Saturday, June 29, 2013

The second time around

I admit, when I got a positive pregnancy test this time my first reaction was "Yay!" followed by "Holy crap, what have we done?"  Lily was our only for a long time - and admittedly is a pretty easy kid to parent, all things considered - and so the addition of a second child was a huge change for us.

I've found that the second time around we're much more laid-back about pretty much everything.  With Lily, we spent months getting the nursery just right and picking out clothes and bedding and gear.   For our second, we set up the playard in our bedroom when I was 36 weeks pregnant (we're using the bassinet for the first few months) and at around 37 weeks I went through the baby clothes and pulled out everything gender neutral to wash.    I think we installed the car seat bases around the same time and I packed my hospital bag at 38 weeks - that was the extent of our preparations.

I'm sure part of my relative calm during labor and delivery was the fact that I did NOT have preeclampsia this time.  Being told you have a potentially life-threatening complication and are going to the hospital for an immediate induction is enough to get anyone a bit wound up, and it so was very stressful for all of us when Lily was born.   Because of the medications I was on, Lily had to be whisked across the room to be evaluated within a minute or so of delivery.   Postpartum I was confined to bed for 24 hours on mag sulfate, getting pretty intensive nursing care and monitoring, and about the only thing I could do was nurse the baby.    This time with the scheduled induction it was all pretty different.  We knew our baby was arriving one way or the other on the 13th, we knew my OB would be the one delivering him/her, and from a medical standpoint I had none of the limitations/restrictions that were necessary when Lily was born.   Because the only meds I had during labor were Pitocin and the epidural I have a clear memory of the entire labor and delivery and was able to get up and actively care for my baby right away.   While I'm thankful for modern obstetrics for getting both me and Lily safely through, I had a much better birth experience with Hannah, and I have zero regrets about the induction.

While it was almost three years since we had a newborn, everything feels more relaxed and comfortable.   Breastfeeding is going SO much easier even though Hannah shares Lily's upper lip tie.  I don't know if it's because Hannah's a bigger baby or if I just have a better idea of what to do but once we worked past Hannah being hypoglycemic at birth, we've had things go a lot more smoothly than they did with Lily.   Bathing, diapering, soothing the baby are all easier - it's like riding a bicycle; once you've been through it once it's a lot easier to pick it up again.   Everyone from friends to coworkers said it would be like this and I'm very happy that so far that's been accurate.

I really like the age spacing of our kids.  Lily has been potty trained for long enough that we've had no setbacks or accidents, and she's old enough that she can legitimately help me with simple tasks.   I can hand her a puzzle or some crayons and a coloring book while I nurse Hannah and she entertains herself.  We have had some minor behavioral regression but that's improving pretty rapidly.   If we go for a third baby (which so far is still a distinct possibility) we're going to try for similar spacing - 2.5 to 3 years behind Hannah.  


Thursday, June 27, 2013

Hannah's birth story

On June 12th I had around 4-5 hours of contractions before they stopped in the evening. I was a little disappointed to not go into labor fully on my own but was glad that Wiggle was waiting for when my OB was on call the next day. We brought Lily and Bella to my parents' house in the afternoon so we were ready to go for the big day. Mark and I woke up early on the 13th and headed for the hospital. 

I got to my room a few minutes after 7 AM and met my labor nurse Tricia. She was actually the nurse who had cared for me a few months ago when I got sent to L&D for monitoring and Mark and I both really liked her. She had me change into my hospital gown and get all situated in bed. We got the monitors on my belly and she started an IV.  At around 7:30 Dr. M came in to check me; my dilation would determine how the induction would start. He said I was 2 cm and 80% effaced so he didn't want to bother with any cervical ripening and would just go to Pitocin.  His plan for the day was "Pitocin, breaking your water around lunch time, an epidural if you want it, and then having a baby!" It sounded like a good plan to us. 

The Pit actually started running at around 8 AM and Tricia turned it up every half hour. I had a light drip of IV fluids as well as the Pitocin. I didn't feel much of anything for the first half hour or 45 minutes and was doing some reading on my Kindle. Then it started kicking in and the contractions felt like they had the day before. I told Tricia that I wanted to walk and she got the telemetry unit for my monitors (she had started charging it as soon as I told her I wanted to go as long as possible before getting the epidural if I got it at all).   Mark pushed my IV pole and we were up and doing laps of the maternity unit. Tricia had asked if it was OK with me to have nursing students observe my care and I had said yes, so at around that time she introduced me to the two nursing students who would be following me that day.  Both them were in the 1 year master's entry to nursing program at UConn. It was their first week of clinicals and their first day on the maternity unit, and they seemed excited that they would probably get to see a delivery.  

