I tried to put Annalise up to my breast in the first hour after her birth (before she was weighed, even), but she never quite understood what I was hoping for, and she didn't latch on. That evening, I was transferred up to the post-partum ward and our nurse tried to help out. Here, Annalise would seem to latch on with a big, open mouth, but wouldn't agree to suck, even a little bit. The nurse even tried putting a few drops of sugar-water on my nipple, but this didn't tempt her, either.
The next morning (Tuesday), a lactation consultant came in and tried to help, but we found the same latch-on-but-no-sucking routine occurring most of the time. At this point I was producing just a few droplets of thick, golden-yellow or white colostrum. By later that evening, she was finally agreeing to latch on and suck a little bit. Frequently, however, her latch was "off" and I was left with a whitish ridge across my nipple, intense pain, and even a droplet or two of blood under the surface of the nipple. We tried basically all of the positions including cradle, cross-cradle, and football. By Wednesday morning, she seemed to be getting the hang of it, but her weight had dropped from 7 lbs 15 oz at birth, to 7 lbs 6 oz only a bit over 24 hours later. We were told that we would need to go to the pediatrician for a weight check on Thursday morning. Also, before we left, our very nice nurse told us about giving a bit of formula by tube (either alongside the nipple or a finger), "just in case it is 2AM and you get desperate). She gave us two tiny bottles of ready-mixed formula along with a syringe and tiny tube for a feeding.
We went home on Wednesday afternoon. Feedings immediately seemed a bit harder as my left upper arm developed an intense pain, which I attributed to my weak muscles and lifting the baby. The pain made it much more difficult to get into certain nursing positions without S's help. A few hours later I realized that it was actually painful because of a tetanus/pertussis vaccine that I had received before hospital discharge. (Apparently this vaccine is recommended for people who have frequent contact with infants under age 12 months. S needs to get one, too). Poor Annalise seemed increasingly fussy, which I attributed to her suddenly getting hungry, but I just didn't have enough colostrum to satisfy her appetite. S was great in that he got up with me throughout the night, providing moral support and other assistance. Sometime around 4 AM, we figured out that maybe she was hungry and gave her some of the formula by tube-feeding. She couldn't seem to latch with the tube fastened to my breast, but she latched onto our fingers and eagerly drank it from there. That night, we actually only gave her 20 mL, which I believe is 2/3 oz. However, this seemed to help a lot and she was finally able to sleep.
Thursday morning, she went to the pediatrician and was weighed. She was down to 7 lbs 3.2 oz at this point, so we were told to return again in 4-5 days. Meanwhile, I think it was this day that I finally noticed some increase in milk production. However, Annalise's frantic suckling had meanwhile left me with scabs on both breasts. Between my left arm, my grade 2 tear, (TMI) hemorrhoids, this intense nipple pain with feeding, AND the general breast pain as they filled with milk, I was (physically) pretty miserable!
By Friday morning, I woke up feeling like I had gotten enormous breast implants. They were as hard as rocks, stuck straight out, and well...I have watched a lot of Dr. 90210 in my life, and I definitely looked like an "after" picture. (This was a novelty to me as I am usually a 34/36 A or B. Within the next several days, my milk seemed to be in oversupply. Annalise would latch on and be surprised by a flood of milk filling her little mouth before she even started sucking. My breasts were extremely uncomfortable after just a few hours and I would need to express some milk even before she latched to allow the nipple to protrude a bit. There were occasions when a "jet" of milk would spray milk up to 12 inches into the air... sort of entertaining, but messy! I quickly developed a new vocabulary, talking to Annalise about breastfeeding, too. My nipple is sometimes called my "nursie," the flannel blankets that we use to clean up the spraying/dripping milk are the "milky towels," and a nursie that is gives out a lot of milk without any real effort on Annalise's part is termed "juicy."
One week after Annalise's birth, we had a home visit from a nurse. A state-funded program sends a nurse to the home of all first-time moms in our county. It was sort of helpful, but definitely aimed more at moms who hadn't read every parenting/newborn care book out there. I was pretty familiar with most of the things that she reviewed with me ("back to sleep" and the like). Anyway, the nurse did weigh Annalise and we found that she had started gaining again and was 7 lbs 12 oz on that date. Thus, I cancelled the followup at the Pediatrician's office. Apparently our next visit there is now at two months! I have weighed her once (at a hospital-based nursing store, where I went in search of a sling/wrap). At that point (last Wednesday, age 2 weeks, 2 days), she was 8 lbs 12 oz, diapered and fully clothed. I think she is growing well and seems very healthy.
By the middle of last week, my milk supply was decreasing to better match her demands, and Annalise started to get frustrated when confronted by "nursies" which were not dripping with milk when presented to her. Her almost inconsolable crying caused a lot of stress on my part that I'll get to in another post. On several occasions, Annalise would be frantically searching for milk, wailing and crying, even as I was literally putting the nipple into her mouth and aiming it right to her palate. Just yesterday, S reminded me that the lactation consultant had suggested priming the nipple by squeezing and getting milk onto the tip before giving it to her. I had been focused on aiming the nipple toward her palate, but I had forgotten about that other suggestion! I started doing it last night and already things have improved... a lot!
I purchased my Medela PISA (Pump in Style Advanced) in the backpack version about a week and a half ago, but I haven't even opened the box yet. Somehow I am intimidated by the thought of breastfeeding AND pumping. However, apparently 3 weeks is the optimal age to introduce bottles (unlikely to reject either breast or bottle at this point), so I need to get started ASAP. I am very surprised about how expensive the breastmilk storage bags are...something like $10 for 20 of the Medela ones...that's 50 cents each! Sheesh! I will post on Ovusoft to find out whether there are other options.
We've abandoned the football hold altogether (she is too tall) and we usually do some sort of cradle hold with the help of the Boppy or another pillow. Side-lying is a new favorite. I just have a feeling that she is working toward being a co-sleeping baby, though. More on that later, too, I think.
I know that breastfeeding is supposed to be this magical bonding time, and sometimes it is. I murmur loving words and admire her, sing silly songs, or sometimes (especially at night) we both just fall asleep. At other times, I lean back in my chair with Annalise content on the Boppy, and I read... I've read many magazines, skimmed a bunch of childbirth and parenting books, and now I'm finishing up my second novel. It feels good to have books back into my life. I haven't read anything at all about breast cancer (my profession), and at this point it feels good to escape that.
Sunday, February 15, 2009
Thursday, February 5, 2009
Annalise's Birth Story
This gets REALLY long, so be warned!
It was Sunday, January 25th, and we were scheduled for induction at 9 PM. However, we were instructed to call in at 7 PM to make sure that there was enough space for me. Apparently it would be a rare occurrence, but if for some reason Labor & Delivery (L&D) was flooded with emergencies, my induction could be postponed. At about 5:30, S & I took a nap for an hour or so, anticipating a busy night ahead. I actually did fall asleep, but S said that he just rested. I don't think that I was having any significant BH contractions, as far as I could tell.
Halfway expecting to be delayed, I called L&D at 7 PM and was told that yes, they were expecting me at 9. The next 2 hours were a flurry of activity as I rushed to finish packing my toiletries, do two loads of laundry (why? I don't know... I guess I do laundry when I'm nervous!), and eat a few bites (S ran up to El Portal for a chicken fajita platter, which we split). We didn't actually leave until sometime around 8:50 PM, but I assured S that 9 was an estimate, not an exact appointment time.
Our trip to the hospital had that same air of anticipation that I always thought would accompany a trip to L&D, minus any pain, discomfort, or sitting-in-a-puddle sensation on my end. S dropped me off at a circular driveway in front of the hospital, and then went to park the car in the lot across the street. I stood there impatiently with our bags, pillows, etc as I watched him move the car at least 3 times to different spaces within the lot. S later explained that some spaces were designated "reserved," and others didn't have a number required to feed the payment machine. While I was waiting, a Bronx Pizza delivery car drove up within the driveway and the driver attempted to enter the hospital. The front door, however, was locked! I suddenly remember that on our hospital tour, we had been instructed to use the side entrance, near the ER, during evening/night hours. The pizza guy immediately got on his cell phone to try to figure out an alternate plan, and meanwhile another person walked up confidently to the locked sliding glass doors and literally pried them open with his hands and walked on in. Pizza delivery guy followed. S soon joined me, and I tried to pry open the doors myself. It turns out that it was easy! Later, I found out that the pizzas were actually for the residents working on L&D, so it was all around kinda funny.
It was about 9:15 by the time that S and I entered the L&D area and checked in at the window. It was really quiet, and I definitely had the impression that they had been waiting for me. I could see a whiteboard in the nurses area with "B____ [our last name], 40w5d, induction" written there. The triage nurse came out and escorted us to our room. There were actually a few staff members in there watching the TV, but they scattered quickly when they saw us coming. I was told to undress and put on a hospital gown, which I did awkwardly. Since I wasn't 100% certain that I was going to stay, I kept saying things like, "Are you sure that you want me to sit in this bed?" Yes. And when a woman from admissions came in to have me sign some papers, I sent her away as I wanted to talk to the doctor first before committing to the induction. Our triage nurse was friendly; she didn't have kids yet, but she was 14 weeks pregnant with her first child.
