I had forgotten how life with a newborn goes...I get 15-20 minutes at a time to do things, but I only get occasional blocks of time to accomplish something substantial. Hence, the delay in the recap.
My disclaimer on this is that the baby recap is as much for me as it is for you--so, there may be a lot more detail in here than you care to read about :) Hopefully it'll be enough detail for me to someday make a baby book (since I have such a stellar track record to this point: 0/2).
As I alluded to in the last post, the story actually starts on Monday, 1/23. I was in for my scheduled non-stress test, which just involved me sitting on the fetal monitors for about an hour. The nurse showed the strip to the doctor in clinic, and he was concerned at the number of fetal decelerations I was having. Basically, the heart rate would go from a baseline of about 150 bpm to 165, but then it would drop into the 110s/120s for a few seconds after each acceleration. Sometimes the drops were associated with contractions, sometimes not. The thought was they were probably variable decelerations, but since I was 37 weeks and technically high risk, the doctor wanted to be safe, and he sent me for a biophysical profile.
I went to wait for the ultrasound, but I was continuing to have contractions every 5 minutes that were a little uncomfortable. The doctor had made it sound like delivery was potentially imminent, depending on the BPP, so I gave Tim and my mom a heads up while I waited. The techs that did the ultrasound commented on how big the baby was (estimated at 7 lbs 14 oz at 37 weeks--a biggie) and how low his head was. In fact, they had to mash on my pelvic bones to try and get a head measurement--and of course, they were pressing right over where I had injured myself falling several weeks earlier. The pain was pretty rough, but I understood that they needed the measurements to get a good reading.
The doctor came into look at the BPP info, and everything (amniotic fluid levels, fetal movements, breathing, tone, and heart rate) looked fine. Ironically, the doctor reading this ultrasound was the same that read my final ultrasound when I was pregnant with Josh--and in both cases, his suggestion was just to deliver. For Josh, it was at around 38 weeks, and the suggestion was because he was measuring so large. This time, his first question was, "What is your cervix doing?" His thought was that if I was making progress at all, I should just be delivered.
I told the doc that as of the previous Friday (3 days earlier), I had no cervical change. He told me that he'd discuss with the clinic doctor that was in, and they'd get back to me. So, I hung out for about another hour. The clinic doctor (who I had never met) had me come back. He was very pleasant, and he suggested that we check to see if I was making progress. When he checked me, he said I was 4 cm dilated. He asked about contractions, and I said I was still having them every 5 minutes or so. He told me that he'd send me home for now, but he wouldn't be surprised if I went into labor that day. He thought just the cervical check might be enough to start real labor. I asked when I should come back in (since I was already having the 5 minute contractions). He said if things got uncomfortable, give a call and come back--he also said I shouldn't wait until the contractions got closer than 5 minutes, since third babies can come fairly rapidly.
So, I went home...and started having fairly painful contractions. They lasted over an hour, and I decided to start making phone calls. It was late afternoon by this point. I told my mom and Tim not to rush. We'd get the kids, get them settled, and then head back up to the hospital, just to get checked out. I wasn't getting contractions closer together, so I figured we had time.
Of course, after making this plan, the contractions very gradually started becoming less painful. They were still 5 minutes apart, but they were more manageable. I debated scrapping heading back up to the hospital. Instead, I called the office and spoke to the doc on call, explaining the situation. She suggested coming back in, just to be safe. So, about 7 PM, Tim and I headed back up to the hospital.
We got checked in and put on monitors. The contractions were still coming regularly, but the discomfort was nearly gone. The resident checked me, and she called me 3 cm, 50% effaced, and -3 station--also known as not really in labor. They kept me on the monitors for a while, and then we decided that I'd walk for about an hour, and she'd check me again. If there was change, she'd admit me. If not, home I go.
So, I walked around the hospital in my very fashionable gown for about an hour. I ran into one of my MSTP classmates who is now a surgical intern, but otherwise it was pretty much empty around the hospital loop. After the walk, it was back to the room to wait for the resident. The verdict: no change. So, about 11 PM, we headed home to wait for real labor.
I give you this false alarm to preface why I was thinking the way I was the following Monday. In the interim, I had another NST, my OB appointment, and some serious contractions on Wednesday. I had several more instance of uncomfortable contractions throughout the week, but the pattern seemed to be the same: contractions that started in my low back and wrapped around the front, coming every 4-6 minutes, and uncomfortable enough that it made me change position and do some deep breathing. Inevitably, they'd last about an hour, and then they'd go away.
