Saturday, February 28, 2015

Emergency Hospitalization

As the mother of three, I came out of the delivery room onto the maternity wing of the hospital as a well seasoned, veteran parent.  Treated far more deferentially than a first time mom by the nursing staff, I was given space to do my thing with our newborn and, right from the get go, I felt confident and comfortable with my knowledge, skills and the idea of introducing our latest addition to the wide world.  And given all of the experience his active, outgoing and curious older siblings have provided us over the past five years, I doubted there was anything that would surprise me as we brought home our perfectly healthy, full term baby boy.  

Unfortunately, I was wrong. Horribly, horribly wrong. 

GV circa 02/2013
While we were at the hospital for the induction and post-delivery day, our oldest boy came home from his Valentine’s Day party with a bit of extra pre-school love in the form of a cold. Congested and occasionally coughing, it didn’t raise any significant red flags when he shared his germs with our daughter (sure, they fight over the train, but this they share) and she too came down with a case of the sniffles.  Knowing it’d be unpleasant for the baby to need aspiration, we asked the big kids to wear masks and wash their hands, but despite our best efforts to contain their symptoms, their excitement about the baby resulted in not only the introduction of them, but of their congestion to FG as well. Starting the sick-little-guy routine, we turned on our humidifiers, administered saline and sucked the increasingly green mucus from his tiny nose with the notorious, yet incredibly handy NoseFrita (and, for the record, the poor kid does not like aspiration the way GV did).  So already sick for the first time going into his two week well-baby appointment, the pediatrician discovered that FG had a nasty ear infection to which she prescribed an antibiotic and instructed us that “if he’s not better after 24 hours or if he develops new symptoms, call back.”

Later that afternoon, HB and I found ourselves independently looking at FG thinking that his color wasn't quite right - he seemed almost grey.  Finding a change in position to resolve the issue or that the artificial lighting from one room to the next was largely to blame, we administered his first dose of antibiotics in hopes that the medicine would diminish his symptoms by the morning thus calming our overtired nerves and trigger-happy fears.  Sharing our concerns briefly before bed, we agreed that FG wasn't demonstrating other red flag behaviors - poor nursing, infrequent diapers, difficulty waking up and ferver - and that we'd keep a close eye on him if and when things changed.

The following day, I attempted to nurse FG every so often but found his latch to be weak (he'd had a frenulectomy at his well baby appointment the day before, so I wasn't terribly concerned) and his general demeanor to be sleepy.  Given that he's still quite new and supposed to be sleeping a lot, I didn't begin to aggressively attempt to rouse him until early afternoon.  Using our typical wake-'em-up tickle up the spine or diaper change tricks to no avail, I told myself not to panic and I began to escalate my pestering techniques - ultimately putting his head directly under running ice cold water - only to have eye lids flutter in minimal response before returning to a deep sleep.  When HB walked through the door shortly there after, I presented FG to him and, while difficult to be sure given the overcast, grey light of the day, we agreed that his color was off again and that the confluence of symptoms he was presenting warranted a follow up call to our doctor. 

With a "come directly here or get to an ER if things get worse" response from the triage nurse, HB hastily buckled our baby into his car seat as I scrambled to get our oldest to tell Grandmama we were leaving - immediately.  Sitting in the back seat of our car watching for any change to his breathing patterns, HB ignored the speed limit on I-95 and got us to the doctors office in about two thirds of the time it usually takes to get to NOVA.  Dropping me at the front door with the car seat, I bit back tears of fear as I impatiently rode the elevator to the right floor.  Walking in, the receptionists didn't ask who I was but quickly glanced at FG and said to "let the doctor know he's here." 

Escorting me back to an exam room, the nurse began to run through the typical baby appointment routine: "Okay, let's have you take off his outfit and get down to a dry dia..."  But she cut herself off mid-sentence and dashed from the room.  Seconds later three other nurses and the pediatrician were entering the tiny room with muddled looks of it's-okay-mommy/holy-shit on their faces.  Ordering for oxygen, a nebulizer and a pulse oximeter, Dr Fox held a stethoscope to FG's chest as HB joined me in the exam room.  

Directing his comment to a nurse "His pulse-ox is 61.  Call 911."

The next several minutes were a blur as firefighters and paramedics streamed into the room with what seemed to be an endless repetition of questions as they loaded FG back into his carseat and prepared to take him by ambulance to Fairfax INOVA.