On the monitor, I was surprised to see that I was in fact having some contractions about every 7 minutes. I guess they were B-H contractions, but I couldn't feel them at all. Soon a resident named Dr. E came in and introduced himself. It was sort of awkward because he made a sort of big deal about saying, "OH, I know you from somewhere. We've worked together before, I'm sure of it!" I told him that he has probably seen me in clinic at the cancer center, as I work right next to the Gyn/Onc attendings, and they usually have a parade of residents accompanying them (and I usually have to kick them off of my computer). He agreed that I must be right. So a bit awkward, but whatever... He examined me and declared that I was still about 1-2 cm, now 70% effaced, and still -3 station. He reiterated Dr. K's plan to start with a Foley catheter bulb to dilate my cervix, then to give Pitocin and/or break my bag of waters (amniotomy) to induce contractions. We talked again about the risks/benefits, etc. He agreed that the rate of C-section would be higher than waiting for natural labor, but he also alluded to the small risk of Bad Fetal Outcomes. Thinking about our friends who had a stillborn daughter (one of twins), S & I decided to proceed. Yes, C-section was an outcome that I wanted to avoid, but obviously, our baby's health was paramount. Besides, I definitely was not going to be comfortable going beyond Wednesday (41w1d), and I wasn't convinced that I would be going into labor by then, in which case, I would be in the same situation, only three days later.
After we committed to staying, the triage nurse drew labs and tried to insert an IV into my left arm. Even though she went for the "intern's vein" (plump vein on the forearm, near the base of the thumb), and even though needles do not usually bother me, it really hurt and I glanced over to see a big hematoma forming around the needle. It took over a minute to stop the bleeding. Luckily, she was able to get the IV in on a second attempt. I was glad that she wouldn't be drawing any more blood from me, though. Soon, I met my "real" nurse for the evening, Katie, who was from Maryland and had a 3 year old child. Katie had been "on-call", and had been called in from home to be my nurse for the evening. She told us that I was actually the only patient in labor on this particular evening. There were other patients on the floor, but they were women with PPROM and other conditions.
The insertion of the Foley catheter was not as bad as I had feared, but immediately thereafter the contractions became closer together -- and suddenly very painful. As I had discovered by reading, the balloon part of the catheter was actually above the cervical os, simulating the pressure that a baby's head would put on the cervix. Katie could see that I was in pretty severe pain already, and encouraged me to take some morphine for some relief, and to hopefully get some rest. I resisted for a bit, but it didn't take long for me to change my mind. She told me that the usual dose was 5 mg IV and 5 mg SQ. I opted for the IV dose only, reasoning that I could take the SQ dose as well if needed. She was right; soon after getting it the pain improved to the point where I could make it through the contractions on my own, without S's attention. He dozed a bit. I tried, but there were weird tapping noises in the ventilation system, a car alarm, and the contractions that were still grabbing me every 4 minutes or so. Meanwhile, I was started on penicillin for the Group B Strep, and got this every 4 hours up until the time that I delivered Annalise.
Every hour, Katie was supposed to come into the room and tug on the catheter a couple of times. By the 3rd or 4th time, the Foley balloon suddenly popped out! Katie told me that this generally implied dilation to 4 cm, as this was the diameter of the balloon. Dr. E checked and confirmed this. I can't remember the effacement and station at this point, but there was not a major change. I asked to labor on my own for a while, as I was having regular contractions and hoped to avoid Pitocin. He agreed to let me go for an hour, and during that time, S got up with me and I sat on the birthing ball and we sort of watched some TV and chatted. It felt wonderful not to have a catheter taped to my leg, and to be unhooked from my IV. After an hour, Katie returned and said that Dr. E had decided to let me go another hour based on my still-regular contractions on the monitor. However, I did notice that since the Foley was out, the contractions were no longer painful again. When I was checked again, it was probably about 5 or 6 AM, and there had basically been no progress over the two hours. It was time to start Pitocin.
I can't recall the exact details, but basically they start a certain dose of Pitocin and then escalate it every 15 minutes or so as long as you are tolerating it. I think I did OK at the initial dose, but by dose 2 or 3, the contractions became extremely painful. I was told that I could have the epidural "at any time." I tried to wait for a bit, but after 10-15 minutes of ever-worsening pains, I pushed my call bell and asked for the anesthesiologist. Suddenly, my body became wracked by uncontrollable shaking. I remember going to the restroom and grabbing the bar next to the toilet during one such contraction, and getting hit by another one between the bathroom and my bed. By the time the anesthesiologist came, I was afraid that I wouldn't be able to be still enough for the epidural. Meanwhile, I was begging the nurse to turn down the Pitocin, or stop it altogether, but she resisted, saying that she would have to start from zero if it was turned off. I eventually reasoned that I didn't care; it would only delay things by one hour if we had to start from zero.
The anesthesia resident who did the epidural was calm and efficient. By the time his attending arrived to supervise, I wasn't able to talk much at all due to severe pain and shaking. I do remember that they mentioned something about puncturing the dura (intentionally, I think), but I think that they never actually gave me any medication via this route (spinal). Instead, they administered standard bupivicaine and fentanyl by epidural. The pain relief was almost immediate, perhaps helped by the fact that my nurse finally relented and turned down the Pitocin. Around this time (just before 7AM), S had to go and move his car to avoid a ticket.
Sometime around this time I managed to call my mom, who was planning to come over as soon as she dropped my sister off at school. I was soon visited by a flurry of new faces as most of the teams seemed to turn over at 7AM. Two new anesthesiologists came in, I met my new nurse, Veronica, and Dr. E was replaced by Dr. V (attending) and Dr. W (resident). Dr. V told me that it was her first day back from maternity leave. Dr. V was actually the OB/GYN who I saw for an annual exam when I first suspected that S and I were having fertility problems. I was not impressed with her back then, but today I found her to be reassuring and straightforward, so I was happy about that. The resident, Dr. W, was sort of distant, and I didn't feel much of a connection with her. They told me that I would labor another hour or two, and that they would then plan to break the bag of waters.
My mom arrived around 8:45 or so, and had brought a half-dozen bagels and strawberry cream cheese. I was hungry, but was told not to eat. It's kind of sad, but a lot of the rest of the day was sort of a blur to me. At first, I thought that I was merely tired from being awake all night. I remember watching part of "A Baby Story," and that Dr. W came in a few times to check my progress, which was slow but seemed steady to me. The contractions were regular and didn't hurt much. They broke my waters some time in the mid-morning, but strangely, no amniotic fluid ever came out until I was at the pushing stage (many hours later). Some time in the early afternoon they didn't think I was progressing fast enough and they decided to put in an intrauterine pressure catheter to directly measure the strength of the contractions. They said this would be more accurate that the external device. They said that if my contractions were strong but ineffective over the next two hours, they might need to talk to me about C-section.
Sometime in the following hour, there were some fetal decelarations (I believe they were the relatively less-concerning type), and so I was checked earlier than originally planned. At this point, Dr. W was replaced by another resident (or maybe an intern) named Dr. B. I really liked Dr. B's bedside manner and trusted her immediately. She found that I had actually progressed, so the C-section was looking less likely at that point. For the fetal decelerations, she and the nurse found that my baby preferred for me to be on my right side, which is a bit unusual (most prefer the left side). At times I had to wear an oxygen mask, but no one ever seemed alarmed by the situation.
At some point I did have increasing pain and I was instructed to push the PCA button (PCA stands for "patient controlled anelgesia"; basically, I was giving myself an extra dose of the epidural medication by pushing the button. I could push the button as often as I wanted, but it would only deliver extra medication every 15 minutes.) Well, I needed to push the button several times over the next hour or so, but unfortunately, this made me increasingly groggy to the point where I could barely stay awake. Even more disturbing was the fact that I lost most of my ability to move my lower extremities. I could wiggle my toes and feet, but I completely lost the ability to life my legs off the bed, or even to turn from side to side. It was not a good feeling. I kept asking the nurse and the anesthesiologist whether it was normal for me to feel so groggy from the epidural medications (fentanyl and bupivicaine). They said that most people do not feel groggy from the epidural, but that it was possible that the narcotic component (the fentanyl) was giving me systemic side effects. I did ask about whether I could get a different combination of medications through the epidural, but I never got a clear answer about that. I think I actually had them turn it off for a while, which allowed me to wake up but also led to increasing pain.
At around 4:45 PM, I was told that I was around 9 cm , and that I had more cervix remaining on one side. Ideally, I should have been lying on my left side to help this, but again, the baby's heart rate tended to drop when I was on that side, so I had to stay on my right side. Now, up until this point, someone had been coming into the room every 15-20 minutes all day long. Suddenly, there was this 1+ hour period during which no one came to check on me. My contractions were very painful, and I needed lower back counterpressure from S and my mom's hands to squeeze to make it through them. I was able to feel the contractions very easily. I remember crying out, "Oh NO...here comes another one!", and I could feel it starting several seconds before it showed up on the monitor. My mom and S help me by telling me when it had peaked, and it felt good to know that an end was in sight. During this time, I wasn't feeling an urge to push or anything like that. We thought it was really strange that no one was coming to check on me, and we finally called for the nurse around 5:45. However, she was apparently busy, so I kept suffering through these contractions for a while longer. I think that my nurse finally came in around 6 PM. She explained that they had suddenly had a string of something like 4 deliveries and one other emergency situation come up in the past hour, and that is why no one had come in to check on me during that time.
