Archive for June 7th, 2008

Birth Story

I’m a bit afraid to sit down and write this here birth story for a couple of reasons.  The first is that right now it’s MINE, all mine, and no one else’s.  Writing it down means sharing it with the world and making it everyone’s.  And there’s something a bit intimidating about that.  Right now I have something special in holding the story close to my heart, and keeping it to myself.  A bond that I share with my babies that no one can take away from me.  Letting the story out to everyone else means giving a piece of them and me away for everyone else to have.  But the second reason it’s a daunting prospect to write this all down is that I’m afraid it’s a bit anticlimactic.  When it boils down to it, I had a c-section.  It’s not the grueling hours of labor and delivery of a vaginal delivery where I might have something interesting to say other than: “I went into surgery, they took the babies out, they sewed me up.”  After all these months of anticipation, perhaps you’re expecting some great and profound words from me.  Perhaps you’re expecting me to be interesting and witty, but I’m not feeling it.  The day of my babies’ birth was a life-changing day, but so were the seven-months leading up to that day, and every day since that day.  My life will never be the same and for that I am incredibly grateful.  But for anyone other than me, I’m not sure the story of that day is particularly interesting.  With that rather anticlimactic introduction, however, here it is, at long last.

My surgery was scheduled for 9:30am on Wednesday, September 19th, 2007.  I was absolutely hysterical about it, still begging to be allowed a vaginal delivery.  I was frantic because the doctor that I knew best in the practice (Dr. P) had been on vacation the whole time I’d been in the hospital and had just gotten back, but wasn’t on call that day, so I wouldn’t see him until after the surgery.  He was the only doctor who I believed would have let me skip the c-section, and a piece of me felt like <i>if only I could talk to Dr. P I could call off this surgery!</i>  Of course, logically that wasn’t the case.  Baby C had long since stopped growing.  She was too tiny to do well with a vaginal delivery.  <i>If</i> she survived a vaginal delivery, it would probably have doubled her NICU stay and would have seriously complicated matters, but emotionally, I was a wreck.  On the inside, anyway.  On the outside, I think I held it together most of that morning, but I took it out on the nurses by becoming a control freak over stupid things.  For example, they brought me a consent form to sign for various things and the consent form included a statement that I had already seen and spoken with an anesthesiologist.  Since I hadn’t yet spoken with the anesthesiologist, I refused to sign the consent, which irritated the nurses, and I got really pissy about it, but that’s how I was acting all morning. 

Seth came in while I was having a fit about the consent form and told me it was fine to hold off on signing the consent form.  He went about packing up all my belongings because I would not be returning to the room I had been calling home after the surgery.  After the surgery, I would be moving to the post-partum unit.  As my things were being packed up, I took out my terbutaline pump and waited for the contractions to pick up.  I paid careful attention to them, knowing that I may never feel contractions again.   This was as close to labor and delivery as I was ever going to get.   At least for THIS pregnancy.  The babies weren’t very awake, so I poked at them, wanting to feel them kicking one last time.   Part of me felt guilty for waking them up prematurely (no pun intended), but again, I knew that this may be my last chance ever to feel a baby (babies!) kicking in my belly.  And ohmigod even as I’m typing this I’m crying just remembing how I felt right then.

Eventually the anesthesiologist came in and I talked with her and told her I’d rather have an epidural than a spinal, because I didn’t like the idea that you can’t turn off a spinal, but you CAN turn off an epidural.  Remember that one of my biggest problems with having a c-section was that I was positively terrified with having a spinal or epidural.  I had a stroke/TIA when I was 23 years old so the very idea of losing feeling in half of my body <i>on purpose</i> was terrifiying to me.  The anesthesiologist said that they actually use epidurals when they want the effects to last <i>longer</i> than a spinal, because once they turn it off, it still takes a couple hours to wear off, so I agreed to a spinal.  I still didn’t love having a needle in my spinal column, of course, but since my only other option was a general anesthetic, which I was wholly opposed to, a spinal anesthetic it was.  I signed the consent form. 

