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Protected: It’s Official

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Protected: The Ties That Bind

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Photo by Jessica

Have I introduced you to my beautiful daughter, Tova Lieba?  Tova = “good” in Hebrew and Lieba = “loved one” in Yiddish (also “heart” in Hebrew, as in “good heart” or “kind heart”).  We’ll call her Tobie to keep up with our West Wing cast… (Abby, Ellie, Sam, now Tobie.  I think we’ll start calling J-man Jed)

So let me tell you a little bit about how Tobie came to be born, a month early and not a moment too soon…

Hydramniowhat?

On April 19th, I had my usual NST at my regular OB’s office.  As usual, my baby was not cooperating, and slept through the whole thing.  Personally, I think she did this kind of thing to get attention, and to make sure Mommy got to see her pretty little face regularly, because a non-reactive NST means we go straight for a biophysical profile ultrasound.  My OB came in frowning, and asked if I was still causing trouble.  Me?  Cause trouble?  I don’t cause trouble, I do everything I’m told.  “Well then stop contracting!” his nurse piped up.  Oh sure, blame ME.  I blamed the baby, but my doctor said the baby is behaving perfectly fine – it was me that was contracting, blowing high blood sugars, failing to hold food down, etc.  I had to admit he had a point.  Still, the baby was the one failing to cooperate for the NST, so a BPP was in order.

Fortunately, the baby was reactive for the BPP, so it wasn’t a one-way ticket to L&D.  However, my fluid was quite low.  I had “just” enough to pass, but with a stern warning not to overdo it, to stick with bed rest, drink if I could (hah!), increase IV fluids if possible, and call immediately if I didn’t feel the baby moving with a normal level of frequency.  The only reason he let me walk out of the office, I think, was because he knew I had another BPP scheduled with the perinatologist for Friday.

Sure enough, on Wednesday, I didn’t feel the baby move all day, so I got sent to L&D for an NST that night, but the baby was reactive.  I didn’t feel the baby move on Thursday all day, either.  So I went to L&D for yet another NST – but got sent home a few hours later.  It was clear that I was coming to the end of this miserable pregnancy, but I really wanted to hang on a little longer – I wanted to give my baby every chance at coming into the world as a full term baby.  I was so close I could taste it.

So on Friday, I went for my scheduled BPP and the sonographer was looking.  And looking.  And looking.  And not saying a single word.  I knew exactly what she was looking for and I knew she was doing her best to keep a passive, non-committal look on her face.  So I said, “yeah, so… not much fluid in there, is there?”  She glanced at me and said, “Um.  I can’t find it.”  I had one pocket of fluid that was sufficient, but my overall level was well below acceptable by her calculations, so she said, “well, you might be having a baby today.  I’ve got to get the doctor.”  Sure enough, the perinatologist came in, did her own measurements and although she got a *slightly* higher number, it was still abysmally low.  She told me to go straight to L&D and told me she’d call my OB to prep for a c-section.  Um.  Really?  Okay, she agreed to let me run home and pack a bag, but otherwise wouldn’t budge.  It wouldn’t be good, she said, to labor with that little fluid.  I was devastated, but not willing to concede her point without talking with my regular OBs to see what they recommended.

C-section Stat?

I ran home and called my husband on the way and told him I didn’t have much amniotic fluid and I was being sent to L&D.  Typically the drill was that I would go to L&D and either be sent home or stay a few days, so he said, “Okay, so you’ll let me know if you’ll be home for Shabbos.”  Yeah, um – not so much.  I didn’t know exactly what to expect, but I knew that I wasn’t leaving the hospital before I delivered, whether it was that day, or two weeks later.  “No sweetie, I think we might be having a baby today.”  He reminded me that we hadn’t yet had a single discussion about names.  Yeah, I almost delivered this baby back in February – you’d think that would have clued us in that talking about names would be wise.  Somehow, though, it still never occurred to me that this baby would come before June – I was convinced that I would go post-term.  Ah well…  Anyway, I told Seth not to come to the hospital yet – I wanted to talk to the OB and find out the game plan, and I didn’t see any reason for him to leave work before we really knew what was going on.  Meanwhile, I worked on a back up plan for the kids, just in case we had to leave them over Shabbos.

