Monday, March 16, 2015

Madelyn Brianne's birth part 2

Here it is, the long awaited part two.  I have to say I've been terribly amused at how many of you are so enthralled in my silly little story.  I had no idea we were such interesting people haha!! Also I must point out that if you can't tell already from the fact this is a two part post, I am a rambler and I cannot communicate short and simple.  Twitter is NOT my thing.  I am too wordy to be able to communicate via 160 characters.  You can ask any of my family, my texts are normally quite long.  So I apologize for the lengthiness as I just don't know how to tell stories with just the facts.  :)  I also apologize for any typos and less than perfect grammar or punctuation.  Please remember I have a week old baby whose days and nights have been reversed (although I think we are starting to turn a corner!).  ;)

At the risk of sounding a bit silly I feel like part of the weirdness of this whole story was just how unfamiliar I was with having a baby in a hospital.  I've been to visit people randomly from time to time who had their baby in a hospital (including my mom with my baby brother) but most of my familiarity is with home births or birthing centers.  Reading up on Conroe Regional's L&D and what they have available is not something that ever occurred to me to do.  I had Isaiah at home and I knew now what to expect of that but the hospital is a foreign place to me.  I have never been in the hospital as a patient before for any reason and the day I spent in observation was so bizarre feeling.  Now I was actually going to have my baby here and I knew hardly anything about what to expect of the process.  This made it a big deal to me emotionally which was why I was so grateful for my midwife coming along as my doula and for the CNM who was doing the actual delivery.  The CNM talked to us briefly before we went over to the hospital side and told Jonathan about how to catch the baby (something he had missed being able to do with Isaiah because I was hanging onto him for dear life) and I was very pleased that he would be allowed to do so.

On top of the new hospital experience was the idea of being induced, that I was going to intentionally bring my baby that night no ifs, ands, or buts.  I had heard so much negativity about pitocin induced labor that I was a bit worried about just how bad this was going to feel.  Isaiah's birth was super intense I thought (compared to all the nice little things I had read about labor and people who actually get up and walk around during it, and get breaks between transition and pushing??  What??? I couldn't imagine) and now we were going to turn it up another notch or five!

We walked into L&D and I felt so strange.  In the movies they are always coming in after they've begun serious labor or their water breaks and everything is rush-rush.  I hadn't had but maybe two contractions since I arrived at the doctor's office so it felt surreal to walk in and very nonchalantly tell the nurses we were here to have a baby.  My doctor happened to already be there by the time we got in which was helpful because the CNM hadn't sent whatever she was supposed to over to L&D yet so they knew to expect us.  I don't remember exactly how it was said now but the most amusing part was the nurse had somehow become aware I was already dilated to a 6.  She seemed very worried and kept saying how busy they had been that day and they didn't have an open room for me yet.  Then she asked how far apart my contractions were and I realized she was trying to formulate a plan for where they were going to deliver this baby and I was able to assure her that I hadn't had any yet.  Later she told me as she was taking us into a room that she was thinking through how they could get a bed out in the hallway if necessary.  She apologized profusely for the room being "all mixed up" because it had only just been cleaned and hadn't been put back together yet.  I wasn't sure what she meant by it since I had never been in one of their rooms before and didn't know what it should look like.  She handed me the wonderful hospital gown and left.

I think it was around 6 PM and my mom arrived just after we got into the room.  The CNM came in and had a labor tincture she told me tasted awful and to hold it under my tongue for as long as I could stand it.  Okay I thought so I dutifully held it.  And held it.  And looked at her.  And waited for her to tell me I could swallow.  I decided maybe she wasn't going to tell me so I just swallowed and she kind of stared at me and finally laughed.  "That's not how people usually react to it" she said.  It really hadn't tasted all that bad I thought.  We also put some clary sage in my palms and she said to smell it frequently.  That was something we had tried at home already and I couldn't tell that it had done anything at all before.  She said she would be back shortly and left.  I think after that was when my midwife arrived and we caught her up with the plan to try the oils and tincture while they got the steroids and antibiotics going and then if that didn't do it we would start the pitocin.  It helped me a lot that she seemed very in favor of everything and even excited.