The last time I rode in an ambulance was when I had the placental abruption during my second pregnancy and, while that was scary, this trip was far worse.  As the patient, all you can do is lie there, watch the lights and attempt to remain stable with whatever willpower you can muster; but as the caregiver who is, literally, along for the ride it is the most helpless, terrifying experience ever.  Just listening to the sirens blare and watching the other vehicles through the back window as they jockeyed to regain their spots on the road made me realize the preciousness of time and unleashed a torrent of regret and what if's... regret about not bringing him back to the doctor the previous day and not going directly to the Emergency Room... and what if... if... if...    

Upon getting to the Pediatric ER at Fairfax INOVA, a team of nurses and physicians swarmed our son.  Informing us that they were completing a full respiratory work-up and beginning worst-case scenario treatments to stem any serious illnesses before they have a chance to gain a leg up on treatment options, we could only stand by and attempt to comfort our baby as the doctors took x-rays, ran an EKG, took blood samples and drew a spinal tap.  

With cables and cannulas, needles and vials, cuffs and Lord knows what else coming and going from the room with various scrub-clad personnel, HB and I were in an overwhelmed trance when a sort of celebratory "whoop!" went up as a nurse reported some results to the team attending FG:  "RSV POSITIVE!" 

Taking us aside, one of the two pediatric trauma physicians in the room explained:  "So what we're looking at here with Baby F is a case of RSV - Respiratory Syncytial Virus - which is pretty serious, but the best answer we could hope for; okay? From what we can see on his x-rays, he has a partially collapsed lung which is typical with this disease and, since this is viral, there really isn't anything more than oxygen that we can do to get him through this. We're ordering him a bed upstairs right now and, hopefully, you'll be able to go home sometime next week." 

... processing... processing... processing...  

Our two week old has a virus that just caused one of his lungs to collapse, to loose almost 40% of normal oxygen saturation and to require a cannula to keep him breathing until it passes?  Right, gotcha. 

He's been upstairs in the Pediatric Intensive Care Unit (PICU) for a day now and, while he appears to be stable, I can't help but perpetually rationalize to myself that the ICU isn't some place they send patients as place holders... The reality is he's sick.  Very, very sick.  He needs oxygen via cannula to breathe which, preventing him from nursing, requires a feeding tube  into his stomach.  He is on a one nurse to two pediatric patient ratio and is visited at least four times a day by an intensivist attending or resident... in other words, he's exactly where he needs to be, getting the exact care that he requires and all we can do is wait for the worst to be over.

We simply pray that is soon. 

Saturday, February 14, 2015

3 Minutes. 9 Pounds. No tearing.

So I have someone simply wonderful and absolutely perfect to introduce to the word: FG!

Born on Wednesday, February 11 at 3:55 AM, he surprised everyone on the labor and delivery floor by coming hours earlier than we anticipated.  Starting the Cytotec, a cervix ripening drug, at 9:00 PM, the nurse briefed the treatment plan that I would receive another dose every three hours until 6:00 AM when I'd have the option of an epidural before starting Pitocin at roughly 7:00 in the morning. Not having decided if I wanted an epidural this go around or not, HB and I nodded in acknowledgment of the schedule as we followed the nurse out into the hall way to begin our ritual of walking the baby out.  

Getting a bit too crampy and too tired to continue our laps by 11:30, we went back to our room where the nurse began to encourage me to take a dose of Ambien and Tylonal so I'd be able to sleep comfortably after receiving my next dose of Cytotec.  Decline both of these medications, the nurse administered the second dose of Cytotec and reported that I was slowly progressing and only 1 cm dilated before turning out the lights and leaving HB and I to a) stew about my lack of progress and b)  sleep.  

A little after 1:30 in the morning, the contractions changed and I couldn't sleep through their frequent and rising intensity.  Thwacking HB with my pillow to get him to wake up (did he take my Ambien?), he helped me to the bathroom and gradually began to look at me with consternation as I went from "me" to "cranky" (his words, not mine).  Attempting to breath my way through the pain, I finally asked HB to go ask the nurse for that dose of Tylonal she'd offered... finding that she was on break, the back-up nurse assigned to my room, Debbie, came in with the small pills and immediately asked if I wanted to consider that epidural. 

Feeling like a complete wimp for not having made it remotely close to 6:00 before giving in on the pain and accepting the drugs, HB translated my non-comprehensible grimace and whimper as an articulate "yes, please" and the nurse called for the anesthesiologist at 2:45.  Gathering supplies and bouncing back and forth from the hallway - before double checking my dilation - it was 3:30 by the time the back-up nurse began to register the look of concern on my face and  helplessness on HB's. 