I don't remember which doctor checked me, but it turns out that I was fully dilated at this point. It also turned out that Dr. K (the OB/GYN who had been taking care of me for my entire pregnancy) had come onto her shift at 5 PM, so she was going to be helping me deliver. Before I knew it, Dr. V was replaced by Dr. K and I was being told to push! They had me push to a count of 10, three times during each contraction. Now, prior to pushing I had felt every painful contraction, but for some reason during the pushing stage, I wasn't able to feel the contractions again. Thus, the nurse had to tell me when to push. For the pushing, I was lying down with me head tilted up. My mom lifted up my left leg and Veronica held up my right leg. S was on my left side, holding my hand, I think. Dr. K was at the end of the bed, and she placed her fingers in my perineal area to give me a target to push towards.
Dr. K was really encouraging with each push and kept saying how great I was doing. I didn't really believe her, but within what seemed like only minutes, she was saying that she could see the baby's head! They got a mirror and I was able to see it, too, a little bit; we were all surprised to see that she appeared to have a fair amount of dark hair! (S and I always assumed that we would have a bald or possibly a wispy blonde-haired child as we both had blonde hair as children and since we both still have baby-fine hair.)
After really only a few more pushes, Dr. K announced that the baby was about to crown! She told me to stop pushing as they still needed to remove the bottom section of the bed. Using the mirror, I could see that my perineum was bulging. Also, there was some blood coming out, and Dr. K said that I had torn a bit already. By the next contraction, I gave a push and Annalise's head and body came out without much difficulty! (I believe they came out in the same push.) I heard my Mom and S saying something like, "Oh my God! Here she is!" Dr K put Annalise directly onto my belly and then S cut the umbilical cord and she was moved up to my chest. I cried tears of joy and held her tight. I felt like I didn't really know how to even hold her. I can't even remember hearing her cry, but I remember that she initially looked a bit bluish but quickly turned to a rosy pink color in her face and trunk. Her hands/fingernails remained a bit bluish for several hours. She had some blood in her hair, and only a small amount of vernix on her skin. She was beautiful...perfectly beautiful! I held her for a long time (probably almost an hour) before she got measured, weighed, and diapered.
It was Sunday, January 25th, and we were scheduled for induction at 9 PM. However, we were instructed to call in at 7 PM to make sure that there was enough space for me. Apparently it would be a rare occurrence, but if for some reason Labor & Delivery (L&D) was flooded with emergencies, my induction could be postponed. At about 5:30, S & I took a nap for an hour or so, anticipating a busy night ahead. I actually did fall asleep, but S said that he just rested. I don't think that I was having any significant BH contractions, as far as I could tell.
Halfway expecting to be delayed, I called L&D at 7 PM and was told that yes, they were expecting me at 9. The next 2 hours were a flurry of activity as I rushed to finish packing my toiletries, do two loads of laundry (why? I don't know... I guess I do laundry when I'm nervous!), and eat a few bites (S ran up to El Portal for a chicken fajita platter, which we split). We didn't actually leave until sometime around 8:50 PM, but I assured S that 9 was an estimate, not an exact appointment time.
Our trip to the hospital had that same air of anticipation that I always thought would accompany a trip to L&D, minus any pain, discomfort, or sitting-in-a-puddle sensation on my end. S dropped me off at a circular driveway in front of the hospital, and then went to park the car in the lot across the street. I stood there impatiently with our bags, pillows, etc as I watched him move the car at least 3 times to different spaces within the lot. S later explained that some spaces were designated "reserved," and others didn't have a number required to feed the payment machine. While I was waiting, a Bronx Pizza delivery car drove up within the driveway and the driver attempted to enter the hospital. The front door, however, was locked! I suddenly remember that on our hospital tour, we had been instructed to use the side entrance, near the ER, during evening/night hours. The pizza guy immediately got on his cell phone to try to figure out an alternate plan, and meanwhile another person walked up confidently to the locked sliding glass doors and literally pried them open with his hands and walked on in. Pizza delivery guy followed. S soon joined me, and I tried to pry open the doors myself. It turns out that it was easy! Later, I found out that the pizzas were actually for the residents working on L&D, so it was all around kinda funny.
It was about 9:15 by the time that S and I entered the L&D area and checked in at the window. It was really quiet, and I definitely had the impression that they had been waiting for me. I could see a whiteboard in the nurses area with "B____ [our last name], 40w5d, induction" written there. The triage nurse came out and escorted us to our room. There were actually a few staff members in there watching the TV, but they scattered quickly when they saw us coming. I was told to undress and put on a hospital gown, which I did awkwardly. Since I wasn't 100% certain that I was going to stay, I kept saying things like, "Are you sure that you want me to sit in this bed?" Yes. And when a woman from admissions came in to have me sign some papers, I sent her away as I wanted to talk to the doctor first before committing to the induction. Our triage nurse was friendly; she didn't have kids yet, but she was 14 weeks pregnant with her first child.
On the monitor, I was surprised to see that I was in fact having some contractions about every 7 minutes. I guess they were B-H contractions, but I couldn't feel them at all. Soon a resident named Dr. E came in and introduced himself. It was sort of awkward because he made a sort of big deal about saying, "OH, I know you from somewhere. We've worked together before, I'm sure of it!" I told him that he has probably seen me in clinic at the cancer center, as I work right next to the Gyn/Onc attendings, and they usually have a parade of residents accompanying them (and I usually have to kick them off of my computer). He agreed that I must be right. So a bit awkward, but whatever... He examined me and declared that I was still about 1-2 cm, now 70% effaced, and still -3 station. He reiterated Dr. K's plan to start with a Foley catheter bulb to dilate my cervix, then to give Pitocin and/or break my bag of waters (amniotomy) to induce contractions. We talked again about the risks/benefits, etc. He agreed that the rate of C-section would be higher than waiting for natural labor, but he also alluded to the small risk of Bad Fetal Outcomes. Thinking about our friends who had a stillborn daughter (one of twins), S & I decided to proceed. Yes, C-section was an outcome that I wanted to avoid, but obviously, our baby's health was paramount. Besides, I definitely was not going to be comfortable going beyond Wednesday (41w1d), and I wasn't convinced that I would be going into labor by then, in which case, I would be in the same situation, only three days later.
After we committed to staying, the triage nurse drew labs and tried to insert an IV into my left arm. Even though she went for the "intern's vein" (plump vein on the forearm, near the base of the thumb), and even though needles do not usually bother me, it really hurt and I glanced over to see a big hematoma forming around the needle. It took over a minute to stop the bleeding. Luckily, she was able to get the IV in on a second attempt. I was glad that she wouldn't be drawing any more blood from me, though. Soon, I met my "real" nurse for the evening, Katie, who was from Maryland and had a 3 year old child. Katie had been "on-call", and had been called in from home to be my nurse for the evening. She told us that I was actually the only patient in labor on this particular evening. There were other patients on the floor, but they were women with PPROM and other conditions.
The insertion of the Foley catheter was not as bad as I had feared, but immediately thereafter the contractions became closer together -- and suddenly very painful. As I had discovered by reading, the balloon part of the catheter was actually above the cervical os, simulating the pressure that a baby's head would put on the cervix. Katie could see that I was in pretty severe pain already, and encouraged me to take some morphine for some relief, and to hopefully get some rest. I resisted for a bit, but it didn't take long for me to change my mind. She told me that the usual dose was 5 mg IV and 5 mg SQ. I opted for the IV dose only, reasoning that I could take the SQ dose as well if needed. She was right; soon after getting it the pain improved to the point where I could make it through the contractions on my own, without S's attention. He dozed a bit. I tried, but there were weird tapping noises in the ventilation system, a car alarm, and the contractions that were still grabbing me every 4 minutes or so. Meanwhile, I was started on penicillin for the Group B Strep, and got this every 4 hours up until the time that I delivered Annalise.
Every hour, Katie was supposed to come into the room and tug on the catheter a couple of times. By the 3rd or 4th time, the Foley balloon suddenly popped out! Katie told me that this generally implied dilation to 4 cm, as this was the diameter of the balloon. Dr. E checked and confirmed this. I can't remember the effacement and station at this point, but there was not a major change. I asked to labor on my own for a while, as I was having regular contractions and hoped to avoid Pitocin. He agreed to let me go for an hour, and during that time, S got up with me and I sat on the birthing ball and we sort of watched some TV and chatted. It felt wonderful not to have a catheter taped to my leg, and to be unhooked from my IV. After an hour, Katie returned and said that Dr. E had decided to let me go another hour based on my still-regular contractions on the monitor. However, I did notice that since the Foley was out, the contractions were no longer painful again. When I was checked again, it was probably about 5 or 6 AM, and there had basically been no progress over the two hours. It was time to start Pitocin.
I can't recall the exact details, but basically they start a certain dose of Pitocin and then escalate it every 15 minutes or so as long as you are tolerating it. I think I did OK at the initial dose, but by dose 2 or 3, the contractions became extremely painful. I was told that I could have the epidural "at any time." I tried to wait for a bit, but after 10-15 minutes of ever-worsening pains, I pushed my call bell and asked for the anesthesiologist. Suddenly, my body became wracked by uncontrollable shaking. I remember going to the restroom and grabbing the bar next to the toilet during one such contraction, and getting hit by another one between the bathroom and my bed. By the time the anesthesiologist came, I was afraid that I wouldn't be able to be still enough for the epidural. Meanwhile, I was begging the nurse to turn down the Pitocin, or stop it altogether, but she resisted, saying that she would have to start from zero if it was turned off. I eventually reasoned that I didn't care; it would only delay things by one hour if we had to start from zero.