When I walked into L&D a little before noon on Friday, April 23rd, I was still convinced I was just walking in to be monitored for a bit.  But when the receptionist greeted me with “I hear today’s the day!” I started to get a little suspicious.  (And yes, I know it’s a little frightening that the frickin’ receptionist knows me by sight…)  When the L&D triage nurse came out to get me and she said, “So you’re having a baby today!” I was a little disconcerted and told her I was hoping not.  “Well, either way, I hear you’re not going home, so I’m going to take you to your nurse, Becky, rather than keeping you in triage forever.”   And when Becky came in and said, “Well, Dr. S is in a c-section right now, but when she’s done, she’ll come talk to you before we start prepping you for surgery.”  Wait, what??

Now I was really starting to freak out, so I did what every sane, rational wife does when they know their husband doesn’t have any leave time at work and should really stay there rather than rushing to the hospital for probably nothing but a lot of waiting around… I called him back and burst into tears and said, “I just.  I just need you to come here.”  To his credit, Seth didn’t miss a beat and said “I’m packing up; I’m on my way.”  He’s quite used to my histrionics, but also knows that I wouldn’t have dragged him down to L&D if it wasn’t important to me.  After all, I practically had my own parking space there, I was there so often. If he’d come with me every time, we’d have racked up babysitting bills bigger than the national debt.

My darling husband arrived just in time – moments before my doctor came out of surgery and came to peer at my ongoing NST and talk to me.  Like the perinatologist, she wasn’t thrilled about the fluid situation.  But I looked at her and asked if we could just consider looking at options other than walking straight into an OR.  She knew very well that it wasn’t that I was so opposed to a c-section, but rather that I was desperate not to have spinal anesthesia ever again.  (Mind you, I didn’t want a c-section either, but my biggest concern was the anesthesia)  I hadn’t gotten any IV fluids the previous night for a variety of reasons that seem pretty flimsy in retrospect, so I asked if we could just try getting my fluids back up and seeing if that improved matters.  She said she was willing to try, but that if it worked, at best it would buy me another week.  Sure doc, but another week buys me a full term baby, and possibly a greater likelihood of being able to go into labor and deliver the baby the old fashioned way.  She was definitely willing to give it a try, but I was to continue to remain on strict bed rest because of the risk of cord compression, I would have continuous fetal monitoring to make sure the baby wasn’t in distress, and if my fluid didn’t get above 7, I wasn’t going home before I delivered a baby.

I was fine with all these conditions.  I was moved to an antepartum room (the same room as my first inpatient visit to that unit back in February… room 25 for those counting on such minuscule details for the sake of posterity).  Seth and I worked out a plan to take care of the kids – he brought them to a friend who also has four kids and he spent Shabbos with them. That way, if he had to come to the hospital suddenly, the kids would already be safe and taken care of.  Plus, those friends live a lot closer to the hospital I was in than we do, so it would make his trip shorter if need be.  And then he was off to get the kids together, etc. and I was alone with my thoughts… and my laptop.  I decided not to post on facebook, this blog, or elsewhere that I was in the hospital.  I only told a couple of friends who needed to know for logistical purposes (like the friend who was taking our 4 kids and my husband for the weekend, for example), and even then I downplayed the reality, saying I was there for monitoring because of the low amniotic fluid, but did my best not to imply that delivery was probably imminent.  By then I knew I wouldn’t be getting my anticipated June baby, but I still had some confidence that I’d hold out to May.  Hah!