As the anesthesiologist began to prep by lumbar spine for the epidural placement, I was beyond my own abilities.  Unable move due to my own tension, HB and Debbie helped me sit up and breath calmly though the first series of needles. Looking at Debbie the whole time, I told her in no uncertain terms that "I feel like I need to push - I'm not - but I feel like I need to."  Having not checked my progress yet, she had no idea what we stage of labor we were actually looking at and could only respond by parroting that I not push.  Within a few seconds of the large gauge needle being inserted into my spine, however, I couldn't wait for the actual medication to be administered and I flat out said "I don't trust myself - I have to push NOW!" 

Helping my lie down, HB and Debbie found the baby fully crowning.  Sending the anesthesiologist into the hall for reinforcements, he returned a moment later with the closest thing he could find to my doctor: two random residents and my primary nurse.  With minor instructions and as much encouragement they could find amid the general shock of the unexpected, the baby's head, his shoulders and then his body along with ALL of my amniotic fluid were out within 3 minutes.  Without tearing. 

Unfortunately for the residents, it was only after my water broke following delivery that the nurse remembered to state: "Oh, yeah, she's poly."  

Collectively feeling like what just happened was completely surreal, the nurses quickly began working on the Baby - who didn't start crying immediately - as the residents cursed the late arriving polyhydramnios warning as they delivered the placenta and collected the pieces necessary for our cord blood kit.   

"Holy cow! He's nine pounds and sleeping!" laughed the nurses from the warming table.

Bringing him over to me, the nurse casually informed us of the NICU nurse lurking in the hallway due to FG's low blood sugar levels of 34 mg/dL.  Having talked with our nurse earlier in the evening about our intent to correct his hypoglycemia ourselves with nutramigen upon birth, she bought us some time as HB held our newborn skin-to-skin on his chest and dripped the formula drop by drop into the baby's mouth.

Requiring that FG's blood sugar above 50 mg/dL in order to prevent his admission to the Neonatal Intensive Care Unit, it was half an hour later that we anxiously watched the nurse prick his heel and apply his blood to the glucose strip.  Feeling like the resulting two seconds of processing was closer to two hours, there was a collective sigh of relief when the number 51 finally appeared upon the screen.  Happily dismissing the NICU nurse to return to her other charges, the labor and delivery team put our paperwork together and transferred our care to the maternity ward where we were generally left in peace by the staff given our "veteran" parent status.

Spending the following 24 hours going through the typical newborn routine, he received his first round of vaccinations, his hearing exam (which, unfortunately, he failed), bilirubin checks (slightly elevated) and his first pediatrician visit.  The pediatrician indicated some concern over his red color (likely a result of elevated hemoglobin levels) and his hips clicking (likely caused by his position while in utero), but indicated that the various abnormal results could be resolved with time or on an out-patient basis.  Otherwise granting a clean bill of health, the doctors found FG fit enough to  earn us a discharged ticket home.

Now that we're here... life with three kids will certainly take some time for us to get accustomed.  Upon walking in the door and introducing the baby to big brother GW and big sister GV, we found ourselves swimming in the deep end as FG promptly peed on the couch mid-diaper change as GV went into a full-on overtired two year old tantrum and GW raced about the house showing off his latest drawings and demonstrating his race car speed for his new brother (it was only on lap number three that he slipped on the hardwood in his socks and began to cry after careening into a cabinet).  I think things will be just fine when we develop our new rhythm, but for the mean time, I'm going to let the contentment of my post-delivery glow and a touch of mommy-brain carry me through.

Happy, happy, happy Mama!

Tuesday, February 10, 2015

Week 38 Appointment: Induction TONIGHT

Well, it's finally February 10th and that means no more guessing and no more waiting: Baby will be here and in my arms by tomorrow.  

The appointment at the Antenatal Testing Center this morning showed a reactive NST and that it'd be necessary for the doctors to administer several doses of Cytotec tonight before beginning Pitocin and actual, active labor tomorrow morning.   I'm excited and glad to have answers to all of my "what if," "when," and "how" questions.  

We're heading home now to have an afternoon full of GW and GV before we head back up to the hospital at 6 PM tonight.  Not sure how long it will take me to get updates up after delivery, but it'll happen :) 

Wish me luck!

Saturday, February 7, 2015

Breastfeeding in Virginia

So as one of three remaining states in the Union that does not outright protect the rights of breastfeeding mothers, the legislature of the Virginia Commonwealth took to voting yesterday to change state law to benefit lunch time.  As it currently stands, it is perfectly legal for mothers to breastfeed their infants on state-owned property in Virginia, but if she is breastfeeding - covered or otherwise - on privately owned property it is legal for the proprietor, employees, volunteers or whomever of that establishment to demand the mother stop nourishing her child or face enforceable eviction.   But the vote is in and that archaic law has changed!