Finally, a nurse from the floor, not a nurse I knew, came in to put an IV line in me (they had blessedly taken my line out a couple days before because it kept getting infected and I didn’t need it).  The resident who would be assisting on the surgery came in around the same time and absolutely threw a fit that this hadn’t been done earlier.  Apparently several other patients were trying to bump my surgery which would be a total disaster because my surgery affected the schedules of at least 16 staff members.  Though my morning had been relatively calm up until that point, things suddenly became a flurry of activity.  The resident told me his name, but I forgot it immediately.  I’m sure it’s in my record somewhere, but I’ve never thought to ask for my record.  He was a very nice, Pakistani, flamboyantly gay doctor and managed to convey a sense of total urgency and relative calm at the same time.  He wheeled me down to the OR, Seth disappeared, presumably to um, well, I don’t know why.  Let me ask him.  He had to gown up, he says.  Also, they wouldn’t let him in the OR while I was getting the spinal, which really pissed me off, but I’d already been warned that would be the case. 

Once I was in the OR, I had to get from my stretcher to the OR table, which was a ridiculous ordeal.  I could barely move by that point and my contractions were pretty regular.  To be honest, without the terbutaline, I probably would have been in labor that afternoon anyway.  I got up on the table with a lot of help and they had me lean over so that they could do the spinal.  Leaning over started some extremely painful contractions and also made it impossible for me to breathe, but I’d been expecting both, so I did my best to stay still.  The spinal was every bit as horrible as I expected it to be, to be honest.  Everyone told me that it wouldn’t be as bad as I was expecting it to be, and I sort of figured that once it was over I would think, “Oh, that wasn’t so bad,” but that wasn’t the case.  I now know that I was 100% justified in my terror over having it.  Now, that isn’t to say that for someone without my history that there’s anything particularly scary about a spinal or epidural… but for me, it was awful.    As soon as the needle went into my back I got the most painful contraction I’d ever had and it was all I could do to not move, but that part was over pretty quickly.  Soon I couldn’t feel anything from my breasts down.  I felt cold and… oddly slimy.  I felt heavy and gross and I felt helpless. 

The operating table felt very narrow and suddenly I felt very wide, but they assured me that I wasn’t about to fall off the table. The resident went about his business of getting me prepped for surgery, but I was wholly unprepared to discover exactly how naked I would suddenly be.  All at once my breasts were covered and that was <i>it</i>.  No one had really warned me about this.  I guess I’d always felt like maybe it would just be my belly exposed and my legs would be covered up, but … not so much!  Seeing as how I couldn’t move anything other than my arms, there wasn’t much I could do about it, so protesting wasn’t going to help me.  I made one more feeble remark about seeing whether they would be willing to let me attempt that vaginal delivery and the resident looked up in shock.  “Oh honey, that would just be too dangerous for little tiny Baby C!  We don’t want any harm to come to your babies!”  Fair enough.  And really, there was no going back at this point, right? 

Finally, the anesthesiologist came in and started to get another line ready… I guess they ran Pitocin through the line after the delivery?  I don’t think it was during the delivery, that wouldn’t make total sense.  I’m not sure.  Once the anesthesiologist got set up, Seth finally got to come in.  I couldn’t see him very well, because I was lying flat on my back and Seth was up by my left shoulder, so I had to twist my head around to see him.  I had asked if I could have a mirror so that I could watch the surgery taking place, but they’d said no… I still don’t understand why, to be honest.  Instead, they set up that blasted drape between my head and my belly (“blah, blah, blah, sterile field, blah, blah, blah”).  And THAT, my friends, is when I had an all-out panic attack.  The stupid blue drape was laying flat against my face and I felt like I couldn’t breathe.  But there was so much hustle and bustle in the room and my arms were pinned down and the drape was covering my face that no one could really hear my muffled cries.  Finally Seth heard my terrified pleas for help and the anesthesiologist pulled the drape away from my face and got me some oxygen (which did NOT help) and told me that as soon as the babies were out they’d give me something for anxiety.  I tried to explain to her that I wouldn’t need it then.  My panic attack was strictly related to having that damn drape covering my face, and oh, you know, the fact that I had no fucking control over my body and no one was fucking listening to me!  But once the drape was not covering my face anymore and everything, I was doing better.  Seth brushed my tears away and I calmed down. 