This part of the evening was probably the most boring as it involved a lot of in and out of nurses starting IVs, the CNM to see if my midwife was helping me to get the labor tincture in every 20-30 minutes, and general prepping.  I think maybe I had to sign a few forms and we talked through a couple of things.  I had various family members show up at the hospital and this was the time they came into the room to say hi before any action really started.  A surprising number of my siblings came up and I think everyone expected I was going to have a baby VERY shortly so they were hoping to be able to see her before they went home.  The CNM told me to get up and go walk for about an hour.  When she left I told Jonathan I was pretty sure she was crazy, at 39 weeks if I walked for an hour I would be way too tired to have a baby.  But I got up and put a robe on and got my shoes and my midwife and Jonathan went walking with me.  I don't know if you've ever walked around a hospital before but it's really rather boring, especially at 9 PM.  I think we managed 30-40 minutes before we were bored and went back to the room.  I still wasn't having contractions of any merit although being hooked up to the fetal monitors they could see I was having them fairly regularly.  We had finished the steroids before they disconnected me to let me walk and the CNM decided to put in the pitocin around 10 PM.  The nurse told me she was going to start it very low (because they were so sure it wouldn't take much to get labor going) and would very slowly increase it if things didn't seem to take off.  I was still thinking it was so late at night I was never going to be able to have a baby at this point because I was going to be too tired.  Have you detected a theme yet?  I was very tired at the end of this pregnancy and that's pretty much all I could think about.  :P

I'm not sure what I expected to happen with the pitocin except that I expected something.  Being hooked up to the monitors was somewhat amusing because everyone could see when I was having a contraction and they would all ask very eagerly how that one felt.  The best I could come up with was that they were stronger than they had been but they still didn't actually hurt even as much as the ones I'd had the weekend before when I thought I was in labor.  They became very close together and regular (I feel like they were mostly 1 1/2-3 minutes apart) and a couple of times I wasn't sure they were releasing all the way before they peaked again but they didn't hurt at all.  The CNM had me rotating positions (switching between laying on my sides with my leg pulled up and sitting up) which was rather annoying I thought because the poor nurse had a really hard time finding the right spot to get the fetal monitor to pick up baby's heartbeat.  And every time I changed positions she spent a lot of time readjusting it trying to get it to pick up again.  They kept increasing the pitocin a little at a time but still nothing was happening.  My waiting room fan club began thinning out as various ones had to go home and I felt bad that they had all come out and didn't get to see a baby.  I was really beginning to feel like I was never going to have her and just be pregnant forever.  It was somewhat validating though that they were having such a hard time getting her to come when I had been trying everything I could think of (except castor oil which I don't think I could ever be desperate enough to try).  It seemed to me that the problem was simply that baby girl hadn't decided she was ready and she hadn't dropped and engaged.  I feel like if she had then she would have come quickly, but she was at -3 when the CNM checked me in the doctor's office earlier in the afternoon.  Everything else seemed ready to go as by now I was completely effaced.

Finally the CNM came in and announced she was going to break my water.  She said I had got two rounds of antibiotics in so she wasn't worried about the GBS being a problem.  I was a bit apprehensive as I've also heard that this is an uncomfortable procedure but figured it wouldn't be that much worse than when my midwife stripped my membranes a week earlier.  At 1:25 she broke my water and literally within seconds I had a horribly painful contraction that seemed to last forever.  Things suddenly went into high gear.  I don't remember or know a lot of what was going on because each contraction was intense and painful and I was just trying to do my darndest to breathe through and make the lower moaning sounds they want you to make instead of the high pitched ones that naturally wanted to come out.  They had me get on my hands and knees and I know Jonathan was on one side and my midwife was on the other.  I held onto each of them and I remember the midwife telling me to try to relax through the contractions (hah!) and I think at some point there was a fuss about the IV being kinked off or something because of wherever I had it under me.  The CNM had told me ahead of time that she liked to have mommies change positions every three contractions to keep things moving along.  At some point she suggested I get out of bed and stand next to it.  I was still hunched over on my hands and knees and managed to wail out that I had no intention of moving.