I actually had almost no contractions on Sunday--which was a good thing, because late Sunday afternoon, my GI system went nuts. I didn't have a fever, and it was lower GI, but I lived in the bathroom Sunday evening into the night. I stayed downstairs Sunday night because I was still very uncomfortable from the pelvic pain (worsened by Monday's ultrasound), couldn't get in and out of bed easily, and I needed to make frequent trips to the bathroom. I could tell I was getting dehydrated, but everything I ate or drank exited quickly. I figured I'd do the best I could and just take it easy.
So Monday, 1/30, I left home about 9 AM for my 10 AM NST. Tim had offered to go with me, but because I hadn't had any real contractions in over 24 hours, I told him just to go to work. I started having some contractions just before I left. They were a little different than the prior week's contractions--less low back, mostly low abdomen/pelvis, with about the same amount of pelvic pressure. I figured they were due to the GI distress/dehydration, so I left for my appointment. As I was driving, I started timing the contractions. They were 4-6 minutes, and they were definitely uncomfortable. I was able to park and walk to my doctor's office, but I had to stop periodically and let the contraction pass. I got into the office and went on the monitors. Baby looked good, and the contractions were staying steady. The nurse had seen me with contractions like this before, and they weren't getting closer, so once the doctor cleared my NST, I left.
I debated asking someone to check me, but I was still thinking about the false labor from the week before, so I just headed back to my car. I called Tim just before I got to the parking garage, and he could hear me breathing through the contractions. I felt they were getting a bit closer--maybe 3-4 minutes--and I had to stop about every 30 feet to breathe. I wouldn't call them painful though; I thought that labor would be painful, and these were just uncomfortable. He recommended that I go back to the office. I told him I could always come back later.
I took the elevator to my car, and I could barely walk the short distance to where I parked. I had the keys in the ignition and was about to drive out, and something made me call the office again. At 10:50 AM, I spoke to the secretary (who recognized me, since I basically lived in the office), and the nurse she handed me to told me to come back, and she'd have the midwife check me, just to be safe. So I waddled back to the office, deep breathing the whole way.
I got in a few minutes later, and the secretary wished me well, hoping this was it. I still had doubts. It took just about two minutes for the midwife to check me. I think she had doubts too--until she checked and said I was 6 cm. She looked at me incredulously when I told her I was going to go home. She said, "You're having a baby," and made the call upstairs to labor and delivery. So, at about 11:15, I called Tim and my mom to tell them we were having a baby!
The same resident from triage a week earlier came by to check me. At about 11:30, she called me 7 cm, 100% effaced, and 0 station. I was breathing through uncomfortable contractions, but while they weren't fun, I still wouldn't have used the word pain. She said she'd wait to break my water until the attending was out of the OR, but she expected things to go pretty quickly after that. I told her I was waiting for my husband anyway, and she asked if I wanted an epidural. I said yes please! I was hoping that would slow things down enough to give Tim a chance to get to the hospital.
The anesthesiologist got in shortly thereafter, and so did Tim. I had my epidural in by 12:30, but my blood pressures dropped fairly dramatically afterward, and it took about an hour (and several rounds of pressor infusions) to get my BP up over 100/60. Nothing scary, but it dropped enough where I got pale, dizzy, and nauseated just lying in the bed, and the docs wanted to make sure it was up high enough to keep getting good blood flow to the baby. By a little after 1, the epidural had take the edge off of the contractions--I could feel pressure, but the discomfort was basically gone. Life was much happier!
My mom and Jen came up soon after, and Joe was up not too long after that. Another resident had come by after the epidural was in, and she called me 9.5 cm with a reducible anterior lip--basically complete. I had done the 7-10 cm transition before the epidural kicked in; that meant I survived the worst part of labor without pain medication. I knew that the delivery was typically the most painful part for me--and the part that the epidural was least likely to help with, judging by past experience--but I was kind of impressed with my pain tolerance. I had gotten epidurals much earlier with the other two kids. I never even got to 7 cm before epidurals with them. The frightening thing was that the labor pains were never as excruciating as I expected, and I think I could've very easily had this baby at home (or in the car) if I had waited for the type of labor pains I was expecting.