There were about 20 people in the room with me, which was a lot more people than I would have liked to have had, given how frickin’ naked I was!  There was my doctor and the resident who was assisting, plus several nurses assisting.  Then there was my anesthesiologist and a nurse or two up at my end, plus Seth.  Then each baby had a team of 3-4 NICU staff and then there were some miscellaneous nurses around, it seemed, though maybe they were also NICU staff?   We’re not really sure.

And then, next thing I knew, surgery started.  There was a tremendous amount of pressure on my body as they were pushing and pulling and whatnot.  It’s really hard to explain, but it really did feel like my guts were being wrenched out, but without any real pain.  I felt like the wind was being knocked out of me and it really caught me by surprise.  And then, they broke the first amniotic sac.  More tugging, more pulling, <i>intense pressure</i>, a rushing in my ears.  I closed my eyes.  I heard a lot of movement in the room as the NICU staff moved into place (truthfully, Baby A’s team was probably already in place over by my belly, so it was probably Baby B’s team getting ready to be in place).

“Amniotic fluid’s clear”
“Sweet Baby Boy!  Hello Baby!”

Tears started streaming out of my eyes and I remember being so embarrassed by that…  I don’t have any idea WHY I would be embarrassed by that, but I didn’t even want Seth to see that I was crying, even though there couldn’t possibly be any more natural reaction in the world.  Still, I was helpless to do anything about it, what with the pinned down arms and the lack of a prehensile nose and the whole, naked body on an operating table and the spinal anesthesia…   Seth wiped away my tears…again.

There’s not enough room in the OR for three babies to be assessed by the NICU staff, so Baby A (my son!) was taken into an anteroom to be assessed, with promises that they would bring him back to join his siblings and see me before going to the NICU. 
Seconds later, more tugging, more pulling, <i>intense pressure</i>, a rushing in my ears.  I closed my eyes.  I heard a lot of movement in the room.  The second sac was broken.

“Meconium-stained,” said the resident.
<i>Dammit.  This is supposed to be going smoothly.  I am not supposed to be having problems right now.</i>
“It’s <i>just</i> light  staining, Karen, just <i>light</i> staining,” said Dr. M, reading my mind.  I’m still not sure <i>how</i> she read my mind since I hadn’t made a peep.
<i>I have no idea what that means, but she obviously thinks this is better.  Breathing now.</i>
“Hello Baby!!”
<i>Baby… ?  Baby WHAT?</i>
It felt like an eternity before finally Dr. M said…
“Baby Girl!”

A huge sigh of relief.  I had gotten my “mix”…  I knew that no matter what Baby C was I wasn’t having three boys, or three girls… I was having some of each.  I would, of course, love my children no matter WHAT sexes they were, but at THAT moment, I was thrilled.  Baby B was taken over to the left side of the OR to be assessed.  She weighed in at 3lb, 12 oz, just about average for triplets.

Another flurry of activity, more tugging, more pulling, <i>intense pressure</i>, a rushing in my ears, no time to even close my eyes, the third sac was broken. 

“Fluid’s clear”
<i>tugging, intense pressure, but thank heavens for clear fluid</i>
“Baby *muffled*”
“Baby What?”
“Baby Girl!”
<i>That was quick</i>.

Baby C was also assessed there in the OR.  She weighed in at 2 pounds 11 ounces.  By then we’d gotten word that big brother had weighed in at 3 pounds, 12 ounces, just like Baby B.  Baby C was the runt of the litter, and it was obvious that we’d made the right “choice” (not that I’d been given much of a choice) to have a c-section.