After 11ish the contractions were strong enough that I decided to stay in my room. I put my iPhone in the stereo dock and put a live Rush album on repeat. I was more comfortable standing up and actually I spent a lot of time near the windows looking outside (it was pouring rain) and then leaning on Mark or swaying/rocking from side to side during the contractions themselves. While the contractions were strong and painful I felt fine in between. They were short-ish contractions  but close together.   A little before 1 PM a resident came in to check me. I was at 4 cm and while she was up there she asked if I wanted my water broken then - I told her to do it. It was a very funny feeling with a big pop and a gush and Wiggle's fluid was nice and clear. Things got noticeably stronger on the contraction front and they dialed the Pitocin down a little so that it didn't hit me quite as hard. Dr. M came in to see me at 1:30ish because he was done in the OR and wanted to decide if he could go back to the office or not. I was still feeling good in between contractions, so he went to the office - but knowing how fast I dilated with Lily, he made me promise that if I felt any pressure or felt the need to push I would tell Tricia because it would take him 15+ minutes to get back to the hospital. 

By 2, I was feeling very uncomfortable during contractions (I had started to cry through them and had a hard time staying on my feet) and they were coming a lot closer together. Tricia offered to check me to see if progress was being made but I was still at 4 cm.   I decided it was epidural time, although I felt like I had given in too early.   At that point the pain was so strong during contractions that I couldn't stand at all, which made things worse because I couldn't rock and sway through them.  The two nursing students got sent back in and they helped Mark coach me through the contractions. Wiggle was a trooper and tolerated the hard labor well.  Tricia let me know that the anesthesiologist was in the OR for a C-section but that he could leave mid-procedure to come do my epidural. He finally arrived with a nurse anesthetist resident a little before 2:30.  Tricia parked Mark in a chair in front of me so he could hold my hands and she had me hug a pillow and lean on her. The contractions were BRUTAL during the epidural process because I had to sit so still, but they told me when I could move a bit. The first positioning of the epi catheter wasn't good so they ended up snaking it up further to get it in the right spot. During one contraction as they were finishing up, I was crying out in such a way that Tricia told the anesthesiologist that she needed to lay me down and check me ASAP, and after that contraction I told her I felt pushy, confirming her suspicions that I'd dilated very fast and gone through transition. They got the epi catheter taped down and Tricia got me laid down and checked me - she thought I was almost fully dilated.  I almost waited too long for the epidural AGAIN! 

The chief resident came in and checked me and said I was actually around 9 cm but she would have them call Dr. M to get back to the hospital ASAP. She reassured me that the baby was tolerating everything well and if that changed, she would deliver the baby without waiting for my doctor to get there.  By this point the anesthesiologist had run meds into the epidural catheter and they were taking effect - I could have kissed that man!  I could still feel the contractions and could still feel and move my legs, it's just that the pain was gone. They had me labor down until Dr. M got there a little before 3.  Mark and I were chatting and laughing with the resident, Tricia, and the nursing students, and it was kind of crazy that in a matter of minutes I'd gone from near-screaming to comfortably sitting in bed 

My doctor checked me and decided that since Wiggle was still sunny side up, we needed to rotate the baby so that I could more effectively push. This involved him and the resident basically reaching up alongside the baby's head and physically rotating the kid as I pushed gently. Thank heavens I had the epidural because I genuinely don't think I could have tolerated that un-medicated.   Mark held my left leg and Tricia held the right, and they brought in a second nurse (Mary Ann) for the baby. The nursing students got to watch from by the warmer. Once we got the baby's head and shoulders rotated it was time to push for real! 

I pushed through several contractions when the doctor told me that he thought one more set would do the trick because the head was right there - I was surprised and he said I could reach down and feel it if I wanted to. I did and it was so amazing to feel the top of my baby's head, and with that motivation another two or three more pushes brought our baby into the world.   Dr. M put the baby on my chest and announced, "It's a girl!"   Mark cut the cord and the nurses got the top of my gown unsnapped, scooted her up onto my chest, and got a warm blanket over the two of us. Mark and I looked at each other after a few minutes and both of us said "She's Hannah" - which was funny, because Hannah was not our first choice girl's name, but we saw her and just knew what her name was meant to be.  

During this time the resident and Dr. M were getting the placenta delivered and repairing the two small tears that I had. He said the damage was less than my first delivery but he still wanted the tears sutured. I noticed that there seemed to be a lot of blood on their gloves and they were talking about the level of bleeding but at first I figured that birth is a messy business - besides, I was focusing on Hannah.  Then we heard him say that because of the bleeding he wanted another bag of Pitocin hung and to get misoprostol (Cytotec).  I asked him if there was a problem, and he reassured us that while I was bleeding more than I should, we weren't in crisis mode yet and the medicines should take care of it.  The nurses got the Pit cranked open and he gave me the Cytotec, and they wanted me to get Hannah nursing quickly because my body's own oxytocin would help my uterus clamp down more. 