The anesthesia resident who did the epidural was calm and efficient. By the time his attending arrived to supervise, I wasn't able to talk much at all due to severe pain and shaking. I do remember that they mentioned something about puncturing the dura (intentionally, I think), but I think that they never actually gave me any medication via this route (spinal). Instead, they administered standard bupivicaine and fentanyl by epidural. The pain relief was almost immediate, perhaps helped by the fact that my nurse finally relented and turned down the Pitocin. Around this time (just before 7AM), S had to go and move his car to avoid a ticket.
Sometime around this time I managed to call my mom, who was planning to come over as soon as she dropped my sister off at school. I was soon visited by a flurry of new faces as most of the teams seemed to turn over at 7AM. Two new anesthesiologists came in, I met my new nurse, Veronica, and Dr. E was replaced by Dr. V (attending) and Dr. W (resident). Dr. V told me that it was her first day back from maternity leave. Dr. V was actually the OB/GYN who I saw for an annual exam when I first suspected that S and I were having fertility problems. I was not impressed with her back then, but today I found her to be reassuring and straightforward, so I was happy about that. The resident, Dr. W, was sort of distant, and I didn't feel much of a connection with her. They told me that I would labor another hour or two, and that they would then plan to break the bag of waters.
My mom arrived around 8:45 or so, and had brought a half-dozen bagels and strawberry cream cheese. I was hungry, but was told not to eat. It's kind of sad, but a lot of the rest of the day was sort of a blur to me. At first, I thought that I was merely tired from being awake all night. I remember watching part of "A Baby Story," and that Dr. W came in a few times to check my progress, which was slow but seemed steady to me. The contractions were regular and didn't hurt much. They broke my waters some time in the mid-morning, but strangely, no amniotic fluid ever came out until I was at the pushing stage (many hours later). Some time in the early afternoon they didn't think I was progressing fast enough and they decided to put in an intrauterine pressure catheter to directly measure the strength of the contractions. They said this would be more accurate that the external device. They said that if my contractions were strong but ineffective over the next two hours, they might need to talk to me about C-section.
Sometime in the following hour, there were some fetal decelarations (I believe they were the relatively less-concerning type), and so I was checked earlier than originally planned. At this point, Dr. W was replaced by another resident (or maybe an intern) named Dr. B. I really liked Dr. B's bedside manner and trusted her immediately. She found that I had actually progressed, so the C-section was looking less likely at that point. For the fetal decelerations, she and the nurse found that my baby preferred for me to be on my right side, which is a bit unusual (most prefer the left side). At times I had to wear an oxygen mask, but no one ever seemed alarmed by the situation.
At some point I did have increasing pain and I was instructed to push the PCA button (PCA stands for "patient controlled anelgesia"; basically, I was giving myself an extra dose of the epidural medication by pushing the button. I could push the button as often as I wanted, but it would only deliver extra medication every 15 minutes.) Well, I needed to push the button several times over the next hour or so, but unfortunately, this made me increasingly groggy to the point where I could barely stay awake. Even more disturbing was the fact that I lost most of my ability to move my lower extremities. I could wiggle my toes and feet, but I completely lost the ability to life my legs off the bed, or even to turn from side to side. It was not a good feeling. I kept asking the nurse and the anesthesiologist whether it was normal for me to feel so groggy from the epidural medications (fentanyl and bupivicaine). They said that most people do not feel groggy from the epidural, but that it was possible that the narcotic component (the fentanyl) was giving me systemic side effects. I did ask about whether I could get a different combination of medications through the epidural, but I never got a clear answer about that. I think I actually had them turn it off for a while, which allowed me to wake up but also led to increasing pain.
At around 4:45 PM, I was told that I was around 9 cm , and that I had more cervix remaining on one side. Ideally, I should have been lying on my left side to help this, but again, the baby's heart rate tended to drop when I was on that side, so I had to stay on my right side. Now, up until this point, someone had been coming into the room every 15-20 minutes all day long. Suddenly, there was this 1+ hour period during which no one came to check on me. My contractions were very painful, and I needed lower back counterpressure from S and my mom's hands to squeeze to make it through them. I was able to feel the contractions very easily. I remember crying out, "Oh NO...here comes another one!", and I could feel it starting several seconds before it showed up on the monitor. My mom and S help me by telling me when it had peaked, and it felt good to know that an end was in sight. During this time, I wasn't feeling an urge to push or anything like that. We thought it was really strange that no one was coming to check on me, and we finally called for the nurse around 5:45. However, she was apparently busy, so I kept suffering through these contractions for a while longer. I think that my nurse finally came in around 6 PM. She explained that they had suddenly had a string of something like 4 deliveries and one other emergency situation come up in the past hour, and that is why no one had come in to check on me during that time.
I don't remember which doctor checked me, but it turns out that I was fully dilated at this point. It also turned out that Dr. K (the OB/GYN who had been taking care of me for my entire pregnancy) had come onto her shift at 5 PM, so she was going to be helping me deliver. Before I knew it, Dr. V was replaced by Dr. K and I was being told to push! They had me push to a count of 10, three times during each contraction. Now, prior to pushing I had felt every painful contraction, but for some reason during the pushing stage, I wasn't able to feel the contractions again. Thus, the nurse had to tell me when to push. For the pushing, I was lying down with me head tilted up. My mom lifted up my left leg and Veronica held up my right leg. S was on my left side, holding my hand, I think. Dr. K was at the end of the bed, and she placed her fingers in my perineal area to give me a target to push towards.
Dr. K was really encouraging with each push and kept saying how great I was doing. I didn't really believe her, but within what seemed like only minutes, she was saying that she could see the baby's head! They got a mirror and I was able to see it, too, a little bit; we were all surprised to see that she appeared to have a fair amount of dark hair! (S and I always assumed that we would have a bald or possibly a wispy blonde-haired child as we both had blonde hair as children and since we both still have baby-fine hair.)
After really only a few more pushes, Dr. K announced that the baby was about to crown! She told me to stop pushing as they still needed to remove the bottom section of the bed. Using the mirror, I could see that my perineum was bulging. Also, there was some blood coming out, and Dr. K said that I had torn a bit already. By the next contraction, I gave a push and Annalise's head and body came out without much difficulty! (I believe they came out in the same push.) I heard my Mom and S saying something like, "Oh my God! Here she is!" Dr K put Annalise directly onto my belly and then S cut the umbilical cord and she was moved up to my chest. I cried tears of joy and held her tight. I felt like I didn't really know how to even hold her. I can't even remember hearing her cry, but I remember that she initially looked a bit bluish but quickly turned to a rosy pink color in her face and trunk. Her hands/fingernails remained a bit bluish for several hours. She had some blood in her hair, and only a small amount of vernix on her skin. She was beautiful...perfectly beautiful! I held her for a long time (probably almost an hour) before she got measured, weighed, and diapered.
Meanwhile, at the other end of the table, Dr. K delivered the placenta. I honestly did not even notice this part. After that, she sewed up my tear, which I was told was a second-degree tear. She later mentioned that my placenta was unusual in that the cord was inserted onto the membranous portion of the placenta. I don't think I quite understand the implications of this even now, but I believe that it could have caused Scary Things to happen to the baby, and I also later found out that because of this, she had to "reach into my uterus" to get the placenta out. (If I understood correctly, she was afraid that if she would have tugged on the cord, it might have detached from the placenta entirely). Anyway, because of this, I took IV antibiotics (Ancef) for an additional 24 hours starting the next morning.
My dad and sister (age 10) arrived pretty soon after the delivery and it was a nice family bonding time. I was still doing a lot of skin-to-skin contact with Annalise and somehow it didn't even bother me that my breasts were pretty much on display. My sister was a little surprised by my half-nudity at first, but quickly got used to it. My mom and S made a few phone calls to other family members, but I just laid there staring -- no, marveling, really -- at the new baby.
I feel SO lucky that we have her.
My dad and sister (age 10) arrived pretty soon after the delivery and it was a nice family bonding time. I was still doing a lot of skin-to-skin contact with Annalise and somehow it didn't even bother me that my breasts were pretty much on display. My sister was a little surprised by my half-nudity at first, but quickly got used to it. My mom and S made a few phone calls to other family members, but I just laid there staring -- no, marveling, really -- at the new baby.
I feel SO lucky that we have her.
Friday, January 30, 2009
Our Snuggle Bug
The first picture is swaddled up in her hospital blanket, and the second is after getting dressed to go home from the hospital. It seems odd that for a girl who was almost 8 lbs at birth, the newborn size clothes are SO huge!
Breastfeeding is definitely a challenge. For me, the pain in the nipple area is pretty excruciating, even though I believe that her latch is correct (entire areola). And today my milk is coming in, so I feel like a literally have cantalopes strapped to my chest. Also, she gets frantic if she doesn't like the way the nipple feels or works on the first latch, so I try to get them primed for her before starting. I know we will work this out. If not, I'll definitely be talking to a lactation consultant sometime next week, because I can't take this pain! I can't end on that kind of negative note, though! Overall, though, I absolutely *adore* my and the entire experience of being a parent. We love her SO SO much!
I still need to write up that birth story...
Thursday, January 29, 2009
Annalise is Here!
I am thrilled to announce that our daughter,
Annalise Lily B____ arrived Monday, January 26th, at 7:03 pm
40 weeks, 6 days (induced)
7 lbs, 15 oz
21 1/4 inches
We are all doing great and we came home from the hospital early Wednesday afternoon.