When I was admitted to antepartum, the doctor discontinued my Procardia and my Terbutaline pump (though obviously, I kept the Zofran pump until after I delivered) on the theory that if I did start to dilate and go into labor, that would be just fine – they weren’t going to stop my labor if it came to that, and it would give me a chance at my VBAC without risking an induction.  I kept joking that as soon as they pulled the terbutaline pump I’d stop contracting.  I actually wasn’t so far from the truth, as it turned out.  My contractions did slow considerably, but they also changed in quality and intensity as the night wore on.  A friend, her husband, and their 4 month old son came to visit Friday evening.  She was kind enough to leave me her camera, as I hadn’t been able to locate mine before I left the house – she didn’t want me to be left with nothing to document delivery day if it turned out I had to deliver sooner than later.

Saturday morning I got taken down to radiology for another BPP.  The sonographer didn’t let me see anything on the screen and as much as I craned my neck, I couldn’t get any hints out of the corner of my eye.  She remained agonizingly silent through the entire ultrasound (about 30 minutes).  Finally, she was done and said that the radiologist would have to review the pictures before posting the report, but she did tell me that I didn’t have any improvement in my fluid level.  My heart sank.  Well, April’s a good time to have a baby, right?  I was taken back to my antepartum room and I hung out reading, waiting for the official news that would surely seal my c-section fate.  I wondered how much time I would have before walking into the OR, and whether Seth would be able to be there.  An hour or two later, the nurse came in and gave me the official news – no improvement.  She said the doctor was planning to be in around noon.

Maybe My Fate Isn’t Sealed… just yet

Sure enough, the doctor came in at noon and told me the same thing – no improvement in my fluid level.  One way or another, this baby needed to come out.  She said she was going to check my cervix and see if I’d dilated at all, but neither of us had much confidence that we could be that lucky.  “It’s going to be long and closed, I’m sure,” I said.  “Well, that will make the rest of our conversation very short, won’t it?”  Astoundingly, despite the slowing of my contractions in the last 12 hours or so, I was definitely more dilated.  I asked the doctor if she thought it would be safe to see if I could deliver vaginally, and made it clear that if she thought a c-section was the only prudent route, the conversation would end there and I’d go straight to the OR without looking back.  She said that for sure if she did a c-section she knew the baby would be out quickly and safely, which was definitely an advantage.  But so far, the baby wasn’t in distress from the contractions, and I was being monitored very closely, so she was willing to try to get my labor moving by trying a foley catheter induction.  Since I was already dilating, this option was available to me and I’m very lucky that she was the doctor on call, because otherwise I’m quite certain that my options would have been limited to a spinal or a general anesthesia for the inevitable c-section.  I was all for trying to explore other options, but I asked if I could please, please, PLEASE take a shower first because I felt disgusting and if I did end up with a c-section, I knew my first post-partum shower wasn’t going to be pleasant in the least bit.  No problem, she said, so long as I was sitting down for the shower and kept it short.  There was still concern about the low fluid level, so taking precautions was certainly reasonable.  It might have been the best shower I’ve had in my adult life, no joke!

So… foley catheter balloon it was, and I daresay inserting the balloon was probably one of the most uncomfortable experiences I’d ever had.  My cervix was still really long, so it wasn’t as easy as it sounds (and frankly, it doesn’t sound all that easy to me in the first place).  This was maybe… 2 o’clock in the afternoon?  After the balloon was inserted, my contractions definitely got more organized and more intense, but they were still completely bearable.  The real difference was that the bulk of the contraction pain shifted into my lower back – not a great sign of things to come, but I was just so thrilled to still be exploring VBAC options that I just didn’t care.  By 5 or 6 o’clock, I was doing great – dilated to 4cm, I think, and ready to get moving.  My doctor said she was going to break my water to get things going.  I find this ironic, given that the whole issue with laboring was the lack of amniotic fluid, but I suppose it would have happened eventually, anyway.  Before all this had happened, I had it firmly set in my mind that I would not allow my water to be broken – because I didn’t want to be laboring against the clock – but I knew that at this point I was laboring on borrowed time anyway, and whatever it took to get my labor really going was worth exploring.

