she'll always have a celebration. 

Her arrival was less than...smooth, shall we say.  While I was never going to write a birthplan (fir this reason specifically!) I definitely was well-informed and had opinions on how I wanted this experience to go.  But, as I was reminded by many of the nurses I encountred, us nurses often fall victim to "The Nurse Curse" when it comes to having our own babies.  I'd say I got a full dose of that sucker!  I do really want to share my story as I think is important to debrief these big events in our life, even the tough stuff.  However, I'm going to  let those darn birth hormones level out a bit as I find even looking at the photos and remembering the details to be extremely emotional.  So, give me a few days but I promise I have a lot to say!  The most important detail of the story is that we are both safe, home, and adjusting to our new, wonderful, terrifying, amazing life.  I am already so overwhelmed with gratitude and amazement that I get to be this little girl's Mommy.

 

All my Bags Are Packed...

I'm ready to go

I'm, well, the rest of the song doesn't really apply!  But we are all ready!  Car seats installed, diapers purchased, clothes laundered, place to sleep at the ready.  My mom and step dad are also here, so now, we just wait.  While we are waiting I am trying to enjoy myself and the last few days before our lives change forever.  We had a lovely picnic at the Resevoir yesterday

39 weeks.  Does this hat make me look fat?

And have slowly begun the daunting task of packing all the non-essentials.  I have to admit I got a little nostalgic when we pulled everything of the walls, I mean, this has been our home for 5 1/2 years!  But, on to bigger and better things I suppose.  I have two more shifts left and then will be officially on maternity leave.  We'll see if I make it through, things are already effacing and dilating so I would not be sad if I had to miss those last two shifts.  I the meantime I'm trying to stay calm and get lots of rest (easier said than done at times) and dream of what this little girl will be like!  Let the baby-watch commence