Having largely become an issue due to uncomfortable individuals accusing mothers of introducing "biohazardous" materials in public venues,  it has long befuddled me how something so natural and completely innocent could be misconstrued as dangerous, lewd or "disgusting."  A baby needs to eat just as the rest of us do and I don't see non-closed mouth chewers facing the same social commentary about their preferred eating method despite the truly displeasing sight their public mastication presents.  But while it may, to some degree, be justifiable to politely ask such individuals to shut their faces, the difference I see between their choice to share their meal with others and breastfeeding in the public sphere is that a mother doesn't choose when her child must feed or where God made her milk come from.  I cannot tell you how infinitely more convenient I would find it to nurse with a finger or something that would enable a wider wardrobe, free my mobility and save my favorite shirts from the accidental leak or lanolin stain.  But, as it is, the breast was made for the purpose of feeding and the fact that we have attached a sexualized stigma to it or socially distanced ourselves from the source of our food (hello, that nugget you're eating is actually chicken; yes, as in "cluck cluck") doesn't diminish the function or utility that God intended of it.  Breastfeeding is beautiful and not something to be regulated.

As I am heading in to have baby #3 in a few short days, this victory for breastfeeding mothers couldn't come at a more prefect time.  I plan to nurse this child just as I did with the first two and, while I prefer to cover and keep the breast-formed bond between me and baby private, I am so grateful that the state has taken the next step to protect a mother's rights to nourish her infant and in doing so combat the discrimination that was no less ignorant than past issues of class, religion, gender or race.  There is so much pressure to make this decision or that choice with regards to how we act and how we raise our children that this new law makes me, as a Mom, feel greatly more empowered to do what is right by my children without fearing that my actions will result in unnecessary drama or legal trouble simply by feeding outside the home.   I've known in my heart since the first day my oldest was born that breastfeeding was right for me and right for our family, but having someone beyond my husband and my intimate friends accept and understand that was a reach -- until now.

So, thank you, Virginia, for the birth day gift you've given me and my new son.  You can bet we'll celebrate your twenty-first century solution the next time errands and snack time just happen to overlap.  

Wednesday, February 4, 2015

God Gave Me You.

In a moment of impatience to have more contact with the little man, I asked HB to pull out our fetal doppler last night so that we could listen to Baby's heart beat.  Having been relatively quiet for the afternoon with only the occasional hiccup or jab to my ribs, I figured the rhythmic drumming of his heart would bring a calming bedtime reassurance that - even if labor hasn't started, yet - he was hanging out and happily doing his thing.  

Covering the probe tip with the sea-green gel, HB placed it with acute precision on my belly and immediately we began to hear Baby's 131 beats per minute.  But then, all of a sudden, something weird happened... the heart beat stopped and in its place came the unmistakable lyrics of "God Gave Me  You."  Having never before heard this machine transmit radio frequency in the combined 27 months we've used it for our three pregnancies, this change of pace took both of us by surprise...  

Now, the truly funny thing about this is that about two or three months ago, HB and I were talking about the personality niches that our kids fill and speculating about what Baby #3 would choose.  Taking the lead as first born, GW, who has recently become known as "G Wiz" at our house, is incredibly smart, very high energy and beyond compassionate.  Translating that into his actions and aspirations, he's taken to discussing that when he grows up he wants to become one of the firefighters that goes into the Twin Towers on 9-11 (we watched the footage together to help him understand an event we were hosting and he thought the first responders were the most heroic men and women he's ever seen).  While the issue of time travel hasn't been broached and, as his mother, I appreciate his sentiment but would really, really rather he did not pursue such... selflessness... it does fairly well summarize his unique personality.

Following in her big brother's footsteps, GV is similarly brilliant, curious and exceptionally happy - the combination of which she expresses in most creative of ways.  Quick to apply her knowledge and understanding of the world around her (me: "what's this letter, GW?" / GW: "I don't know" / GV: "That's an 'H,' Mama"), she recently dubbed herself "Princess Pee" as a result of her combined interest in the PBS children's show "Super Why" and toilet training.  Given that HB loathes all socially driven princess-phenomenon things, it's hilariously entertaining to hear his accolades emanating from the bathroom for her appropriate application of the moniker.  Proving herself cunning with with words and humorously attuned to the attitudes of people around her, I have no flipping clue what she'll become as a grown-up, but I have zero reservations about the broad scope of possibilities.  