I got moved to a labor room (vs. my antepartum room) and my doctor broke my water around 7pm.  Not surprisingly, it wasn’t super comfortable, but it wasn’t miserable either, and of course it felt like I was wetting myself.  My contractions picked up at that point and things seemed to be moving right along.  Seth arrived at the hospital after Shabbos ended – maybe 9pm or so.  By midnight, my contractions had petered out a bit, so I went walking for an hour – a luxury I hadn’t thought I would be afforded, but since I’d been on continuous monitoring all day and the baby hadn’t had significant or frequent decels, they were okay with me taking a walk, provided that they got me back on the monitor within an hour.  And, yes, my contractions did pick up while I was walking, but as soon as I was back in bed – they were practically gone again.  The doctor came in around 2am and suggested that we try a low-dose pitocin.  While typically OB’s try to avoid pitocin for VBAC inductions, under very controlled circumstances, they’ll use it, if necessary.  Frankly, knowing I was against the clock and knowing I was on borrowed time, I was willing to try anything, provided that my doctor was comfortable with the risks.  I was being constantly monitored and we felt like the risks at a low dose were minimal.  As my contractions were picking up, they were watching the baby’s heart rate closely – apparently, decels *during* contractions were not something they would worry so much about… that would indicate that without enough fluid in the uterus to cushion the baby/placenta/cord, that the contractions was causing the cord to compress, and the answer to that is to replenish the amniotic fluid (fortunately, this never became necessary).  If, however, decels occurred immediately after contractions, that would indicate that the baby was in distress, and that would be our sign that we needed to throw in the towel.   I remember there was one other piece of criteria that would have meant going into surgery, but I can’t remember what that one was.  I just thought the distinction between the decel timing was interesting enough to remember and record.

Around 7, my doctor checked my cervix again, and I was about 5cms dilated.  The contractions were very painful, but not yet one on top of another.   Still 2-3 minutes apart, but they were all in my back essentially, and that made staying in bed really unbearable.  Unfortunately, with the pitocin, I needed to stay in bed to labor (another fine reason I’d never wanted pitocin – but it was definitely a necessary evil in this case).  The only real relief I got during contractions was when I got up to go to the bathroom.  It was tempting to have to go to the bathroom far more often than I needed to, just for the relief.

Shortly before 9am, the contractions were one on top of another and I was in agony.  I got checked and I was 6cm.  I was horrified.  One stinking centimeter.  And four more to go! My doctor offered either an epidural or IV pain medication.  I asked for the IV pain medication (Nubain), and told her that it wasn’t a granola crunchy aversion to the epidural, it was just a fear of losing control over part of my body (I had a stroke when I was 23 – having the spinal with my c-section was a horrific experience that was all-too-familiar).  She said she knew that, which is why she offered, and then she headed out to order the Nubain when suddenly I was completely out of control, sobbing, unable to imagine going through this kind of pain for another four whole centimeters.  I told Seth to hell with the Nubain, I wanted the damned epidural.  I figured I could better handle the anxiety attack from the loss of control in my body than I could handle this level of pain for hours to come.  All I could think was, “if it’s this bad now, and transition is going to be so much worse, there is no way I want to go through transition.”    Seth caught the doctor before she’d even gotten to the nurse’s station (across the hall from my door) and told her I wanted the anesthesiologist.  And so, I got myself an anesthesiologist.  I didn’t like him much, but mostly I wanted the pain to go away.