I don't know exactly how many contractions or minutes transpired before I felt the baby moving lower.  They seemed so focused on other things like the fetal monitor which kept needing readjusting (or so it seemed) and I became worried no one would be paying any attention when I pushed the baby out so I think I managed to frantically ask someone how close she was or otherwise indicate I felt like she was going to be born very soon and the CNM said that she was getting closer.  I wasn't sure though if she was just saying it in a general sense or if she really did mean it and after the next contraction I think I made some other slightly more insistent comment that I could feel her coming.  I think somewhere in my head was the worry that Jonathan would once again miss his opportunity to catch the baby but I was never able to verbalize that part, but also I was afraid I would miss switching to short pushes in order to prevent tearing (something I totally botched with Isaiah due to a lack of understanding on my part and communication between myself and my midwife--I pushed him out in one push and ended up with a second degree tear and stitches, and I was desperate to avoid that if possible).  There were so many different sensations going on and everything was happening so fast I am not quite sure but at some point I knew she was crowning and I tried so very hard to do the short pushes and try to not just get her out and it over with.  I felt like I was doing pretty well until all of a sudden I just felt like I couldn't hold it back anymore and at 1:55 AM, only thirty minutes after breaking my water and real labor beginning, Madelyn Brianne was born.  Unlike Isaiah's birth though the pain didn't go away with her exit thanks to the pitocin continuing to make everything contract.  Everyone kept saying "you did it! she's here! you're done!" and I'm sure they meant to be encouraging but I kept saying "no it's not done, it's not over" because I was hurting so much and I knew that I made that mistake with Isaiah thinking I had reached the end when in reality there was so much left to go.

Someone put the baby on my stomach and I think my midwife asked if that was all the room the cord had.  They were able to move her up a tiny bit and I did my best to hold onto her but I remember thinking I was afraid I might drop her since she was wet and I was in so much pain still.  Finally I was able to ask if Jonathan caught her and he assured me he had pulled his arm away from me and moved down to the end of the bed when he realized we were close.  I was so very glad he was able to have that experience this time and thanks to my midwife being there I hadn't noticed his absence.  When I asked if I tore the CNM said "only a very tiny small little bit, you won't need any stitches".  That was all I needed to hear!  I had told Jonathan after Isaiah that I was pretty sure getting stitched up was worse than pushing him out.  When the cord stopped pulsing they clamped it and I was able to move Maddie up closer and someone suggested we go ahead and try nursing.  I was shaking like the dickens and had the hardest time trying to nurse her.  Jonathan helped and we finally got her latched on but I was still feeling like I might drop her because I could not stop the shaking and the pain continued.  The nurse commented when I said something about it that she was giving me a few more minutes on the pitocin before turning it off to be sure everything was contracting properly and my bleeding wasn't out of control.  They allowed me quite a few minutes of skin to skin with Maddie before they weighed and measured her and cleaned her all up.  I was so glad for that because it was one regret I had with Isaiah.  I felt like we had hardly any time together even though we were at home because the midwife was concerned about getting me stitched up and settled.  I asked the midwife and CNM now that they could see her what their weight guesses were.  My midwife had told me prior to her birth she thought around 8 lbs and the CNM had said at least 8 1/2.  Now though the CNM was thinking 9 lbs and my midwife seemed unsure.  She was 8 lbs, 6 oz and 20.5".  I'm not sure what it is about my babies that makes them look bigger but I decided for Maddie it must have been all in her cheeks.  She does look different than Isaiah I think but people keep asking who she looks like and I'm not really sure.  She just looks like her own little self.  :)

The rest is quite boring as it mostly involved a lot of tired people going home, and one nurse finishing up with Maddie and getting me ready to move to postpartum which happened around 5 AM.  Man was I tired at that point!!  I think something I marveled at a lot was that I already felt so much better than with Isaiah.  Sitting was not painful, there was only a little bit of tenderness.  Maddie did a great job of nursing, and I soon realized that she was like her brother and also just wanted something to suck for comfort so I was very happy to get home to our wubbanub and stash of pacis.  For those of you who will now be concerned about my milk supply rest assured that we are nursing every 2-3 hours as it is and I think my milk is doing very well.  :)  Maddie also does not seem to have any issue with nipple confusion.  We did get to go home on Friday afternoon which I was so glad for because I could not rest very well in the hospital.  Everyone kept saying "rest now while you can!" but I found that to be backwards.  With all the people in and out of your hospital room and being in a strange bed I didn't find that rest was much what I experienced.