Coming to Baby #3, I'll admit that I have been not-so-secretly hoping that this little one might select the laid-back, easy going and plain-ol'-chill personality niche that we have yet to witness.  Knowing full well that he already looks very much like both his siblings, combining their brains with a bit more tranquility wouldn't be such a terrible thing to my mind... But do you think that'll happen?  Well, let me just tell you optimists out there a little story before we draw any conclusions... 
So there HB and Grandmama were, no shit, sitting in the kitchen watching Saturday Night Live music videos.   Not so much a music fan myself, I was flitting back and forth doing Lord knows what about the house as they went from one random band to the next - Neil Young, Aerosmith, Willie Nelson, LL Cool J - clearly proving no linear taste whatsoever. Now, you'd expect my Mother and HB to skip certain videos for others with actual musical substance, but no, giving all musicians their artistic license they set about listening to all the songs that popped onto the play list.  Tolerating some songs and meeting others with complete annoyance, I was nothing but stunned when Baby not only woke up, but actively started to kick along with the steady beat (aka noise) of Kanye West.  
So, to answer my own question, no, I don't think I'm in for a peaceful little guy this go around.  Given his musical interest - and questionable taste - at this in utero stage, I think it's more likely that I wind up with G Wiz, Princess Pee and a rapper than I will with any other unfilled personality niche, desired or otherwise. 

Bringing this all back to the doppler last night, you can see the irony in the first time presence of music emanating from my belly.  The fact that it was country music rather than Snoop Dogg or whomever else HB has been playing lately and that the song had relevance to the 1 Samuel 1:27 bible verse "for this child I have prayed; and the Lord hath given me my petition which I asked of him" was frankly awesome.  I'm so excited to meet this little man in the next week (can you believe it?!) and to see who he's going to become... rapper or not, serene or not, he's my baby and for that I love him entirely.

Tuesday, February 3, 2015

Week 37 Update

With yet another week gone and still no arrival of baby, HB and I found ourselves in NOVA for another MFM check up today.  Doing one last non-stress test, sonogram and pelvic exam before going ahead with the planned induction next week, the morning's check ups made me feel both more confident that we have a plan and less sure that we'd actually go through with it: 
  • The NST was reactive and perfect.  The nurses had the radio cranked up loud and while it wasn't Blake Shelton or Kanye West, Baby seemed to find the additional ruckus worthy of contributing phenomenal heart rate acceleration and a down right wiggly performance.   Showing a content and thriving baby, this test doesn't guarantee a thing in terms of when labor could or will begin but it does indicate that he's doing exactly what he needs to be doing without distress so proactive action before induction isn't necessary.  
  • The pelvic exam was more or less the same as the last several weeks.  Slightly dilated and partially effaced, Baby wasn't showing much interest in making an "early," unscheduled exit as he is still floating - or perhaps he is swimming - at minus 2 station.   Requiring that I come back again next Tuesday morning to see if a cervix ripener would actually be necessary later that evening or if I could skip the evening check-in and proceed straight to Pitocin on Wednesday morning, the exam generally seemed to reinforce our plan for induction. 
  • The sonogram, however, indicated that next week's plan for induction may be a pipe dream for predictability.  Knowing for at least one fact that it'll be messy, the sonogram showed that my amniotic fluid index levels had further increased from it's previously "high" measurement of 28.6 cm.  Taking three measurements of the fluid pockets in the four uterine quadrants - 40 cm, 36 cm and 38 cm - to create a best-guess average of 37.8 cm, my case of polyhydramnios (or, as my belly has  come to be called, "poly") is much more significant than earlier in the pregnancy.   
The situation with polyhydramnios is that by week 35, fluid levels should begin to drop rather than increase which would indicate that complications upon membrane rupture may be more likely - for example, umbilical cord prolapse and prolonged uterine hemorrhage post-delivery.  As most pregnant women have an average of 14 cm of fluid around this point of the pregnancy, poly cases are classified as any AFI higher than 25 cm of fluid - which means that last week's measurements had me as a minor case, whereas this week we've been bumped up to "severe." 

While far from reassuring that things will play out smoothly in this last week, the good news from today's appointment is that the worst-case scenario involving polyhydramnios - fetal death - isn't a high concern for my doctors given the fact that the NST results are exactly where they ought to be.   I'm feeling somewhat hopeful that things will continue to be as uneventful as they have been these past several weeks and that we'll repeat our mommy-daddy "date night" of induction next week just as we did with GV, but only God knows what is really in store.  

Either way, Baby in bound in T-minus 7 days or less.