The anesthesiologist administered Pitocin to get my uterus to contract and the doctors pushed down on my uterus with what felt like so much pressure I almost choked.  I imagine there’s a point to this, but holy hell, they should warn a girl about this!  Then the anesthesiologist told me she was giving me something for the anxiety, Xanax, I think, and I tried to explain to her that this was completely useless since I wasn’t having any anxiety anymore, but it was too late.  I was pretty ticked about it, because I didn’t want any drugs that were going to make me loopy.  Fortunately, Xanax, according to my pharmacist husband, is relatively short acting (not short enough, in MY opinion, but a couple of hours according to him).   Meanwhile, Dr. M and the resident went about sewing me up. Dr. M said, “I gave you a nice low, transverse incision, so you’re all set for your VBAC anytime you want, okay?”  <i>From her mouth to G-d’s ears</i>.  I’m all for it. 

At some point, Dr. M got to a point where she left things for the resident to finish up and she went to write up orders for my post-op medications, so she had Seth come and consult with her on that.  Her own Pharmacy Consultant.  Seth walked around and saw that the resident was brushing something on my still-enormous-belly (but slightly less enormous than before) and he asked what he was doing.  The resident told him he was putting tincture of benzoine on the incision.  Er…  see, there’s this red bracelet on my wrist that specifically says I’m allergic to tincture of benzoine…  I didn’t know what was going on at all, but suddenly I heard the resident asking me what exactly happens when I have tincture of benzoine on me.  “Um, why do you ask?”  “Well, because I was just putting it on your incision and your husband said you’re allergic to it.”  “Um, well, I haven’t had it since I was really young, but I think I get a rash.  Uh, but this is one thing I don’t want to find out the hard way!”  Suffice it to say, they very quickly REMOVED the tincture of benzoine (how do you remove tincture of benzoine?  I’m not really sure, I think maybe with alcohol.  I’m not even really sure what tincture of benzoine is for… Seth says it’s an antiseptic).

While all this was going on, the babies were swaddled and brought over to me and I got to see each one and Seth got to hold them.  The nurses made sure to get a picture of Seth holding them all in the OR, which was great of them.  The neonatologist came over to talk to me to let me know that they looked great and that they’d be moving the babies to the NICU for further assessment and that they’d talk to me more once they’d been able to fully evaluate the babies.  Each of the babies’ Apgar scores were terrific, which is great news. 

Jessica made this great video and posted it on YouTube:
<object width="425" height="355"><param name="movie" value="http://www.youtube.com/v/pM270–WCrU&hl=en"></param><param name="wmode" value="transparent"></param><embed src="http://www.youtube.com/v/pM270–WCrU&hl=en" type="application/x-shockwave-flash" wmode="transparent" width="425" height="355"></embed></object>

Finally, I was taken out to PACU (post anesthesia care unit) for recovery.    PACU was pretty boring, actually.  I was there for hours and hours and hours and hours and hours because there were no beds available in the postpartum unit.  Seth went down to the NICU to check on the babies.  Baby A was having a little difficulty breathing, a condition the NICU nurses described as “wimpy white boy syndrome” so they gave him some help in the form of forced room air through a nasal canula at a higher volume to help him out.  The girls were doing fine, though Baby C was obviously very small and they still needed to decide if the IUGR was just because her placenta wasn’t located in prime real estate or if there was a metabolic problem.   I kept asking for a breast pump, but I was told that I would get one in my postpartum room.  Problem with that was that I was in the PACU for hours and hours and hours and hours and hours.  Hello?  There’s a flaw in this system.  If I ever have to have a c-section again, I’m bringing my own pump with me and pumping immediately after delivery, dammit.  They ought to have pumps available immediately post-op.  Whatever.


Seth and I took some time to talk about names.  We came up with the girls’ names (tentatively) in the PACU, but still had nothing for Baby A.  NOTHING.  NADA.  ZILCH.  ZERO.  We had absolutely NO boy names.  Not a clue. 

Dr. M stopped in as did Dr. G.  Mostly I was frustrated about not being able to move my legs and frustrated about the level of pain I was in as the feeling was coming back in my abdomen.  It was excruciating. 

Finally, around 4pm, I got moved out of the PACU.  They wheeled me down to the NICU first to see the babies, which was really nice.  I didn’t get to hold the babies, but they brought the babies up next to me so that I could see them.  They were so tiny, but they were doing well.  Baby A (still nameless) was already off the nasal canula.  The girls were still doing fine.  All three were on a TPN, none were taking any PO feedings yet.  And after that, I got moved up to my room in the postpartum unit. 