By this point, I had the charge nurse and my nurse (who had come on shift at 7am) in my room trying to get a bolus of fluid into my PICC line (always a challenge) because an epidural can cause a drastic drop in blood pressure (mine was already fairly low), so the help negate that effect, they give a large bolus of fluid before administering the epidural.  I finally gave up on the directive to stay laying down, and I jumped up at some point and said I just absolutely had to change positions.  What I really wanted was to be on my hands and knees, but there was no good place to do so.  I settled for putting my elbows and arms down on my bed and leaning over it.  Even better was to stand up against someone and let them support my weight.  My bet is that this is part of why water births are so helpful in terms of managing pain – though it’s not a large pool, there’s probably a fair bit of stress taken off the body, as the water helps to support you.  (but a water birth wasn’t an option for me given all that was going on).  I was so embarrassed about my carrying on, crying and antics.  At the height of the contractions, I was basically hyperventilating because I couldn’t really think of what else to do, but the charge nurse (whom I’ve adored since I first met her in February) kept talking me through breathing that actually helped a fair bit – it was just hard to keep up because my mouth was so dry and I really couldn’t hold down enough water to fix it.  Every contraction left me feeling like I was going to throw up and I’m quite certain that if I’d taken a big sipful of water, I would have thrown up immediately.  Ice chips were bad enough, and they didn’t help all that much anyway.  I remember apologizing several times for my hysteria, but the nurses just kept telling me that most women break at 3cm and that it was astounding I’d labored so long without any drama.  I’m pretty sure they were just trying to make me feel better – 3cm wasn’t the most comfortable place in the world, but it was completely doable.  But regardless of their motive, it worked, and I did feel a little better about crying in front of strangers.

Finally, the anesthesiologist was ready to place the epidural – it felt like an eternity, but it turns out it wasn’t long at all.  I remember thinking that he was just taking his sweet little time to aggravate me, and I was quite angry about it (though I don’t think I said so out loud – at least not until later when it was just Seth and me). Seth assured me after the fact that the anesthesiologist was working steadily from the minute he walked in the room, and wasn’t dilly-dallying a bit.  I’m still not sure I believe him.  And then I had to sit on the bed and bend over and not move a millimeter while a very large needle was being inserted into my epidural space through my SPINE. You know, all while having murderously awful contractions.  No problem, right?  I swear, I almost just told them to forget it and get me the Nubain.  I wanted nothing to do with continuing this ridiculous epidural thing.  I just wanted to be able to move around, flail about if necessary, and just get something to take the edge off the pain at least (which the Nubain probably would have accomplished).  But it was too late, really, there was already a needle in my spine – gah!

Finally, the anesthesiologist was done and I was able to sit back up.  The medication was running through the epidural and the anesthesiologist told me to let him know if I could feel it working.  Oh, I could, yes.  But only on my left side.  (Fortunately, that was enough to cause the remaining pain to be very tolerable).  This was precisely the reason I did not want an epidural.  It wasn’t a need for a “natural” birth (frankly, I find that term to be condescending – my children are not somehow less “natural” because of how they were conceived or how they were birthed, but I do know why people use the term), but rather a desire to avoid replicating the feelings and circumstances of my stroke a decade ago.

At about 9:30, right after the epidural had been placed, Seth asked the nurse if she had any idea how much longer I’d be likely to be laboring (while admitting that we recognize that every woman is different, and there would be a wide margin of error in any guess she could hazard).  She said that I would probably be getting ready to push by noon or 1pm.  But, she said, she was just going to check just to get a better idea of where things were.   We expected I’d still be 6, maybe 7cms.  But… not so much; she went to check and found the baby’s head – I was about to deliver a baby, so she dashed out to get the doctor.     That certainly explained the sudden and horrific pain, nausea, etc – my fear of transition was well-founded, it turned out – I’d BEEN in transition while sobbing for the epidural.  Mystery solved.  Minutes later, I was pushing my baby out, much to my shock.

And so I found myself pushing a baby out – something I never thought I would do.  “They” say that one loses all modesty in the delivery room.  I do not think this was the case for me.  I didn’t lose any sense of modesty – I just lost the ability to enforce my need for privacy.  When you’re delivering a baby (in a hospital, anyway), there are just going to be people staring at your hoo haa, like it or not, and there’s not a lot you can do about it.    The doctor got me a mirror, which I wasn’t sure I wanted, but I figured if I didn’t want to keep looking, I could look away, close my eyes, or ask them to take it away.  So I got to see my baby come into the world, and I lived to tell the tale.