I will post pics and then later, hopefully today but no guarantee. ;)
I also need to post her birth story, of course!
Thank you all for your good wishes!
Annalise Lily B____ arrived Monday, January 26th, at 7:03 pm
40 weeks, 6 days (induced)
7 lbs, 15 oz
21 1/4 inches
We are all doing great and we came home from the hospital early Wednesday afternoon.
I will post pics and then later, hopefully today but no guarantee. ;)
I also need to post her birth story, of course!
Thank you all for your good wishes!
Sunday, January 25, 2009
40w5d: Owwwwww! (my ankle!)
40w5d here...
As I mentioned yesterday, we are going to go in to the hospital tonight (as planned), but ask to speak to the on-call attending physician (a different OB/GYN named Dr. D) before we really commit to the induction. I have never met her, but Dr. D is supposed to be really good, so I hope that she lives up to her reputation. Since this is an academic medical center, she should be there the entire time overnight to supervise the interns and residents. Basically, S & I are hoping for a repeat exam and a second opinion. If Dr. D seems confident that induction is the way to go, we'll go ahead with it. If she is ambivalent or against it, we may wait 2-3 more days, hopefully with another NST in the meantime.
Yesterday afternoon, things seemed a bit hopeful. I noticed some clear blobs of what I assume were parts of my mucus plug. It wasn't a huge volume, and these blobs were clear with absolutely no tinge of blood or yellow, so who knows. Also, I noticed that I could at least touch my cervix again (barely), but it was more accessible than a few days ago. My, the things I learned from "Taking Charge of Your Fertility"!
I ate left over HOT Thai food for lunch, and then S and I took a nice walk in our neighborhood. Later, we got dinner (BBQ) and went to see "The Wrestler" (depressing). For some reason (probably the loud music/noise in this movie), BabyGirl was super awake during the entire thing and was squirming up a storm and setting off pretty frequent B-H contractions. Also, I was getting some sharp stabbing pains in my cervix, which has not happened much before. I really felt like maybe something was starting.
When we got home at about 9:30 PM, S and I decided to take another short walk -- really only a few blocks, but it was a nice evening, so why not? I wore the same black clogs that I had worn to the movie. When we were almost back to our house, I somehow managed to step off the side of my shoe and fall to the ground. DH and I were holding hands, so saw me falling and he held onto my hand really tightly. I fell hard onto my left calf and really twisted my poor right ankle. I got up, tried to dust myself off, laughed at my clumsiness, and walked home, but about 1/2 hour later my ankle/foot started really killing me. It's so weird because there is no bruising and no swelling, but it really really hurts! OWWWW!
Needless to say that our plans to go to a local park and museums (Balboa Park for the SoCal people) this afternoon are shot. In fact, I can't think of anything much that I can do... not even chores! Ice is helping a bit, and I am using hiking poles around the house to try to take some weight off of it. My mom is going to bring over some old crutches this afternoon. If I weren't going to the hospital tonight, and if I had to work tomorrow, I would seriously have to consider going to the ER.
Assuming that I go ahead with this induction tonight, I'm going to try to have the baby (late tomorrow?) and then if it's still bad, I will ask for some sort of quick ortho or PT eval before I go home (presumably Tuesday?). Maybe they can give me one of those walking boots or something. I can't see how I can really take care of a baby when I can barely walk. And so much for my plans to try a lot of the squatting/standing positions during my contractions...
As I mentioned yesterday, we are going to go in to the hospital tonight (as planned), but ask to speak to the on-call attending physician (a different OB/GYN named Dr. D) before we really commit to the induction. I have never met her, but Dr. D is supposed to be really good, so I hope that she lives up to her reputation. Since this is an academic medical center, she should be there the entire time overnight to supervise the interns and residents. Basically, S & I are hoping for a repeat exam and a second opinion. If Dr. D seems confident that induction is the way to go, we'll go ahead with it. If she is ambivalent or against it, we may wait 2-3 more days, hopefully with another NST in the meantime.
Yesterday afternoon, things seemed a bit hopeful. I noticed some clear blobs of what I assume were parts of my mucus plug. It wasn't a huge volume, and these blobs were clear with absolutely no tinge of blood or yellow, so who knows. Also, I noticed that I could at least touch my cervix again (barely), but it was more accessible than a few days ago. My, the things I learned from "Taking Charge of Your Fertility"!
I ate left over HOT Thai food for lunch, and then S and I took a nice walk in our neighborhood. Later, we got dinner (BBQ) and went to see "The Wrestler" (depressing). For some reason (probably the loud music/noise in this movie), BabyGirl was super awake during the entire thing and was squirming up a storm and setting off pretty frequent B-H contractions. Also, I was getting some sharp stabbing pains in my cervix, which has not happened much before. I really felt like maybe something was starting.
When we got home at about 9:30 PM, S and I decided to take another short walk -- really only a few blocks, but it was a nice evening, so why not? I wore the same black clogs that I had worn to the movie. When we were almost back to our house, I somehow managed to step off the side of my shoe and fall to the ground. DH and I were holding hands, so saw me falling and he held onto my hand really tightly. I fell hard onto my left calf and really twisted my poor right ankle. I got up, tried to dust myself off, laughed at my clumsiness, and walked home, but about 1/2 hour later my ankle/foot started really killing me. It's so weird because there is no bruising and no swelling, but it really really hurts! OWWWW!
Needless to say that our plans to go to a local park and museums (Balboa Park for the SoCal people) this afternoon are shot. In fact, I can't think of anything much that I can do... not even chores! Ice is helping a bit, and I am using hiking poles around the house to try to take some weight off of it. My mom is going to bring over some old crutches this afternoon. If I weren't going to the hospital tonight, and if I had to work tomorrow, I would seriously have to consider going to the ER.
Assuming that I go ahead with this induction tonight, I'm going to try to have the baby (late tomorrow?) and then if it's still bad, I will ask for some sort of quick ortho or PT eval before I go home (presumably Tuesday?). Maybe they can give me one of those walking boots or something. I can't see how I can really take care of a baby when I can barely walk. And so much for my plans to try a lot of the squatting/standing positions during my contractions...
Saturday, January 24, 2009
40w4d: And Waiting...
No, no, I'm still here and still pregnant...
Here are some updates:
From Tuesday, 1/20/09 (40w0d):
I actually went to work today (my due date) because, well, I couldn't see any real reason not to do so. (Tuesday is one of my days working at the VA, and I only have ~3-4 weeks of paid leave (accumulated sick leave and vacation time), so I decided that I might as well go there, work a little, and not use up my precious sick leave/vacation time. I am feeling more ambivalent about going to my other work site tomorrow. It is more stressful. Still, there is the issue of taking leave now versus later, and the other issue of not being paid for my entire maternity leave anyway. We'll see!
I truly have nothing new to report. Occasional B-H contractions, none involving my back. Really no extra "pressure" to speak of, no mucus plug, nothing. I just feel bigger and bigger but nothing is happening. I sometimes wonder if this baby is even in my pelvis at all. I woke up 3 times overnight to use the bathroom, but during the day it seems like I am waiting for hours with no problem (even less of a problem than a few weeks ago). Argh! My biggest fear at this point is getting induced sometime next week, failing to progress, and then getting a C-section that I don't really need. I'm trying to take it day by day and trying to distract myself.
From Thursday, 1/22/09 (40w2d):
I just got back from my OB/GYN appt. I'm currently 40w2d, with essentially zero progress over the past 2 weeks (1 cm, 50-60% effaced, soft, -3 station). So disappointing!
From what I've read, induction of labor is not very successful in women with numbers like these (especially primigravidas, or first time preggos, like myself). Lots of info out there on the so called "Bishop Score." I specifically asked my OB/GYN about that, and she seemed to think that induction would be successful (but I'm not sure why). She said that my score would be pretty good. By my own calculation, my score is 3, which is actually in the group most likely to end up getting a C-section.
The plan is to induce me on Sunday night (40w5d) with hopes of me having the baby on ~Monday at 40w6d. I asked about the method of induction (Cervidil, prostaglandins, Pitocin, or whatever) and my OB/GYN said that they would use a Foley catheter inserted into my cervix to start dilation. She said that oftentimes they do this, labor starts, and they don't even need Pitocin.
I had never heard of this induction method before and wonder if anyone has first-hand experience. So far, my friend tells me that one of her friends had this done and it was very uncomfortable. I *HATE* having a Foley in my bladder, so I cannot really imagine how it is going to feel having that thing in my cervix. Online (google), people who had it done seemed to say that it was not too uncomfortable. I did some searching on google and pubmed, and it sounds like this is a low-tech way to start labor, is used worldwide, but for some reason is just starting to catch on here in the US.
I have to admit that I started crying a little bit after we discussed the induction. I want this to happen on its own SO badly. But at the same time, I don't want to wait past 41 weeks and beyond.
After my appointment, I had an NST and everything looks great with the baby. The placenta has some minor signs of being "older" but nothing unexpected. My amniotic fluid index is 13 point-something, so better than last time (9).
I'm going to do everything possible between now and then in hopes of something happening on its own.
From today, Saturday, 1/24/08 (40w4d):
Yesterday (Friday, 1/23/08) was my birthday (34!), so my thought that maybe the BabyGirl and I would share a bday did not come true. However, I finally took a day off from work and officially started maternity leave.