I asked immediately for a lactation consultant and a breast pump and was told that it was too late to get a lactation consultant into the room that day (I was furious), but that they’d get me set up with the breast pump pronto.  SIX HOURS LATER, they got me set up with the breast pump (more on that later).  My next 12 hours in the postpartum unit were quite possibly the worst 12 hours of my life.  Seth couldn’t stay with me because someone needed to be home with J.  I didn’t want to have J with my mother or with another friend, because his whole life had been up in the air while I was in the hospital and with three babies now about to come home, I thought it would only be fair for him to have a parent home with him that night.   That was a mistake, but it was for a good cause.  Seth left to go take care of J around 8ish, I think. 

The nurse that I had “taking care” of me that night was about as negligent as she could possibly have been.  She ignored my requests to get set up with the breast pump.  She didn’t bring me pain medicine.  She didn’t answer the call button.  She didn’t answer the phone.  After Seth left, my friend L came to help me for a couple hours and she finally got the nurse to get me set up with the breast pump.  The nurse told me that I should rinse the pump parts between each use.  Since the nurse had also just told me I wasn’t allowed out of bed until the next morning, I asked her exactly how I was supposed to accomplish this.  She looked at me in shock and said, “Well, don’t you have someone staying with you tonight?”  No, no I don’t.  “Why isn’t your husband staying with you?” she asked incredulously.  I couldn’t believe she was asking me such a ridiculous question, particularly since she KNEW I had a four year old at home.  I cannot have been the first woman to have come through her unit to not have a husband staying with her.  And hello?  Is it not her job to help me through the night?

While my friend L was with me, my IV SmartPump started beeping because it had run out and we called the nurse.  Half an hour later, L went to the nurse’s station and told them that no one had answered my call button, but that my IV pump was beeping.  Half an hour after that, she went back to the nurse’s station to remind them that my IV pump was still beeping and that I was still waiting for someone to do something about this, and by the way, while they were at it, I was overdue for pain medicine.  Finally, half an hour after THAT she finally came to take care of the IV Pump.  L didn’t like leaving me, but she’s got four kids of her own, and I assured her I’d be fine.  How bad could it be, after all?  So eventually, she left.  Once I was able to pump, I spoke with a friend who’s a lactation consultant, and she suggested that I could just rinse the pump parts with a washcloth and water, so before L left, she got me a basin of water to make up for the evil nurse.

The night was pretty hellish.  I couldn’t get the nurse to answer the phone, or the call button.  At one point, I dropped one of the pump parts on the floor and I almost fell out of bed trying to get it.  No one would come into my room to pick up the colostrum that I’d managed to pump to put into the refrigerator and I was in a dead panic that it would go "bad" and I wouldn’t be able to give it to my babies.  Fortunately, I had a pitcher of ice in the room, so I put the bottles on ice, which I decided was good enough.  No one would take care of the incessant beeping when my IV ran out, nor would they give me pain medicine when it wore off.  The theory was that I should have still had sufficient pain relief from the spinal for 24 hours, but that wasn’t the case (nevermind the fact that my orders from post-op were that I should have pain medicine administered PRN).    I was having significant bleeding, but couldn’t do anything about it, since I was confined to bed and didn’t have any supplies to take care of it anyway. 

I spent most of the night half panicked.  It’s hard to describe, now 8 months after-the-fact…  why I was so panicked, really, but I was absolutely in a dead-panic that I would find myself in a true medical emergency unable to get help.  It never occurred to me that I could simply call the operator and tell them I was having an emergency.   I didn’t know WHAT to do, in all honesty.  If I’d been thinking straight at all, I would have called Seth at home.  He knew that all I really had to do was hit the blue code button over my bed (I’m not even certain I could have reached it, to be honest) if I’d been having a real emergency, but I didn’t know that. 