Hannah was also shaky/jittery and she was bigger than we expected her to be.  The nurses did a heel stick and found that her blood sugar was too low (hypoglycemia), so it was doubly important to get her to the breast.  She nursed while they finished getting me fixed up and my bleeding under control, but when they re-checked her sugar a half hour later they found it hadn't gone up. We were given three options: supplementing with formula via SNS (recommended), supplementing with formula via cup feeding, or sending her to the special care nursery for a glucose IV and monitoring.  I knew immediately that I didn't want her having to go to special care - not only did the IV seem kind of traumatic, but she would be separated from me for hours and that didn't seem like a good way to get started on breastfeeding and bonding.   So we supplemented at the breast with the SNS and a little formula (20 mL).  She stopped shaking immediately and the next check showed her sugar up in the normal range!   She was on the "glucose protocol" for 24 hours after delivery - I had to call for a glucose check each time she wanted to nurse in order to determine if she needed additional supplementation to keep her blood sugar in a good range.  It was a bit annoying and after around 18 hours the postpartum nurses basically adopted a "don't ask, don't tell" strategy.  We only needed the one supplement and she nursed like a champ after that.  

Hannah didn't leave my chest for 45 minutes after birth and as soon as her weighing and wristbanding/baby LoJack was done she came back to me. Mark was right there with us and it was an amazing time to bond as a family.  I loved that we could do skin to skin for so long after delivery this time around.   Once my bleeding situation had been resolved Dr. M said I had done a great job and Hannah was perfect, and that he would check on us later that night and in the morning.  He and the resident left us to the nurses to finish my recovery and move us to postpartum.  Because the maternity unit was so nuts at the time, I OKed the nursing students actually helping the nurses with our care (a little more than just the observation experience they had expected!).  Then Tricia had to leave; she had already stayed well past the end of her shift and Mark and I were so grateful for the wonderful care she gave me that day.  The nursing students needed to leave a little while later - they both thanked us very much for letting them be a part of my labor and delivery.  At that point another nurse came in to finish getting us ready to go and we were ready to move to the postpartum side of the unit. 

Around 2.5 hours after I delivered, we arrived in my postpartum room. I was almost finished with my extra bag of Pitocin for the postpartum hemorrhage and my nurse was able to pull my IV a little while later (I promised that I'd make my uterus behave so that she wouldn't have to start another one). We settled in with our Hannah, I ate dinner, and we finally called our families to let them know about our new arrival.   My parents immediately set off for the hospital with Lily in tow and Mark's dad headed over too.   Lily got to be the first one to meet her baby sister, and then the proud grandparents got their turns.  

Saturday, June 22, 2013

I've been away...

Yeah, I know.  I bailed on blogging for the last several months - it just wasn't conducive to my mental state along with working, parenting, and being pregnant along with tons of worry about money and all of that.

The awesome news is that Mark got a good job offer when I was around 37 weeks along, and he will start on Monday.  I cannot express what a relief this was for me, heading into having a baby.  His new employer was totally fine with him waiting to start work until after the baby arrived, which was also a relief.  It's a return to sales, but he will probably end up making more money than he was at his last job which is definitely nice.   I should be able to take a full 3 months off or close to it, now that Mark will be working again - which makes me SO happy.

The remainder of my pregnancy went pretty smoothly, although my OB decided to see me weekly from 32 weeks onward due to my history of preeclampsia.  Because I had some ongoing reduced fetal movement concerns that resulted in an emergency trip to L&D for monitoring at 30 weeks when my OB was out of the office, I had a weekly non-stress test and ultrasound at each of those appointments, too.   Fortunately Wiggle did beautifully on all of the NSTs.   My doctor suspects that my feeling of reduced movement was due to an anterior placenta and a baby who decided to stay sunny-side up most of the time, and thus was kicking the placenta rather than me.

At my 38 week appointment, my OB proposed scheduling an induction.   If I had wanted to keep going, we would have with additional monitoring but due to my history he preferred to get Wiggle safely delivered by my due date.  I trust his judgment and honestly I was starting to feel D-O-N-E by that point as well.   Neither of us wanted to risk my borderline high blood pressure progressing to actual hypertension or preeclampsia, as that would necessitate an immediate, high risk induction and quite likely needing mag sulfate again during active labor and for 24 hours after delivery (mag sulfate is a wonderful, life-saving drug but it SUCKS to be on it).   A scheduled induction could be set up for his on-call day at the hospital and would mean freedom of movement and a more normal delivery for me.   At only 1 cm dilated as of 38w2d, there was a chance I'd go into labor myself but it wasn't likely.   So we scheduled the induction for his on-call day during my 39th week, Thursday June 13th.

I worked through the 11th.  While I did have signs of going into labor on the 12th including some hard contractions, they never got anywhere close enough together to call and ended up stopping on their own during the evening.   We got Lily and the dog to my parents' house that night and headed to the hospital bright and early on the 13th.    I was up to 2 cm and nearly fully effaced, so my OB started me on Pitocin right off the bat and I had a textbook-perfect induction, labor, and delivery.  Things got a little interesting for both me and baby in the hour or two after delivery but both of us were just fine with a bit of help.  I'll do a separate post with the birth story.

Hannah Elizabeth arrived at 3:14 PM on 6/13/13, weighing in at 8 pounds 12 ounces and measuring 20 inches long.   Lily was right all along in insisting that she was getting a sister!   She is beautiful and healthy and we love her so much.