I ran a bunch of errands. I checked out two Ina May Gaskin/midwifery books from the library. Even though I am not going that route, I think it is interesting and hopefully I'll enjoy reading positive birth stories during my labor.
I spontaneously made a last-minute acupuncture appointment to see if that could add anything. I have done acupuncture exactly once before, on the day before my embryo transfer for IVF. This same woman says that she has experience in inducing labor, too. Anyway, I thought I would be there 30-45 minutes, but the session ended up lasting a little over 2 hours (!).
The acupuncturist first put needles in the webs between my thumb and index finger, in my supraclavicular fossa area (between neck and shoulder), and in several spots on my inner leg (above ankle, inner calf, and lower/inner thigh). She lit a charcoal/herb stick and moved it around in front of my belly and also my legs. It was warm, and it felt good.
She then put an electrode-type thing on several of the needles and turned it up to the point where it made my muscles twitch just a tiny bit. and said that the baby would probably start being really active. She left me there for probably ~40 minutes in near-darkness, with nice relaxing music. I was mostly just lying quietly and relaxing, but I dozed a bit and was awake at certain times, too. BabyGirl, instead of getting super active, seemed to snooze almost the entire time.
The acupuncturist then returned to the room and had me role on my side. She put some needles on my lower back and again placed the electrodes again. BabyGirl woke up a bit more and was moving some, but nothing extreme. Around this time, I realized that a buzzing sound that I had been hearing intermittantly was not "some weird machine in the next room," but either my pager or cell phone going off. This did kill the mood a bit, but I tried to just ignore it.
Finally, the acupuncturist returned again and placed some glass cups on my back (moxibustion/cupping). Again, only minor movements from the BabyGirl. Personally, I think that the fact that I hadn't eaten lunch before my 1:30 appointment had a lot to do with her relatively quiet state. Like I mentioned earlier, I had no idea that I would be there for over 2 hours!
For dinner, I went with my mom, dad, sister and S to my favorite Thai restaurant. I asked them to make the spiciest dish even spicier. I also asked the owner (my mom kinda knows her as we've been going to this restaurant for ~15 years) if there were any specific Thai foods rumored to induce labor. She didn't know of any, unfortunately.
Later, S and I came home and got busy... (It had been TOO long...both of our faults, I suppose)... Well, that felt great actually, but it didn't really seem to set off any major contractions, either. Waaah. This AM, I woke up feeling a little achy in my pelvis, kinda like when I have my period. However, there is no contraction-y aspect to this feeling.
This morning, I saw that someone replied to my post about Foley catheter inductions on the Ovusoft Labor/Delivery/Post-Partum forum. This poster is a Bradley method instructor, so knowledgeable about birth, but obviously on the lower intervention side of things. Anyway, she suggested that I will be at higher risk of cord prolapse during an induction because of BabyGirl's -3 station. Ugh! How terrifying!! I hadn't even thought of that.
She also said that she would assume that they are planning to break my water if the Foley catheter alone doesn't work to start labor. (She guessed that on her own, but yes, my OB/GYN did mention that possibility.) Finally, she also suggests that I am putting myself at a high risk of C-section, which was also my previous concern. Argh!
I talked about all of this with S. Right now, I think I am going ahead with planning for induction Sunday night. (Of course, I am really REALLY hoping that I might make progress before then.) Maybe BabyGirl can at least move down a little bit more? My Bishop score would improve a lot (and risk of C-section would decrease) if she would at least move down to -2 or -1 station. Anyway, I'll plan to go in to the hospital Sunday night, as planned, but before absolutely commiting to the induction, I'll ask the attending MD there to check me out and tell me my current dilation, effacement, and station. Then, I am going to try to get their honest opinion about the risks involved with waiting for this to happen naturally versus induction. I will make it very clear that we are not pushing for either decision. We just want to do the best thing for BabyGirl, and if that is truly a toss-up, also for me.
Here are some updates:
From Tuesday, 1/20/09 (40w0d):
I actually went to work today (my due date) because, well, I couldn't see any real reason not to do so. (Tuesday is one of my days working at the VA, and I only have ~3-4 weeks of paid leave (accumulated sick leave and vacation time), so I decided that I might as well go there, work a little, and not use up my precious sick leave/vacation time. I am feeling more ambivalent about going to my other work site tomorrow. It is more stressful. Still, there is the issue of taking leave now versus later, and the other issue of not being paid for my entire maternity leave anyway. We'll see!
I truly have nothing new to report. Occasional B-H contractions, none involving my back. Really no extra "pressure" to speak of, no mucus plug, nothing. I just feel bigger and bigger but nothing is happening. I sometimes wonder if this baby is even in my pelvis at all. I woke up 3 times overnight to use the bathroom, but during the day it seems like I am waiting for hours with no problem (even less of a problem than a few weeks ago). Argh! My biggest fear at this point is getting induced sometime next week, failing to progress, and then getting a C-section that I don't really need. I'm trying to take it day by day and trying to distract myself.
From Thursday, 1/22/09 (40w2d):
I just got back from my OB/GYN appt. I'm currently 40w2d, with essentially zero progress over the past 2 weeks (1 cm, 50-60% effaced, soft, -3 station). So disappointing!
From what I've read, induction of labor is not very successful in women with numbers like these (especially primigravidas, or first time preggos, like myself). Lots of info out there on the so called "Bishop Score." I specifically asked my OB/GYN about that, and she seemed to think that induction would be successful (but I'm not sure why). She said that my score would be pretty good. By my own calculation, my score is 3, which is actually in the group most likely to end up getting a C-section.
The plan is to induce me on Sunday night (40w5d) with hopes of me having the baby on ~Monday at 40w6d. I asked about the method of induction (Cervidil, prostaglandins, Pitocin, or whatever) and my OB/GYN said that they would use a Foley catheter inserted into my cervix to start dilation. She said that oftentimes they do this, labor starts, and they don't even need Pitocin.
I had never heard of this induction method before and wonder if anyone has first-hand experience. So far, my friend tells me that one of her friends had this done and it was very uncomfortable. I *HATE* having a Foley in my bladder, so I cannot really imagine how it is going to feel having that thing in my cervix. Online (google), people who had it done seemed to say that it was not too uncomfortable. I did some searching on google and pubmed, and it sounds like this is a low-tech way to start labor, is used worldwide, but for some reason is just starting to catch on here in the US.
I have to admit that I started crying a little bit after we discussed the induction. I want this to happen on its own SO badly. But at the same time, I don't want to wait past 41 weeks and beyond.
After my appointment, I had an NST and everything looks great with the baby. The placenta has some minor signs of being "older" but nothing unexpected. My amniotic fluid index is 13 point-something, so better than last time (9).
I'm going to do everything possible between now and then in hopes of something happening on its own.
From today, Saturday, 1/24/08 (40w4d):
Yesterday (Friday, 1/23/08) was my birthday (34!), so my thought that maybe the BabyGirl and I would share a bday did not come true. However, I finally took a day off from work and officially started maternity leave.
I ran a bunch of errands. I checked out two Ina May Gaskin/midwifery books from the library. Even though I am not going that route, I think it is interesting and hopefully I'll enjoy reading positive birth stories during my labor.
I spontaneously made a last-minute acupuncture appointment to see if that could add anything. I have done acupuncture exactly once before, on the day before my embryo transfer for IVF. This same woman says that she has experience in inducing labor, too. Anyway, I thought I would be there 30-45 minutes, but the session ended up lasting a little over 2 hours (!).
The acupuncturist first put needles in the webs between my thumb and index finger, in my supraclavicular fossa area (between neck and shoulder), and in several spots on my inner leg (above ankle, inner calf, and lower/inner thigh). She lit a charcoal/herb stick and moved it around in front of my belly and also my legs. It was warm, and it felt good.
She then put an electrode-type thing on several of the needles and turned it up to the point where it made my muscles twitch just a tiny bit. and said that the baby would probably start being really active. She left me there for probably ~40 minutes in near-darkness, with nice relaxing music. I was mostly just lying quietly and relaxing, but I dozed a bit and was awake at certain times, too. BabyGirl, instead of getting super active, seemed to snooze almost the entire time.
The acupuncturist then returned to the room and had me role on my side. She put some needles on my lower back and again placed the electrodes again. BabyGirl woke up a bit more and was moving some, but nothing extreme. Around this time, I realized that a buzzing sound that I had been hearing intermittantly was not "some weird machine in the next room," but either my pager or cell phone going off. This did kill the mood a bit, but I tried to just ignore it.
Finally, the acupuncturist returned again and placed some glass cups on my back (moxibustion/cupping). Again, only minor movements from the BabyGirl. Personally, I think that the fact that I hadn't eaten lunch before my 1:30 appointment had a lot to do with her relatively quiet state. Like I mentioned earlier, I had no idea that I would be there for over 2 hours!
For dinner, I went with my mom, dad, sister and S to my favorite Thai restaurant. I asked them to make the spiciest dish even spicier. I also asked the owner (my mom kinda knows her as we've been going to this restaurant for ~15 years) if there were any specific Thai foods rumored to induce labor. She didn't know of any, unfortunately.
Later, S and I came home and got busy... (It had been TOO long...both of our faults, I suppose)... Well, that felt great actually, but it didn't really seem to set off any major contractions, either. Waaah. This AM, I woke up feeling a little achy in my pelvis, kinda like when I have my period. However, there is no contraction-y aspect to this feeling.