At 3 pm, the midwife came by to check me again. My water hadn't broken yet on its own, but I was otherwise ready to go, so she broke my water. She suggested a trial push, which moved the baby down some, but she suggested waiting to push any more until after we gave labor a chance to push the baby down. Since my blood pressure had stabilized, the nurse sat me up, and we let gravity and labor work.
My OB popped by about this time--she has clinic off the hospital campus on Monday, but she heard I was in labor and wanted to stop by and say hi. Her partner had come by just before to introduce herself, and I thought she seemed like a wonderful doctor, so I told my OB that I was happy to let the on call doc deliver me.
I started having more pressure with each contraction, and I could tell that we weren't far from delivery. I never had a clear urge to push with Sophie--maybe because I pushed for 3.5 hours with her--but I did have that feeling with Josh. I was still unfortunately having some pressure due to my lingering GI issues as well, so it was hard for me to determine exactly where the pressure was coming from. I told the nurse a little after 4 that I thought we were close.
The attending doc came back shortly thereafter, and she checked me. The good news was that the baby had descended a bit, though he was still a little higher than she likes to start pushing. The bad news was that I was bleeding--a lot--and she was worried that I might have abrupted. The fetal monitors were still ok, but as the baby descended, it was harder and harder to follow the tracing. She said that she'd usually give me more time to stretch and let the baby do the work, but because of the bleeding, it was go time.
This is the part where things get blurry for me. Tim tells me that all of a sudden, there went from two people in the room (the attending and the nurse) to about 12. They had planned to call pediatrics for the delivery, just because of the diabetes, but apparently the bleeding caused a bunch of extra people to be on hand for me and the baby.
I think I only pushed about 10 minutes, but they were an excruciating 10 minutes. The pain was so bad that I couldn't even open my eyes. I was actually worried I might pass out at one point because I was so lightheaded. Tim and the doc did a great job of talking me through. The doctor told me afterward that the pain was likely so bad because of a few things: no time to stretch things out, the placental abruption itself is painful, and the little man came out sunny side up (occiput posterior). This is a painful position, and it effectively makes a tight space tighter during delivery. It makes sense, given my presentation: back labor, persistent anterior cervical lip, prolonged labor compared to presentation, and increased stress on the tissues at delivery. Looking back on how things were happening, I'm thrilled that the doc was able to deliver me so quickly. With the big head, OP position, and abruption, there's a decent chance I might've needed an emergency c-section. Instead, we had less than 8 hours of labor total, no need for pitocin this time, and a quick (though painful) delivery.
I got to hold Noah for a little while while they fixed me up. The doctor did confirm the abruption after the placenta was delivered. She told me that while it didn't mean I couldn't have more kids, it was something I should tell any future OB if I got pregnant again. I reassured her that another pregnancy wasn't in the cards, but I appreciated the information. Noah was doing well initially after delivery--his Apgars were 8 and 8, with some residual blueness just beyond the hands and feet. He measured 8 lbs 8 oz, 19.5 inches, with a head circumference of 36 cm. The pediatrician had checked him at delivery and thought he was doing ok. Not too long afterward (maybe 1/2 hour or so), he started grunting while breathing. He was still having normal oxygen saturation, but the OB wanted the pediatrician to come back and take another look. They came back shortly after, and they called the NICU fellow to come and look. The nurse had put Noah back in the warmer, with some blow-by oxygen, and his cyanosis had decreased centrally, with just a little remaining at the extremities. The NICU fellow discussed with the pediatrician for a little bit, and they decided that Noah should go to the NICU for respiratory distress, just to be safe.
I had a hard time with this. All of the ultrasounds had looked great, and I never had any problems with the other kids. I hadn't even thought about the possibility that they might have to take Noah to the NICU. I was beyond 38 weeks--full term--and I had a big baby. He should be great. But I knew it was better to be safe than sorry.
They took Noah away before my family could come back up and see him. Tim and I got to hold him briefly, and they they took him out about 5:30. I was pretty upset, and the OB was very sweet and tried to comfort me. What we had been told at that time was that they would watch Noah in the NICU, probably overnight, and then he might be able to come back to the regular nursery the next day.