At 10:11am, our daughter was born into the world, nameless, cold, and ticked off – the most beautiful sight I could ask for.  The doctor told me she was a girl and I was in shock.  I’d spent my whole pregnancy convinced that I was having a girl, and yet it still surprised me.  I’m quite certain if she’d been a boy, I would have been just as shocked.  She was a month early, and not a moment too soon.  She was late enough to avoid serious health complications and early enough that I didn’t have to endure another month of that horrendous and miserable pregnancy.  I needed a bunch of stitches, but not nearly as many as when I had a c-section, so I have no complaints.  (My OB told me that the stitches were the part where most women are grateful to have the epidural in place… I believe it.  I was still numb on my left side but I could still feel my right side, so the stitches definitely weren’t painless.  The doctor offered to use some lidocaine, but I knew it wouldn’t last forever and lidocaine stings like a… well, you know.

Since Tobie was premature, they did have to have a neonatologist in the room when I delivered so that she could be examined immediately – which meant I couldn’t hold her and nurse her immediately.  But she was put on my stomach right after she came out and I did get to snuggle for a couple minutes before she was handed over to the neonatologist (and still only a few feet from my bed).  She was pronounced healthy enough to go back to mom, so she came back to me and nursed for a few minutes until she fell asleep.  Within an hour or two, I was moved to my room on the  mother-baby unit.  I had finally arrived – I was in a postpartum room, and I had a baby with me not over in the NICU.  It was an incredibly good feeling.  I can’t do justice to adequately describing the sense of relief I felt.  This was a baby that almost entered the world at 24/25 weeks back in February.  I never ever anticipated that she’d be coming home with me and there she was – right next to me in my postpartum room.  I’m not sure there could have been a greater gift at that moment.  Holding this little girl – so wanted, so anticipated, so hard-fought-for – was the best possible answer to all the years of waiting, in a way that the arrival of the triplets, I admit, was not.  Their arrival was full of anxiety, fear, and uncertainty, whereas Tobie’s arrival was pure joy (once, you know, the pain wasn’t my main focus).

My birth experience was a lot of things I had never thought I wanted – induction, amniotomy, pitocin (gah!), and an epidural.  But it was perfect in all the ways that mattered.  I was so fortunate that the OB on call for my practice Friday through Sunday was that particular doctor.  I’m quite certain she was the most likely to explore options of anyone in the practice.  I never felt like she took unnecessary or unsafe risks, but I felt that my desire for exploring options was always respected.   I am incredibly grateful for that.  I had made peace with what I thought would be my inevitable c-section sometime on Friday – just knowing my doctor was willing to try rehydration, etc. in order to keep options open made me feel like I was being listened to, and made me feel that if we had to move to a c-section, it wouldn’t have been just because it was the convenient option.  I’m grateful that I got my VBAC, but even more grateful that I knew all possible avenues were being explored.

I’ll write more on the postpartum days later, but I will note here that Tobie is a great baby.  She mostly sleeps, loves to be held (hates to be put down), and is just a delight.  What I find incredibly hard to believe is how much easier it is to have one newborn than three.  I know that this would seem to be self-evident, but I never thought having infant triplets was all that difficult.  It wasn’t a walk in the park, but it was far easier than we’d anticipated, and it was all we knew… so we just did it.  So having one baby – well, I figured it would still be rough.  But she’s a delight, and we’re so much better rested than we had been.  I have no complaints.

Most people want to know how I’m feeling and whether I’m able to eat yet. I can eat, but I don’t eat much – eating still makes me pretty queasy and leaves me with huge painful knots in my stomach.  I’ve got a lot of things that hurt, and I wish I felt slightly more human, but mostly?  I feel nine billion times better than I did when I was pregnant – so I have no right to complain.  I know recovering from 4 months of bed rest, not eating for 8 months, and an overall crappy pregnancy will take time, and I have no issues being patient about it.  Tobie is the perfect distraction.  I adore her and can’t imagine my life without her.

Welcome to the world, Tobie.

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