This morning, I saw that someone replied to my post about Foley catheter inductions on the Ovusoft Labor/Delivery/Post-Partum forum. This poster is a Bradley method instructor, so knowledgeable about birth, but obviously on the lower intervention side of things. Anyway, she suggested that I will be at higher risk of cord prolapse during an induction because of BabyGirl's -3 station. Ugh! How terrifying!! I hadn't even thought of that.
She also said that she would assume that they are planning to break my water if the Foley catheter alone doesn't work to start labor. (She guessed that on her own, but yes, my OB/GYN did mention that possibility.) Finally, she also suggests that I am putting myself at a high risk of C-section, which was also my previous concern. Argh!
I talked about all of this with S. Right now, I think I am going ahead with planning for induction Sunday night. (Of course, I am really REALLY hoping that I might make progress before then.) Maybe BabyGirl can at least move down a little bit more? My Bishop score would improve a lot (and risk of C-section would decrease) if she would at least move down to -2 or -1 station. Anyway, I'll plan to go in to the hospital Sunday night, as planned, but before absolutely commiting to the induction, I'll ask the attending MD there to check me out and tell me my current dilation, effacement, and station. Then, I am going to try to get their honest opinion about the risks involved with waiting for this to happen naturally versus induction. I will make it very clear that we are not pushing for either decision. We just want to do the best thing for BabyGirl, and if that is truly a toss-up, also for me.
Monday, January 19, 2009
39w6d: Still Waiting!
It seems that I cannot manage both being in a pregnancy buddy group (I joined one on Ovusoft) and updating here. However, this is a more "permanent" record (and I want to update anyone who is still reading!), so I'm going to cut and paste some of my posts from there to fill in some gaps here.
~ ~ ~ ~ ~ ~ ~ ~
From Thursday, 1/8/09 (38w2d):
I had my 38w2d OB appointment today. BP still fine at 90/58. Weight stable from last week, but I'm up about 33 lbs now. And then it was time for my first cervical exam. I asked her about whether there is any concern about doing an internal exam on someone who is Group B Strep (GBS) positive, and she said that it is not a problem. However, take her answer with a grain of salt (and read the paragraph below). Anyway, she did the exam, and she had to really push hard up inside to find my cervix, and she eventually pronounced that it is "1 cm dilated and 50% effaced" and that she can feel the baby's head. No comment about whether is high, medium, or low, although it certainly felt like she was going in really far (ie high).
The next part was kinda upsetting. Right after telling me that I was 1 cm and 50% effaced, she continued to poke around and she said, "and now I'm sweeping your membranes." Right away I said, "Um, wait, I'm not quite ready for that." I mean, that is supposed to help induce labor, and she never even asked me if I wanted her to do it. The answer would have been no, because I am still hoping to tie up a few loose ends over the weekend and early next week! And now I've been reading about this procedure, and I see that there is some controversy about the safety of sweeping/stripping membranes in someone who is a Group B Strep carrier...which I am, and which we had JUST discussed. Argh. I am rather annoyed now. I do think that everything will be OK, but I also feel that she should have discussed it with me before doing it. I'm not sure how much she did. Once I told her to stop, she did, but then she still told me that I would probably experience spotting and increasing contractions tonight.
~ ~ ~ ~ ~ ~ ~ ~
From Saturday, 1/10/09 (38w4d):
As for me...(may be TMI, so watch out!!) After the membrane stripping incident on Thursday (done without telling me first), I was kinda relieved when nothing much happened that evening. However, on Friday AM I woke up with a bunch of bloody discharge/spotting in my underwear (several teaspoonfuls in volume, I'd guess). It looked like the beginning of my period, but when I wiped, nothing more was there or inside. Nothing much happened during the day yesterday: no significant discharge, no contractions.
In the evening we saw the movie "Milk" (excellent!) and during the movie I felt at least 7-8 Braxton-Hicks type of non-painful contractions. I woke up at about 5 this AM to use the bathroom. At night, I do this without turning on any lights or flushing the toilet. Afterwards, I was surprised to feel that my underwear felt pretty wet, so I turned on the light to see what was up. There was a ~4 inch wet spot, and it appeared to be kinda a light brownish color (maybe discharge mixed with blood.) I decided that it was not amniotic fluid and went back to bed. When I got up to pee again at about 8AM, I noticed that there was a bit of mucousy discharge. I think it might be part of my mucous plug! Of course, I still don't think that it means much. I haven't had any further contractions (not even B-H), and I figure that Dr K might have dislodged it with her exam/membrane sweeping. I'm assuming that they have to dislodge it if they are putting their finger thru the cervix, right?Anyhow, baby shower #2 (a small group of work colleagues) is this afternoon.
~ ~ ~ ~ ~ ~ ~ ~
From Monday, 1/12/09 (38w6d):
I had a lovely baby shower #2 on Saturday. About 14 women from work ended up coming, more than I had expected, and it was held in a local restaurant during their mid-afternoon lull. They let us take over a large section of the restaurant, so we had it to ourselves other than for a lonely-appearing man who decided to take the table right next to our group and watch (and yes, there were lots of other seats elsewhere in the restaurant). Now I have many, many thank you notes to write, including a few that I haven't done from baby shower #1.
I had been having B-H contractions on Friday night, and they've all but stopped now. No further symptoms at all, really. I then went with my mom & little sister to Babies R Us on Saturday night to get the rest of the must-haves from the registry. This included a baby book, which I cannot wait to get started on. (Thank you notes first, though!) Sunday night, we had our final childbirth class. I don't think any of the couples in the class have had their babies yet. We actually have the first due date, and the other late January/early February couples were all still there. Most of the people in the class were due in late February, March, and even April. The instructor overall was nice but a bit (unintentionally) preachy at times and made me feel like a little kid with her tone. "REMEMBER...your birth may be DIFFERENT!" So, I'm glad to be finished with it. My favorite parts of the class were definitely the relaxation techniques...and the movies.
I made it through my last Monday at work. Mondays are my busiest day, clinic-wise, and next week is MLK Day, so I'm off no matter what. Today something really embarrassing happened, though. I was in a room seeing a patient (age 27 - and yes, she has breast cancer!), her best friend, her mother, brother (age ~12) and daughter (3). I was sitting on one of those round stools with no back, and wheels. Well, I kinda perched on the edge of the thing and before I knew it, the entire stool rolled out from under me. I landed flat on my butt!! It was one of the most embarrassing things that I've ever had happen in front of a patient. Luckily, I wasn't injured, so I was able to laugh it off and kinda say, "Well, at least my water didn't break in front of you guys!" The family was very kind, actually.
~ ~ ~ ~ ~ ~ ~ ~
From Tuesday, 1/13/09 (39w0d):
A couple of people told me that I am "still carrying high." Grrr...do not say this to a woman at 39 weeks! The only interesting development is that since this afternoon, when I stand up the tendons in my inner thighs feel kinda like they feel after I ride a horse or bike. Kinda stretched out, I guess. Maybe I finally have some relaxin hormone in my system and maybe she can finally start to work her way down?? Right? Right? Has anyone else noticed this kind of symptom?
I tried to do my kick count a while ago. I had 5 kicks in 2 minutes, and none since then (45 minutes ago.) This is why I HATE kick counts!! Now I'm going to get stressed out!
~ ~ ~ ~ ~ ~ ~ ~
From Thursday, 1/15/09 (39w2d):
Nothing much to report here. I'm still at work. TMI ALERT: maybe a somewhat-looser-than-typical BM today, but it's not like my entire colon is cleaned out or anything. I don't even seem to get B-H contractions at this point. I have an OB/GYN appointment at 4:30 this afternoon. I'm very very curious about whether there has been any "progress." I think that part of my wish to get started is related to the following. I have committed to be back to work on a certain date. If she is born before by due date, I would get to spend 12.5 weeks with her, but if she is born later, it would only be something like 11 weeks. I want as much time as possible with her. I know legally I could get the full 12 weeks off (assuming that I work next week), but I just feel guilty as my colleagues will need to be covering for me the entire time.
Later that day...
I had my OB/GYN appointment this afternoon. My BP and the baby's heartbeat were fine. I have now gained about 33 lbs. Recall that last week, I was "1 cm dilated, 50% effaced." Well, today Dr. K told me that my cervix is "a loose 1 cm dilated and maybe 65% effaced and very soft." Hmmmmmmm. It sounds like maybe she is trying to make me feel better, but that I am basically the same as last week.
I asked her about the sweeping the membranes from last week and whether it was safe given that I am GBS+, and she basically said that in her opinion it is safe, but that she wouldn't do it if I didn't want her to. Well, I was sort of tempted, but in the end she didn't do it.If I come to next week's appointment (40w2d) we will likely schedule an induction for sometime around 41 weeks, but still give the baby a few more days to appear on her own. That sounds like a good compromise to me.
There is something that I don't quite like about "choosing a birthday", but at the same time I think I would go insane if this went into February. I really really hope that it happens on its own, though. Our conception (via IVF/ICSI) was pretty much devoid of any romance or naturality, so I'd at least like to have a spontaneous labor/birth story to balance that out.
After work I went to Target and spent over 1.5 hours there. I did buy 2 new nursing bras (which I desperately need NOW, even if I need to buy another size in the next week or two), overnight type pads for me (for lochia), PJs on clearance (I figure I'll be lounging in comfy clothes 75% of the time for the next couple of months), baby wipes in a small hard plastic case for the diaper bag, more thank you cards, etc.