The mystery of the falling platelets has not completely been solved yet.  We will have to check them again at 6 weeks postpartum to see if they are headed back up.  If they are then the likelihood is I had gestational thrombocytopenia which may never bother me again or could come back with another pregnancy.  I'm very much hoping that it's a one time event because there is no place like home even for giving birth.  I am grateful for hospitals and the medical care they provide when it's needed but I definitely like to be in my own little space, with my own food, and I missed Isaiah terribly.  I also now have a birth pool liner purchased and ready to go that needs using.  ;)

Something that has been so neat to experience is the expansion of love as a parent with the addition of another child.  I've heard people talk about it but it's totally different to actually feel it.  A few times while I was pregnant I briefly wondered how I could feel love for two children (or more) at once that I had for Isaiah, and I don't know how but somehow I love Isaiah even more now that I have another one, and I love her just as much.

We are all doing very well recovering and adjusting, and this is my first week on my own with both babies.  Thankfully Maddie is super so far and easy to work her schedule around Isaiah and whatever else is going on.  I hope she stays that way as she gets older and doesn't suddenly come out of the newborn phase and want to make her own schedule all the time like Isaiah did.  :)  Thanks to all who have prayed for us during the last few weeks!  We are so glad to have Maddie here.  We did a newborn photo shoot last Saturday and I can't wait to see the pictures and share them.  There are many exciting days ahead I know with two kiddos 13 months apart but there are some of you out there who have walked that road and have already encouraged me.  I hear if we can survive the first two years that after that it's wonderful.  ;)

Thursday, March 12, 2015

Madelyn Brianne's birth part 1

Some of you asked about a birth story so I thought I would attempt it.  If birth stories are not your thing feel free to skip this post.  ;)  I don't think I wrote one for Isaiah so this is new for me but here goes.

As most of you know I had a complication free pregnancy and a home water birth with Isaiah.  I was so pleased with the experience I very much wanted to repeat it when I found out Madelyn was on the way.  We began making plans for that and signed up with a midwife.  At my first prenatal labwork she noted that my platelets were a little on the low side (120,000 with normal range being 140,000-400,000) and the lab noted the presence of an antibody.  She wasn't terribly concerned but commented that since it was low she wanted to check it again in 4 weeks to see if it came back low again.  After the 4 weeks they had dropped to about 113,000 but there were no antibodies present.  This was puzzling because I had no other symptoms or indication of any problems so we decided to just recheck the platelets again in a few weeks.  I honestly gave it next to no thought after the first discussions because it didn't really seem like a big deal.  My midwife researched and I did some googling and we came up with a few supplements to try and see if we could bring the platelets up.  However as we watched and my due date got closer they continued to drop.  At 36 weeks they were down to 97,000 at which point my midwife recommended we consult with her backup OB on what his opinion was on the matter and whether a home birth was potentially unsafe.

Since Isaiah was born at 37 weeks exactly all on his own timing we weren't sure how much longer I would actually be pregnant as it was.  I called and set the appointment with the OB for the middle of my 37th week and half hoped I would just have a baby before then and we wouldn't have to deal with anything.  We were all in agreement that at 97,000 we would be okay proceeding with the home birth until we had talked to the doctor.  Meanwhile I began taking even more supplements to try to bring the levels up some.  Two days before the doctor's appointment I had my 37 week appointment with my midwife and we ran another platelet check so we would have fresh numbers to take with us and also know where I stood for the next week.  The lab was annoyingly slow and I did not hear the results (which I expected to be around the low 90s) until my midwife met us at the doctor's office.  The lab had sent back they were down to 67,000.  This really shocked me and was a huge game changer.  For them to have fallen so dramatically in a week's time I knew was a bad thing and I was very apprehensive about a hospital birth that I had not been able to prepare myself for mentally and that we knew would be very expensive as we do not have insurance.  We went into the appointment and the doctor was definitely concerned.  There were two likelihoods he felt like, one that I had gestational thrombocytopenia which is basically an autoimmune reaction from my body to the pregnancy and resolves after delivery (and may or may not come back with subsequent pregnancies) or ITP which he felt like was less likely and would be something I had all the time and could potentially cause platelet issues in my baby.  He wanted to send me to L&D for a check of the platelets at his lab (he was concerned about the accuracy of the one we had used), a full ultrasound, and some fetal monitoring to see how things were looking.  He mentioned a possible induction if things were really that bad.  After spending the morning and afternoon in an observation room the results came back that my platelets were actually 87,000 and all I got from the nurses was that the doctor said I should go home and follow up the next Monday or Tuesday.  Talk about a roller coaster of emotions!  My mother in law gave me a beautiful baby shower that Saturday and I just decided that Maddie was waiting for me to be able to have that before she came.