Seth had been planning to go to shul first thing in the morning to name the girls, but I called him hysterical at 6am and told him I needed him.  Nothing was particularly wrong, but I was in a lot of pain, and hadn’t seen a nurse at all in hours and hours.  As soon as I heard Seth’s voice, I totally lost it.  I just felt like if I’d had any sort of emergency, I would truly have been lost and helpless.  If I couldn’t have gotten a nurse to come to my room to collect my milk or bring me pain medicine, how would I get a nurse to come help me if I had fallen out of bed like I almost did?    Seth came in immediately (thankfully, we only live 5 minutes away from the hospital and my mother had spent the night at our house so there was someone at the house with J).

Before Seth arrived at the hospital, a nurse came into my room and saw me crying.  She tried to talk to me but I told her to get out.  She sent the nurse manager in to talk to me and I asked her to please wait until Seth came in, which she agreed to do.  I explained that I didn’t want her to just brush me off as being a hormonal post-partum woman and I wanted her to hear what he had to say instead.  She agreed that this made sense.  I admit that once Seth got in and we talked to the nurse manager, things improved.  I never saw the evil nurses again, I had more attention… but there were still aggravating things… I never had my bedsheets changed in the four days I was there.  I could never get them to get me a fresh hospital gown.  I had to beg for pain medicine and they’d treat me like a drug addict every time I asked for it.  They acted like I was inconveniencing them every time I asked for a transport down to the NICU (this required nothing more than a phone call from them, since they weren’t the ones who transported me down to the NICU).  It was really crazy. 

Oh there’s more, but is it worth it?  Probably not.  Suffice it to say, the postpartum nurses were evil. 

But one floor down, my babies were awesome, and the NICU nurses were astounding.  The NICU nurses kept telling me to make CERTAIN I didn’t slack on taking my pain medicine (ironic considering I had to keep pulling teeth to GET pain medicine).  Saturday was Yom Kippur, and I was still in the hospital.  Dr. P. came in to see me and to get my discharge paperwork ready for Sunday.  I was still so angry about having the c-section and I talked with Dr. P. about that, since he was the doctor I knew would have let me have the vaginal delivery if it had been possible.  He made it very clear to me that even he wouldn’t have advised me to have a vaginal delivery with a baby that small.  It just wasn’t a good idea.  If I’d tried to deliver a baby who was under 3 pounds, it could have spelled disaster for her.  Most importantly, he reminded me that one of his patients delivered her triplets at 24 weeks the night before I delivered my 33 week triplets.  She lost one of her babies, and I had three relatively healthy babies downstairs.  All about perspective. 

And then, Dr. P. gave me a great gift.  He sat down and gave me a very frank talk about my pregnancy and talked to me about exactly what I made it through.  He wanted me to understand how much I really got through so that I wouldn’t think it was some minor accomplishment.  He told me how worried he’d been about me at 17 weeks, and at 22 weeks, and 28, and 29…  How he wasn’t sure I was going to make it past 30 weeks when he saw me in the hospital the last time, and how proud he was of me for making it to 33 weeks.  He talked through each of the scares that I’d had and what each one of them meant, medically.  And he talked to me about what I could expect in my recovery.  After three months of solid bed rest, it wasn’t going to be pretty, and yes, I had three babies to take care of, but I needed to remember that my body had a lot of abuse to recover from.  I’m not sure that he could have given me a greater gift, to be honest.  I’m not sure I ever would have realized, or appreciated, what I’d really been through.  I think I spent a lot of time thinking I was just whining over nothing, to be honest.  But you know what?  I wasn’t.  I went through hell in that pregnancy, and I wasn’t whining about it.  I worked hard and I was pretty damn calm about it. 

And finally, Sunday, I was released from my prison, my home, my world.  It was bittersweet, because it meant walking (wheeling) away from my babies.  But it was time.  I packed up all of my stuff and Seth and J came and got me, we went down to see the babies and we introduced J to E, A, and then-nameless "whatshisname".  And home we went. 

I was back again to the NICU later that day, and the next morning, and the day after that, and …

Well, you know the rest of the story.  24 days after they were born, my little monsters came home with the rest of us, my beautiful babies.  And the rest, as they say, is history.

Read Full Post »