~ ~ ~ ~ ~ ~ ~ ~
From Sunday, 1/18/09 (39w5d):
Nothing much is going on here. I walked maybe 2-3 miles with my parents in Rose Cany.on yesterday. I also ate an entire can of pineapple (yum) but then I read that it has to be fresh pineapple to have a labor-inducing effect. Well, I'm honestly not much of a believer in some of these measures, but I figure that they can't hurt. I'm getting maybe one B-H per hour, sometimes less.
S and I will go out walking again today, too. I think I want to repeat the amniotic fluid check (biophysical profile/BPP) and non-stress test (NST) sometime this week if nothing happens. I did have one earlier this month and I found it very reassuring to have that info. Also, the baby's fluid was on the low end of normal, so I'd like to see that again before next weekend. Hopefully my OB will agree.
~ ~ ~ ~ ~ ~ ~ ~
From Thursday, 1/8/09 (38w2d):
I had my 38w2d OB appointment today. BP still fine at 90/58. Weight stable from last week, but I'm up about 33 lbs now. And then it was time for my first cervical exam. I asked her about whether there is any concern about doing an internal exam on someone who is Group B Strep (GBS) positive, and she said that it is not a problem. However, take her answer with a grain of salt (and read the paragraph below). Anyway, she did the exam, and she had to really push hard up inside to find my cervix, and she eventually pronounced that it is "1 cm dilated and 50% effaced" and that she can feel the baby's head. No comment about whether is high, medium, or low, although it certainly felt like she was going in really far (ie high).
The next part was kinda upsetting. Right after telling me that I was 1 cm and 50% effaced, she continued to poke around and she said, "and now I'm sweeping your membranes." Right away I said, "Um, wait, I'm not quite ready for that." I mean, that is supposed to help induce labor, and she never even asked me if I wanted her to do it. The answer would have been no, because I am still hoping to tie up a few loose ends over the weekend and early next week! And now I've been reading about this procedure, and I see that there is some controversy about the safety of sweeping/stripping membranes in someone who is a Group B Strep carrier...which I am, and which we had JUST discussed. Argh. I am rather annoyed now. I do think that everything will be OK, but I also feel that she should have discussed it with me before doing it. I'm not sure how much she did. Once I told her to stop, she did, but then she still told me that I would probably experience spotting and increasing contractions tonight.
~ ~ ~ ~ ~ ~ ~ ~
From Saturday, 1/10/09 (38w4d):
As for me...(may be TMI, so watch out!!) After the membrane stripping incident on Thursday (done without telling me first), I was kinda relieved when nothing much happened that evening. However, on Friday AM I woke up with a bunch of bloody discharge/spotting in my underwear (several teaspoonfuls in volume, I'd guess). It looked like the beginning of my period, but when I wiped, nothing more was there or inside. Nothing much happened during the day yesterday: no significant discharge, no contractions.
In the evening we saw the movie "Milk" (excellent!) and during the movie I felt at least 7-8 Braxton-Hicks type of non-painful contractions. I woke up at about 5 this AM to use the bathroom. At night, I do this without turning on any lights or flushing the toilet. Afterwards, I was surprised to feel that my underwear felt pretty wet, so I turned on the light to see what was up. There was a ~4 inch wet spot, and it appeared to be kinda a light brownish color (maybe discharge mixed with blood.) I decided that it was not amniotic fluid and went back to bed. When I got up to pee again at about 8AM, I noticed that there was a bit of mucousy discharge. I think it might be part of my mucous plug! Of course, I still don't think that it means much. I haven't had any further contractions (not even B-H), and I figure that Dr K might have dislodged it with her exam/membrane sweeping. I'm assuming that they have to dislodge it if they are putting their finger thru the cervix, right?Anyhow, baby shower #2 (a small group of work colleagues) is this afternoon.
~ ~ ~ ~ ~ ~ ~ ~
From Monday, 1/12/09 (38w6d):
I had a lovely baby shower #2 on Saturday. About 14 women from work ended up coming, more than I had expected, and it was held in a local restaurant during their mid-afternoon lull. They let us take over a large section of the restaurant, so we had it to ourselves other than for a lonely-appearing man who decided to take the table right next to our group and watch (and yes, there were lots of other seats elsewhere in the restaurant). Now I have many, many thank you notes to write, including a few that I haven't done from baby shower #1.
I had been having B-H contractions on Friday night, and they've all but stopped now. No further symptoms at all, really. I then went with my mom & little sister to Babies R Us on Saturday night to get the rest of the must-haves from the registry. This included a baby book, which I cannot wait to get started on. (Thank you notes first, though!) Sunday night, we had our final childbirth class. I don't think any of the couples in the class have had their babies yet. We actually have the first due date, and the other late January/early February couples were all still there. Most of the people in the class were due in late February, March, and even April. The instructor overall was nice but a bit (unintentionally) preachy at times and made me feel like a little kid with her tone. "REMEMBER...your birth may be DIFFERENT!" So, I'm glad to be finished with it. My favorite parts of the class were definitely the relaxation techniques...and the movies.
I made it through my last Monday at work. Mondays are my busiest day, clinic-wise, and next week is MLK Day, so I'm off no matter what. Today something really embarrassing happened, though. I was in a room seeing a patient (age 27 - and yes, she has breast cancer!), her best friend, her mother, brother (age ~12) and daughter (3). I was sitting on one of those round stools with no back, and wheels. Well, I kinda perched on the edge of the thing and before I knew it, the entire stool rolled out from under me. I landed flat on my butt!! It was one of the most embarrassing things that I've ever had happen in front of a patient. Luckily, I wasn't injured, so I was able to laugh it off and kinda say, "Well, at least my water didn't break in front of you guys!" The family was very kind, actually.
~ ~ ~ ~ ~ ~ ~ ~
From Tuesday, 1/13/09 (39w0d):
A couple of people told me that I am "still carrying high." Grrr...do not say this to a woman at 39 weeks! The only interesting development is that since this afternoon, when I stand up the tendons in my inner thighs feel kinda like they feel after I ride a horse or bike. Kinda stretched out, I guess. Maybe I finally have some relaxin hormone in my system and maybe she can finally start to work her way down?? Right? Right? Has anyone else noticed this kind of symptom?
I tried to do my kick count a while ago. I had 5 kicks in 2 minutes, and none since then (45 minutes ago.) This is why I HATE kick counts!! Now I'm going to get stressed out!
~ ~ ~ ~ ~ ~ ~ ~
From Thursday, 1/15/09 (39w2d):
Nothing much to report here. I'm still at work. TMI ALERT: maybe a somewhat-looser-than-typical BM today, but it's not like my entire colon is cleaned out or anything. I don't even seem to get B-H contractions at this point. I have an OB/GYN appointment at 4:30 this afternoon. I'm very very curious about whether there has been any "progress." I think that part of my wish to get started is related to the following. I have committed to be back to work on a certain date. If she is born before by due date, I would get to spend 12.5 weeks with her, but if she is born later, it would only be something like 11 weeks. I want as much time as possible with her. I know legally I could get the full 12 weeks off (assuming that I work next week), but I just feel guilty as my colleagues will need to be covering for me the entire time.
Later that day...
I had my OB/GYN appointment this afternoon. My BP and the baby's heartbeat were fine. I have now gained about 33 lbs. Recall that last week, I was "1 cm dilated, 50% effaced." Well, today Dr. K told me that my cervix is "a loose 1 cm dilated and maybe 65% effaced and very soft." Hmmmmmmm. It sounds like maybe she is trying to make me feel better, but that I am basically the same as last week.
I asked her about the sweeping the membranes from last week and whether it was safe given that I am GBS+, and she basically said that in her opinion it is safe, but that she wouldn't do it if I didn't want her to. Well, I was sort of tempted, but in the end she didn't do it.If I come to next week's appointment (40w2d) we will likely schedule an induction for sometime around 41 weeks, but still give the baby a few more days to appear on her own. That sounds like a good compromise to me.
There is something that I don't quite like about "choosing a birthday", but at the same time I think I would go insane if this went into February. I really really hope that it happens on its own, though. Our conception (via IVF/ICSI) was pretty much devoid of any romance or naturality, so I'd at least like to have a spontaneous labor/birth story to balance that out.
After work I went to Target and spent over 1.5 hours there. I did buy 2 new nursing bras (which I desperately need NOW, even if I need to buy another size in the next week or two), overnight type pads for me (for lochia), PJs on clearance (I figure I'll be lounging in comfy clothes 75% of the time for the next couple of months), baby wipes in a small hard plastic case for the diaper bag, more thank you cards, etc.
~ ~ ~ ~ ~ ~ ~ ~
From Sunday, 1/18/09 (39w5d):
Nothing much is going on here. I walked maybe 2-3 miles with my parents in Rose Cany.on yesterday. I also ate an entire can of pineapple (yum) but then I read that it has to be fresh pineapple to have a labor-inducing effect. Well, I'm honestly not much of a believer in some of these measures, but I figure that they can't hurt. I'm getting maybe one B-H per hour, sometimes less.
S and I will go out walking again today, too. I think I want to repeat the amniotic fluid check (biophysical profile/BPP) and non-stress test (NST) sometime this week if nothing happens. I did have one earlier this month and I found it very reassuring to have that info. Also, the baby's fluid was on the low end of normal, so I'd like to see that again before next weekend. Hopefully my OB will agree.
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