We set up my 38 week appointment with my midwife for Monday to check platelet levels again.  My midwife had read online that some people have trouble with their platelets clumping and that in these cases a special type of tube should be used to prevent that.  She ordered that test instead and this time they came back up to 100,000!  This was a miracle I felt like and absolutely direction from God that a home birth was still okay because many people had suggested that as the cut off.  To be sure though I made an appointment with the OB for that week and asked his opinion.  He said that he would be okay with a home birth at 100 and suggested we do what we could to encourage baby girl to be born that week.  He recommended some things (some I had already been trying like evening primrose oil, and some I had not considered like stripping my membranes) and sent me on my way.  My midwife stripped my membranes for me a couple of days after that and I waited with baited breath.  The evening after this I began having regular contractions and feeling lightly crampy.  I was very excited that maybe this was it, I was going to have this baby at home!  The contractions continued into the night even when I tried to go to bed.  At 4 AM I suddenly felt like I needed to throw up.  I thought that was strange because I hadn't felt nauseous at all but a quick google check seemed to indicate some women did this during labor so I was encouraged.  About an hour later I thought I could feel pressure much lower during a contraction so I woke Jonathan up and said I really wanted to go ahead and call the midwife and my mom.  They both headed out and Jonathan set up the birth pool in anticipation.  After everyone arrived I began throwing up more and my contractions spaced themselves out even though they were fairly painful.  My midwife at some point recommended I try to get some rest and that I wasn't far enough into labor for her to be there, she felt like I would feel like a watched pot.  So she left with instructions to call her if things changed.  The only change that happened was that I quit throwing up around noon and my contractions began to lighten around 3 PM.  This was terribly disappointing to me, but I knew I had my church baby shower that Sunday so I thought maybe after that I would go into labor.  The birth pool stayed up, the midwife's bags were all lined out on the dining table as well as my birth kit because everyone just knew I would have her any day.  But still she didn't come.

We had my 39 week appointment and checked platelets again.  The doctor had requested that I come in again each week with my platelet levels so they could help monitor.  The lab came back two hours before my appointment at 59,000.  I was stunned.  I was so tired of the up and down from one week to the next (and sometimes from one day to the next).  I felt like I knew what was going to happen so I threw my emergency hospital bag in the car, kissed my baby boy good and long before I left him at his grandmother's, and mentally prepared myself for a hospital delivery that night.  Thankfully Jonathan was able to meet me at my appointment (it was for 4 PM) so he could be there with me for whatever happened.  I assumed at the least I would have to go in for another check of my levels but I was fairly sure I knew the doctor would push an induction since I was over 39 weeks and at this point dilated to about 5 cm and 50% effaced.  The doctor came in and said pretty much what I thought he might.  He wanted to send me straight over to L&D to have a baby.  I was still not sure what to make of the idea of a hospital birth since that had not been my plan but I was also relieved to end the constant seesaw of emotions and to finally have my baby in my hands.  The CNM who worked with the OB came in and checked me.  She was surprised to find I was dilated to 6 cm and 80% effaced.  She couldn't believe I was walking around like that with no regular contractions.  She also said she would be the one delivering the baby (this was super important to me as I had been disappointed thinking I would have a male OB when I knew I would be more comfortable with a female) and helped talk me through some of the things she wanted to try--some herbal tinctures and oils while they got me going on a steroid to temporarily boost platelets and some IV antibiotics because I was GBS+.  She felt like doing the herbs first might work and if not they would give me some pitocin but she wanted to avoid breaking my water because Maddie was so high up and she didn't want to risk a prolapsed cord.  I felt somewhat better about the birth after discussing things with her but this was still new and different and I had not heard many good things about pitocin inductions and was a bit nervous about that.  Jonathan and I called and texted our moms and my midwife to let them know we were going to have a baby soon and prayed before walking out of the office.  I wish I could tell you I had a wonderful spiritual moment in which suddenly I was perfectly happy about the whole deal but I did have a peace that this was what we needed to do for some reason.  And yet I was mourning the loss of my ideal delivery and had to choke back tears a few times.  I'm sure hormones had NOTHING to do with that.  ;)

So this is what led up to my walking into Conroe Regional on a Wednesday evening to have a baby.  It was a crazy ride (and continued to be) and made little sense to me but I was confident God had clearly directed through circumstances and the doctor that we needed to be there.  My midwife met us there to act as my doula and we all settled in for what we hoped would be a short evening before baby girl joined us.