Jen had gone home to get the kids and get them dinner, and my mom and Joe came back up to the delivery room after Noah left. Jay and Kim came up with the girls too. It was nice to see everyone, but it felt empty to be in a delivery room with no baby. The NICU had said to give them an hour or so to get things situated, and then Tim could come over to check on things. He headed over there, and family got to go over a few people at a time to see Noah. Jen brought the kids up with my dad after dinner. It was nice to see them, though I could tell Sophie and Josh were a little confused about what was going on. The NICU did not allow kids under 12, so there was no way they could see Noah. I kept trying to explain that to Sophie, but all she had been told over and over again was that she'd get to see her baby brother at the hospital. It was too late to try and explain to her now why that couldn't happen.
We were waiting to be transferred up to a recovery floor, and as it got past 8 o'clock, I could tell Sophie and Josh needed to head home to bed. Tim was going to stay with me, and my mom was going to stay with the kids. People started heading out soon thereafter, and at about 9:30, we got moved to our room.
The women's hospital has two recovery floors, which were recently redone and are very spacious single rooms. The renovations had just started when we had Josh, but even then, the rooms were more than big enough. I was looking forward to finally getting to enjoy the new rooms. Imagine my surprise when they told me I wasn't going to floor 3 or 5 for recovery--I was going to 6. I had been on 6 for a cardiology consult in August. It was the gyn surgery/preterm labor floor. It was old, dark, and had little rooms. Instead of the nice, bright, large single rooms, I was going to a small room that barely fit a bed and had a shared bathroom with another patient in the neighboring room.
When we got up to the floor, the nurse had some trouble locating postpartum supplies. He was very nice, be he said he'd have to go look for some items like large pads, a sitz bath, ice packs, dermoplast, and witch hazel pads. These are things that were usually pre-stocked in the recovery rooms--I had never had to ask for any supplies while I was there with Sophie and Josh. Once I got checked into floor 6, Tim wheeled me down to the 4th floor, towards the NICU. I hadn't seen my son in over 4 hours, and I was anxious to get there.
I was overwhelmed by the NICU. It had recently undergone a huge renovation. Each baby had their own room, with plenty of space, a rocking chair, a large couch, personal lockers, and a mini fridge. There were also multiple family lounges and bathrooms with showers on the floor. Between the main NICU and the stepdown unit, there were 82 private beds. It was unreal--like a hospital unto itself, but one that wasn't sterile and cold. There were lots of bright colors, and the NICU was subdivided into four "pods" that felt less overwhelming.
I was glad that Noah had such a beautiful place to stay, but it was still overwhelming to see him in his little warmer, with an IV in his left hand and a bunch of leads attached to his chest. He didn't require oxygen, which was a good sign, and he was sleeping peacefully when we got there.
Tuesday morning, I waited for my doctors while Tim headed over to the NICU. Overnight, I had pumped twice and was anxious to feed Noah, but I had to wait for the on service doctor to see me. Unfortunately, it was the one doctor in the practice I don't particularly care for (and the one that helped deliver Josh), so I was underwhelmed when she finally came by. She obviously didn't know much about me--she thought I was a c-section, and she hadn't realized Noah was in the NICU. After she left, I walked over to the NICU and just caught the end of the team rounding on Noah. It turned out that he was signed up for a 48 hours stay, since he was now a "rule out sepsis" baby. He had already been given ampicillin and gentimycin, and until the 48 cultures came back, he couldn't go to the nursery. This also meant he couldn't come to my room, and I wouldn't be leaving the 6th floor. I was really disappointed by this--I was unimpressed with my floor (those postpartum supplies never did show up), and I knew this meant that Sophie and Josh couldn't come to see Noah while he was in the hospital. It also meant that I might be discharged before Noah. His cultures were due back at 7 PM on Wednesday--and I would be discharged Wednesday morning. I figured this meant he wouldn't be discharged until Thursday morning, after the NICU team rounded on him.
Tim had to leave to go to work Tuesday afternoon. He had a big meeting Wednesday afternoon that he needed to attend, and there was still some work to do for it. He left after lunch Tuesday, and I basically had Noah to myself in the afternoon. I avoided going back to my room--partially because I wanted to be with my son, and partially because my room creeped me out. I had a woman on one side who screamed all day long about her pain (thin walls--she was a 25 week pregnant woman who had come in with contractions, but once the contractions stopped and she was going to be discharged, she screamed about her pain constantly. Was she trying to delay discharge? Who knows...). I shared a bathroom with a woman on the other side--I could occasionally hear her on fetal monitors, but all I knew what that the bathroom was occupied either by her or her male companion for most of the day. I went back to my room for my meals, my motrin every 6 hours, and my vitals check once a shift...and that was about it. I was walking back and forth from my room to the NICU less than 24 hours after delivery. It wasn't because I wasn't in pain, but I didn't have a way for someone to wheel me down there, so I did what I needed to do.
By the end of the day Tuesday, Noah was eating a lot better, and I had caught up to him with my pumping. I got to visit with a mom/former MSTP friend of mine, which made the day less lonely. Tim went home after work to be with the kids, and my mom and dad came up to the NICU. People had gotten to see Noah in the NICU on Monday, but no one had gotten to hold him. I had a nice visit with my parents, they got to hold Noah, and then it was back to my room for the night (pumping every few hours).
Wednesday, Tim took the kids into daycare in the morning, and then he came up to the NICU. I waited for my doctor to discharge me, and then I would head over to the NICU. My regular OB came by just to make a social visit, which was nice, but the service attending still hadn't shown up by the time the NICU team rounded. I felt like a prisoner in my room. I had pumped enough to feed Noah, but I wanted to be over there. Tim relayed good news from the team--his 24 hour cultures had been negative, and the suspicion for sepsis was low, so the NICU team was willing to discharge Noah around dinner time (with an informal call to the lab to make sure the cultures were still negative). That just made me more antsy to be discharged so I could go to the NICU. I was showered, packed, and ready to go since 9 AM. I had signed all the paperwork with the nurses. I was just waiting for the OB to lay eyes on me so I could go.
Noah was scheduled to be circumcised at 2 PM, and I wanted to at least see him before he went, so I told my nurse that I'd be over at the NICU at 1:45--and that the docs could call over if they came by. She was sympathetic to my situation, and she said she had paged them multiple times to see if they were going to see me or just sign off on the paperwork. I went over (finally!) at 2 to see Noah--Tim and Jen were both with him, but they had to leave by 2 for work/school, so no one would be there after 2. I stopped by, held him for a bit, and then headed back to my room. The nurse told me that the doc was just going to sign off on my discharge without seeing me (which sounded unreal to me, but whatever--I was tired of waiting). I grabbed my bags and some veggie sticks from the patient fridge (I hadn't ordered lunch, figuring I'd be gone before then), and I trekked over to the NICU.
Noah's circ was delayed until 3, so I got to see him for a bit longer (though not feed him yet, due to the circ). My former lab PI and my postdoc friend came over to visit about 2:30. They got to see Noah briefly before he was taken back, and then we chatted for a while. When Noah got back, he was ravenous, and things got a little hectic, so the visitors took off, and Noah and I hung out again. The nurse said that we might be able to go as soon as 5 PM, but Tim's meeting ran long, and there were a few paperwork issues, so we didn't actually get to leave until almost 7 PM. It was weird to finally get to hold Noah without all of the wires attached. I packed everything up, and when Tim arrived, we were ready to go. It was a much different experience than when we left with the two other kids. The recovery floors have a system--discharges start about 11 AM (we were usually out around noon), mom gets wheeled out carrying the baby, the baby has to be checked out at the desk with the electronic tracking bands deactivated, and the nurse wheels you all the way to the valet station and the car. Here, Tim brought the car seat in, we put Noah in it, and we just...walked out. Obviously, there was security that we had to be buzzed through, but between me being discharged and walking myself over to the NICU, and now Tim and I walking out carrying Noah, things just seemed much less official.
We headed home, where my parents were watching the kids. We hadn't told the kids for sure that we would be home Wednesday, figuring it would be tough to explain another setback to Sophie. Instead, my parents had them ready, and we now have video of us surprising Sophie and Josh. It was adorable. I hadn't seen them since Monday night, and they hadn't seen Noah at all, so it was so nice to be a family again.
Things have been both easier and harder than I expected. Despite the first day setbacks, Noah eats like a champ--with none of the latching trouble the other two had. Sophie and Josh have both been great with Noah, but there has been some acting out for attention--Sophie much more than Josh. We are working hard to make sure they both get one on one attention, but there have been more than a few frustrating moments.
Noah is sleeping about as expected--not a ton at night, but that won't last forever.
Overall, we are all doing well. It's still nuts to me to think we have three kids. We are working on how two adults manage three munchkins, but we will just learn on the job!